2024-11-13T16:26:22-06:00 2023-12-31 420714325 RSM US LLP 4650 EAST 53RD STREET DAVENPORT IA 528073479 990 2023-01-01 420842204 PELLA REGIONAL HEALTH CENTER PELL 6416283150 404 JEFFERSON STREET PELLA IA 50219 ROBERT KROESE CHIEF EXECUTIVE OFFICER 6416283150 2024-11-12 1 0 JENIFER L CHASE P01306883 5638884000 2024-11-12 2023 2024-10-15 13:58:12Z ROBERT KROESE 404 JEFFERSON STREET PELLA IA 50219 160339215 0 X HTTPS://WWW.PELLAHEALTH.ORG X 1958 IA TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION 11 8 1065 50 56855 0 2206094 1189840 108834419 125839069 4004936 2196268 14607665 19309610 129653114 148534787 8432 8238 0 0 68916367 74536634 0 0 0 58679415 64659667 127604214 139204539 2048900 9330248 158071652 177241268 42177917 43886881 115893735 133354387 X THE MISSION OF PELLA REGIONAL HEALTH CENTER IS TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. 0 0 120317302 8238 144908363 PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) IS A 25-BED ACUTE CARE HOSPITAL LOCATED IN PELLA, IOWA. THE HEALTH CENTER ALSO OPERATES CLINICS IN PELLA, SULLY, KNOXVILLE, PRAIRIE CITY, BUSSEY, AND OTTUMWA, IOWA. ANNUALLY, THE HEALTH CENTER HAS OVER 1,200 ADMISSIONS, OVER 600 LIVE BIRTHS, OVER 8,900 EMERGENCY RELATED VISITS, AND PERFORMS OVER 6,800 SURGERIES.THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE HEALTH CENTER'S CHARITY CARE POLICY WAS APPROXIMATELY $1,090,000 FOR THE YEAR-ENDED DECEMBER 31, 2023. TOTAL DIRECT AND INDIRECT COSTS RELATED TO THESE FORGONE CHARGES WERE $600,000 AT DECEMBER 31, 2023, BASED ON AN AVERAGE RATIO OF COST TO GROSS CHARGES.THE 340B PROGRAM OFFERS ELIGIBLE HEALTH CARE PROVIDERS ACCESS TO LOW-COST MEDICATIONS, WHICH ALLOWS THEM TO EXPAND THE TYPE AND VOLUME OF CARE THEY PROVIDE TO THE MOST VULNERABLE PATIENT POPULATIONS. THE 340B PROGRAM REQUIRES DRUG MANUFACTURERS TO PROVIDE THE OUTPATIENT DRUGS TO ELIGIBLE HEALTH CARE ORGANIZATIONS OR COVERED ENTITIES AT SIGNIFICANTLY REDUCED PRICES. THE HEALTH CENTER IS AN ELIGIBLE HEALTH CARE ORGANIZATION AND IS PARTICIPATING IN THE PROGRAM. THE REVENUE GENERATED FROM THIS PROGRAM WAS APPROX. $7,323,000 AND THE RELATED EXPENSES WERE APPROX $4,924,000 FOR 2023. 120317302 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 73 0 1 1065 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X BRUCE HEIFNER 6416283150 404 JEFFERSON STREET PELLA IA 50219 X DR RICHARD POSTHUMA BOARD MEMBER 40.00 X 434940 0 54852 STEPHEN BARNES DO BOARD MEMBER 40.00 X 479030 0 53148 JIM BRANDL VICE PRESIDENT 0.50 0.20 X X 0 0 0 MARY GLENDENING PRESIDENT 0.50 X X 0 0 0 CHAD HUYSER BOARD MEMBER 0.50 X 0 0 0 LESLIE JOHNSON FORMER BOARD MEMBER 0.50 X 0 0 0 PAUL JONES BOARD MEMBER 0.50 X 0 0 0 MIKE MORGAN FORMER BOARD MEMBER 0.50 X 0 0 0 RANDY STRAVERS BOARD MEMBER 0.50 X 0 0 0 TRAVIS TURNBULL TREASURER 0.50 X X 0 0 0 DR CRAIG WITTENBERG BOARD MEMBER 40.00 X 553254 0 55404 KATHY CASHEN THOMPSON BOARD MEMBER 0.50 X 0 0 0 TRIXANNA WANG BOARD MEMBER 0.50 X 0 0 0 ROBERT KROESE CHIEF EXECUTIVE OFFICER 40.00 2.00 X 394431 0 86273 BRUCE HEIFNER CHIEF FINANCIAL OFFICER 40.00 X 225304 0 37938 LEZLIE MORRIS CHIEF OF CLINIC SERVICES 40.00 X 200757 0 16154 JODY VAN VEEN CHIEF NURSING OFFICER 40.00 X 199250 0 23465 RUSSELL