HENRY COUNTY HEALTH CENTER INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- HENRY COUNTY HEALTH CENTER INC (EIN 86-2701018)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-09
- IRS object ID
- 202421309349302017
- Schema version
- 2022v5.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-09T09:21:24-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 862701018 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HENR | BusinessNameControlTxt |
| Phone | 3193853141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 S WHITE STREET | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEREMY ALEXANDER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3193853141 | PhoneNum |
| Signature | 2024-05-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEREMY | PersonFirstNm |
| Person Last | ALEXANDER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2024-05-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER HENRY COUNTY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERESA COLGAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 S WHITE STREET | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $39,722,831 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GREATRIVERHEALTH.ORG/HENRY-COUNTY-HEALTH-CENT | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2021 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | HENRY COUNTY HEALTH CENTER IS COMMITTED TO ENHANCING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES THROUGH HIGH QUALITY, EFFECTIVE AND EFFICIENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 44 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,609,874 | PYContributionsGrantsAmt |
| CY Contributions Grants | $109,625 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $36,067,916 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,052,362 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,599 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,069,607 | PYOtherRevenueAmt |
| CY Other Revenue | $505,271 | CYOtherRevenueAmt |
| PY Total Revenue | $42,760,996 | PYTotalRevenueAmt |
| CY Total Revenue | $39,667,258 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,430,169 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,249,010 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,874,232 | PYOtherExpensesAmt |
| CY Other Expenses | $25,239,782 | CYOtherExpensesAmt |
| PY Total Expenses | $39,304,401 | PYTotalExpensesAmt |
| CY Total Expenses | $40,488,792 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,456,595 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$821,534 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,730,020 | TotalAssetsBOYAmt |
| Total Assets EOY | $30,966,020 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,167,059 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,188,284 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,562,961 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,777,736 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HENRY COUNTY HEALTH CENTER IS COMMITTED TO ENHANCING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES THROUGH HIGH QUALITY, EFFECTIVE AND EFFICIENT SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $40,488,792 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $39,052,362 | RevenueAmt |
| Desc | HENRY COUNTY HEALTH CENTER, INC., HAS ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS, INCLUDING OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG-TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND FOUR RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDES COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. | Desc |
| Total Program Service Expenses | $40,488,792 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHERYL ALBIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3197681000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 S GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| MATT WENZEL | |||||||
| DIRECTOR (THROUGH 10/12/22) | 0.50 | 42.50 | Yes (X) | $0 | $1,122,540 | $53,171 | |
| DR MICHAEL MCCOY | |||||||
| DIRECTOR | 0.50 | 42.50 | Yes (X) | $0 | $624,684 | $51,091 | |
| ROBB GARDNER | |||||||
| CEO (THROUGH JULY 2022) | 40.00 | 0.00 | $0 | $553,735 | $72,309 | Yes (X) | |
| TERESA COLGAN | |||||||
| CEO | 40.00 | 0.00 | $0 | $494,596 | $49,949 | Yes (X) | |
| DAVID MUHS | |||||||
| CFO | 40.00 | 0.00 | $191,144 | $0 | $51,408 | Yes (X) | |
| DAVID FILE | |||||||
| CHAIRPERSON | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| MIKE PATTEN | |||||||
| VICE CHAIRMAN & DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| WHITNEY ROGERS | |||||||
| DIRECTOR & VICE CHAIRMAN | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| SARA BETH SCHURR | |||||||
| SECRETARY/TREASURER | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DR DEWAYNE FRAZIER | |||||||
