COMMUNITY HOSPITAL INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL INC (EIN 42-0738969)
- Tax period
- 2022-10-01 to 2023-09-30
- Filed
- 2024-08-14
- IRS object ID
- 202432279349301938
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-08-14T12:26:56-05:00 | ReturnTs |
| Tax Period End | 2023-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420738969 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 7123821515 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2959 US HIGHWAY 275 | AddressLine1Txt |
| City | HAMBURG | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 516405052 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CRISTIN HENDRICKSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7123821515 | PhoneNum |
| Signature | 2024-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| 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 | MEGAN L KOZIOL CPA | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2024-08-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2024-08-08 14:25:15Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GEORGE C GRAPE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CRISTIN HENDRICKSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2959 US HIGHWAY 275 | AddressLine1Txt |
| City | HAMBURG | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 516405052 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,095,633 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GRAPEHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | CRITICAL ACCESS HOSPITAL | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 138 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $818,365 | PYContributionsGrantsAmt |
| CY Contributions Grants | $73,999 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,988,401 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,965,854 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,652 | PYInvestmentIncomeAmt |
| CY Investment Income | $10,521 | CYInvestmentIncomeAmt |
| PY Other Revenue | $42,544 | PYOtherRevenueAmt |
| CY Other Revenue | $45,259 | CYOtherRevenueAmt |
| PY Total Revenue | $12,851,962 | PYTotalRevenueAmt |
| CY Total Revenue | $13,095,633 | 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 | $6,705,557 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,663,767 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,601,682 | PYOtherExpensesAmt |
| CY Other Expenses | $8,031,714 | CYOtherExpensesAmt |
| PY Total Expenses | $14,307,239 | PYTotalExpensesAmt |
| CY Total Expenses | $14,695,481 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,455,277 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,599,848 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,958,587 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,615,904 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,024,549 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,239,972 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,934,038 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,375,932 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | GEORGE C. GRAPE COMMUNITY HOSPITAL'S WELL TRAINED MEDICAL STAFF AND HEALTH CARE TEAM WILL STRIVE TO EXCEED PATIENTS' EXPECTATIONS BY PROVIDING CONTINUITY OF PERSONALIZED CARE THROUGH EASY ACCESS TO SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,135,484 | ExpenseAmt |
| Revenue | $12,965,854 | RevenueAmt |
| Desc | GEORGE C. GRAPE COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL THAT RECEIVED INITIAL CERTIFICATION ON AUGUST 1, 2001. THE HOSPITAL IS OWNED AND OPERATED BY COMMUNITY HOSPITAL INC., DOING BUSINESS AS GEORGE C. GRAPE COMMUNITY HOSPITAL.AS A CRITICAL ACCESS HOSPITAL, GEORGE C. GRAPE COMMUNITY HOSPITAL PERFORMS AN ANNUAL PROGRAM EVALUATION IN ORDER TO DETERMINE WHETHER THE SERVICE IS APPROPRIATE, ADEQUATE, EFFECTIVE AND EFFICIENT. THIS EVALUATION ALSO DETERMINES WHETHER THE UTILIZATION OF SERVICES WAS APPROPRIATE, ESTABLISHED POLICIES WERE FOLLOWED, DETERMINES ANY CHANGES NEEDED AND RECOMMENDS PROJECTS FOR DEVELOPMENT DURING THE NEXT YEAR. STATISTICAL ANALYSIS: 1.) ACUTE CARE- THERE WERE A TOTAL OF 79 INPATIENT ADMISSIONS DURING FISCAL YEAR 2023 COMPARED TO 63 ADMISSIONS DURING FISCAL YEAR 2022.2.) SWING BED- 49 SWING BED ADMISSIONS WERE RECORDED DURING FISCAL YEAR 2023 COMPARED TO 34 ADMISSIONS DURING FISCAL YEAR 2022. 