2024-08-14T12:26:56-05:00 2023-09-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-10-01 420738969 COMMUNITY HOSPITAL INC COMM 7123821515 2959 US HIGHWAY 275 HAMBURG IA 516405052 CRISTIN HENDRICKSON CEO 7123821515 2024-08-14 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-08-07 2022 2024-08-08 14:25:15Z GEORGE C GRAPE COMMUNITY HOSPITAL CRISTIN HENDRICKSON 2959 US HIGHWAY 275 HAMBURG IA 516405052 13095633 0 X WWW.GRAPEHOSPITAL.COM X 1955 IA CRITICAL ACCESS HOSPITAL 7 7 138 7 0 0 818365 73999 11988401 12965854 2652 10521 42544 45259 12851962 13095633 0 0 0 0 6705557 6663767 0 0 0 7601682 8031714 14307239 14695481 -1455277 -1599848 9958587 8615904 3024549 3239972 6934038 5375932 X 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. 0 0 12135484 12965854 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. 12135484 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 1 138 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X DOUG BRANDT 7123821515 2959 US HWY 275 HAMBURG IA 51640 DR THOMAS LARGEN PRESIDENT 1.00 0.00 X X 0 0 0 GREG WARDEN VICE PRESIDENT 1.00 0.00 X X 0 0 0 CONNIE SMITH SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 TROY HENDRICKSON DIRECTOR 1.00 0.00 X 0 0 0 LOA TRIVELY DIRECTOR 1.00 0.00 X 0 0 0 DR MICHAEL WELLS DIRECTOR 1.00 0.00 X 0 0 0 ANGIE ETTLEMAN DIRECTOR 1.00 0.50 X 0 0 0 CRISTIN HENDRICKSON CEO 40.00 0.00 X 172257 0 10387 MICHAEL ANDERSON INTERIM CFO THRU 1/23 36.00 0.00 X 34775 0 0 DOUG BRANDT CFO 40.00 0.00 X 0 0 0 TANYA HAYES DIRECTOR OF NURSING 40.00 0.00 X 109860 0 6550 CINDY BRUCE RN 36.00 0.00 X 110066 0 15208 PATTY HAMMONS RN 36.00 0.00 X 114369 0 5211 CRAIG WELLS CIO 36.00 0.00 X 102242 0 6456 MAKAYLA OAKS RN 40.00 0.00 X 103598 0 16888 747167 0 60700 7 0 1 0 MEDICAL CLINIC PC 1219 MAIN STREET HAMBURG IA 51640 ER PHYSICIANS 552516 THE GRAHAM GROUP 421 GRAND AVENUE DES MOINES IA 50309 CONSTRUCTION SERVICES 441581 FUSION MEDICAL STAFFING LLC PO BOX 30131 OMAHA NE 68103 TRAVELING PERSONNEL 344223 GET MED STAFFING INC PO BOX 8667 OMAHA NE 68108 TRAVELING PERSONNEL 321468 ANDERSON & ASSOCIATES ENTERPRISE 1231 200TH STREET SHENANDOAH IA 51601 ANESTHESIA SERVICES 255389 14 13023 60976 73999 NPSR - MEDICARE/MEDICAID 624100 10379698 10379698 NPSR - PRIVATE PAY 624100 2419984 2419984 AMBULANCE SERVICES 624100 77851 77851 CONTRACT SERVICES 624100 57687 57687 30634 30634 12965854 10521 10521 3800 0 3800 3800 3800 CAFETERIA 624200 41459 41459 41459 13095633 12965854 0 55780 X 217419 217419 5226744 4258120 968624 115228 93080 22148 707108 513055 194053 397268 312868 84400 5403 5403 67860 67860 100288 100288 4585997 4030187 555810 13992 198 13794 372757 253400 119357 240900 180900 60000 20892 18671 2221 16774 11243 5531 21689 21689 581103 485801 95302 81798 64907 16891 MEDICAL SUPPLIES 1900297 1900297 DUES & SUBSCRIPTIONS 21964 12757 9207 14695481 12135484 2559997 0 612863 229786 429582 1096562 1175435 1204739 104297 4297 333267 447280 35841 23845 15031576 9585435 6042460 5446141 121512 163254 1103330 0 9958587 8615904 2356500 907719 41675 53427 567204 546638 59170 1732188 3024549 3239972 X 6934038 5375932 6934038 5375932 9958587 8615904 -1599848 41742 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1421 1421 0 PART II-B, LINE 1: COMMUNITY HOSPITAL, INC. PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. 98000 98000 6375212 3068972 3306240 8328525 6328775 1999750 229839 187688 42151 5446141 CAPITAL LEASE OBLIGATIONS 8188 EST THIRD-PARTY PAYOR SETTLEMENTS 1724000 1732188 X 13137375 41742 41742 13095633 0 13095633 14695481 0 14695481 0 14695481 PART X, LINE 2: 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. 1 1 X 1 X 1 X 1 1 0 1 1 69867 0 69867 0.00480 1998292 935372 1062920 0.07230 2068159 935372 1132787 0.07710 4199 0 4199 0.00030 4199 4199 0.00030 2072358 935372 1136986 0.07740 1 231516 0 9053451 9188614 -135163 X 1 1 1 1 COMMUNITY HOSPITAL INC 2959 US HWY 275 HAMBURG IA 51640 WWW.GRAPEHOSPITAL.COM 360067H X X X X GEORGE C GRAPE COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 21 1 0 0 1 X HTTPS://WWW.GRAPEHOSPITAL.COM/GETPAGE.PHP?NAME=NEWS_CHNA2022 X 1 21 1 HTTPS://WWW.GRAPEHOSPITAL.COM/GETPAGE.PHP?NAME=NEWS_CHNA2022 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_POLICY.PDF X HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/FAP_WEB_APPLICATION.PDF X HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/PLAIN_LANGUAGE_SUMMARY.PDF X X X X X 1 X 0 X X X X X 1 X 0 0 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. 1 1 - SOUTHWEST IOWA HOME HEALTH 803 INDIANA STREET SIDNEY IA 51652 HOME HEALTH/PUBLIC HEALTH AGENCY 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 X X 0 0 0 0 0 0 0 0 0 CRISTIN HENDRICKSON CEO 172257 0 0 0 0 0 4058 0 6329 0 182644 0 0 0 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. GRAPE HOSPITAL FOUNDATION PO BOX 9 HAMBURG IA 51640 421335348 FUNDRAISING AND SUPPORT OF GEORGE C. GRAPE COMMUNITY HOSPITAL IA 501(C)(3) LINE 12B, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0