CENTRAL COMMUNITY HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL COMMUNITY HOSPITAL (EIN 42-0818642)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-03-28
- IRS object ID
- 201830879349300723
- Schema version
- 2016v3.0
- 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 | 2018-03-28T13:24:43-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1545 ASSOCIATES DR STE 101 | AddressLine1Txt |
| City | DUBUQUE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420818642 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 5632457000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brooke Kensinger | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5632457000 | PhoneNum |
| Signature | 2018-03-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2018-03-23 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 74.84.124.22 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-03-23 | IPDt |
| IP Tm | 16:08:26 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 330E77A2EC15986A2DC713C7FDB26B906589BB96 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 330E77A2EC15986A2DC713C7FDB26B906589BB96 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Brooke Kensinger | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,831,539 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.centralcommunityhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | Provide healthcare services to the surrounding community | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 106 | TotalEmployeeCnt |
| Total Volunteers | 32 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $143,736 | PYContributionsGrantsAmt |
| CY Contributions Grants | $165,526 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,143,314 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,597,756 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,438 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,776 | CYInvestmentIncomeAmt |
| PY Other Revenue | $40,948 | PYOtherRevenueAmt |
| CY Other Revenue | $45,307 | CYOtherRevenueAmt |
| PY Total Revenue | $7,337,436 | PYTotalRevenueAmt |
| CY Total Revenue | $7,820,365 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,100 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,100 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,890,414 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,347,050 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $31,893 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,057,493 | PYOtherExpensesAmt |
| CY Other Expenses | $4,121,528 | CYOtherExpensesAmt |
| PY Total Expenses | $6,949,007 | PYTotalExpensesAmt |
| CY Total Expenses | $7,469,678 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $388,429 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $350,687 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,939,907 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,946,163 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,632,034 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,266,550 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,307,873 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,679,613 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | "Every patient matters" | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,935,396 | ExpenseAmt |
| Grant | $1,100 | GrantAmt |
| Revenue | $7,598,198 | RevenueAmt |
| Desc | Central Community Hospital is a 25-Bed Critical Access Hospital serving residents of Clayton County, Iowa. Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Central Community Hospital's charitable mission. Central Community Hospital is governed by an independent Board, which includes community leaders, consumer representatives and business experts. The Board has a history of commitment to acting with the highest integrity. During this year, the Board worked with management to continue to make improvements to assure the organization is in compliance with all rules and regulations governing the healthcare industry and non-profit organizations.Continued on Schedule O.Central Community Hospital makes care accessible to the entire community it serves. Central Community Hospital operates a full-time emergency room and provides care regardless of ability to pay. Central Community Hospital had 1,029 emergency visits and 49 outpatient surgery cases this year.The Hospital provided 774 acute, swing-bed, and respect patient days and 5,649 outpatient visits to the residents in the service area. Central Community Hospital provided care at many levels including Acute, Skilled, Intermediate, Same-Day-Surgery, Observation Care, Outpatient, and Rehab services. In addition, Central Community Hospital provides non-emergency services. These services are accessible to the community through participation in government programs like Medicare and Medicaid. Financial counseling is available to patients. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were $72,329 for the year ended June 30, 2017. The direct and indirect costs related to these forgone charges were $42,000 at June 30, 2017, based on an average ratio of costs to gross charges.The Hospital 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. | Desc |
| Total Program Service Expenses | $5,935,396 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 106 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 | Brooke Kensinger | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5632457000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| Robert Bodensteiner | ||||||
| President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Jennifer Cowsert | ||||||
| Vice President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Tom Neuhaus | ||||||
| Treasurer | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Kevin Ihde | ||||||
| Secretary (Until Sept 2016) | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Justin Vorwald | ||||||
