2022-11-14T08:39:56-06:00 2021-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-01-01 421320763 PALMER LUTHERAN HEALTH CENTER INC PALM 5634223811 112 JEFFERSON ST WEST UNION IA 52175 BRENDA MOSER CFO 5634223811 2022-11-08 1 BRENDA MOSER 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-11-08 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z GUNDERSON PALMER LUTHERAN HOSPITAL AND CLINIC PATRICE KUENNEN 112 JEFFERSON ST WEST UNION IA 52175 42849075 0 X HTTPS://WWW.GUNDERSENHEALTH.ORG/PALMER/ X 1949 IA WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. 7 3 254 3 0 0 686691 4856172 30673211 37706881 20807 58538 82135 224665 31462844 42846256 8850 6000 0 0 12310249 18611368 0 0 0 17329664 15009546 29648763 33626914 1814081 9219342 33192593 40855020 23805643 22079586 9386950 18775434 X WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. 0 0 28664526 6000 37706881 PALMER LUTHERAN HEALTH CENTER IS A 25-LICENSED BED CRITICAL ACCESS HOSPITAL. THE ONLY HOSPITAL IN WEST UNION, IOWA, AND EMPLOYS ABOUT 240 EMPLOYEES. PALMER LUTHERAN HEALTH CENTER ALSO HAS THREE RURAL HEALTH CLINICS IN THE COMMUNITIES OF WEST UNION, FAYETTE AND POSTVILLE, A HOME CARE DEPARTMENT, HOSPICE DEPARTMENT, AND HOME MEDICAL EQUIPMENT DEPARTMENT. IN ADDITION, PALMER OPERATES AN AFTERHOURS AND WEEKEND WALK-IN CLINIC, ALLOWING PATIENTS TO BE SEEN 7 DAYS A WEEK IN THIS SETTING. THIS IS OFFERED TO SPECIFICALLY MEET COMMUNITY HEALTH NEEDS OF WORKING FAMILIES. ANNUALLY, PALMER HAS ABOUT 375 ADMISSIONS, OVER 70 LIVE BIRTHS; OVER 3,300 EMERGENCY CENTER VISITS, ABOUT 29,000 PATIENT VISITS IN THE CLINICS AND PERFORMS OVER 560 SURGERIES (INCLUDING AMBULATORY).ACCOMPLISHMENTS: WHEN RENOVATED, THE HOSPITAL WAS DESIGNED TO ACHIEVE THREE GOALS - CREATE A HEALING ENVIRONMENT THAT WELCOMES AND SUPPORTS PATIENTS/FAMILIES, DESIGN WORK AREAS TO BETTER ACCOMMODATE CURRENT AND FUTURE TECHNOLOGIES, SYSTEMS AND APPROACHES TO CARE, AND TO COMPLY MORE FULLY WITH HIPPA REGULATIONS. PALMER LUTHERAN HEALTH CENTER LEADS DELIVERY OF HEALTHCARE TO ITS REGION THROUGH OVER 215 ASSOCIATES (INCLUDING 3 PHYSICIANS, 5 PHYSICIANS ASSISTANTS, 3 NURSE PRACTITIONERS AND 1 CERTIFIED NURSE MIDWIFE ON STAFF) WHICH COORDINATE CARE TO DELIVER PATIENT CARE AS AN INTEGRATED UNIT. PALMER LUTHERAN HEALTH CENTER AND ITS AFFILIATES ALSO WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARDS FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO PALMER LUTHERAN HEALTH CENTER'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLY, PALMER LUTHERAN HEALTH C\CENTER IS GOVERNED BY A BOARD THAT INCLUDES 3 INDEPENDENT BOARD MEMBERS WHO ARE COMMUNITY LEADERS, CONSUMER REPRESENTATIVES, BUSINESS EXPERTS, AND CLINICAL HEALTHCARE EXPERTS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST OF INTEGRITY FOR THE BENEFIT OF THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER ALSO MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. PALMER OPERATES A FULL-TIME EMERGENCY ROOM AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. PALMER PROVIDES CLINICAL SERVICES NEEDED TO OPERATE THE EMERGENCY CENTER AND PROVIDES ON-SITE EMERGENCY MEDICAL, RESCUE