FORT MADISON COMMUNITY HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- FORT MADISON COMMUNITY HOSPITAL (EIN 42-1081055)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-12
- IRS object ID
- 201142249349301279
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-12T09:50:01-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM McGladrey Inc | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Locust St Ste 640 | AddressLine1 |
| City | Des Moines | City |
| State | IA | State |
| ZIP Code | 503092354 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421081055 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FORT | NameControl |
| Phone | 3193726530 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 174 | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRADLEY KOKJOHN | Name |
| Title | CFO | Title |
| Phone | 3193762125 | Phone |
| Date Signed | 2011-08-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Crystal Jolin Tax Manager | Name |
| Phone | 5155586600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | C JAMES PLATT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 174 | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 48937329 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | fmchosp.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | TO ADVANCE THE HEALTH AND WELL BEING OF ALL PEOPLE THROUGH COMPASSIONATE QUALITY CARE, EDUCATION AND COMMUNITY SERVICE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 489 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 34677 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -1736 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 300000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 250000 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 44736586 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 47985866 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 408623 | InvestmentIncomePriorYear |
| Investment Income Current Year | 356944 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2224099 | OtherRevenuePriorYear |
| Other Revenue Current Year | 334063 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 47669308 | TotalRevenuePriorYear |
| Total Revenue Current Year | 48926873 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 42617 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 65716 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 28031477 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28573638 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 17633410 | OtherExpensePriorYear |
| Other Expenses Current Year | 19217790 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 45707504 | TotalExpensesPriorYear |
| Total Expenses Current Year | 47857144 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1961804 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1069729 | RevenuesLessExpensesCY |
| Total Assets BOY | 49303502 | TotalAssetsBOY |
| Total Assets EOY | 49886926 | TotalAssetsEOY |
| Total Liabilities BOY | 11521657 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10929024 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 37781845 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 38957902 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO ADVANCE THE HEALTH AND WELL BEING OF ALL PEOPLE THROUGH COMPASSIONATE QUALITY CARE, EDUCATION AND COMMUNITY SERVICE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 40760127 | Expense |
| Grants | 65716 | Grants |
| Revenue | 48070416 | Revenue |
| Description | FORT MADISON COMMUNITY HOSPITAL (FMCH) IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, LOCATED IN FORT MADISON, IOWA, TO MEET THE HEALTHCARE NEEDS OF ITS COMMUNITIES AS WELL AS PROVIDE PROGRAMS AND SERVICES AIMED AT HEALTH, SAFETY, EDUCATION, PREVENTION, AND OVERALL HEALTH AND WELLNESS. IN SO DOING, THEY STRENGTHEN THEIR ROLE AS A PARTNER IN THE COMMUNITY BY IMPROVING THE HEALTH OF AREA CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES THEY SERVE. FORT MADISON COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO AREA RESIDENTS. FMCH SERVES THE RESIDENTS OF SOUTHEAST IOWA AND WEST CENTRAL ILLINOIS. THE 50 BED HOSPITAL HAD 2,518 PATIENT ADMISSIONS AND 8,766 PATIENT DAYS OF MEDICAL CARE. THIS INCLUDED 1,116 PATIENT ACCOUNTS WHO RECEIVED UNCOMPENSATED CARE. HEALTH SERVICES AND CARE PROVIDED BY FMCH INCLUDE: PHYSICIANS AND SURGEONS PRACTICING IN THE FOLLOWING AREAS: FAMILY PRACTICE, INTERNAL MEDICINE, OBSTETRICS & GYNECOLOGY, ORTHOPEDICS & SPORTS MEDICINE, PEDIATRICS, PSYCHIATRY, SURGERY AND UROLOGY; BIRTHPLACE SERVICES; SPECIALTY CLINICS IN THE FOLLOWING AREAS: CARDIOLOGY, DERMATOLOGY, OTOLARYNGOLOGY, GASTROENTEROLOGY AND NEUROLOGY; EMERGENCY DEPARTMENT SERVICES; HOME HEALTH CARE; REHABILITATION/THERAPY SERVICES; LABORATORY AND PATHOLOGY SERVICES; AND WOUND HEALING CARE. | Description |
| Total Program Service Expense | 40760127 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 |
| 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 | 1 | 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 64 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 489 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| 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 | BRADLEY J KOKJOHN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3193726530 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 174 | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 526270174 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JOHN MCKILLIP | |||||||