| Secretary | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Jay Moser | ||||||
| Member | 0.50 | Yes (X) | $0 | $0 | $0 | |
| William Reimer | ||||||
| Member | 0.50 | Yes (X) | $0 | $0 | $0 | |
| LaVonne Auguston | ||||||
| Member (Began Nov 2016) | 0.50 | Yes (X) | $0 | $0 | $0 | |
| Fran Zichal | ||||||
| CEO (Until Dec 2016) | 40.00 | Yes (X) | $140,801 | $0 | $4,767 | |
| Brooke Kensinger | ||||||
| CEO (Began Oct 2016) | 40.00 | Yes (X) | $51,032 | $0 | $2,714 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $191,833 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $7,481 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | 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 |
|---|---|---|---|---|---|
| WMG Red Hawthorne LLC | |||||
| 107 Flynn Drive Suite 600 | Milbank | SD | 57252 | Provider Coverage | $592,452 |
| Northern Iowa Therapy | |||||
| 217 East Bremer Ave Suite B | Waverly | IA | 50677 | Therapy Coverage | $452,646 |
| Mercy Health Network | |||||
| Dept CH14370 | Palatine | IL | 600554370 | Management Agreement | $269,707 |
| Medical Associates Clinic | |||||
| 1500 Associates Drive | Dubuque | IA | 52002 | Provider Coverage | $110,287 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $121,052 | GovernmentGrantsAmt |
| All Other Contributions | $44,474 | AllOtherContributionsAmt |
| Total Contributions | $165,526 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenu | 622110 | $7,421,965 | $7,421,965 |
| Electronic health reco | 900099 | $153,826 | $153,826 |
| Supporting revenue | 900099 | $21,965 | $21,965 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,597,756 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,776 | TotalRevenueColumnAmt |
| Exclusion | $11,776 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $56,481 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $11,174 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $45,307 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,307 | TotalRevenueColumnAmt |
| Exclusion | $45,307 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,820,365 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,597,756 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $57,083 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,100 | TotalAmt |
| Program Services | $1,100 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,139 | TotalAmt |
| Management And General | $202,139 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,575,998 | TotalAmt |
| Program Services | $2,116,400 | ProgramServicesAmt |
| Management And General | $433,775 | ManagementAndGeneralAmt |
| Fundraising | $25,823 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,481 | TotalAmt |
| Program Services | $38,613 | ProgramServicesAmt |
| Management And General | $8,392 | ManagementAndGeneralAmt |
| Fundraising | $476 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $339,049 | TotalAmt |
| Program Services | $278,557 | ProgramServicesAmt |
| Management And General | $57,093 | ManagementAndGeneralAmt |
| Fundraising | $3,399 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,383 | TotalAmt |
| Program Services | $149,843 | ProgramServicesAmt |
| Management And General | $30,712 | ManagementAndGeneralAmt |
| Fundraising | $1,828 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,118 | TotalAmt |
| Management And General | $180,118 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,825 | TotalAmt |
| Management And General | $45,825 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,080,091 | TotalAmt |
| Program Services | $1,783,688 | ProgramServicesAmt |
| Management And General | $296,403 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,634 | TotalAmt |
| Program Services | $531 | ProgramServicesAmt |
| Management And General | $24,103 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,179 | TotalAmt |
| Program Services | $119,166 | ProgramServicesAmt |
| Management And General | $77,646 | ManagementAndGeneralAmt |
| Fundraising | $367 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80 | TotalAmt |
| Program Services | $80 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,145 | TotalAmt |
| Program Services | $99,702 | ProgramServicesAmt |
| Management And General | $4,443 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,113 | TotalAmt |
| Program Services | $20,602 | ProgramServicesAmt |
| Management And General | $18,511 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,166 | TotalAmt |
| Program Services | $2,166 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $554,844 | TotalAmt |
| Program Services | $554,844 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,559 | TotalAmt |
| Management And General | $106,559 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $657,928 | $657,928 | |
| Bad debt | $84,139 | $84,139 | |
| Food | $23,665 | $23,665 | |
| Community benefits | $3,595 | $3,545 | $50 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,447 | TotalAmt |
| Program Services | $827 | ProgramServicesAmt |
| Management And General | $16,620 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,469,678 | TotalAmt |
| Program Services | $5,935,396 | ProgramServicesAmt |
| Management And General | $1,502,389 | ManagementAndGeneralAmt |
| Fundraising | $31,893 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,341,875 | BOYAmt |
| EOY | $2,149,354 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $875,079 | BOYAmt |
| EOY | $1,359,078 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,995 | BOYAmt |
| EOY | $63,285 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,100 | BOYAmt |
| EOY | $69,750 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,704,629 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,657,608 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,361,700 | BOYAmt |
| EOY | $3,047,021 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,020,186 | BOYAmt |