AND MEDICAL TRANSPORTATION SERVICES. IN ADDITION, PALMER LUTHERAN HEALTH CENTER, THROUGH ITS INTEGRATED NETWORK OF PROVIDERS, PROVIDES NON-EMERGENCY SERVICES TO THE COMMUNITY IT SERVES. IT MAKES THESE SERVICES ACCESSIBLE TO THE COMMUNITY THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS LIKE MEDICARE AND MEDICAID AND BY HELPING THROUGH PALMER'S CHARITY CARE POLICY, AND SOCIAL SERVICES DEPARTMENT. PALMER LUTHERAN HEALTH CENTER UTILIZES TECHNOLOGY THAT PROVIDES A COMPLETE ELECTRONIC MEDICAL RECORD. OUR ELECTRONIC HEALTH RECORD IS CONNECTED TO GUNDERSEN HEALTH SYSTEM, WHICH ALLOWS US TO SHARE TEST RESULTS AND OTHER PATIENT INFORMATION. THIS ENHANCES THE PATIENT CARE AT OUR FACILITY, AS WELL AS OTHER GUNDERSEN ENTITIES THROUGHOUT THE REGION. THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNTS OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE HEALTH CENTER'S CHARITY CARE POLICY WERE $773,584 FOR THE YEAR ENDED DECEMBER 31, 2021. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION WERE $630,500. THE HEALTH CENTER ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. PALMER LUTHERAN HEALTH CENTER TAKES ITS MISSION TO IMPROVE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVICES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE COMMUNITY. IT STRIVES TO IDENTIFY COMMUNITY NEEDS BEYOND BASIC HEALTHCARE, THEN RESPOND TO THEM, AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER TAKES A STRATEGIC, COMMUNITY NEEDS-BASED APPROACH TO DELIVERING BENEFITS TO THE COMMUNITY. 28664526 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 50 0 254 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X BRENDA MOSER 5634223811 112 JEFFERSON ST WEST UNION IA 52175 DR MORDECHAI LEDERMAN SECRETARY / TREASURER 0.50 0.00 X X 0 315095 66520 LISA WIED DIRECTOR 0.50 39.50 X 0 261892 52741 KEN BEACH CRNA 40.00 0.00 X 198049 0 26854 PATRICE KUENNEN CEO 40.00 0.00 X 0 170842 46388 SARA CARPENTER DIRECTOR 0.50 39.50 X 0 140580 43297 BRENDA MOSER FINANCE ADMINISTRATOR 32.00 8.00 X 0 122933 42780 HEATHER SANDS DIRECTOR INPATIENT OPS 40.00 0.00 X 109397 0 43795 CHUCK JOHNSON DIRECTOR 0.50 39.50 X 0 124418 10058 DEBBIE BRINK RN 40.00 0.00 X 120681 0 12033 EMILY MORK PHARMACY MANAGER 40.00 0.00 X 104076 0 28087 JESSICA LOBAN NURSE PRACTITIONER 40.00 0.00 X 115259 0 7235 LYNN LAUER CHAIR 0.50 0.00 X X 0 0 0 KRISTI FLACK VICE CHAIR 0.50 0.00 X X 0 0 0 ANDREW WENTHE DIRECTOR 0.50 0.00 X 0 0 0 647462 1135760 379788 8 0 1 0 IOWA EMERGENCY PHYSICIANS 200 CORPORATE BLVD LAFAYETTE LA 70508 PHYSICIAN SERVICES 1727834 REHAB VISIONS 11623 ARBOR ST OMANA NE 68144 REHAB SERVICES 1530643 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 75373 PHYSICIAN SERVICES 649006 STAFFENCY 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 STAFFING SERVICES 490261 PERFORMANCE REHAB 204 E CHARLES ST OELWEIN IA 50662 REHAB SERVICES 133583 5 334576 4521596 312327 4856172 PATIENT SERVICE REVENUE 621110 28757783 28757783 PHARMACY REVENUE 621110 8752687 8752687 196411 196411 37706881 61357 61357 40487 0 40487 40487 40487 2819 -2819 -2819 -2819 CAFETERIA REVENUE 900099 49879 49879 134299 134299 184178 42846256 