VIRGINIA GAY HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- VIRGINIA GAY HOSPITAL INC (EIN 42-1231996)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-04-24
- IRS object ID
- 201841149349300104
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-04-24T08:53:08-05:00 | 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 | 421231996 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Virginia Gay Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | VIRG | BusinessNameControlTxt |
| Phone | 3194726255 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9th Avenue | AddressLine1Txt |
| City | Vinton | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 523492254 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Riege | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3194726255 | PhoneNum |
| Signature | 2018-04-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carmen Krantz | PreparerPersonNm |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2018-04-15 | 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 | 2018-04-23 | IPDt |
| IP Tm | 09:51:19 | 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 | Michael Riege | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9th Avenue | AddressLine1Txt |
| City | Vinton | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 523492254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,471,353 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.myvghinc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1923 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | Provision of health care services | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 344 | TotalEmployeeCnt |
| Total Volunteers | 57 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $266,034 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,342,072 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,987,049 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,846,925 | CYProgramServiceRevenueAmt |
| PY Investment Income | $239,606 | PYInvestmentIncomeAmt |
| CY Investment Income | $274,198 | CYInvestmentIncomeAmt |
| PY Other Revenue | $35,396 | PYOtherRevenueAmt |
| CY Other Revenue | $5,944 | CYOtherRevenueAmt |
| PY Total Revenue | $26,528,085 | PYTotalRevenueAmt |
| CY Total Revenue | $28,469,139 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $9,802 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,102,045 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,602,047 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $77,702 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,764,998 | PYOtherExpensesAmt |
| CY Other Expenses | $12,227,951 | CYOtherExpensesAmt |
| PY Total Expenses | $24,867,043 | PYTotalExpensesAmt |
| CY Total Expenses | $26,839,800 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,661,042 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,629,339 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,890,097 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,981,930 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,865,790 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,933,972 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,024,307 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,047,958 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Our purpose is to provide quality health care services by using innovative, growth-oriented techniques and maintaining a sound financial base. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,152,858 | ExpenseAmt |
| Grant | $9,802 | GrantAmt |
| Revenue | $26,846,925 | RevenueAmt |
| Desc | Virginia Gay Hospital leads delivery of healthcare to its region through over 280 associates (including 19 providers) which coordinate care to deliver patient care as an integrated unit. Virginia Gay Hospital and its affiliates also work seamlessly to meet the needs of the communities they serve. The Hospital provides care to patients and residents 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 amounts of charges foregone for services provided under the Hospital's charity care policy were $152,154 for the year ended June 30, 2017. Total direct and indirect costs related to these charges foregone were approximately $83,000 at June 30, 2017, based on an average ratio of cost to gross charges.In addition, the Hospital provides services to other patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided.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.Virginia Gay Hospital also makes medical care accessible to the entire community it serves. The Hospital operates a full-time emergency room and provides emergency care regardless of ability to pay. Virginia Gay Hospital had over 3,758 emergency room visits this year. The Hospital provides clinical services needed to operate the emergency room and provides on-site emergency medical care and medical transportation services through an area ambulance service, van service, and an onsite helipad.The Hospital had 39,162 outpatient visits and the rural health clinics had 39,237 visits. | Desc |
| Total Program Service Expenses | $24,152,858 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | 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 | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 344 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | Barry Dietsch | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3194726255 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9th Avenue | AddressLine1Txt |
| City | Vinton | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52349 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Mark Mossman | ||||||||
| Chair | 0.50 | 0.90 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Ketchen | ||||||||
| Vice Chair | 0.50 | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| David Vermedahl | ||||||||
| Secretary | 0.50 | 0.90 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Yundt | ||||||||