| EOY | $1,026,650 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,324 | BOYAmt |
| EOY | $228,377 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,648 | BOYAmt |
| EOY | $2,648 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,939,907 | BOYAmt |
| EOY | $7,946,163 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $473,336 | BOYAmt |
| EOY | $543,492 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $702,117 | BOYAmt |
| EOY | $583,962 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,581 | BOYAmt |
| EOY | $19,096 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $418,000 | BOYAmt |
| EOY | $120,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,632,034 | BOYAmt |
| EOY | $1,266,550 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,088,701 | BOYAmt |
| EOY | $6,439,388 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,172 | BOYAmt |
| EOY | $240,225 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,307,873 | BOYAmt |
| EOY | $6,679,613 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,939,907 | BOYAmt |
| EOY | $7,946,163 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $350,687 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $21,053 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,015 | OtherCostOrOtherBasisAmt |
| Book Value | $26,015 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,039,909 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,561,193 | DepreciationAmt |
| Book Value | $1,478,716 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,638,705 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,096,415 | DepreciationAmt |
| Book Value | $1,542,290 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,047,021 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $120,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $120,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $7,747,400 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$84,139 | OtherRevenueAmt |
| Revenue Not Reported | -$84,139 | RevenueNotReportedAmt |
| Revenue Subtotal | $7,831,539 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$11,174 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$11,174 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $7,820,365 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,396,713 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $11,174 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $11,174 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,385,539 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $84,139 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $84,139 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,469,678 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital is organized as an Iowa nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Interanl Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined that it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Bad debt expense included in expenses on Form 990 -84,139. |
| Part XI, Line 4b - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990 -11,174. |
| Part XII, Line 2d - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990 11,174. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense included in expenses on Form 990 84,139. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $64,944 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $64,944 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,533,123 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $941,179 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $591,944 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,598,067 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $941,179 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $656,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08890 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,640,067 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $941,179 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $698,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09460 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $675 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $675 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $675 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $675 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $84,139 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $4,291 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,643,879 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,651,855 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,976 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.centralcommunityhospital.com | WebsiteAddressTxt |
| State License | 220051H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.centralcommunityhospital.com/billing/financial-assistance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.centralcommunityhospital.com/billing/financial-assistance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.centralcommunityhospital.com/billing/financial/assistance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Central Community Hospital | Part V, Section B, Line 5: In conducting the needs assessment, CCH consulted the local nursing home, local clinic, Substance Abuse and Prevention Services, Clayton County Public Health, Northland Agency on Aging, Guttenberg Municipal Hospital, Central Community School, Clayton Ridge School, MFLMarMac School, SHIIP volunteers, Clayton County Board of Health, Clayton County EMS, Northeast Iowa Community Action, Northeast Iowa Mental Health, and HAWC Partnership for Children. |
| Central Community Hospital | Part V, Section B, Line 6a: The community health needs assessment was conducted with Guttenberg Municipal Hospital in Guttenberg, Iowa. |
| Central Community Hospital | Part V, Section B, Line 6b: The CHNA was conducted with Clayton County Public Health. |
