2026-04-28T14:45:40-05:00 2025-06-30 410746749 CLIFTONLARSONALLEN LLP 121 WEST BRIDGE STREET OWATONNA MN 55060 990 2024-07-01 900126510 KNOXVILLE HOSPITAL AND CLINICS KNOX 6418421407 1002 S LINCOLN ST KNOXVILLE IA 50138 SEAN DHABALT CFO 6418421407 2026-04-28 1 0 JUSTIN HARTERT P02236744 5074467100 2026-04-28 2024 2025-03-06 01:10:19Z SEAN DHABALT 1002 S LINCOLN ST KNOXVILLE IA 50138 65150504 0 X KNOXVILLEHOSPITAL.ORG X 1981 IA TO PROVIDE EXCEPTIONAL HEALTHCARE TO THE PEOPLE OF KNOXVILLE & SURROUNDING COMMUNITIES. 7 6 362 18 0 0 1782277 833491 54675394 62608067 351518 1259226 223885 327514 57033074 65028298 15039 0 0 0 22752433 25260015 0 0 0 26346291 32934526 49113763 58194541 7919311 6833757 69395664 67241886 28898660 29304192 40497004 37937694 FAITHFULLY PROVIDING EXCEPTIONAL HEALTH CARE 0 0 53016955 0 62608067 KNOXVILLE COMMUNITY HOSPITAL, INC IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN BOTH INPATIENT AND OUTPATIENT SETTINGS. DURING FISCAL YEAR 2025, THE HOSPITAL PROVIDED 699 DAYS OF SKILLED NURSING CARE AND 221,363 OUTPATIENT OCCASIONS OF SERVICE. 53016955 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 82 0 1 362 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X SEAN DHABALT 6418421401 1002 S LINCOLN ST KNOXVILLE IA 50138 JIM BUTLER PRESIDENT & TREASURER 1.00 0.00 X X 0 0 0 TODD CHAMBERS VICE PRESIDENT 1.00 0.00 X X 0 0 0 CINDI FULLER 2ND VICE PRESIDENT & SECRETARY 1.00 1.00 X X 0 0 0 DAVE JOHNSON BOARD MEMBER 1.00 0.00 X 0 0 0 LISA CROSSETT BOARD MEMBER 1.00 0.00 X 0 0 0 LORI BAILEY BOARD MEMBER 1.00 0.00 X 0 0 0 CONNIE CHRISMAN BOARD MEMBER 1.00 0.00 X 0 0 0 KEVIN KINCAID CEO 40.00 0.00 X 147406 0 16958 MAGGIE HAMILTON - BEYER CFO (THRU 6/30/25) 40.00 0.00 X 219912 0 65676 SEAN DHABALT CFO 40.00 0.00 X 0 0 0 SAMANTHA KEADY PHYSICIAN 40.00 0.00 X 436663 0 73660 LOGAN MILLER PHYSICIAN 40.00 0.00 X 395317 0 74282 THOMAS HOEHNS PHYSICIAN 40.00 0.00 X 317180 0 82988 JAMES LAW PHYSICIAN 40.00 0.00 X 295681 0 80666 CYNTHIA HOQUE PHYSICIAN 40.00 0.00 X 288904 0 69456 2101063 0 463686 30 0 1 0 EDGE COMMERCIAL 3155 SE MIEHE DR STE 2 GRIMES IA 50111 CONSTRUCTION 2067808 21ST CENTURY REHAB PO BOX 461 NEVADA IA 50201 PHYSICAL/OCC THERAPY SERVICES 1302889 CAPITAL ORTHOPEADICS 124999 UNIVERSITY AVE SUITE 210 CLIVE IA 50325 OUTPATIENT CLINIC 1192919 DOCS WHO CARE 800 W FRONTIER LN OLATHE KS 66061 ER DOC, HOSPITALIST 1181881 CERNER CORPORATION 8779 HILLCREST RD KANSAS CITY MO 64138 SOFTWARE/SUPPORT 816771 30 812965 8100 12426 833491 NET PATIENT REVENUE 621110 59742468 59742468 PHARMACY 621110 2865599 2865599 62608067 1144013 1144013 1800 0 1800 1800 1800 145259 92160 122206 0 23053 92160 115213 115213 MISCELLANEOUS 900099 171308 171308 CAFETERIA 900099 154406 154406 325714 65028298 62608067 0 1586740 X 705985 705985 19181239 17311627 1869612 904861 810725 94136 3124358 2724410 399948 1343572 1167502 176070 108912 108912 137417 137417 9436 