| Treasurer | 0.50 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Hodgson | ||||||||
| Director | 0.50 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Dr Brian Meeker DO | ||||||||
| Director | 40.50 | 0.00 | Yes (X) | $569,089 | $0 | $24,478 | ||
| Marie Therese Foth | ||||||||
| Director | 0.50 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| John Watson | ||||||||
| Director | 0.50 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Dr Michelle Elgin DO | ||||||||
| Director | 40.50 | 0.30 | Yes (X) | $214,737 | $0 | $21,904 | ||
| Michael Riege | ||||||||
| CEO | 40.00 | 3.30 | Yes (X) | $177,710 | $0 | $19,930 | ||
| Barry Dietsch | ||||||||
| CFO | 40.00 | 3.30 | Yes (X) | $120,634 | $0 | $2,917 | ||
| Michele Burnes PA-C | ||||||||
| Family Medicine | 40.00 | 0.00 | $234,444 | $0 | $21,393 | Yes (X) | ||
| Rita Taylor-Stewart PA-C | ||||||||
| Family Medicine | 40.00 | 0.00 | $221,537 | $0 | $8,168 | Yes (X) | ||
| Dr Gene Lariviere MD | ||||||||
| Surgeon | 40.00 | 0.00 | $356,904 | $0 | $26,719 | Yes (X) | ||
| Dr Margaret Mangold MD | ||||||||
| Family Medicine | 40.00 | 0.00 | $332,077 | $0 | $26,664 | Yes (X) | ||
| Stephanie Vogeler PA-C | ||||||||
| Family Medicine | 40.00 | 0.00 | $214,045 | $0 | $21,393 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,441,177 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $173,566 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| National Therapeutic Association | |||||
| 11623 Arbor Street | Omaha | NE | 68144 | PT, OT, ST | $1,292,410 |
| UI Comm Medical Services Inc | |||||
| 2346 Mormon Trek Blvd | Iowa City | IA | 52246 | Computer services | $1,060,473 |
| Health Enterprises | |||||
| 4250 Glass Road | Cedar Rapids | IA | 524022513 | CRNA & Ultrasound | $492,704 |
| Lawrence Group | |||||
| 319 N 4th Street | St Louis | MO | 63102 | Construction planning services | $264,593 |
| CPSI | |||||
| 6600 Wall Street | Mobile | IL | 36695 | Computer services | $256,797 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,301,083 | RelatedOrganizationsAmt |
| Government Grants | $8,000 | GovernmentGrantsAmt |
| All Other Contributions | $32,989 | AllOtherContributionsAmt |
| Total Contributions | $1,342,072 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient & resident revenue | 622110 | $25,444,912 | $25,444,912 |
| Pharmacy revenue | 900099 | $1,117,242 | $1,117,242 |
| Supporting revenue | 900099 | $284,771 | $284,771 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,846,925 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $276,412 | TotalRevenueColumnAmt |
| Exclusion | $276,412 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,944 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,944 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,944 | TotalRevenueColumnAmt |
| Exclusion | $5,944 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,214 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$2,214 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,214 | TotalRevenueColumnAmt |
| Exclusion | -$2,214 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,469,139 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,846,925 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $280,142 | 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 | $802 | TotalAmt |
| Program Services | $802 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,000 | TotalAmt |
| Program Services | $9,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,141,833 | TotalAmt |
| Program Services | $812,494 | ProgramServicesAmt |
| Management And General | $329,339 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,077 | TotalAmt |
| Program Services | $36,077 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,391,742 | TotalAmt |
| Program Services | $10,404,997 | ProgramServicesAmt |
| Management And General | $953,526 | ManagementAndGeneralAmt |
| Fundraising | $33,219 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,631 | TotalAmt |
| Program Services | $138,963 | ProgramServicesAmt |
| Management And General | $236 | ManagementAndGeneralAmt |
| Fundraising | $432 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,072,747 | TotalAmt |
| Program Services | $962,941 | ProgramServicesAmt |
| Management And General | $106,909 | ManagementAndGeneralAmt |
| Fundraising | $2,897 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $820,017 | TotalAmt |
| Program Services | $730,666 | ProgramServicesAmt |
| Management And General | $86,511 | ManagementAndGeneralAmt |
| Fundraising | $2,840 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,067 | TotalAmt |
| Management And General | $16,067 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,567 | TotalAmt |
| Program Services | $8,000 | ProgramServicesAmt |
| Management And General | $61,567 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,353,675 | TotalAmt |
| Program Services | $5,088,080 | ProgramServicesAmt |
| Management And General | $263,395 | ManagementAndGeneralAmt |
| Fundraising | $2,200 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $253,266 | TotalAmt |
| Program Services | $115,506 | ProgramServicesAmt |
| Management And General | $106,559 | ManagementAndGeneralAmt |
| Fundraising | $31,201 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,409,915 | TotalAmt |
| Program Services | $1,301,054 | ProgramServicesAmt |
| Management And General | $104,391 | ManagementAndGeneralAmt |
| Fundraising | $4,470 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,789 | TotalAmt |
| Program Services | $43,241 | ProgramServicesAmt |
| Management And General | $325,548 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,806 | TotalAmt |
| Program Services | $48,058 | ProgramServicesAmt |
| Management And General | $4,720 | ManagementAndGeneralAmt |
| Fundraising | $28 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,502 | TotalAmt |
| Program Services | $38,760 | ProgramServicesAmt |
