2018-05-14T14:09:35-05:00 2017-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2016-07-01 421087612 KNOXVILLE COMMUNITY HOSPITAL INC KNOX 6418421407 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 MAGGIE HAMILTON-BEYER CFO 6418421407 2018-05-11 1 MARC D BEHRENS P01543366 4023302660 209.34.201.180 2018-05-11 08:20:20 CD P 876BE3EDFAF35ED687A48C1D6A395F974978876D A4DB24C5AB8EB2ABEC143517BC341AFF020B8A0E 2016 2021-01-29 14:40:06Z MAGGIE HAMILTON-BEYER 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 31595991 0 X WWW.KNOXVILLEHOSPITAL.ORG X 1981 IA TO FAITHFULLY PROVIDE EXCEPTIONAL HEALTHCARE TO THE PEOPLE OF KNOXVILLE & SURROUNDING COMMUNITIES AND TO BE A HEALTHCARE DESTINATION BUILT ON COMPASSION AND INNOVATION. 9 9 368 13 1120 -1796 247468 142636 30209209 31217081 -5647 58975 205477 177299 30656507 31595991 24014 10891 0 0 14302035 15168426 0 0 0 15263796 15975673 29589845 31154990 1066662 441001 30368979 31507902 19443899 20079821 10925080 11428081 X WE ARE DEDICATED TO PROVIDING PERSONAL PROGRESSIVE QUALITY HEALTHCARE WITH COMPASSION TO THE PEOPLE OF KNOXVILLE AND SURROUNDING AREAS. WE VALUE TEAMWORK, INNOVATION, COMPASSION, INTEGRITY, SERVICE, AND PEOPLE-CENTERED CARE. 0 0 27932879 10891 31230415 KNOXVILLE COMMUNITY HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN BOTH INPATIENT AND OUTPATIENT SETTINGS. DURING FISCAL YEAR 2017, THE HOSPITAL PROVIDED 1,058 DAYS OF SKILLED NURSING CARE AND 217,314 OUTPATIENT OCCASIONS OF SERVICE. 27932879 1 1 0 1 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 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 107 0 1 368 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MAGGIE HAMILTON-BEYER 6418421402 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 MEGAN MCKAY PRESIDENT 1.00 0.00 X X 0 0 0 JIM BUTLER 1ST VICE PRESIDENT 1.00 1.00 X X 0 0 0 PATRICK STOCKTON 2ND VP & TREASURER 1.00 0.00 X X 0 0 0 TRESA MOTT SECRETARY 1.00 0.00 X X 0 0 0 LISA CROSSETT MEMBER 1.00 0.00 X 0 0 0 DAVE JOHNSON MEMBER 1.00 0.00 X 0 0 0 TODD CHAMBERS MEMBER 1.00 1.00 X 0 0 0 LORI BAILEY MEMBER 1.00 0.00 X 0 0 0 ROCHELLE KLOOTWYK MEMBER 1.00 0.00 X 0 0 0 KEVIN KINCAID CEO 40.00 0.00 X 257895 0 16284 MAGGIE HAMILTON-BEYER CFO 40.00 0.00 X 134034 0 2750 DAVID KERMODE SURGEON 40.00 0.00 X 403677 0 22135 MARTHA ERRTHUM PHYSICIAN 39.00 1.00 X 239810 0 29989 THOMAS HOEHNS PHYSICIAN 40.00 0.00 X 260206 0 21674 EARL MCKEEVER PHYSICIAN 40.00 0.00 X 231809 0 27163 SHANNON REMMINGTON PHYSICIAN 40.00 0.00 X 242259 0 36760 1769690 0 156755 17 0 1 1 RUSSELL CONSTRUCTION COMPANY INC 4600 E 53RD STREET DAVENPORT IA 52807 GENERAL CONTRACTOR 2358066 DOCS EMERGENCY MEDICINE INC 800 W FRONTIER LN OLATHE KS 66061 ER PHYSICIAN COVEREAGE 1577128 21ST CENTURY REHAB PO BOX 461 NEVADA IA 50201 PT/OT SERVICES 851581 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 COMPUTER SOFTWARE SYSTEMS 585178 SQUAREWAVEFORM ANESTHESIOLOGY PO BOX 1192 MARSHALLTOWN IA 50158 ANESTHESIOLOGY COVERAGE 424133 17 6816 69211 66609 142636 MEDICARE 621110 14009690 14009690 NET PATIENT SERVICE REVENUE 621110 11479663 11479663 MEDICAID 621110 3178927 3178927 PHARMACY 621110 2445993 2445993 OTHER PROGRAM SERVICE REVENUE 621110 74763 74763 28045 28045 31217081 55685 55685 38193 0 38193 38193 38193 3290 0 3290 3290 3290 CAFETERIA 900099 125772 1120 124652 MISCELLANEOUS 900099 13334 13334 139106 31595991 31230415 1120 221820 X 10891 10891 410962 410962 12046909 10698903 1348006 2710555 2347776 362779 217935 75836 142099 21370 21370 79798 79798 4571 4571 4987993 4834557 153436 146430 146430 567888 430862 137026 62260 62163 97 1852880 1776629 76251 45059 19649 25410 26584 26584 632743 556866 75877 2008469 1767618 240851 246245 200957 45288 MEDICAL SUPPLIES 3945040 3945040 BAD DEBTS 787136 787136 DUES & LICENSES 214288 124844 89444 FOOD COST 107791 107791 21193 12347 8846 31154990 27932879 3222111 0 53800 48313 6715610 7091949 3049146 3333818 46701 28701 320605 25600 402203 394945 169462 320085 31279443 13295169 17817836 17984274 1180057 2208004 148275 67213 465284 5000 30368979 31507902 2221682 1713690 15821979 15456417 1290388 1086084 109850 1823630 19443899 20079821 X 10925080 11428081 10925080 11428081 30368979 31507902 441001 62000 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3783 3783 0 PART II-B, LINE 1: KNOXVILLE COMMUNITY HOSPITAL, INC. PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, OF WHICH A PORTION (21%) IS USED FOR LOBBYING ACTIVITIES. 