9436 10148063 9294516 853547 65373 1550 63823 95420 95420 898275 885362 12913 72270 56059 16211 1045351 1045351 2212316 2212316 212517 135754 76763 MEDICAL SUPPLIES 11718602 11468227 250375 BAD DEBT EXPENSE 2191903 2191903 PROVIDER CARE TAX 1787401 1787401 REPAIRS AND MAINTENANCE 1765214 1586984 178230 466056 241848 224208 58194541 53016955 5177586 0 763211 64193 33385767 32406655 6487852 5586422 499332 679591 268255 334256 49339100 24893147 23200522 24445953 3662147 2887428 1128578 837388 69395664 67241886 5492241 3726893 3885 22535188 21874151 369481 335452 140982 137108 360768 3226703 28898660 29304192 X 39997004 37937694 500000 0 40497004 37937694 69395664 67241886 6833757 246722 -9639789 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3140 3140 0 PART II-B, LINE 1: KNOXVILLE COMMUNITY HOSPITAL, INC. PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. 255596 255596 36171469 15357005 20814464 11952647 9536142 2416505 959388 959388 24445953 THIRD PARTY PAYOR SETTTLEMENT 3226703 3226703 X PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2025, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 0 1 X 1 1 0 1 1 368539 368539 0.00660 10893032 4730473 6162559 0.11000 11261571 4730473 6531098 0.11660 46 8467 8467 0.00020 123 245756 10000 235756 0.00420 264444 112237 112237 0.00200 264613 366460 10000 356460 0.00640 264613 11628031 4740473 6887558 0.12300 1409 1409 0.00000 500 1824 1824 0.00000 500 3233 3233 0.00000 1 2191903 263028 14673504 14867708 -194204 X 1 1 1 1 KNOXVILLE COMMUNITY HOSPITAL INC AND CLINICS 1002 S LINCOLN STREET KNOXVILLE IA 50138 WWW.KNOXVILLEHOSPITAL.ORG 630031H X X X X KNOXVILLE COMMUNITY HOSPITAL INC 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 22 1 SEE PART V, SECTION B, LINE 7D 0 1 X 300.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION B, LINE 16J X SEE PART V, SECTION B, LINE 16J X SEE PART V, SECTION B, LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 KNOXVILLE COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 5: RESEARCH TO ENSURE PROPER TOWN HALL REPRESENTATION AND TO DETERMINE THE PRIMARY SERVICE AREA WAS DONE AND DATA WAS COLLECTED TO ANNOUNCE UPCOMING CHNA WORK AND REQUEST PUBLIC SAFETY PARTICIPATION, A PUBLIC RELATIONS STORY WAS PREPARED AND POSTED ON SOCIAL MEDIA, AS WELL AS SENT TO THE LOCAL MEDIA. A PAPER SURVEY AS WELL AS AN ONLINE LINK TO THE SURVEY WAS MADE AVAILABLE FOR THE PUBLIC TO RESPOND. KHC STAFF ALSO VISITED WITH MANY LOCAL GROUPS SUCH AS ROTARY ABOUT THE CHNA PROCESS AND REQUESTED COMPLETION OF SURVEYS FOR THOSE PRESENT AT THAT MEETING. A PAPER SURVEY WAS USED WITH AN ONLINE LINK TO PSA RESIDENTS. THE SURVEY WAS SENT TO 1,000 PARTICIPANTS WITH THE ANTICIPATION OF RECEIVING 250 COMPLETED SURVEYS. WE PREPARED AND PUBLISHED A TOWN HALL INVITATION TO THE PUBLIC AND COLLABORATING PARTIES SUCH AS PUBLIC HEALTH, SCHOOL LEADERS, FAITH-BASED LEADERS, PHYSICIANS AND