| Management And General | $742 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,305 | TotalAmt |
| Program Services | $80,305 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,318,691 | TotalAmt |
| Program Services | $1,318,691 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,600 | TotalAmt |
| Program Services | $45,100 | ProgramServicesAmt |
| Management And General | $148,500 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $2,013,264 | $2,013,264 | |
| Repairs & maintenance | $458,069 | $396,426 | $61,643 |
| Provision for bad debts | $259,250 | $259,250 | |
| Food | $181,972 | $181,972 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,213 | TotalAmt |
| Program Services | $119,211 | ProgramServicesAmt |
| Management And General | $39,587 | ManagementAndGeneralAmt |
| Fundraising | $415 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,839,800 | TotalAmt |
| Program Services | $24,152,858 | ProgramServicesAmt |
| Management And General | $2,609,240 | ManagementAndGeneralAmt |
| Fundraising | $77,702 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $400 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,088,807 | BOYAmt |
| EOY | $623,522 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,513,786 | BOYAmt |
| EOY | $4,815,623 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10,000 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $371,444 | BOYAmt |
| EOY | $382,968 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,654 | BOYAmt |
| EOY | $482,770 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $29,928,061 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,917,608 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,922,162 | BOYAmt |
| EOY | $14,010,453 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,864,523 | BOYAmt |
| EOY | $7,501,313 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $947,445 | BOYAmt |
| EOY | $979,385 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,000 | BOYAmt |
| EOY | $112,496 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,276 | BOYAmt |
| EOY | $1,063,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,890,097 | BOYAmt |
| EOY | $29,981,930 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,369,679 | BOYAmt |
| EOY | $1,572,976 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,640,500 | BOYAmt |
| EOY | $665,209 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $559,110 | BOYAmt |
| EOY | $361,111 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,850,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,501 | BOYAmt |
| EOY | $484,676 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,865,790 | BOYAmt |
| EOY | $4,933,972 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,880,342 | BOYAmt |
| EOY | $24,895,644 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,305 | BOYAmt |
| EOY | $35,654 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,660 | BOYAmt |
| EOY | $116,660 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,024,307 | BOYAmt |
| EOY | $25,047,958 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,890,097 | BOYAmt |
| EOY | $29,981,930 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,629,339 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $394,312 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $116,660 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $8,185 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $8,185 | OtherExpendituresAmt |
| End Year Balance | $116,660 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $116,660 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,725 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,725 | OtherExpendituresAmt |
| End Year Balance | $116,660 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $116,660 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,225 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,225 | OtherExpendituresAmt |
| End Year Balance | $116,660 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $116,660 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $8,526 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $8,526 | OtherExpendituresAmt |
| End Year Balance | $116,660 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $116,660 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $9,104 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $9,104 | OtherExpendituresAmt |
| End Year Balance | $116,660 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $67,494 | OtherCostOrOtherBasisAmt |
| Book Value | $67,494 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $151,876 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $17,095,532 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,196,213 | DepreciationAmt |
| Book Value | $8,051,195 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,674,686 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,060,456 | DepreciationAmt |
| Book Value | $1,614,230 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,938,473 | OtherCostOrOtherBasisAmt |
| Depreciation | $660,939 | DepreciationAmt |
| Book Value | $4,277,534 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,010,453 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Construction accounts payable | $483,909 |
| Interest payable | $767 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $484,676 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $27,294,769 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $394,312 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$259,250 | OtherRevenueAmt |
| Revenue Not Reported | $135,062 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,159,707 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,309,432 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,309,432 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $28,469,139 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,580,550 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,580,550 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $259,250 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $259,250 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,839,800 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Income from the endowment funds is to be used for repairs and maintenance and capital improvements. |