| Central Community Hospital | Part V, Section B, Line 11: The Community Health Needs Assessment identified seven significant needs to be addressed by the Central Community Hospital staff over the next three years (2015, 2016, 2017). The seven needs are: mental health, obesity, unintended pregnancy, substance abuse, EMS Volunteer crisis, falls and water fluoridation.* Mental Health. CCH has added tele-psychiatry in the ER in the spring of 2017. This program gives CCH providers access to board-certified psychiatrists MD or ARNP. Opportunities for community education on mental health are identified each year in the Marketing Plan. * Obesity is addressed working with schools and regional Food and Fitness program. CCH has identified educational opportunities in the Marketing Plan. * Unintended Pregnancies will be addressed with limited activities. CCH does not have OB services which limits access to pregnant mothers. CCH staff provide basic sex and pregnancy information to students at Central Community School. Working with the local teachers, a schedule was developed. The Medical Staff were solicited for suggestions and ideas for presentations.* Substance Abuse. Because there is a prevention agency in town, CCH will support their activities and watch for opportunities to suggest programs successful in other communities. * EMS Volunteer Crisis. Increasing community awareness and assuring access to EMS will be the primary goal. Multi-disciplinary teams will work on studying the models of EMS care delivery. * Falls. Falls are the number one reason to call an ambulance or seek ER care. Assessment and community engagement will be the key to addressing this need.* Water fluoridation. CCH will be a limited partner in this program. Key to this need is offering appropriate education to the community and city leadership to ensure our citizens have appropriate fluoridation levels in the water we drink. |
| Central Community Hospital | Part V, Section B, Line 13b: 1. Patients whose family income is at or below 200% of the FPL are eligible to receive free care. 2. Patients whose family income is above 200% but not more than 300% of the FPL are eligible to receive discounts. 3. Patients whose family income exceeds 300% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of Central Community Hospital; however the discounted rates shall not be greater than the AGB. |
| Central Community Hospital | Part V, Section B, Line 13h: There are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. Central Community Hospital may use outside agencies to determine eligibility. These resources may use demographic and household information and/or credit scoring technology to determine eligibility. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application. Presumptive eligibility awards must be 100% discounts. Other forms of presumptive eligibility include: Eligible for the Iowa Cares Program, bankruptcy, death with no estate resources, and Title XIX eligible and receiving non-covered services. |
| Central Community Hospital | Part V, Section B, Line 16j: At the time of registrations, CCH staff makes every effort to determine if a patient may possibly need or qualify for any financial assistance. We notify patients of the availability of these programs by posting information in our registration and emergency room areas. We offer a private meeting with a financial counselor. Inpatients are offered an opportunity to meet with the counselor upon discharge. Financial assistance information is provided in all correspondence regarding patient bills. Our financial counselor attempts phone contact whenever possible. We do an annual article about the service in our newsletter. |
| Central Community Hospital | Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
| Part V, Section B, line 7a: | Community Health Needs Assessmentwww.centralcommunityhospital.com/patient-info/community-assessment/ |
| Part V, Section B, Line 10a: | Implementation Strategywww.centralcommunityhospital.com/patient-info/community-assessment/ |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Patients whose family income exceeds 300% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of Central Community Hospital; however the discounted rates shall not be greater than the AGB. There are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application. Presumptive eligibility awards must be 100% discounts. Other forms of presumptive eligibility include: Eligible for Bankruptcy, death with no estate resources, and Title XIX eligible and receiving non-covered services. |
| Part I, Line 6a: | The community benefit report is available at the front desk of the facility. It can also be found on its website at www.centralcommunityhospital.com. |
| Part I, Line 7: | Charity care expense was reported at cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. Medicaid is cost reimbursed therefore there is no community benefit expense reported. The cost for subsidized health services on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $84,139. |
| Part II, Community Building Activities: | We make every effort to have a constant presence at the community level to promote health related activities and report on the value a hospital brings to a small community. Two individuals counsel Medicare Part D participants on the program and annually review the participant's choice to assure the most appropriate insurance program is selected. The Hospital's EMTs attend the Central Community School football games to provide immediate assistance to athletes, coaches and fans. |
| Part III, Line 2: | All forms of payment, including self-pay, insurance, contractual allowances, and discounts, are applied to the patient's account before the account is classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Central Community Hospital does not refuse services to patients that generate bad debt.Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | A reasonable estimate of the Hospital's bad debt expense attributable to patients eligible under the charity care policy is 5.1% of bad debt expense. This is based on the percentage of individuals below the poverty level in the area. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on pages 8 and 9 of the attached audited financial statements. |