OTHER CARE PROVIDERS, AS WELL AS THE MENTAL HEALTH PROVIDER COMMUNITY, FREE CLINICS, LOCAL RESIDENTS, COMMUNITY LEADER, BUSINESS LEADERS, LOCAL GOVERNMENT, PEOPLE WITH CHRONIC CONDITIONS, AND UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, COMMUNITY LEADER, BUSINESS LEADERS, LOCAL GOVERNMENT, PEOPLE WITH CHRONIC CONDITIONS, AND UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS ALONG WITH KNOXVILLE HOSPITAL & CLINICS. WE PREPARED A BRIEF OF GOALS, OBJECTIVE, PURPOSE, OUTCOMES, ROLES, AND COMMUNITY INVOLVEMENT AND HELD A KICK-OFF MEETING. COMMUNITY HEALTH FACTS AND PRACTICE DATA WERE COLLECTED AND PUBLISHED. COMMUNITY OPINIONS WERE COLLECTED ON HEALTH NEEDS, PRACTICES, AND PHYSICIANS AND CARE PROVIDER AVAILABILITY. THE COMMUNITY HEALTH NEEDS REPORT WAS THEN PREPARED AND PRESENTED TO THE COMMUNITY WITH RECOMMENDED ACTIONS. THE TOWN HALL MEETING INCLUDED DISCUSSION ON PURPOSE, ROLES, REVIEW OF HISTORICAL DATA, PARTICIPANT DISCUSSIONS TALLY AND RANKING OF HEALTH CONCERNS, AND REFLECTION ON THE HEALTH NEEDS OF THE COMMUNITY. THE MEETING CONCLUDED WITH INFORMATION ABOUT THE NEXT STEPS. THE COMMUNITY WAS ENCOURAGED TO CONTINUE TO PARTICIPATE BY CONTRIBUTING IDEAS TO THE HOSPITAL AND PUBLIC HEALTH DEPARTMENT VIA EMAIL OR PERSONAL CONVERSATION. IN ADDITION, OTHER MEETINGS, INTERVIEWS, AND FOCUS GROUPS WERE HELD. KNOXVILLE COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON OUR WEBSITE AT: HTTPS://KNOXVILLEHOSPITAL.ORG/COMMUNITY/WHO-WE-ARE/CHNA AND IMPLEMENTATION DIRECT LINK:HTTPS://KNOXVILLEHOSPITAL.ORG/WP-CONTENT/UPLOADS/2022/07/CHNA_REPORT_MARIONCO_JULY2022-FINAL.PDF KNOXVILLE COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 11: IN THE MOST RECENT CHNA CONDUCTED THE FOLLOWING NEEDS WERE IDENTIFIED IN THE ORDER OF IMPORTANCE: 1. MENTAL HEALTH INCREASE THE PROVIDED AND BREADTH OF SERVICES FOR MENTAL HEALTH NEEDS IN THE COMMUNITIES. 2.HOUSING/HOMELESSNESS INCREASE THE AVAILABILITY OF AFFORDABLE HOUSING IN THE COMMUNITY, DEVELOP/FORMALIZE COUNTYWIDE IMPACT PLAN TO ADDRESS HOMELESSNESS. 3. TRANSPORTATION MAKE ACCESSIBLE (EASY) FOR INDIVIDUALS TO USE WITH REASONABLE ACCESS & AFFORDABILITY. 4. FOOD INSECURITY INCREASE THE AVAILABILITY OF AFFORDABLE FOOD OPTIONS FOR MEMBERS OF THE COMMUNITY. IN THE CURRENT YEAR, THE HOSPITAL HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS THESE NEEDS:1. MENTAL HEALTH KNOXVILLE HOSPITAL & CLINICS CONTINUES TO PROVIDE ACCESS TO TELEHEALTH MENTAL HEALTH PROVIDERS FOR PATIENTS AS NEEDED IN THE EMERGENCY ROOM AND INPATIENT UNIT. THESE PROVIDERS CONTINUE TO ASSESS THE PATIENTS AS NEEDED AND BEGIN TREATMENT PROTOCOLS. ALSO, KNOXVILLE HOSPITAL & CLINICS CEO KEVIN KINCAID CONTINUES TO WORK WITH THE IOWA HOSPITAL ASSOCIATION ON LOBBYING FOR LEGISLATION TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES IN THE COMMUNITY AND STATEWIDE.3. TRANSPORTATION: KNOXVILLE HOSPITAL AND CLINICS' COMMUNITY HEALTH NAVIGATOR ASSISTS PATIENTS WITH ACCESS TO TRANSPORTATION PROGRAMS THROUGH MEDICAID AND OTHER PROGRAMS. THE HOSPITAL WILL PROVIDE PATIENTS WITH FUNDS TO PAY FOR TRANSPORTATION HOME FROM THE FACILITY IF ALL OTHER OPTIONS HAVE BEEN EXHAUSTED. THE HOSPITAL CONTINUES TO ADVOCATE FOR BETTER TRANSPORTATION FOR PATIENTS THROUGH HIRTA AND OTHER PROGRAMS. 