| 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 Internal 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 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 consolidated 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: | Provision for Bad Debts recorded in expenses per Form 990 -259,250. |
| Part XI, Line 4b - Other Adjustments: | Transfers from Affiliates recorded in revenue per Form 990 1,301,083. Contributions recorded in revenue per Form 990 8,349. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts recorded in expenses per Form 990 259,250. |
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 |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 240.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $83,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $83,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $83,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $83,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2843 | PersonsServedCnt |
| Total Community Benefit Expns | $80,755 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $80,755 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,080 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,220,640 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,703,904 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $516,736 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01940 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 566 | PersonsServedCnt |
| Total Community Benefit Expns | $1,335 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,335 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3409 | PersonsServedCnt |
| Total Community Benefit Expns | $6,305,810 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,703,904 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $601,906 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02260 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3409 | PersonsServedCnt |
| Total Community Benefit Expns | $6,388,810 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,703,904 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $684,906 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02570 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,310 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,310 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,310 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,310 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $259,250 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,648,322 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,685,362 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$37,040 | 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 | Virginia Gay Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9th Avenue | AddressLine1Txt |
| City | Vinton | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 523492254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | myvghinc.org | WebsiteAddressTxt |
| State License | 060178H | 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 |
| Other | 4 provider based rural health clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Virginia Gay Hospital Inc | 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 | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.myvgh.org | 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 | www.myvgh.org | 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 | 240.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.myvgh.org/charity-care/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.myvgh.org/charity-care/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.myvgh.org/charity-care/ | 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 |
| 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 | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Virginia Gay Hospital, Inc. | Part V, Section B, Line 5: Virginia Gay Hospital utilized Benton County Public Health professionals in the process of the FY2016 CHNA to perform research, conduct interviews/surveys, and identify and prioritize the healthcare needs. Key members of VGH senior leadership and members of the Board of Directors also met regularly to discuss the future needs and actions to ensure the area's healthcare needs continued to be met. This team also engaged in several tactics (personal interviews, emails, coalition meetings) to ensure different members of the community were contacted, including those knowledgeable of healthcare needs of vulnerable populations. Community representatives include: VGH Senior Staff/Providers/Health Coaches/Quality Department, Benton County Board of Health, Benton County Public Health, Benton County Emergency Management, Benton County Disaster Recovery Coalition, Benton County Coalition (mental health stakeholders), Benton County Social Services, Benton County Department of Human Services, Benton County School Districts, Benton County Auditor's Office, Benton County Development Group, Vinton Unlimited, Above the Influence Coalition (Substance Abuse), Iowa State Benton County Extension Office, Vinton Police Department, Better Tomorrows (Early Childhood Iowa), Benton-Iowa Decategorization, Hawkeye Area Community Action Program (HACAP), and Area Substance Abuse Council (ASAC). There is ongoing discussions, correspondence, and implementation amongst members of the above listed groups to address the identified needs and concerns. |