37706881 0 283203 X 6000 6000 15823274 13866082 1957192 452220 355736 96484 1606659 1263867 342792 729215 573632 155583 381048 381048 43200 43200 5597992 5500867 97125 62102 1921 60181 218511 118365 100146 1235002 12674 1222328 1004323 960565 43758 154605 148179 6426 30386 22252 8134 210048 168038 42010 812437 649950 162487 64146 500 63646 MEDICAL SUPPLIES 4128732 4115031 13701 PROVISION FOR BAD DEBTS 596625 596625 DIETARY 100393 100141 252 MEDICAL EQUIPMENT 96011 89130 6881 273985 114971 159014 33626914 28664526 4962388 0 1934 1934 20721740 23780414 3989028 5718297 823292 874503 131553 134381 15876860 8297059 6713301 7579801 811745 2765690 33192593 40855020 6545562 2828972 7822117 3353942 5721332 5069311 855276 2455698 2861356 8371663 23805643 22079586 X 8845467 18064809 541483 710625 9386950 18775434 33192593 40855020 X 9219342 169142 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4036 4036 0 PART II-B, LINE 1: PALMER LUTHERAN HEALTH CENTER PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND TO THE IOWA HOSPITAL ASSOCIATION (IHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THESE ORGANIZATIONS HAVE NOTIFIED PALMER LUTHERAN HEALTH CENTER THAT $4,036 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. 168281 168281 8409185 2500138 5909047 7114354 5749792 1364562 185040 47129 137911 7579801 RIGHT OF USE ASSETS 2055065 ASSETS HELD IN CHARITABLE TRUST 33500 INTEREST IN NET ASSETS OF FOUNDATION 677125 2765690 DUE FROM RELATED PARTY 48780 3RD PARTY SETTLEMENTS PAYABLE 3125151 ADVANCE COVID PAYMENTS 5197732 8371663 X PART X, LINE 2: GUNDERSEN HEALTH SYSTEM HAS REVIEWED TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2016 AND PRIOR YEARS. 1 1 X 1 X 1 X 1 1 1 0 0 424341 424341 0.01260 5076114 4994429 81685 0.00240 5500455 4994429 506026 0.01500 16360 16360 0.00050 10275018 5953259 4321759 0.12850 10200 10200 0.00030 10301578 5953259 4348319 0.12930 15802033 10947688 4854345 0.14430 2468 10358 10358 0.00030 800 694 694 0.00000 3268 11052 11052 0.00030 0 328144 164072 12479585 12604381 -124796 X 1 1 1 1 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 WWW.GUNDERSENHEALTH.ORG/PALMER X X X X RURAL HEALTH CLINIC PALMER LUTHERAN HEALTH CENTER 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE SUPPLEMENTAL SECTION X 1 19 1 SEE SUPPLEMENTAL SECTION 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X X 1 X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X X 1 X 0 0 PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 5: TOGETHER, GUNDERSEN PALMER, MERCY HOSPITAL AND FAYETTE COUNTY PUBLIC HEALTH DEVELOPED A SURVEY, WHICH WAS MADE AVAILABLE TO THE PUBLIC ON-LINE AND IN PAPER FORM. THE PUBLIC WAS INVITED THROUGH MASS EMAILING INVITATIONS, ADVERTISING, AND PUBLICITY, ON BEHALF OF THE PARTNERS, COMMUNITY CHAMBER, ORGANIZATIONS, ETC., TO TAKE THE SURVEY JULY-OCTOBER, 2019.PAPER SURVEYS WERE DISTRIBUTED AND MADE AVAILABLE AT GUNDERSEN PALMER, THE URGENT CARE CLINIC, THE EMERGENCY ROOM AND WITHIN WEST UNION, POSTVILLE (SPANISH AND SOMALIAN VERSIONS AVAILABLE) AND FAYETTE CLINICS. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, ETC. A TOTAL OF 201 ELECTRONIC AND PAPER SURVEYS WERE COLLECTED, WITH PAPER RESPONSES BEING ENTERED INTO THE ELECTRONIC SURVEY DATABASE. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 11: PALMER LUTHERAN HEALTH CENTER HAS A NUMBER OF INITIATIVES IN PLACE TO HELP ADDRESS THE TOP THREE PRIORITIES SELECTED IN THE CHNA. THE HOSPITAL WORKS WITH A VARIETY OF COMMUNITY PARTNERS TO DEVELOP, IMPLEMENT AND SUSTAIN THESE PROGRAMS AND ACTIVITIES. A LIST OF THE CURRENT ACTIONS AND GOALS FOR EACH OF THE TOP THREE PRIORITIES IS INCLUDED IN THE IMPLEMENTATION PLAN POSTED ON THE HOSPITAL'S WEBSITE.AS WITH ALL HEALTH CARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES PALMER LUTHERAN HEALTH CENTER SERVES. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED, HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, THE HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 13H: THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 15E: ALL SELF-PAY PATIENTS ARE GIVEN INFORMATION ON THE HOSPITAL'S CHARITY CARE POLICY AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 16J: OUR SELF-PAY COLLECTION AGENCY UTILIZES INFORMATION TO IDENTIFY ACCOUNTS THAT SHOULD QUALIFY FOR THE FAP. WE WRITE THESE ACCOUNTS OFF WITHOUT REQUIRING ANY PAPERWORK OR APPLICATION. PART VI, SECTION B, LINE 7A HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ PART VI, SECTION B, LINE 10A HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 10 1 - GUNDERSEN PALMER - WEST UNION CLINIC 112 JEFFERSON STREET WEST UNION IA 52175 RURAL HEALTH CLINIC 2 - GUNDERSEN PALMER - POSTVILLE CLINIC 111 SOUTH REYNOLDS STREET POSTVILLE IA 52162 RURAL HEALTH CLINIC 3 - GUNDERSEN PALMER HOME HEALTH 200 JEFFERSON STREET WEST UNION IA 52175 HOME HEALTH 4 - GUNDERSEN PALMER HOME HEALTH - OELWEIN 230 2ND AVE SE OELWEIN IA 50662 HOME HEALTH 5 - GUNDERSEN PALMER - FAYETTE CLINIC 110 KING STREEET FAYETTE IA 52142 RURAL HEALTH CLINIC 6 - GUNDERSEN PALMER MEDICAL SUPPLY-W UNION 200 JEFFERSON STREET WEST UNION IA 52175 MEDICAL SUPPLY AND EQUIPMENT 7 - GUNDERSEN PALMER MEDICAL SUPPLY-OELWEIN 230 2ND AVE SE OELWEIN IA 50662 MEDICAL SUPPLY AND EQUIPMENT 8 - GUNDERSEN PALMER HOSPICE - WEST UNION 200 JEFFERSON STREET WEST UNION IA 52175 HOSPICE SERVICES 9 - GUNDERSEN PALMER HOSPICE - OELWEIN 230 2ND AVE SE OELWEIN IA 50662 HOSPICE SERVICES 10 - GUNDERSEN PALMER COMMUNITY HEALTH 200 JEFFERSON STREET WEST UNION IA 52175 PUBLIC HEALTH SERVICES PART I, LINE 6A: THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT PALMER LUTHERAN HEALTH CENTER INCLUDE THREE RURAL HEALTH CLINICS AND THE INPATIENT ADULTS AND PEDIATRICS UNIT. ALL THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF THE HOSPITAL AND SHARE MANY OF THE SUPPORT FUNCTIONS OF THE HOSPITAL TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON A COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF PALMER LUTHERAN HEALTH CENTER TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATE TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR FORM 990 PURPOSES. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT ADVOCACY PROMOTES THE HEALTH OF THE COMMUNITY BY ADDRESSING THE NEEDS OF THE COMMUNITY, SUCH AS JOBS, CLEAN WATER/SEWER, INDUSTRY ATTRACTION, ADDRESSING THE NEEDS OF THE SCHOOL AND COUNTY, AND INSURING WE OFFER THE SERVICES THAT ARE IMPORTANT TO THE COMMUNITY. WE ALSO PROVIDE EDUCATION FOR SCHOOL AGE CHILDREN HOPING TO REACH THOSE THAT DON'T HAVE ACCESS TO HEALTH INFORMATION. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY:PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.THE ORGANIZATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: PALMER LUTHERAN HEALTH CENTER IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS URGENT CARE OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT PALMER LUTHERAN HEALTH CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: BEFORE BILLS ARE SENT TO COLLECTION, PALMER LUTHERAN HEALTH CENTER UTILIZES A "FAST TAX" PROGRAM TO SEE WHAT PATIENT ACCOUNTS ARE "PRESUMPTIVE CHARITY." ANY PATIENT THAT QUALIFIES FOR PRESUMPTIVE CHARITY IS ABLE TO RECEIVE A WRITE-OFF WITHOUT HAVING TO FILE ANY PAPERWORK. ONCE AN ACCOUNT IS IDENTIFIED, ALL COLLECTION PROCEEDINGS STOP, AND THE APPROPRIATE CHARITY PERCENTAGE IS APPLIED. ALSO, COLLECTION EFFORTS CEASE ON ACCOUNTS THAT ARE SENT TO COLLECTIONS AND LATER FOUND TO BE ELIGIBLE FOR ASSISTANCE. ONLY THEIR PERSONAL PORTION DUE WOULD FOLLOW NORMAL COLLECTION PROCEDURES. PART VI, LINE 2: TOGETHER, GUNDERSEN PALMER, MERCY HOSPITAL AND FAYETTE COUNTY PUBLIC HEALTH DEVELOPED A SURVEY, WHICH WAS MADE AVAILABLE TO THE PUBLIC ON-LINE AND IN PAPER FORM. THE PUBLIC WAS INVITED THROUGH PERSONAL INVITATION, MASS EMAILING INVITATIONS, ADVERTISING, AND PUBLICITY, ON BEHALF OF THE PARTNERS, COMMUNITY CHAMBER, ORGANIZATIONS, ETC., TO TAKE THE SURVEY JULY-OCTOBER 2019. PAPER SURVEYS WERE DISTRIBUTED AND MADE AVAILABLE AT GUNDERSEN PALMER, LOCAL HEALTH FAIRS, VARIOUS ORGANIZATIONAL MEETINGS, WALK-IN CLINIC AND WITHIN WEST UNION, POSTVILLE (SPANISH AND SOMALIN VERSIONS AVAILABLE) AND FAYETTE CLINICS. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, ETC. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY. AS A CRITICAL ACCESS HOSPITAL, WE HAVE AN ADVISORY BOARD THAT INCLUDES A MEMBER OF THE COMMUNITY. THIS GROUP REVIEWS ALL SERVICES OF THE CAH TO ASSURE SERVICES OFFERED ARE EFFECTIVE AND EFFICIENT AND MEET THE COMMUNITY'S NEEDS. OUR CAH HAS BEEN DESIGNATED AS BEING IN A HPSA REGION. WE ALSO HAVE A PATIENT SATISFACTION COMMITTEE THAT MEETS QUARTERLY. THIS COMMITTEE INCLUDES REPRESENTATIVES FROM ALL THE COMMUNITIES IN OUR COUNTY, AND PROVIDES FEEDBACK REGARDING SERVICES, HEALTH CARE CONCERNS, ETC. PART VI, LINE 3: THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. ALL SELF-PAY PATIENTS ARE REFERRED TO SOCIAL SERVICES FOR INFORMATION ON ABOVE PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. ALL PATIENT STATEMENTS REFERENCE THE AVAILABILITY OF FINANCIAL ASSISTANCE. PART VI, LINE 4: PALMER LUTHERAN HEALTH CENTER IS A 25-BED ACUTE CARE HEALTH CENTER SERVING A RURAL POPULATION OF 2,490 PER THE 2020 U.S. CENSUS. AS THE ONLY HOSPITAL IN WEST UNION, IOWA, IT ALSO SERVES A 30 TO 40-MILE RADIUS AROUND WEST UNION. THE CLOSEST HOSPITAL IS MERCY ONE OELWEIN MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL, LOCATED ABOUT 19 MILES FROM WEST UNION. IN ADDITION, OUR HOMECARE DEPARTMENT SERVES A POPULATION IN A 50-MILE RADIUS. WE ARE A MEDICARE DEPENDENT HOSPITAL AND HAVE A LARGE MEDICAID POPULATION AS WELL. THE MOST COMMON INDUSTRIES IN WEST UNION ARE MANUFACTURING AND CONSTRUCTION. 