| PRESIDENT | 2.00 | X | X | 3003 | 0 | 0 | |
| DEANNA BARR | |||||||
| VICE PRESIDENT | 2.00 | X | X | 1963 | 0 | 0 | |
| JAMES GERDES | |||||||
| PAST PRESIDENT | 2.00 | X | X | 1016 | 0 | 0 | |
| RICHARD CANELLA | |||||||
| DIRECTOR | 2.00 | X | 39 | 0 | 0 | ||
| JEANNINE HANEY | |||||||
| DIRECTOR | 2.00 | X | 903 | 0 | 0 | ||
| CHARLES BERTLSHOFER JR | |||||||
| DIRECTOR | 2.00 | X | 114 | 0 | 0 | ||
| ANN MENKE | |||||||
| DIRECTOR | 2.00 | X | 787 | 0 | 0 | ||
| C JAMES PLATT | |||||||
| CEO/SECRETARY | 40.00 | X | 313345 | 0 | 60433 | ||
| BRADLEY KOKJOHN | |||||||
| CFO/TREASURER | 40.00 | X | 198234 | 0 | 40604 | ||
| MITCHELL PAUL | |||||||
| PHYSICIAN | 40.00 | 883426 | 0 | 31046 | X | ||
| JAMES G KANNENBERG | |||||||
| PHYSICIAN | 40.00 | 501028 | 0 | 26582 | X | ||
| ERIC R SARGENT | |||||||
| PHYSICIAN | 40.00 | 448920 | 0 | 26893 | X | ||
| TIMOTHY S STAUDTE | |||||||
| PHYSICIAN | 40.00 | 409748 | 0 | 33320 | X | ||
| KATHY J ANDERSON | |||||||
| PHYSICIAN | 40.00 | 381194 | 0 | 12527 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3143720 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 231405 | TotalOtherCompensation |
| Number Individuals GT100 K | 22 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FIDELITY | |||||
| 900 SALEM STREET | SMITHFIELD | RI | 02917 | THIRD PARTY ADMINISTRATION | 2017540 |
| BI-STATE CONTRACTING | |||||
| 12917 115TH | BURLINGTON | IA | 52601 | CONTRACTOR BUILDING PHYSICAL THERAPY ADD | 1413282 |
| EMCARE PHYSICIAN SERVICES INC | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | EMERGENCY ROOM PHYSICIAN STAFFING | 1360483 |
| QUORUM HEALTH RESOURCES INC | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370275014 | HOSPITAL MANAGEMENT SERVICES | 921649 |
| GE HEALTHCARE | |||||
| 3000 N GRANDVIEW BLVD | WAUKESHA | WI | 53188 | MEDICAL SUPPLIES/SERVICES | 304687 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Related Organizations | 250000 | RelatedOrganizations |
| Total Contributions | 250000 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE RE | 621110 | 47904780 | 47904780 |
| SE RENAL DIALYSIS | 621300 | 81086 | 81086 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 47985866 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 367400 | TotalRevenueColumn |
| Exclusion | $367,400 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 68555 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 68555 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 68555 | TotalRevenueColumn |
| Exclusion | $68,555 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 10456 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -10456 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -10456 | TotalRevenueColumn |
| Exclusion | -$10,456 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | 141894 | $141,894 | ||
| HOUSEKEEPING, MAINTENA | 811000 | 55925 | 21248 | 34677 | |
| PHARMACY | 446110 | 23028 | 23028 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 44661 | TotalRevenueColumn |
| Related Or Exempt Function Income | 40274 | RelatedOrExemptFunctionIncome |
| Exclusion | $4,387 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 265508 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48926873 | TotalRevenueColumn |
| Related Or Exempt Function Income | 48070416 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 34677 | UnrelatedBusinessRevenue |
| Exclusion | $571,780 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65716 | Total |
| Program Services | 65716 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 624516 | Total |
| Management And General | 624516 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21894713 | Total |
| Program Services | 19804884 | ProgramServices |
| Management And General | 2089829 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 806121 | Total |
| Program Services | 730292 | ProgramServices |
| Management And General | 75829 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3869291 | Total |
| Program Services | 3496015 | ProgramServices |
| Management And General | 373276 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1378997 | Total |
| Program Services | 1218583 | ProgramServices |
| Management And General | 160414 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 280951 | Total |
| Program Services | 156783 | ProgramServices |
| Management And General | 124168 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35247 | Total |
| Management And General | 35247 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59569 | Total |
| Management And General | 59569 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3398493 | Total |
| Program Services | 3398493 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 241059 | Total |
| Program Services | 134522 | ProgramServices |
| Management And General | 106537 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6118859 | Total |
| Program Services | 5114059 | ProgramServices |
| Management And General | 1004800 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 962414 | Total |
| Program Services | 537070 | ProgramServices |