| Virginia Gay Hospital, Inc. | Part V, Section B, Line 11: It was determined through the CHNA process that Obesity, Mental Health, and Substance Abuse were the top three health priorities for our communities. Decisions to prioritize the needs are based upon internal and external assets to sustain programs that would make a meaningful impact. Although important, health needs not directly addressed by VGH are prevent injury/violence, protect against environmental hazards, prevent epidemics/spread of disease, and prepare/respond/recover from public health emergencies. These needs are either being addressed by other community partners, are areas beyond the control of Virginia Gay Hospital, would need governmental or regulatory action/support or were not a priority within Virginia Gay Hospital's mission.OBESITY 1. Strategies are on track to increase awareness of health related concerns due to obesity through health promotion campaigns. Working with Virginia Gay Hospital and community partners to help distribute information and provide training to community members. Healthy eating information handed out at the Benton County Fair and other health fair activities. 2. Strategy to implement patient education on Body Mass Index are being completed.3. Healthy food options have been made available in the VGH grab-and-go cooler. There have also been employee activities to help promote physical exercise such as a Walking Challenge in which 130 Virginia Gay Hospital employees participated in. MENTAL HEALTH1. Virginia Gay Hospital has made improvements to increasing the number of depression screenings on patients over 12 years old. 2. Strategy to increase awareness of signs and symptoms of youth depression through health promotional campaigns. Education and viewing of documentary "Paper Tigers" made available throughout the community (schools, hospital, community partners) to increase awareness of adverse childhood experiences. CDC suicide booklet provided to Benton County school nurses. 3. Virginia Gay Hospital still has plans to expand services to include a provider in behavioral health. This position has not been posted yet as future plans are still being finalized. SUBSTANCE ABUSE1. Virginia Gay Hospital representation on the Above the Influence Coalition continues. 2. Assistance in dissemination of materials regarding the Count, Lock-Up, Dispose campaign occurs in the clinic, hospital, and community outreach opportunities such as health fairs. 3. Patients receiving narcotic prescriptions are provided on-going education and close-monitoring to prevent opportunities for drug abuse. Alternative options are being considered for pain control such as a referral to the pain clinic services offered at Virginia Gay Hospital. |
| Virginia Gay Hospital, Inc. | Part V, Section B, Line 13h: Presumptive eligibility is also used to identify patients who might qualify for financial assistance. Acceptable programs are: Food Stamp programs, Mothers and Children (MAC), Iowa Family Planning Network (IFPN), Medically Needy Program, Limited eligibility, County relief programs, and deceased patients with no known estate. |
| Virginia Gay Hospital, Inc. | Part V, Section B, Line 16j: A summary of the policy and financial assistance information is posted in the emergency, admitting and waiting rooms, admissions and business offices, included with patient bills and information is available on our website. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Virginia Gay Nursing & Rehab | ||||
| 502 N 9th Avenue | Vinton | IA | 52349 | Intermediate care facility |
| 2 - Virginia Gay Hospital Home Health Agency | ||||
| 502 N 9th Avenue | Vinton | IA | 52349 | Skilled nursing care, PT, OT, ST, home health aide, homemaker services |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Discount Current Year's Federal FPI for Family size100% Family income is less or equal to 200% of FPIG80% Family income is 201% to 210% of FPIG60% Family income is 211% to 220% of FPIG40% Family income is 221% to 230% of FPIG20% Family income is 231% to 240% of FPIG0% Family income is greater than 240% of FPIG |
| Part I, Line 6a: | The community benefit report is available upon request. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. Community health improvement services, health professions education and cash and in-kind contributions to community groups are reported based on costs reported in the general ledger. 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 $259,250. |
| Part II, Community Building Activities: | The community benefit expenses were for the Senior Health Insurance Information Program. Virginia Gay Hospital absorbed the rent on the building and other costs such as utilities, garbage, communications, phone, copier and all marketing materials. |
| Part III, Line 2: | Prior to any account being classified as bad debt, all payments are applied including contractual allowances and discounts, and every effort is made with the patient in an attempt to collect the outstanding balance. Payments on accounts that were written off as bad debt reduces bad debt expense in the current year. Virginia Gay Hospital continues to serve patients in emergency situations even after the patients have generated significant bad debt.Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | Virginia Gay Hospital monitors the level of charity care it provides. Virginia Gay Hospital has several procedures in place to determine which patients would qualify for charity even if the applications are not completed. Therefore, the Hospital feels confident that no amount of bad debt expense is attributable to patients eligible under the Organization's financial assistance policy. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on pages 9 and 10 of the attached audited financial statements. |
| Part III, Line 8: | There was a Medicare shortfall for the fiscal year. Even at a loss the Hospital continues to provide services to these patients because access to healthcare and individual's health is important. Therefore, the Hospital considers the Medicare shortfall a community benefit.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 the Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $379,180.Medicare fee schedule revenue $ 177,749Medicare estimated costs of care relating to payments (556,929)Net (Shortage) $ (379,180) |