3.) SURGICAL CASES- THERE WERE A TOTAL OF 155 SURGICAL CASES FOR THE 2023 FISCAL YEAR AS COMPARED TO 194 SURGICAL CASES DURING FISCAL YEAR 2022.4.) OUTPATIENT SERVICES- EMERGENCY ROOM SERVICES DECREASED FROM 898 VISITS IN FISCAL YEAR 2022 TO 871 VISITS IN FISCAL YEAR 2023. LABORATORY SERVICES INCREASED FROM 12,181 IN FISCAL YEAR 2022 TO 14,505 IN FISCAL YEAR 2023. RADIOLOGY SERVICES INCREASED FROM 2,099 IN FISCAL YEAR 2022 TO 2,253 IN FISCAL YEAR 2023. ULTRASOUND SERVICES DECREASED FROM 544 IN FISCAL YEAR 2022 TO 540 IN FISCAL YEAR 2023. NUCLEAR MEDICINE SERVICES INCREASED FROM 39 IN FISCAL YEAR 2022 TO 40 IN FISCAL YEAR 2023. | Desc |
| Total Program Service Expenses | $12,135,484 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 138 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DOUG BRANDT | PersonNm |
| Phone | 7123821515 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2959 US HWY 275 | AddressLine1Txt |
| City | HAMBURG | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51640 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DR THOMAS LARGEN | ||||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GREG WARDEN | ||||||||
| VICE PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CONNIE SMITH | ||||||||
| SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TROY HENDRICKSON | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LOA TRIVELY | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR MICHAEL WELLS | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ANGIE ETTLEMAN | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| CRISTIN HENDRICKSON | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $172,257 | $0 | $10,387 | ||
| MICHAEL ANDERSON | ||||||||
| INTERIM CFO THRU 1/23 | 36.00 | 0.00 | Yes (X) | $34,775 | $0 | $0 | ||
| DOUG BRANDT | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TANYA HAYES | ||||||||
| DIRECTOR OF NURSING | 40.00 | 0.00 | $109,860 | $0 | $6,550 | Yes (X) | ||
| CINDY BRUCE | ||||||||
| RN | 36.00 | 0.00 | $110,066 | $0 | $15,208 | Yes (X) | ||
| PATTY HAMMONS | ||||||||
| RN | 36.00 | 0.00 | $114,369 | $0 | $5,211 | Yes (X) | ||
| CRAIG WELLS | ||||||||
| CIO | 36.00 | 0.00 | $102,242 | $0 | $6,456 | Yes (X) | ||
| MAKAYLA OAKS | ||||||||
| RN | 40.00 | 0.00 | $103,598 | $0 | $16,888 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $747,167 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $60,700 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MEDICAL CLINIC PC | |||||
| 1219 MAIN STREET | HAMBURG | IA | 51640 | ER PHYSICIANS | $552,516 |
| THE GRAHAM GROUP | |||||
| 421 GRAND AVENUE | DES MOINES | IA | 50309 | CONSTRUCTION SERVICES | $441,581 |
| FUSION MEDICAL STAFFING LLC | |||||
| PO BOX 30131 | OMAHA | NE | 68103 | TRAVELING PERSONNEL | $344,223 |
| GET MED STAFFING INC | |||||
| PO BOX 8667 | OMAHA | NE | 68108 | TRAVELING PERSONNEL | $321,468 |
| ANDERSON & ASSOCIATES ENTERPRISE | |||||
| 1231 200TH STREET | SHENANDOAH | IA | 51601 | ANESTHESIA SERVICES | $255,389 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $13,023 | RelatedOrganizationsAmt |
| All Other Contributions | $60,976 | AllOtherContributionsAmt |
| Total Contributions | $73,999 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NPSR - MEDICARE/MEDICAID | 624100 | $10,379,698 | $10,379,698 |
| NPSR - PRIVATE PAY | 624100 | $2,419,984 | $2,419,984 |
| AMBULANCE SERVICES | 624100 | $77,851 | $77,851 |
| CONTRACT SERVICES | 624100 | $57,687 | $57,687 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,634 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,634 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,965,854 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,521 | TotalRevenueColumnAmt |
| Exclusion | $10,521 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,800 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,800 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,800 | TotalRevenueColumnAmt |
| Exclusion | $3,800 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 624200 | BusinessCd |
| Total Revenue Column | $41,459 | TotalRevenueColumnAmt |