252056 252056 20835167 7491629 13343538 10170054 5803540 4366514 22166 22166 17984274 CAPITAL LEASES 1811877 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 11753 1823630 X PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS RECEIVED A DETERMINATION LETTER INDICATING THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HOSPITAL'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB 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 JUNE 30, 2017 AND 2016, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 1 X 1 X 1 1 1 0 1 1 98829 0 98829 0.00330 4198017 3178927 1019090 0.03360 3949718 2133298 1816420 0.05980 8246564 5312225 2934339 0.09670 38454 10138 28316 0.00090 228950 0 228950 0.00750 29933 1185 28748 0.00090 297337 11323 286014 0.00930 8543901 5323548 3220353 0.10600 2820 0 2820 0.00010 10513 0 10513 0.00030 1362 0 1362 0.00000 6440 559 5881 0.00020 15423 0 15423 0.00050 2839 0 2839 0.00010 39397 559 38838 0.00120 1 787136 0 12477662 12564856 -87194 X 1 1 1 1 KNOXVILLE COMMUNITY HOSP INC & CLINICS 1002 S LINCOLN STREET KNOXVILLE IA 50138 WWW.KNOXVILLEHOSPITAL.ORG 630031H X X X X KNOXVILLE COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X X 15 1 0 0 1 X WWW.KNOXVILLEHOSPITAL.ORG X 1 15 1 WWW.KNOXVILLEHOSPITAL.ORG 0 1 X X X 0 1 X X X X 1 X WWW.KNOXVILLEHOSPITAL.ORG X WWW.KNOXVILLEHOSPITAL.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 3J: THE TOP FOUR HEALTH NEEDS IDENTIFIED FROM THE 2015 CHNA REPORT WERE MENTAL HEALTH, WELLNESS, HEALTHY EATING CHOICES AND PREVENTATIVE MEDICINE. OTHER HEALTH NEEDS IDENTIFIED WERE HEALTH ACCESS, TRANSPORTATION, BEDS, EDUCATION, WELLNESS EDUCATION, SUBSTANCE ABUSE TREATMENT AND PREVENTION, FAMILY PLANNING IN HIGH SCHOOL FOR BIRTH CONTROL, TRAILS AND SIDEWALKS, SPECIALTY SERVICES LIKE PSYCHIATRY, ORTHOPEDICS, G.I., OBGYN, COMMUNITY PERCEPTION AND COMMUNICATION, COMMUNITY BUY-IN FOR PREVENTIVE HEALTHCARE, CANCER, ADULT DAY CARE, UNINSURED DENTAL CARE, URGENT CARE, ECONOMIC DEVELOPMENT, EXTENDED CLINIC HOURS, WEEKEND HOSPITAL SERVICE, OCCUPATIONAL HEALTH PROVIDERS, BETTER COORDINATION AMONG PROVIDERS, MAMMOGRAPHY, ER DOCTORS, EXPAND MEDICAID, VETERANS CARE, DIABETES EDUCATION AND MONITORING, MENTAL HEALTH TELEMEDICINE SERVICES AVAILABLE AND HEALTHY WEIGHT PLANNING. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 5: RESEARCH WAS PERFORMED AND DATA WAS COLLECTED TO ENSURE PROPER TOWN HALL REPRESENTATION AND TO DETERMINE THE PRIMARY SERVICE AREA. PR STORY WAS PREPARED AND SENT TO LOCAL MEDIA TO PUBLISH AND ANNOUNCE UPCOMING CHNA WORK AND REQUEST PUBLIC SURVEY PARTICIPATION. A PAPER SURVEY WAS USED WITH AN ONLINE LINK TO PSA RESIDENTS. THE SURVEY WAS SENT TO 1,000 PARTICIPANTS WITH ANTICIPATION OF RECEIVING 250 RETURNS. WE PREPARED AND PUBLISHED A TOWN HALL INVITATION TO THE PUBLIC AND COLLABORATING PARTIES SUCH AS PUBLIC HEALTH, SCHOOL LEADERS, FAITH-BASED LEADERS, PHYSICIANS AND OTHER CARE PROVIDERS, MENTAL HEALTH COMMUNITY, FREE CLINICS, LOCAL RESIDENTS, COMMUNITY LEADERS, BUSINESS LEADERS, LOCAL GOVERNMENT, PEOPLE WITH CHRONIC CONDITIONS, UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS ALONG WITH KNOXVILLE HOSPITAL AND CLINICS. WE PREPARED A BRIEF OF GOALS, OBJECTIVES, PURPOSE, OUTCOME, ROLES, AND COMMUNITY INVOLVEMENT AND HELD A KICK-OFF MEETING. COMMUNITY HEALTH FACTS AND PRACTICE DATA WERE COLLECTED AND PUBLISHED. A SECOND ROUND TABLE WAS THEN HELD TO REVIEW THE RESEARCH GATHERED, OPINIONS