| Management And General | 425344 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160897 | Total |
| Program Services | 89788 | ProgramServices |
| Management And General | 71109 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200475 | Total |
| Program Services | 111874 | ProgramServices |
| Management And General | 88601 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3094241 | Total |
| Program Services | 1726725 | ProgramServices |
| Management And General | 1367516 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 695671 | Total |
| Program Services | 388216 | ProgramServices |
| Management And General | 307455 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 1901505 | 1901505 | |
| PHYSICIAN FEES | 1654619 | 1654619 | |
| REPAIRS AND MAINTENANCE | 257713 | 143815 | 113898 |
| SUBSCRIPTIONS | 122827 | 68543 | 54284 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33250 | Total |
| Program Services | 18625 | ProgramServices |
| Management And General | 14625 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47857144 | Total |
| Program Services | 40760127 | ProgramServices |
| Management And General | 7097017 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1337788 | BOY |
| EOY | 1444806 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6495785 | BOY |
| EOY | 5076402 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7185609 | BOY |
| EOY | 7152653 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 6393 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 664967 | BOY |
| EOY | 660181 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 822423 | BOY |
| EOY | 990650 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 50475934 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 29578082 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19477674 | BOY |
| EOY | 20897852 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9283396 | BOY |
| EOY | 9692639 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3970585 | BOY |
| EOY | 3914028 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65275 | BOY |
| EOY | 51322 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49303502 | BOY |
| EOY | 49886926 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4539949 | BOY |
| EOY | 5350925 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6219528 | BOY |
| EOY | 5145176 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 762180 | BOY |
| EOY | 432923 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11521657 | BOY |
| EOY | 10929024 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37587027 | BOY |
| EOY | 38757181 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 4903 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 194818 | BOY |
| EOY | 195818 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37781845 | BOY |
| EOY | 38957902 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49303502 | BOY |
| EOY | 49886926 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1139463 | OtherCostOrOtherBasis |
| Book Value | 1139463 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22227011 | OtherCostOrOtherBasis |
| Depreciation | 11912452 | Depreciation |
| Book Value | 10314559 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 24717364 | OtherCostOrOtherBasis |
| Depreciation | 17665630 | Depreciation |
| Book Value | 7051734 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2392096 | OtherCostOrOtherBasis |
| Book Value | 2392096 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 20897852 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| SE RENAL DIALYSIS, LC | 697508 | C |
| INVESTMENT IN SUBSIDIARIES | 3216520 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 3914028 | TotalOfBookValueProgramRelated |
| Total Revenue | 48926873 | TotalRevenue |
| Total Expenses | 47857144 | TotalExpenses |
| Excess Or Deficit For Year | 1069729 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 133894 | NetUnrealizedGLOnInvestments |
| Other | -$27,566 | OtherAmount |
| Total Adjustments | 106328 | TotalAdjustments |
| Excess Or Deficit Per FS | 1176057 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 49036157 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 133894 | NetUnrealizedGainsInvestments |
| Other Revenues | 225390 | OtherRevenues |
| Revenue Not Rptd F990 | 359284 | RevenueNotRptdF990 |
| Revenue Subtotal | 48676873 | RevenueSubtotal |
| Other Revenues Not Included | 250000 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 250000 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 48926873 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 47860100 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 10456 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 10456 | ExpensesNotRptdF990 |
| Expenses Subtotal | 47849644 | ExpensesSubtotal |