BANDSTRA MD PHYSICIAN 40.00 X 712250 0 35481 KIMBERLY BINA DO PHYSICIAN 40.00 X 519696 0 16675 SETH STREETER DO PHYSICIAN 40.00 X 486208 0 52445 MATT MORGAN DO PHYSICIAN 40.00 X 621641 0 53546 JOHN WELANDER MD PHYSICIAN 40.00 X 678476 0 53130 5505237 0 538511 112 0 1 0 MEDICAL ONCOLOGY AND HEMATOLOGY 1221 PLEASANT STREET SUITE 100 DES MOINES IA 50309 ONCOLOGY SERVICES 872465 MEDICAL INFORMATION TECHNOLOGY INC PO BOX 74569 CHICAGO IL 60696 EHR SYSTEM 497436 DOCS WHO CARE 800 W FRONTIER LANE OLATHE KS 66061 CONTRACT LABOR FOR EMERGENCY DEPT 363531 UROLOGY CENTER OF IOWA 12129 UNIVERSITY AVE CLIVE IA 50325 UROLOGY SERVICES 356735 IOWA PATHOLOGY ASSOC PC 1212 PLEASANT LL3 DES MOINES IA 50309 LAB SERVICES 356203 16 1176397 13443 1189840 PATIENT SERVICE REVENUE 621110 125839069 125839069 125839069 2698796 2698796 195172 11711 183461 183461 183461 11250838 39351 11721006 71711 -470168 -32360 -502528 -502528 OTHER OPERATING REVENUE 900099 14916886 14916886 PHARMACY REVENUE 456110 4209263 4152408 56855 19126149 148534787 144908363 56855 2379729 8238 8238 2814201 2070255 743946 136861 136861 58653664 51666501 6987163 2390383 2006958 383425 6772590 5752091 1020499 3768935 3250805 518130 67159 1113 66046 119362 9100 110262 10535 10535 118994 118994 12988358 11247624 1740734 166671 4748 161923 11878731 10214860 1663871 1628344 366047 1262297 1434425 1369221 65204 228726 217845 10881 430105 347902 82203 686348 686348 6668492 3548925 3119567 829986 435459 394527 MEDICAL SUPPLIES 26821183 26821183 FOOD 383087 2919 380168 DUES AND MEMBERSHIPS 144521 102694 41827 EQUIPMENT PARTS AND REP 17448 17448 37192 32157 5035 139204539 120317302 18887237 0 15262241 13978517 14173155 24250410 1830908 2015716 1851250 1799270 144550848 97535301 48688873 47015547 73752995 86025475 2512230 2156333 158071652 177241268 13537833 17098194 19871185 17882283 2819143 2264981 5949756 6641423 42177917 43886881 X 115886235 133346887 7500 7500 115893735 133354387 158071652 177241268 9330248 8130404 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10535 10535 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 23.2% OF MEMBERSHIP DUES PAID TO THE IOWA HOSPITAL ASSOCIATION, OR $8,043.50, AND 23.2% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $2,491.50. 7500 7500 7500 7500 7500 7500 7500 7500 7500 7500 0.00000 1.00000 0.00000 0 1 0 4288227 4288227 101593935 69776194 31817741 717100 299694 417406 34265349 26374868 7890481 3686237 1084545 2601692 47015547 ESTIMATED CLAIMS PAYABLE 1558353 BOND ISSUANCE COSTS -29869 THIRD PARTY SETTLEMENTS 1533396 DEFERRED COMPENSATION 2213019 OPERATING LEASE LIABILITY 1366524 6641423 X PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SERVE THE PURPOSE OF THE RESTRICTIONS PLACED ON THE FUNDS BY THE RESPECTIVE DONORS. PART X, LINE 2: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) AND PELLA HOSPITAL FOUNDATION (FOUNDATION) ARE ORGANIZED AS IOWA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HEALTH CENTER AND FOUNDATION ARE EACH ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THEY ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE HEALTH CENTER AND FOUNDATION BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HEALTH CENTER AND FOUNDATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. FORMS 990 AND 990-T FILED BY THE HEALTH CENTER AND FOUNDATION ARE GENERALLY SUBJECT TO EXAMINATION BY THE IRS UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. 