GIVEN, AND NEEDS IDENTIFIED. COMMUNITY OPINIONS WERE COLLECTED ON HEALTH NEEDS, PRACTICES, AND PHYSICIAN AND CARE PROVIDER MANPOWER AVAILABILITY. THE COMMUNITY HEALTH NEEDS REPORT WAS THEN PREPARED AND PRESENTED TO COMMUNITY LEADERS WITH RECOMMENDED ACTIONS. AT THE TOWN HALL MEETING THE DISCUSSION INCLUDED PURPOSE, ROLES, REVIEW OF HISTORICAL DATA, PARTICIPANT DISCUSSIONS TALLY AND RANKING OF HEALTH CONCERNS, AND REFLECTION ON THE HEALTH NEEDS OF THE COMMUNITY. THE MEETING CLOSED WITH INFORMATION ABOUT THE NEXT STEPS. THE COMMUNITY WAS ENCOURAGED TO CONTINUE TO PARTICIPATE BY CONTRIBUTING IDEAS TO THE HOSPITAL AND HEALTH DEPARTMENT VIA EMAIL OR PERSONAL CONVERSATIONS. IN ADDITION, OTHER MEETINGS, INTERVIEWS, AND FOCUS GROUPS WERE HELD. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 11: DURING THE FISCAL YEAR JULY 1, 2016 THRU JUNE 30, 2017 THE HOSPITAL ADDRESSED THE SIGNIFICANT NEEDS IN THE FOLLOWING WAYS:1.) INPATIENT MENTAL HEALTH SERVICES- KEVIN KINCAID, CEO OF THE HOSPITAL SPENT APPROXIMATELY 80 HOURS ON ACTIVITIES SPECIFIC TO MENTAL HEALTH REDESIGN AND IMPROVEMENTS. MOST OF THE EFFORTS WERE CONCENTRATED ON STATEWIDE AND COUNTYWIDE INITIATIVES. THROUGH THE IOWA HOSPITAL ASSOCIATION THERE WERE SEVERAL INTERACTIONS WITH INDIVIDUAL LEGISLATORS AND SUBCOMMITTEE HEARINGS ON MENTAL HEALTH. IN COLLABORATIONS WITH THE MARION COUNTY SHERIFF'S OFFICE, WE ORGANIZED A REGIONAL LISTENING POST FOR PUBLIC COMMENT ON OPIOID ADDICTION AND THE CONNECTION TO MENTAL HEALTH. KEVIN ALSO ATTENDED SEVERAL OF OUR MENTAL HEALTH REGIONAL MEETINGS FOR INPUT.2.) ACCESS TO MENTAL HEALTH PROVIDERS- IN FEBRUARY OF 2017 THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT IMPLEMENTED TELE-PSYCH TO IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS IN THE EMERGENCY DEPARTMENT. THE TELE-PSYCH SYSTEM IS UTILIZED FOR AROUND 95% OF OUT MENTAL HEALTH PATIENTS THAT PRESENT IN THE ED. THE PROGRAM ASSISTED WITH TRANSFERRING MOST OF THOSE PATIENT TO A MENTAL HEALTH FACILITY. SOME PATIENTS COULD RETURN TO THE HOME WITH OUTPATIENT THERAPY PER THE RECOMMENDATIONS OF THE ITP OUR TELE-PSYCH PROVIDER.THE USE OF TELE-PSYCH FREES UP VALUABLE TIME FOR THE NURSES AS ITP WILL DO ALL OF THE LEG WORK IN FINDING PLACEMENT FOR OUR PATIENTS WHEN THEY REQUIRE TRANSFER TO AN INPATIENT FACILITY. THIS SERVICE DOES FACILITATE GETTING PATIENTS TO A HIGHER LEVEL OF CARE AS WE ARE AT THE MERCY OF A SMALL NUMBER OF MENTAL HEALTH HOSPITAL BED THROUGHOUT THE STATE.TELE-PSYCH DOES HELP TREMENDOUSLY IN THE CARE OF THE PATIENT. IT ALLOWS OUR PROVIDERS TO UTILIZE MENTAL HEALTH PROFESSIONALS FOR AN EXPERT OPINION ON THE SPECIAL TREATMENT NEEDS FOR THESE PATIENTS. ITPS PROVIDERS CAN ALSO BE A GREAT RESOURCE FOR ASSISTING ED PROVIDERS WITH MEDICATION ADJUSTMENT CONSULTS.3.) FIGHT OBESITY (NUTRITION AND FITNESS)- EFFECTIVE MEDIA FOR EDUCATION THE KNOXVILLE COMMUNITY HAS BEEN IMPLEMENTED BY HOSPITAL'S MARKETING TEAM AND VARIOUS HEALTH AND WELLNESS LEADERS. DIETARY AND PHYSICAL ACTIVITY TIPS ARE PROVIDED ON THE HOSPITAL'S FACEBOOK PAGE ON A WEEKLY BASIS. ACCREDITED ARTICLES, TIPS FROM THE HOSPITAL'S DIETITIAN AND PHYSICAL THERAPY TEAM ARE PROVIDED FOR THE HOSPITAL'S FACEBOOK FOLLOWERS. A RADIO SPOTLIGHT HAS BEEN COMPLETED BY THE HOSPITAL DIETITIAN ON WAYS TO FIGHT OBESITY, AS WELL AS DIABETES MANAGEMENT AND PREVENTING CHRONIC DISEASES IN JANUARY OF 2018. THE HOSPITAL WILL CONTINUE REACHING OUT TO THE COMMUNITY THROUGH MEDIA ON A CONSISTENT BASIS.THE HOSPITAL IS WORKING UNDER THE STATE INNOVATION MODEL IN COLLABORATION OF MARION COUNTY PUBLIC HEALTH WITH MAJOR IMPROVEMENTS MADE TOWARDS OUR MAIN FOCAL POINT, THE SIMS PROJECT. AS OF DECEMBER 2017, OUR SIMS PROGRAM HAS GROWN AT A PROGRESSIVE RATE WITH IMPLAUSIBLE AND POSITIVE RESULTS. ON AVERAGE, 80% OUR DIABETIC PATIENTS THAT ARE LOYAL TO OUR SIMS PROGRAM HAVE IMPROVED THEIR A1C% RESULTS. THERE IS NOW A FULL-TIME NURSE DEDICATED SOLELY TO SIMS PARTICIPANTS, DUE TO ENCOURAGING OUTCOMES