2023-11-09T19:57:48-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2022-01-01 430926316 INDEPENDENCE HEALTH SYSTEM INC INDE 5735476546 800 SOUTH KINGSHIGHWAY PERRYVILLE MO 63775 DANA KORANDO ADMINISTRATOR/CEO 5735476546 2023-11-07 1 DANA KORANDO 999009999 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2023-11-01 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z DANA KORANDO 800 SOUTH KINGSHIGHWAY PERRYVILLE MO 63775 8874062 0 X HTTP://WWW.INDEPENDENCEHEALTHSYSTEM.ORG X 1969 MO TO PROVIDE THE ELDERLY WITH RETIREMENT AND HEALTH CARE SERVICES. 9 9 203 15 0 0 0 1400 7417423 7922146 42897 702466 232939 52878 7693259 8678890 0 2548 0 0 4669442 4580564 0 0 0 3092872 4450446 7762314 9033558 -69055 -354668 18722799 16593629 604236 851029 18118563 15742600 TO PROVIDE THE ELDERLY WITH RETIREMENT AND HEALTH CARE SERVICES WHICH ARE DEDICATED TO EXCELLENCE, IN AN ENVIRONMENT WHICH PROMOTES LIVING WITH DIGINITY, SECURITY AND INDEPENDENCE. 0 0 8093410 2548 7984524 PROVIDED LONG TERM CARE FOR THE ELDERLY AT VARIOUS STAGES: SKILLED NURSING FACILITY, 133 LICENSED BEDS; RESIDENTIAL CARE, 95 LICENSED BEDS; INDEPENDENT LIVING, 8 LIVING UNITS CONSISTING OF COTTAGES AND DUPLEXES. ACCEPT MEDICARE, MEDICAID, AND PRIVATE PAY WHERE APPLICABLE.WE PROVIDE CARE FOR OUR RESIDENTS FROM HEAD TO TOE. WE WANT OUR RESIDENTS TO LIVE THEIR BEST LIFE WHILE LIVING HERE. WE TAKE PRIDE IN OUR PROVIDERS THAT COME INTO OUR FACILITY TO PROVIDE CARE SO THE RESIDENTS DON'T HAVE TO LEAVE THE FACILITY.WE ALSO PROVIDE ADDITIONAL CARE WITH THERAPY, FACIALS, MANICURES, PEDICURES, AND BEAUTY SHOP TREATMENT. 0 0 -62378 THE SYSTEM ACCEPTS MEDICAID RESIDENTS WITH THE UNDERSTANDING THAT A PORTION OF THESE REVENUES WILL BE UNCOLLECTIBLE. THE CONTRACTUAL ADJUSTMENT IS RECORDED IN NET RESIDENT SERVICE REVENUE. THE SYSTEM CONSIDERS THIS CONTRACTUAL ADJUSTMENT TO BE CHARITABLE CARE. 8093410 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 45 0 203 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DANA KORANDO 5735476546 800 SOUTH KINGSHIGHWAY PERRYVILLE MO 63775 BRIAN DREYER PRESIDENT 2.00 X X 0 0 0 PATTY WICHERN VICE PRESIDENT 2.00 X X 0 0 0 JUDITH ERNST SECRETARY/TREASURER 2.00 X X 0 0 0 JENNIFER STREILER BOARD MEMBER 1.00 X 0 0 0 TERRI GREEN BOARD MEMBER 1.00 X 0 0 0 JUSTIN KOENIG BOARD MEMBER 1.00 X 0 0 0 VIDA YAMNITZ BOARD MEMBER 1.00 X 0 0 0 DONALD PALISCH BOARD MEMBER 1.00 X 0 0 0 FRED EGGERS BOARD MEMBER 1.00 X 0 0 0 DANA KORANDO ADMINISTRATOR/CEO 40.00 X 112979 0 4949 RHONDA PFISTER CFO 40.00 X 85062 0 9951 CASEY ELLIS ADMINISTRATOR 40.00 X 76461 0 3484 274502 0 18384 1 0 0 0 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 68501 STAFFING AGENCY 899720 SELECT REHABILITATION PO BOX 71985 CHICAGO IL 60694 THERAPY 368633 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 554850737 STAFFING AGENCY 239137 3 1400 1400 NURSING REVENUE 623000 7922146 7922146 7922146 226283 226283 671355 195172 476183 476183 476183 358 0 358 358 MISCELLANEOUS 623000 42166 42166 BEAUTY SHOP 623000 8395 8395 MEDICARE LEVEL PAYMENT 623000 1863 1863 96 96 52520 8678890 7922146 0 755344 X 1048 1048 1500 1500 274502 274502 3516921 2937750 579171 69612 67624 1988 433160 420792 12368 286369 278192 8177 399 388 11 62875 61080 1795 2023775 2018379 5396 34895 33899 996 895056 882994 12062 17748 17241 507 413795 401979 11816 8918 5472 3446 1 1 324843 315567 9276 163831 159153 4678 NFRA AND NFAC FEES 411907 400145 11762 RECRUITMENT EXPENSES 61135 59389 1746 BAD DEBT 15469 15469 DUES AND SUBSCRIPTIONS 11128 10810 318 4671 4538 133 9033558 8093410 940148 0 43271 154896 1740073 857357 264465 443507 84790 79080 48337 103663 14585673 11332790 3503877 3252883 13030370 11702243 7616 0 18722799 16593629 604236 829185 21844 604236 851029 X 18118563 15742600 18118563 15742600 18722799 16593629 -354668 -2021295 0 X X 0 1 X 1 0 X 14404 10515 1400 26319 9925801 9496119 9890555 7688488 7922146 44923109 10712 10712 9940205 9506634 9890555 7688488 7934258 44960140 0 0 0 44960140 20909 1431 2366 4772 226283 255761 20909 1431 2366 4772 226283 255761 42166 42166 9961114 9508065 9892921 7693260 8202707 45258067 0.99340 0.99520 0.00570 0.00480 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2022 AMOUNT: $ 42,166. 