2015-08-13T10:28:11-05:00 2014-12-31 450250958 EIDE BAILLY LLP 1545 ASSOCIATES DR STE 101 DUBUQUE IA 52002 990 2014-01-01 421320763 Palmer Lutheran Health Center Inc PALM 5634223811 112 Jefferson Street West Union IA 52175 Tanya Tysland Interim CEO 5634223811 2015-08-05 1 Carmen Krantz P00031958 5635561790 2015-08-03 2014 2016-02-25 16:41:14Z Tanya Tysland 112 Jefferson Street West Union IA 52175 23253230 0 X www.palmerlutheran.org X 1949 IA Acute care health center 7 7 241 35 0 0 374559 478504 21943187 22472959 -252024 231644 12926 41130 22078648 23224237 0 0 0 0 11552895 10996888 0 0 0 11201202 11752568 22754097 22749456 -675449 474781 22398809 25032768 13796970 16360796 8601839 8671972 X Meet the health care needs of our communities, recognizing that people, knowledge and technology are our greatest assets. 0 0 19847216 22472959 Palmer Lutheran Health Center is a 25-licensed bed critical access hospital, the only hospital in West Union, Iowa and employs over 220 employees. Palmer Lutheran Health Center also has a Home Care Department, Hospice Department, and Home Medical Equipment Department. In addition, Palmer operates an after hours and weekend Urgent Care clinic. This was done specifically to meet community health needs of working families. Annually, Palmer has over 375 admissions, over 90 live births; over 3,600 Emergency Center visits; over 875 Urgent Care visits; and performs over 575 surgeries (including ambulatory). The newly constructed Hospital was designed to achieve three goals: create a healing environment that welcomes and supports patients/families; design work areas to better accommodate current and future technologies, systems and approaches to care; and to comply more fully with HIPAA regulations. Palmer Lutheran Health Center leads delivery of healthcare to its region through over 35 associates (including 5 physicians, 8 physician assistants, and 1 nurse practitioner on staff) which coordinate care to deliver patient care as an integrated unit. Palmer Lutheran Health Center and its affiliates also work seamlessly to meet the needs of the communities they serve. Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Palmer Lutheran Health Center's larger charitable mission of improving health and quality of life. Specifically, Palmer Lutheran Health Center is governed by an independent board including community leaders, consumer representatives, business experts, and clinical healthcare experts. 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. Palmer Lutheran Health Center also makes medical care accessible to the entire community it serves. Palmer operates a full-time emergency room and provides emergency care regardless of ability to pay. We had over 3,600 Emergency Center visits this year. Palmer provides clinical services needed to operate the Emergency Center and provides on-site emergency medical, rescue and medical transportation services. In addition, Palmer Lutheran Health Center, 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 Palmer's charity care policy, and social services department. Palmer Lutheran Health Center is dedicated to implementing a complete electronic medical record. To meet this goal, Palmer has all clinical staff currently using this technology, and is currently working on physician order entry, as well as connectivity to our affiliate hospital, Gundersen Lutheran, to share test results. This will enhance patient care at our facility, as well as Gundersen clinics and hospitals throughout the region.The Health Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Health Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Health Center's charity care policy were $272,804 for the year ended December 31, 2014. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended December 31, 2014 were $184,000.The Health Center 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.Palmer Lutheran Health Center 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, then respond to them, aiming to make a positive, life-enhancing difference in the community. Palmer Lutheran Health Center takes a strategic, community needs based approach to delivering benefits to the community. 19847216 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 17 0 1 241 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Joni Gisleson 5634223811 112 Jefferson Street West Union IA 52175 Kent McElvania Chair 1.00 X X 0 0 0 Tobin Britt Vice Chair 1.00 X X 0 0 0 Mark Klinkefus Secretary 1.00 X X 0 0 0 Lynn Lauer Treasurer 1.00 X X 0 0 0 Rick Hofmeyer Director 1.00 X 0 0 0 Trudy Campbell Director 1.00 X 0 0 0 Judy Hanson Director 1.00 X 0 0 0 Steve Stark CEO 40.00 X 147084 0 30242 Joni Gisleson CFO 40.00 X 114313 0 9509 Ken Beach Anesthetist 40.00 X 174320 0 33077 Richard Kreiman Anesthetist 40.00 X 167278 0 32760 Kathy Begalske Director of Nursing 40.00 X 104508 0 31327 Cheryl Meyer Chief Human Resource Officer 40.00 X 105648 0 29626 813151 0 166541 6 0 1 0 Iowa Emergency