FOR REFERRED DIABETIC PATIENTS AND AN IMPROVED COMMUNICATION SYSTEM WITH PROVIDERS. THE PROGRAM WILL BE CONTINUED WITH NO ANTICIPATED CONCLUDING DATE. THE HOSPITAL CONTINUES TO EXPLORE WEIGHT LOSS PROGRAM OPTIONS DESIGNED TO FIT THE NEEDS OF THE COMMUNITY. THE HOSPITAL'S REGISTERED DIETITIAN HAS MADE IT A PRIORITY AND GOAL TO HAVE A TENTATIVE PROGRAM OUTLINED BY THE END OF 2019.THE HOSPITAL WILL CONTINUE TO HOST NUTRITION FOCUSED COOKING CLASSES AT LEAST TWICE A YEAR TO THE COMMUNITY. A PARTNERSHIP WITH THE LOCAL HY-VEE HAS BEEN CREATED AND WILL BE BUILT UPON, WITH DISCUSSION OF FREEZER MEAL CLASSES FOR GENERAL HEALTH AND DIABETES. THE HOSPITAL'S DIETITIAN AND NUTRITION SERVICES TEAM IS ARRANGING TO HOST COOKING CLASSES FOR HOSPITAL STAFF LX/MONTH STARTING IN THE FALL OF 2018. THE HOSPITAL'S DIETITIAN IS ALSO PLANNING TO COLLABORATE WITH THE KNOXVILLE COMMUNITY SCHOOL DISTRICT TO IMPLEMENT COOKING CLASSES FOR STUDENTS AND PARENTS, FOCUSING PRIMARILY ON ATHLETES AND PROPER NUTRITION.4.) VISITING SPECIALISTS CLINICS (PEDIATRICS AND PULMONOLOGY)- THE HOSPITAL'S ADMINISTRATION CONTINUES TO WORK CLOSELY WITH THEIR NETWORK PARTNER, MERCY HEALTH NETWORK TO INCREASE LOCAL ACCESS TO VARIOUS MEDICAL SPECIALISTS. IN THE FALL OF 2017, THE HOSPITAL ENTERED INTO A CONTRACT TO PROVIDE A MERCY ENT SPECIALIST AT THE HOSPITAL. DR. DEAN A BOARD-CERTIFIED ENT SPECIALIST HOLDS A MONTHLY CLINIC SERVING THE KNOXVILLE COMMUNITY. DR. DEAN IS SEEING AROUND 12 TO 14 PATIENTS EACH MONTH AND MOST WHO ARE UNDER THE AGE OF 18.DEVELOP A MARKETING PLAN TO PROMOTE TO THE COMMUNITY THE HOSPITAL'S PROVIDERS WHO HAVE EXTENSIVE EXPERIENCE CARING FOR PEDIATRIC PATIENTS. SOME OF THE MARKETING STRATEGIES INCLUDED:A.) PARTICIPATE IN COMMUNITY SPONSORED EVENTS INVOLVING CHILDREN AND FAMILIESB.) ORGANIZE AND SPONSOR A KIDS' HEALTH FAIR, IN PARTNERSHIP WITH ISU EXTENSION SERVICE AND OTHER LOCAL GROUPS AND BUSINESSESC.) PARTNER WITH AREA SCHOOL SYSTEMS TO PROVIDE PUBLIC HEALTH INFORMATION TO STUDENTSD.) HOST A "TOUR THE HOSPITAL" EVENT FOR ALL NEW SCHOOL EMPLOYEESE.) SPONSOR HEALTH EDUCATION BOOKS FOR ALL 1ST GRADE STUDENTSF.) PARTNER WITH KNOXVILLE SCHOOL SYSTEM AND CITY OF KNOXVILLE ON A HEALTHY KIDS INITIATIVE WALKG.) DONATE HEALTHY SNACKS FOR THE MISS MARY STRAWBERRY CLASSES ON A QUARTERLY BASISH.) USE FACEBOOK MONTHLY TO DISTRIBUTE HEALTH INFORMATION TO PARENTS AND YOUTH, WHICH CAN BE SHARED BY THE SCHOOLS ON THEIR FACEBOOK SITESI.) PARTICIPATE IN THE BACKPACK BUDDIES PROGRAM, WHICH PROVIDES HEALTHY SNACKS AND MEALS TO LOW-INCOME CHILDRENJ.) HOST A SCHOOL SUPPLIES DRIVEK.) DEVELOP AND DISTRIBUTE CHILDHOOD IMMUNIZATION GUIDEL.) DEVELOP AND DISTRIBUTE A BROCHURE LISTING ALL PRIMARY CARE PROVIDERS. THE BROCHURE WILL BE DISTRIBUTED TO ALL ACUTE CARE PATIENTS, ALL NEW PATIENTS, TO ALL NEW COMMUNITY RESIDENTS, AND MADE AVAILABLE AT PUBLIC EVENTS.M.) PARTICIPATE IN THE WARM WELCOMES PROGRAM, WHICH GREETS ALL NEW RESIDENTS IN THE COMMUNITYN.) PARTNER WITH MARION COUNTY PUBLIC HEALTH DEPARTMENT ON SEVERAL COMMUNITY OUTREACH PROGRAMS SERVING YOUTH AND THEIR FAMILIESO.) PARTICIPATE ON COMMITTEES SERVING YOUTH (WELLNESS COMMITTEE, THRIVE, MENTAL HEALTH COALITION, ETC.)P.) ESTABLISH RELATIONSHIPS AND LIAISON WITH LOCAL BUSINESSES, COMMUNITY ORGANIZATIONS, GOVERNMENTAL ENTITIES, PUBLIC HEALTH ORGANIZATION, YOUTH GROUPS.5.) HEALTHCARE TRANSPORTATION- INVESTIGATE TRANSPORTATION SOLUTIONS IN OTHER (SIMILAR) HOSPITALS. IDENTIFY POSSIBLE SOLUTIONS TO ELIMINATE BARRIERS OF CURRENT TRANSPORTATION OPTIONS. COLLABORATE WITH MARION COUNTY PUBLIC HEALTH, MARION COUNTY BOARD OF SUPERVISORS, LOCAL RESOURCE ORGANIZATIONS, OTHER HOSPITALS AND THE HOSPITAL'S LEADERS AND STAFF. PLAN TACTICS UTILIZED TO ADDRESS THESE NEEDS INCLUDED THE FOLLOWING:A.) ONE OF THE HOSPITAL'S EMPLOYEES (GINNY KRICHAU) JOINED HIRTA TAG COMMITTEE- GROUP THAT MEETS QUARTERLY TO DISCUSS TRANSPORTATION NEEDS/ISSUES AND BRAINSTORMS SOLUTIONS. THIS GROUP ALSO