| Other Expenses Not Included | 7500 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 7500 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 47857144 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | THE HOSPITAL, FOUNDATION AND FORT MADISON PROFESSIONAL BUILDING ASSOCIATION FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO ORGANIZATIONS SUCH AS THIS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE CONTINUTED TAX EXEMPT STATUS OF BONDS ISSUED BY THE HOSPITAL, THE NATURE, THE CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. HOWEVER, AS OF SEPTEMBER 30, 2010 AND 2009, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY AS MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS TAKEN ANY TAX POSITIONS THAT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES. FORMS 990 AND 990T FILED BY THE HOSPITAL, FOUNDATION AND FORT MADISON PROFESSIONAL BUILDING ASSOCIATION ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. THE HOSPITAL'S IRS FORMS 990 AND 990T ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS 2006 AND PRIOR. RENAISSANCE HEALTH SERVICES, INC. IS A TAXABLE ORGANIZATION AND CURRENTLY FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE APPLICABLE STATE JURISDICTIONS. THIS ENTITY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS SEPTEMBER 30, 2006 AND PRIOR. |
| Part XI, Line 8 - Other Adjustments: | EQUITY IN NET INCOME OF SUBSIDIARIES: 214934. CONTRIBUTION INCOME REPORTED AS NET ASSET TRANSFER IN FINANCIAL STATEMENTS: -250000. UNMATCHED PORTION OF FUNDS COMMITTED IN 2008, UNCOMMITTED AND RECLASSIFIED: 7500. | |
| Part XII, Line 2d - Other Adjustments: | INCOME ON EQUITY IN SUBSIDIARY: 214934. LOSS ON SALE OF FIXED ASSETS RECLASSIFIED AS REVENUE ON FORM 990: 10456. | |
| Part XII, Line 4b - Other Adjustments: | CONTRIBUTION INCOME REPORTED AS NET ASSET TRANSER ON F/S: 250000. | |
| Part XIII, Line 2d - Other Adjustments: | LOSS ON SALE OF FIXED ASSETS RECLASSIFIED AS REVENUE ON FORM 990: 10456. | |
| Part XIII, Line 4b - Other Adjustments: | UNMATCHED PORTION OF FUNDS COMMITTED IN 2008, UNCOMMITTED AND RECLASSIFIED: 7500. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| 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 | 967439 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 967439 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02110 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4170831 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3652084 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 518747 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01130 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5138270 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3652084 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1486186 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03240 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 120581 | PersonsServed |
| Total Community Benefit Expense | 255080 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 255080 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00560 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 958 | PersonsServed |
| Total Community Benefit Expense | 139095 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 139095 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1940 | PersonsServed |
| Total Community Benefit Expense | 89404 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 89404 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 123479 | PersonsServed |
| Total Community Benefit Expense | 483579 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 483579 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 123479 | PersonsServed |
| Total Community Benefit Expense | 5621849 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3652084 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1969765 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04290 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12300 | PersonsServed |
| Total Community Building Expense | 6216 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 6216 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7824 | PersonsServed |
| Total Community Building Expense | 909 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 909 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 25000 | PersonsServed |
| Total Community Building Expense | 164 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 164 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 45124 | PersonsServed |
| Total Community Building Expense | 7289 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7289 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $960,276 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10981000 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12171441 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1190441 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SE RENAL DIALYSIS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | DIALYSIS SERVICES | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.20000 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.00000 | PhysicansProfitOrOwnership |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 174 | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Er Other | X | ErOther |