Physicians PO Box 674579 Detroit MI 48267 Contracted ER providers 1158774 Rehab Visions 11623 Arbor Street Omaha NE 68144 Contracted therapy 874802 Larson Construction Box 112 Independence IA 50644 Construction 405849 Universal Hospital Services Box 86 Minneapolis MN 55486 Biomedical maintenance 256088 Alliance Imaging PO Box 6600 Newport Beach CA 92658 Contracted MRI 193540 7 1284 477220 478504 Patient service revenue 622110 21685710 21685710 EHR incentive 900099 358941 358941 Supporting revenue 900099 255108 255108 Comm & Co public health 900099 173200 173200 22472959 4687 4687 59080 17950 41130 41130 41130 238000 11043 226957 226957 226957 23224237 22472959 0 272774 X 295555 295555 8241771 7164294 1077477 370848 324520 46328 1514086 1294571 219515 574628 486753 87875 51635 51635 54465 54465 4153207 3733640 419567 60174 60174 1138368 570869 567499 338776 338776 219939 197789 22150 416770 416770 1923689 1923689 58611 58611 Medical supplies 2432472 2432472 Bad debt expense 899352 899352 Auxiliary expenses 4566 4566 544 544 22749456 19847216 2902240 0 915774 2230329 5085431 5070539 586629 764775 18771 155753 31183719 16409782 13827774 14773937 779017 514172 805906 401449 6000 373507 1121814 22398809 25032768 1705214 2906375 71232 788623 10536021 9901547 1021503 1808251 144000 108000 319000 848000 13796970 16360796 X 7795933 8270523 805906 401449 8601839 8671972 22398809 25032768 X 474781 -404648 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 3106 4757 4566 3297 0 258612 258612 352725 18772276 9225030 9899971 11068765 6734353 4334412 731341 450399 280942 14773937 Estimated health claims payable 175000 Estimated third-party payor settlements 673000 848000 X 21862984 -899352 -899352 22762336 461901 461901 23224237 21845538 0 21845538 903918 903918 22749456 Part IV, Line 1b: Palmer Lutheran Health Center Auxiliary uses the Health Center's FEIN but has its own checking and savings account. The Auxiliary account balances were not included in the financial statements. Part X, Line 2: The Health Center is organized as an Iowa non-profit 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 Health Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Health Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Health Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health Center 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 included in revenue per financial statements -899,352. Part XI, Line 4b - Other Adjustments: Contributions recorded in fund balance for financial statements 457,144. Palmer Lutheran Health Center Auxiliary revenue included on Form 990 4,757. Part XII, Line 4b - Other Adjustments: Palmer Lutheran Health Center Auxiliary expenses included on Form 990 4,566. Provision for bad debts included in expenses on Form 990 899,352. 1 1 X 1 X 1 X 0 1 1 0 1 1 184000 184000 0.00840 800553 575032 225521 0.01030 984553 575032 409521 0.01870 30750 30750 0.00140 34500 34500 0.00160 3800977 3350135 450842 0.02060 8762 8762 0.00040 3874989 3350135 524854 0.02400 4859542 3925167 934375 0.04270 5000 5000 0.00020 15000 15000 0.00070 20000 20000 0.00090 0 899352 8018 8286637 8403940 -117303 X 1 1 1 1 Palmer Lutheran Health Center Inc 112 Jefferson Street West Union IA 52175 www.palmerlutheran.org 330070H X X X X Palmer Lutheran Health Center Inc 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X www.palmerlutheran.org/hospital/about-us/community-health-needs-assessment X 1 13 1 www.palmerlutheran.org/hospital/about-us/community-health-needs-assessment 0 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X X X X X X X X X 1 X 0 X X X X 1 X 0 0 Palmer Lutheran Health Center Inc. Part V, Section B, Line 5: In May 2013, in response to the CHNA requirement, a community-wide focus group with over 30 participants was conducted. PLHC invited public participants to the event via website and local newspapers. In addition, various organizations, health-related stakeholders and community-minded individuals were personally invited to give input to the discussion. The process included separate groups each with a facilitator and open discussion about community health care needs. Five groups were given direction to discuss what they believed to be community health needs in the area. Facilitators were given national, state and local data for informational purposes for each group; however, they were to facilitate the discussion and not offer ideas or opinions. Each facilitator was provided with a list of topic starters if needed to keep conversation and brainstorming continuing. This list contained specific data in the areas of: Youth/Young Adult Health, Adults/General Public Health, Adequacy and Affordability of Health Care Services, Public Health and Environmental Hazards, Preventing Injuries, and the community's satisfaction in certain health-related areas. This stakeholders' session was held in West Union on May 13, 2013, with public health, school, business, government, organizational, community