| Exclusion | $41,459 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $41,459 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,095,633 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,965,854 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $55,780 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,419 | TotalAmt |
| Management And General | $217,419 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,226,744 | TotalAmt |
| Program Services | $4,258,120 | ProgramServicesAmt |
| Management And General | $968,624 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,228 | TotalAmt |
| Program Services | $93,080 | ProgramServicesAmt |
| Management And General | $22,148 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $707,108 | TotalAmt |
| Program Services | $513,055 | ProgramServicesAmt |
| Management And General | $194,053 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $397,268 | TotalAmt |
| Program Services | $312,868 | ProgramServicesAmt |
| Management And General | $84,400 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,403 | TotalAmt |
| Management And General | $5,403 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,860 | TotalAmt |
| Management And General | $67,860 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,288 | TotalAmt |
| Management And General | $100,288 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,585,997 | TotalAmt |
| Program Services | $4,030,187 | ProgramServicesAmt |
| Management And General | $555,810 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,992 | TotalAmt |
| Program Services | $198 | ProgramServicesAmt |
| Management And General | $13,794 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $372,757 | TotalAmt |
| Program Services | $253,400 | ProgramServicesAmt |
| Management And General | $119,357 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,900 | TotalAmt |
| Program Services | $180,900 | ProgramServicesAmt |
| Management And General | $60,000 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,892 | TotalAmt |
| Program Services | $18,671 | ProgramServicesAmt |
| Management And General | $2,221 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,774 | TotalAmt |
| Program Services | $11,243 | ProgramServicesAmt |
| Management And General | $5,531 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,689 | TotalAmt |
| Management And General | $21,689 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $581,103 | TotalAmt |
| Program Services | $485,801 | ProgramServicesAmt |
| Management And General | $95,302 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,798 | TotalAmt |
| Program Services | $64,907 | ProgramServicesAmt |
| Management And General | $16,891 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,900,297 | $1,900,297 | |
| DUES & SUBSCRIPTIONS | $21,964 | $12,757 | $9,207 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,695,481 | TotalAmt |
| Program Services | $12,135,484 | ProgramServicesAmt |
| Management And General | $2,559,997 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $612,863 | BOYAmt |
| EOY | $229,786 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $429,582 | BOYAmt |
| EOY | $1,096,562 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,175,435 | BOYAmt |
| EOY | $1,204,739 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,297 | BOYAmt |
| EOY | $4,297 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $333,267 | BOYAmt |
| EOY | $447,280 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,841 | BOYAmt |
| EOY | $23,845 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,031,576 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,585,435 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,042,460 | BOYAmt |
| EOY | $5,446,141 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,512 | BOYAmt |
| EOY | $163,254 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,103,330 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,958,587 | BOYAmt |
| EOY | $8,615,904 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,356,500 | BOYAmt |
| EOY | $907,719 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,675 | BOYAmt |
| EOY | $53,427 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $567,204 | BOYAmt |
