FORT MADISON COMMUNITY HOSPITAL: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- FORT MADISON COMMUNITY HOSPITAL (EIN 42-1081055)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-12
- IRS object ID
- 202211329349301896
- Schema version
- 2020v4.2
- 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 I
- Schedule J
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-12T15:02:00-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S 6TH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421081055 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FORT | BusinessNameControlTxt |
| Phone | 3193726530 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEREMY ALEXANDER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3193726530 | PhoneNum |
| Signature | 2022-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEREMY | PersonFirstNm |
| Person Last | ALEXANDER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KOREY BOELTER | PreparerPersonNm |
| PTIN | P00775161 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2022-05-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | DAN LINHART | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $64,130,470 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GREATRIVERMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO ADVANCE THE HEALTH AND WELL-BEING OF ALL PEOPLE THROUGH COMPASSIONATE, QUALITY CARE, EDUCATION, AND COMMUNITY SERVICE. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 491 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $34,185 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,460,529 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,843,531 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $36,877,185 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $57,781,995 | CYProgramServiceRevenueAmt |
| PY Investment Income | $222,138 | PYInvestmentIncomeAmt |
| CY Investment Income | $294,006 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,886,860 | PYOtherRevenueAmt |
| CY Other Revenue | -$1,643 | CYOtherRevenueAmt |
| PY Total Revenue | $46,446,712 | PYTotalRevenueAmt |
| CY Total Revenue | $63,917,889 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,844 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $62,661,060 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,733,988 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,739,393 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,139,993 | PYOtherExpensesAmt |
| CY Other Expenses | $29,173,962 | CYOtherExpensesAmt |
| PY Total Expenses | $45,879,825 | PYTotalExpensesAmt |
| CY Total Expenses | $122,574,415 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $566,887 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$58,656,526 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $68,331,649 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,789,930 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $53,541,719 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO ADVANCE THE HEALTH AND WELL-BEING OF ALL PEOPLE THROUGH COMPASSIONATE, QUALITY CARE, EDUCATION, AND COMMUNITY SERVICE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $107,819,699 | ExpenseAmt |
| Grant | $62,661,060 | GrantAmt |
| Revenue | $57,747,810 | RevenueAmt |
| Desc | FORT MADISON COMMUNITY HOSPITAL IS A GENERAL, MEDICAL, AND SURGICAL HOSPITAL LOCATED IN FORT MADISON, IOWA, TO MEET THE HEATLH CARE NEEDS OF ITS COMMUNITIES AS WELL AS PROVIDE PROGRAMS AND SERVICES AIMED AT HEALTH, SAFETY, EDUCATION, PREVENTION, AND OVERALL HEALTH AND WELLNESS. IN DOING SO, THEY STRENGTHEN THEIR ROLE AS A PARTNER IN HTE COMMUNITY BY IMPROVING THE HEALTH OF AREA CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES THEY SERVE FORT MADISON COMMUNITY HOSPITAL (FMCH) IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO AREA RESIDENTS. FMCH SERVICES THE RESIDENTS OF SOUTHEAST IOWA AND WEST CENTRAL ILLINOIS. THE 50-BED HOSPITAL HAD 1082 PATIENT ADMISSIONS AND 2,943 PATIENT DAYS OF MEDICAL CARE. HEALTH SERVICES AND CARE PROVIDED BY FMCH INCLUDE PHYSICIANS AND SURGEONS PRACTICING IN THE FOLLOWING AREAS: FAMILY PRACTICE, INTERNAL MEDICINE, OBSTETRICS & GYNECOLOGY, ORTHOPEDICS & SPORTS MEDICINE, PEDIATRICS, PSYCHIATRY, SURGERY AND UROLOGY, AND BIRTHPLACE SERVICES. IN ADDITION, FMCH HAS SPECIALTY CLINICS IN THE FOLLOWING AREAS: CARDIOLOGY, DERMATOLOGY, OTOLARYNGOLOGY, GASTROENTEROLOGY AND NEUROLOGY, EMERGENCY DEPARTMENT SERVICES, HOME HEALTH CARE, HOSPICE, REHABILITATION/THERAPY SERVICES, LABORATORY AND PATHOLOGY SERVICES, AND WOUND HEALING CARE. | Desc |
| Total Program Service Expenses | $107,819,699 | 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 | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | Yes (1) | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 48 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 491 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHERYL ALBIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3193726530 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DAVE POLAND | ||||||||
| CHAIRPERSON | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NEAL DODD | ||||||||
| VICE CHAIRPERSON | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| VICKI STEPHENSON | ||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MATT WENZEL | ||||||||
| PRESIDENT & CEO | 24.00 | 16.00 | Yes (X) | Yes (X) | $0 | $859,097 | $55,534 | |
| STEVE DAVIS MD | ||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ANN MENKE | ||||||||