1 1 X 1 X 1 X 1 1 1 0 0 477638 477638 0.00340 10399802 11817431 0 0.00000 10877440 11817431 477638 0.00340 1251352 1251352 0.00900 65599 16800 48799 0.00040 43548245 24880270 18667975 0.13410 9942 9942 0.00010 44875138 24897070 19978068 0.14360 55752578 36714501 20455706 0.14700 414607 414607 0.00300 414607 414607 0.00300 0 581181 26200861 27064091 -863230 X 1 1 1 1 PELLA REGIONAL HEALTH CENTER 404 JEFFERSON STREET PELLA IA 50219 WWW.PELLAHEALTH.ORG 630165H X X X X PELLA REGIONAL HEALTH CENTER 1 0 0 1 X X X X X X X X X 23 1 0 1 1 X WWW.PELLAHEALTH.ORG/ABOUT-US/COMMUNITY/ X 1 23 1 WWW.PELLAHEALTH.ORG/ABOUT-US/COMMUNITY/ 0 1 X 200.000000000000 200.000000000000 X X X 1 1 X X X 1 X WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X X 1 X 0 0 PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 5: EACH COMMUNITY HAS A WEALTH OF EXPERTISE TO BE TAPPED FOR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DEVELOPMENT. FOR THIS REASON, A TOWN HALL IS THE PERFECT FORUM TO GATHER COMMUNITY INSIGHT AND PROVIDE AN ATMOSPHERE TO OBJECTIVELY BUILD CONSENSUS AND PRIORITIZE COUNTY HEALTH ISSUES.ALL TOWN HALL PRIORITY-SETTING AND SCORING PROCESSES INVOLVE THE INPUT OF KEY STAKEHOLDERS IN ATTENDANCE. INDIVIDUALS AND ORGANIZATIONS ATTENDING THE TOWN HALLS WERE CRITICALLY IMPORTANT TO THE SUCCESS OF THE CHNA.ENTITIES INVITED TO THE TOWN HALL MEETING INCLUDED LOCAL HOSPITALS, PUBLIC HEALTH, MENTAL HEALTH PROVIDERS, SERVICE PROVIDERS, EMPLOYERS, LOCAL RESIDENTS, FAITH-BASED LEADERSHIP, SCHOOL LEADERSHIP, BUSINESS LEADERS, LOCAL GOVERNMENT OFFICIALS, AND THOSE THAT RECEIVE CARE (INCLUDING PERSONS WITH CHRONIC CONDITIONS, UNINSURED, LOW-INCOME, AND MINORITY GROUPS). PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 6B: MARION COUNTY PUBLIC HEALTH DEPARTMENT PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 11: THE 2023 IMPLEMENTATION PLAN DESCRIBES THE FOLLOWING NEEDS THAT WILL BE ADDRESSED IN THE FUTURE:1) MENTAL HEALTH: INCREASE THE PROVIDED AND BREADTH OF SERVICES FOR MENTAL HEALTH NEEDS IN THE COMMUNITIES. ACTIONS: INCREASE PROVIDERS AND ACCESS, ASSESS EMPLOYMENT OPPORTUNITIES FOR PROVIDERS, DISCOVER OPTIONS FOR FUNDING REIMBURSEMENT FOR SHORTAGE OF OR BARRIER FOR SERVICES, IMPROVE COMMUNITY RESPONSES (EXAMPLE: EMT EDUCATION), AND INCREASE ACCESS TO TRANSPORTATION TO AND FROM SERVICES IN OTHER COMMUNITIES.2) SUBSTANCE ABUSE: REDUCE THE CONCERN FOR AND PRESENCE OF SUBSTANCE ABUSE RELATED HEALTH/SAFETY ISSUES. ACTIONS: ASSESS AND CREATE PLAN FOR SUBSTANCE ABUSE PREVENTION AND SUPPORT IN THE COMMUNITIES, PROVIDE DRUGS AND SUBSTANCE USE AND PREVENTION SERVICES/RESPONSE, AND INCREASE ACCESS TO SERVICES.3) WORKFORCE SHORTAGES: ATTRACT TO AND RETAIN WITHIN THE COUNTY EMPLOYEES AND WORKERS IN ALL SECTORS. ACTIONS: COLLABORATING WITH COMMUNITY PARTNERS TO ATTRACT AND RETAIN HEALTHCARE AND OTHER EMPLOYEES TO THE COUNTY, INVESTIGATE HOUSING OPTIONS FOR LOW-INCOME WORKERS AVAILABLE WITHIN THE COMMUNITY, AND INVESTIGATE INCENTIVES FOR ATTRACTING