0 1 X 805094 194487 6101 1005682 254200 254200 13017534 10367589 2649945 1313939 965201 348738 3252883 X 6657595 -2021295 -2021295 8678890 0 8678890 9033558 0 9033558 0 9033558 PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS ON BEHALF OF RESIDENTS. PART V, LINE 4: THE ENDOWMENT FUNDS ARE TO BE USED FOR BOND PAYMENTS. PART X, LINE 2: THE SYSTEMS INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE SYSTEM IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAXEXEMPT STATUS. THE SYSTEM IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAX EXCEPT FOR THOSE THAT ARE ALREADY REPORTED ANNUALLY. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CAN ACT ON BEHALF OF THE BOARD AND INCLUDES THE PRESIDENT, VICE PRESIDENT, AND SECRETARY/TREASURER. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO: A.) APPROVE THE DISSOLUTION OR MERGER OF THE CORPORATION, OR THE SALE, PLEDGE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; B.) APPOINT OR REMOVE DIRECTORS OR FILL VACANCIES ON THE BOARD OR ON COMMITTEES OF THE BOARD; C.) ADOPT, AMEND OR REPEAL THESE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION; D.) AUTHORIZE DISTRIBUTIONS TO DIRECTORS, OFFICERS, EMPLOYEES OR AGENTS OF THE CORPORATION EXCEPT FOR VALUE AND IN ACCORDANCE WITH THE PROVISIONS OF THE MISSOURI NONPROFIT ACT. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS JUDY ERNST AND BRIAN DREYER HAVE A BUSINESS RELATIONSHIP WHERE JUDY WAS A VICE PRESIDENT WITH BANK OF MISSOURI. JUDY RETIRED AND BRIAN NOW SITS ON THEIR BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. THE ADMINISTRATOR SIGNS AND A COPY IS PRESENTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C A LETTER AND QUESTIONNAIRE CONCERNING THE POSSIBILITY OF CONFLICTS OF INTEREST IS SENT TO EACH MEMBER OF THE BOARD OF DIRECTORS, THE CEO, AND THE CFO. A LETTER PERTAINING TO CONFLICTS OF INTEREST IS SIGNED BY EACH DEPARTMENT HEAD, RESPONSES ARE REVIEWED BY THE HR DIRECTOR, CFO, AND CEO , DEPENDING ON WHETHER IT IS A BOARD OF DIRECTOR MEMBER OR DEPARTMENT HEAD. BOARD OF DIRECTOR MEMBERS WOULD ABSTAIN FROM ANY VOTE WHERE A POSSIBILE CONFLICT OF INTEREST MIGHT ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD DETERMINES THE CEO AND ADMINISTRATORS SALARY. THEY PERFORM AN ANNUAL EVALUATION AND BASE ANY INCREASE ON THEIR PERFORMANCE REVIEW. HR PROVIDES THE BOARD WITH COMPARABLE WAGES FROM LOCAL CEOS AND ADMINISTRATOR'S. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES AND WAS LAST PERFORMED IN 2022. THE CFO, ADMINISTRATOR, AND HR DIRECTOR REVIEW COMPENSATION FOR THEIR OFFICERS AND KEY EMPLOYEES. ANY CHANGES ARE DOCUMENTED AND BROUGHT TO THE BOARD FOR APPROVAL. THIS PROCESS WAS LAST DONE IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G STAFFING AGENCY: PROGRAM SERVICE EXPENSES 1,421,447. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,421,447. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 154,956. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,956. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 132,949. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,949. SPEECH THERAPY: PROGRAM SERVICE EXPENSES 63,967. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,967. OTHER CONTRACTED FEES: PROGRAM SERVICE EXPENSES 61,456. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,456. PURHASED SERVICES: PROGRAM SERVICE EXPENSES 99,995. MANAGEMENT AND GENERAL EXPENSES 2,939. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,934. PAYROLL SERVICE FEES: PROGRAM SERVICE EXPENSES 44,434. MANAGEMENT AND GENERAL EXPENSES 1,306. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,740. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 39,175. MANAGEMENT AND GENERAL EXPENSES 1,151. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,326. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.