| DIRECTOR | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOANN LAMPE | ||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DEANNA BARR | ||||||||
| DIRECTOR (THRU 1/21) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN MCKILLIP | ||||||||
| DIRECTOR (THRU 1/21) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SHELBY BURCHETT | ||||||||
| COO/CEO | 10.00 | 30.00 | Yes (X) | $0 | $234,393 | $42,131 | ||
| DAN LINDHART | ||||||||
| VP OF FINANCE | 40.00 | 1.00 | Yes (X) | $181,123 | $0 | $36,197 | ||
| JEREMY ALEXANDER | ||||||||
| CFO | 1.00 | 42.00 | Yes (X) | $0 | $500,802 | $45,513 | ||
| BRENT WOODBURY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $749,598 | $0 | $44,196 | Yes (X) | ||
| TIMOTHY STAUDTE MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $533,906 | $0 | $45,388 | Yes (X) | ||
| DEREK BREDER MD | ||||||||
| PHYSICIAN | 40.00 | 1.00 | $532,104 | $0 | $35,261 | Yes (X) | ||
| YADIRA GARCIA MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $400,789 | $0 | $42,954 | Yes (X) | ||
| KOLLEEN BURNETT-BARNHARDT MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $354,924 | $0 | $44,742 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,752,444 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,594,292 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $391,916 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 47 | 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 |
|---|---|---|---|---|---|
| WAPITI MEDICAL STAFFING | |||||
| 6112 CHANCELLOR DRIVE | CEDAR FALLS | IA | 50613 | ER PHYSICIAN STAFFING | $2,668,377 |
| GREAT RIVER MEDICAL CENTER | |||||
| 1221 S GEAR AVENUE | WEST BURLINGTON | IA | 52655 | STAFFING | $869,505 |
| GE HEALTHCARE IITS USA CORP | |||||
| 6112 CHANCELLOR DRIVE | CEDAR FALLS | IA | 50613 | TECHNICAL SUPPORT | $686,443 |
| MUTUAL CONSULTING & MANAGEMENT | |||||
| 1221 S GEAR AVENUE | WEST BURLINGTON | IA | 52655 | EXECUTIVE MANAGEMENT | $318,205 |
| MIDWEST ANESTHESIA CARE | |||||
| 400 E 10TH ST | WACONIA | MN | 55387 | ANESTHESIA STAFFING | $296,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 38 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $5,752,196 | RelatedOrganizationsAmt |
| Government Grants | $91,335 | GovernmentGrantsAmt |
| Noncash Contributions | $7,980 | NoncashContributionsAmt |
| Total Contributions | $5,843,531 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE RE | 621110 | $51,361,521 | $51,361,521 |
| PHARMACY REVENUE | 446110 | $5,226,405 | $5,226,405 |
| SE RENAL DIALYSIS K-1 | 621400 | $905,814 | $905,814 |
| CAFETERIA REVENUE | 900099 | $144,747 | $144,747 |
| ADVANCE PT K-1 | 621400 | $61,006 | $61,006 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $82,502 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $48,317 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $34,185 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $57,781,995 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $295,431 | TotalRevenueColumnAmt |
| Exclusion | $295,431 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $145,448 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $211,156 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$65,708 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$65,708 | TotalRevenueColumnAmt |
| Exclusion | -$65,708 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,425 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$1,425 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,425 | TotalRevenueColumnAmt |
| Exclusion | -$1,425 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $64,065 | TotalRevenueColumnAmt |
| Exclusion | $64,065 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $64,065 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,917,889 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $57,747,810 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $34,185 | UnrelatedBusinessRevenueAmt |
| Exclusion | $292,363 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,661,060 | TotalAmt |
| Program Services | $62,661,060 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,004 | TotalAmt |
| Management And General | $457,004 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,424,328 | TotalAmt |
| Program Services | $20,534,021 | ProgramServicesAmt |
| Management And General | $2,890,307 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $922,324 | TotalAmt |
| Program Services | $798,967 | ProgramServicesAmt |
| Management And General | $123,357 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,438,394 | TotalAmt |
| Program Services | $3,862,014 | ProgramServicesAmt |
| Management And General | $576,380 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,497,343 | TotalAmt |
| Program Services | $1,290,113 | ProgramServicesAmt |
| Management And General | $207,230 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,047 | TotalAmt |
| Management And General | $15,047 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $260,586 | TotalAmt |
| Management And General | $260,586 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,857 | TotalAmt |
| Management And General | $69,857 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,977,805 | TotalAmt |
| Program Services | $6,144,257 | ProgramServicesAmt |
| Management And General | $4,833,548 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $322,701 | TotalAmt |
| Management And General | $322,701 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,147 | TotalAmt |
| Program Services | $120,625 | ProgramServicesAmt |
| Management And General | $208,522 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,059,154 | TotalAmt |