FAMILIES INTO THE COUNTY FOR WORK, EDUCATION, AND RESIDENCE.4) ACCESS TO CHILD CARE SERVICES: COMMUNICATE, CONVENE OPTIONS FOR CHILDCARE ACCESS AND SERVICES IN COMMUNITIES. ACTIONS: COLLABORATE WITH CHILDCARE PROVIDERS TO ADDRESS ACCESS.5) TRANSPORTATION SERVICES: SERVICES FOR THE MEDICALLY NEEDY AND ELDERLY IN THE COMMUNITY. ACTIONS: CONTINUE TO ADDRESS THE NEEDS OF TRANSPORTATION SERVICES FOR EMERGENCY MANAGEMENT AND MEDICAL TREATMENT NEEDS FOR THE COMMUNITY, INCLUDING BUT NOT LIMITED TO THE ELDERLY IN THE COMMUNITIES.6) HEALTH AND HOUSING STABILITY COALITION FOR THE COUNTY: CONTINUE TO WORK ON SERVICES FOR THE ELDERLY IN THE COMMUNITY INCLUDING HOUSING, IN-HOME SUPPORT, STAFFING, DAY/ACUTE SERVICES, AND FUNDING SOURCES. COALITION GROUP TO ADDRESS THE SERVICES AND ACCESS FOR COMMUNITY HEALTH AND HOUSING STABILITY NEEDS. ACTIONS: ASSESSMENT FOR THE NEED OF COMMUNITY COALITION ("ACTION" GROUP), CREATE SCOPE OF WORK AND PURPOSE FOR GROUP THAT WILL ACTIVELY ADDRESS HEALTH AND HOUSING STABILITY NEEDS WITHIN THE COMMUNITIES, AND PLAN AND DEVELOP INIATIVES FOR COMMUNITY "HEALTH" COALITION. PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 20E: IN ADDITION TO THE ACTIONS TAKEN IN PART V, SECTION B, LINE 20A-20D, PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) SENDS INSUFFICIENT PAYMENT LETTERS TO INDIVIDUALS FOR PAYMENTS NOT MEETING THE HOSPITAL'S MINIMUM PAYMENT REQUIREMENTS. THE HEALTH CENTER ALSO SENDS MINIMUM PAYMENT LETTERS THAT OUTLINED ITS MINIMUM PAYMENT REQUIREMENTS. 14 1 - PELLA MEDICAL CLINIC 405 MONROE PELLA IA 50219 PHYSICIAN CLINIC 2 - PELLA REGIONAL PHARMACY 802 WASHINGTON ST PELLA IA 50219 RETAIL PHARMACY 3 - OTTUMWA MEDICAL CLINIC 920 N QUINCY AVE OTTUMWA IA 52501 PHYSICIAN CLINIC 4 - KNOXVILLE MEDICAL CLINIC 1208 N LINCOLN KNOXVILLE IA 50138 PHYSICIAN CLINIC 5 - PELLA REGIONAL PHARMACY 405 JEFFERSON ST PELLA IA 50219 FIRSTFILL PHARMACY 6 - PRAIRIE CITY CLINIC 404 E 2ND STREET PRAIRIE CITY IA 50228 PHYSICIAN CLINIC 7 - PRAIRIE CITY PHARMACY 404 E 2ND STREET PRAIRIE IA 50228 RETAIL PHARMACY 8 - HOSPICE OF PELLA (COMFORT HOUSE) 505 UNION STREET PELLA IA 50219 HOSPICE 9 - OTTUMWA THERAPY AGENCY 301 W SECOND ST SUITE B-1 OTTUMWA IA 52501 PHYSICAL AND OCCUPATIONAL THERAPY 10 - HOME HEALTH 1119 E 2ND STREET PELLA IA 50219 HOME HEALTHCARE 11 - THERAPY - WESTPOORT 2525 WASHINGTON ST PELLA IA 50219 PHYSICAL AND OCCUPATIONAL THERAPY 12 - BUSSEY MEDICAL CLINIC 411 MERRILL STREET BUSSEY IA 50044 PHYSICIAN CLINIC 13 - SULLY CLINIC 704 3RD STREET SULLY IA 50251 PHYSICIAN CLINIC 14 - PRAIRE CITY THERAPY 404 S COMMERCE DR STE 2 PRAIRIE CITY IA 50228 PHYSICAL AND OCCUPATIONAL THERAPY PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS USED TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSE AND REVENUE AMOUNTS RECORDED FROM THE EVENTS IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART I, LINE 7G: THE ORGANIZATION USED THE MEDICARE COST REPORT AS WELL AS INTERNAL FINANCIAL STATEMENTS TO CALCULATE A COST-TO-CHARGE RATIO FOR EACH DEPARTMENT THAT CONSTITUTES A SUBSIDIZED HEALTH SERVICE ACTIVITY. THE FOLLOWING PHYSICIAN CLINIC COSTS WERE INCLUDED IN COMMUNITY BENEFIT EXPENSE: PELLA MEDICAL CLINIC - $34,125,008, SULLY CLINIC - $635,373, OTTUMWA