4. FOOD SECURITY - KNOXVILLE HOSPITAL & CLINIC COMMUNITY SERVICE WORKER HAS ASSISTED MANY PATIENTS TO PROMOTE AWARENESS OF FOOD RESOURCES TO INCREASE ACCESS AND UNDERSTANDING OF LOCAL/STATE/NATIONAL RESOURCES, SUCH AS SNAP FOOD ASSISTANCE, WIC, MEALS ON WELLS, AND LOCAL FOOD PANTRIES THROUGHOUT THIS LAST YEAR. SOCIAL MEDIA/PRINT PUBLICATIONS HAVE BEEN AVAILABLE TO COMMUNITY MEMBERS TO INFORM THEM WHEN THE VARIOUS FOOD PANTRIES HAVE AN AVAILABLE SUPPLY. MANY CHURCHES IN THE COMMUNITY POST ON FACEBOOK TO ALERT THOSE IN NEED AND THIS INFORMATION IS PASSED ON TO THOSE IN NEED AT THIS TIME. THE HOSPITAL CONTINUES TO BE AN ACTIVE PARTNER IN COMMUNITY LEADERSHIP TO DEVELOP AFFORDABLE AND SAFE HOUSING OPTIONS FOR COMMUNITY MEMBERS BUT HAS NOT DONE ANY WORK DIRECTLY TO ADDRESS HOMELESSNESS OR HOUSING ISSUES. KNOXVILLE COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 13H: THE HOSPITAL CONSIDERED FAMILY SIZE IN ADDITION TO THE CRITERIA ABOVE. KNOXVILLE COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 15E: A LETTER IS SENT PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. KNOXVILLE COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT:HTTPS://KNOXVILLEHOSPITAL.ORG/BILLING-INFORMATION-POLICIES/FINANCIAL-ASSISTANCE/FINANCIAL ASSISTANCE POLICY DIRECT LINK:HTTPS://MERCYHEALTHNETWORK-KHC.POLICYSTAT.COM/POLICY/TOKEN_ACCESS/DCC0415D-7DC8-4EF4-A8CE-12508058EBE0/FINANCIAL ASSISTANCE POLICY APPLICATION DIRECT LINK:HTTPS://KNOXVILLEHOSPITAL.ORG/BILLING-INFORMATION-POLICIES/FINANCIAL-ASSISTANCE-APPLICATION/PLAIN LANGUAGE SUMMARY DIRECT LINK:HTTPS://KNOXVILLEHOSPITAL.ORG/WP-CONTENT/UPLOADS/2019/02/FINANCIAL-ASSISTANCE-POLICY-PLAIN-LANGUAGE-SUMMARY-02062019.PDF 3 1 - KNOXVILLE AREA COMMUNITY HOSPITAL CLINIC 1202 WEST HOWARD STREET KNOXVILLE IA 50138 PHYSICIAN CLINIC 2 - PLEASANTVILLE PHYSICIAN CLINIC 104 NORTH WASHINGTON STREET PLEASANTVILLE IA 50225 PHYSICIAN CLINIC 3 - RED ROCK HEALTH CENTER 615 WASHINGTON STREET PELLA IA 50219 PHYSICIAN CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES, AS WELL AS INSURANCE STATUS, AND FAMILY SIZE, ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. ELIGIBILITY IS DETERMINED ON A HOUSEHOLD SIZE AND INCOME BASIS USING THE MOST RECENTLY PUBLISHED HHS POVERTY GUIDELINES IN EFFECT AT THE TIME SERVICES ARE RENDERED. FINANCIAL ASSISTANCE UNDER THIS POLICY IS LIMITED TO CITIZENS OF THE UNITED STATES. APPLICANTS ARE RESPONSIBLE FOR PROVIDING COMPLETE AND ACCURATE HOUSEHOLD SIZE AND INCOME INFORMATION NECESSARY FOR A TIME ELIGIBILITY DETERMINATION.IN ADDITION, PRESUMPTIVE