| Part III, Line 9b: | For patients who are known to qualify for charity care or financial assistance and who qualify for 100% discount, there will be no collection efforts. If a patient qualifies for a partial write-off of their bill, any personal portion due that is delinquent would follow the same collection procedures as other patients. Virginia Gay Hospital tries to identify patients who are uninsured or under-insured and patients who meet the presumptive eligibility criteria. Acceptable programs are: the Food Stamp program, Mothers and Children (MAC), Iowa Family Planning Network (IFPN), Medically Needy Program, Limited eligibility, County relief programs, and deceased patients with no known estate. If a patient qualifies for assistance after their account has already been sent to collections, all collection efforts cease immediately and all credit issues are reversed. If a patient enters into an extended payment plan, Virginia Gay Hospital will not impose wage garnishments, or liens on primary residences, will not send unpaid bills to outside collection agencies, and will cease all collection efforts, as long as the patient complies with their payment agreement, or contacts Virginia Gay Hospital with changed financial information. |
| Part VI, Line 2: | The Hospital provides staff to attend Community Coalitions and Advisory Committees which are focused on specific populations and/or community health issues. Examples of the committees include but are not limited to: the Benton County (Provider) Coalition, the Benton County Disaster Recovery Coalition, and Above The Influence (substance abuse) Coalition. These coalitions meet regularly throughout the year, gather/assess data to identify problems, and work towards resolution of the identified problems. Virginia Gay Hospital's staff participates in the community needs assessment process for public health. The target area for the 2016 Community Health Needs Assessment (CHNA) is Benton County, Iowa. Special attention was paid to recruiting diverse subsets of the population to help accurately identify the most critical issues in the area. Following the collection of all the statistical data, each health indicator was analyzed by comparing it regionally, to the state average rate, and national rates to determine the community's priority health concerns. Obesity, Mental Health, and Substance Abuse were identified as the highest priority health needs in Benton County. The CHNA and implementation strategy are posted on our website and can be viewed in their entirety at www.myvghinc.org . |
| Part VI, Line 3: | Virginia Gay Hospital is committed to providing charity care to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care based on their individual financial situation. Virginia Gay Hospital strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. Patients are expected to cooperate with Virginia Gay Hospital's procedures for obtaining charity care or other forms of payment of financial assistance, to contribute to the cost of their care based on their individual ability to pay. The charity care policy includes all departments of the facility, including Vinton Family Medical Clinic, Urbana Family Medical Clinic, Van Horne Family Medical Clinic, Atkins Family Medical Clinic and the Nursing and Rehab. The Virginia Gay Hospital Home Health Agency has a separate financial assistance procedure, due to their Public Health role in the community.Notification about charity care is available by the publication of notices in patient bills, posting of notices in the emergency rooms, admitting and registration departments, the Business Office, and other public places the Hospital may elect. Information is also included on the facility website, and in the patient information packets. A request for charity may be made by the patient or a family member, close friend or associate of the patient, subject to the applicable privacy laws. |
| Part VI, Line 4: | Virginia Gay Hospital is a Critical access hospital serving an estimated population of 26,000. Virginia Gay Hospital is located in Vinton, Iowa, the county seat at Benton County. Vinton has a population of approximately 5,200 people. The closest hospitals are located 37 miles away in Cedar Rapids, Iowa. Virginia Gay Hospital currently operates four separate clinics; one clinic is located on the hospital campus in Vinton, another located in the rural town of Van Horne, Iowa which is 15 miles from Vinton, another located in the rural community of Urbana, 13 miles from Vinton, and the other located in the rural community of Atkins which is 19 miles from Vinton. The Hospital and clinics serve a large number of Medicare and Medicaid patients that represent admissions and registrations of 40% and 8% respectively. The median household income for Benton County was $60,606 and 5.86% of the population was uninsured. The 2016 percentage of residents living in poverty in 2016 was 9%. The 2016 unemployment rate was 3.5%. Construction, agriculture and electrical equipment are the most common industries. |