CLINIC - $4,852,555, BUSSEY - $646,497 AND PRAIRIE CITY CLINIC - $2,964,888. PART II, COMMUNITY BUILDING ACTIVITIES: INFECTION CONTROL SERVES AS A COMMUNITY BENEFIT AS IT TRACKS INFECTIONS THROUGHOUT THE WORLD, NATION, AND LOCAL AREA IN AN EFFORT TO REDUCE OR PREVENT INCIDENCE OR LOCAL OCCURRENCE. ALSO, IT HELPS TO PREPARE FOR THE EVENTUALITY OF INFECTION ISSUES WITHIN THE COMMUNITY AND AT OUR FACILITY. PART III, LINE 2: PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.BAD DEBT EXPENSE ON LINE 2 IS REPORTED AT CHARGES AS PRESENTED ON THE FINANCIAL STATEMENTS. PART III, LINE 3: NOT APPLICABLE PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PELLA REGIONAL HEALTH CENTER PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THAT THEY WILL NOT RECOVER ALL OF THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE. THE ORGANIZATION REPORTED ONLY THOSE ALLOWABLE COSTS AND MEDICARE REIMBURSEMENTS REPORTED IN THE MEDICARE COST REPORT FOR THE YEAR.TOTAL REVENUE RECEIVED FROM MEDICARE (INCLUDING DSH AND IME) IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT (INCLUDING LSA). BOTH THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: PELLA REGIONAL HEALTH CENTER'S COLLECTION POLICY HAS PROVISIONS FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE OR CHARITY CARE AND FOR PATIENTS IN THE PROCESS OF APPLYING FOR ASSISTANCE. PELLA REGIONAL HEALTH CENTER DOES NOT PURSUE COLLECTION EFFORTS WHILE A PATIENT IS IN THE PROCESS OF APPLYING FOR ANY TYPE OF ASSISTANCE OR FOR ANY PORTION OF A PATIENT'S BILL CONSIDERED CHARITY CARE. AFTER ASSISTANCE IS DETERMINED, ANY PERSONAL PORTION DUE WOULD FOLLOW THE SAME COLLECTION PROCEDURES AS OTHER PATIENTS. IF A PAYMENT PLAN IS ESTABLISHED AND THE PATIENT DEFAULTS, THEIR CHARITY CARE STATUS IS REVOKED AND THE REMAINING BALANCE IS SENT TO COLLECTIONS. PART VI, LINE 2: PELLA REGIONAL HEALTH CENTER PARTICIPATED IN A COMMUNITY ENGAGEMENT PROJECT IN 2023. THIS PROJECT INCLUDED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), KEY INFORMANT INTERVIEWS, AND SECONDARY DATA ANALYSIS ADMINISTERED BY SARAH PAVELKA OF PALVELKA'S POINT CONSULTING FROM CEDAR FALLS, IOWA. CREATING HEALTHY COMMUNITIES REQUIRES A HIGH LEVEL OF MUTUAL UNDERSTANDING AND COLLABORATION AMONG COMMUNITY LEADERS. THE DEVELOPMENT OF THIS ASSESSMENT BRINGS TOGETHER COMMUNITY HEALTH LEADERS AND PROVIDERS, ALONG WITH LOCAL RESIDENTS, TO RESEARCH AND PRIORITIZE COUNTY HEALTH NEEDS AND DOCUMENT COMMUNITY HEALTH DELIVERY SUCCESSES. THIS HEALTH ASSESSMENT WILL SERVE AS THE FOUNDATION FOR COMMUNITY HEALTH IMPROVEMENT EFFORTS FOR THE NEXT THREE YEARS. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) REQUIRES NOT-FOR-PROFIT HOSPITALS TO CONDUCT A CHNA EVERY THREE YEARS AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED BY THE CHNA. THIS ASSESSMENT WAS COORDINATED AND PRODUCED BY PALVELKA'S POINT CONSULTING (CEDAR FALLS, IOWA) UNDER THE DIRECTION OF SARAH PAVELKA. A CHNA PROVIDES BENEFITS TO LOCAL HEALTH SERVICE ORGANIZATIONS, THE HOSPITAL, THE PUBLIC HEALTH DEPARTMENT, AS WELL AS OTHER COMMUNITY PROVIDERS AND STAKEHOLDERS IN THE FOLLOWING WAYS: 1) INCREASES KNOWLEDGE OF COMMUNITY HEALTH NEEDS AND RESOURCES; 2) CREATES A COMMON UNDERSTANDING