| Program Services | $588,318 | ProgramServicesAmt |
| Management And General | $470,836 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,659 | TotalAmt |
| Program Services | $52,855 | ProgramServicesAmt |
| Management And General | $3,804 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,449 | TotalAmt |
| Program Services | $23,194 | ProgramServicesAmt |
| Management And General | $9,255 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,820,110 | TotalAmt |
| Program Services | $2,730,516 | ProgramServicesAmt |
| Management And General | $1,089,594 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $656,174 | TotalAmt |
| Management And General | $656,174 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUG | $8,503,746 | $8,503,746 | |
| PROVISION FOR BAD DEBTS | $1,940,108 | $1,940,108 | |
| REPAIRS & MAINTENANCE | $446,646 | $356,192 | $90,454 |
| MEDICAID ASSESSMENT | $394,422 | $394,422 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $289,351 | TotalAmt |
| Program Services | $153,821 | ProgramServicesAmt |
| Management And General | $135,530 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,574,415 | TotalAmt |
| Program Services | $107,819,699 | ProgramServicesAmt |
| Management And General | $14,754,716 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,563,052 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,889,622 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $504,087 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $609,670 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,393,610 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,902,230 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,099,378 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,331,649 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,627,976 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,216,763 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,755,191 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,190,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,789,930 | BOYAmt |
| EOY | $0 | 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 | $43,356,079 | BOYAmt |
| EOY | $0 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,185,640 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,541,719 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,331,649 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$58,656,526 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $3,952,561 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,162,246 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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) |
|---|---|---|
| Political Expenditures | $0 | PoliticalExpendituresAmt |
| Volunteer Hours | 0 | VolunteerHoursCnt |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| 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 | $12,407 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $12,407 | 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 | FORT MADISON COMMUNITY HOSPITAL PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION. THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. | ExplanationTxt |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| 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) |
|---|---|---|
| Total Community Benefit Expns | $833,504 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $833,504 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00690 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,101,492 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,851,769 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,934,996 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,851,769 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $833,504 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00690 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $91,323 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $91,323 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,478,688 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,191,835 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $286,853 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,544 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,544 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,585,555 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,191,835 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $393,720 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,520,551 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,043,604 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,227,224 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,940,108 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $11,312,687 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,578,202 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,265,515 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5445 AVENUE O PO BOX 174 | AddressLine1Txt |
| City | FORT MADISON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52627 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FMCHOSP.COM | WebsiteAddressTxt |