| DIRECTOR (THROUGH 3/28/23) | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CHAD HUDSON | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEN MOUTRIE | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR JOEL RYON | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR JOE TANSEY | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $191,144 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,795,555 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $277,928 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WAPITI MEDICAL GROUP | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | EMERGENCY ROOM SERVICES | $1,496,046 |
| LOCUM TENENS | |||||
| PO BOX 405547 | ATLANTA | GA | 30384 | CONTRACTED LABOR | $627,108 |
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND STREET SUITE 300 | OMAHA | NE | 68114 | CONTRACTED LABOR | $536,248 |
| PSYCHIATRIC MEDICAL CARE | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | CONTRACTED LABOR | $486,549 |
| ABC STAFFING | |||||
| 3451 S MERCY ROAD SUITE 102 | GILBERT | AZ | 85297 | CONTRACTED LABOR | $331,266 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $109,625 | AllOtherContributionsAmt |
| Total Contributions | $109,625 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621400 | $38,356,566 | $38,356,566 |
| PARTNERSHIP INCOME | 621400 | $425,000 | $425,000 |
| OTHER OPERATING INCOME | 621400 | $270,796 | $270,796 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,052,362 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $370,664 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $55,573 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $315,091 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $315,091 | TotalRevenueColumnAmt |
| Exclusion | $315,091 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 900099 | $141,952 | $141,952 |
| MISCELLANEOUS INCOME | 900099 | $48,228 | $48,228 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $190,180 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,667,258 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,052,362 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $505,271 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,071,740 | TotalAmt |
| Program Services | $13,071,740 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,177,270 | TotalAmt |
| Program Services | $2,177,270 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,324,617 | TotalAmt |
| Program Services | $17,324,617 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,638 | TotalAmt |
| Program Services | $360,638 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $950,720 | TotalAmt |
| Program Services | $950,720 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $378,174 | TotalAmt |
| Program Services | $378,174 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $5,334,645 | $5,334,645 |
| BAD DEBT EXPENSE | $890,988 | $890,988 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,488,792 | TotalAmt |
| Program Services | $40,488,792 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,476 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,121,696 | BOYAmt |
| EOY | $525,226 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,944,436 | BOYAmt |
| EOY | $5,121,452 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $947,715 | BOYAmt |
| EOY | $881,989 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,524 | BOYAmt |
| EOY | $1,162,525 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,465,173 | BOYAmt |
| EOY | $23,274,828 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,730,020 | BOYAmt |
| EOY | $30,966,020 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,395,954 | BOYAmt |
| EOY | $2,913,458 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,771,105 | BOYAmt |
| EOY | $23,274,826 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,167,059 | BOYAmt |
| EOY | $26,188,284 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,562,961 | BOYAmt |
| EOY | $4,777,736 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,562,961 | BOYAmt |
| EOY | $4,777,736 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,730,020 | BOYAmt |
| EOY | $30,966,020 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$821,534 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $36,309 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,847 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,847 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | HENRY COUNTY HEALTH CENTER PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT-OF-USE LEASE ASSETS | Desc |
| Book Value | $23,274,828 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $23,274,828 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT-OF-USE LEASE LIABILITIES | Desc |