| Other | TRAUMA CENTER | Other |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: THE ORGANIZATION CALCULATED THE COST AMOUNTS NOTED IN PART 1, LINE 7 BY UTILIZING ITS CURRENT COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS REPORTED ON, INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, MEDICAID, UNINSURED, AND MEDICARE. WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, AS PROVIDED IN THE IRS INSTRUCTIONS WAS USED TO DETERMINE THE APPROPRIATE RATIO. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: THE AMOUNT OF BAD DEBT SUBTRACTED FROM OPERATING EXPENSES IN ORDER TO CALCULATE COLUMN F - % OF TOTAL EXPENSE - 1,901,505. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Patient accounts receivable due directly from the patients are carried at the original charge for the service provided, less amounts covered by third-party payors and less an estimated allowance for doubtful receivables. Management determines the allowance for doubtful accounts by identifying troubled accounts and by historical experience applied to an aging of accounts. Patient accounts receivable are written off when deemed uncollectible. Recoveries of patient accounts receivable previously written off are recorded when received. The bad debt calculation for Line 2 is presented at cost based upon a cost to charge ratio. Worksheet 2, Ratio of Patient Care Cost to Charges, as provided in the IRS instructions was used to determine the appropriate ratio. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The Organization derived its costing methodology used to determine the Medicare allowable costs reported in the Organization's Medicare Cost Report by using Cost Report Worksheets. Medicare Costs are determined through the Medicare cost finding process which allocates general service center costs to revenue departments. Routine and ICU costs are determined based on an average cost per day multiplied by the number of Medicare allowable days. Medicare ancillary costs are determined by the ratio of department costs to department charges, then the resulting percent is applied to Medicare allowable charges. The methodology described in the instructions to Schedule H, Part III, Section B, Line 6 does not take into account all costs incurred by the hospital and does not represent the total community benefit conferred in this area. The Medicare shortfall on Fee Schedule Reimbursed Services totaled $465,189 for the reportable year. This shortfall is not included on Sch H, Part III, line 7.The reasons Medicare shortfall should be treated as a community benefit are: absent the Medicare program, it is likely many of the individuals whould qualify for financial assistance or other needs-based government programs; by accepting payment below cost to treat these individuals, the burdens of government are relieved with respect to these individuals; there is a significant possibility that continued reduction in reimbursement may actually create difficulties in access for these individuals; and the amount spent to cover Medicare shortfall is money not available to cover financial assistance and other community benefit needs. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: The Fort Madison Community Hospital (FMCH) charity program is designed to identify those accounts where the guarantor is not able to make payment, or only limited payments that would work a definite hardship on the household, and "adjust" those accounts as early as possible.Financial Evaluation of Patient - if the primary payor is other than an insurance company, FMCH evaluates the ability of the guarantor to: 1) Handle the projected financial obligation personally; 2) Qualify for county, state or federal assistance. Assistance may be available if: a) there are dependent children in the home (Medicaid); b) possible determination of disability by the Social Security Administration; and c) patient is pregnant (Medicaid); 3) If patient appears to qualify for assistance in one of the above categories, FMCH evaluates how likely is it that the patient will follow through with the application process. If the patient is not likely to follow through, assistance is obtained from an outside agency to help the patient through the application process; 4) If the initial review indicates there is no other payor than the individual guarantor, and an assessment of the guarantor's means (income, assets and liabilities) leaves considerable questions as to how he/she will resolve the impending debt, FMCH then determines if full or partial charity is appropriate; 5) Residenty Test - To be eligible for charity care, the patient's home must be within the primary or secondary service area of FMCH. These areas are defined by zip codes; 6) Using the completed Personal Financial Statement, a copy of the most recent tax return, a copy of the moste recent payroll stubs and any other information that may be appropriate, the guarantor's income must be evaluated on a sliding scale based on poverty guidelines; 7) Additional circumstances such as, but not limited to, if the guarantor has limited cash income but has significiant property holdings (personal or business), those assets must be taken into account and may supersede the application of the above discount guidelines;Negotiations - Dependent upon the guarantor's means, FMCH may negotiate a settlement. If a resonable monthly payment for the balance owed can not be agreed upon, it is in everyone's best interest to resolve the debt earlier by agreeing to a negotiated amount.Recommendations from staff such as the CEO, CFO, DON, RU, Doctors and Department Heads to assist with patients that are having financial difficulty is always considered.Following discharge or billing, a determination of charity may be made by using the above process as soon as the question of possible charity is raised. This determination should always be made at the earliest possible time in the life of the account. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Fort Madison Community Hospital utilizes a community health needs assessment performed by the local United Way. In addition to this needs assessment, the hospital board of directors hold an annual planning meeting with representatives from the medical staff in attendance. This physician representation allows for good input of the community medical needs by those that are closest to the issues. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: The hospital has a written charity care policy in place to ensure that necessary health care services are not denied based on ability to pay and that all patients are treated fairly and equitably, and with respect and compassion. The hospital assists persons without insurance coverage by waiving all or part of the charges for services it provides. Charges for services are discounted on a sliding fee scale based on federal poverty guidelines. Individuals whose income is within 100 to 250% of the federal poverty guidelines are eligible for free or discounted services. The financial assistance contact information is available at all of the registration points in which eligible patients are likely to be present. In addition, financial assistance contact information is included in the patient bills, included in a patient's handbook given upon admission, addressed in letter form to patients that appear to be having difficulty paying their bill and/or a discussion is had with the patient on the availability of various government benefits, such as Medicaid or state programs. Where applicable, the patient is assisted with qualification for such programs.Additionally, a concerted effort is made to inform non-English speaking patients about financial assistance policies. Multilingual signs are posted in the registration and waiting areas so that hospital are clearly communicated to patients and prospective patients. The role and responsibilities of the financial assistance counselor include how to qualify patients for Medicaid, SCHIP and other government programs. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Fort Madison Community Hospital serves a community of approximately 12,916 and a combined service area of approximately 39,879. The Hospital's primary service area includes most of Lee County, IA as well as portions of Hancock County, IL. The primary service area has a population of approximately 22,505 and a median age of 43.6. Fort Madison Community Hospital receives 50.8% of the primary service area inpatient market share. The Hospital's secondary service area includes portions of Lee County, IA, Van Buren County, IA and Hancock County, IL. The secondary service area has a population of approximately 17,374 and a median age of 42. Fort Madison Community Hospital receives 10.2% of the secondary service area inpatient market share. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: Fort Madison Community Hospital participates in Community Building activities in a variety of ways. FMCH employees routinely participate in community activities such as parades, first aid tents at community events and Big Brother-Big Sister activities. They also participate in community health improvement advocacy efforts. The hospital marketing director is on the local Chamber of Commerce board of directors and the CEO is a member of the Southeast Iowa Regional Riverboat Commission that awards grants to local community benefit projects.In addition to the above, the hospital is in the process of building a new Outpatient Rehabilitation Center. The building includes space for physical, occupational and speech therapy services, including a small pool. The design includes a walking track for use by the public. The walking track will be used to promote wellness with all of our client groups: business, patients, employees. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: Fort Madison Community Hospital furthers its efforts to promote the health of the community by ensuring the majority of the organization's governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization, nor family members of such. The organization also extends medical privileges to all qualified physicians in its community for some or all of its departments. Fort Madison Community Hospital is committed to serving the residents of area communities. The hospital continues these efforts by using excess funds to expand its facilities and services to better serve the community. Furthermore, the organization has partnered with Jefferson Elementary School to improve the health and well-being of the youngest members of our community. Fort Madison Community Hospital is a disproportionate share (for Medicaid) hospital which participates in Medicare, Medicaid, CHAMPUS, Tricare and other government sponsored health care programs. Payments for services provided to beneficiaries of these programs are based on pre-established and unilaterally set fee schedules in accordance with the patient's diagnosis or test or procedure performed. The difference between the service price and the contracted price is