2025-05-14T12:50:09-05:00 2024-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-07-01 420859940 BURGESS HEALTH CENTER BURG 7124232311 1600 DIAMOND STREET ONAWA IA 51040 LYNN WOLD PRESIDENT/CEO 7124232311 2025-05-14 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-05-14 2023 2025-03-06 01:10:19Z LYNN WOLD 1600 DIAMOND STREET ONAWA IA 51040 73741611 0 X WWW.BURGESSHC.ORG X 1959 IA TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY 10 9 335 10 2199677 0 1976616 1426773 30801308 36995382 878770 4273566 255371 370638 33912065 43066359 0 0 0 0 20177252 19749454 0 0 0 15481513 16556959 35658765 36306413 -1746700 6759946 63607419 66207546 24627480 23037952 38979939 43169594 X BURGESS HEALTH CENTER IS COMMITTED TO IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES IT SERVES BY PROVIDING EXCELLENT HEALTHCARE AND EXCEPTIONAL PATIENT EXPERIENCES. 0 0 28295226 31146014 BURGESS HEALTH CENTER INCLUDES A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. OUR PHYSICIANS AND STAFF ARE COMMITTED TO PROVIDING PATIENTS WITH COMPASSIONATE, KNOWLEDGEABLE AND TRUSTWORTHY CARE. WE PROVIDE THE FOLLOWING SERVICES: CANCER CARE AND INFUSION, CARDIAC REHABILITATION, DIABETES CENTER, EMERGENCY SERVICES, HOME HEALTH, HOSPICE, PRIVATE DUTY AND LIFE ASSIST CARE, ON-SITE LABORATORY, MENTAL HEALTH, SURGERY, FAMILY BEGINNINGS, ORTHOPEDICS, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, PULMONARY REHAB, RADIOLOGY, SCREENINGS, AND VARIOUS OUTPATIENT SPECIALTY CLINICS. 2505568 2758007 BURGESS HEALTH CENTER INCLUDES TWO RURAL HEALTH CLINICS IN A FOUR COUNTY SERVICE AREA. CLINICS ARE LOCATED IN SLOAN AND MAPLETON, IOWA; WHICH ARE STAFFED BY DEDICATED PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS TO PROVIDE A COMPLETE SPECTRUM OF HEALTHCARE SERVICES FOR THE WHOLE FAMILY. 1000983 1101834 BURGESS HEALTH CENTER INCLUDES HOME HEALTH SERVICES. STAFF ARE DEDICATED TO ADD COMFORT TO PATIENTS' RECOVERY, EASE THE IMPACT ON FRIENDS AND FAMILY, AND HELP PATIENTS' TRANSITION TO LIFESTYLE ADJUSTMENTS NECESSARY FOR THE ILLNESS. SERVICES INCLUDE I.V. MEDICATIONS, NOURISHMENT, WOUND CARE, HYGIENE AND DAILY LIVING ASSISTANCE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES, SUPPORT THROUGH SOCIAL WORKERS, SKILLED NURSING VISITS, AND HOMEMAKER SERVICES.BURGESS HOSPICE STAFF PROVIDE PROFESSIONAL GRIEF COUNSELORS AND SKILLED VOLUNTEERS TO PATIENTS (TYPICALLY WITH A LIFE-LIMITING ILLNESS WITH A SHORT-TERM SURVIVAL ESTIMATE). ENSURING THE PATIENT IS AS COMFORTABLE AND PAIN-FREE AS POSSIBLE. THEY, ALSO, HELP FAMILY MEMBERS COPE WITH END OF LIFE ISSUES. 