HOSTS ANNUAL STRATEGIC PLANNING MEETINGS INCLUDING THE LOCAL COMMUNITY, INCLUDING STAFF FROM VARIOUS COMMUNITY RESOURCES AND ALSO PEOPLE WHO UTILIZE/NEED TRANSPORTATION SERVICES.B.) HIRTA AND THE HOSPITAL ARE TRIALING A NEW PROCESS FOR PATIENTS WHO NEED A RIDE HOME AFTER AN APPOINTMENT. HIRTA PROVIDED THE HOSPITAL WITH A PRIVATE "WILL CALL" NUMBER IN HOPES TO EXPEDITE THE DRIVER RETURN TIME. PRIOR TO THIS, CALLERS HAD TO REMAIN ON HOLD FOR LONG PERIODS OF TIME, WAITING IN THE CUE FOR DISPATCH. MEANWHILE, THE PATIENT WAITED (SOMETIMES MORE THAN 40 MINUTES) FOR A RIDE HOME.C.) THE HOSPITAL RECEIVED A GRANT FROM COVERYS FOR A PATIENT'S "SAFE TRANSITIONS". PART OF THE FUNDING FROM THIS GRANT WILL ASSIST PATIENTS WITH A SAFE RIDE HOME FROM THE HOSPITAL.D.) THE HOSPITAL BEGAN A COMMUNITY PATIENT/FAMILY ADVISORY COUNCIL CONSISTING OF PATIENTS/FAMILIES, STAFF AND VOLUNTEERS. THE GROUP MEETS 6-7 TIMES PER YEAR TO DISCUSS VARIOUS ISSUES/OPTIONS CONCERNING ALL ASPECTS OF HEALTHCARE AND INTERACTIONS WITH THE HOSPITAL (INCLUDING ACCESS TO SERVICES-TRANSPORTATION).E.) THE HOSPITAL, MARION COUNTY PUBLIC HEALTH AND PELLA REGIONAL HEALTH CENTER WORK COLLABORATIVELY AS PART OF THE SIM GRANT- TRANSPORTATION AND ACCESS TO SERVICES ARE COMMON TOPICS AS ARE OTHER SOCIAL DETERMINANTS OF HEALTH.F.) SEVERAL OF THE HOSPITAL'S STAFF MEMBERS REGULARLY ATTEND VARIOUS MEETINGS IN WHICH COMMUNITY MEMBERS COLLABORATE/WORK TO PREVENT VARIOUS LIFE/HEALTH ISSUES. TRANSPORTATION AND ACCESS TO SERVICES/SOLUTIONS ARE OFTEN THE TOPIC. THE FOLLOWING ARE SOME OF THE GROUP MEETINGS ATTENDED:I.) MARION COUNTY COALITION FOR CHANGE (MC3) -SUBSTANCE ABUSE TASK FORCEII.) SUICIDE PREVENTION TASK FORCEIII.) KNOXVILLE COMMUNITY WELLNESS- WORKING WITH WELLMARK'S "HEALTHIEST HOMETOWNS" INITIATIVEIV.) MARION COUNTY BEHAVIORAL HEALTH TASK FORCE KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 13H: THE HOSPITAL CONSIDERED FAMILY SIZE IN ADDITION TO THE CRITERIA ABOVE. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 15E: A LETTER IS SENT PRIOR TO COLLECTION DETAILING THE PAYMENT PLAINS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 16J: A LETTER IS SENT, AND IN MANY CASES TWO, PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. THE HOSPITAL ALSO MAKES THREE ATTEMPTS TO REACH BY PHONE. 4 1 - KNOXVILLE AREA COMMUNITY HOSPITAL CLINIC 1202 WEST HOWARD STREET KNOXVILLE IA 50138 PHYSICIAN CLINIC 2 - MELCHER PHYSICIANS CLINIC 113 NORTH MAIN STREET MELCHER IA 50163 PHYSICIAN CLINIC 3 - PLEASANTVILLE PHYSICIAN CLINIC 104 NORTH WASHINGTON STREET PLEASANTVILLE IA 50225 PHYSICIAN CLINIC 4 - RED ROCK HEALTH CENTER 615 WASHINGTON STREET PELLA IA 50219 PHYSICIAN CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE OR DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 7: THE COST TO CHARGE RATIO AS FOLLOWS WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST: (TOTAL EXPENSES - BAD DEBT) / (GROSS PATIENT SERVICE REVENUE + OTHER REVENUE) = PERCENTAGE OF COST TO CHARGE. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST BASED ON KNOXVILLE COMMUNITY HOSPITAL INC.'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $787,136. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SERVICE: THE HOSPITAL PROVIDES MEETING ROOM SPACE TO A LARGE NUMBER OF COMMUNITY ORGANIZATIONS AT NO COST. THE HOSPITAL PROVIDES SUPPORT TO THE LOCAL CHAMBER WITH MONETARY AND TIME DONATIONS. A FIRST AID TENT INCLUDING LABOR AND SUPPLIES FOR MEDICAL TREATMENT IS PROVIDED DURING KNOXVILLE NATIONALS AND CHAMBER EVENTS. THE HOSPITAL HOSTS AN ANGEL TREE EVERY YEAR TO HELP FAMILIES IN NEED AT CHRISTMAS. EMPLOYEES PARTICIPATE IN FESTIVAL OF TREES AND HELP AT FOOD PANTRY. THE HOSPITAL OFFERS HEALTH FAIRS ANNUALLY TO MEN, WOMEN AND CHILDREN.ECONOMIC DEVELOPMENT: HOSPITAL LEADERS ARE SENT TO LEADERSHIP DEVELOPMENT TRAINING ANNUALLY. ROTATIONS AND PRECEPTORSHIPS ARE MADE AVAILABLE IN VARIOUS SPECIALTIES FOR STUDENTS GOING INTO THE MEDICAL FIELD. JOB