written-off by the hospital. The contracted amount received from these programs is often less than the actual cost of the service, the difference of which represents a benefit to the patient and the community.Fort Madison Community Hospital operates an emergency room that is open 24 hours per day, 365 days per year. The emergency room has a trauma center with a certification level of III. The hospital's emergency room provides services to all individuals, regardless of their ability to pay and denies services to no one.The hospital provides various programs and services to inform and train members of the community on safety, health and lifestyle topics, as well as provide opportunities for learning in a safe environment. The programs are free or a nominal fee is charged to defray a portion of the cost. Examples of the programs are education programs for advanced directives, diabetes, CPR/first aid, prenatal, family/parenting and sibling relationships, as well as training to students of a variety of ages. The hospital served approximately 2,700 persons during educational programs.The hospital organized support groups for various groups including cancer, diabetes, ostomy and other health topics and served approximately 250 persons.Fitness, exercise and self-help programs were offered to promote and support the benefits of physical fitness, exercise, healthy lifestyles and stress management. The hospital sponsored or participated in community health fairs and the community health and fitness fair is held annually by the hospital for the community consisting of various exhibits on health related topics. It is open to all ages. Another annual event is the women's health conference for area women of all ages. The conference includes speakers on women related health issues. The hospital also sponsors a kid's day at the Lee County Fair, the Lee County Fair Senior Day, Lee County Safety Day and the local Relay for Life. Almost 13,000 persons benefited from these activities.The hospital provides a courtesy transportation service to almost 4,000 residents of several area communities. Various pick-up times and locations are provided.Fort Madison Community Hospital maintains a website to provide the community with free information on health and wellness topics, physicians, community programs, health services and employment opportunities.The hospital provides various services to area businesses on a contract basis including education programs on wellness and workplace injury prevention, on-site ergonomic evaluations, drug/alcohol testing/screening, evaluation of work related injuries and back assessments. The hospital underwrites a portion of the cost of these services. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: Not applicable | AffiliatedHealthCareSystem |
| Reports Filed With States | IA | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| FORT MADISON RODEO CORP | |||||||
| PO BOX 80 | FORT MADISON | IA | 52627 | 420658297 | 501(C)(4) | 10500 | PROMOTE COMMUNITY ACTIVE LIFESTYLE |
| FORT MADISON ECONOMIC DEVELOPMENT | |||||||
| PO BOX 427 | FORT MADISON | IA | 52627 | 421300666 | 501(C)(3) | 10000 | PROMOTE FORT MADISON TO INDUSTRIES AND BUSINESS |
| DENMARK FIRE DEPARTMENT | |||||||
| 408 5TH STREET | DENMARK | IA | 52624 | 421722664 | 501(C)(3) | 6000 | PROMOTE SAFETY OF COMMUNITY AND SURROUNDING AREAS |
| FORT MADISON COMMUNITY HOSPITAL FOUNDATION | |||||||
| HIGHWAY 61 WEST | FORT MADISON | IA | 52627 | 421446727 | 501(C)(3) | 6883 | PROMOTE FOUNDATION ACTIVITIES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: AS DONATION REQUESTS ARE RECEIVED BY THE HOSPITAL, AN INDEPENDENT SENIOR LEADERSHIP TEAM EVALUATES AND APPROVES THE RECIPIENTS FOR THE CHARITABLE/COMMUNITY BENEFIT DONATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | 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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C JAMES PLATT | |||||||||||||
| 245246 | 0 | 60839 | 0 | 7260 | 0 | 12250 | 0 | 48183 | 0 | 373778 | 0 | 0 | 0 |
| BRADLEY KOKJOHN | |||||||||||||
| 169662 | 0 | 28572 | 0 | 0 | 0 | 7929 | 0 | 32675 | 0 | 238838 | 0 | 0 | 0 |
| MITCHELL PAUL | |||||||||||||
| 883426 | 0 | 0 | 0 | 0 | 0 | 11500 | 0 | 19546 | 0 | 914472 | 0 | 0 | 0 |
| JAMES G KANNENBERG | |||||||||||||
| 360277 | 0 | 140751 | 0 | 0 | 0 | 11500 | 0 | 15082 | 0 | 527610 | 0 | 0 | 0 |
| ERIC R SARGENT | |||||||||||||
| 448920 | 0 | 0 | 0 | 0 | 0 | 11500 | 0 | 15393 | 0 | 475813 | 0 | 0 | 0 |
| TIMOTHY S STAUDTE | |||||||||||||
| 227725 | 0 | 182023 | 0 | 0 | 0 | 11500 | 0 | 21820 | 0 | 443068 | 0 | 0 | 0 |
| KATHY J ANDERSON | |||||||||||||
| 237515 | 0 | 143679 | 0 | 0 | 0 | 11500 | 0 | 1027 | 0 | 393721 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 5 | MITCHELL PAUL, JAMES KANNENBURG, ERIC SARGENT, TIMOTHY STAUDTE, AND KATHY ANDERSON COMPENSATION ARRANGEMENT INCLUDES A BASE COMPENSATION AMOUNT PLUS A PRODUCTIVITY BONUS BASED ON A CERTAIN PERCENT OF NET BILLINGS IN EXCESS OF CERTAIN NET BILLING THRESHOLDS. THE ANNUAL THRESHOLD IS SET BY THE BOARD OF DIRECTORS, REVIEWED BY THE COMPENSATION COMMITTEE AND INCLUDES A COMPENSATION CAP. | |
| Part I, Line 7 | C. JAMES PLATT AND BRAD KOKJOHN COMPENSATION ARRANGEMENTS INCLUDE A BASE COMPENSATION PLUS A BONUS OF WHICH 80% IS BASED ON CERTAIN OPERATING FACTORS AND 20% BASED ON BOARD DISCRETION. | |