31801777 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 46 0 1 335 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X LYNN WOLD 7124239206 1600 DIAMOND STREET ONAWA IA 51040 JOHN GARRED JR MD BOARD MEMBER THRU 05/2024 40.00 X 264315 0 39829 PAUL DUDLEY MD BOARD MEMBER 2.00 X 24140 0 0 KEITH SCHRUNK OD CHAIRMAN 2.00 X X 0 0 0 MARI MILLER VICE CHAIRMAN 2.00 X X 0 0 0 AMY MAULE SECRETARY/TREASURER 2.00 X X 0 0 0 SHEILA DUARTE DDS BOARD MEMBER 2.00 X 0 0 0 TERRY MURRELL BOARD MEMBER 2.00 X 0 0 0 MATTHEW MINNIHAN BOARD MEMBER 2.00 X 0 0 0 ANDY TIREVOLD BOARD MEMBER 2.00 X 0 0 0 BEAU HUPKE BOARD MEMBER 2.00 X 0 0 0 JEFFREY PRATT BOARD MEMBER 2.00 X 0 0 0 MARY BLACK BOARD MEMBER THRU 11/2024 2.00 X 0 0 0 CARL BEHNE CEO THRU 3/2024 39.00 1.00 X 143613 0 15540 JOHN WILKER VICE PRESIDENT OF FINANCE THRU 09/2023 39.00 1.00 X 156821 0 631 LYNN WOLD CEO 39.00 1.00 X 74512 0 16859 JAMES GOBELL VICE PRESIDENT OF FINANCE 39.00 1.00 X 32181 0 1271 TERESA BUTLER VP OF CLINICAL SERVICES/IN 40.00 X 174167 0 17924 WASEEM ALOUNK MD PHYSICIAN 40.00 X 478079 0 55649 RACHEL KNUDSON DO GENERAL SURGERY SPECIALIST 40.00 X 441204 0 48871 PETER DAHER MD PHYSICIAN 40.00 X 381646 0 46610 MONTY MCKINVEN CRNA 40.00 X 266827 0 46594 LYNN CHARRLIN MD PHYSICIAN 40.00 X 252925 0 27797 2690430 0 317575 25 0 1 0 GRAHAM CONSTRUCTION CO 421 GRAND AVENUE DES MOINES IA 50309 CONTRACTOR FOR BUILDING 564763 GRAPETREE MEDICAL STAFFING INC 2501 BOJI BEND DRIVE MILFORD IA 51351 STAFFING 467870 FAMILY MEDICINE CLINIC PC 1614 DIAMOND STREET PLACE ONAWA IA 51040 ER PHYSICIAN COVERAGE 415407 CNOS PC 575 SIOUX POINT RD DAKOTA DUNES SD 57049 PHYSICIAN SERVICES 287990 RODNEY J DEAN MD PC 3549 SOUTHERN HILLS DRIVE SIOUX CITY IA 51102 PHYSICIAN SERVICES 141980 9 558604 696388 171781 1426773 NET PATIENT SERVICE REVENUE 624100 34656740 34656740 RETAIL PHARMACY 456110 2199677 2199677 138965 138965 36995382 1015626 1015626 283117 65091 218026 218026 143635 74391 33856101 12000 30610161 0 3245940 12000 3257940 3257940 CAFETERIA / DIETARY 722514 86097 86097 REBATES / DISCOUNTS 900099 66515 66515 152612 43066359 35005855 2199677 4434054 961804 222315 739489 149446 149446 15077871 13856334 1221537 311340 271397 39943 2231613 2036410 195203 1017380 897390 119990 93867 93867 107901 107901 3492176 2093315 1398861 52050 410 51640 2102793 1882881 219912 9535 9535 436512 402608 33904 104433 86740 17693 845296 805130 40166 2093145 1996198 96947 265908 253412 12496 MEDICAL SUPPLIES 4191244 4191244 RETAIL PHARMACY EXPENSE 2389121 2389121 FOOD 152210 152210 LICENSES & TAXES 106195 43723 62472 114573 61958 52615 36306413 31801777 4504636 0 297454 3454225 8050493 20415500 3525420 6139440 48656 141577 1234398 952097 551592 499730 57635363 29354928 25536329 28280435 22264283 4160705 2098794 2163837 63607419 66207546 4736593 2813836 661492 0 18349542 19321818 879853 902298 24627480 23037952 X 38979939 43169594 38979939 43169594 63607419 66207546 6759946 -2570291 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 5340 5340 0 PART II-B, LINE 1: BURGESS HEALTH CENTER PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. 