INDEPENDENCE HEALTH SYSTEM INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- INDEPENDENCE HEALTH SYSTEM INC (EIN 43-0926316)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-09-08
- IRS object ID
- 202132519349300533
- Schema version
- 2020v4.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-09-08T11:31:05-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 430352985 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3266 LEXINGTON AVENUE | AddressLine1Txt |
| City | CAPE GIRARDEAU | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 430926316 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDEPENDENCE HEALTH SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INDE | BusinessNameControlTxt |
| Phone | 5735476546 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 SOUTH KINGSHIGHWAY | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANA KORANDO | PersonNm |
| Person Title | ADMINISTRATOR/CEO | PersonTitleTxt |
| Phone | 5735476546 | PhoneNum |
| Signature | 2021-09-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DANA | PersonFirstNm |
| Person Last | KORANDO | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NANCY LEGRAND | PreparerPersonNm |
| PTIN | P00066956 | PTIN |
| Phone | 5733340568 | PhoneNum |
| Preparation | 2021-09-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DANA KORANDO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 SOUTH KINGSHIGHWAY | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,898,226 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.INDEPENDENCEHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE ELDERLY WITH RETIREMENT AND HEALTH CARE SERVICES WHICH ARE DEDICATED TO EXCELLENCE, IN AN ENVIRONMENT WHICH PROMOTES LIVING WITH DIGINITY, SECURITY AND INDEPENDENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 251 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $10,515 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,437,525 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,852,195 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,431 | PYInvestmentIncomeAmt |
| CY Investment Income | -$2,939 | CYInvestmentIncomeAmt |
| PY Other Revenue | $58,594 | PYOtherRevenueAmt |
| CY Other Revenue | $43,665 | CYOtherRevenueAmt |
| PY Total Revenue | $9,508,065 | PYTotalRevenueAmt |
| CY Total Revenue | $9,892,921 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,420,261 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,063,771 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,495,645 | PYOtherExpensesAmt |
| CY Other Expenses | $2,866,856 | CYOtherExpensesAmt |
| PY Total Expenses | $7,915,906 | PYTotalExpensesAmt |
| CY Total Expenses | $7,930,627 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,592,159 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,962,294 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,592,693 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,734,252 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $608,514 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $782,160 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,984,179 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,952,092 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE ELDERLY WITH RETIREMENT AND HEALTH CARE SERVICES WHICH ARE DEDICATED TO EXCELLENCE, IN AN ENVIRONMENT WHICH PROMOTES LIVING WITH DIGINITY, SECURITY AND INDEPENDENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,386,902 | ExpenseAmt |
| Revenue | $9,849,256 | RevenueAmt |
| Desc | PROVIDED LONG TERM CARE FOR THE ELDERLY AT VARIOUS STAGES: SKILLED NURSING FACILITY, 133 LICENSED BEDS; RESIDENTIAL CARE, 95 LICENSED BEDS; INDEPENDENT LIVING, TWO COTTAGES AND THREE DUPLEXES. ACCEPT MEDICARE, MEDICAID, AND PRIVATE PAY WHERE APPLICABLE. | Desc |
| Total Program Service Expenses | $6,386,902 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | 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 | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 251 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANA KORANDO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5735476546 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 S KINGSHIGHWAY | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| JUSTIN KOENIG | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PATTY WICHERN | ||||||
| VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DON PALISCH | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| VIDA YAMNITZ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| FRED EGGERS | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JENNIFER STREILER | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JUDITH ERNST | ||||||
| SECRETARY / TREASURE | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| BRIAN DREYER | ||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| TERRI GREEN | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DANA KORANDO | ||||||
| ADMINISTRATOR/CEO | 40.00 | $96,381 | $0 | $0 | Yes (X) | |
| RHONDA PFISTER | ||||||
| CFO | 40.00 | $84,586 | $0 | $0 | Yes (X) | |
| CASEY ELLIS | ||||||
| ADMINISTRATOR | 40.00 | $80,024 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $260,991 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PERRY COUNTY HEALTH SYSTEMS | |||||
| 434 NORTH WEST STREET | PERRYVILLE | MO | 63775 | MANAGEMENT FEE | $764,508 |
| REHAB CARE GROUP INC | |||||
| PO BOX 503534 | ST LOUIS | MO | 63150 | THERAPY SERVICE | $283,436 |
| MARTIN BROTHERS DISTRIBUTING | |||||
| PO BOX 69 | CEDAR FALLS | IA | 50613 | FOOD SERVICE | $145,764 |
| LARRY GREENWALL VENDING | |||||
| 3633 MCLANE DR | POPLAR BLUFF | MO | 63901 | FOOD SERVICE | $125,404 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ROOM AND BOARD | 623000 | $8,214,698 | $8,214,698 |