| Part III, Line 8: | Central Community Hospital has a Medicare shortfall and considers this a community benefit. The Hospital provides services to Medicare patients regardless of the shortfall because access to healthcare and individual's health is important. 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. |
| Part III, Line 9b: | We make every effort to determine if a patient is eligible for financial assistance. If a patient cannot pay their balance in full in 30 days, a financial counselor is available to discuss payment options. After financial assistance is determined, any personal portion due follows the same debt collection policy as other patients without financial assistance. If a bankruptcy notice is received on any account, all collection activities will cease immediately. Central Community Hospital will not harass a patient for their past due account, nor make false statements to get the patient to pay their account. There are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. Central Community Hospital may use outside agencies to determine eligibility. These resources may use demographic and household information and/or credit scoring technology to determine eligibility. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application. Presumptive eligibility awards must be 100% discount. Other forms of presumptive eligibility include: eligible for the Iowa Cares Program, bankruptcy, death with no estate resources, and Title XIX eligible and receiving non-covered services (reviewed case by case). |
| Part VI, Line 2: | The Community Health Needs Assessment was completed and posted to the website June, 2016. The assessment was conducted beginning February, 2016 with the help of Guttenberg Municipal Hospital in Guttenberg, Iowa (located in Clayton County). Representatives of 18 organizations compiled Clayton County data on their services and populations served. Seven priorities for health care needs were established for the county. When Central Community Hospital (CCH) created their Action Plan, they selected these seven priorities. CCH established action steps to be taken under each of the priorities. CCH will begin the process of re-assessing the CHNA in 2018. |
| Part VI, Line 3: | At the time of registrations, CCH staff makes every effort to determine if a patient may possibly need or qualify for any financial assistance. We notify patients of the availability of these programs by posting information in our registration and emergency room areas. We offer a private meeting with a financial counselor. Inpatients are offered an opportunity to meet with the counselor upon discharge. Financial assistance information is provided in all correspondence regarding patient bills. Our financial counselor attempts phone contact whenever possible. Our charity program information is available on our website. We do an annual article about the service in our newsletter. Our financial counselor will also assist with enrollment in external programs. |
| Part VI, Line 4: | Central Community Hospital serves the residents of the central part of Clayton County into the northeast section of the county. It is a rural, agricultural area. The geographic area of Clayton County is 778.54 square miles. The nearest larger city is Dubuque, Iowa, which is 72 miles from Elkader, the county seat. With a population of 17,806, Clayton County is the 39th most populated county in the state of 99 counties. The population saw a 1.4% decline from 2008-2012. In 2015, the median household income of Clayton County residents was $48,007. 11.1% of Clayton County residents live in poverty. The median age for Clayton County residents is 45.4 years young. The largest Clayton County racial/ethnic groups are White (96.4%) followed by Hispanic (1.8%) and 1.8% (other). |
| Part VI, Line 5: | Central Community Hospital's board members reside in the primary service area. None of the board members are employed by the Hospital nor are they contractors of the Hospital. None of the board members have family members employed by Central Community Hospital. Central Community Hospital extends hospital privileges to all qualified physicians in our service area extending to Dubuque, Iowa, where specialists serve our area. CCH encourages specialists to offer clinics in our facility to improve access for our local residents. Many of CCH older patients are apprehensive to drive 72 miles one-way to a large city to see a specialist. When the Hospital creates its budget, efforts are made by the Administrative Team to allocate funds to improve patient care through updating equipment, expanding supplies or hiring staff. Each year dollars are allocated to improve services based on recommendations submitted by department managers.Central Community Hospital (CCH) works with the city of Elkader to assure tax dollars are collected to purchase ambulances when needed, provide annual maintenance and tires for the vehicles and purchase 50% of the gas consumed. CCH pays the other 50% of the gas bill, employs the staff, and buys all equipment and supplies for the ambulances.There are two critical access hospitals in Clayton County, Iowa - Central Community Hospital in Elkader, Iowa and Guttenberg Memorial Hospital in Guttenberg, Iowa. Central Community Hospital is 25-30 minutes away from Guttenberg Memorial Hospital as well as the same distance away from the three other critical access hospitals. The residents of Elkader and surrounding areas depend on the emergency room being available 24/7/365 when an emergency health need arises. The hospital also employs all EMS personnel who work for Central Ambulance