SHADOWING IS PROVIDED FOR LOCAL HIGH SCHOOL AND COLLEGE STUDENTS. THE HOSPITAL IS A MEMBER OF THE LOCAL CHAMBER AND ROTARY CLUB, WITH EMPLOYEES PARTICIPATING IN BOTH. THE HOSPITAL'S COMPLIANCE OFFICER IS ON THE LOCAL DAY CARE BOARD. THE HOSPITAL DONATES TO LOCAL PROJECTS ON A REGULAR BASIS.COMMUNITY SUPPORT: MONETARY AND IN-KIND DONATIONS ARE GIVEN TO MANY COMMUNITY ORGANIZATIONS AND SCHOOL GROUPS IN SUPPORT OF CANCER FUND RAISERS, PROM SAFETY EVENTS, SPORTING TEAMS, AND OTHER EVENTS. THE HOSPITAL PARTICIPATES IN LOCAL PARADES AND CHAMBER EVENTS. HOSPITAL EMPLOYEES SERVE ON LOCAL COMMUNITY BOARDS; SPEAK AT SCHOOL HEALTH AND CAREER EVENTS; PARTICIPATE IN THE LOCAL THEATER GROUP; PROVIDE COACHING FOR AREA SPORTS TEAMS; AND DONATE TIME TO HABITAT FOR HUMANITY; AND 4H CLUBS.ECONOMIC IMPROVEMENTS: THE HOSPITAL AGGRESSIVELY RECRUITS FOR NEW PROVIDERS IN AN EFFORT TO SUSTAIN AND GROW. THE HOSPITAL COMPLETED AN EXTENSIVE REMODEL AND EXPANSION, UTILIZING AREA VENDORS. THE HOSPITAL CONTINUOUSLY LOOKS FOR NEW WAYS TO IMPROVE THE HEALTH OFFERINGS PROVIDED TO THE COMMUNITY. THE HOSPITAL STARTED THE "LET'S DO MORE" CAMPAIGN TO CONTINUE FACILITY IMPROVEMENTS. THE HOSPITAL HAS FORMED A RELATIONSHIP WITH AREA SCHOOLS, OFFERING FREE SPORTS PHYSICALS. COALITION BUILDING: THE HOSPITAL'S ER COORDINATOR IS A MEMBER OF THE MARION COUNTY HEALTH COALITION TEAM, WHICH INCLUDES A NUMBER OF NURSES ALSO EMPLOYED BY THE HOSPITAL. THE ER NURSE COORDINATOR IS A MEMBER OF THE IOWA NURSE COALITION, EBOLA, PHEL, CEPC, AND STAR. HOSPITAL EMPLOYEES WORK WITH THE LOCAL PUBLIC HEALTH DEPARTMENT. THE HOSPITAL ALSO PERFORMS THE COMMUNITY HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENT AND MAINTAINS A PRESENCE IN THE COMMUNITY MENTAL HEALTH TEAM.COMMUNITY HEALTH IMPROVEMENT: THE HOSPITAL PROVIDES FOOD TO THE LOCAL FOOD PANTRY WEEKLY AND PARTICIPATES IN MEALS ON WHEELS THROUGHOUT THE YEAR. THE HOSPITAL HOSTS, PARTICIPATES IN, OR PROVIDES SUPPORT FOR A VARIETY OF COMMUNITY PROGRAMS AND EVENTS INCLUDING PICK A BETTER SNACK SCHOOL PROGRAM, LOCAL HEALTH FAIRS, GIRLS NIGHT OUT, LOVE YOUR HEART DAY, SPORTS PHYSICALS, SPORTING EVENTS, DIABETES EDUCATION, CPR AND BLS CLASSES, FLU SHOT CLINICS, HEALTHY COOKING CLASSES, AND MORE. DOCTORS, NURSES AND CLERKS WORK AT THE LOCAL FREE CLINIC AT NO CHARGE. PHYSICIANS PARTICIPATE IN LOCAL HEALTH BOARDS AND CONSULT FREE OF CHARGE TO THE OTHER ORGANIZATIONS. THE HOSPITAL HAS EXTENDED ITS HOURS TO IMPROVE ACCESS TO CARE AT A LOWER COST. THE HOSPITAL CEO IS NOW ON OTHER ORGANIZATIONS' BOARDS, AND CONTINUES TO WORK ON A PLAN TO IMPROVE ACCESS TO MENTAL HEALTH CARE TO PATIENTS IN OUR AREA. THE HOSPITAL IS INVOLVED IN AN ACO HEALTH GRANT, FOR WHICH A NURSE PROVIDES HEALTH EDUCATION AND CARE FOR PATIENTS WITH VARIOUS HEALTH NEEDS.OTHER: THE HOSPITAL PROVIDES CAB FARE FROM THE EMERGENCY ROOM FOR INDIGENTS AND USE OF OUR ROOMS FOR LOCAL CLUBS AND COMMUNITY MEETINGS. ADMINISTRATIVE ASSISTANCE IS OFFERED TO VARIOUS ORGANIZATIONS. ONE OF OUR DOCTORS IS PRESIDENT OF THE IOWA PHYSICIANS SOCIETY AND PHYSICIAN CHAMPION FOR THE ACO HEALTH GRANT. THE HOSPITAL NOW OFFERS TELEHEALTH TO HELP PROVIDE ACCESS TO MENTAL HEALTH PROFESSIONALS TO OUR AREA PATIENTS. CURRENTLY, THE HOSPITAL HAS A LOCAL PROVIDER OFFERING SERVICES ON A LIMITED BASIS. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 7 AND 9 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE AND "CHARITY CARE". PART III, LINE 8: "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT D & E WORKSHEETS, OR PS&R. PART III, LINE 9B: THE CHARITY CARE POLICY ALLOWS FOR PROACTIVE WRITE OFF TO ALLOWANCE FOR CHARITY CARE OF ANY BALANCE OWED BY A PATIENT KNOWN TO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. COLLECTION PROCEDURES DO NOT ENSUE ON ANY ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: DURING FISCAL YEAR 2016, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS, IN COLLABORATION WITH MARION COUNTY PUBLIC