| EOY | $546,638 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,170 | BOYAmt |
| EOY | $1,732,188 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,024,549 | BOYAmt |
| EOY | $3,239,972 | 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 | $6,934,038 | BOYAmt |
| EOY | $5,375,932 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,934,038 | BOYAmt |
| EOY | $5,375,932 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,958,587 | BOYAmt |
| EOY | $8,615,904 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,599,848 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $41,742 | NetUnrlzdGainsLossesInvstAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 | $1,421 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,421 | 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 | COMMUNITY HOSPITAL, INC. PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $98,000 | OtherCostOrOtherBasisAmt |
| Book Value | $98,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,375,212 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,068,972 | DepreciationAmt |
| Book Value | $3,306,240 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,328,525 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,328,775 | DepreciationAmt |
| Book Value | $1,999,750 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $229,839 | OtherCostOrOtherBasisAmt |
| Depreciation | $187,688 | DepreciationAmt |
| Book Value | $42,151 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,446,141 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE OBLIGATIONS | $8,188 |
| EST THIRD-PARTY PAYOR SETTLEMENTS | $1,724,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,732,188 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,137,375 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $41,742 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $41,742 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,095,633 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,095,633 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,695,481 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $14,695,481 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,695,481 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN 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 SEPTEMBER 30, 2023 AND 2022, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. | 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 |
| Percent400 | Yes (X) | Percent400Ind |
| 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 | $69,867 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $69,867 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,998,292 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $935,372 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,062,920 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07230 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,068,159 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $935,372 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,132,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07710 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,199 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,199 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,199 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,199 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,072,358 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $935,372 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,136,986 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $231,516 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,053,451 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,188,614 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$135,163 | 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 | COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2959 US HWY 275 | AddressLine1Txt |
| City | HAMBURG | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51640 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GRAPEHOSPITAL.COM | WebsiteAddressTxt |
| State License | 360067H | 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 | GEORGE C GRAPE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.GRAPEHOSPITAL.COM/GETPAGE.PHP?NAME=NEWS_CHNA2022 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.GRAPEHOSPITAL.COM/GETPAGE.PHP?NAME=NEWS_CHNA2022 | StrategyWebsiteURLTxt |