Service. This volunteer service is also available 24/7/365 for all 911 calls and transfer calls. The hospital works relentlessly to ensure that coverage for both the ER and the Ambulance service is always available for the community, in an increasingly tough recruitment market. If these services weren't available - the community would suffer tremendously. It is a huge task to ensure that healthcare personnel are up to date on all required training. We offer training for physicians, APPs, nurses and EMS personnel each year in CPR-BLS, CPR-ACLS, CPR-PALS, CPR-NRP, ATLS, TNCC and these are just a few.CCH has been involved in community workgroups and coalitions. The hospital is involved in the Clayton County Coalition that involves other healthcare providers, public health and emergency management. The hospital is also involved in a regional coalition that includes six other counties that works towards emergency preparedness strategies together. |
| Part VI, Line 6: | Central Community Hospital has a management agreement with Mercy Health Network, Des Moines, IA. Mercy Health Network provides 29 affinity meetings on a regular basis covering all aspects of services in the hospital (administrative, clinical, supportive). The staff is available daily to answer questions, provide assistance with policies and procedures and assign experts to offer classes, webinars, written materials and telephone conferences. They offer additional services that include provider recruitment, legal services and administrative support for major decision-making projects including major construction, adding service line or addressing new regulatory mandates. CCH also has a Critical Access Network Agreement with Mercy Medical Center, Dubuque, IA to meet the regulations regarding support for critical access including transportation, communication, quality and credentialing. Mercy Medical Center Dubuque is committed to supporting health care in rural areas as demonstrated by their joint operations with Medical Associates of Dubuque and their subsidy of the Family Care Network Clinic in Elkader and Monona. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the officers of the Board. The President of the Board chairs the Committee. The Committee has the power to exercise authority of the Board when necessary or advisable between meetings of the Board. The Committee reports all of its actions to the Board at the next regular or special meeting of the Board, and such actions are subject to revision and alteration by the Board; provided however, that the rights of third parties are not affected by any revision or alteration. The Committee has the duty of reviewing the Bylaws of the Board at least annually and recommending to the Board the amendment of the Bylaws of the Hospital. The Executive Committee oversees compliance of the Hospital with requirements of regulatory bodies and meets on the call of the President. Minutes are kept of all meetings. |
| Form 990, Part VI, Section A, line 2 | Kevin Ihde and Justin Vorwald had a family relationship. |
| Form 990, Part VI, Section A, line 6 | The Organization has members who are all of one class and resident citizens of the Central Community Hospital service area. |
| Form 990, Part VI, Section A, line 7a | Members of the Board are elected by the resident citizens of the Central Community Hospital service area at the annual meeting to serve for a term of four years. |
| Form 990, Part VI, Section A, line 8b | No committees are able to act on behalf of the board. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is made available to all Board Members before it is filed. The CEO reviews and approves the 990. |
| Form 990, Part VI, Section B, line 12c | Any duality of interest or possible conflict of interest on the part of any Board member and officer is disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any individual having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter, and should not be counted in determining the quorum for the meeting, even where permitted by law. The minutes of the meeting reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing board and CEO complete and sign the conflict of interest form yearly. The forms are reviewed by the Board President, and if a potential conflict is identified the Board President follows up. |
| Form 990, Part VI, Section B, line 15a | Brooke Kensinger, CEO, is considered a common law employee of Central Community Hospital. The process for determining compensation for the CEO is based on salary adjustment recommendations using a various tools. The process uses an annual evaluation, CEO wage scales, and scales from a variety of sources and MHN compensation system. All of the tools include a review of wages in comparison to comparable positions, bed size of hospital, size of community, and other factors. HR of MHN documents and provides substantiation of the recommended CEO wage to the board. The processes are done on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents and conflict of interest policy are available upon written request. The financial statements are attached to the Form 990 and therefore available for public inspection. |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 1,517,437. Management and general expenses 64,726. Fundraising expenses 0. Total expenses 1,582,163. Repairs and maintenance: Program service expenses 194,550. Management and general expenses 225,001. Fundraising expenses 0. Total expenses 419,551. Professional fees: Program service expenses 66,001. Management and general expenses 0. Fundraising expenses 0. Total expenses 66,001. Contract Labor: Program service expenses 5,700. Management and general expenses 6,676. Fundraising expenses 0. Total expenses 12,376. |
| Form 990, Part XI, line 9: | Change in interest in net assets of Central Community Hospital Foundation 21,053. |
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