DETERMINATIONS OF FINANCIAL ASSISTANCE ELIGIBILITY MAY BE MADE FOR INDIVIDUALS BASED ON AVAILABLE INFORMATION, INCLUDING BUT NOT LIMITED TO PRIOR ELIGIBILITY DETERMINATIONS OR PARTICIPATION IN OTHER NEED-BASED ASSISTANCE PROGRAMS. PATIENTS WHO MAY QUALIFY FOR MEDICAL COVERAGE THROUGH AFFORDABLE CARE ACT SUBSIDIES, MEDICAID, OR OTHER AVAILABLE COVERAGE SOURCES, BUT WHO HAVE NOT ELECTED TO PURSUE SUCH OPTIONS, WILL BE ENCOURAGED TO DO SO PRIOR TO FINAL CONSIDERATION OF AN APPLICATION FOR ASSISTANCE. 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 CONTRIBUTIONS, LINE 7I ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE HOSPITAL'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,191,903. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SERVICE: THE HOSPITAL PROVIDES MEETING ROOM SPACE TO A NUMBER OF COMMUNITY ORGANIZATIONS AT NO COST. THE HOSPITAL PROVIDES SUPPORT TO THE LOCAL CHAMBER WITH MONETARY AND TIME DONATIONS. A FIRST AID TENT INCLUDING LABOR AND SUPPLIES FOR MEDICAL TREATMENT IS PROVIDED DURING KNOXVILLE NATIONALS AND CHAMBER EVENTS. THE HOSPITAL HOSTS AN ANGEL TREE EVERY YEAR TO HELP FAMILIES IN NEED AT CHRISTMAS. WE SUPPORT THE ANNUAL CHRISTMAS LIGHT SHOW AT MARION COUNTY PARK. THE PROCEEDS GO TO THE LOCAL HISTORICAL SOCIETY. THE HOSPITAL OFFERS HEALTH FAIRS ANNUALLY TO MEN, WOMEN, AND CHILDREN. THE HOSPITAL MAINTAINS A STRONG RELATIONSHIP WITH THE LOCAL SCHOOL SYSTEM, PROVIDING ATHLETIC TRAINING CARE AT EVENTS AND FREE SPORT PHYSICALS. WE HELD A BREAST CANCER SUPPORT EVENT ON THE SQUARE WITH HEALTH INFORMATION VENDORS. ECONOMIC DEVELOPMENT: THE HOSPITAL PROVIDES LEADERSHIP DEVELOPMENT TRAINING QUARTERLY TO DEPARTMENT LEADERS. ROTATIONS AND PRECEPTORSHIPS ARE MADE AVAILABLE IN VARIOUS SPECIALTIES FOR STUDENTS GOING INTO THE MEDICAL FIELD. THE HOSPITAL IS A MEMBER OF THE LOCAL CHAMBER AND ROTARY CLUB, WITH EMPLOYEES PARTICIPATING IN BOTH. THE HOSPITAL'S ADMISSIONS DIRECTOR IS ON THE LOCAL DAY CARE BOARD. THE HOSPITAL DONATES TO LOCAL PROJECTS ON A REGULAR BASIS. THE HOSPITAL HAS EMPLOYEES ATTENDING CAREER FAIRS IN THE AREA, AND IS PART OF THE LOCAL THRIVE PROGRAM. ECONOMIC IMPROVEMENTS: THE HOSPITAL AGGRESSIVELY RECRUITS FOR NEW PROVIDERS IN AN EFFORT TO SUSTAIN AND GROW. THE HOSPITAL IS PLANNING AN EXTENSIVE REMODEL TO EXPAND ITS EMERGENCY ROOM AND SURGERY AREA. THE HOSPITAL CONTINUOUSLY LOOKS FOR NEW WAYS TO IMPROVE THE HEALTH OFFERINGS PROVIDED TO THE COMMUNITY. THE HOSPITAL HAS EXPANDED COMMUNITY INVOLVEMENT IN IMPROVEMENT AND EXPANSION OF HOSPITAL SPACES. THE HOSPITAL HAS A RELATIONSHIP WITH AREA SCHOOLS, OFFERING FREE SPORTS PHYSICALS. THE HOSPITAL IS CURRENTLY WORKING ON PLANS FOR A NEW PROVIDER CLINIC AND RELOCATION OF CONTRACTED SPECIALISTS TO A BIGGER SPACE AS WELL AS A NEW INFUSION CENTER.OTHER: THE HOSPITAL PROVIDES CAB FARE FROM THE EMERGENCY ROOM FOR INDIGENTS AND USE OF OUR ROOMS FOR LOCAL CLUBS AND COMMUNITY