HEALTH, HELD TOWN HALL MEETINGS TO DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT TO SET HEALTH GOALS AND PROGRAMS TO ADDRESS THE HEALTH NEEDS AND DESIRES OF THE COMMUNITY CAPTURED IN THE HOSPITAL'S ANNUAL COMMUNITY BENEFIT REPORT. ALSO, THE HOSPITAL ALWAYS UTILIZES INPUT FROM MEDICAL STAFF, THE BOARD OF DIRECTORS AND VARIOUS HOSPITAL ADMINISTRATIVE STAFF WHO REGULARLY REVIEW THE TREATMENT OF PATIENTS TO ENSURE MEDICAL NECESSITY AND APPROPRIATE LEVELS OF CARE ARE CONSISTENTLY PROVIDED TO THE PATIENTS OF THE HOSPITAL. PART VI, LINE 3: CUSTOMER SERVICE AND BILLING STAFF CONTINUALLY MONITOR BALANCES WITHOUT ACTIVITY AND THEN CONTACT THE PATIENTS TO OFFER FINANCIAL ASSISTANCE OR ARRANGE PAYMENT PLANS. THE HOSPITAL ALSO OFFERS THE ABILITY TO MAKE PAYMENTS VIA A WEB-BASED PORTAL. THE PORTAL CONTAINS INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE AND PAYMENT PLAN POLICIES. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING CITIES IN MARION COUNTY: KNOXVILLE (POP. 11,583), PLEASANTVILLE (POP. 2,954), AND MELCHER/DALLAS (POP. 1,625). THE KNOXVILLE COMMUNITY IS 40 MILES SOUTHEAST OF DES MOINES, IOWA. PART VI, LINE 5: KNOXVILLE COMMUNITY HOSPITAL, INC. AND THE CLINICS PROVIDE NUMEROUS OUTPATIENT SPECIALTY PROVIDER CLINICS SUCH AS PODIATRY, ORTHOPEDICS, CARDIOLOGY, UROLOGY, DERMATOLOGY, SLEEP STUDY, ONCOLOGY, AUDIOLOGY, RHEUMATOLOGY AND EMG TESTING AND OBGYN. PROVIDERS AND STAFF PROVIDE VARIOUS FREE EDUCATIONAL/WELLNESS PROGRAMS FOR THE COMMUNITY/SCHOOLS. THE HOSPITAL IS ADDING TO ITS SPECIALTIES YEARLY, HOSTING ANNUAL PUBLIC EVENTS INCLUDING SAFE SITTER CLASSES AND FREE SKIN CANCER SCREENING. THESE ARE PUBLISHED IN LOCAL NEWSPAPERS. PART VI, LINE 6: DURING FISCAL YEAR 2016, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS WERE AFFILIATED MEMBERS OF THE MERCY HEALTH NETWORK - CENTRAL IOWA THROUGH MERCY HOSPITAL - DES MOINES, IOWA. MERCY HEALTH NETWORK - CENTRAL IOWA INCLUDES 16 CAH/TWEENER HOSPITALS ALL LOCATED IN CENTRAL IOWA. BENEFITS OF THE AFFILIATION ARE NUMEROUS AND INCLUDE: A. SHARING OF BEST PRACTICES B. SAVINGS ON GROUP PURCHASING AGREEMENTS C. SAVINGS THROUGH GROUP CONTRACTING FOR NUMEROUS SERVICES D. ACCESS TO NUMEROUS HEALTH CARE EXPERTS E. ACCESS TO PROVIDERS OF ALL TYPES AND SPECIALTIES F. ACCESS TO COMPARATIVE REPORTING G. SUPPORT FOR HUMAN RESOURCES PART VI, LINE 7, REPORTS FILED WITH STATES IA X X 0 0 0 0 0 0 0 0 0 KEVIN KINCAID CEO 257895 0 0 0 0 0 0 0 16284 0 274179 0 0 0 DAVID KERMODE SURGEON 390612 0 11250 0 1815 0 5600 0 16535 0 425812 0 0 0 MARTHA ERRTHUM PHYSICIAN 238296 0 0 0 1514 0 14666 0 15323 0 269799 0 0 0 THOMAS HOEHNS PHYSICIAN 233854 0 24676 0 1676 0 5139 0 16535 0 281880 0 0 0 EARL MCKEEVER PHYSICIAN 215133 0 15000 0 1676 0 8758 0 18405 0 258972 0 0 0 SHANNON REMMINGTON PHYSICIAN 225500 0 15000 0 1759 0 14464 0 22296 0 279019 0 0 0 SCHEDULE J, PART II: KEVIN KINCAID, CEO, WAS PAID BY AN UNRELATED ORGANIZATION, MERCY MEDICAL CENTER - DES MOINES. MERCY MEDICAL CENTER HAS A MANAGEMENT AGREEMENT WITH KNOXVILLE COMMUNITY HOSPITAL INC. KNOXVILLE COMMUNITY HOSPITAL PAYS MERCY MEDICAL CENTER FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. THE AMOUNT OF COMPENSATION PAID BY MERCY MEDICAL CENTER TO KEVIN KINCAID FOR HIS SERVICES AS CEO TO KNOXVILLE COMMUNITY HOSPITAL WAS $257,895. MERCY MEDICAL CENTER IS PART OF CATHOLIC HEALTH INITIATIVES. A CITY OF KNOXVILLE IOWA 426004843 2014-09-20 8650000 REFINANCE INDEBTEDNESS INCURRED TO RENOVATE FACILITIES AND PURCHASE EQUIP. 0 0 0 B MARION COUNTY IOWA 421182528 2014-09-20 8650000 FINANCE RENOVATION OF FACILITIES AND PURCHASE EQUIP. 