2024-10-02T15:16:49-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2023-01-01 430926316 INDEPENDENCE HEALTH SYSTEM INC INDE 5735476546 800 SOUTH KINGSHIGHWAY PERRYVILLE MO 63775 DANA KORANDO ADMINISTRATOR/CEO 5735476546 2024-10-02 1 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2024-10-02 2023 2024-10-15 13:58:12Z DANA KORANDO 800 SOUTH KINGSHIGHWAY PERRYVILLE MO 63775 12415747 0 X HTTP://WWW.INDEPENDENCEHEALTHSYSTEM.ORG X 1969 MO INDEPENDENCE HEALTH SYSTEM, INC. IS DEDICATED TO DELIVERING EFFECTIVE, EFFICIENT, AND RESPECTFUL CARE TO OUR RESIDENTS WITH INTEGRITY AND ACCOUNTABILITY USING BOTH PROVEN AND INNOVATIVE METHODS. 9 9 193 25 0 0 1400 1146594 7922146 7830163 702466 268007 52878 35429 8678890 9280193 2548 1500 0 0 4580564 5048907 0 0 0 4450446 4490743 9033558 9541150 -354668 -260957 16593629 17455335 851029 874552 15742600 16580783 X TO PROVIDE THE ELDERLY WITH RETIREMENT AND HEALTH CARE SERVICES WHICH ARE DEDICATED TO EXCELLENCE, IN AN ENVIRONMENT WHICH PROMOTES LIVING WITH DIGINITY, SECURITY AND INDEPENDENCE. 0 1 8470252 1500 7847423 PROVIDED LONG TERM CARE FOR THE ELDERLY AT VARIOUS STAGES: SKILLED NURSING FACILITY, 133 LICENSED BEDS; RESIDENTIAL CARE, 95 LICENSED BEDS; INDEPENDENT LIVING, 8 LIVING UNITS CONSISTING OF COTTAGES AND DUPLEXES. ACCEPT MEDICARE, MEDICAID, AND PRIVATE PAY WHERE APPLICABLE.WE PROVIDE CARE FOR OUR RESIDENTS FROM HEAD TO TOE. WE WANT OUR RESIDENTS TO LIVE THEIR BEST LIFE WHILE LIVING HERE. WE TAKE PRIDE IN OUR PROVIDERS THAT COME INTO OUR FACILITY TO PROVIDE CARE SO THE RESIDENTS DON'T HAVE TO LEAVE THE FACILITY.WE ALSO PROVIDE ADDITIONAL CARE WITH THERAPY, FACIALS, MANICURES, PEDICURES, AND BEAUTY SHOP TREATMENT. 0 0 -17260 THE SYSTEM ACCEPTS MEDICAID RESIDENTS WITH THE UNDERSTANDING THAT A PORTION OF THESE REVENUES WILL BE UNCOLLECTIBLE. THE CONTRACTUAL ADJUSTMENT IS RECORDED IN NET RESIDENT SERVICE REVENUE. THE SYSTEM CONSIDERS THIS CONTRACTUAL ADJUSTMENT TO BE CHARITABLE CARE. 8470252 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 39 0 193 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DANA KORANDO 5735476546 800 S KINGSHIGHWAY PERRYVILLE MO 63775 JENNIFER STREILER BOARD MEMBER 1.00 X 0 0 0 TERRI GREEN BOARD MEMBER 1.00 X 0 0 0 JUSTIN KOENIG BOARD MEMBER 1.00 X 0 0 0 VIDA YAMNITZ BOARD MEMBER 1.00 X 0 0 0 DONALD PALISCH BOARD MEMBER 1.00 X 0 0 0 FRED EGGERS BOARD MEMBER 1.00 X 0 0 0 BRIAN DREYER PRESIDENT 2.00 X X 0 0 0 JUDITH ERNST SECRETARY/TREASURER 2.00 X X 0 0 0 PATTY WICHERN VICE PRESIDENT 2.00 X X 0 0 0 CASEY ELLIS ADMINISTRATOR 40.00 X 38684 0 3888 DANA KORANDO ADMINISTRATOR/CEO 40.00 X 116129 0 9405 RHONDA PFISTER CFO 40.00 X 92205 0 16444 247018 0 29737 1 0 0 0 FUSION MEDICAL STAFFING LLC PO BOX 30131 OMAHA NE 681031231 NURSING STAFF 1266325 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 554850737 NURSING STAFF 323132 2 1146594 1146594 NURSING REVENUE 623000 7822152 7822152 MEDICARE LEVEL PAYMENTS 623000 8011 8011 7830163 322119 322119 2470817 610625 2855403 280151 -384586 330474 -54112 -54112 277 0 277 277 MISCELLANEOUS 623000 19908 19908 BEAUTY SHOP 623000 14280 14280 EMPLOYEE & GUEST MEALS 623000 964 964 35152 9280193 7830163 0 303436 X 500 500 1000 1000 276755 276755 3785649 3090835 694814 68436 66482 1954 435543 423106 12437 482524 468746 13778 7 7 263312 255793 7519 2029026 2021221 7805 451 438 13 172978 172017 961 19744 19180 564 392562 381353 11209 7242 5240 2002 2204 2204 300100 291531 8569 191785 186309 5476 NFRA AND NFAC FEES 437471 424979 12492 FOOD SUPPLIES 409701 398002 11699 MEDICAL SUPPLIES 221973 221973 BAD DEBT 19527 19527 22660 22013 647 9541150 8470252 1070898 0 154896 41079 857357 149691 443507 1505747 79080 93076 103663 171766 13669154 10918620 3252883 2750534 11702243 12727297 0 16145 16593629 17455335 829185 835819 21844 22587 0 16146 851029 874552 X 15742600 16580783 15742600 16580783 16593629 17455335 -260957 1099140 0 X X 0 1 X 1 0 X 10515 1400 1146594 1158509 9496119 9890555 7688488 7922146 7830163 42827471 10712 15244 25956 9506634 9890555 7688488 7934258 8992001 44011936 0 0 0 44011936 1431 2366 4772 226283 322119 556971 1431 2366 4772 226283 322119 556971 42166 19908 62074 9508065 9892921 7693260 8202707 9334028 44630981 0.98610 0.99340 0.01250 0.00570 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2022 AMOUNT: $ 42,166. 