MEETINGS. ADMINISTRATIVE ASSISTANCE IS OFFERED TO VARIOUS ORGANIZATIONS. ONE OF OUR DOCTORS IS PRESIDENT OF THE IOWA PHYSICIANS SOCIETY AND PHYSICIAN CHAMPION FOR THE ACO HEALTH GRANT. THE HOSPITAL NOW OFFERS TELEHEALTH TO HELP PROVIDE ACCESS TO MENTAL HEALTH PROFESSIONALS TO OUR AREA PATIENTS, AND WE PAY FOR PATIENT TRANSPORTATION TO FACILITIES THAT CAN PROVIDE MENTAL HEALTH SERVICES WE DO NOT PROVIDE. PART III, LINE 2: THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. FOR THE FISCAL YEAR, THIS AMOUNTS TO $2,191,903. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 12% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS IS DISCUSSED IN THE "PATIENT RECEIVABLES AND "ALLOWANCES FOR CREDIT LOSSES" SECTION OF NOTE 1 TO THE FINANCIAL STATEMENTS, ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL IS BASED ON THE INFORMATION FROM THE COST REPORT. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS, THEREFORE THE ENTIRE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. PART III, LINE 9B: THE CHARITY CARE POLICY ALLOWS FOR PROACTIVE WRITE OFF TO ALLOWANCE FOR CHARITY CARE OF ANY BALANCE OWED BY A PATIENT KNOWN TO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. COLLECTION PROCEDURES DO NOT ENSUE ON ANY ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: THE HOSPITAL ALWAYS UTILIZES INPUT FROM MEDICAL STAFF, THE BOARD OF DIRECTORS AND VARIOUS HOSPITAL ADMINISTRATIVE STAFF WHO REGULARLY REVIEW THE TREATMENT OF PATIENTS TO ENSURE MEDICAL NECESSITY AND APPROPRIATE LEVELS OF CARE ARE CONSISTENTLY PROVIDED TO THE PATIENTS OF THE HOSPITAL. PART VI, LINE 3: CUSTOMER SERVICE AND BILLING STAFF CONTINUALLY MONITOR BALANCES WITHOUT ACTIVITY AND THEN CONTACT THE PATIENTS TO OFFER FINANCIAL ASSISTANCE OR ARRANGE PAYMENT PLANS. THE HOSPITAL ALSO OFFERS THE ABILITY TO MAKE PAYMENTS VIA A WEB-BASED PORTAL. THE PORTAL CONTAINS INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE AND PAYMENT PLAN POLICIES. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING COMMUNITIES IN MARION COUNTY, IOWA: KNOXVILLE (POP. 7,595), PLEASANTVILLE (POP. 1,676), AND MELCHER-DALLAS (POP. 1,176).MARION COUNTY IS CONSIDERED 47% RURAL. THE COUNTY POPULATION CONSISTS OF 18.6% AT OR OVER THE AGES OF 65 YEARS. MARION COUNTY, IOWA HAS A POPULATION OF 23.4% UNDER THE AGE OF 18.8. 0% OF MARION COUNTY RESIDENTS LIVE BELOW THE RATE OF POVERTY AND APPROXIMATELY 20% OF RESIDENTS ARE ENROLLED IN MEDICAID. APPROXIMATELY 10% OF MARION COUNTY RESIDENTS ARE UNINSURED, WITH 3% OF CHILDREN BEING UNINSURED. 