2025-11-17T08:53:05-06:00 2024-12-31 420714325 RSM US LLP 4650 EAST 53RD STREET DAVENPORT IA 528073479 990 2024-01-01 420842204 PELLA REGIONAL HEALTH CENTER PELL 6416283150 404 JEFFERSON STREET PELLA IA 50219 ROBERT KROESE CHIEF EXECUTIVE OFFICER 6416283150 2025-11-12 1 0 JENIFER L CHASE P01306883 5638884000 2025-11-12 2024 2025-03-06 01:10:19Z ROBERT KROESE 404 JEFFERSON STREET PELLA IA 50219 175604473 0 X HTTPS://WWW.PELLAHEALTH.ORG X 1958 IA TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION 10 8 1122 47 58477 0 1189840 1144216 125839069 150391769 2196268 7768014 19309610 332837 148534787 159636836 8238 10427 0 0 74536634 81986798 0 0 0 64659667 66737970 139204539 148735195 9330248 10901641 177241268 192410195 43886881 40219904 133354387 152190291 X THE MISSION OF PELLA REGIONAL HEALTH CENTER IS TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. 0 0 126634924 10427 150333292 PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) IS A 25-BED ACUTE CARE HOSPITAL LOCATED IN PELLA, IOWA. THE HEALTH CENTER ALSO OPERATES CLINICS IN PELLA, SULLY, KNOXVILLE, PRAIRIE CITY, BUSSEY, AND OTTUMWA, IOWA. ANNUALLY, THE HEALTH CENTER HAS OVER 1,360 ADMISSIONS, OVER 620 LIVE BIRTHS, OVER 8,500 EMERGENCY RELATED VISITS, AND PERFORMS OVER 7,600 SURGERIES.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 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 WAS APPROXIMATELY $1,114,000 FOR THE YEAR-ENDED DECEMBER 31, 2024. TOTAL DIRECT AND INDIRECT COSTS RELATED TO THESE FORGONE CHARGES WERE $646,000 AT DECEMBER 31, 2024, BASED ON AN AVERAGE RATIO OF COST TO GROSS CHARGES.THE 340B PROGRAM OFFERS ELIGIBLE HEALTH CARE PROVIDERS ACCESS TO LOW-COST MEDICATIONS, WHICH ALLOWS THEM TO EXPAND THE TYPE AND VOLUME OF CARE THEY PROVIDE TO THE MOST VULNERABLE PATIENT POPULATIONS. THE 340B PROGRAM REQUIRES DRUG MANUFACTURERS TO PROVIDE THE OUTPATIENT DRUGS TO ELIGIBLE HEALTH CARE ORGANIZATIONS OR COVERED ENTITIES AT SIGNIFICANTLY REDUCED PRICES. THE HEALTH CENTER IS AN ELIGIBLE HEALTH CARE ORGANIZATION AND IS PARTICIPATING IN THE PROGRAM. THE REVENUE GENERATED FROM THIS PROGRAM WAS APPROX. $4,395,000 AND THE RELATED EXPENSES WERE APPROX $3,497,000 FOR 2024. 126634924 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 83 0 1 1122 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X BRUCE HEIFNER 6416283150 404 JEFFERSON STREET PELLA IA 50219 X STEPHEN BARNES DO BOARD MEMBER, PHYSICIAN 40.00 X 467785 0 64423 JIM BRANDL VICE PRESIDENT 0.50 0.20 X X 0 0 0 MARY GLENDENING FORMER PRESIDENT 0.50 X X 0 0 0 CHAD HUYSER BOARD MEMBER 0.50 X 0 0 0 PAUL JONES BOARD MEMBER 0.50 X 0 0 0 BRIANNE SCHLULTE BOARD MEMBER 0.50 X 0 0 0 RANDY