| 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_POLICY.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/FAP_WEB_APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/PLAIN_LANGUAGE_SUMMARY.PDF | 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 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 |
|---|---|
| GEORGE C. GRAPE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: IN ORDER TO REPRESENT THE COMMUNITY EQUALLY, MULTIPLE AVENUES OF COLLECTING INFORMATION WERE USED THAT PROVIDED NECESSARY INFORMATION TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY.AVENUES IDENTIFIED:-FOCUS GROUP (TOWN HALL MEETING)-SURVEY-STATE AND COUNTY HEALTH STATISTICSTO DETERMINE THE MAIN HEALTH CONCERNS OF THE COMMUNITY THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE INVITED MEMBERS OF THE COMMUNITY TO BE PART OF A TOWN HALL MEETING. THE COMMUNITY MEMBER MEETING CONSISTED OF PEOPLE FROM THE VARIOUS HEALTH CARE AREAS SUCH AS SCHOOL NURSE, OCCUPATIONAL THERAPIST, PHARMACIST, CASE MANAGER FOR MI/MR, IOWA STATE UNIVERSITY EXTENSION OUTREACH, MEDICAL CLINICS, A MEMBER FROM THE HOSPITAL'S BOARD OF DIRECTORS AND MEMBERS OF THE BUSINESS COMMUNITY.THERE WAS AN ONLINE SURVEY CONDUCTED. ADVERTISEMENTS FOR THE SURVEY WERE PUT IN THE HOSPITAL'S NEWSLETTER AND MAILED OUT TO THE COMMUNITY. THE COMMUNITY WAS ENCOURAGED TO GO ONLINE AND FILL OUT THE SURVEY.THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT COMMITTEE MET AND REVIEWED THE SURVEYS. THE INFORMATION AND DATA FROM THE SURVEY WERE THEN PRESENTED TO THE TOWN HALL MEETING GROUP, ALONG WITH THE PROPOSED ACTION TO BE TAKEN BY THE HOSPITAL. |
| GEORGE C. GRAPE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: IN THE 2022-2023 FISCAL YEAR, GEORGE C. GRAPE COMMUNITY HOSPITAL (THE HOSPITAL) CONTINUED TO ADDRESS THE NEEDS OF THE COMMUNITY (AS IDENTIFIED IN THE CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT).SPECIFIC NEEDS TO BE ADDRESSED INCLUDE MENTAL HEALTH, PRIMARY CARE, FOOD INSECURITY, VISITING SPECIALISTS, SENIOR ACTIVITIES, ADEQUATE HEALTHCARE STAFFING AND SUBSTANCE ABUSE.IN DECEMBER OF 2022, A FACEBOOK POST WAS PUBLISHED ON NATIONAL INFLUENZA VACCINATION WEEK. THIS WAS A REMINDER TO THE COMMUNITY THAT THERE WAS STILL TIME TO GET THE FLU VACCINE.IN DECEMBER OF 2022, THE HOSPITAL HOSTED A BLOOD DRIVE FOR THE COMMUNITY. FACEBOOK POSTS WERE PUBLISHED ABOUT THIS EVENT.IN FEBRUARY OF 2023, A FACEBOOK POST WAS PUBLISHED ABOUT NATIONAL WEAR RED DAY. THIS IS A DAY WHERE RED IS WORN TO SHOW SUPPORT FOR THE AWARENESS OF HEART DISEASE. WITHIN THIS POST THERE WAS EDUCATION ON HEART DISEASE AND OUR SPECIALTY DOCTORS.IN MARCH OF 2023, EMPLOYEES OF THE HOSPITAL PARTICIPATED IN A COLLEGE FAIR.IN APRIL OF 2023, A FACEBOOK POST WAS PUBLISHED ON NATIONAL DONATE LIFE MONTH. THIS POST INCLUDED INFORMATION ON BECOMING AN ORGAN DONOR. THIS POST ALSO INCLUDED A LINK TO INFORMATION ABOUT ORGAN DONATION AND HOW TO SIGN UP TO BE AN ORGAN DONOR.IN MAY OF 2023, THE HOSPITAL HOSTED A BLOOD DRIVE FOR THE COMMUNITY. FACEBOOK POSTS WERE PUBLISHED ABOUT THIS EVENT.IN MAY OF 2023, A FACEBOOK POST WAS SHARED FROM OUR PUBLIC HEALTH PAGE ON MATTER OF BALANCE. MATTER OF BALANCE WAS A CLASS HELD BY OUR PUBLIC HEALTH FOR THOSE WHO HAD CONCERNS ABOUT FALLING. THIS WAS A FREE CLASS HELD FOR THE COMMUNITY.IN JUNE OF 2023, A FACEBOOK POST WAS PUBLISHED ON WORLD BLOOD DONOR DAY. THIS IS A DAY TO THANK VOLUNTARY, UNPAID BLOOD DONORS FOR THEIR LIFE-SAVING GIFTS OF BLOOD AND TO RAISE AWARENESS OF THE NEED FOR BLOOD DONATION. THIS POST HAD A LINK TO INFORMATION ON BLOOD DONATION.IN JUNE OF 2023, EMPLOYEES OF THE HOSPITAL VOLUNTEERED AT A LOCAL SCHOOL FOR NO HUNGER SUMMER. THIS PROGRAM PROVIDES MEALS TO KIDS DURING THE SUMMERTIME FOR FREE.IN JUNE OF 2023, A FACEBOOK POST WAS PUBLISHED ON MEN'S HEALTH MONTH. THIS POST INCLUDED STATISTICS AND LINKED INFORMATION ABOUT CERTAIN MEN'S HEALTH.IN JULY OF 2023, A FACEBOOK POST WAS PUBLISHED ON SKIN CANCER. THIS WAS A VIDEO MADE BY HOSPITAL STAFF TO BRING AWARENESS TO THE SIGNS AND HOW TO PROTECT YOURSELF FROM SKIN CANCER.IN JULY OF 2023, A FACEBOOK POST WAS PUBLISHED ON