| Amt | $23,274,826 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $23,274,826 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,892 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $77,892 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $131,419 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $113,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,662 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $209,311 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $113,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $95,554 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $95,624 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $95,624 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $95,624 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $95,624 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $304,935 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $113,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $191,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $890,988 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $91,771 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,141,158 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,344,218 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$203,060 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HEALTH CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 SOUTH WHITE STREET | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GREATRIVERHEALTH.ORG/HENRY-COUNTY- | WebsiteAddressTxt |
| State License | 440047H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE LINE 16J | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE LINE 16J | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE LINE 16J | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HENRY COUNTY HEALTH CENTER | PART V, SECTION B, LINE 2: HENRY COUNTY HEALTH CENTER, INC., RECEIVED TAX EXEMPT STATUS AS A 501(C)(3) IN MARCH 2021 AND ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS. THIS INCLUDES OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND FOUR RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDES COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. |
| HENRY COUNTY HEALTH CENTER | PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE ONLINE AT WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-SERVICES/. |
| HENRY COUNTY HEALTH CENTER | PART V, SECTION B, LINE 20E: HCHC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - PARK PLACE ELDER LIVING | ||||
| 401 S VAN BUREN STREET | MT PLEASANT | IA | 52641 | NURSING HOME CARE |
| 2 - HCHC - MT PLEASANT CLINIC | ||||
| 407 S WHITE STREET SUITE 103 | MT PLEASANT | IA | 52641 | PROVIDER HEALTH CLINIC |
| 3 - HCHC - WINFIELD CLINIC | ||||
| 110 W PINE STREET | WINFIELD | IA | 52659 | PROVIDER HEALTH CLINIC |
| 4 - HCHC - WAYLAND CLINIC | ||||
| 227 W MAIN STREET | WAYLAND | IA | 52654 | PROVIDER HEALTH CLINIC |
| 5 - HCHC - NEW LONDON CLINIC | ||||
| 111 W WASHINGTON STREET | NEW LONDON | IA | 52645 | PROVIDER HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | HENRY COUNTY HEALTH CENTER (HCHC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE. |
| PART I, LINE 7: | THE AMOUNTS INCLUDED IN PART I, LINES 7A-7D WERE CALCULATED USING COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. PART I, LINES 7E-7J ARE ACTUAL COSTS. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSES OF $890,988 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. |
| PART III, LINE 2: | THE HEALTH CENTER DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE HEALTH CENTER'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE HEALTH CENTER DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE HEALTH CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. |
| 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 THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL. 10.3% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. |
| PART III, LINE 4: | SEE THE "PATIENTS RECEIVABLES" PARAGRAPH IN NOTE 1 ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. |
| 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. 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 REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE (A) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (B) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; AND (C) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. |
| PART III, LINE 9B: | EACH PATIENT RECEIVES CARE REGARD LESS OF THE ABILITY TO PAY. ANY PATIENT CAN APPLY FOR FINANCIAL ASSISTANCE PRIOR TOO RAFTER RECEIVING A STATEMENT FOR SERVICES. THERE ARE NO COLLECTION EFFORTS WHILE AN INDIVIDUAL IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES ON PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST STATEMENT AND PROVIDES PATIENTS 240 DAYS TO APPLY FOR ASSISTANCE. |
| PART VI, LINE 2: | HENRY COUNTY HEALTH CENTER, INC., RECEIVED TAX EXEMPT STATUS AS A 501(C)(3) IN MARCH 2021 AND ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS. THIS INCLUDES OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND FOUR RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDES COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. |
| PART VI, LINE 3: | NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM HCHC IS DISSEMINATED BY VARIOUS MEANS AT HCHC, WHICH INCLUDES PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. HCHC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. HCHC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE SEIRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM. |