| Part VI, Line 5: | Virginia Gay Hospital is proudly recognized as having one of the lowest costs per stay rates in the state of Iowa. The Hospital offers twenty-five beds in an acute care setting with state of the art technology and professional services. Virginia Gay Hospital also offers 24 hour acute care, short term skilled nursing services, radiology, respiratory care, cardio-pulmonary rehabilitation, physical therapy, occupational therapy, speech therapy, laboratory services, surgical services, outpatient clinics and emergency care. In addition, our staff has contributed multiple hours providing uncompensated time in areas such as family/parenting/sibling education, medical expertise for the schools' athletic teams, health fairs, information and referrals to community services, safety classes, sports physicals and many other uncompensated services.Requirements of the IRS community benefit standard for tax-exempt organizations are integral to the Hospital's larger charitable mission of improving health and quality of life. Specifically, Virginia Gay Hospital is governed by an independent board including community leaders, physicians, consumer representatives, business experts and clinical healthcare experts who reside in our primary service area. The Board has a history of commitment to acting with the highest integrity and has been proactively evaluating opportunities to voluntarily adopt governance best practices to ensure the organization continues to operate with the highest of integrity for the benefit of the community.To meet the needs of our community, the Hospital extends privileges to medical staff that are qualified through licensure in the state of Iowa.Excess funds are reinvested and used for patient care and facility upgrades.Virginia Gay's Home Health Agency offers a variety of services to all ages in the rural population of Benton County. The Hospital also offers such services as skilled and non-skilled service home care, blood pressure checks, and group teaching classes such as cardiopulmonary resuscitation (CPR), Advanced Life Support (ALS) and Pediatric Advanced Life Support (PALS).In addition, Virginia Gay Hospital, through its integrated network of providers, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare and Medicaid and by offering assistance through their Financial assistance program.Virginia Gay Hospital's Financial Assistance Policy provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The Financial Assistance Policy is designed to ensure the entire community served by the Hospital has access to needed healthcare services.Virginia Gay Hospital takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the community. It strives to identify community needs beyond basic healthcare, respond to them, aiming to make a positive, life-enhancing difference in the community.Contributing to Community Education: The nursing staff and Home Health Agency nurses participate in county wide community health fairs. These events provide information and guidelines to those in need of Medical information.Preventive Care a Priority: The Hospital has taken steps to enhance preventive care for people of all ages by ensuring that those who come here for preventive care receive the screenings and recommendations appropriate to their personal and family history. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Health profession scholarships | GrantTypeTxt |
| Recipient | 9 | RecipientCnt |
| Cash Grant | $9,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | High school seniors are selected in part because they plan to pursue a career in a health profession. An application must be completed with two letters of reference from non-family members, a one page biographical essay which includes professional goals and why the recipient should be chosen for the scholarship, and school transcripts. The Scholarship Committee choses the recipients and funds are disbursed to the schools to ensure they are used appropriately. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Brian Meeker DO | ||||||||||||||
| Director | $340,390 | $0 | $228,699 | $0 | $0 | $0 | $5,385 | $0 | $19,093 | $0 | $593,567 | $0 | $0 | $0 |
| Dr Michelle Elgin DO | ||||||||||||||
| Director | $143,457 | $0 | $71,280 | $0 | $0 | $0 | $1,631 | $0 | $20,273 | $0 | $236,641 | $0 | $0 | $0 |
| Michael Riege | ||||||||||||||
| CEO | $177,710 | $0 | $0 | $0 | $0 | $0 | $13,616 | $0 | $6,314 | $0 | $197,640 | $0 | $0 | $0 |
| Michele Burnes PA-C | ||||||||||||||
| Family Medicine | $110,648 | $0 | $123,796 | $0 | $0 | $0 | $2,400 | $0 | $18,993 | $0 | $255,837 | $0 | $0 | $0 |
| Rita Taylor-Stewart PA-C | ||||||||||||||
| Family Medicine | $117,446 | $0 | $104,091 | $0 | $0 | $0 | $2,400 | $0 | $5,768 | $0 | $229,705 | $0 | $0 | $0 |
| Dr Gene Lariviere MD | ||||||||||||||
| Surgeon | $356,904 | $0 | $0 | $0 | $0 | $0 | $6,446 | $0 | $20,273 | $0 | $383,623 | $0 | $0 | $0 |
| Dr Margaret Mangold MD | ||||||||||||||
| Family Medicine | $238,142 | $0 | $93,935 | $0 | $0 | $0 | $3,446 | $0 | $23,218 | $0 | $358,741 | $0 | $0 | $0 |
| Stephanie Vogeler PA-C | ||||||||||||||
| Family Medicine | $110,648 | $0 | $103,397 | $0 | $0 | $0 | $2,400 | $0 | $18,993 | $0 | $235,438 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Vinton Iowa | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 426005303 | BondIssuerEIN |
| Bond Issued | 2008-02-28 | BondIssuedDt |
| Issue Price | $6,800,000 | IssuePriceAmt |
| Purpose | New patient unit, emergency, physical/occupational therapy, & imaging dept | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $6,134,791 | RetiredAmt |
| Total Proceeds | $6,800,000 | TotalProceedsAmt |
| Other Spent Proceeds | $6,800,000 | OtherSpentProceedsAmt |
| Substantial Completion | 2010 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Date Rebate Computation Performed | Issuer Name: City of Vinton, Iowa Date the Rebate Computation was Performed: 04/26/2011 |
| Schedule K, Part IV, Line 2c: | All proceeds had been spent as of 4/26/2011. Since no proceeds have arisen since, it is not necessary to do any future arbitrage calculations. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dr Michelle Elgin DO | PersonNm |
| Relationship With Org | Director | RelationshipWithOrgTxt |
| Loan Purpose | Forgivable medical educational loan | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $10,000 | OriginalPrincipalAmt |
| Balance Due | $10,000 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $10,000 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kelly Henkle | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Daughter of Vice Chair, John Ketchen | RelationshipDescriptionTxt |
| Transaction | $36,077 | TransactionAmt |