STRAVERS PRESIDENT 0.50 X X 0 0 0 TRAVIS TURNBULL TREASURER 0.50 X X 0 0 0 KATHY CASHEN THOMPSON SECRETARY 0.50 X X 0 0 0 TRIXANNA WANG BOARD MEMBER 0.50 X 0 0 0 CRAIG WITTENBERG MD BOARD MEMBER, PHYSICIAN 40.00 X 722512 0 68638 ROBERT KROESE CHIEF EXECUTIVE OFFICER 40.00 2.00 X 456894 0 53732 BRUCE HEIFNER CHIEF FINANCIAL OFFICER 40.00 X 240897 0 49646 LEZLIE MORRIS CHIEF OF CLINIC SERVICES 40.00 X 214802 0 21392 JODY VAN VEEN CHIEF NURSING OFFICER 40.00 X 212929 0 29544 RUSSELL BANDSTRA MD PHYSICIAN 40.00 X 828619 0 35776 NATHAN NICHOLSON DO PHYSICIAN 40.00 X 847259 0 65361 STEWART KANIS DO PHYSICIAN 40.00 X 653348 0 60140 MATT MORGAN DO PHYSICIAN 40.00 X 775310 0 66888 JOHN WELANDER MD PHYSICIAN 40.00 X 708456 0 68084 6128811 0 583624 120 0 1 0 MEDICAL INFORMATION TECHNOLOGY INC PO BOX 74569 CHICAGO IL 60696 EHR SYSTEM 691999 MEDICAL ONCOLOGY AND HEMATOLOGY 1221 PLEASANT STREET SUITE 100 DES MOINES IA 50309 ONCOLOGY SERVICES 450950 BAKER GROUP 1600 SE CORPORATE WOODS DRIVE ANKENY IA 500217501 CONSTRUCTION 392365 CASSLING 13810 FND PKWY OMAHA NE 68154 IMAGING SERVICES 387083 UROLOGY CENTER OF IOWA 12129 UNIVERSITY AVE CLIVE IA 50325 UROLOGY SERVICES 379419 14 1132669 11547 1144216 PATIENT SERVICE REVENUE 621110 113259350 113259350 PHARMACY REVENUE 456110 20437225 20378748 58477 OTHER OPERATING REVENUE 900099 16695194 16695194 150391769 3214356 3214356 338988 6151 332837 332837 332837 20466916 48228 15916499 44987 4550417 3241 4553658 4553658 159636836 150333292 58477 8100851 10427 10427 3117221 2316052 801169 138842 138842 65259714 57126996 8132718 2544240 2133638 410602 6861512 5464568 1396944 4065269 3489814 575455 221666 1314 220352 136192 8400 127792 7213 7213 138033 138033 12299334 9677106 2622228 224947 6495 218452 13807888 11958060 1849828 2463228 817585 1645643 1578839 1443754 135085 224600 211890 12710 462525 322926 139599 576580 576580 6962259 4172572 2789687 862005 465354 396651 MEDICAL SUPPLIES 26109191 26109191 FOOD 419162 2205 416957 DUES AND MEMBERSHIPS 176512 133396 43116 EQUIPMENT PARTS AND REP 26217 26217 41579 21542 20037 148735195 126634924 22100271 0 13978517 17894115 24250410 17974048 2015716 1912151 1799270 2320158 154801678 103853984 47015547 50947694 86025475 91564769 2156333 9797260 177241268 192410195 17098194 15742675 17882283 15728026 2264981 2576955 6641423 6172248 43886881 40219904 X 133346887 145542641 7500 6647650 133354387 152190291 177241268 192410195 X 10901641 124441 7809822 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7213 7213 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 15.7% OF MEMBERSHIP DUES PAID TO THE IOWA HOSPITAL ASSOCIATION, OR $5,477, AND 15.7% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $1,736. 