| State License | 560087H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | TRAUMA CENTER | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS//WWW.FMCHOSP.COM/COMMUNITY-WELLNESS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.FMCHOSP.COM | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.FMCHOSP.COM/PATIENTS-VISITORS/FMCH-CHARITY-POLICY/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.FMCHOSP.COM/PATIENTS-VISITORS/FMCH-CHARITY-POLICY | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.FMCHOSP.COM/PATIENTS-VISITORS/FMCH-CHARITY-POLICY | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 3J: THE HOSPITAL HAS A WRITTEN CHARITY CARE POLICY IN PLACE TO ENSURE THAT NECESSARY HEALTH CARE SERVICES ARE NOT DENIED BASED ON ABILITY TO PAY AND THAT ALL PATIENTS ARE TREATED FAIRLY AND EQUITABLY, AND WITH RESPECT AND COMPASSION, THE HOSPITAL ASSISTS PERSONS WITHOUT INSURANCE COVERAGE BY WAIVING ALL OR PART OF THE CHARGES FOR SERVICES IT PROVIDES. CHARGES FOR SERVICES ARE DISCOUNTED ON A SLIDING FEE SCALE BASED ON FEDERAL POVERTY GUIDELINES. INDIVIDUALS WHOSE INCOME IS WITHIN 0% TO 300% OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE FOR FREE OR DISCOUNTED SERVICES. |
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: THE FIRST STEP OF THE PROCESS WAS A COUNTY-WIDE SURVEY MADE AVAILABLE THROUGH SURVEYMONKEY AND PAPER COPIES. THE PURPSOE OF THE SURVEY WAS TO GET COMMUNITY MEMBERS' VIEWPOINT ON THE HEALTH NEEDS OF THE COUNTY. WE WORKED WITH COUNTY LIBRARIES, HEALTH DEPARTMENT AGENCIES, LARGE EMPLOYERS, AND PUBLIC INVITATION THROUGH MASS MEDIA TO ENCOURAGE PARTICIPATION. THE SURVEYS WERE MADE AVAILABLE FROM MAY THROUGH SEPTEMBER 2018. THE RESULTS OF THE SURVEY WERE COMPILED, AND A TOWN HALL MEETING WAS HELD ON OCTOBER 4, 2018. THIS WAS AN OPEN MEETING HELD IN THE COUNTY - COUNTY LEADERS, HEALTH CARE PROFESSIONALS, AND THE GENERAL PUBLIC WERE INVITED TO ATTEND. THE PARTICIPANTS WERE GIVEN COUNTY DATA ALONG WITH THE SURVEY RESULTS. THEY WERE THEN LED THROUGH THE PROCESS OF DRILLING DOWN TO THE MOST PREVALENT AND IMMEDIATE COMMUNITY HEALTH NEEDS FOR THE COUNTY. THE RESULTS WERE DRAFTED BY THE LEE COUNTY HEALTH DEPARTMENT, AND FMCH FORMULATED THEIR GOALS. AFTER FORMULATING THEIR GOALS, FMCH HAD THEM APPROVED BY THE LEE COUNTY BOARD OF HEALTH. |
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6A: UNITY POINT KEOKUK |
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6B: LEE COUNTY HEALTH DEPARTMENT |
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: FORT MADISON COMMUNITY HOSPITAL PARTNERED WITH THE LEE COUNTY HEALTH DEPARTMENT AND UNITY POINT KEOKUK TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. THIS CONSISTED OF A COMMUNITY-WIDE SURVEY AND TOWN HALL MEETING. THE FOLLOWING OUTLINE THE HEALTH NEEDS IDENTIFIED AS 2020-2023 COMMUNITY HEALTH NEEDS, GOALS, AND THE STRATEGIES FORT MADISON COMMUNITY HOSPITAL WILL EMPLOY TO ADDRESS THESE NEEDS. 1.) FORT MADISON COMMUNITY HOSPITAL IS DEDICATED TO PROMOTING HEALTHY BEHAVIORS AND IMPROVING HEALTH OUTCOMES TO ACHIEVE THIS GOAL. WE HAVE ADOPTED STRATEGIES TO REDUCE OBESITY RATES AND PREVENTABLE HOSPITAL STAYS DUE TO CHRONIC DISEASE, PREVENT OR REDUCE TEEN BIRTHS AND STD'S, PREVENT AND REDUCE ALCOHOL, TOBACCO, AND OTHER DRUG ABUSE AMONG OUR YOUTH AND YOUNG ADULTS, AND IMPROVE THE MENTAL HEALTH AND WELL-BEING OF OUR POPULATION. 2.) FOCUS ON PROMOTING ELDERLY WELLNESS BY IMPLEMENTING STRATEGIES TO IMPROVE THE HEALTH, FUNCTION, AND QUALITY OF LIFE OF OLDER ADULTS. FORT MADISON COMMUNITY HOSPITAL IS DEDICATED TO MAKING A STRONGER, HEALTHIER COMMUNITY. |
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 16J: IN ADDITION TO THE METHODS IDENTIFIED IN PART V, SECTION B, QUESTIONS 16A-16H, FORT MADISON COMMUNITY HOSPITAL WILL ALSO ADVISE INDIVIDUALS AND FAMILIES OF THE FINANCIAL ASSISTANCE POLICY THROUGH THE FOLLOWING METHODS - DIRECT PATIENT CONTACT, IN PERSON OR ON THE PHONE - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE WILL BE POSTED IN REGISTRATION AREAS, EMERGENCY DEPARTMENT, AND OTHER WAITING AREAS - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE IS PRINTED ON PATIENT STATEMENTS - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED ON THE HOSPITAL'S WEBSITE ALONG WITH THE FINANCIAL ASSISTANCE POLICY - OUTREACH TO PUBLIC AGENCIES AND OTHER NOT-FOR-PROFIT AGENCIES SERVING THE COMMUNITY MOST LIKELY TO UTILIZE FINANCIAL ASSISTANCE. |
| FORT MADISON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 20E: IN ADDITION TO THE METHODS IDENTIFIED IN PART V, SECTION B, QUESTIONS 20A-20D, FORT MADISON COMMUNITY HOSPITAL WILL ALSO ADVISE INDIVIDUALS AND FAMILIES OF THE FINANCIAL ASSISTANCE POLICY THROUGH THE FOLLOWING METHODS - DIRECT PATIENT CONTACT, IN PERSON OR ON THE PHONE - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE WILL BE POSTED IN REGISTRATION AREAS, EMERGENCY DEPARTMENT, AND OTHER WAITING AREAS - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE IS PRINTED ON PATIENT STATEMENTS - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED ON THE HOSPITAL'S WEBSITE ALONG WITH THE FINANCIAL ASSISTANCE POLICY - OUTREACH TO PUBLIC AGENCIES AND OTHER NOT-FOR-PROFIT AGENCIES SERVING THE COMMUNITY MOST LIKELY TO UTILIZE FINANCIAL ASSISTANCE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SOUTHEASTERN RENAL DIALYSIS LLC | ||||
| 407 SOUTH WHITE STREET | MT PLEASANT | IA | 52641 | DIALYSIS SERVICES |
| 2 - ADVANCE PHYSICAL THERAPY LLC | ||||
| 3032 BROADWAY | QUINCY | IL | 62301 | PHYSICAL THERAPY |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NOT APPLICABLE |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS PREPARED BY FORT MADISON COMMUNITY HOSPITAL AND IS NOT INCLUDED IN A REPORT PREPARED BY ITS RELATED ORGANIZATIONS. |
| PART I, LINE 7: | THE ORGANIZATION CALCULATED THE COST AMOUNTS NOTED IN PART I, LINE 7 BY UTILIZING ITS CURRENT COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS REPORTED ON, INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, MEDICAID, UNINSURED, AND MEDICARE WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, AS PROVIDED IN THE IRS INSTRUCTIONS, WAS USED TO DETERMINE THE APPROPRIATE RATIO. |
| PART I, LINE 7G: | THE AMOUNTS REPORTED ON LINE 7G ARE ASSOCIATED WITH PHYSICIAN SERVICES. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, RELATES TO THE PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS THAT IS ALSO REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | NOT APPLICABLE |
| PART III, LINE 2: | THE ORGANIZATION USED ITS AUDITED FINANCIAL STATEMENTS TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE TO REPORT ON LINE 2. |
| PART III, LINE 3: | NOT APPLICABLE |
| PART III, LINE 4: | THE ORGANIZATION DOES NOT ISSUE A STANDALONE FINANCIAL STATEMENT; HOWEVER, IT IS INCLUDED AS A PART OF THE GREAT RIVER HEALTH SYSTEM, INC. AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. THE FOOTNOTE FROM THE CONSOLIDATED FINANCIAL STATEMENT IS AS FOLLOWS: "ACCOUNTS RECEIVABLE CONSISTS MAINLY OF PATIENT RECEIVABLES. PATIENT RECEIVABLES WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BOTH BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND AND BY CONSIDERING THE PATIENTS' FINANCIAL HISTORY, CREDIT HISTORY, AND CURRENT ECONOMIC CONDITIONS. GREAT RIVER MEDICAL CENTER, RIVERVIEW SYSTEM, LTD, AND FORT MADISON COMMUNITY HOSPITAL DO NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A RECOVERY OF BAD DEBT WHEN RECEIVED."THE CHARITY CARE FOOTNOTE DISCLOSURE AS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENT IS AS FOLLOWS:"GREAT RIVER MEDICAL CENTER AND FORT MADISON COMMUNITY HOSPITAL PROVIDE CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE MEDICAL CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE." |
| PART III, LINE 8: | THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST-FINDING PROCESS, WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. ROUTINE AND ICU COSTS ARE DETERMINED BASED ON AN AVERAGE COST PER DAY MULTIPLIED BY THE NUMBER OF MEDICARE ALLOWABLE DAYS. MEDICARE ANCILLARY COSTS ARE DETERMINED BY THE RATIO OF DEPARTMENT COSTS TO DEPARTMENT CHARGES. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. |
| PART III, LINE 9B: | THE FORT MADISON COMMUNITY HOSPITAL (FMCH) CHARITY PROGRAM IS DESIGNED TO IDENTIFY THOSE ACCOUNTS WHERE THE GUARANTOR IS NOT ABLE TO MAKE PAYMENT, OR IS ABLE TO MAKE ONLY LIMITED PAYMENTS THAT WOULD CAUSE A DEFINITE HARDSHIP ON THE HOUSEHOLD, AND "ADJUST" THOSE ACCOUNTS AS EARLY AS POSSIBLE. FINANCIAL EVALUATION OF A PATIENT - IF THE PRIMARY PAYOR IS OTHER THAN AN INSURANCE COMPANY, FMCH EVALUATES THE ABILITY OF THE GUARANTOR TO 1) HANDLE THE PROJECTED FINANCIAL OBLIGATION PERSONALLY, 2) QUALIFY FOR COUNTY, STATE, OR FEDERAL ASSISTANCE (ASSISTANCE MAY BE AVAILABLE IF A) THERE ARE DEPENDENT CHILDREN IN THE HOME [MEDICAID], B) POSSIBLE DETERMINATION OF DISABILITY BY THE SOCIAL SECURITY ADMINISTRATION, AND C) PATIENT IS PREGNANT [MEDICAID]), 3) IF PATIENT APPEARS TO QUALIFY FOR ASSISTANCE IN ONE OF THE ABOVE CATEGORIES, FMCH EVALUATES HOW LIKELY IT IS THAT THE PATIENT WILL FOLLOW THROUGH WITH THE APPLICATION PROCESS (IF THE PATIENT IS NOT LIKELY TO FOLLOW THROUGH, ASSISTANCE IS OBTAINED FROM AN OUTSIDE AGENCY TO HELP THE PATIENT THROUGH THE APPLICATION PROCESS), 4) IF THE INITIAL REVIEW INDICATES THERE IS NO OTHER PAYOR THAN THE INDIVIDUAL GUARANTOR, AND AN ASSESSMENT OF THE GUARANTOR'S MEANS (INCOME, ASSETS, AND LIABILITIES) LEAVES CONSIDERABLE QUESTIONS AS TO HOW HE/SHE WILL RESOLVE THE IMPENDING DEBT, FMCH THEN DETERMINES IF FULL OR PARTIAL CHARITY IS APPROPRIATE, 5) RESIDENCY TEST - TO BE ELIGIBLE FOR CHARITY CARE, THE PATIENT'S HOME MUST BE WITHIN THE PRIMARY OR SECONDARY SERVICE AREA OF FMCH (THESE AREAS ARE DEFINED BY ZIP CODES), 6) USING THE COMPLETE PERSONAL FINANCIAL STATEMENT, A COPY OF THE MOST RECENT TAX RETURN, A COPY OF THE MOST RECENT PAYROLL STUBS, AND ANY OTHER INFORMATION THAT MAY BE APPROPRIATE, THE GUARANTOR'S INCOME MUST BE EVALUATED ON A SLIDING SCALE BASED ON POVERTY GUIDELINES, 7) ADDITIONAL CIRCUMSTANCES SUCH AS, BUT NOT LIMITED TO, IF THE GUARANTOR HAS LIMITED CASH INCOME BUT HAS SIGNIFICANT PROPERTY HOLDINGS (PERSONAL OR BUSINESS), THOSE ASSETS MUST BE TAKEN INTO ACCOUNT AND MAY SUPERSEDE THE APPLICATION OF THE ABOVE DISCOUNT GUIDELINES, NEGOTIATIONS - DEPENDENT UPON THE GUARANTOR'S MEANS, FMCH MAY NEGOTIATE A SETTLEMENT IF A REASONABLE MONTHLY PAYMENT FOR THE BALANCE OWED CAN NOT BE AGREED UPON, IT IS IN EVERYONE'S BEST INTEREST TO RESOLVE THE DEBT EARLIER BY AGREEING TO A NEGOTIATED AMOUNT. RECOMMENDATIONS FROM STAFF SUCH AS THE CEO, CFO, DON, RU, DOCTORS AND DEPARTMENT HEADS TO ASSIST WITH PATIENTS THAT ARE HAVING FINANCIAL DIFFICULTY IS ALWAYS CONSIDERED. FOLLOWING DISCHARGE OR BILLING, A DETERMINATION OF CHARITY MAY BE MADE BY USING THE ABOVE PROCESS AS SOON AS THE QUESTION OF POSSIBLE CHARITY IS RAISED. THIS DETERMINATION SHOULD ALWAYS BE MADE AT THE EARLIEST POSSIBLE TIME IN THE LIFE OF THE ACCOUNT. |
| PART VI, LINE 2: | FORT MADISON COMMUNITY HOSPITAL UTILIZES A COMMUNITY HEALTH NEEDS ASSESSMENT PERFORMED BY THE LOCAL UNITED WAY. IN ADDITION TO THIS NEEDS ASSESSMENT, THE HOSPITAL BOARD OF DIRECTORS HOLD AN ANNUAL PLANNING MEETING WITH REPRESENTATIVES FROM THE MEDICAL STAFF IN ATTENDANCE. THIS PHYSICIAN REPRESENTATION ALLOWS FOR GOOD INPUT OF THE COMMUNITY MEDICAL NEEDS BY THOSE THAT ARE CLOSEST TO THE ISSUES. |