| PART VI, LINE 4: | LOCATED IN SOUTHEAST IOWA, MOUNT PLEASANT IS AT THE CROSSROADS OF U.S. HIGHWAY 218 AND U.S. 34. HENRY COUNTY HAS 11 CITIES AND MORE THAN 20,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IN HENRY COUNTY IS $62,365. THIS IS LOWER THAN THE STATE MEDIAN ($69,588) AND NATIONAL MEDIAN ($74,755). ELEVEN PERCENT OF ALL RESIDENTS AND 15% OF CHILDREN UNDER THE AGE OF 18 LIVE IN HOUSEHOLDS EARNING LESS THAN THE FEDERAL POVERTY LEVEL. THE STATE POVERTY LEVEL IS 11% FOR ALL RESIDENTS AND 12.2% FOR CHILDERN UNDER THE AGE OF 18. THE FEDERAL LEVEL IS 12.6% FOR ALL RESIDENTS AND 16.3% FOR CHILDERN UNDER THE AGE OF 18. 27.0% OF THE POPULATION IS 65 YEARS OR OLDER WHICH IS HIGHER THAN IOWA'S OVERALL RATE OF 18.4%. THERE IS A LOWER PERCENTAGE OF YOUNG PEOPLE UNDER THE AGE OF 30 LIVING IN HENRY COUNTY (37.5%) COMPARED TO IOWA (38.7%). ACCORDING TO THE U.S. CENSUS 2020 ESTIMATES, HENRY COUNTY IS 87.8% WHITE, 2.5% BLACK OR AFRICAN AMERICAN, 0.4% AMERICAN INDIAN AND ALASKA NATIVE, 2.2% ASIAN, AND 4.8% TWO OR MORE RACES. |
| PART VI, LINE 5: | THE BOARD MEMBERS LIVE IN THE HOSPITAL SERVICE AREA AND USE THE FACILITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. HENRY COUNTY HEALTH CENTER USES SURPLUS FUNDS TO INVEST IN HOSPITAL EQUIPMENT AND IMPROVEMENTS. |
| PART VI, LINE 6: | HENRY COUNTY HEALTH CENTER IS PART OF GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF TWO HOSPITALS, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME, ABOUT 25 PRIMARY-CARE AND SPECIALTY PHYSICIAN CLINICS, AND IS AFFILIATED WITH AN OUTPATIENT RENAL DIALYSIS CENTER.THE NON-HOSPITAL HEALTH CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL ARE: GREAT RIVER HEALTH SYSTEM-ANESTHESIA; GREAT RIVER HEALTH SYSTEM-AUDIOLOGY; GREAT RIVER HEALTH SYSTEM-BUSINESS HEALTH; GREAT RIVER HEALTH SYSTEM-CANCER CENTER; GREAT RIVER HEALTH SYSTEM-CARDIOLOGY; GREAT RIVER HEALTH SYSTEM-DIABETIC FOOT CLINIC; GREAT RIVER HEALTH SYSTEM-EYE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE, MERCY PLAZA; GREAT RIVER HEALTH SYSTEM-GASTROENTEROLOGY; GREAT RIVER HEALTH SYSTEM-HEALTHY LIVING; GREAT RIVER HEALTH SYSTEM-HERITAGE FAMILY PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE MEDICAL EQUIPMENT AND SUPPLIES; GREAT RIVER HEALTH SYSTEM-HERITAGE PARK PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE PARTNERS PHARMACY; GREAT RIVER HEALTH SYSTEM-KEOKUK; GREAT RIVER HEALTH SYSTEM-MEDIAPOLIS; GREAT RIVER HEALTH SYSTEM-MEDICINE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-MENTAL HEALTH; GREAT RIVER HEALTH SYSTEM-NEPHROLOGY; GREAT RIVER HEALTH SYSTEM-ORTHOPAEDIC SPECIALISTS; GREAT RIVER HEALTH SYSTEM-PULMONOLOGY; GREAT RIVER HEALTH SYSTEM-QUICK CARE; GREAT RIVER HEALTH SYSTEM-SURGEONS; GREAT RIVER HEALTH SYSTEM-UROLOGY; GREAT RIVER HEALTH SYSTEM-WAPELLO; GREAT RIVER HEALTH SYSTEM-WEST POINT; GREAT RIVER HEALTH SYSTEM-WOMEN'S HEALTH; GREAT RIVER HEALTH SYSTEM-WOUND AND HYPERBARIC; SOUTHEASTERN RENAL DIALYSIS. |
| PART VI, LINE 7: | HCHC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MATT WENZEL | ||||||||||||||
| DIRECTOR (THROUGH 10/12/22) | $0 | $740,784 | $0 | $213,774 | $0 | $167,982 | $0 | $15,250 | $0 | $37,921 | $0 | $1,175,711 | $0 | $0 |
| DR MICHAEL MCCOY | ||||||||||||||
| DIRECTOR | $0 | $532,528 | $0 | $80,672 | $0 | $11,484 | $0 | $15,250 | $0 | $35,841 | $0 | $675,775 | $0 | $0 |
| ROBB GARDNER | ||||||||||||||
| CEO (THROUGH JULY 2022) | $0 | $219,407 | $0 | $43,750 | $0 | $290,578 | $0 | $15,250 | $0 | $57,059 | $0 | $626,044 | $0 | $0 |
| TERESA COLGAN | ||||||||||||||
| CEO | $0 | $421,350 | $0 | $65,421 | $0 | $7,825 | $0 | $15,250 | $0 | $34,699 | $0 | $544,545 | $0 | $0 |
| DAVID MUHS | ||||||||||||||
| CFO | $191,144 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $51,408 | $0 | $242,552 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4A | MATT WENZEL RECEIVED A SEVERANCE PAYMENT OF $164,442. THIS AMOUNT WAS INCLUDED IN W-2 WAGES. ROBB GARDNER RECEIVED A SEVERANCE PAYMENT OF $250,000. THIS AMOUNT WAS INCLUDED IN W-2 WAGES. |
| FORM 990, PART VII, SECTION A, LINE 5: | DAVID MUHS IS EMPLOYED BY HENRY COUNTY SOLDIERS & SAILORS MEMORIAL HOSPITAL. THE EMPLOYEES FROM THAT HOSPITAL ARE LEASED TO HENRY COUNTY HEALTH CENTER INC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DR. MICHAEL MCCOY, MATT WENZEL AND JEREMY ALEXANDER HAVE BUSINESS RELATIONSHIPS BY SERVING AS OFFICERS AND/OR BOARD MEMBERS OF FOR-PROFIT SUBSIDIARIES OF GREAT RIVER HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 3 | EXECUTIVES AND EMPLOYEES OF GREAT RIVER HEALTH SYSTEM, INC., MANAGE THE ACTIVITIES OF THE HENRY COUNTY HEALTH CENTER, INC. THE CFO IS AN EMPLOYEE OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL AND PROVIDES SERVICES THROUGH A SERVICES AGREEMENT WITH THAT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT RIVER HEALTH SYSTEM, INC., AN IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF HENRY COUNTY HEALTH CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER, GREAT RIVER HEALTH SYSTEM, INC (GRHS), HAS THE SOLE POWER TO ELECT OR REMOVE ALL BOARD MEMBERS OF HENRY COUNTY HEALTH CENTER. THE NOMINATING COMMITTEE SHALL PRESENT A RECOMMENDATION FOR THE ELECTION OF DIRECTORS TO THE BOARD, WHICH UPON APPROVAL OF THE BOARD AND THE SUBSEQUENT