| Transaction | Compensation and benefits as an employee | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the officers of the Board of Directors. The Executive Committee has the power to transact all regular business of the Hospital during the period between the meetings of the Governing Board, subject to any prior limitation imposed by the Governing Board and with the understanding that all matters of major importance will be referred to the Governing Board. The Executive Committee must submit to the Governing Board at its last meeting before the end of the fiscal year, a budget showing the expected receipts, income, and expense for the coming year. Minutes of the Executive Committee meetings must be submitted to the Board, and its actions are subject to approval or disapproval at the next regular board meeting. |
| Form 990, Part VI, Section A, line 2 | John Ketchen, Vice Chair of the Board, and Mark Mossman, Chair of the Board, had a business relationship. Mark Mossman, David Vermedahl, John Ketchen, John Yundt, all board members, Michael Riege, and Barry Dietsch had a business relationship. |
| Form 990, Part VI, Section A, line 7a | One of the Directors of the Board is the Mayor of the city of Vinton, Iowa. Two Directors are appointed by the Mayor and approved by the City Council of the City of Vinton for such terms as the City Council determines. One of these appointments is a physician in active practice and a resident of Benton County, Iowa. The second Director appointed by the City of Vinton is a resident of Benton County, Iowa. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is distributed to the Board members prior to filing. The 990 is reviewed by the Hospital's CEO and CFO. |
| Form 990, Part VI, Section B, line 12c | Any director, officer, key employee, Medical Staff member or committee member having an existing or potential interest in a contract or other transaction presented to the Board of Directors for deliberation, authorization, approval, or ratification, or any such person who reasonably believes such an interest exists in another person should make a prompt disclosure of the interest to the Board or committee prior to its acting on such contract or transaction. The interested party is required to disclose the nature and extent of his/her interest and any relevant and material facts known to him/her about the contract or transaction which might reasonably be construed to be adverse to the organization's interest. The Board requires annual statements from officers, directors, key employees, and key members of the Medical Staff. The body to which such disclosure is made determines, by majority vote, whether the disclosure shows that the non-voting and non-participation provisions below must be observed. If so, such persons should not vote on, nor use his/her personal influence on, nor participate (other than to present factual information or to respond to questions) in the discussions or deliberations with respect to such contract or transaction. Such persons may not be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted upon. The minutes of the meeting reflect the disclosure made and, where applicable, the abstention from voting and participation and whether a quorum was present. |
| Form 990, Part VI, Section B, line 15 | The Board Wage & Salary Committee and full board reviews compensation increases for the CEO based on annual evaluations and the IHA Salary Survey. Comparisons to state averages are used. Substantiation of the deliberation and decision is documented in the Board minutes. The process is completed annually. The CEO determines compensation for the CFO and key employees, with approval from the Board Wage & Salary committee and full Board, based on annual performance evaluations and the IHA Salary Survey. Contemporaneous substantiation of the deliberation and decision is provided for any actions taken regarding compensation. The process is completed annually. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 5,082,023. Management and general expenses 237,731. Fundraising expenses 2,200. Total expenses 5,321,954. Collection Fees: Program service expenses 6,057. Management and general expenses 25,664. Fundraising expenses 0. Total expenses 31,721. |
| Form 990, Part XII, Line 2c: | The process did not change from the prior year. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Virginia Gay Trust | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9th Avenue | AddressLine1Txt |
| City | Vinton | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52349 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 426367590 | EIN |
| Primary Activities | Provide financial support for Virginia Gay Hospital, Inc. | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12b, II | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Virginia Gay Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Vernon S Flechner Trust | ||||||||||||
| 502 N 9th Avenue | Vinton | IA | 52349 | 426351376 | Provide income for maint of the Hospital and annex buildings | IA | Virginia Gay Hospital Inc | T | $148,339 | $1,466,375 | 1.00000 | Yes (1) |
| JW Fry Trust | ||||||||||||
| 502 N 9th Avenue | Vinton | IA | 52349 | 426287710 | Provide unrestricted and corpus restricted income for Hospital additions | IA | Virginia Gay Hospital Inc | T | $251,211 | $1,508,495 | 1.00000 | Yes (1) |
| Cedar View Retirement Community Inc | ||||||||||||
| 502 N 9th Avenue | Vinton | IA | 52349 | 421398570 | Provide an 18-unit housing alternative for the elderly | IA | Virginia Gay Hospital Inc | C | $154,300 | $702,723 | 1.00000 | Yes (1) |
| Cedar View Condominium Association | ||||||||||||
| 502 N 9th Avenue | Vinton | IA | 52349 | 473986649 | Condominium Association | IA | Virginia Gay Hospital Inc | C | $23,070 | $13,925 | 1.00000 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Vernon S Flechner Trust | ||
| C | $110,000 | General ledger |
| JW Fry Trust | ||
| C | $130,000 | General ledger |