2025-08-04T14:09:50-05:00 2024-09-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-10-01 420738969 COMMUNITY HOSPITAL INC COMM 7123821515 2959 US HIGHWAY 275 HAMBURG IA 516405052 DOUG BRANDT CFO 7123821515 2025-07-31 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-07-31 2023 2025-03-06 01:10:19Z GEORGE C GRAPE COMMUNITY HOSPITAL CRISTIN HENDRICKSON 2959 US HIGHWAY 275 HAMBURG IA 516405052 17126740 0 X WWW.GRAPEHOSPITAL.COM X 1955 IA CRITICAL ACCESS HOSPITAL 7 7 141 7 0 0 73999 632696 12965854 16412796 10521 26619 45259 54629 13095633 17126740 0 0 0 0 6663767 8079067 0 0 0 8031714 8212784 14695481 16291851 -1599848 834889 8615904 9111422 3239972 2838429 5375932 6272993 X GEORGE C. GRAPE COMMUNITY HOSPITAL'S WELL TRAINED MEDICAL STAFF AND HEALTH CARE TEAM WILL STRIVE TO EXCEED PATIENTS' EXPECTATIONS BY PROVIDING CONTINUITY OF PERSONALIZED CARE THROUGH EASY ACCESS TO SERVICES. 1 0 13691242 16412796 GEORGE C. GRAPE COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL THAT RECEIVED INITIAL CERTIFICATION ON AUGUST 1, 2001. THE HOSPITAL IS OWNED AND OPERATED BY COMMUNITY HOSPITAL INC., DOING BUSINESS AS GEORGE C. GRAPE COMMUNITY HOSPITAL.AS A CRITICAL ACCESS HOSPITAL, GEORGE C. GRAPE COMMUNITY HOSPITAL PERFORMS AN ANNUAL PROGRAM EVALUATION IN ORDER TO DETERMINE WHETHER THE SERVICE IS APPROPRIATE, ADEQUATE, EFFECTIVE AND EFFICIENT. THIS EVALUATION ALSO DETERMINES WHETHER THE UTILIZATION OF SERVICES WAS APPROPRIATE, ESTABLISHED POLICIES WERE FOLLOWED, DETERMINES ANY CHANGES NEEDED AND RECOMMENDS PROJECTS FOR DEVELOPMENT DURING THE NEXT YEAR. STATISTICAL ANALYSIS: 1.) ACUTE CARE- THERE WERE A TOTAL OF 88 INPATIENT ADMISSIONS DURING FISCAL YEAR 2024 COMPARED TO 79 ADMISSIONS DURING FISCAL YEAR 2023.2.) SWING BED- 43 SWING BED ADMISSIONS WERE RECORDED DURING FISCAL YEAR 2024 COMPARED TO 49 ADMISSIONS DURING FISCAL YEAR 2023. 3.) SURGICAL CASES- THERE WERE A TOTAL OF 148 SURGICAL CASES FOR THE 2024 FISCAL YEAR AS COMPARED TO 155 SURGICAL CASES DURING FISCAL YEAR 2023.4.) OUTPATIENT SERVICES- EMERGENCY ROOM SERVICES DECREASED FROM 871 VISITS IN FISCAL YEAR 2023 TO 847 VISITS IN FISCAL YEAR 2024. LABORATORY SERVICES DECREASED FROM 14,505 IN FISCAL YEAR 2023 TO 14,149 IN FISCAL YEAR 2024. RADIOLOGY SERVICES DECREASED FROM 2,253 IN FISCAL YEAR 2023 TO 2,218 IN FISCAL YEAR 2024. ULTRASOUND SERVICES DECREASED FROM 540 IN FISCAL YEAR 2023 TO 479 IN FISCAL YEAR 2024. NUCLEAR MEDICINE SERVICES DECREASED FROM 40 IN FISCAL YEAR 2023 TO 39 IN FISCAL YEAR 2024. 13691242 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 43 0 1 141 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X DOUG BRANDT 7123821515 2959 US HWY 275 HAMBURG IA 51640 DR THOMAS LARGEN PRESIDENT 1.00 X X 0 0 0 GREG WARDEN VICE PRESIDENT 1.00 X X 0 0 0 CONNIE SMITH SECRETARY/TREASURER 1.00 X X 0 0 0 TROY HENDRICKSON DIRECTOR 1.00 X 0 0 0 LOA TRIVELY DIRECTOR 1.00 X 0 0 0 DR MICHAEL WELLS DIRECTOR 1.00 X 0 0 0 ANGIE ETTLEMAN DIRECTOR 1.00 X 0 0 0 CRISTIN HENDRICKSON CEO 40.00 X 188854 