7500 7500 7500 7500 7500 7500 7500 7500 7500 7500 0.00000 1.00000 0.00000 0 1 0 4322587 4322587 107267053 73628272 33638781 695677 324649 371028 38460609 28762980 9697629 4055752 1138083 2917669 50947694 OTHER RECEIVABLES 212732 ESTIMATED CLAIMS RECEIVABLE 363574 OPERATING LEASE RIGHT TO USE ASSET 1928490 ACCUMLATED AMORT ROU ASSET -517358 INVESTMENT IN PELLA HOSPITAL FOUNDATION 7809822 9797260 ESTIMATED CLAIMS PAYABLE 1476875 THIRD PARTY SETTLEMENTS 640624 DEFERRED COMPENSATION 2583906 OPERATING LEASE LIABILITY 1470843 6172248 X PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SERVE THE PURPOSE OF THE RESTRICTIONS PLACED ON THE FUNDS BY THE RESPECTIVE DONORS. PART X, LINE 2: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) AND PELLA HOSPITAL FOUNDATION (FOUNDATION) ARE ORGANIZED AS IOWA NONPROFIT CORPORATIONS AND HAVE 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 AND FOUNDATION ARE EACH ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THEY ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE HEALTH CENTER AND FOUNDATION BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HEALTH CENTER AND FOUNDATION 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. FORMS 990 AND 990-T FILED BY THE HEALTH CENTER AND FOUNDATION ARE GENERALLY SUBJECT TO EXAMINATION BY THE IRS UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. 1 1 X 1 X 1 X 1 1 0 0 499072 499072 0.00340 9676671 9198442 478229 0.00320 10175743 9198442 977301 0.00660 998548 998548 0.00670 398470 12250 386220 0.00260 49713166 30036513 19676653 0.13230 10740 10740 0.00010 51120924 30048763 21072161 0.14170 61296667 39247205 22049462 0.14830 342130 342130 0.00230 342130 342130 0.00230 0 1562002 25932109 26977063 -1044954 X 1 1 1 1 PELLA REGIONAL HEALTH CENTER 404 JEFFERSON STREET PELLA IA 50219 WWW.PELLAHEALTH.ORG 630165H X X X X PELLA REGIONAL HEALTH CENTER 1 0 0 1 X X X X X X X X X 23 1 0 1 1 X WWW.PELLAHEALTH.ORG/ABOUT-US/COMMUNITY/ X 1 23 1 WWW.PELLAHEALTH.ORG/ABOUT-US/COMMUNITY/ 0 1 X 200.000000000000 200.000000000000 X X X X 1 1 X X X 1 X WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X X 1 X 0 0 PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 5: EACH COMMUNITY HAS A WEALTH OF EXPERTISE TO BE TAPPED FOR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DEVELOPMENT. FOR THIS REASON, A TOWN HALL IS THE PERFECT FORUM TO GATHER COMMUNITY INSIGHT AND PROVIDE AN ATMOSPHERE TO OBJECTIVELY BUILD CONSENSUS AND PRIORITIZE COUNTY HEALTH ISSUES.ALL TOWN HALL PRIORITY-SETTING AND SCORING PROCESSES INVOLVE THE INPUT OF KEY STAKEHOLDERS IN ATTENDANCE. INDIVIDUALS AND