| PART VI, LINE 3: | THE HOSPITAL HAS A WRITTEN CHARITY CARE POLICY IN PLACE TO ENSURE THAT NECESSARY HEALTH CARE SERVICES ARE NOT DENIED BASED ON ABILITY TO PAY AND THAT ALL PATIENTS ARE TREATED FAIRLY AND EQUITABLY, AND WITH RESPECT AND COMPASSION. THE HOSPITAL ASSISTS PERSONS WITHOUT INSURANCE COVERAGE BY WAIVING ALL OR PART OF THE CHARGES FOR SERVICES IT PROVIDES. CHARGES FOR SERVICES ARE DISCOUNTED ON A SLIDING FEE SCALE BASED ON FEDERAL POVERTY GUIDELINES. INDIVIDUALS WHOSE INCOME IS WITHIN 0% TO 300% OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE FOR FREE OR DISCOUNTED SERVICES. |
| PART VI, LINE 4: | FORT MADISON COMMUNITY HOSPITAL SERVES A COMMUNITY OF APPROXIMATELY 11,051 AND A COMBINED SERVICE AREA OF APPROXIMATELY 58,378. THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES MOST OF LEE COUNTY, IA AS WELL AS PORTIONS OF HANCOCK COUNTY, IL. THE PRIMARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 42,365 AND A MEDIAN AGE OF 40. FORT MADISON COMMUNITY HOSPITAL RECEIVES 50.8% OF THE PRIMARY SERVICE AREA INPATIENT MARKET SHARE. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES PORTIONS OF LEE COUNTY, IA, VAN BUREN COUNTY, IA AND HANCOCK COUNTY, IL. THE SECONDARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 16,013 AND A MEDIAN AGE OF 44. FORT MADISON COMMUNITY HOSPITAL RECEIVES 10.2% OF THE SECONDARY SERVICE AREA INPATIENT MARKET SHARE. |
| PART VI, LINE 5: | FORT MADISON COMMUNITY HOSPITAL IS AN INTIMATE PART OF PROMOTING HEALTHY LIFESTYLES IN OUR COMMUNITY. WE ARE ACTIVE PARTICIPANTS ON THE LIVE HEALTHY LEE COUNTY COALITION, COMMUNITY TASK FORCES FORMED AS A RESULT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND THE NATIONAL ALLIANCE ON MENTAL HEALTH (NAMI). WE PARTNER WITH THE LEE COUNTY HEALTH DEPARTMENT ON MANY PROJECTS THAT EDUCATE AND MOTIVATE COMMUNITY MEMBERS TO ADOPT HEALTHY HABITS, I.E. VETERAN'S HEALTH FAIR, PRODUCE BOXES, ETC. THE HOSPITAL SPONSORED OR PARTICIPATED IN COMMUNITY HEALTH FAIRS AND THE COMMUNITY HEALTH AND FITNESS FAIR IS HELD ANNUALLY BY THE HOSPITAL FOR THE COMMUNITY, CONSISTING OF VARIOUS EXHIBITS ON HEALTH-RELATED TOPICS. IT IS OPEN TO ALL AGES. ANOTHER ANNUAL EVENT IS THE WOMMEN'S HEALTH CONFERENCE FOR AREA WOMEN OF ALL AGES. THE CONFERENCE INCLUDES SPEAKERS ON WOMEN'S HEALTH-RELATED ISSUES. THE HOSPITAL ALSO SPONSORS A KID'S DAY AT THE LEE COUNTY FAIR, THE LEE COUNTY FAIR SENIOR DAY, AND THE LOCAL RELAY FOR LIFE. FORT MADISON COMMUNITY HOSPITAL IS A STAUNCH SUPPORTER, BOTH FINANCIALLY AND WITH STAFFING, FOR COMMUNITY PROJECTS THAT PROMOTE AN ACTIVE LIFESTYLE. THIS INCLUDES THE PORT RECREATIONAL TRAIL DEVELOPMENT, THE LOCAL YMCA, AND THE BUILDING OF THE BAXTER SPORTS COMPLEX. FORT MADISON COMMUNITY HOSPITAL PROVIDES FULL-TIME ATHLETIC TRAINERS TO THE TWO AREA HIGH SCHOOLS IN OUR PRIMARY SERVICE AREA. THESE HEAVILY SUBSIDIZED POSITIONS PROVIDE FOR THE HEALTH AND SAFETY OF STUDENT ATHLETES. AS PART OF THIS PROGRAM, WE ALSO OFFER ATHLETIC SCREENINGS AT A DISCOUNTED RATE WITH HALF OF THE PROCEEDS DONATED BACK TO THE SCHOOLS. FORT MADISON COMMUNITY HOSPITAL FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH. THE ORGANIZATION ALSO EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARMENTS. FORT MADISON COMMUNITY HOSPITAL IS COMMITTED TO SERVING THE RESIDENTS OF THE AREA COMMUNITIES. THE HOSPITAL CONTINUES THESE EFFORTS BY USING EXCESS FUNDS TO EXPAND ITS FACILITIES AND SERVICES TO BETTER SERVE THE COMMUNITY. WE CONTRACT WITH AREA SPECIALISTS TO HOLD ONSITE CLINICS SO OUR PATIENTS CAN GET THE CARE THEY NEED WITHOUT HAVING TO TRAVEL OUTSIDE THE AREA. WE FINANCIALLY SUPPORT A REGIONAL DIALYSIS CENTER IN FORT MADISON, WHICH IS A COLLABORATIVE EFFORT OF ALL SOUTHEAST IOWA HEALTH CARE ORGANIZATIONS. FORT MADISON COMMUNITY HOSPITAL ACTS AS A TEACHING RESOURCE AT ALL LEVELS OF HEALTH CARE EDUCATION, INCLUDING HIGH SCHOOL STUDENTS, COLLEGE STUDENTS IN A VARIETY OF HEALTH CARE CAREERS, AND MEDICAL STUDENTS DOING CLINICAL ROTATIONS. FORT MADISON COMMUNITY HOSPITAL IS A DIPROPORTIONATE SHARE (FOR MEDICAID) HOSPITAL WHICH PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE, AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. PAYMENTS FOR SERVICES PROVIDED TO BENEFICIARIES OF THESE PROGRAMS ARE BASED ON PRE-ESTABLISHED AND UNILATERALLY SET FEE SCHEDULES IN ACCORDANCE WITH THE PATIENT'S DIAGNOSIS OR TEST OR PROCEDURE PERFORMED. THE DIFFERENCE BETWEEN THE SERVICE PRICE AND THE CONTRACTED PRICE IS WRITTEN-OFF BY THE HOSPITAL. THE CONTRACTED AMOUNT RECEIVED FROM THESE PROGRAMS IS OFTEN LESS THAN THE ACTUAL COST OF THE SERVICE, THE DIFFERENCE OF WHICH REPRESENTS A BENEFIT TO THE PATIENT AND THE COMMUNITY. FORT MADISON COMMUNITY HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS OPEN 24 HOURS A DAY, 365 DAYS PER YEAR. THE EMERGENCY ROOM HAS A TRAUMA CENTER WITH A CERTIFICATION LEVEL OF IV. THE HOSPITAL'S EMERGENCY ROOM PROVIDES SERVICES TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY, AND DENIES SERVICES TO NO ONE. FORT MADISON COMMUNITY HOSPITAL PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES IN A VARIETY OF WAYS. FMCH EMPLOYEES ROUTINELY PARTICIPATE IN COMMUNITY ACTIVITIES SUCH AS PARADES, FIRST AID TENTS AT COMMUNITY EVENTS, AND A VARIETY OF LOCAL CHARITY ACTIVITIES. MEMBERS OF OUR LEADERSHIP TEAM SIT ON THE FORT MADISON CHAMBER OF COMMERCE, FORT MADISON ECONOMIC DEVELOPMENT, AND LOCAL CIVIC ORGANIZATIONS. THE OUTPATIENT REHABILITATION CENTER INCLUDES AN INDOOR WALKING TRACK FOR USE BY THE PUBLIC. THE WALKING TRACK IS USED TO PROMOTE WELLNESS WITH ALL OF OUR CLIENT GROUPS, BUSINESSES, PATIENTS, AND EMPLOYEES. IN ADDITION, THE HOSPITAL MAINTAINS AN OUTDOOR WALKING TRACK OPEN FOR PUBLIC USE. THE HOSPITAL PROVIDES