2018-04-24T08:53:08-05:00 2017-06-30 450250958 EIDE BAILLY LLP 1545 ASSOCIATES DR STE 101 DUBUQUE IA 52002 990 2016-07-01 421231996 Virginia Gay Hospital Inc VIRG 3194726255 502 N 9th Avenue Vinton IA 523492254 Michael Riege CEO 3194726255 2018-04-23 1 Carmen Krantz P00031958 5635561790 2018-04-15 74.84.124.22 2018-04-23 09:51:19 CD P 330E77A2EC15986A2DC713C7FDB26B906589BB96 330E77A2EC15986A2DC713C7FDB26B906589BB96 2016 2021-01-29 14:40:06Z Michael Riege 502 N 9th Avenue Vinton IA 523492254 28471353 0 X www.myvghinc.org X 1923 IA Provision of health care services 9 6 344 57 0 0 266034 1342072 25987049 26846925 239606 274198 35396 5944 26528085 28469139 0 9802 0 0 14102045 14602047 0 0 77702 10764998 12227951 24867043 26839800 1661042 1629339 26890097 29981930 3865790 4933972 23024307 25047958 X Our purpose is to provide quality health care services by using innovative, growth-oriented techniques and maintaining a sound financial base. 0 0 24152858 9802 26846925 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. 24152858 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 29 0 1 344 1 0 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Barry Dietsch 3194726255 502 N 9th Avenue Vinton IA 52349 Mark Mossman Chair 0.50 0.90 X X 0 0 0 John Ketchen Vice Chair 0.50 1.30 X X 0 0 0 David Vermedahl Secretary 0.50 0.90 X X 0 0 0 John Yundt Treasurer 0.50 0.30 X X 0 0 0 James Hodgson Director 0.50 0.30 X 0 0 0 Dr Brian Meeker DO Director 40.50 0.00 X 569089 0 24478 Marie Therese Foth Director 0.50 0.30 X 0 0 0 John Watson Director 0.50 0.30 X 0 0 0 Dr Michelle Elgin DO Director 40.50 0.30 X 214737 0 21904 Michael Riege CEO 40.00 3.30 X 177710 0 19930 Barry Dietsch CFO 40.00 3.30 X 120634 0 2917 Michele Burnes PA-C Family Medicine 40.00 0.00 X 234444 0 21393 Rita Taylor-Stewart PA-C Family Medicine 40.00 0.00 X 221537 0 8168 Dr Gene Lariviere MD Surgeon 40.00 0.00 X 356904 0 26719 Dr Margaret Mangold MD Family Medicine 40.00 0.00 X 332077 0 26664 Stephanie Vogeler PA-C Family Medicine 40.00 0.00 X 214045 0 21393 2441177 0 173566 14 0 1 0 National Therapeutic Association 11623 Arbor Street Omaha NE 68144 PT, OT, ST 1292410 UI Comm Medical Services Inc 2346 Mormon Trek Blvd Iowa City IA 52246 Computer services 1060473 Health Enterprises 4250 Glass Road Cedar Rapids IA 524022513 CRNA & Ultrasound 492704 Lawrence Group 319 N 4th Street St Louis MO 63102 Construction planning services 264593 CPSI 6600 Wall Street Mobile IL 36695 Computer services 256797 7 1301083 8000 32989 1342072 Patient & resident revenue 622110 25444912 25444912 Pharmacy revenue 900099 1117242 1117242 Supporting revenue 900099 284771 284771 26846925 276412 276412 5944 0 5944 5944 5944 2214 -2214 -2214 -2214 28469139 26846925 0 280142 X 802 802 9000 9000 1141833 812494 329339 36077 36077 11391742 10404997 953526 33219 139631 138963 236 432 1072747 962941 106909 2897 820017 730666 86511 2840 16067 16067 69567 8000 61567 5353675 5088080 263395 2200 253266 115506 106559 31201 1409915 1301054 104391 4470 368789 43241 325548 52806 48058 4720 28 39502 38760 742 80305 80305 1318691 1318691 193600 45100 148500 Medical supplies 2013264 2013264 Repairs & maintenance 458069 396426 61643 Provision for bad debts 259250 259250 Food 181972 181972 159213 119211 39587 415 26839800 24152858 2609240 77702 400 2088807 623522 3513786 4815623 10000 371444 382968 54654 482770 29928061 15917608 12922162 14010453 6864523 7501313 947445 979385 110000 112496 17276 1063000 26890097 29981930 1369679 1572976 1640500 665209 559110 361111 1850000 296501 484676 