SUNSCREEN. THIS WAS A VIDEO MADE BY HOSPITAL STAFF ON HOW TO PROPERLY WEAR SUNSCREEN AND HOW THIS COULD HELP WITH THE PREVENTION OF SKIN CANCER.IN JULY OF 2023, A FACEBOOK POST WAS PUBLISHED ON STAYING SAFE DURING THE SUMMER. THIS POST INCLUDED A LINK TO 20 STEPS TO HELP YOU STAY SAFE DURING THE SUMMER.IN AUGUST OF 2023, A FACEBOOK POST WAS PUBLISHED ON GRILLING SAFETY. THIS POST INCLUDED A LINK TO TIPS AND TRICKS ON HOW TO STAY SAFE WHEN USING THE GRILL.IN AUGUST OF 2023, EMPLOYEES OF THE HOSPITAL PARTICIPATED IN A COLLEGE FAIR.IN AUGUST OF 2023, A FACEBOOK POST WAS PUBLISHED ON A PUBLIC SAFETY ALERT. THE IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES HAD ISSUED A WARNING ABOUT THE DRUG XYLAZINE. THIS POST INCLUDED A LINK TO LEARN MORE ABOUT THE DRUG AND THE ALERT.IN SEPTEMBER OF 2023, THE HOSPITAL PARTICIPATED IN THE ANNUAL POPCORN DAYS. THE HOSPITAL HAD A FREE BOUNCE HOUSE FOR THE KIDS TO ENJOY AND JUMP OFF SOME ENERGY.IN SEPTEMBER OF 2023, A FACEBOOK POST WAS PUBLISHED FOR NATIONAL SUICIDE PREVENTION AWARENESS MONTH. THIS POST INCLUDED INFORMATION ON TYPES OF SYMPTOMS AND THE LIFE SAVING NUMBER TO CALL IF YOU OR A FRIEND HAD THOUGHTS OF SUICIDE. THIS POST ALSO HAD A LINK TO MORE INFORMATION ON SUICIDE.DURING THE 2022-2023 YEAR MULTIPLE FACEBOOK POSTS WERE PUBLISHED ON HIRING.DURING THE 2022-2023 YEAR MULTIPLE FACEBOOK POSTS WERE PUBLISHED ON SPECIALTY CLINIC DOCTORS AND THEIR SPECIALTIES. THESE POSTS THEN HAD LINKS ON INFORMATION ABOUT EACH SPECIALTY AND INFORMATION ON WHAT THEY TREATED.THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED. THERE ARE, HOWEVER, ACTIVITIES IN THE IMPLEMENTATION STRATEGY THAT HAVE NOT BEEN ADDRESSED IN THE CURRENT YEAR DUE TO BEING UNDERSTAFFED, INCLUDING THE FOLLOWING:1) CONTINUE TO EDUCATE ER STAFF REGARDING MENTAL HEALTH DELIVERY ISSUES AND HOW TO ADDRESS THEM. PROVIDE CONTINUING EDUCATION COURSES, LUNCH AND LEARN PRESENTATIONS, ETC. TO KEEP THEM CURRENT IN TERMS OF TREATING MENTAL HEALTH ISSUES.2) TRAIN STAFF TO WORK WITH OUR PROVIDER, HEARTLAND FAMILY SERVICES.3) CONTINUE TO PROVIDE EDUCATION AT FAIRS AND EDUCATIONAL PROGRAMS, INCLUDING VARIOUS SCREENINGS.ACTIVITIES NOT ADDRESSED DUE TO SPENDING GRANT RESEARCH FUNDS ON MULTIPLE PIECES OF EQUIPMENT, INCLUDE SEEKING ADDITIONAL FEDERAL AND STATE GRANT MONEY TO SUPPORT ADDITIONAL PROVIDER COVERAGE FOR PRIMARY CARE AND VISITING SPECIALISTS. ADDITIONAL ACTIVITIES NOT ADDRESSED DURING THE CURRENT FISCAL YEAR INCLUDE THE FOLLOWING:1) SENIOR ACTIVITIES - CONTINUE UPDATING THE COMMUNITY FACEBOOK PAGE. PROVIDE WEB LINKS TO AREA PROVIDERS, SCHOOLS, CHURCHES, AND COMMUNITY PROGRAMS. ENCOURAGE ENTITIES TO ADD HEALTH INFO TO THEIR PAGES. A SHARED POST ABOUT MATTER OF BALANCE CLASSES WAS THE ONLY SENIOR ACTIVITY PROMOTED ON OUR FACEBOOK PAGE, WITH NO LINKS ATTACHED. THIS WAS LARGELY DUE TO THE CHANGE IN CHNA COMMITTEE WITH STAFFING CHANGES. 2) ADEQUATE HEALTHCARE STAFFING - CREATE/PROVIDE HEALTHCARE WORKFORCE MATERIALS FOCUSING ON MEDICAL CAREERS TO SCHOOLS. THIS WAS NOT ADDRESSED DUE TO AN INCREASED FOCUS ON CAREER FAIRS/COLLEGE FAIRS TO TRY TO COUNTER OUR STAFFING SHORTAGES. |
| GEORGE C. GRAPE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 20E: WE ORALLY NOTIFY PATIENTS WHEN THEY COME IN DURING THE FINANCIAL COUNSELORS WORKING HOURS. A PLAIN LANGUAGE SUMMARY OF THE FAP IS MAILED TO EVERYONE 30 DAYS PRIOR TO THEIR ACCOUNT BEING SENT TO COLLECTIONS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - SOUTHWEST IOWA HOME HEALTH | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 803 INDIANA STREET | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51652 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | HOME HEALTH/PUBLIC HEALTH AGENCY | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS AND UNDERINSURANCE STATUS ARE USED, ALONG WITH FEDERAL POVERTY GUIDELINES, TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED PARTY. |
| PART I, LINE 7: | THE COST TO CHARGE RATIO WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST AS DERIVED FROM COMMUNITY HOSPITAL, INC.'S INTERNAL ACCOUNTING RECORDS. |
| PART I, LINE 7G: | THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL DOES NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES IN PART II. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REFLECTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. |