VARIOUS PROGRAMS AND SERVICES TO INFORM AND TRAIN MEMBERS OF THE COMMUNITY ON SAFETY, HEALTH AND LIFESTYLE TOPICS, AS WELL AS PROVIDE OPPORTUNITIES FOR LEARNING IN A SAFE ENVIRONMENT. THE PROGRAMS ARE FREE OR A NOMINAL FEE IS CHARGED TO DEFRAY A PORTION OF THE COST. EXAMPLES OF THE PROGRAMS ARE EDUCATION PROGRAMS FOR CPR/FIRST AID, PRENATAL, FAMILY/PARENTING AND SIBLING RELATIONSHIPS, AS WELL AS TRAINING TO STUDENTS OF A VARIETY OF AGES. THE HOSPITAL PROVIDES A COURTESY TRANSPORTATION SERVICE TO RESIDENTS OF SEVERAL AREA COMMUNITIES. VARIOUS PICK-UP TIMES AND LOCATIONS ARE PROVIDED. FORT MADISON COMMUNITY HOSPITAL MAINTAINS A WEBSITE TO PROVIDE THE COMMUNITY WITH ACCESS TO PROVIDER INFORMATION, COMMUNITY PROGRAMS, HEALTH SERVICES, EMPLOYMENT OPPORTUNITIES, AND THE PATIENT PORTAL. THE HOSPITAL PROVIDES VARIOUS SERVICES TO AREA BUSINESSES ON A CONTRACT BASIS, INCLUDING EDUCATION PROGRAMS ON WELLNESS AND WORKPLACE INJURY PREVENTION, ON-SITE ERGONOMIC EVALUATIONS, DRUG/ALOCHOL TESTING/SCREENING, EVALUATION OF WORK-RELATED INJURIES, AND VACCINES. THE HOSPITAL UNDERWRITES A PORTION OF THE COST OF THESE SERVICES. |
| PART VI, LINE 6: | UPON THE AFFILIATION OF GREAT RIVER HEALTH AND FORT MADISON COMMUNITY HOSPITAL, A GRHS-FMCH COMMUNITY HEALTH FOUNDATION WAS FORMED TO PROVIDE FINANCIAL SUPPORT FOR COMMUNITY PROJECTS THAT WILL POSITIVELY AFFECT THE HEALTH OF OUR COMMUNITY. THE FIRST PROJECT FUNDED IS AN EXPANSION OF RECREATIONAL TRAILS IN FORT MADISON THROUGH PORT OF FORT MADISON. RECREATIONAL TRAILS PROVIDE A TOOL TO ENCOURAGE HEALTHY LIVING. THIS IS ALSO ONE OF OUR CHNA GOALS. WE WILL CONTINUE TO LOOK FOR WAYS TO WORK TOGETHER TO IMPACT THE HEALTH OF OUR COMMUNITIES WE SERVE. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| LEE COUNTY ECONOMIC DEVELOPMENT GROUP | |||||||
| 2700 KINDUSTRY PARK ROAD | KEOKUK | IA | 52632 | 043605260 | 501(C)(3) | $5,000 | ECONOMIC DEVELOPMENT |
| GREAT RIVER MEDICAL CENTER | |||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 420680407 | 501(C)(3) | $62,646,645 | CONTRIBUTION OF ASSETS DUE TO MERGER |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MATT WENZEL | ||||||||||||||
| PRESIDENT & CEO | $0 | $855,707 | $0 | $0 | $0 | $3,390 | $0 | $11,400 | $0 | $44,134 | $0 | $914,631 | $0 | $0 |
| BRENT WOODBURY MD | ||||||||||||||
| PHYSICIAN | $645,986 | $0 | $103,612 | $0 | $0 | $0 | $14,250 | $0 | $29,946 | $0 | $793,794 | $0 | $0 | $0 |
| TIMOTHY STAUDTE MD | ||||||||||||||
| PHYSICIAN | $501,163 | $0 | $32,743 | $0 | $0 | $0 | $14,250 | $0 | $31,138 | $0 | $579,294 | $0 | $0 | $0 |
| DEREK BREDER MD | ||||||||||||||
| PHYSICIAN | $484,330 | $0 | $47,774 | $0 | $0 | $0 | $14,250 | $0 | $21,011 | $0 | $567,365 | $0 | $0 | $0 |
| JEREMY ALEXANDER | ||||||||||||||
| CFO | $0 | $499,517 | $0 | $0 | $0 | $1,285 | $0 | $11,400 | $0 | $34,113 | $0 | $546,315 | $0 | $0 |
| YADIRA GARCIA MD | ||||||||||||||
| PHYSICIAN | $302,236 | $0 | $98,553 | $0 | $0 | $0 | $12,462 | $0 | $30,492 | $0 | $443,743 | $0 | $0 | $0 |
| KOLLEEN BURNETT-BARNHARDT MD | ||||||||||||||
| PHYSICIAN | $263,742 | $0 | $91,182 | $0 | $0 | $0 | $14,250 | $0 | $30,492 | $0 | $399,666 | $0 | $0 | $0 |
| SHELBY BURCHETT | ||||||||||||||
| COO/CEO | $0 | $197,607 | $0 | $0 | $0 | $36,786 | $0 | $9,828 | $0 | $32,303 | $0 | $276,524 | $0 | $0 |
| DAN LINDHART | ||||||||||||||
| VP OF FINANCE | $169,382 | $0 | $0 | $0 | $11,741 | $0 | $7,116 | $0 | $29,081 | $0 | $217,320 | $0 | $0 | $0 |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail (7 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| GREAT RIVER MEDICAL CENTER | |||||||||
| CASH | 2021-06-30 | $10,805,325 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| GREAT RIVER MEDICAL CENTER | |||||||||
| ACCOUNTS RECEIVABLE | 2021-06-30 | $7,177,224 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| GREAT RIVER MEDICAL CENTER | |||||||||
| INVENTORIES | 2021-06-30 | $579,416 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| GREAT RIVER MEDICAL CENTER | |||||||||
| PREPAID EXPENSES | 2021-06-30 | $646,119 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| GREAT RIVER MEDICAL CENTER | |||||||||
| LAND, BUILDINGS AND EQUIPMENT, NET | 2021-06-30 | $18,574,648 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| GREAT RIVER MEDICAL CENTER | |||||||||
| INVESTMENTS - PUBLIC SECURITIES | 2021-06-30 | $18,097,969 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| GREAT RIVER MEDICAL CENTER | |||||||||
| INVESTMENTS - PROGRAM RELATED | 2021-06-30 | $6,765,944 | ACTUAL COST | 420680407 | 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 501(C)3 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | Yes (1) | DirectorOfSuccessorInd |
| Employee Of Successor | 0 | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2E: | PERSON(S) INVOLVED: MATT WENZEL |