OF THE PRIORITIES OF THE COMMUNITY'S HEALTH NEEDS; 3) ENHANCES RELATIONSHIPS AND MUTUAL UNDERSTANDING BETWEEN AND AMONG STAKEHOLDERS; 4) PROVIDES A BASIS UPON WHICH COMMUNITY STAKEHOLDERS CAN MAKE DECISIONS ABOUT HOW THEY CAN CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY; 5) PROVIDES RATIONALE FOR CURRENT AND POTENTIAL FUNDERS TO SUPPORT EFFORTS TO IMPROVE THE HEALTH OF THE COMMUNITY; 6) CREATES OPPORTUNITIES FOR COLLABORATION IN DELIVERY OF SERVICES TO THE COMMUNITY; AND 7) PROVIDES GUIDANCE TO THE HOSPITAL AND LOCAL HEALTH DEPARTMENT FOR HOW THEY CAN ALIGN THEIR SERVICES AND COMMUNITY BENEFIT PROGRAMS TO BEST MEET NEEDS.IN MARCH 2023, PELLA REGIONAL BEGAN ITS FOURTH COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN SUMMER THROUGH FALL 2023, PELLA REGIONAL HEALTH CENTER SPONSORED/CONDUCTED PRIMARY RESEARCH (SURVEY) TO ALL RESIDENTS RESIDING OR RECEIVING SERVICES IN THEIR PRIMARY SERVICE AREA, WITH 420 INDIVIDUAL REPLIES. IN ADDITION, A FOCUS GROUP WITH 15 COMMUNITY LEADERS INCLUDING SENIOR CITIZENS, CONSUMERS, HEALTH CARE PROVIDERS/CLINICIANS, EDUCATORS, BUSINESS OWNERS, CLERGY, AND LAW ENFORCEMENT OFFERED QUALITATIVE INFORMATION TO SUPPLEMENT THE SURVEY.THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED COMMUNITY HEALTH STRENGTHS AND WEAKNESSES. OUR FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT AND HEALTH IMPLEMENTATION PLAN WAS POSTED TO OUR WEBSITE IN DECEMBER 2023. PART VI, LINE 3: PELLA REGIONAL HEALTH CENTER'S PATIENT ADVOCATES ARE AVAILABLE TO WORK WITH PATIENTS PRIOR TO NON-EMERGENCY SERVICES TO REVIEW SPECIFIC INSURANCE SITUATIONS AND THE DOCTOR'S RECOMMENDED SERVICE FOR THE PATIENT. THE ADVOCATE ESTIMATES EACH PATIENT'S ACTUAL COST AND WORKS WITH THEM TO FIND THE BEST METHOD OF PAYMENT OR HELPS DETERMINE ELIGIBILITY FOR CHARITY CARE FROM PELLA REGIONAL HEALTH CENTER OR THROUGH GOVERNMENT PROGRAMS. PART VI, LINE 4: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) IS A CRITICAL ACCESS, NOT-FOR-PROFIT PROVIDER OF HEALTHCARE THAT IS ACCREDITED BY THE JOINT COMMISSION. IT EARNED A 4-STAR RATING FOR OVERALL HOSPITAL QUALITY FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN 2022, IT WAS RECOGNIZED BY WELLMARK BLUE CROSS AND BLUE SHIELD AS A BLUE DISTINCTION CENTER FOR KNEE AND HIP DESIGNATIONS. THE HEALTH CENTER WAS ALSO AWARDED THE CLEAN FACILITY CERTIFICATE FROM THE ASSOCIATION FOR THE HEALTH CARE ENVIRONMENT (AHE) FOR ITS COMMITMENT TO INFECTION PREVENTION STRATEGIES AND PREPAREDNESS FOR BIOLOGICAL EVENTS. PELLA REGIONAL HEALTH CENTER'S MISSION IS TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. THE HEALTH CENTER OFFERS A LARGE ARRAY OF INPATIENT AND OUTPATIENT SERVICES. A LIST OF SERVICES CAN BE FOUND AT PELLAHEALTH.ORG. THE HEALTH CENTER PRIMARILY SERVES MARION, MAHASKA, JASPER AND WAPELLO COUNTIES. PELLA IS A THRIVING COMMUNITY APPROXIMATELY 40 MILES SOUTHEAST OF DES MOINES, IOWA AND IS HOME TO THE HEALTH CENTER AS WELL AS THE CORPORATE HEADQUARTERS FOR PELLA CORP, A LARGE MANUFACTURER OF WINDOWS AND DOORS AND VERMEER CORPORATION, A MANUFACTURER OF INDUSTRIAL AND AGRICULTURAL EQUIPMENT. THE POPULATION IN PELLA FOR 2023 WAS 10,820. THE MEDIAN HOUSEHOLD INCOME WAS $86,025 AND THERE WERE 