96% OF RESIDENTS ARE WHITE AND SPEAK ENGLISH AS A PRIMARY LANGUAGE. MARION COUNTY IS SOUTHEAST OF DES MOINES, IOWA. PART VI, LINE 5: KNOXVILLE COMMUNITY HOSPITAL, INC. AND THE CLINICS PROVIDE NUMEROUS OUTPATIENT SPECIALTY PROVIDER CLINICS SUCH AS PODIATRY, ORTHOPEDICS, CARDIOLOGY, UROLOGY, DERMATOLOGY, SLEEP STUDY, ONCOLOGY, AUDIOLOGY, NEPHROLOGY, RHEUMATOLOGY AND EMG TESTING AND OBGYN. PROVIDERS AND STAFF PROVIDE FREE EDUCATIONAL/WELLNESS PROGRAMS FOR THE COMMUNITY/SCHOOLS. THE HOSPITAL IS ADDING TO ITS SPECIALTIES YEARLY, HOSTING ANNUAL PUBLIC EVENTS INCLUDING FREE SKIN CANCER SCREENING. THESE ARE PUBLISHED IN LOCAL NEWSPAPERS. PART VI, LINE 6: DURING TAX YEAR 2024, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS WERE AFFILIATED MEMBERS OF THE MERCY HEALTH NETWORK - CENTRAL IOWA THROUGH MERCY HOSPITAL - DES MOINES, IOWA. MERCY HEALTH NETWORK - CENTRAL IOWA INCLUDES 17 CAH/TWEENER HOSPITALS ALL LOCATED IN CENTRAL IOWA. BENEFITS OF THE AFFILIATION ARE NUMEROUS AND INCLUDE: A. SHARING OF BEST PRACTICES B. SAVINGS ON GROUP PURCHASING AGREEMENTS C. SAVINGS THROUGH GROUP CONTRACTING FOR NUMEROUS SERVICES D. ACCESS TO NUMEROUS HEALTH CARE EXPERTS E. ACCESS TO PROVIDERS OF ALL TYPES AND SPECIALTIES F. ACCESS TO COMPARATIVE REPORTING G. SUPPORT FOR HUMAN RESOURCES, MEDICAL CLINICS, PURCHASING, FINANCE, NUTRITION, MEDICAL SURGERY, AND ANCILLARY AREAS. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X 0 0 0 0 0 0 0 0 0 SAMANTHA KEADY PHYSICIAN 436663 0 0 0 0 0 16535 0 57125 0 510323 0 0 0 LOGAN MILLER PHYSICIAN 395317 0 0 0 0 0 17177 0 57105 0 469599 0 0 0 THOMAS HOEHNS PHYSICIAN 317180 0 0 0 0 0 15298 0 67690 0 400168 0 0 0 JAMES LAW PHYSICIAN 267917 0 27764 0 0 0 14352 0 66314 0 376347 0 0 0 CYNTHIA HOQUE PHYSICIAN 288904 0 0 0 0 0 12945 0 56511 0 358360 0 0 0 MAGGIE HAMILTON - BEYER CFO (THRU 6/30/25) 204912 0 15000 0 0 0 22300 0 43376 0 285588 0 0 0 KEVIN KINCAID CEO 72136 0 75270 0 0 0 3366 0 13592 0 164364 0 0 0 A CITY OF KNOXVILLE IOWA 426004843 2012-11-13 3000000 2012 SERIES, RENOVATION & EQUIP HOSPITAL & CLINIC 0 0 0 B MARION COUNTY IOWA 421182528 2014-08-20 8650000 RENOVATE & EQUIP HOSPITAL & CLINIC 0 0 0 C CITY OF MELCHER-DALLAS IOWA 421277655 2023-05-23 10000000 BUILD INFUSION CENTER, SPECIALTY CLINIC 0 0 0 A 2581653 3000000 6000 2940000 2016 0 0 1 1 B 2667644 8650000 128143 8521857 2016 0 0 1 1 C 176552 10000000 65175 9934825 2023 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART II, COLUMN A, LINE 11: $1,994,377 FOR OTHER PROCEEDS WERE SPENT TO REFUND THE 2012 BONDS THAT WERE CALLED ON AUGUST 20,2014. SCHEDULE K, PART II, COLUMN B, LINE 12: $1,360,000 OF THE BOND ISSUE PRICE WAS NEVER DRAWN UPON AND THERE WILL NEVER BY ANY MONEY BORROWED UPON OR SPENT FROM THIS AMOUNT. SCHEDULE K, PART II, COLUMN A AND B, LINE 13: THE PROJECT WAS DONE AS A PHASE IN PROJECT WITH MULTIPLE AREAS RENOVATED AND NEW AREAS BUILT. THE ENTIRE PROJECT WAS CONSIDERED COMPLETED BY JUNE 3, 2016. SCHEDULE K, PART III, COLUMNS A AND B, LINE 4: IN 2023, NONE OF THE NEW CLINIC SPACE WAS LEASED. ALL OF THE LEASED SPACE BY SPECIALTY DOCTORS HAS BEEN CONVERTED TO CONTRACT PROVIDER AGREEMENTS OR MOVED TO A NON-BOND FINANCED AREA. THE HOSPITAL HAD ALL OF THE CONTRACT PROVIDER AGREEMENTS REVIEWED BY LEAGAL COUNSEL TO ENSURE THAT THE CONTRACTS MEET