0 7511 DOUGLAS BRANDT CFO 40.00 X 117459 0 16801 TANYA HAYES DIRECTOR OF NURSING 40.00 X 108358 0 4861 ANGELA MALLAS LAB TECH 40.00 X 110426 0 0 HOLLY RIHNER RN 40.00 X 139074 0 0 CRAIG WELLS CIO 36.00 X 107884 0 4871 JAMIE HUTT RADIOLOGY SUPERVISOR 40.00 X 116019 0 5161 888074 0 39205 7 0 1 0 MEDICAL CLINIC PC 1219 MAIN STREET HAMBURG IA 51640 ER PHYSICIANS 550537 THE GRAHAM GROUP 421 GRAND AVENUE DES MOINES IA 50309 CONSTRUCTION SERVICES 429415 INSPIRE 8181 ARISTA P1 SUITE 100 BROOMFIELD CO 80021 PHYSICAL/OCCUPATIONAL THERAPY 405946 FUSION MEDICAL STAFFING LLC PO BOX 30131 OMAHA NE 68103 TRAVELING PERSONNEL 312116 GET MED STAFFING INC PO BOX 8667 OMAHA NE 68108 TRAVELING PERSONNEL 264088 10 152328 439294 41074 632696 PATIENT SERVICE REVENUE 624100 16228345 16228345 AMBULANCE SERVICES 624100 74348 74348 CONTRACT SERVICES 624100 61908 61908 48195 48195 16412796 26619 26619 7200 0 7200 7200 7200 CAFETERIA 624200 47429 47429 47429 17126740 16412796 0 81248 X 340094 340094 6273844 5097761 1176083 142497 112446 30051 849447 651488 197959 473185 380245 92940 4852 4852 69308 69308 136892 136892 3959302 3871658 87644 22429 8069 14360 311812 194973 116839 51275 51079 196 324683 258160 66523 27430 23789 3641 12266 8258 4008 69374 69374 613634 513354 100280 161191 85364 75827 MEDICAL SUPPLIES 2405527 2405527 DUES & SUBSCRIPTIONS 29694 22704 6990 MISCELLANEOUS 13115 6367 6748 16291851 13691242 2600609 0 229786 218760 1096562 701420 1204739 1366595 4297 170324 447280 447932 23845 57551 16799849 10888905 5446141 5910944 163254 225426 0 12470 8615904 9111422 907719 1075650 53427 23504 546638 869972 1732188 869303 3239972 2838429 X 5375932 6272993 5375932 6272993 8615904 9111422 834889 62172 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 98000 98000 7070804 3712514 3358290 9097431 6912484 2184947 533614 263907 269707 5910944 CAPITAL LEASE OBLIGATIONS 6045 EST THIRD-PARTY PAYOR SETTLEMENTS 863258 869303 X PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2024 AND 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 57116 57116 0.00350 1831605 1831605 1888721 1831605 57116 0.00350 5842 5842 0.00040 152386 148614 3772 0.00020 158228 148614 9614 0.00060 2046949 1980219 66730 0.00410 1 237222 21587 8883653 7860043 1023610 X 1 1 1 1 COMMUNITY HOSPITAL INC 2959 US HWY 275 HAMBURG IA 51640 WWW.GRAPEHOSPITAL.COM 360067H X X X X GEORGE C GRAPE COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 21 1 0 0 1 X HTTPS://WWW.GRAPEHOSPITAL.COM/GETPAGE.PHP?NAME=NEWS_CHNA2022 X 1 21 1 HTTPS://WWW.GRAPEHOSPITAL.COM/GETPAGE.PHP?NAME=NEWS_CHNA2022 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_POLICY.PDF X HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/FAP_WEB_APPLICATION.PDF X HTTPS://WWW.GRAPEHOSPITAL.COM/DOCS/PLAIN_LANGUAGE_SUMMARY.PDF X X X X X 1 X 0 X X X X X 1 X 0 0 GEORGE C. GRAPE COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN ORDER TO REPRESENT THE COMMUNITY EQUALLY, MULTIPLE AVENUES OF COLLECTING INFORMATION WERE USED THAT PROVIDED