leaders and community-minded individuals, to prioritize each section's top five community health needs creating a database of over 30 areas to improve. From these priorities, using public outcomes as stated above, health professionals determined the most significant health needs for the local communities. Palmer Lutheran Health Center Inc. Part V, Section B, Line 11: The following needs will not be addressed due to the amount of items on the list the CHNA determined were needed (19 total). These issues will not be addressed from the original listing: dental needs, mental health (children and adult), health transportation, trails and recreational needs, medical specialist, elderly services, alcohol misuse, autism, workplace wellness, driving/biking/walking safety, and violence in relationships. However, three larger topics were prioritized (see below). In addition, other entities were notified of the conclusions as some of the listed needs were geared more towards other organizations' mission statements. For these priorities, Palmer Lutheran has offered assistance in their plan and implementation. Needs that will be addressed, but were not as of the end of the year for the 990:Resources/Knowledge of Services: confusion or no knowledge of current services within the community and other providers/organizations; organizations not working in sync to offer the best care to the community; funds between organizations are not being collaborated; no place to find all health-related organizations quickly; confusion over insurance. Youth Health/Wellbeing Concerns: obesity within the youth population is increasing; healthy eating/nutrition; safe environments; lack of basic life necessities; lack of mentors; sex education; staying fit; social media; lack of places to participate in physical activities; and lack of life skills. Disaster Preparedness: community as a whole is not prepared for disasters; lack of action plan; need for simulations; unsure where to find resources before/during/after a disaster. Palmer Lutheran Health Center Inc. Part V, Section B, Line 13h: We use a sliding scale, with individuals at the poverty level receiving a 100% write-off. Individuals at 150% of the poverty level receive a 75% write-off, individuals at 175% of the poverty level receive a 50% write-off, and individuals at 200% of the poverty level receive a 25% write-off. Palmer Lutheran Health Center Inc. Part V, Section B, Line 15e: All self-pay patients are given information on the Hospital's charity care policy as part of the discharge process. In addition, patients identified by our outsourced collectors as being potentially eligible for assistance are also provided application forms and information on how to apply. Palmer Lutheran Health Center Inc. Part V, Section B, Line 16i: Our self-pay collection agency utilizes information to identify accounts that should qualify for the FAP. We write these accounts off without requiring any paperwork or application. 10 Palmer Home Health 200 Jefferson Street West Union IA 52175 Home health Palmer Home Health - Oelwein 1602 South Frederick Oelwein IA 50662 Home health Palmer Home Health - Sumner 201 West 1st Street Sumner IA 50674 Home health Palmer Medical Supply - West Union 200 Jefferson Street West Union IA 52175 Medical supply and equipment Palmer Medical Supply - Oelwein 1602 South Frederick Oelwein IA 50662 Medical supply and equipment Palmer Medical Supply - Sumner 201 West 1st Street Sumner IA 50674 Medical supply and equipment Palmer Hospice - Oelwein 1602 South Frederick West Union IA 50662 Hospice services Palmer Hospice - Sumner 201 West 1st Street Sumner IA 50674 Hospice services Palmer Community Health 200 Jefferson Street West Union IA 52175 Public health services Palmer Hospice - West Union 200 Jefferson Street West Union IA 52175 Hospice services Part I, Line 3c: We use a sliding scale, with individuals at the poverty level receiving a 100% write-off. Individuals at 150% of the poverty level receive a 75% write-off, individuals at 175% of the poverty level receive a 50% write-off, and individuals at 200% of the poverty receive a 25% write-off. Part I, Line 6a: The Organization's 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 addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services, line 7e, health professions education, line 7f, and cash and in-kind donations, line 7i were compiled using actual costs and recorded in CBISA software. The cost for subsidized health services reported 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 $899,352. Part II, Community Building Activities: Community health improvement advocacy promotes the health of the community by addressing the needs of the community, such as jobs, clean water/sewer, industry attraction, addressing the needs of the school and county, and insuring we offer the services that are important to the community. We also provide education for school age children hoping to reach those that don't have access to health information. Part III, Line 2: Palmer Lutheran Health Center determines bad debt expense by using an allowance throughout the year which is adjusted by the auditors at the end of the year. The allowance is used after taking into account appropriate discounts and payments (insurance discounts, uninsured discounts, and eligible charity care discounts/adjustments). Payments on accounts that were written off as bad debt are offset to bad debt expense in the current year.