| PART I, LINE 2E: | EXPLANATION OF INVOLVEMENT: MATT WENZEL IS PRESIDENT/CEO OF THE ENTIRE HEALTH SYSTEM THAT INCLUDES FORT MADISON COMMUNITY HOSPITAL AND GREAT RIVER MEDICAL CENTER. AFTER THE MERGER HE WILL CONTINUE HIS ROLE AS PRESIDENT/CEO. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | GREAT RIVER HEALTH SYSTEM BEGAN PROVIDING MANAGEMENT SERVICES TO THE FORT MADISON COMMUNITY HOSPITAL AS OF AUGUST 1, 2018. GREAT RIVER HEALTH SYSTEM BEGAN COMPENSATING JEREMY ALEXANDER DURING THE CALENDAR YEAR ENDED DECEMBER 31, 2018. COMPENSATION FROM GREAT RIVER HEALTH SYSTEM IS INCLUDED IN REPORTABLE COMPENSATION IN PART VII, LINE 1 AND SCHEDULE J, AS APPLICABLE. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION AMENDED THEIR BYLAWS IN JANUARY 2021. THERE WERE SPECIFIC POWERS THAT WERE RESERVED STRICTLY FOR GRHS. THOSE ITEMS INCLUDED ELECT AND REMOVAL OF BOARD MEMBERS, AMENDING ARTICLES OF INCORPORATION AND BYLAWS, DISSOLVING OR MERGING, AND APPROVING BUDGET AND DEBT. THE BOARD SIZE WAS DROPPED TO TOTAL OF 7 MEMBERS. THE COMMITTEE STRUCTURE OUTLINED THREE STANDING COMMITTEES THAT THE BOARD MEMBERS WOULD ATTEND. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT RIVER HEALTH SYSTEM, INC., A RELATED ORGANIZATION AND IOWA NONPROFIT CORPORATION, IS THE SOLE CORPORATE MEMBER OF FORT MADISON COMMUNITY HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS THE SOLE MEMBER OF FORT MADISON COMMUNITY HOSPITAL, GREAT RIVER HEALTH SYSTEM, INC., HAS THE EXCLUSIVE POWER TO APPOINT, AFTER NOMINATION OF DIRECTORS FOR ELECTION BY THE CORPORATION'S BOARD, ANY DIRECTOR TO THE CORPORATION'S BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | AS THE SOLE MEMBER OF FORT MADISON COMMUNITY HOSPITAL (FMCH), GREAT RIVER HEALTH SYSTEM, INC. (GRHS) HAS THE EXCLUSIVE POWER TO APPOINT, AFTER NOMINATION OF DIRECTORS FOR ELECTION BY THE CORPORATION'S BOARD, ANY DIRECTOR TO THE CORPORATION'S BOARD. THE BOARD OF DIRECTORS MAY ONLY REMOVE DIRECTORS THAT WERE NOT SELECTED AND APPOINTED BY GRHS. FMCH MUST ALSO RECEIVE CONSENT FROM GRHS' BOARD OF DIRECTORS FOR CERTAIN ACTIONS TO BE TAKE, SUCH AS ADOPTION OF STRATEGIC PLANS FOR FMCH OR FMCH AFFILIATES, ADOPTION OF OPERATING AND CAPITAL BUGETS FOR FMCH OR FMCH AFFILIATES, APPROVAL OF INDEBTEDNESS INCURRED BY FMCH OR FMCH AFFILIATES, THE TRANSFER, SALE, OR CLOSURE OF ANY FACILITY, DEPARTMENT OR FUNCTION OF FMCH OR FMCH AFFILIATES, ANY AMENDMENT TO THE ARTICLES OR BYLAWS OF FMCH OR FMCH AFFILIATES, ETC. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 WAS REVIEWED BY THE ORGANIZATION'S CONTROLLER AND VICE PRESIDENT OF FINANCE WITH THE EXTERNAL ACCOUNTANTS FOR COMPLETENESS AND ACCURACY PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOTH CORPORATE AND SUBSIDIARY BOARD MEMBERS ARE PROVIDED EDUCATION REGARDING CONFLICTS OF INTEREST. THIS EDUCATION IS PROVIDED BY THE CHIEF COMPLIANCE OFFICER. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. RELATIONSHIPS NOTED ON THE THIS FORM MAY BE DISCUSSED WITH THE RESPECTIVE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS RELATING TO THE TRANSACTION IN QUESTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF OFFICERS IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM, INC. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE CORPORATE BOARD OF DIRECTORS IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF THREE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON AN ANNUAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYSTEM, INC. PARTICIPATES IN AND UTILIZES EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP BIENNIALLY TO ASSESS AND VALIDATE THE ENTIRETY OF EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2021. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | EQUITY IN SUBSIDIARY EARNINGS 1,162,246. |
| PART XII, LINE 2C | THE PROCESS FOR SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GREAT RIVER HEALTH FOUNDATION INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421446727 | SUPPORT FORT MADISON COMMUNITY HOSPITAL | IA | 501(C)(3) | LINE 12A, I | FORT MADISON COMMUNITY HOSPITAL | Yes (1) | |
| GREAT RIVER HEALTH SYSTEM INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193185 | HOLDING COMPANY | IA | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| GREAT RIVER MEDICAL CENTER | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 420680407 | HOSPITAL | IA | 501(C)(3) | LINE 3 | GREAT RIVER HEALTH SYSTEM INC | Yes (1) | |
| GRMC FOUNDATION CORP | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193186 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | LINE 12B, II | GREAT RIVER HEALTH SYSTEM INC | Yes (1) | |
| GREAT RIVER FOUNDATION INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421469162 | SUPPORT FORT MADISON COMMUNITY HOSPITAL | IA | 501(C)(3) | LINE 12B, II | GREAT RIVER HEALTH SYSTEM INC | Yes (1) | |
| GRHS-FMCH COMMUNITY HEALTH FOUNDATION | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 832357759 | SPONSORS HEALTH INITIATIVES IN LEE COUNTY, IA | IA | 501(C)(3) | LINE 10 | GREAT RIVER HEALTH SYSTEM INC | Yes (1) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| RIVERVIEW SYSTEMS LTD | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421191960 | MEDICAL SERVICES | IA | N/A | C | 0 |
| GREAT RIVER MEDICAL SERVICES INC | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421493449 | MEDICAL SERVICES | IA | N/A | C | 0 |
| MUTUAL CONSULTING AND MANAGEMENT SERVICES | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421349668 | MANAGEMENT SERVICES | IA | N/A | C | 0 |
| HEALTH CARE REALTY | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193532 | REAL ESTATE | IA | N/A | C | 0 |
| HERITAGE PARK PHARMACY | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421191957 | PHARMACY | IA | N/A | C | 0 |
| HERITAGE MEDICAL EQUIPMENT AND SUPPLY | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421191958 | MEDICAL SUPPLY | IA | N/A | C | 0 |
| SOUTHEASTERN IOWA MEDICAL SERVICES | |||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421307141 | PHYSICIAN CLINICS | IA | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | 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 | Yes (1) | 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 | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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