12.06% OF RESIDENTS IN WEST UNION HAD INCOME BELOW THE POVERTY LEVEL IN 2021. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2021 WAS $66,708 WHICH IS DOWN COMPARED TO THE STATE OF IOWA MEDIAN OF $72,429. UNEMPLOYMENT WAS 5.1% IN 2021 COMPARED TO THE NATIONAL AVERAGE OF 3.9%. PART VI, LINE 5: 3 OF THE 7 MEMBERS 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 THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL ITS DEPARTMENTS. THE ORGANIZATION APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE BY PURCHASING UP-TO-DATE EQUIPMENT, AND A STATE-OF-THE-ART FACILITY. CREATE MORE COMMUNITY OUTREACH, AWARENESS AND EDUCATION" IS ONE OF OUR STRATEGIC OBJECTIVES. TO MEET THAT OBJECTIVE, WE HAVE AN ONGOING PROCESS IN PLACE TO MONITOR OUR THREATS AND OUR OPPORTUNITIES IN OUR SERVICE AREA. WE UTILIZE THE IOWA HOSPITAL ASSOCIATION DIMENSIONS SOFTWARE TO DETERMINE THE ORIGIN AND DESTINATION OF OUR PATIENT POPULATION. OUR STRATEGIC PLANNING TEAM INCLUDES OUR GOVERNING BOARD AND SENIOR MANAGEMENT WHO HAVE AN EXTENSIVE KNOWLEDGE BASE OF THE ORGANIZATION. THE SENIOR MANAGEMENT TEAM INCLUDES REPRESENTATION FROM FINANCE, NURSING, HR., MARKETING, FAMILY PRACTICE PROVIDERS AND DIRECTORS OF HOSPITAL OUTPATIENT SERVICES. THE GOVERNING BOARD HAS AN ACTIVE ROLE IN THIS PROCESS AS WELL. THEY HAVE THE BENEFIT OF BEING OUT IN THE COMMUNITY AND GAINING A UNIQUE INSIGHT AND THE PULSE OF THE COMMUNITY. IN ADDITION, WE ARE A CLINICAL SITE FOR STUDENTS OF PHARMACY, NURSING, HIM, PA, AND MEDICAL STUDENTS. PART VI, LINE 6: PALMER LUTHERAN HEALTH CENTER IS AN AFFILIATE HOSPITAL OF THE GUNDERSEN HEALTH SYSTEM IN LACROSSE, WISCONSIN. GUNDERSEN HEALTH SYSTEM PROVIDES THE PRIMARY CARE PROVIDERS WHO SEE PATIENTS IN OUR THREE CLINICS. THEY ALSO PROVIDE A NUMBER OF SPECIALISTS WHO TRAVEL TO THE CLINICS IN OUR SERVICE AREA AND UTILIZE TELEMEDICINE OPPORTUNITIES TO MEET THE NEEDS OF THE POPULATION. PATIENTS ARE TRANSFERRED TO THE TERTIARY LEVEL OF CARE AS INDICATED. GUNDERSEN HEALTH SYSTEM IS INVOLVED IN OUR COMMUNITY, BEING A COMMUNITY PARTNER TO FURTHER HEALTH CARE INITIATIVES. PART VI, LINE 7, REPORTS FILED WITH STATES IA 1 SCHOLARSHIPS 4 6000 FMV PART I, LINE 2: DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS IN ORDER TO RECEIVE THE GRANT FUNDS, THE GRANTEE MUST HAVE ALREADY MET THE REQUIRED CRITERIA OUTLINED IN THE GRANT APPLICATION. 0 0 0 0 0 0 0 0 0 DR MORDECHAI LEDERMAN SECRETARY / TREASURER 0 313095 0 2000 0 0 0 42050 0 24470 0 381615 0 0 LISA WIED DIRECTOR 0 259869 0 2023 0 0 0 20873 0 31868 0 314633 0 0 KEN BEACH CRNA 195547 0 2502 0 0 0 0 0 26854 0 224903 0 0 0 PATRICE KUENNEN CEO 0 168842 0 2000 0 0 0 24650 0 21738 0 217230 0 0 SARA CARPENTER DIRECTOR 0 138508 0 2072 0 0 0 18727 0 24570 0 183877 0 0 BRENDA MOSER FINANCE ADMINISTRATOR 0 120676 0 2257 0 0 0 18292 0 24488 0 165713 0 0 HEATHER SANDS