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on an estimate of charges foregone to gross patient charges. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. Part III, Line 8: Palmer Lutheran Health Center, Inc. is a critical access hospital and in prior years has not shown a Medicare shortfall. There was a shortfall for 2014 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicaid and Medicare Services. Part III, Line 9b: Before bills are sent to collection, we utilize a "Fast Tag" program to see what patient accounts are "presumptive charity." Any patient that qualifies for presumptive charity is able to receive a write-off without having to file any paperwork. Once an account is identified, all collection proceedings stop, and the appropriate charity percentage is applied. Also, collection efforts cease on accounts that are sent to collections and later found to be eligible for assistance. Only their personal portion due would follow normal collection procedures. Part VI, Line 2: The community health needs assessment was conducted in conjunction with Fayette County Public Health. A community-wide focus group with over 30 participants was conducted in May 2013. These individuals represented the broad community. The community health needs assessment is posted to our website at www.palmerlutheran.org. The implementation strategy is a separate document addressing the needs in our community health needs assessment and is also included on our website. As a Critical Access Hospital, we have an advisory board that includes a member of the community. This group reviews all services of the CAH to assure services offered are effective and efficient and meet the community's needs. Our CAH has been designated as being in a HPSA region.In addition, our community health department participates in ongoing community needs assessment activities. This process will help to identify vulnerable or underserved populations. Specific topics addressed by the community needs assessment include: preventing injuries, promoting healthy lifestyles; preventing epidemics and increasing immunizations; protection from environmental hazard; preparing for/responding to/recovering from disaster situations. Part VI, Line 3: The charity care policy is posted in the emergency room area. Palmer Lutheran Health Center discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. All self-pay patients are referred to social services for information on above programs, as well as the Hospital's charity care policy, as part of the discharge process. In addition, patients identified by our outsourced collectors as being potentially eligible for assistance are also provided application forms and information on how to apply. Part VI, Line 4: Palmer Lutheran Health Center is a 25-bed acute care health center serving a rural population of 2,486 per the 2010 U.S. Census. As the only hospital in West Union, Iowa, it also serves a 30 to 40 mile radius around West Union. The closest hospital is Mercy Hospital of Franciscan Sisters-Oelwein, a critical access hospital, located about 19 miles from West Union. In addition, our Homecare department serves a population in a 50 mile radius. We are a Medicare dependent hospital and have a large Medicaid population as well. We have a growing amount of bad debt and charity care, as we have lost a number of industries in the last few years. The most common industries in West Union are manufacturing and construction. 12.7% of residents in West Union had income below the poverty level in 2010. The estimated median household income in 2010 was $40,769, down over $8,000 compared to the State of Iowa. Unemployment was 5.64% in 2012 compared to the national average of 8.08%. Part VI, Line 5: All of the Organization's governing body is comprised of persons who reside in the Organization's primary service area who are neither employees nor contractors of the Organization, nor family members thereof. The Organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments. The Organization applies surplus funds to improvements in patient care by purchasing up-to-date equipment, and a state of the art facility. Developing community partners is one of our strategic objectives. To meet that objective, we have an ongoing process in place to monitor our threats and our opportunities in our service area. We utilize the Iowa Hospital Association Dimensions software to determine the origin and destination of our patient population.Our