APPROVAL OF GRHS, SHALL BE ELECTED TO THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE GRHS BOARD OF DIRECTORS HAS THE FOLLOWING SPECIFIC POWERS RELATED TO ALL SUBSIDIARY CORPORATIONS AND AFFILIATED ORGANIZATIONS: 1. ELECT OR REMOVE THE BOARD OF DIRECTORS, OR ANY OTHER MEMBER OF THE BOARD OF DIRECTORS; 2. AMEND THE ARTICLES OF INCORPORATION OR THE BYLAWS; 3. DISSOLVE OR APPROVE MERGER WITH ANY OTHER CORPORATE ENTITY; 4. APPROVE STRATEGIC OR OTHER BUSINESS PLANS; 5. APPROVE CAPITAL AND OPERATING BUDGETS; 6. APPROVAL OF ANY INDEBTEDNESS INCURRED; 7. TRANSFER, SELL OR CLOSE ANY FACILITY, DEPARTMENT OR FUNCTION; 8. APPROVE ANY CHARITABLE DISBURSEMENTS, WHETHER INTERNAL OR EXTERNAL, IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000.00) IN THE AGGREGATE DURING ANY FISCAL YEAR; 9. THE SALE, DISPOSITION OR ANY ENCUMBRANCE (OTHER THAN ROUTINE LEASE TRANSACTIONS) OF ANY REAL ESTATE; 10. ADOPT, AMEND, OR TERMINATE EMPLOYEE BENEFIT PROGRAMS OR PLANS; 11. APPOINT OR TERMINATE THE CHIEF EXECUTIVE OFFICER; 12. APPROVE THE ELECTION OF ANY OFFICER OR CHAIRPERSON OF THE BOARD OF DIRECTORS; AND 13. TO TAKE ANY OTHER ACTION NECESSARY DEEMED IN THE BEST INTERESTS OF GRHS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 WAS REVIEWED IN DETAIL BY A MEMBER OF THE ACCOUNTING DEPARTMENT, DIRECTOR OF FINANCE AND CFO. ANY NECESSARY ADJUSTMENTS WERE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 WAS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD MEMBERS WERE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOTH CORPORATE AND SUBSIDIARY BOARD MEMBERS ARE PROVIDED EDUCATION REGARDING CONFLICTS OF INTEREST. THIS EDUCATION IS PROVIDED BY THE CHIEF COMPLIANCE OFFICER. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. RELATIONSHIPS NOTED ON THIS FORM MAY BE DISCUSSED WITH THE RESPECTIVE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS RELATING TO THE TRANSACTION IN QUESTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. CONFLICT OF INTEREST PROCEEDINGS ARISING FROM CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF OFFICERS IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM, INC. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE CORPORATE BOARD OF DIRECTORS IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF THREE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON AN ANNUAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYSTEM, INC. PARTICIPATES IN AND UTILIZES EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP BIENNIALLY TO ASSESS AND VALIDATE THE ENTIRETY OF EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2023. |
| FORM 990, PART VI, SECTION C, LINE 19 | HENRY COUNTY HEALTH CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 40,300. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,300. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 17,284,317. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,284,317. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GREAT RIVER HEALTH SYSTEM INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193185 | HEALTH CARE | IA | 501(C)(3) | LINE 12C, III-FI | N/A | 0 | |
| SOUTHEAST IOWA REGIONAL MEDICAL CENTER | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 420680407 | HOSPITAL | IA | 501(C)(3) | LINE 3 | 0 | GREAT RIVER HEALTH SYSTEM INC | |
| GRHS HOLDINGS INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193186 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | LINE 12B, II | 0 | GREAT RIVER HEALTH SYSTEM INC | |
| GREAT RIVER HEALTH FOUNDATION INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421446727 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | LINE 12B, II | 0 | GREAT RIVER HEALTH SYSTEM INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHEAST RENAL DIALYSIS LC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH WHITE STREET | AddressLine1Txt |
| City | MOUNT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391878280 | EIN |
| Primary Activities | MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $348,110 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,635,953 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | Yes (1) | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.25000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| RIVERVIEW SYSTEM LTD | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421191960 | MEDICAL SERVICES | IA | N/A | C | 0 |
| GREAT RIVER MEDICAL SERVICES INC | |||||||||
| 1201 WEST AGENCY ROAD | WEST BURLINGTON | IA | 52655 | 421493449 | MEDICAL SERVICES | IA | N/A | C | 0 |
| MUTUAL CONSULTING & MANAGEMENT SERVICES | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421349668 | MANAGEMENT SERVICES | IA | N/A | C | 0 |
| HERITAGE PARK PHARMACY | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421191957 | PHARMACY | IA | N/A | C | 0 |
| HERITAGE MEDICAL EQUIPMENT & SUPPLY | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421191958 | MEDICAL SUPPLY | IA | N/A | C | 0 |
| RIGHTCHOICE INC | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 923383523 | STAFFING AGENCY | IA | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Comments