| PART III, LINE 3: | THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COST, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR THE HOSPITAL. THE COSTS OF CARING FOR PATIENTS WHO QUALIFY UNDER THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE POLICY FOR THE YEARS ENDED SEPTEMBER 30, 2023 AND 2022 WERE APPROXIMATELY $63,000 AND $34,000, RESPECTIVELY. |
| PART III, LINE 4: | THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 7, 10 AND 11 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES", "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". |
| PART III, LINE 8: | "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT, D, E, H AND M WORKSHEETS, OR PS&R. ALL OF THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. |
| PART III, LINE 9B: | THE COLLECTIONS/CHARITY WRITE-OFF POLICY PROVIDES THAT ONCE THE PATIENT/GUARANTOR QUALIFIES FOR CHARITY CARE HE/SHE WILL BE NOTIFIED OF THE AMOUNT OF FREE CARE AND THE NON-CHARITY AMOUNT. PAYMENT ARRANGEMENTS WILL BE MADE FOR THE NON-CHARITY AMOUNT AT THE TIME OF NOTIFICATION. NO ACTIONS ARE TAKEN ON ACCOUNTS UNTIL REASONABLE EFFORTS ARE MADE TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTNACE. COLLECTION ACTIONS ARE THE SAME FOR THE NON-CHARITY AMOUNT AS OTHER PATIENTS. |
| PART VI, LINE 2: | AT GEORGE C. GRAPE HOSPITAL, WE EMPLOY SEVERAL STRATEGIES IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO ASSESS THE HEALTH CARE NEEDS OF OUR COMMUNITY:1. PATIENT FEEDBACK AND SURVEYS: WE REGULARLY COLLECT AND ANALYZE FEEDBACK FROM OUR PATIENTS THROUGH SATISFACTION SURVEYS, SUGGESTION BOXES, AND DIRECT PATIENT INTERVIEWS. THIS HELPS US UNDERSTAND THEIR EXPERIENCES, IDENTIFY GAPS IN SERVICES, AND MAKE NECESSARY IMPROVEMENTS.2. COLLABORATION WITH LOCAL HEALTH ORGANIZATIONS: WE PARTNER WITH LOCAL PUBLIC HEALTH DEPARTMENTS, CLINICS, AND COMMUNITY ORGANIZATIONS SUCH AS FREMONT COUNTY PUBLIC HEALTH AND IOWA STATE UNIVERSITY EXTENSION AND OUTREACH OFFICE TO SHARE INFORMATION AND INSIGHTS. THIS COLLABORATIVE APPROACH ALLOWS US TO GAIN A COMPREHENSIVE UNDERSTANDING OF COMMUNITY HEALTH TRENDS AND NEEDS.3. HEALTH DATA ANALYSIS: WE REVIEW AND ANALYZE HEALTH DATA FROM VARIOUS SOURCES, INCLUDING THE CDC, STATE HEALTH DEPARTMENTS, AND LOCAL HEALTH STATISTICS. THIS DATA HELPS US IDENTIFY PREVALENT HEALTH ISSUES, EMERGING HEALTH TRENDS, AND AREAS REQUIRING FOCUSED ATTENTION.4. EMERGENCY DEPARTMENT AND CLINIC UTILIZATION REPORTS: BY ANALYZING THE UTILIZATION PATTERNS OF OUR EMERGENCY DEPARTMENT AND CLINICS, WE CAN IDENTIFY COMMON HEALTH ISSUES AND UNMET NEEDS IN THE COMMUNITY. THIS HELPS US TAILOR OUR SERVICES TO ADDRESS THESE SPECIFIC NEEDS.5. HEALTH SCREENINGS AND OUTREACH PROGRAMS: OUR HOSPITAL CONDUCTS REGULAR HEALTH SCREENINGS AND OUTREACH PROGRAMS IN VARIOUS COMMUNITY SETTINGS. THESE INITIATIVES NOT ONLY PROVIDE DIRECT HEALTH SERVICES BUT ALSO OFFER INSIGHTS INTO THE HEALTH STATUS AND NEEDS OF DIFFERENT POPULATION GROUPS WITHIN OUR COMMUNITY.6. ENGAGEMENT WITH HEALTHCARE PROVIDERS: WE MAINTAIN REGULAR COMMUNICATION WITH OUR NETWORK OF HEALTHCARE PROVIDERS, INCLUDING PRIMARY CARE PHYSICIANS, SPECIALISTS, AND ALLIED HEALTH PROFESSIONALS. THEIR FIRSTHAND EXPERIENCES AND OBSERVATIONS PROVIDE VALUABLE INFORMATION ABOUT THE HEALTH NEEDS AND CHALLENGES FACED BY THEIR PATIENTS.BY COMBINING THESE METHODS, WE CAN GAIN A UNDERSTANDING OF THE HEALTH CARE NEEDS OF OUR COMMUNITY AND ENSURE THAT OUR SERVICES ARE ALIGNED WITH THOSE NEEDS, ULTIMATELY ENHANCING THE OVERALL HEALTH AND WELL-BEING OF THE RESIDENTS WE SERVE. |
| PART VI, LINE 3: | THE HOSPITAL COMMUNICATES VIA MAIL WITH EACH PATIENT. THE ON STAFF FINANCIAL COUNSELOR ASSISTS PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION WHEN NECESSARY. PATIENTS WILL RECEIVE STATEMENTS OF ACCOUNT VIA MAIL WITH FINANCIAL ASSISTANCE POLICY INFORMATION INCLUDED. WHEN POSSIBLE, THE FINANCIAL COUNSELOR WILL SPEAK WITH PATIENTS PERSONALLY BEFORE BEING DISCHARGED TO DISCUSS THEIR CHARITY CARE NEEDS. |