85000 85000 20391731 16170675 4221056 14719222 12555248 2163974 22439410 629005 21810405 28280435 DEFERRED COMPENSATION 277215 RIGHT OF USE LEASE LIABILITY 107582 RELATED PARTY PAYABLE 517501 902298 X PART X, LINE 2: THE HEALTH CENTER AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2024 AND 2023, THE HEALTH CENTER AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 1 0 1 1 161125 161125 0.00440 3895489 3895489 4056614 3895489 161125 0.00440 92828 92828 0.00260 2325236 1844807 480429 0.01320 2418064 1844807 573257 0.01580 6474678 5740296 734382 0.02020 1 884961 265488 9961518 10170491 -208973 X 1 1 1 1 BURGESS HEALTH CENTER 1600 DIAMOND STREET ONAWA IA 61040 WWW.BURGESSHC.ORG 670082H X X X X BURGESS HEALTH CENTER 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X WWW.BURGESSHC.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 21 1 WWW.BURGESSHC.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X 1 X WWW.BURGESSHC.ORG/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE/ X WWW.BURGESSHC.ORG/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE/ X WWW.BURGESSHC.ORG/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X X 1 X 0 0 BURGESS HEALTH CENTER PART V, SECTION B, LINE 5: COMMUNITY STAKEHOLDERS WERE ASKED TO DETERMINE KEY AREAS THEY SEE AS A CONCERN. STAKEHOLDERS WERE CHOSEN TO SHOWCASE A UNIQUE PERSPECTIVE OF COUNTY BARRIERS BASED ON THEIR PROFESSIONS, CHILDREN, HEALTHCARE SERVICES, COUNTY AND SURROUNDING COUNTY SERVICES AND INDIVIDUAL TOWN NEEDS. STAKEHOLDERS INCLUDED:- SCHOOL ADMINISTRATORS - BURGESS HEALTH CENTER DIRECTORS- MONONA COUNTY WELLNESS COALITION - ONAWA CHAMBER OF COMMERCE- MONONA COUNTY CHILD ABUSE PREVENTION COUNCIL - MONONA COUNTY BOARD OF HEALTH- MONONA COUNTY COMMUNITY MAYORSTHE INFORMATION COLLECTED WAS ANALYZED AND A COMMUNITY SURVEY WAS CREATED TO DETERMINE WHAT RESIDENTS OF MONONA COUNTY FELT WERE AREAS OF GREATEST CONCERN. THE SURVEY INCLUDED DEMOGRAPHICS AND FOUR QUESTIONS TO HELP NARROW THE BARRIERS FACED BY MONONA COUNTY RESIDENTS. THE SURVEY WAS MADE AVAILABLE ONLINE AND IN PRINT. IT WAS ADVERTISED ON SOCIAL MEDIA, IN NEWSPAPERS AND FLYERS WERE PLACED IN LOCAL ESTABLISHMENTS. A TOTAL OF 104 RESIDENT RESPONDED TO THE SURVEY, ACCOUNTING FOR 1.2% OF THE POPULATION. BURGESS HEALTH CENTER PART V, SECTION B, LINE 11: NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA INCLUDE: MENTAL HEALTH AND MENTAL HEALTH DISORDERS, OVERWEIGHT AND OBESITY RATES, OLDER HEALTH/AGING ISSUES, AND RATE OF CANCER. TO ADDRESS, EDUCATE AND PREVENT THE PRIMARY CONCERNS OF THE CHNA, BURGESS HEALTH CENTER HAS DEVELOPED THE FOLLOWING GOALS AND PROGRAMS TO ADDRESS THE NEEDS IDENTIFIED IN OUR SERVICE AREA:1) MENTAL HEALTH AND MENTAL HEALTH DISORDERS - PARTNERED WITH VA TO BRING "ASK THE QUESTION" CAMPAIGN TO BURGESS CLINICS, AND WORKED WITH NAMI SOUTHWEST IOWA TO BRING SUPPORT GROUPS TO MONONA COUNTY. STARTED PROGRAMS CALLED UNLICKING BRAIN FITNESS FOR DEMENTIA PREVENTIA. PROMOTED THE 988 MENTAL HEALTH NUMBER THROUGH SOCIAL MEDIA AND COMMUNITY PARTNERS. PROMOTED MENTAL HEALTH WALK-IN CLINIC FOR THOSE THAT ARE WAITING TO BE SEEN BY A THERAPIST. WORKED WITH FUNERAL DIRECTORS TO ACCESS MORE INFORMATION ON SUICIDE AND HELPING FAMILIES COPE WHEN LOSING SOMEONE TO SUICIDE.2) OVERWEIGHT AND OBESITY RATES - PROMOTED HEALTHY LIFESTYLES AND ROUTINE CHECK-UPS WITH PHYSICIANS VIA SOCIAL MEDIA. STARTED 5 2 1 0 PROGRAM IN WEST MONONA SCHOOL, AS WELL AS THE "DIABETES PREVENTION" PROGRAM THAT IS FREE FOR ALL PARTCIPANTS. WORKED WITH THE CITY OF ONAWA ON CREATING A WALKING TRAIL.3) OLDER HEALTH/AGING ISSUES - PROMOTED HEALTH MONTH AND WELLNESS CHECKUPS, AS WELL AS ROUTINE WELLNESS VISITS AND MEN'S HEALTH MONTH FOR SCREENINGS. STARTED DEMENTIA PREVENTION CLASS IN ONAWA CALLED UNLOCKING THE KEYS TO DEMENTIA PREVENTION. PROMOTED SPECIALTY SERVICES SUCH AS COLONOSCOPIES, DIABETES PREVENTION, ORTHOPEDIC SERVICES, ETC.4) RATES OF CANCER - PROMOTED COLORECTAL CANCER SCREENING THROUGH COMPUTER SOFTWARE, AS WELL AS MEN'S HEALTH MONTH AND ROUTINE VISITS FOR EARLY CANCER DETECTION. PROMOTED ANNUAL WELLNESS VISITS AND CHRONIC CARE MANAGEMENT FOR MEDICARE PATIENTS.THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED. OTHER NEEDS THAT WERE IDENTIFIED, BUT NOT ADDRESSED INCLUDE DIABETES, RADON TESTING AND PREVENTION, IMMUNIZATIONS, CANCER SCREENINGS, LOW BIRTH WEIGHT, DEPRESSION, ACCIDENTS AND EMERGENCY PREPAREDNESS. THESE NEEDS WERE NOT ADDRESSED BECAUSE OTHER EXISTING PROGRAMS ARE ALREADY ADDRESSING THE NEED OR THERE IS A LACK OF HUMAN AND FINANCIAL RESOURCES TO DEDICATE TO THE ISSUE. BURGESS HEALTH CENTER PART V, SECTION B, LINE 13B: BURGESS HEALTH CENTER USES HUD GUIDELINES FOR IOWA WHICH ARE LESS RESTRICTIVE FOR THE PATIENTS. THESE GUIDELINES CAN BE FOUND AT HUDUSER.GOV. 5 1 - BURGESS FAMILY CLINIC - MAPLE VALLEY 513 SOUTH MUCKEY STREET MAPLETON IA 51304 FAMILY MEDICAL CLINIC 2 - BURGESS FAMILY CLINIC - SLOAN 409 EVANS SLOAN IA 51055 FAMILY MEDICAL CLINIC 3 - BURGESS CLINIC WHITING 153 BLAIR STREET WHITING IA 51063 FAMILY MEDICAL CLINIC 4 - BURGESS HOME CARE & HOSPICE 1600 DIAMOND ST ONAWA IA 51040 HOSPICE AND HOME HEALTH CARE 5 - BURGESS COMMUNITY MENTAL HEALTH CENTER 1600 DIAMOND ST ONAWA IA 51040 OUTPATIENT ADULT BEHAVIORAL HEALTH CLINIC PART I, LINE 3C: BURGESS HEALTH CENTER USES HUD GUIDELINES WHICH ARE LESS RESTRICTIVE FOR OUR PATIENTS. THE HOSPITAL DOES NOT USE ASSET TESTING OR OTHER FACTORS REGARDLESS OF INCOME AS A FACTOR TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. OTHER FACTORS USED INCLUDE MEDICAL INDIGENCY, INSURANCE STATUS AND UNDERINSURANCE STATUS. 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 TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND SUBSIDIZED HEALTH SERVICES, LINE 7G, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART I, LINE 7G: ALL COSTS REPORTED ON PART I, LINE 7G ARE ATTRIBUTABLE TO THE PHYSICIAN CLINICS. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HEALTH CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. THE AMOUNT REPORTED AS IMPLICIT PRICE CONCESSIONS DURING THE YEAR IS $884,961. PART III, LINE 3: THE IMPLICIT PRICE CONCESSIONS RECOGNIZED OF $884,961, IS 2.55% OF NET PATIENT SERVICE REVENUE FOR THE FISCAL YEAR. BURGESS HEALTH CENTER ESTIMATES THAT 30% OF IMPLICIT PRICE CONCESSIONS IS FOR PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE IF THEY WOULD APPLY. ALL OF THIS AMOUNT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 10 AND 11 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH 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 CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: IF ALL RESPONSIBLE PERSONS APPLY FOR FINANCIAL ASSISTANCE UNDER THE POLICY, AND THE BUSINESS OFFICE DETERMINES DEFINITIVELY THAT THE RESPONSIBLE INDIVIDUALS ARE INELIGIBLE FOR ANY FINANCIAL ASSISTANCE UNDER THE POLICY (INCLUDING BECAUSE THE PATIENT WAS NOT UNINSURED), BHC MAY INITIATE ECAS.IF ANY RESPONSIBLE INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE POLICY PRIOR TO THE APPLICATION DEADLINE, THEN ECAS MAY NOT BE INITIATED UNTIL AFTER EACH OF THE FOLLOWING STEPS HAS BEEN COMPLETED.A. BUSINESS OFFICE PROVIDES THE RESPONSIBLE INDIVIDUAL WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION OR DOCUMENTATION REQUIRED UNDER THE POLICY IN ORDER TO COMPLETE THE APPLICATION FOR FINANCIAL ASSISTANCE, WHICH NOTICE WILL INCLUDE A COPY OF THE ALL-HOSPITAL PLAIN LANGUAGE SUMMARY.B. BUSINESS OFFICE PROVIDES THE RESPONSIBLE INDIVIDUAL WITH AT LEAST 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT BHC MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL IF THE POLICY APPLICATION IS NOT COMPLETED OR PAYMENT IS NOT MADE; PROVIDED, HOWEVER, THAT THE DEADLINE FOR COMPLETION OR PAYMENT MAY NOT BE SET PRIOR TO THE APPLICATION DEADLINE.C. IF THE RESPONSIBLE INDIVIDUAL WHO HAS SUBMITTED THE INCOMPLETE APPLICATION COMPLETES THE APPLICATION FOR FINANCIAL ASSISTANCE, AND THE BUSINESS OFFICE DETERMINES DEFINITIVELY THAT THE RESPONSIBLE INDIVIDUAL IS INELIGIBLE FOR ANY FINANCIAL ASSISTANCE UNDER THE POLICY, BHC MAY INITIATE ECAS.D. IF THE RESPONSIBLE INDIVIDUAL WHO HAS SUBMITTED THE INCOMPLETE APPLICATION FAILS TO COMPLETE THE APPLICATION BY THE DEADLINE SET IN THE NOTICE, THEN ECAS MAY BE INITIATED.E. IF AN APPLICATION, COMPLETE OR INCOMPLETE, FOR FINANCIAL ASSISTANCE UNDER THE POLICY IS SUBMITTED BY A RESPONSIBLE PERSON, AT ANY TIME PRIOR TO THE APPLICATION DEADLINE BHC WILL SUSPEND ECAS WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING. PART VI, LINE 2: BURGESS HEALTH CENTER REVIEWS DATA FROM THE IOWA DEPARTMENT OF PUBLIC HEALTH. BURGESS HEALTH CENTER FOCUSES ON TOP ADMISSIONS TO THE HOSPITAL AND REVIEWS THE AGGREGATE DATA FROM WELLNESS SCREENS. PART VI, LINE 3: PATIENTS' BILLS CONTAIN INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND GIVES CONTACT INFORMATION FOR OBTAINING THIS ASSISTANCE. IF A PATIENT HAS NOT RESPONDED TO THE BILL, THE FINANCIAL COUNSELOR WILL CONTACT THE PATIENT TO MAKE ARRANGEMENTS TO HELP THE PATIENT APPLY FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: BURGESS HEALTH CENTER IS SITUATED IN MONONA COUNTY, IA. THE SERVICE AREA IS CONSIDERED A RURAL SETTING WITH A POPULATION OF APPROXIMATELY 9,000. OF THIS POPULATION, 24.7% OF MONONA COUNTY IS OVER AGE 65. THE SERVICE AREA RANKS LOW REGARDING THE MEDIAN HOUSEHOLD INCOME. THE IOWA AVERAGE HOUSEHOLD INCOME IS $62,000 WITH MONONA COUNTY HAVING AN AVERAGE HOUSEHOLD INCOME OF $53,000, $9,000 LOWER. THE UNEMPLOYMENT RATE IN MONONA COUNTY IS 3%, HIGHER THAN THE STATE AVERAGE OF 2.7%. PART VI, LINE 5: PROMOTING THE HEALTH OF THE COMMUNITIES BURGESS HEALTH CENTER SERVES IS IMPORTANT TO BURGESS HEALTH CENTER. FURTHERMORE, IT IS PART OF THE MISSION STATEMENT OF BURGESS HEALTH CENTER. - "BURGESS HEALTH CENTER IS COMMITTED TO IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE BY PROVIDING EXCELLENT HEALTHCARE AND EXCEPTIONAL PATIENT EXPERIENCES." TO HELP SUPPORT THAT MISSION BURGESS HEALTH CENTER HAS OPENED UP MEDICALLY ORIENTED GYMS (MOGS) IN 2 COMMUNITIES OF OUR SERVICE AREA, MAPLETON AND ONAWA. THROUGH FITNESS, WELLNESS AND GUIDANCE, THE MOGS ARE SPECIFICALLY DESIGNED TO IMPROVE THE LIFE AND HEALTH OF OUR COMMUNITY MEMBERS. THE PROFESSIONAL STAFF DEVELOP CUSTOMIZED FITNESS PROGRAMS TO HELP PEOPLE OF ALL AGES OBTAIN A HEALTHY LIFESTYLE.BURGESS HEALTH CENTER ALSO PARTNERS WITH OTHER ORGANIZATIONS IN THE COMMUNITY TO IMPROVE COMMUNITY HEALTH AND WELL BEING. BURGESS HEALTH CENTER PARTICIPATES IN MEDICARE, MEDICAID CHAMPUS AND TRICARE. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X 0 0 0 0 0 0 0 0 0 WASEEM ALOUNK MD PHYSICIAN 478079 0 0 0 0 0 30000 0 25649 0 533728 0 0 0 RACHEL KNUDSON DO GENERAL SURGERY SPECIALIST 441204 0 0 0 0 0 22500 0 26371 0 490075 0 0 0 PETER DAHER MD PHYSICIAN 381646 0 0 0 0 0 30000 0 16610 0 428256 0 0 0 MONTY MCKINVEN CRNA 266827 0 0 0 0 0 29984 0 16610 0 313421 0 0 0 JOHN GARRED JR MD BOARD MEMBER THRU 05/2024 264315 0 0 0 0 0 37039 0 2790 0 304144 0 0 0 LYNN CHARRLIN MD PHYSICIAN 252925 0 0 0 0 0 20563 0 7234 0 280722 0 0 0 TERESA BUTLER VP OF CLINICAL SERVICES/IN 174167 0 0 0 0 0 10690 0 7234 0 192091 0 0 0 CARL BEHNE CEO THRU 3/2024 143613 0 0 0 0 0 5987 0 9553 0 159153 0 0 0 JOHN WILKER VICE PRESIDENT OF FINANCE THRU 09/20 156821 0 0 0 0 0 631 0 0 0 157452 0 0 0 KATHRYN GARRED EMPLOYEE OF ORGANIZATION AND SPOUSE OF JOHN GARRED JR., MD, BOARD MEMBER 40099 EMPLOYEES W-2 WAGES 0 FAMILY MEDICINE CLINIC DR. PAUL DUDLEY OWNS 100% OF THE CLINIC AND IS A CURRENT BOARD MEMBER 415407 CONTRACTED SERVICES PROVIDED FOR ER COVERAGE 0 MATTHEW GARRED EMPLOYEE OF ORGANIZATION AND SON OF JOHN GARRED JR., MD, BOARD MEMBER 109347 EMPLOYEES W-2 WAGES 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 6 BURGESS HEALTH CENTER HAS MEMBERS. A PERSON MAY BECOME A MEMBER IF HE OR SHE (1) IS AT THAT TIME A RESIDENT OF THE GEOGRAPHIC AREA SERVED BY THE CORPORATION; (2) COMPLETES A MEMBERSHIP REGISTRATION FORM, AND (3) PAYS A LIFE MEMBERSHIP FEE OF $10. FORM 990, PART VI, SECTION A, LINE 7B THERE IS AN ANNUAL MEETING OF THE MEMBERS. AT THE MEETING, THE MEMBERS RECEIVE AN ANNUAL REPORT ON THE AFFAIRS OF THE CORPORATION AND HAVE THE OPPORTUNITY TO OFFER THEIR INPUT ON ANY MATTER AFFECTING THE CORPORATION. THE MEMBERS SHALL ALSO CARRY OUT ANY DUTIES RESERVED TO MEMBERS UNDER THE IOWA NONPROFIT CORPORATION ACT. EACH MEMBER HAS ONE VOTE. THE ACT OF A MAJORITY OF MEMBERS PRESENT AND VOTING SHALL BE THE ACT OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS E-MAILED TO THE ENTIRE BOARD; ALL QUESTIONS AND COMMENTS ARE ADDRESSED PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON A ANNUAL BASIS, ALL BOARD MEMBERS ALONG WITH THE MANAGEMENT STAFF (MANAGERS, DIRECTORS, OFFICERS) COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THE RESULTS ARE REVIEWED AT ONE OF THE BOARD MEETINGS. IF THERE IS A CONFLICT, THE BOARD MEMBER REFRAINS FROM VOTING ON THAT ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO SALARY IS DETERMINED BASED ON GRADE, NUMBER OF YEARS IN THE POSITION AND COMPARED TO IOWA HOSPITAL ASSOCIATION DATA SHOWING MARKET RATES FOR THE BURGESS CUSTOM GROUP. THIS INFORMATION IS PASSED ON TO THE EXECUTIVE COMMITTEE OF THE BOARD WHO MAKES A RECOMMENDATION TO THE COMPLETE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINAL DECISION. OFFICER'S COMPENSATION OTHER THAN THE CEO IS DETERMINED BY THE IHA SALARY SURVEY, CAH GROUP AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 BURGESS HEALTH CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BURGESS FOUNDATION 1600 DIAMOND STREET ONAWA IA 51040 421188964 RAISING FUNDS FOR BURGESS HEALTH CENTER IA 501(C)(3) LINE 7 BURGESS HEALTH CENTER 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 0 0 BURGESS FOUNDATION C 558604