ORGANIZATIONS ATTENDING THE TOWN HALLS WERE CRITICALLY IMPORTANT TO THE SUCCESS OF THE CHNA.THE FOLLOWING LIST OUTLINES PARTNERS INVITED TO TOWN HALL: LOCAL HOSPITALS, PUBLIC HEALTH COMMUNITY, MENTAL HEALTH COMMUNITY, FREE CLINICS, COMMUNITY BASED CLINICS, SERVICE PROVIDERS, LOCAL RESIDENTS, COMMUNITY LEADERS, OPINION LEADERS, SCHOOL LEADERS, BUSINESS LEADERS, LOCAL GOVERNMENT, FAITH-BASED ORGANIZATIONS AND PERSONS (OR ORGANIZATIONS SERVING THEM), PEOPLE WITH CHRONIC CONDITIONS, UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS. PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 6B: MARION COUNTY PUBLIC HEALTH DEPARTMENT PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 11: THE 2023 IMPLEMENTATION PLAN DESCRIBES THE FOLLOWING NEEDS THAT WILL BE ADDRESSED IN THE FUTURE:1) MENTAL HEALTH: ASSESS AND SUPPORT THE DEPTH AND BREADTH OF SERVICES FOR MENTAL HEALTH NEEDS IN THE COMMUNITIES. PELLA REGIONAL HEALTH CENTER WILL EVALUATE OPTIONS TO INCREASE PROVIDERS AND ACCESS. TO ADDRESS THIS ISSUE PELLA REGIONAL HAS PARTNERED WITH TELEHEALTH FLOW STATE TELEPHYCH. PELLA REGIONAL ALSO RENOVATED TWO ROOMS IN THE EMERGENCY DEPARTMENT AS MENTAL HEALTH ROOMS OUTFITTED WITH SAFETY FEATURES SUCH AS LIGATURE-RESISTANT FIXTURES, AND THE ABILITY TO LOCK EQUIPMENT/SUPPLY STATIONS. 2) SUBSTANCE ABUSE: ASSESS AND SUPPORT THE DEPTH AND BREADTH OF SERVICES FOR SUBSTANCE USE AND ABUSE IN THE COMMUNITIES. PELLA REGIONAL COLLABORATES WITH MARION COUNTY CARES COALITION, MARION COUNTY LAW ENFORCEMENT AND SAMHSA REGION 7 TO PROVIDE SUBSTANCE ABUSE PREVENTION AND SUPPORT FOR THE COMMUNITY. PELLA REGIONAL CO-SPONSORED COMMUNITY AWARENESS SESSIONS THAT ARE FREE TO THE PUBLIC.3) WORKFORCE SHORTAGES: ATTRACT AND RETAIN EMPLOYEES AND WORKERS IN/INTO THE COUNTY FOR ALL SECTORS. PELLA REGIONAL PARTNERS WITH PACE ALLIANCE, ECONOMIC DEVELOPMENT, PELLA AND PELLA CHRISTIAN SCHOOLS AND CENTRAL COLLEGE IN THE WORKFORCE CONNECTOR PROGRAM. PELLA REGIONAL ALSO PARTICIPATES IN THE WORKFORCE DEVELOPMENT COUNCIL. PELLA REGIONAL OFFERS JOB SHADOW AND INTERNSHIP OPPORTUNITIES. PELLA REGIONAL ALSO OFFERS TUITION ASSISTANCE AND SUPPORT FOR ADVANCED CERTIFICATIONS FOR CURRENT EMPLOYEES TO ADVANCE THEIR CAREERS. 4) ACCESS TO CHILD CARE SERVICES: COMMUNICATE, CONVENE OPTIONS FOR CHILDCARE ACCESS AND SERVICES IN COMMUNITIES NOTE: THIS IS NOT PART OF PELLA REGIONAL'S CORE BUSINESS OPERATIONS. PRHC WILL REFER TO CHILDCARE PROVIDERS FOR ACTIONS. IOWA CHILD CARE RESOURCE & REFERRAL, MARION COUNTY PUBLIC HEALTH AND PACE ALLIANCE ARE THE RESOURCE PARTNERS. 