| PART VI, LINE 4: | OUR PRIMARY SERVICE AREA INCLUDES FREMONT COUNTY. THE NORTHERN PART OF THE COUNTY IS BEGINNING TO GROW AT A SLOW PACE. THE MIDDLE AND SOUTHERN PART OF THE COUNTY IS EITHER DECLINING OR MAINTAINING THEIR POPULATIONS. THE SOUTHERN PART OF THE COUNTY ALSO HAS A HIGH POVERTY RATE. THIS SERVICE AREA HAS A POPULATION OF 7,147. OUR SECONDARY SERVICE AREA INCLUDES THREE SURROUNDING COUNTIES IN IOWA, TWO IN MISSOURI, AND TWO IN NEBRASKA WHICH HAVE AN ESTIMATED POPULATION OF 93,000. THE HOSPITAL DOES SERVE SOME PATIENTS IN THE SECONDARY SERVICE AREA, BUT THE MAJORITY OF THE PATIENTS COME FROM THE PRIMARY SERVICE AREA. |
| PART VI, LINE 5: | THE HOSPITAL USES THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT TO DETERMINE FOCUS AREAS FOR THE COMMUNITY. THE HOSPITAL ALSO HOSTS A HEALTH FAIR FOR THE COMMUNITY TO HAVE ACCESS TO BLOOD DRAWS OUT OF POCKET. |
| PART VI, LINE 6: | COMMUNITY HOSPITAL, INC. IS NOT PART OF AN AFFILIATED HEALTH CARE ORGANIZATION. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CRISTIN HENDRICKSON | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $172,257 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $4,058 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $6,329 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $182,644 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | GRAPE COMMUNITY HOSPITAL IS A CORPORATION THAT HAS MEMBERS. MEMBERSHIP IN THE CORPORATION SHALL CONSIST OF THE PERSONS, CORPORATIONS OR ASSOCIATIONS WHO SUBSCRIBED AS INCORPORATORS AND SUCH OTHER PERSONS, CORPORATIONS OR ASSOCIATIONS WHO HAVE CONTRIBUTED $100 OR MORE TO THE CORPORATION IN CASH, PROPERTY OR VOLUNTEER SERVICES RENDERED TO THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE INDIVIDUAL MEMBERS (NOT CORPORATE OR ASSOCIATION MEMBERS) OF GRAPE COMMUNITY HOSPITAL (AS DESCRIBED ON FORM 990, PART VI, SECTION A, LINE 6) SHALL ELECT, AT THE ANNUAL MEETING, THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND DIRECTOR OF FINANCE WILL REVIEW THE 990 PRIOR TO SUBMISSION. THE 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL DIRECTORS AND KEY EMPLOYEES WILL BE REQUIRED TO ANNUALLY COMPLETE THE "CONFLICT OF INTERESTS STATEMENT". THIS POLICY IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND GIVEN TO EACH NEW DIRECTOR FOR SIGNATURE DURING ORIENTATION. ANY CONFLICTS THAT ARISE DURING THE YEAR ARE DISCLOSED TO THE BOARD OF DIRECTORS AND APPROPRIATELY DOCUMENTED. SHOULD ANY CONFLICT REQUIRE BOARD ACTION, THE DIRECTORS SHALL HOLD A MEETING TO VOTE ON THE MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S SALARY WAS DETERMINED BY USING THE IOWA HOSPITAL ASSOCIATION (IHA) SALARY SURVEY. IT WAS DISCUSSED BY INDEPENDENT BOARD MEMBERS AND REVIEWED BY LEGAL COUNSEL. THIS PROCESS HAS BEEN IN PLACE SINCE 2008. ALL OTHER SALARIES, REGARDLESS OF THE POSITION, ARE COMPARED TO THE IHA SALARY SURVEY WITH YEARS OF EXPERIENCE TAKEN INTO CONSIDERATION AS WELL. THE HOSPITAL HAS SENIOR ADMINISTRATION THAT ARE INVOLVED IN THE HIRING OF MANAGEMENT, INCLUDING THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,228,550. MANAGEMENT AND GENERAL EXPENSES 555,810. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,784,360. ER COVERAGE: PROGRAM SERVICE EXPENSES 541,247. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 541,247. NURSING SERVICES: PROGRAM SERVICE EXPENSES 1,134,491. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,134,491. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 211,412. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 211,412. LAB SERVICES: PROGRAM SERVICE EXPENSES 553,710. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 553,710. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 360,777. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 360,777. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAPE HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 9 | AddressLine1Txt |
| City | HAMBURG | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51640 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421335348 | EIN |
| Primary Activities | FUNDRAISING AND SUPPORT OF GEORGE C. GRAPE COMMUNITY HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12B, II | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| 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 | Yes (1) | 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 | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments