IDA COUNTY IOWA COMMUNITY HOSPITAL: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- IDA COUNTY IOWA COMMUNITY HOSPITAL (EIN 42-0843389)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-10-12
- IRS object ID
- 202302859349300320
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-10-12T09:22:35-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | 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 | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420843389 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IDA COUNTY IOWA COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | IDAC | BusinessNameControlTxt |
| Phone | 7123643311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 EAST 2ND STREET | AddressLine1Txt |
| City | IDA GROVE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51445 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GLEN WINEKAUF | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7123643311 | PhoneNum |
| Signature | 2023-10-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | GLEN | PersonFirstNm |
| Person Last | WINEKAUF | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| 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 | 2023-10-06 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HORN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GLEN WINEKAUF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 EAST 2ND STREET | AddressLine1Txt |
| City | IDA GROVE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51445 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $27,385,713 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HORNMEMORIALHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1966 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF IDA GROVE & THE SURROUNDING COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 247 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $203,623 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,737,904 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,679,468 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $25,368,481 | CYProgramServiceRevenueAmt |
| PY Investment Income | $205,817 | PYInvestmentIncomeAmt |
| CY Investment Income | $111,654 | CYInvestmentIncomeAmt |
| PY Other Revenue | $178,192 | PYOtherRevenueAmt |
| CY Other Revenue | $164,561 | CYOtherRevenueAmt |
| PY Total Revenue | $24,267,100 | PYTotalRevenueAmt |
| CY Total Revenue | $27,382,600 | 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 | $13,066,111 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,537,932 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,867,129 | PYOtherExpensesAmt |
| CY Other Expenses | $12,843,821 | CYOtherExpensesAmt |
| PY Total Expenses | $23,933,240 | PYTotalExpensesAmt |
| CY Total Expenses | $26,381,753 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $333,860 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,000,847 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,282,126 | TotalAssetsBOYAmt |
| Total Assets EOY | $34,695,468 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,466,197 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,475,409 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,815,929 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,220,059 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY CARE AND EDUCATION AS A PARTNER IN YOUR HEALTH AND WELLNESS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,336,958 | ExpenseAmt |
| Revenue | $25,368,481 | RevenueAmt |
| Desc | IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC. D/B/A HORN MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICE TO PATIENTS IN THE AREA OF IDA GROVE, IOWA. IT ALSO OPERATES HOME HEALTH AND HOSPICE AGENCIES, PROVIDER-BASED RURAL HEALTH CLINICS IN IDA GROVE, IOWA AND SURROUNDING COMMUNITIES, AND OTHER HEALTHCARE SERVICES.HEALTHCARE SERVICES PROVIDED TO PATIENTS: 693 ACUTE PATIENT DAYS, 873 SKILLED PATIENT DAYS, 32 INTERMEDIATE DAYS, 22,676 OUTPATIENT OCCASIONS OF SERVICE, 2,787 HOME HEALTH VISITS. | Desc |
| Total Program Service Expenses | $24,336,958 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 247 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | JONI SCHUMANN | PersonNm |
| Phone | 7123643311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 EAST 2ND STREET | AddressLine1Txt |
| City | IDA GROVE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51445 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| ALBERT VELTRI | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $388,362 | $0 | $64,498 | ||
| MAX DELANEY | ||||||||
| CRNA | 40.00 | 0.00 | Yes (X) | $230,308 | $0 | $53,949 | ||
| SHARON VANDEVEGTE | ||||||||
| PHYSICIAN | 32.00 | 0.00 | Yes (X) | $225,607 | $0 | $53,327 | ||
| CURTIS HESSE | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $217,005 | $0 | $24,811 | ||
| GLEN WINEKAUF | ||||||||
| CEO | 40.00 | 1.00 | $190,859 | $0 | $46,691 | Yes (X) | ||
| JOEY HOEFLING | ||||||||
| ARNP | 40.00 | 0.00 | Yes (X) | $156,004 | $0 | $7,597 | ||
| JONI SCHUMANN | ||||||||
| CFO | 40.00 | 1.00 | $123,602 | $0 | $23,992 | Yes (X) | ||
| JEAN BURNS | ||||||||
| CHAIR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| DAVID FORBES | ||||||||
| VICE CHAIR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| KELLI BOYLE | ||||||||
| SECRETARY | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| KEITH ROBINSON | ||||||||
| SECRETARY THRU 04/22 | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| COLE BOGER | ||||||||
| TREASURER | 0.50 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| PETER GOLDSMITH | ||||||||
| DIRECTOR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| CHRISTINA HANSON | ||||||||
| DIRECTOR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| VANCE LUNDELL | ||||||||
| DIRECTOR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ROB PAULSEN | ||||||||
| DIRECTOR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KRIS GUNDERSON | ||||||||
| DIRECTOR | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JEN CONOVER | ||||||||
| DIRECTOR THRU 04/22 | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,531,747 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $274,865 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | 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 |
|---|---|---|---|---|---|
| WMG RED HAWTHORNE LLC | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | ER PHYSICIAN SERVICES | $1,374,321 |
| SPORTS REHAB & PHYSICAL THERAPY CENTER | |||||
| 315 W 5TH ST | STORM LAKE | IA | 50588 | REHAB SERVICES | $1,057,543 |
| FUSION MEDICAL STAFFING LLC | |||||
| PO BOX 850781 | MINNEAPOLIS | MN | 55485 | CONTRACTED STAFFING | $486,753 |
| SANFORD LABORATORIES | |||||
| PO BOX 5056 | SIOUX FALLS | SD | 57117 | LAB SERVICES | $212,154 |
| CASSLING | |||||
| 13810 FNB PKWY SUITE 200 | OMAHA | NE | 68154 | CT, DRX, RADIOLOGY SERVICES | $168,379 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $70,000 | RelatedOrganizationsAmt |
| Government Grants | $1,105,833 | GovernmentGrantsAmt |
| All Other Contributions | $562,071 | AllOtherContributionsAmt |
| Total Contributions | $1,737,904 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 624100 | $17,686,892 | $17,686,892 |
| PATIENT SERVICE REVENUE | 624100 | $6,738,096 | $6,738,096 |
| 340B REVENUE | 624100 | $747,621 | $747,621 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $195,872 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $195,872 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $25,368,481 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $111,654 | TotalRevenueColumnAmt |
| Exclusion | $111,654 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $71,680 | 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 | $71,680 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,680 | TotalRevenueColumnAmt |
| Exclusion | $71,680 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $8,173 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $3,113 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,060 | TotalRevenueColumnAmt |
| Exclusion | $5,060 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA/DIETARY | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $87,821 | TotalRevenueColumnAmt |
| Exclusion | $87,821 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $87,821 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,382,600 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $25,368,481 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $276,215 | 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 | $385,144 | TotalAmt |
| Management And General | $385,144 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,205,562 | TotalAmt |
| Program Services | $9,483,272 | ProgramServicesAmt |
| Management And General | $722,290 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $347,777 | TotalAmt |
| Program Services | $323,588 | ProgramServicesAmt |
| Management And General | $24,189 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,879,103 | TotalAmt |
| Program Services | $1,716,881 | ProgramServicesAmt |
| Management And General | $162,222 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720,346 | TotalAmt |
| Program Services | $639,740 | ProgramServicesAmt |
| Management And General | $80,606 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,617 | TotalAmt |
| Management And General | $138,617 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,495 | TotalAmt |
| Management And General | $24,495 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,441,579 | TotalAmt |
| Program Services | $5,367,601 | ProgramServicesAmt |
| Management And General | $73,978 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,016 | TotalAmt |
| Program Services | $57,008 | ProgramServicesAmt |
| Management And General | $8,008 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $558,331 | TotalAmt |
| Program Services | $489,560 | ProgramServicesAmt |
| Management And General | $68,771 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,267,024 | TotalAmt |
| Program Services | $1,110,961 | ProgramServicesAmt |
| Management And General | $156,063 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,736 | TotalAmt |
| Program Services | $139,184 | ProgramServicesAmt |
| Management And General | $19,552 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,071 | TotalAmt |
| Program Services | $27,244 | ProgramServicesAmt |
| Management And General | $3,827 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,754 | TotalAmt |
| Program Services | $250,961 | ProgramServicesAmt |
| Management And General | $1,793 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,676,547 | TotalAmt |
| Program Services | $1,578,912 | ProgramServicesAmt |
| Management And General | $97,635 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,543 | TotalAmt |
| Program Services | $114,464 | ProgramServicesAmt |
| Management And General | $16,079 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,305,979 | $2,305,979 | $0 |
| DUES AND SUBSCRIPTIONS | $321,159 | $281,601 | $39,558 |
| BAD DEBT EXPENSE | $293,627 | $293,627 | $0 |
| MISCELLANEOUS | $119,151 | $104,474 | $14,677 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,192 | TotalAmt |
| Program Services | $51,901 | ProgramServicesAmt |
| Management And General | $7,291 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,381,753 | TotalAmt |
| Program Services | $24,336,958 | ProgramServicesAmt |
| Management And General | $2,044,795 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,141 | BOYAmt |
| EOY | $13,872 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,643,988 | BOYAmt |
| EOY | $10,760,743 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,999 | BOYAmt |
| EOY | $305,374 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,527,074 | BOYAmt |
| EOY | $3,267,778 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $533,143 | BOYAmt |
| EOY | $530,148 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $209,710 | BOYAmt |
| EOY | $73,555 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,061,091 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,429,741 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,707,491 | BOYAmt |
| EOY | $15,631,350 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,966,693 | BOYAmt |
| EOY | $2,454,613 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $581,233 | BOYAmt |
| EOY | $449,633 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,654 | BOYAmt |
| EOY | $1,208,402 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,282,126 | BOYAmt |
| EOY | $34,695,468 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,643,751 | BOYAmt |
| EOY | $1,857,698 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,585,813 | BOYAmt |
| EOY | $8,275,769 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,236,633 | BOYAmt |
| EOY | $341,942 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,466,197 | BOYAmt |
| EOY | $10,475,409 | 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 | $23,815,929 | BOYAmt |
| EOY | $23,751,859 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $468,200 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,815,929 | BOYAmt |
| EOY | $24,220,059 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,282,126 | BOYAmt |
| EOY | $34,695,468 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,000,847 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$587,594 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$9,123 | PriorPeriodAdjustmentsAmt |
| 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 | $3,122 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,122 | 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 | THE HOSPITAL PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $253,789 | OtherCostOrOtherBasisAmt |
| Book Value | $253,789 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,148,477 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,322,950 | DepreciationAmt |
| Book Value | $9,825,527 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,730,458 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,458,906 | DepreciationAmt |
| Book Value | $2,271,552 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,928,367 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,647,885 | DepreciationAmt |
| Book Value | $3,280,482 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $15,631,350 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT OF USE ASSET - FINANCING LEASE (NET) | Desc |
| Amt | $341,942 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $341,942 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,501,379 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$587,594 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$587,594 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,088,973 | RevenueSubtotalAmt |
| Other Revenues Not Included | $293,627 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $293,627 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $27,382,600 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,088,126 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,088,126 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $293,627 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $293,627 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,381,753 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB 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 DECEMBER 31, 2022, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 293,627. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 293,627. |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| 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) |
|---|---|---|
| Persons Served | 62 | PersonsServedCnt |
| Total Community Benefit Expns | $21,919 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $21,919 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2024 | PersonsServedCnt |
| Total Community Benefit Expns | $2,842,351 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,226,787 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $615,564 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02360 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 97 | PersonsServedCnt |
| Total Community Benefit Expns | $388 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $388 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2183 | PersonsServedCnt |
| Total Community Benefit Expns | $2,864,658 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,226,787 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $637,871 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02440 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 35358 | PersonsServedCnt |
| Total Community Benefit Expns | $35,085 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,377 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,708 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 62 | PersonsServedCnt |
| Total Community Benefit Expns | $33,423 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $33,423 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 422 | PersonsServedCnt |
| Total Community Benefit Expns | $25,393 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,393 | DirectOffsettingRevenueAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 24300 | PersonsServedCnt |
| Total Community Benefit Expns | $86,023 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $86,023 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 60142 | PersonsServedCnt |
| Total Community Benefit Expns | $179,924 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $40,770 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $139,154 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 62325 | PersonsServedCnt |
| Total Community Benefit Expns | $3,044,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,267,557 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $777,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02980 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $293,627 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,930,525 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,083,909 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$153,384 | 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 | HORN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 EAST 2ND STREET | AddressLine1Txt |
| City | IDA GROVE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51445 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HORNMEMORIALHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 470061H | 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 | IDA COUNTY IOWA COMMUNITY HOSPITAL INC | 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 |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | 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 | WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_NEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_NEEDS | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 | WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=PAYMENT_ARRANGEMENTS | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=PAYMENT_ARRANGEMENTS | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=PAYMENT_ARRANGEMENTS | 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 Translated | Yes (X) | FAPTranslatedInd |
| 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 |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC | PART V, SECTION B, LINE 5: PARTICIPANTS VIA ONLINE SURVEY INCLUDED 19 HEALTH PROVIDERS, 1 SOCIAL SERVICES PROVIDER, AND 26 OTHER COMMUNITY LEADERS. MULTIPLE OTHER DATA SOURCES WERE ALSO CONSULTED TO COMPLEMENT THE RESEARCH QUALITY OF THE CHNA. WRITTEN COMMENTS AND FEEDBACK WERE ALSO REQUESTED THROUGH HORN'S WEBSITE. COMMUNITY DEFINED FOR THE CHNA INCLUDED THE THREE COUNTIES OF IDA, MONONA, AND SAC BASED ON THE AREAS OF RESIDENCE OF MOST RECENT PATIENTS OF HORN MEMORIAL HOSPITAL. |
| IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC | PART V, SECTION B, LINE 11: HORN'S COMMITTEE OF NINE MEMBERS MET TO DISCUSS AND PRIORITIZE THE TOP HEALTH NEEDS IDENTIFIED FROM THE CHNA. THE BOARD OF TRUSTEES OFFICIALLY REVIEWED AND APPROVED THE FOUR PRIORITIZED SIGNIFICANT COMMUNITY NEEDS AND INITIATIVES RELATED TO THESE AREAS:1) MENTAL HEALTH - INCREASE AWARENESS AND ACCESS TO MENTAL HEALTH SERVICES.2) HEART DISEASE & STROKE - INCREASE ACCESS AND AWARENESS OF HEART DISEASE AND STROKE RESOURCES.3) CANCER - PROMOTE/ENCOURAGE REFERRALS FOR PREVENTABLE CANCER SCREENINGS.4) ACCESS TO HEALTHCARE - INCREASE ACCESS TO HEALTHCARE SERVICES IN OUR SERVICE AREA AND INCREASE COMMUNITY AWARENESS OF SERVICES AVAILABLE FOR HORN.HORN IS NOT ADDRESSING THE FOLLOWING NEEDS IDENTIFIED: 1) SUBSTANCE ABUSE - OTHER FACILITIES OR ORGANIZATIONS IN THE COMMUNITY ARE ADDRESSING THE NEED.2) RESPIRATORY DISEASE - DUE TO RESOURCE CONSTRAINTS.3) ORAL HEALTH - DUE TO THE RELATIVELY LOW PRIORITY ASSIGNED TO THE NEED.4) INJURY & VIOLENCE - DUE TO THE RELATIVELY LOW PRIORITY ASSIGNED TO THE NEED. |
| IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC | PART V, SECTION B, LINE 13B: DISCOUNTS FOR PATIENTS WITH NO INSURANCE AND PROMPT PAYMENT ARE NOT BASED ON ANY INCOME LEVEL. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - HORN PHYSICIANS CLINIC IDA GROVE | ||||
| 700 EAST 2ND STREET | IDA GROVE | IA | 51445 | PHYSICIAN CLINIC |
| 2 - HORN PHYSICIANS CLINIC ODEBOLT | ||||
| 300 SOUTH MAPLE STREET | ODEBOLT | IA | 51458 | PHYSICIAN CLINIC |
| 3 - HORN PHYSICIANS CLINIC MAPLETON | ||||
| 412 MAIN STREET | MAPLETON | IA | 51034 | PHYSICIAN CLINIC |
| 4 - HORN PHYSICIANS CLINIC HOLSTEIN | ||||
| 1400 SOUTH KIEL STREET | HOLSTEIN | IA | 51025 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | FOR PATIENTS WITH THE ABILITY TO PAY, A 5% DISCOUNT IS OFFERED ON HOSPITAL SERVICES, WHICH APPLIES ONLY IF THE BALANCE IS PAID IN FULL WITHIN THIRTY DAYS FROM THE RECEIPT OF THE FIRST PRIVATE PAY STATEMENT. THIS DISCOUNT DOES NOT APPLY TO ANY CLINIC OR PUBLIC HEALTH CHARGES. A $4.00 DISCOUNT IS OFFERED TO PATIENTS AT THE TIME OF SERVICE IN THE CLINICS IF THE HOUSEHOLD INCOME IT AT OR BELOW 400% OF THE FEDERAL POVERTY GUIDELINES.FOR COLLECTION PURPOSES, PATIENTS WITH NO INSURANCE AS GIVEN A 20% DISCOUNT ON HOSPITAL SERVICES. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED PARTY. |
| PART I, LINE 7: | THE HOSPITAL USES AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G INCLUDE WELLNESS CHECKS AND FOOT CLINICS. FOOT CLINICS ACCOUNT FOR $3,300 OF EXPENSES AND $2,725 OF OFFSETTING REVENUE. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $293,627. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL DOES NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES. |
| PART III, LINE 2: | CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE HOSPITAL HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH UNINSURED BALANCES (COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON COLLECTION HISTORY WITH THOSE PATIENTS. |
| PART III, LINE 3: | THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTH CARE SERVICES THEY RECEIVE. IT IS THE 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 THE STATEMENTS OF OPERATIONS. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR PATIENT FINANCIAL ASSISTANCE PATIENTS FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021 WERE APPROXIMATELY $14,900 AND $20,800, RESPECTIVELY. |
| PART III, LINE 4: | THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE" CAN BE FOUND ON PAGES 8, 10, 11, & 14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. |
| PART III, LINE 9B: | ONCE A PATIENT HAS BEEN DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PAYMENT PLAN IS ESTABLISHED. IF THEY DEFAULT, AFTER TWO MONTHS OUR BAD DEBT COLLECTION POLICIES ARE ENACTED AND FOLLOWED. |
| PART VI, LINE 2: | COMMUNITY NEEDS ARE ASSESSED REGULARLY THROUGH FEEDBACK FROM PATIENT SURVEYS, OUR MEDICAL STAFF (MANY OF WHOM ARE COMMUNITY RESIDENTS) AND EMPLOYEES, AS WELL AS OUR BOARD OF TRUSTEES WHO LIVE IN AND REPRESENT THECOMMUNITIES WE SERVE. A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS CONDUCTED EVERY THREE YEARS TO EVALUATE OUR ONGOING SERVICE REQUIREMENTS, IDENTIFY NEW SIGNIFICANT HEALTH NEEDS, AND IMPLEMENT STRATEGIES TO ADDRESS THEM. |
| PART VI, LINE 3: | OUR CONSENT TO TREATMENT FORM INCLUDES LANGUAGE REGARDING FINANCIAL ASSISTANCE AND CONTACT INFORMATION. THIS IS ALSO PRINTED AT THE REGISTRATION DESKS. IN ADDITION, OUR FINANCIAL ASSISTANCE POLICY IS POSTED IN REGISTRATION AREAS OF BOTH THE HOSPITAL AND ITS CLINICS. OUR HOSPITAL WEBSITE OFFERS ADDITIONAL INFORMATION UNDER THE PATIENTS AND VISITORS, PAYMENT ARRANGEMENTS SECTION REGARDING OUR PAYMENT REQUIREMENTS, FINANCIAL ASSISTANCE POLICY, SLIDING FEE SCALES, AND THE APPLICATION FORM FOR FINANCIAL ASSISTANCE. MAIL AND PHONE INQUIRIES REGARDING PATIENT INVOICES OR PAYMENT ARRANGEMENTS ARE REFERRED TO OUR FINANCIAL COUNSELOR FOR ASSISTANCE. |
| PART VI, LINE 4: | THE HOSPITAL SERVES THE COUNTIES OF IDA, MONONA AND SAC IN THE STATE OF IOWA. THE POPULATION OF THIS AREA IS OVER 25,000 RESIDENTS. IN THE TOTAL SERVICE AREA, 21.8% OF THE POPULATION ARE CHILDREN AGE 0-17; ANOTHER 55.4%ARE AGE 18 TO 64, WHILE 22.8% ARE AGE 65 AND OLDER. THE PROPORTION OF OLDER ADULTS (AGE 65+) IS SIGNIFICANTLY ABOVE THAT SEEN STATEWIDE OR (ESPECIALLY) NATIONALLY. |
| PART VI, LINE 5: | AS A PRIVATE, NON-PROFIT CRITICAL ACCESS HOSPITAL, HORN MEMORIAL HOSPITAL AND ITS CLINICS ARE ABLE TO IMPROVE ACCESS TO HEALTHCARE TO THOSE AT RISK BECAUSE OF FINANCIAL ABILITY, LACK OF ADEQUATE INSURANCE, MINORITY, OR OTHER BARRIERS, THROUGH OUR FOUR LOCATIONS WITHIN THREE RURAL COUNTIES.WE OFFER A VARIETY OF SPECIALTY CLINICS TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE, AND MAINTAIN FOUR RURAL HEALTH CLINICS, A 24 HOUR EMERGENCY DEPARTMENT AND A 20 BED INPATIENT WING. THE HOSPITAL SPONSORS WEEKLY RADIO BROADCASTS ADDRESSING A WIDE VARIETY OF HEALTHCARE SERVICES AND ISSUES/CONCERNS. A MONTHLY NEWSLETTER IS ALSO PUBLISHED WHICH INCLUDES INFORMATION REGARDING SCHEDULED SPECIALTY CLINICS AND OTHER TIMELY CONCERNS OR INFORMATION FOR OUR READERSHIP. WE PROVIDE TRANSLATION SERVICES AT ALL LOCATIONS. WE PARTNER THROUGH LOCAL, COUNTY, AND STATE AGENCIES TO PROVIDE PUBLIC HEALTH SERVICES TO OUR COMMUNITIES. |
| PART VI, LINE 6: | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALBERT VELTRI | ||||||||||||||
| PHYSICIAN | $387,862 | $0 | $500 | $0 | $0 | $0 | $20,157 | $0 | $44,341 | $0 | $452,860 | $0 | $0 | $0 |
| MAX DELANEY | ||||||||||||||
| CRNA | $229,808 | $0 | $500 | $0 | $0 | $0 | $12,144 | $0 | $41,805 | $0 | $284,257 | $0 | $0 | $0 |
| SHARON VANDEVEGTE | ||||||||||||||
| PHYSICIAN | $225,357 | $0 | $250 | $0 | $0 | $0 | $11,891 | $0 | $41,436 | $0 | $278,934 | $0 | $0 | $0 |
| CURTIS HESSE | ||||||||||||||
| PHYSICIAN | $216,505 | $0 | $500 | $0 | $0 | $0 | $10,959 | $0 | $13,852 | $0 | $241,816 | $0 | $0 | $0 |
| GLEN WINEKAUF | ||||||||||||||
| CEO | $189,749 | $0 | $500 | $0 | $610 | $0 | $10,014 | $0 | $36,677 | $0 | $237,550 | $0 | $0 | $0 |
| JOEY HOEFLING | ||||||||||||||
| ARNP | $155,504 | $0 | $500 | $0 | $0 | $0 | $4,068 | $0 | $3,529 | $0 | $163,601 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| CITY OF IDA GROVE IOWA | ||||||||
| A | 426004785 | NONEAVAIL | 2016-08-08 | $7,457,000 | REFUND PRIOR ISSUES (SERIES 2004) | 0 | 0 | 0 |
| CITY OF IDA GROVE IOWA | ||||||||
| B | 426004785 | NONEAVAIL | 2016-08-08 | $4,843,000 | REFUND PRIOR ISSUES (SERIES 2004) | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | RetiredRetiredAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $7,457,000 | $7,457,000 | 2016 | Yes (1) | 0 | Yes (1) | Yes (1) | |||
| B | $4,843,000 | 2016 | Yes (1) | 0 | Yes (1) | Yes (1) | $3,883,242 | $92 | $4,842,908 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS OF THE ORGANIZATION SHALL BE THOSE PERSONS WHO SHALL CONTRIBUTE NOT LESS THAN $10.00 PER PERSON OR $20.00 PER FAMILY ANNUALLY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE ORGANIZATION'S CEO AND CFO AND A COPY IS PROVIDED TO ALL BOARD MEMBERS BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE SIGNED ANNUALLY BY EACH BOARD MEMBER. IF A POSSIBLE CONFLICT EXISTS, A BOARD MEMBER ABSTAINS FROM VOTING ON THE MATTER. COMPLIANCE WITH THE POLICY IS MONITORED BY THE ADMINISTRATION AND THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | SALARY CHANGES FOR THE CEO OCCUR EACH JANUARY. CHANGES ARE BASED ON SEVERAL FACTORS WHICH ARE PROVIDED TO THE BOARD CHAIR UPON REQUEST; AFTER BOARD REVIEW AND APPROVAL, THE CHANGE IS COMMUNICATED TO THE CFO. COMPENSATION FOR ALL OTHER EMPLOYEES USES SIMILAR DATA, AND IS REVIEWED AND APPROVED BY THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO DISCLOSED AT THE ANNUAL MEETING WHICH IS OPEN TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,901,653. MANAGEMENT AND GENERAL EXPENSES 73,978. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,975,631. SURGERY SERVICES: PROGRAM SERVICE EXPENSES 1,364,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,364,600. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,307,522. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,307,522. PHYSICAL THERAPY SERVICES: PROGRAM SERVICE EXPENSES 793,826. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 793,826. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE 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 | HORN MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 EAST 2ND STREET | AddressLine1Txt |
| City | IDA GROVE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51445 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421478302 | EIN |
| Primary Activities | FUNDRAISING | 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 | Yes (1) | 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