NECESSARY INFORMATION TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY.AVENUES IDENTIFIED:-FOCUS GROUP (TOWN HALL MEETING)-SURVEY-STATE AND COUNTY HEALTH STATISTICSTO DETERMINE THE MAIN HEALTH CONCERNS OF THE COMMUNITY THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE INVITED MEMBERS OF THE COMMUNITY TO BE PART OF A TOWN HALL MEETING. THE COMMUNITY MEMBER MEETING CONSISTED OF PEOPLE FROM THE VARIOUS HEALTH CARE AREAS SUCH AS SCHOOL NURSE, OCCUPATIONAL THERAPIST, PHARMACIST, CASE MANAGER FOR MI/MR, IOWA STATE UNIVERSITY EXTENSION OUTREACH, MEDICAL CLINICS, A MEMBER FROM THE HOSPITAL'S BOARD OF DIRECTORS AND MEMBERS OF THE BUSINESS COMMUNITY.THERE WAS AN ONLINE SURVEY CONDUCTED. ADVERTISEMENTS FOR THE SURVEY WERE PUT IN THE HOSPITAL'S NEWSLETTER AND MAILED OUT TO THE COMMUNITY. THE COMMUNITY WAS ENCOURAGED TO GO ONLINE AND FILL OUT THE SURVEY.THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT COMMITTEE MET AND REVIEWED THE SURVEYS. THE INFORMATION AND DATA FROM THE SURVEY WERE THEN PRESENTED TO THE TOWN HALL MEETING GROUP, ALONG WITH THE PROPOSED ACTION TO BE TAKEN BY THE HOSPITAL. GEORGE C. GRAPE COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: IN THE 2023-2024 FISCAL YEAR, GEORGE C. GRAPE COMMUNITY HOSPITAL (THE HOSPITAL) CONTINUED TO ADDRESS THE NEEDS OF THE COMMUNITY (AS IDENTIFIED IN THE CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT).SPECIFIC NEEDS TO BE ADDRESSED INCLUDE MENTAL HEALTH, PRIMARY CARE, FOOD INSECURITY, VISITING SPECIALISTS, SENIOR ACTIVITIES, ADEQUATE HEALTHCARE STAFFING AND SUBSTANCE ABUSE.MENTAL HEALTH1. PROMOTE EXISTING MENTAL HEALTH SERVICES, FACILITIES AND PROVIDERS. EDUCATE COMMUNITY ON PLACEMENT PROCESS AND OPTIONS. THIS WAS ADDRESSED BY POSTING A SOCIAL MEDIA POST ABOUT THE CRISIS PHONE NUMBER AND CHAT LINE AVAILABLE.PRIMARY CARE1. CONTINUE TO RECRUIT PROVIDERS TO AREA. UTILIZE NATIONAL RECRUITERS TO FIND QUALITY PROVIDERS, IF NECESSARY. THIS WAS ADDRESSED BY POSTING SOCIAL MEDIA POST FOR OUR PROVIDERS AND THE FREE CLINICS THAT WERE HELD IN THE YEAR LIKE DIABETES SCREENING, BLOOD DRIVE AND SPORTS PHYSICALS. THERE WAS ALSO WORK ON RECRUITING THREE NEW ADVANCED PROACTIVE PROVIDERS.FOOD INSECURITY1. CONTINUE "AWARENESS PROGRAM" TO EDUCATE ELEMENTARY /MIDDLE SCHOOL CHILDREN AND THEIR FAMILIES ABOUT NUTRITION AND LOCAL PROGRAMS.2. CONTINUE TO PROVIDE EDUCATION AT FAIRS AND EDUCATIONAL PROGRAMS, INCLUDING VARIOUS SCREENINGS. THIS WAS ADDRESSED BY SUPPLYING EDUCATIONAL INFORMATION AT THE COUNTY FAIR WITH A CRAFT AREA. WE ALSO HANDED OUT EDUCATIONAL INFORMATION AT THE RODEO PARADE.VISITING SPECIALIST1. DEVELOP PARTNER RELATIONSHIPS WITH AREA PROVIDERS FOR COLLECTIVELY RECRUITING VISITING SPECIALISTS. IDENTIFY/CONTACT KEY COLLABORATIVE PARTNERS TO POSSIBLY SHARE OFFICE SPACE, WORKFORCE AND EQUIPMENT. THIS WAS ADDRESSED BY POSTING SOCIAL MEDIA POSTS ABOUT ALL THE SPECIALTY SERVICES THAT ARE OFFERED AND THE PROVIDERS THAT OFFER IT. THERE WAS ALSO WORK ON RECRUITING NEW SPECIALTY SERVICES.SENIOR