0 0 0 A 323724 8650000 128143 6527480 1994377 2016 1 0 1 1 B 159859 8650000 128143 7161857 1360000 2016 0 0 1 1 A 0 1 0 0 0.00060 0.00060 0 0 1 B 0 1 0 0 0 0 1 A 0 0 0 0 1 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 1 B 1 SCHEDULE K, PART II, COLUMN A, LINE 11: $1,994,377 FOR OTHER PROCEEDS WERE SPENT TO REFUND THE 2012 BONDS THAT WERE CALLED ON AUGUST 20, 2014. SCHEDULE K, PART II, COLUMN B, LINE 12: $1,360,000 OF THE BOND ISSUE PRICE WAS NEVER DRAWN UPON AND THERE WILL NEVER BE ANY MONEY BORROWED UPON OR SPENT FROM THIS AMOUNT. SCHEDULE K, PART II, COLUMNS A AND B, LINE 13: THE PROJECT WAS DONE AS A PHASE IN PROJECT WITH MULTIPLE AREAS RENOVATED AND NEW AREAS BUILT. THE ENTIRE PROJECT WAS CONSIDERED COMPLETED BY JUNE 3, 2016. SCHEDULE K, PART III, COLUMNS A AND B, LINE 2: DURING FISCAL YEAR 2017, THE HOSPITAL RENTED ONE HALL OF THE NEW CLINIC TO VISITING SPECIALITY DOCTORS WHO WERE CHARGED RENT BY THE HOUR/DAY. SCHEDULE K, PART III, COLUMNS A AND B, LINE 4: DURING FISCAL YEAR 2017, THE HOSPITAL RENTED ONE HALL OF THE NEW CLINIC TO VISITING SPECIALITY DOCTORS WHO WERE CHARGED RENT BY THE HOUR/DAY. THE HIGHEST NUMBER OF VISITING DOCTORS USING THE SPACE IN THE NEW CLINIC BUILDING DURING THE FISCAL YEAR 2017 WAS 8, BUT THE TIME SPENT WAS INTERMITTENT AND MOSTLY ONLY DURING 4 DAYS OF THE WEEK. BY THE END OF 2018, THE HOSPITAL EXPECTS THAT NONE OF THE NEW CLINIC SPACE WILL BE LEASED. THE HOSPITAL ANTICIPATES THAT NEARLY ALL OF THE LEASED SPACE BY SPECIALTY DOCTORS WILL BE CONVERTED TO CONTRACT PROVIDER AGREEMENTS OR MOVED TO A NON-BOND FINANCED AREA. THE HOSPITAL WILL HAVE ALL CONTRACT PROVIDER AGREEMENTS IN THE NEW CLINIC REVIEWED BY BOND COUNSEL TO ENSURE THAT THE CONTRACTS MEET THE SAFE HARBOR REQUIREMENTS FOR SERVICE AND MANAGEMENT CONTRACTS, THEREBY RESULTING IN NO PRIVATE USE IN THE NEW CLINIC. SHANNON REMMINGTON HIGHEST COMPENSATED EMPLOYEE COMPENSATION X 72000 28701 0 1 1 28701 FORM 990, PART VI, SECTION A, LINE 3 KNOXVILLE COMMUNITY HOSPITAL CONTRACTS WITH MERCY MEDICAL CENTER - DES MOINES FOR OVERSIGHT OF MANAGEMENT SERVICES. MERCY MEDICAL CENTER PROVIDES A FULL-TIME HOSPITAL CHIEF EXECUTIVE OFFICER/ADMINISTRATOR TO PROVIDE MANAGEMENT SERVICES AND ADMINISTRATIVE DIRECTION. KNOXVILLE COMMUNITY HOSPITAL PAYS MERCY MEDICAL CENTER FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CFO AND CEO PRIOR TO BEING FILED, IT IS REVIEWED BY THE BOARD OF DIRECTORS AT THE NEXT BOARD MEETING, WHICH MAY OCCUR AFTER FORM 990 HAS BEEN FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER REVIEWS THE POLICIES AND UPDATES THEM ANNUALLY. THE COMPLIANCE TEAM MEETS QUARTERLY TO REVIEW ALL COMPLIANCE AREAS AND CONFLICT OF INTEREST IS ONE OF THOSE AREAS. THE COMPLIANCE OFFICER ATTENDS BOARD MEETINGS AND MEMBERS DO NOT VOTE ON AREAS OF CONFLICT. THE COMPLIANCE OFFICER ATTENDS SPECIAL TRAININGS ON COMPLIANCE REGULATIONS. FORM 990, PART VI, SECTION B, LINE 15 PER HUMAN RESOURCE POLICIES, KNOXVILLE COMMUNITY HOSPITAL UTILIZES THE IHA WAGE SURVEY AND COMPARATIVE ANALYSIS AND MARKET RATES. MOST WAGES ARE ADJUSTED WHEN THE BOARD OF DIRECTORS APPROVES PAY INCREASE PERCENTAGES. KNOXVILLE COMMUNITY HOSPITAL HOPES TO INSTITUTE A NEW PAY FOR PERFORMANCE PLAN IN THE NEAR FUTURE. FORM 990, PART VI, SECTION C, LINE 19 KNOXVILLE COMMUNITY HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST AT ORGANIZATION'S ADMINISTRATIVE OFFICES DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G OUTSIDE MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,302,994. MANAGEMENT AND GENERAL EXPENSES 153,436. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,456,430. NURSING SERVICES: PROGRAM SERVICE EXPENSES 144,228. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,228. EMERGENCY ROOM SERVICES: PROGRAM SERVICE EXPENSES 1,542,432. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,542,432. PHYSICAL THERAPY SERVICES: PROGRAM SERVICE EXPENSES 844,903. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 844,903. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED DURING THE YEAR. KNOXVILLE HOSPITAL & CLINICS FOUNDATION 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 900126510 SUPPORT FOR KNOXVILLE COMMUNITY HOSPITAL IA 501(C)(3) LINE 7 KNOXVILLE COMMUNITY HOSPITAL INC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0