4.2% OF PEOPLE LIVING IN POVERTY. UNDER HEALTH, PERSONS WITH A DISABILITY UNDER 65 YEARS WAS 5.2% AND PERSONS WITHOUT HEALTH INSURANCE UNDER AGE 65 WAS 4.5%. THIS INFORMATION WAS OBTAINED FROM HTTPS://WWW.CENSUS.GOV/QUICKFACTS/PELLACITYIOWA PART VI, LINE 5: THE BOARD MEMBERS ALL RESIDE IN THE SERVICE AREA. A MAJORITY OF THE BOARD MEMBERS ARE NOT EMPLOYED BY PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) AND NONE ARE FAMILY MEMBERS. PHYSICIANS ARE ENCOURAGED TO PARTICIPATE ON THE BOARD AS THEY HAVE DIRECT CONTACT WITH OUR PATIENTS AND KNOW FIRSTHAND THE NEEDS OF THE COMMUNITY. PELLA REGIONAL HEALTH CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY EXCEPT FOR PHYSICIANS WITH PENDING QUALITY ISSUES. THE HEALTH CENTER APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH THROUGH THE NORMAL BUDGET AND CAPITAL BUDGET PROCESSES. ALSO, PELLA REGIONAL HEALTH CENTER PROMOTES THE HEALTH OF THE COMMUNITY BY OPERATING AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY, PARTICIPATING IN GOVERNMENT-SPONSORED HEALTH PROGRAMS AND VOLUNTEERING IN THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X 0 1 0 0 0 0 0 0 0 RUSSELL BANDSTRA MD PHYSICIAN 712250 0 0 0 0 0 12889 0 22592 0 747731 0 0 0 JOHN WELANDER MD PHYSICIAN 678476 0 0 0 0 0 19800 0 33330 0 731606 0 0 0 MATT MORGAN DO PHYSICIAN 621641 0 0 0 0 0 19800 0 33746 0 675187 0 0 0 DR CRAIG WITTENBERG BOARD MEMBER 553254 0 0 0 0 0 19800 0 35604 0 608658 0 0 0 SETH STREETER DO PHYSICIAN 486208 0 0 0 0 0 19800 0 32645 0 538653 0 0 0 KIMBERLY BINA DO PHYSICIAN 519696 0 0 0 0 0 9046 0 7629 0 536371 0 0 0 STEPHEN BARNES DO BOARD MEMBER 479030 0 0 0 0 0 19800 0 33348 0 532178 0 0 0 DR RICHARD POSTHUMA BOARD MEMBER 434940 0 0 0 0 0 19800 0 35052 0 489792 0 0 0 ROBERT KROESE CHIEF EXECUTIVE OFFICER 394431 0 0 0 0 0 59800 0 26473 0 480704 0 0 0 BRUCE HEIFNER CHIEF FINANCIAL OFFICER 225304 0 0 0 0 0 14001 0 23937 0 263242 0 0 0 JODY VAN VEEN CHIEF NURSING OFFICER 199250 0 0 0 0 0 12048 0 11417 0 222715 0 0 0 LEZLIE MORRIS CHIEF OF CLINIC SERVICES 200757 0 0 0 0 0 12048 0 4106 0 216911 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2023 SPONSORED BY PELLA REGIONAL HEALTH CENTER (HEALTH CENTER): ROBERT KROESE. IN JANUARY 2023, THE CURRENT YEAR CONTRIBUTION OF $40,000 WAS MADE BY THE HEALTH CENTER ON BEHALF OF THE INDIVIDUAL TO THE PLAN AND IS INCLUDED IN REPORTABLE COMPENSATION IN PART VII AND SCHEDULE J. A HEALTH FACILITIES REVENUE REFUNDING BOND 521699886 NONEAVAIL 2017-06-08 41734118 REFUND BONDS ISSUED 09/28/06 0 1 0 A 41734118 3836530 703275 44867373 2009 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 PCBB 15.000000000000 0 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: HEALTH FACILITIES REVENUE REFUNDING BOND DATE THE REBATE COMPUTATION WAS PERFORMED: 10/03/2017 JAMIE STEENHOEK ARNP SEE BELOW IN PART V 136861 JAMIE STEENHOEK RECEIVES COMPENSATION AS AN ADVANCED PRACTICE PROVIDER. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - JAMIE STEENHOEK, ARNPJAMIE STEENHOAK, ARNP IS THE SISTER OF JODY VAN VEEN, KEY EMPLOYEE OF PELLA REGIONAL HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT, VICE PRESIDENT, SECRETARY, AND TREASURER. THE COMMITTEE ACTS FOR THE BOARD OF TRUSTEES AND DIRECTS AND CONTROLS THE AFFAIRS OF THE CORPORATION DURING THE INTERIM BETWEEN BOARD MEETINGS BUT IS SUBJECT TO THE SUPERVISION OF THE BOARD AND PROVIDED ANY ACTION TAKEN DOES NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD. THE EXECUTIVE COMMITTEE KEEPS AN ACCURATE AND COMPLETE RECORD OF ALL OF ITS PROCEEDINGS AND THE RECORD MUST BE SUBMITTED FOR CONFIRMATION TO THE BOARD OF TRUSTEES AT THE BOARD'S NEXT MEETING AND MADE A PART OF THE MINUTES. THE EXECUTIVE COMMITTEE HAS THE RIGHT TO APPROVE OR REJECT THE CEO'S RECOMMENDATIONS ON EMPLOYMENT OF PERSONNEL, PLAN OF INTERNAL ORGANIZATION OF THE CORPORATION, AND RULES AND REGULATIONS DEFINING DUTIES, HOURS AND INTERDEPARTMENTAL RELATIONSHIPS OF PERSONNEL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS DISTRIBUTED TO THE BOARD'S FINANCE COMMITTEE AND PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS ALSO REVIEWED BY THE CEO AND CFO. FORM 990, PART VI, SECTION B, LINE 12C PELLA REGIONAL HEALTH CENTER HAS CONFLICT OF INTEREST POLICIES COMPLETED EACH YEAR BY ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES THUS MONITORING ANY POTENTIAL CONFLICTS OF INTEREST. THE CEO AND CFO REVIEW THE COMPLETED STATEMENTS. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE CEO FOLLOWS UP. ANY ACTUAL OR POTENTIAL DUALITY OR CONFLICT OF INTEREST, INCLUDING BUT NOT LIMITED TO, OWNERSHIP OR CONTROL OF ANY ENTITY THAT CONTRACTS WITH PELLA REGIONAL HEALTH CENTER FOR ANY PRODUCTS OR SERVICES MUST BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD IN THE MINUTES WHEN THE SUBJECT OF SUCH INTEREST BECOMES A MATTER OF BOARD ACTION. WHEN CONFLICT ARISES, THE MEMBER IS ASKED TO BE EXCUSED FROM THE MEETING. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY ADJUSTMENT RECOMMENDATIONS BASED ON AN ANNUAL EVALUATION AND INPUT FROM HUMAN RESOURCES. THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS SET BY THE CEO WITH SALARY ADJUSTMENTS BASED ON ANNUAL EVALUATIONS AND DIRECTION FROM HUMAN RESOURCES. COMPARABILITY DATA IS USED TO DETERMINE COMPENSATION FOR TOP MANAGEMENT OFFICIALS, OFFICERS, AND EMPLOYEES IN NON-MANAGEMENT POSITIONS. SEVERAL SURVEYS ARE USED FOR COMPARABILITY INCLUDING THE IOWA HOSPITAL ASSOCIATION, IOWA HEALTH SYSTEM, IOWA INTEGRATED HEALTHCARE STRATEGIES, COMPDATA SURVEYS, IOWA ASSOCIATION OF HOMES AND SERVICES FOR THE AGING, IOWA MEDICAL GROUP MANAGEMENT ASSOCIATION, AND SOUTHEAST IOWA COMP CLUB. THE ORGANIZATION DOCUMENTS AND PROVIDES SUBSTANTIATION FOR ITS COMPENSATION PROCESS FOR ALL EMPLOYEES. THIS PROCESS WAS LAST UNDERTAKEN IN 2023. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AS THEY ARE ATTACHED TO THE FORM 990. FORM 990, PART VII, SECTION A: THE PHYSICIANS/DIRECTORS ARE COMPENSATED FOR THEIR SERVICES AS PHYSICIANS. THEIR TIME SERVED AS BOARD MEMBERS IS ON A VOLUNTEER BASIS, AND NO COMPENSATION IS RECEIVED FOR THOSE SERVICES. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM PRIOR TAX YEARS. PELLA HOSPITAL FOUNDATION 404 JEFFERSON STREET PELLA IA 50219 421430122 SOLICIT FUNDS AND SUPPORT PELLA REGIONAL HEALTH CENTER IA 501(C)(3) LINE 7 PELLA REGIONAL HEALTH CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 PELLA HOSPITAL FOUNDATION C 1176397 FAIR MARKET VALUE