| Part III | AMOUNTS REPORTED IN PART II FOR C JAMES PLATT AND BRADLEY KOKJOHN WERE PAID BY QUORUM HEALTH RESOURCES. | Supplemental Information |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF FORT MADISON IOWA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 426004688 | IssuerEIN |
| CUSIP Number | NONEAVAIL | CUSIPNumber |
| Date Issued | 2003-09-08 | DateIssued |
| Issue Price | 5810000 | IssuePrice |
| Description Of Purpose | CONSTRUCT BUILDING ADDITION AND ADVANCE REFUND OF 2001 SERIES | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 5810000 | TotalProceeds |
| Issuance Costs From Proceeds | 99500 | IssuanceCostsFromProceeds |
| Capital Expenditures | 4000000 | CapitalExpenditures |
| Year Of Subst Completion | 2004 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | 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 | 1 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 0 | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.04670 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.04670 | 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 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | RICHARD CANELLA | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBER OF FMCH AND BOARD MEMBER OF BANK DOING BUSINESS WITH FMCH. | Relationship |
| Amount Of Transaction | 118722 | AmountOfTransaction |
| Description Of Transaction | BANK TRANSACTIONS AT ARMS LENGTH. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | DUE TO OVERLAP OF BOARD MEMBERSHIP ON RELATED ENTITIES, THE FOLLOWING INDIVIDUALS HAVE/HAS A BUSINESS RELATIONSHIP: RICHARD CANELLA JAMES GERDES JEANNINE HANEY CHARLES BERTLSHOFER, JR. ANN MENKE | |
| Form 990, Part VI, Section A, line 3 | C. JAMES PLATT, CEO AND BRAD KOKJOHN, CFO ARE EMPLOYED BY QUORUM HEALTH RESOURCES, A HEALTHCARE MANAGEMENT SERVICES COMPANY, WHICH PROVIDES MANAGEMENT SERVICES TO THE ORGANIZATION. | |
| Form 990, Part VI, Section B, line 11 | A COPY OF THE FORM 990 WAS REVIEWED BY THE CFO WITH THE EXTERNAL ACCOUNTANTS FOR COMPLETENESS AND ACCURACY PRIOR TO FILING THE FORM 990. A COPY OF THE FINAL VERSION WAS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS. | |
| Form 990, Part VI, Section B, line 12c | EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, 2) HAS READ AND UNDERSTANDS THE POLICY, 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. UPON ANY DISCLOSURE OF THE FINANCIAL INTEREST, THE INTERESTED PERSON LEAVES THE BOARD OR COMMITTEE WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. ALL SUCH ACTIONS ARE RECORDED IN THE MINUTES OF THE BOARD OR COMMITTEE MEETING. | |
| Form 990, Part VI, Section B, line 15 | THE COMPENSATION COMMITTEE, ACTING ON BEHALF OF THE BOARD OF DIRECTORS, MEETS AT LEAST ANNUALLY TO ASSIST THE BOARD OF DIRECTORS IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR EXECUTIVE COMPENSATION. QUORUM HEALTH RESOURCES PRESENTS TO THE FULL BOARD OF DIRECTORS COMPENSATION INFORMATION WHICH INCLUDES COMPARABLES AND INDUSTRY GUIDELINES ALONG WITH RECOMMENDATIONS FOR THE BOARD'S APPROVAL FOR COMPENSATION OF THE CEO AND CFO. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION DATA AND RELATED POLICIES AND DETERMINES WHETHER SUCH COMPENSATION IS REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE IN ORDER TO RECOMMEND TO THE FULL BOARD OF DIRECTORS COMPENSATION AMOUNTS FOR APPROVAL. COMPENSATION OF PHYSICIANS EMPLOYED OR CONTRACTED BY FMCH OR AN AFFILIATE ARE REVIEWED ANNUALLY USING THE MGMA DATA FOR COMPARISON. THE COMPENSATION COMMITTEE MAINTAINS DOCUMENTATION, CONSISTENT WITH THE RECORD RETENTION POLICY, OF ITS ACTIVITIES AND THE BASIS FOR ITS DECISIONS. THIS PROCESS OCCURS ANNUALLY. | |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION PROVIDES A COPY OF ITS FORM 990 TO ANYONE WHO REQUESTS A COPY. OTHER DOCUMENTS ARE NOT MADE AVAILABLE. | |
| FORM 990, PART XI, LINE 2C: | THERE WAS NO CHANGE IN THE PROCESS FROM PRIOR YEAR. | AUDITED FINANCIAL STATEMENT |
| FORM 990, SCHEDULE R, PART V: SCHEDULE R DISCLOSURES: ALL TRANSACTIONS REPORTED IN THIS SECTION ARE BASED UPON CORPORATE BOOKS AND RECORDS WHICH ARE KEPT ACCORDING TO GENERALLY ACCEPTED ACCOUNTING PRINCIPALS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | |||||||||
| PO BOX 174 | FORT MADISON | IA | 52627 | 421298064 | SUPPORT FORT MADISON COMMUNITY HOSPITAL | IA | 501(C)(3) | 11(A) | FORT MADISON COMMUNITY HOSPITAL |
| FORT MADISON COMMUNITY HOSPITAL FOUNDATION | |||||||||
| HIGHWAY 61 WEST | FORT MADISON | IA | 52627 | 421446727 | SUPPORT FORT MADISON COMMUNITY HOSPITAL | IA | 501(C)(3) | 11(A) | FORT MADISON COMMUNITY HOSPITAL |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RENAISSANCE HEALTH SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | HIGHWAY 61 WEST | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421298222 | EIN |
| Primary Activity | MEDICAL SERVICE | PrimaryActivity |
| Legal Domicile State | IA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 13 | ShareOfTotalIncome |
| Share Of EOY Assets | 13307 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | |
| J | 409940 |
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | |
| C | 250000 |
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | |
| K | 26460 |
| FORT MADISON COMMUNITY HOSPITAL FOUNDATION | |
| B | 6883 |