ACTIVITIES1. SUPPORT COMMUNITY-BASED ACTIVITIES ON OUR SOCIAL MEDIAL PLATFORMS. THIS WAS ADDRESSED BY POSTING SOCIAL MEDIA POSTS ABOUT THE VARIOUS ACTIVITIES PROVIDED. FOR EXAMPLE, DINNER WAS SERVED AT THE RIVERTON COMMUNITY DAYS, AND POSTS WERE MADE ABOUT A FREE WORKOUT DAY.ADEQUATE HEALTHCARE STAFFING1. MARKET IN LOCAL JOB FAIRS. PROMOTE THROUGH SOCIAL MEDIAL TOOLS/HOSPITAL WEBPAGE. THIS WAS ADDRESSED BY POSTING SOCIAL MEDIAL POSTS ABOUT ALL OPEN POSITIONS, FREE TRAININGS AND SCHOLARSHIPS.SUBSTANCE ABUSE WAS NOT ADDRESSED DURING THE YEAR DUE TO STAFFING SHORTAGES. GEORGE C. GRAPE COMMUNITY HOSPITAL PART V, SECTION B, LINE 20E: WE ORALLY NOTIFY PATIENTS WHEN THEY COME IN DURING THE FINANCIAL COUNSELORS WORKING HOURS. A PLAIN LANGUAGE SUMMARY OF THE FAP IS MAILED TO EVERYONE 30 DAYS PRIOR TO THEIR ACCOUNT BEING SENT TO COLLECTIONS. 4 1 - SOUTHWEST IOWA HOME HEALTH 803 INDIANA STREET SIDNEY IA 51652 HOME HEALTH/PUBLIC HEALTH AGENCY 2 - HAMBURG MEDICAL CLINIC 1219 MAIN STREET HAMBURG IA 51640 RURAL HEALTH CLINIC 3 - SIDNEY MEDICAL CLINIC 313 MAIN STREET SIDNEY IA 51652 RURAL HEALTH CLINIC 4 - TABOR MEDICAL CLINIC 710 CENTER STREET TABOR IA 51653 RURAL HEALTH CLINIC PART I, LINE 3C: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS AND UNDERINSURANCE STATUS ARE USED, ALONG WITH FEDERAL POVERTY GUIDELINES, TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND SUBSIDIZED HEALTH SERVICES, LINE 7G, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART III, LINE 2: THE AMOUNT ON LINE 2 REFLECTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 9.1% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 11 AND 12 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. THERE IS NO SHORTFALL IN THE CURRENT YEAR. PART III, LINE 9B: THE COLLECTIONS/CHARITY WRITE-OFF POLICY PROVIDES THAT ONCE THE PATIENT/GUARANTOR QUALIFIES FOR CHARITY CARE HE/SHE WILL BE NOTIFIED OF THE AMOUNT OF FREE CARE AND THE NON-CHARITY AMOUNT. PAYMENT ARRANGEMENTS WILL BE MADE FOR THE NON-CHARITY AMOUNT AT THE TIME OF NOTIFICATION. NO ACTIONS ARE TAKEN ON ACCOUNTS UNTIL REASONABLE EFFORTS ARE MADE TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. COLLECTION ACTIONS ARE THE SAME FOR THE NON-CHARITY AMOUNT AS OTHER PATIENTS. PART VI, LINE 2: AT GEORGE C. GRAPE HOSPITAL, WE EMPLOY SEVERAL STRATEGIES IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO ASSESS THE HEALTH CARE NEEDS OF OUR COMMUNITY:1. PATIENT FEEDBACK AND SURVEYS: WE REGULARLY COLLECT AND ANALYZE FEEDBACK FROM OUR PATIENTS THROUGH SATISFACTION SURVEYS, SUGGESTION BOXES, AND DIRECT PATIENT INTERVIEWS. THIS HELPS US UNDERSTAND THEIR EXPERIENCES, IDENTIFY GAPS IN SERVICES, AND MAKE NECESSARY IMPROVEMENTS.2. COLLABORATION WITH LOCAL HEALTH ORGANIZATIONS: WE PARTNER WITH LOCAL PUBLIC HEALTH DEPARTMENTS, CLINICS, AND COMMUNITY ORGANIZATIONS SUCH AS FREMONT COUNTY PUBLIC HEALTH AND IOWA STATE UNIVERSITY EXTENSION AND OUTREACH OFFICE TO SHARE INFORMATION AND INSIGHTS. THIS COLLABORATIVE APPROACH ALLOWS US TO GAIN A COMPREHENSIVE UNDERSTANDING OF COMMUNITY HEALTH TRENDS AND NEEDS.3. HEALTH DATA ANALYSIS: WE REVIEW AND ANALYZE HEALTH DATA FROM VARIOUS SOURCES, INCLUDING THE CDC, STATE HEALTH DEPARTMENTS, AND LOCAL HEALTH STATISTICS. THIS DATA HELPS US IDENTIFY PREVALENT HEALTH ISSUES, EMERGING HEALTH TRENDS, AND AREAS REQUIRING FOCUSED ATTENTION.4. EMERGENCY DEPARTMENT AND CLINIC UTILIZATION REPORTS: BY ANALYZING THE UTILIZATION PATTERNS OF OUR EMERGENCY DEPARTMENT AND CLINICS, WE CAN IDENTIFY COMMON HEALTH ISSUES AND UNMET NEEDS IN THE COMMUNITY. THIS HELPS US TAILOR OUR SERVICES TO ADDRESS THESE SPECIFIC NEEDS.5. HEALTH SCREENINGS AND OUTREACH PROGRAMS: OUR HOSPITAL CONDUCTS REGULAR HEALTH SCREENINGS AND OUTREACH PROGRAMS IN VARIOUS COMMUNITY SETTINGS. THESE INITIATIVES NOT ONLY PROVIDE DIRECT HEALTH SERVICES BUT ALSO OFFER INSIGHTS INTO THE HEALTH STATUS AND NEEDS OF DIFFERENT POPULATION GROUPS WITHIN OUR COMMUNITY.6. ENGAGEMENT WITH HEALTHCARE PROVIDERS: WE MAINTAIN REGULAR COMMUNICATION WITH OUR NETWORK OF HEALTHCARE PROVIDERS, INCLUDING PRIMARY CARE PHYSICIANS, SPECIALISTS, AND ALLIED HEALTH PROFESSIONALS. THEIR FIRSTHAND EXPERIENCES AND OBSERVATIONS PROVIDE VALUABLE INFORMATION ABOUT THE HEALTH NEEDS AND CHALLENGES FACED BY THEIR PATIENTS.BY COMBINING THESE METHODS, WE CAN GAIN A UNDERSTANDING OF THE HEALTH CARE NEEDS OF OUR COMMUNITY AND ENSURE THAT OUR SERVICES ARE ALIGNED WITH THOSE NEEDS, ULTIMATELY ENHANCING THE OVERALL HEALTH AND WELL-BEING OF THE RESIDENTS WE SERVE. PART VI, LINE 3: THE HOSPITAL COMMUNICATES VIA MAIL WITH EACH PATIENT. THE ON STAFF FINANCIAL COUNSELOR ASSISTS PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION WHEN NECESSARY. PATIENTS WILL RECEIVE STATEMENTS OF ACCOUNT VIA MAIL WITH FINANCIAL ASSISTANCE POLICY INFORMATION INCLUDED. WHEN POSSIBLE, THE FINANCIAL COUNSELOR WILL SPEAK WITH PATIENTS PERSONALLY BEFORE BEING DISCHARGED TO DISCUSS THEIR CHARITY CARE NEEDS. PART VI, LINE 4: OUR PRIMARY SERVICE AREA INCLUDES FREMONT COUNTY. THE NORTHERN PART OF THE COUNTY IS BEGINNING TO GROW AT A SLOW PACE. THE MIDDLE AND SOUTHERN PART OF THE COUNTY IS EITHER DECLINING OR MAINTAINING THEIR POPULATIONS. THE SOUTHERN PART OF THE COUNTY ALSO HAS A HIGH POVERTY RATE. THIS SERVICE AREA HAS A POPULATION OF 7,147. OUR SECONDARY SERVICE AREA INCLUDES THREE SURROUNDING COUNTIES IN IOWA, TWO IN MISSOURI, AND TWO IN NEBRASKA WHICH HAVE AN ESTIMATED POPULATION OF 93,000. THE HOSPITAL DOES SERVE SOME PATIENTS IN THE SECONDARY SERVICE AREA, BUT THE MAJORITY OF THE PATIENTS COME FROM THE PRIMARY SERVICE AREA. PART VI, LINE 5: THE HOSPITAL USES THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT TO DETERMINE FOCUS AREAS FOR THE COMMUNITY. THE HOSPITAL ALSO HOSTS A HEALTH FAIR FOR THE COMMUNITY TO HAVE ACCESS TO BLOOD DRAWS OUT OF POCKET. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X 0 0 0 0 0 0 0 0 0 CRISTIN HENDRICKSON CEO 188854 0 0 0 0 0 6161 0 2037 0 197052 0 0 0 FORM 990, PART III, LINE 2 EFFECTIVE DECEMBER 31, 2023, THE HOSPITAL PURCHASED THE REAL ESTATE OF MEDICAL CLINIC, INC. THE CLINIC OPERATES THREE RURAL HEALTH CLINICS PROVIDING OUTPATIENT SERVICES IN IOWA IN THE TOWNS OF HAMBURG, SIDNEY AND TABOR. FORM 990, PART VI, SECTION A, LINE 6 GRAPE COMMUNITY HOSPITAL IS A CORPORATION THAT HAS MEMBERS. MEMBERSHIP IN THE CORPORATION SHALL CONSIST OF THE PERSONS, CORPORATIONS OR ASSOCIATIONS WHO SUBSCRIBED AS INCORPORATORS AND SUCH OTHER PERSONS, CORPORATIONS OR ASSOCIATIONS WHO HAVE CONTRIBUTED $100 OR MORE TO THE CORPORATION IN CASH, PROPERTY OR VOLUNTEER SERVICES RENDERED TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE INDIVIDUAL MEMBERS (NOT CORPORATE OR ASSOCIATION MEMBERS) OF GRAPE COMMUNITY HOSPITAL (AS DESCRIBED ON FORM 990, PART VI, SECTION A, LINE 6) SHALL ELECT, AT THE ANNUAL MEETING, THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND DIRECTOR OF FINANCE WILL REVIEW THE 990 PRIOR TO SUBMISSION. THE 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS AND KEY EMPLOYEES WILL BE REQUIRED TO ANNUALLY COMPLETE THE "CONFLICT OF INTERESTS STATEMENT". THIS POLICY IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND GIVEN TO EACH NEW DIRECTOR FOR SIGNATURE DURING ORIENTATION. ANY CONFLICTS THAT ARISE DURING THE YEAR ARE DISCLOSED TO THE BOARD OF DIRECTORS AND APPROPRIATELY DOCUMENTED. SHOULD ANY CONFLICT REQUIRE BOARD ACTION, THE DIRECTORS SHALL HOLD A MEETING TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY WAS DETERMINED BY USING THE IOWA HOSPITAL ASSOCIATION (IHA) SALARY SURVEY. IT WAS DISCUSSED BY INDEPENDENT BOARD MEMBERS AND REVIEWED BY LEGAL COUNSEL. THIS PROCESS HAS BEEN IN PLACE SINCE 2008. ALL OTHER SALARIES, REGARDLESS OF THE POSITION, ARE COMPARED TO THE IHA SALARY SURVEY WITH YEARS OF EXPERIENCE TAKEN INTO CONSIDERATION AS WELL. THE HOSPITAL HAS SENIOR ADMINISTRATION THAT ARE INVOLVED IN THE HIRING OF MANAGEMENT, INCLUDING THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,752,479. MANAGEMENT AND GENERAL EXPENSES 87,644. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,840,123. ER COVERAGE: PROGRAM SERVICE EXPENSES 160,976. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 160,976. NURSING SERVICES: PROGRAM SERVICE EXPENSES 1,229,985. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,229,985. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 221,862. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 221,862. LAB SERVICES: PROGRAM SERVICE EXPENSES 358,912. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 358,912. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 147,444. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 147,444. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEDICAL CLINIC INC 1219 MAIN ST HAMBURG IA 51640 420994017 MEDICAL CLINIC IA 1659078 654357 COMMUNITY HOSPITAL INC GRAPE HOSPITAL FOUNDATION PO BOX 9 HAMBURG IA 51640 421335348 FUNDRAISING AND SUPPORT OF GEORGE C. GRAPE COMMUNITY HOSPITAL IA 501(C)(3) LINE 12B, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0