DIRECTOR INPATIENT OPS 104664 0 4733 0 0 0 5665 0 38130 0 153192 0 0 0 SCHEDULE J, PART 1, LINE 3 FOR THE PURPOSE OF DETERMINING EXECUTIVE COMPENSATION, PALMER LUTHERAN HEALTH CENTER, INC. RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSON LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND OTHER HIGHLY COMPENSATED EMPLOYEES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. A FAYETTE COUNTY IOWA 426005367 2013-08-29 8382387 HOSPITAL FACILITY IMPROVEMENTS 0 0 0 A 660264 8382387 8382387 2007 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 FORM 990, SCHEDULE K, PART IV, LINE 2B BONA FIDE DEBT SERVICE FUND EXCEPTION X LED LIGHTING 1 312327 ACTUAL COST 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ARTICLES OF INCORPORATION OF PALMER LUTHERAN HEALTH CENTER PROVIDE FOR ONE MEMBER OF THE CORPORATION. THE SOLE CORPORATE MEMBER OF PALMER LUTHERAN HEALTH CENTER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER AND UNDER TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. GUNDERSEN LUTHERAN HEALTH SYSTEM INC. MAY APPOINT FOUR MEMBERS TO THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN THE APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND PRESIDENT/CEO REVIEW THE 990 BEFORE IT IS FILED. THE ENTIRE BOARD OF DIRECTORS RECEIVES A COPY OF THE 990 AFTER IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REQUIRED TO BE SIGNED ANNUALLY BY OFFICERS, DIRECTORS AND KEY EMPLOYEES. THE SIGNED POLICIES ARE THEN REVIEWED BY PALMER LUTHERAN HEALTH CENTER'S COMPLIANCE COMMITTEE TO DETERMINE IF THERE IS A DEEMED CONFLICT OF INTEREST. BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON AREAS WHERE THERE IS A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A FOR PURPOSES OF DETERMINING COMPENSATION, PALMER LUTHERAN HEALTH CENTER RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990. FORM 990, PART IX, LINE 11G SURGERY SERVICES: PROGRAM SERVICE EXPENSES 254,602. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 254,602. EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 20,377. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,377. LAB SERVICES: PROGRAM SERVICE EXPENSES 501,596. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 501,596. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,074,198. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,074,198. HOME HEALTH SERVICES: PROGRAM SERVICE EXPENSES 423,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 423,316. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,641,322. MANAGEMENT AND GENERAL EXPENSES 97,125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,738,447. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 585,456. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 585,456. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 169,142. FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS GIVES THE FINAL APPROVAL OF THE AUDIT FIRM AND AUDIT REPORTS AND TAKES TIME ANNUALLY TO MEET WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT. THERE WAS NO CHANGE TO THIS PROCESS DURING THE FILING PERIOD. 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