3865790 4933972 X 22880342 24895644 27305 35654 116660 116660 23024307 25047958 26890097 29981930 1629339 394312 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 116660 8185 8185 116660 116660 3725 3725 116660 116660 3225 3225 116660 116660 8526 8526 116660 116660 9104 9104 116660 0.00000 1.00000 0.00000 0 0 67494 67494 151876 17095532 9196213 8051195 7674686 6060456 1614230 4938473 660939 4277534 14010453 Construction accounts payable 483909 Interest payable 767 484676 X 27294769 394312 -259250 135062 27159707 1309432 1309432 28469139 26580550 0 26580550 259250 259250 26839800 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. 1 1 X 1 X 1 X 240.000000000000 1 1 0 1 1 83000 83000 0.00310 83000 83000 0.00310 2843 80755 80755 0.00300 3080 3080 0.00010 6220640 5703904 516736 0.01940 566 1335 1335 0.00010 3409 6305810 5703904 601906 0.02260 3409 6388810 5703904 684906 0.02570 24310 24310 0.00090 24310 24310 0.00090 1 259250 0 6648322 6685362 -37040 X 1 1 1 1 Virginia Gay Hospital Inc 502 N 9th Avenue Vinton IA 523492254 myvghinc.org 060178H X X X X 4 provider based rural health clinics Virginia Gay Hospital Inc 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.myvgh.org X 1 15 1 www.myvgh.org 0 1 X 200.000000000000 240.000000000000 X X 1 1 X X X 1 X www.myvgh.org/charity-care/ X www.myvgh.org/charity-care/ X www.myvgh.org/charity-care/ X X X X X X 1 X 0 X X X 1 X 0 0 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. 2 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 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. 1 Health profession scholarships 9 9000 Part I, Line 2: 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. X X X 0 0 0 0 0 0 0 0 0 Dr Brian Meeker DO Director 340390 0 228699 0 0 0 5385 0 19093 0 593567 0 0 0 Dr Michelle Elgin DO Director 143457 0 71280 0 0 0 1631 0 20273 0 236641 0 0 0 Michael Riege CEO 177710 0 0 0 0 0 13616 0 6314 0 197640 0 0 0 Michele Burnes PA-C Family Medicine 110648 0 123796 0 0 0 2400 0 18993 0 255837 0 0 0 Rita Taylor-Stewart PA-C Family Medicine 117446 0 104091 0 0 0 2400 0 5768 0 229705 0 0 0 Dr Gene Lariviere MD Surgeon 356904 0 0 0 0 0 6446 0 20273 0 383623 0 0 0 Dr Margaret Mangold MD Family Medicine 238142 0 93935 0 0 0 3446 0 23218 0 358741 0 0 0 Stephanie Vogeler PA-C Family Medicine 110648 0 103397 0 0 0 2400 0 18993 0 235438 0 0 0 A City of Vinton Iowa 426005303 2008-02-28 6800000 New patient unit, emergency, physical/occupational therapy, & imaging dept 0 0 0 A 6134791 6800000 6800000 2010 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 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. Dr Michelle Elgin DO Director Forgivable medical educational loan X 10000 10000 0 1 1 10000 Kelly Henkle Daughter of Vice Chair, John Ketchen 36077 Compensation and benefits as an employee 0 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. Virginia Gay Trust 502 N 9th Avenue Vinton IA 52349 426367590 Provide financial support for Virginia Gay Hospital, Inc. IA 501(c)(3) Line 12b, II Virginia Gay Hospital Inc 1 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 148339 1466375 1.00000 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 251211 1508495 1.00000 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 154300 702723 1.00000 1 Cedar View Condominium Association 502 N 9th Avenue Vinton IA 52349 473986649 Condominium Association IA Virginia Gay Hospital Inc C 23070 13925 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 Vernon S Flechner Trust C 110000 General ledger JW Fry Trust C 130000 General ledger