THE SAFE HARBOR REQUIREMENTS FOR SERVICE AND MANAGEMENT CONTRACTS, THEREBY RESULTING IN NO PRIVATE USE IN THE NEW CLINIC. MCKAY GROUP TODD CHAMBERS, BOARD MEMBER, OWNS 60% OF MCKAY GROUP 86338 INSURANCE COVERAGE 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE DELEGATED THE AUTHORITY TO ACT IN BEHALF OF THE CORPORATION AND BE RESPONSIBLE TO THE CORPORATION IN MAKING DECISIONS AND INTERPRETING ITS POLICIES BASED ON RECOMMENDATIONS AND ADVICE AS PRESENTED BY THE CEO ON MATTERS DEALING WITH FINANCES, CURRENT ACTIVITIES, CHAIN OF EVENTS INVOLVED IN THE ROUTINE AFFAIRS OF THE HOSPITAL, AND THE ONGOING CONVERN OF ITS OPERATIONS. THE CEO SHALL MAKE AVAILABLE ALL NECESSARY REPORTS AND INFORMATION AS NEEDED, BY REQUEST, SO THAT THE EXECUTIVE COMMITTEE MAY BE APPRISED OF ALL RELATIVE MATTERS. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO MAKE AND ADOPT SUCH RULES AND REGULATIONS, NOT INCONSISTENT WITH THE LAW, THE ARTICLES OF INCORPORATION OR THE BYLAWS AS IT MAY DEEM ADVISABLE FOR THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 3 KNOXVILLE COMMUNITY HOSPITAL CONTRACTS WITH MERCYONE MEDICAL CENTER - DES MOINES FOR OVERSIGHT OF MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS SIGNED BY THE CFO PRIOR TO BEING FILED, IT IS REVIEWED BY THE BOARD OF DIRECTORS AT THE NEXT BOARD MEETING, WHICH MAY OCCUR AFTER FORM 990 HAS BEEN FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER PROVIDES A COMPLIANCE OVERVIEW AND BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY. THE COMPLIANCE OFFICER REVIEWS THE POLICIES AND UPDATES THEM ANNUALLY. THE COMPLIANCE TEAM MEETS QUARTERLY TO REVIEW ALL COMPLIANCE AREAS AND CONFLICT OF INTEREST IS ONE OF THOSE AREAS. THE COMPLIANCE OFFICER ATTENDS SPECIAL TRAININGS ON COMPLIANCE REGULATIONS. EVERY CONFLICT OF INTEREST ONCE RECOGNIZED, MUST BE EVALUATED. IF A CONFLICT EXISTS, THE INDIVIDUAL WILL NOT BE PRESENT DURING GENERAL DISCUSSION NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 PER HUMAN RESOURCE POLICIES, THE IHA WAGE SURVEY AND COMPARATIVE ANALYSIS AND MARKET RATES ARE UTILIZED. MOST WAGES ARE ADJUSTED WHEN THE BOARD OF DIRECTORS APPROVES PAY INCREASE PERCENTAGES. KNOXVILLE COMMUNITY HOSPITAL DOES PAY FOR PERFORMANCE IN CONJUNCTION WITH SALARY SURVEYS. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2025. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES DURNING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,294,516. MANAGEMENT AND GENERAL EXPENSES 853,547. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,148,063. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. KNOXVILLE HOSPITAL AND CLINICS FOUNDATION 1002 S LINCOLN ST KNOXVILLE IA 50138 900126510 SUPPORT FOR KNOXVILLE COMMUNITY HOSPITAL IA 501(C)(3) LINE 7 KNOXVILLE COMMUNITY HOSPITAL INC 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 KNOXVILLE HOSPITAL AND CLINICS FOUNDATION C 812965 FAIR MARKET VALUE