| PROVIDER RELIEF FUNDS | 623000 | $1,637,497 | $1,637,497 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,852,195 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,366 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,366 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,305 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$5,305 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,305 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$5,305 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| MISCELLANEOUS INCOME | 900099 | $14,900 | $0 | $14,900 |
| BEAUTY & BARBER SHOP | 812900 | $10,413 | $0 | $10,413 |
| OTHER REVENUE | 900099 | $9,400 | $0 | $9,400 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,952 | TotalRevenueColumnAmt |
| Exclusion | $8,952 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $43,665 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,892,921 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,849,256 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $43,665 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,226,656 | TotalAmt |
| Program Services | $3,411,213 | ProgramServicesAmt |
| Management And General | $815,443 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $553,393 | TotalAmt |
| Program Services | $448,248 | ProgramServicesAmt |
| Management And General | $105,145 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,722 | TotalAmt |
| Program Services | $229,815 | ProgramServicesAmt |
| Management And General | $53,907 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,382 | TotalAmt |
| Program Services | $4,500 | ProgramServicesAmt |
| Management And General | $1,882 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,168 | TotalAmt |
| Management And General | $80,168 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,313 | TotalAmt |
| Program Services | $455,313 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,697 | TotalAmt |
| Program Services | $2,630 | ProgramServicesAmt |
| Management And General | $2,067 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,512 | TotalAmt |
| Program Services | $37,807 | ProgramServicesAmt |
| Management And General | $29,705 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,734 | TotalAmt |
| Program Services | $4,891 | ProgramServicesAmt |
| Management And General | $3,843 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,183 | TotalAmt |
| Program Services | $205,622 | ProgramServicesAmt |
| Management And General | $161,561 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,218 | TotalAmt |
| Program Services | $1,242 | ProgramServicesAmt |
| Management And General | $976 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13 | TotalAmt |
| Management And General | $13 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $309,690 | TotalAmt |
| Program Services | $278,721 | ProgramServicesAmt |
| Management And General | $30,969 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,903 | TotalAmt |
| Program Services | $124,266 | ProgramServicesAmt |
| Management And General | $97,637 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NFRA FEES | $550,972 | $550,972 | |
| FOOD | $352,484 | $352,484 | |
| SUPPLIES | $309,439 | $206,295 | $103,144 |
| R&M | $99,395 | $55,661 | $43,734 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,753 | TotalAmt |
| Program Services | $17,222 | ProgramServicesAmt |
| Management And General | $13,531 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,930,627 | TotalAmt |
| Program Services | $6,386,902 | ProgramServicesAmt |
| Management And General | $1,543,725 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,863 | BOYAmt |
| EOY | $53,162 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,057,073 | BOYAmt |
| EOY | $2,519,810 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $492,795 | BOYAmt |
| EOY | $499,780 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,914 | BOYAmt |
| EOY | $70,951 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,011 | BOYAmt |
| EOY | $41,350 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,101,169 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,868,196 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,332,012 | BOYAmt |
| EOY | $3,232,973 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,542,025 | BOYAmt |
| EOY | $11,294,845 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $21,381 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,592,693 | BOYAmt |
| EOY | $17,734,252 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $569,739 | BOYAmt |
| EOY | $743,385 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,775 | BOYAmt |
| EOY | $38,775 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $608,514 | BOYAmt |
| EOY | $782,160 | 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 | $13,984,179 | BOYAmt |
| EOY | $16,952,092 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,984,179 | BOYAmt |
| EOY | $16,952,092 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,592,693 | BOYAmt |
| EOY | $17,734,252 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,962,294 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,002,820 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,799 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,400 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $18,385 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,404 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,515 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $59,704 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,188,241 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,173,171 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,925,801 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,496,119 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,890,555 | CurrentTaxYearAmt |