strategic planning team includes our senior management who have an extensive knowledge base of the Organization including finance, nursing, HR, facility operations, IT and outpatient services. The Governing Board has an active role in this process as well. They have the benefit of being out in the community and gaining a unique insight and the pulse of the community.In addition, we are a clinical site for students of pharmacy, nursing, HIM, PA and medical students. Part VI, Line 6: Palmer Lutheran Health Center is an affiliate hospital of Gundersen Lutheran LaCrosse, Wisconsin. Gundersen has three regional clinics that provide medical care in our service area. They also provide a number of specialists who travel to West Union and utilize telemedicine opportunities to meet the needs of the population. Patients are transferred to the tertiary level of care as indicated. Gundersen is involved in our community, being a community partner to further health care initiatives. Part VI, Line 7, Reports Filed With States IA X X X 0 0 0 0 0 0 0 0 0 Steve Stark CEO 147084 0 0 0 0 0 6914 0 23328 0 177326 0 0 0 Ken Beach Anesthetist 174320 0 0 0 0 0 8209 0 24868 0 207397 0 0 0 Richard Kreiman Anesthetist 167278 0 0 0 0 0 7892 0 24868 0 200038 0 0 0 A City of West Union Iowa 426005366 2006-08-31 1815000 Hospital facility improvements 0 0 0 B Fayette County Iowa 426005367 2006-08-31 10000000 Hospital facility improvements 0 0 0 A 397693 1815000 36300 1778700 2007 0 0 1 1 B 2192209 10000000 200000 9800000 2007 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: City of West Union, Iowa Date the Rebate Computation was Performed: 08/01/2010 Issuer Name: Fayette County, Iowa Date the Rebate Computation was Performed: 08/01/2010 Schedule K, Part IV, Line 2c: For both the City of West Union and Fayette County bonds, as of the computation date on 8/01/2010, there were no remaining proceeds of the bonds and no positive rebate. Unless proceeds arise in the future, it is not necessary to do any future arbitrage calculations. Form 990, Part VI, Section A, line 6 Palmer Lutheran Health Center has two classes of members. The first class of membership is a corporate member class. The sole member of this class is Lutheran Health System-La Crosse, Inc., a Wisconsin non-stock, non-profit corporation. The second class of membership is a public membership made up of persons of legal age who are interested in promoting the aims, purposes, and welfare of the Hospital. Form 990, Part VI, Section A, line 7a Two Board Members are elected annually by Lutheran Health System-LaCrosse, Inc., at its annual meeting and are eligible to serve six consecutive one-year terms. Three Board Members are elected by a majority vote of public members at the annual meeting of Palmer Lutheran Health Center for three-year terms. Form 990, Part VI, Section A, line 8b Palmer Lutheran Health Center does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The entire Board receives a copy of the 990 before it is filed. The 990 is reviewed by the President/CEO and CFO. Form 990, Part VI, Section B, line 12c The conflict of interest policy is required to be signed annually by officers, directors and key employees. The signed policies are then reviewed at the board level and administration level. Board members are not allowed to vote on areas where there is conflict. Form 990, Part VI, Section B, line 15a The Board determines the compensation for the CEO. It is based on the Iowa Hospital Salary Survey, as well as performance. The compensation process is documented. Compensation for the CFO, key employees and other employees is determined by the CEO of the Hospital, with input from Human Resources. The Board is not involved in the determination of these salaries. The IHA salary survey is used as a guideline to determine salary ranges for all job descriptions. Typically, raises are given as a percentage increase across the board. This process for determining salary is used each year. Form 990, Part VI, Section C, line 19 The Organization's governing documents and conflict of interest policy are not available to the public. The financial statements are required to be attached to the Form 990, therefore this information is available to the public through the public disclosure copy of the 990. Form 990, Part IX, line 11g Purchased services: Program service expenses 3,733,640. Management and general expenses 366,520. Fundraising expenses 0. Total expenses 4,100,160. Collection services: Program service expenses 0. Management and general expenses 53,047. Fundraising expenses 0. Total expenses 53,047. Form 990, Part XI, line 9: Change in Palmer Lutheran Health Center Auxiliary assets -191. Change in interest in net assets of Palmer Memorial Foundaton -404,457. Form 990, Part XII, Line 2c: Palmer Lutheran Health Center's Board of Directors assumes responsibility for oversight of the audit of its financial statements and selection of an independent accountant.