2023 AMOUNT: $ 19,908. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 44200 44200 12381954 9974640 2407314 1243000 943980 299020 2750534 LEASE LIABILITY 16146 16146 X 10379333 1099140 1099140 9280193 0 9280193 9541150 0 9541150 0 9541150 PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS ON BEHALF OF RESIDENTS. PART X, LINE 2: THE SYSTEM'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE SYSTEM IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE SYSTEM IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAX EXCEPT FOR THOSE THAT ARE ALREADY REPORTED ANNUALLY. FORM 990, PART III, LINE 3 WE CLOSED INDEPENDENCE SQUARE WHICH WAS A RESIDENTIAL CARE FACILITY ACROSS TOWN. IT HAD A 20-BED LICENSURE AND FAILED TO GAIN ADMISSIONS AND STAFF SINCE COVID. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE PRESIDENT, VICE PRESIDENT AND SECRETARY/TREASURER. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO: A.) APPROVE THE DISSOLUTION OR MERGER OF THE CORPORATION, OR THE SALE, PLEDGE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; B.) APPOINT OR REMOVE DIRECTORS OR FILL VACANCIES ON THE BOARD OR ON COMMITTEES OF THE BOARD; C.) ADOPT, AMEND OR REPEAL THESE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION; D.) AUTHORIZE DISTRIBUTIONS TO DIRECTORS, OFFICERS, EMPLOYEES OR AGENTS OF THE CORPORATION EXCEPT FOR VALUE AND IN ACCORDANCE WITH THE PROVISIONS OF THE MISSOURI NONPROFIT ACT. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. THE ADMINISTRATOR SIGNS AND A COPY IS PRESENTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C A LETTER AND QUESTIONNAIRE CONCERNING THE POSSIBILITY OF CONFLICTS OF INTEREST IS SENT TO EACH MEMBER OF THE BOARD OF DIRECTORS, THE CEO, AND THE CFO. A LETTER PERTAINING TO CONFLICTS OF INTEREST IS SIGNED BY EACH DEPARTMENT HEAD, RESPONSES ARE REVIEWED BY THE HR DIRECTOR, CFO, AND CEO, DEPENDING ON WHETHER IT IS A BOARD OF DIRECTOR MEMBER OR DEPARTMENT HEAD. BOARD OF DIRECTOR MEMBERS WOULD ABSTAIN FROM ANY VOTE WHERE A POSSIBILE CONFLICT OF INTEREST MIGHT ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD DETERMINES THE CEO AND ADMINISTRATOR'S SALARY. THEY PERFORM AN ANNUAL EVALUATION AND BASE ANY INCREASE ON THEIR PERFORMANCE REVIEW. HR PROVIDES THE BOARD WITH COMPARABLE WAGES FROM LOCAL CEOS AND ADMINISTRATORS. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES AND WAS LAST PERFORMED IN 2024. THE CFO, ADMINISTRATOR, AND HR DIRECTOR REVIEW COMPENSATION FOR THEIR OFFICERS AND KEY EMPLOYEES. ANY CHANGES ARE DOCUMENTED AND BROUGHT TO THE BOARD FOR APPROVAL. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2024. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G STAFFING AGENCY: PROGRAM SERVICE EXPENSES 1,399,686. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,399,686. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 120,754. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,754. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 118,705. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 118,705. SPEECH THERAPY: PROGRAM SERVICE EXPENSES 56,358. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,358. OTHER CONTRACTED FEES: PROGRAM SERVICE EXPENSES 60,162. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 60,162. PURHASED SERVICES: PROGRAM SERVICE EXPENSES 107,882. MANAGEMENT AND GENERAL EXPENSES 3,171. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 111,053. PAYROLL SERVICE FEES: PROGRAM SERVICE EXPENSES 73,897. MANAGEMENT AND GENERAL EXPENSES 2,172. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,069. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 83,777. MANAGEMENT AND GENERAL EXPENSES 2,462. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,239. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.