| Total | $47,673,887 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,204,641 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,191,556 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,940,205 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,506,634 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,890,555 | CurrentTaxYearAmt |
| Total | $47,733,591 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $47,733,591 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $37,807 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $192,253 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,909 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,431 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,366 | CurrentTaxYearAmt |
| Total | $254,766 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $37,807 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $192,253 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,909 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,431 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,366 | CurrentTaxYearAmt |
| Total | $254,766 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,242,448 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,383,809 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,961,114 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,508,065 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,892,921 | CurrentTaxYearAmt |
| Total | $47,988,357 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99470 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99400 | PublicSupportPY509Pct |
| Investment Income CY | 0.00530 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00600 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $805,094 | BeginningYearBalanceAmt |
| Contributions | $194,487 | ContributionsAmt |
| Investment Earnings Or Losses | $6,101 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,005,682 | OtherExpendituresAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $814,633 | BeginningYearBalanceAmt |
| Contributions | $644,814 | ContributionsAmt |
| Investment Earnings Or Losses | -$5,575 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $648,779 | OtherExpendituresAmt |
| End Year Balance | $805,094 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $805,900 | BeginningYearBalanceAmt |
| Contributions | $583,124 | ContributionsAmt |
| Investment Earnings Or Losses | $15,209 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $589,600 | OtherExpendituresAmt |
| End Year Balance | $814,633 | EndYearBalanceAmt |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $254,200 | OtherCostOrOtherBasisAmt |
| Book Value | $254,200 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,692,806 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,057,180 | DepreciationAmt |
| Book Value | $2,635,626 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,154,163 | OtherCostOrOtherBasisAmt |
| Depreciation | $811,016 | DepreciationAmt |
| Book Value | $343,147 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,232,973 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $9,871,287 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $9,871,287 | RevenueSubtotalAmt |
| Other Revenues Not Included | $21,634 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $21,634 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $9,892,921 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,949,464 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$2,797 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$2,797 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,952,261 | ExpensesSubtotalAmt |
| Other Expenses Not Included | -$21,634 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | -$21,634 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,930,627 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 21,634. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | ROUNDING -2,797. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -21,634. |
| PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS | THE ENDOWMENT FUNDS ARE TO BE USED FOR BOND PAYMENTS. |
| PART XIII - SUPPLEMENTAL FINANCIAL INFORMATION | MANAGEMENT HAS EVALUATED THEIR TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III - OTHER ADDITIONAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | FORM 990, PART VII, LINE 5 INDEPENDENCE HEALTH SYSTEM, INC. PAID PERRY COUNTY HEALTH SYSTEMS $6382 FOR CONSULTING | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JUDY ERNST, BOARD MEMBER BRIAN DREYER, BOARD MEMEBER BUSINESS RELATIONSHIP |
| FORM 990, PART VI, SECTION B, LINE 11B | ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE FORM 990 IS REVIEWED BY THE CEO AND CFO WITH THE PREPARER AND PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | A LETTER AND QUESTIONNAIRE CONCERNING THE POSSIBILITY OF CONFLICTS OF INTEREST IS SENT TO EACH MEMBER OF THE BOARD OF DIRECTORS, THE CEO, AND THE CFO. A LETTER PERTAINING TO CONFLICTS OF INTEREST IS SIGNED BY EACH DEPARTMENT HEAD, RESPONSES ARE REVIEWED BY THE HR DIRECTOR, CFO, AND CEO,DEPENDING ON WHETHER IT IS A BOARD OF DIRECTOR MEMBER OR DEPARTMENT HEAD. BOARD OF DIRECTOR MEMBERS WOULD ABSTAIN FROM ANY VOTE WHERE A POSSIBILE CONFLICT OF INTEREST MIGHT ARISE. |
| FORM 990, PART VI, SECTION B, LINE 15A | A COMPENSATION REVIEW WAS CONDUCTED IN 2017 BY PATRICK CARRON, PRIOR CEO OF PERRY COUNTY HEALTH SYSTEMS, AND THE BOARD OF DIRECTORS FOR INDEPENDENCE HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | ROUNDING 2,799. |
| FORM 990, PART XII, LINE 2C | THE ORGANIZATION'S OVERSIGHT IS THE BOARD OF DIRECTORS. |