5) TRANSPORTATION SERVICES: SERVICES FOR THE MEDICALLY NEEDY AND ELDERLY IN THE COMMUNITY NOTE: THIS IS NOT PART OF PELLA REGIONAL'S CORE BUSINESS OPERATIONS. PRHC WILL REFER TO AREA RESOURCES FOR ACTIONS. PRHC PAYS FOR PATIENT TRANSPORTATION TO HOME FOLLOWING DISCHARGE AS NEEDED UTILIZING LOCAL TAXI SERVICES AND HIRTA BUS OPTIONS.6) HEALTH AND HOUSING STABILITY COALITION FOR THE COUNTY: COALITION GROUP TO ADDRESS THE SERVICES AND ACCESS FOR COMMUNITY HEALTH AND HOUSING STABILITY NEEDS. NOTE: THIS IS NOT PART OF PELLA REGIONAL'S CORE BUSINESS OPERATIONS. PELLA REGIONAL PARTICIPATES IN THE COMMUNITY COALITION ALONG WITH MARION COUNTY PUBLIC HEALTH, CITY AND COUNTY GOVERNMENTAL AGENCIES. PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 13B: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) ALSO REVIEWS A PATIENT'S MONTHLY INCOME, EXPENSES, ASSETS, LIABILITIES, PRIOR HEALTH HISTORY, AND TOTAL OUTSTANDING BILLS IN ADDITION TO PROVIDING FREE OR DISCOUNTED CARE BASED ON THE FEDERAL POVERTY GUIDELINES. THE FEDERAL POVERTY GUIDELINES ARE USED AS A STARTING POINT TO DETERMINE FINANCIAL ASSISTANCE, BUT SEVERAL OTHER FACTORS ARE TAKEN INTO CONSIDERATION BEFORE DETERMINING HOW MUCH OF A PATIENT'S BILL WILL BE WRITTEN OFF TO CHARITY CARE IF THE PATIENT'S EARNINGS ARE ABOVE THE 200% FEDERAL POVERTY GUIDELINE BASE AMOUNT.THE HEALTH CENTER ALSO OFFERS UNINSURED PATIENTS A 20% CASH DISCOUNT FOR FINAL BILLS PAID IN FULL WITHIN 60 DAYS. THE HEALTH CENTER DOES NOT CHARGE INTEREST ON UNPAID BALANCES WHEN PAYMENT PLANS ARE SET UP WITHIN 60 DAYS OF PATIENTS RECEIVING THEIR FINAL BILL. PELLA REGIONAL HEALTH CENTER PART V, SECTION B, LINE 20E: IN ADDITION TO THE ACTIONS TAKEN IN PART V, SECTION B, LINE 20A-20D, PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) SENDS INSUFFICIENT PAYMENT LETTERS TO INDIVIDUALS FOR PAYMENTS NOT MEETING THE HEALTH CENTER'S MINIMUM PAYMENT REQUIREMENTS. THE HEALTH CENTER ALSO SENDS MINIMUM PAYMENT LETTERS THAT OUTLINES ITS MINIMUM PAYMENT REQUIREMENTS. 14 1 - PELLA MEDICAL CLINIC 405 MONROE PELLA IA 50219 PHYSICIAN CLINIC 2 - PELLA REGIONAL PHARMACY 802 WASHINGTON ST PELLA IA 50219 RETAIL PHARMACY 3 - OTTUMWA MEDICAL CLINIC 920 N QUINCY AVE OTTUMWA IA 52501 PHYSICIAN CLINIC 4 - KNOXVILLE MEDICAL CLINIC 1208 N LINCOLN KNOXVILLE IA 50138 PHYSICIAN CLINIC 5 - PELLA REGIONAL PHARMACY 405 JEFFERSON ST PELLA IA 50219 FIRSTFILL PHARMACY 6 - PRAIRIE CITY PHARMACY 404 E 2ND STREET PRAIRIE IA 50228 RETAIL PHARMACY 7 - PRAIRIE CITY CLINIC 404 E 2ND STREET PRAIRIE CITY IA 50228 PHYSICIAN CLINIC 8 - HOSPICE OF PELLA (COMFORT HOUSE) 505 UNION STREET PELLA IA 50219 HOSPICE 9 - HOME HEALTH 1119 E 2ND STREET PELLA IA 50219 HOME HEALTHCARE 10 - OTTUMWA THERAPY AGENCY 301 W SECOND ST SUITE B-1 OTTUMWA IA 52501 PHYSICAL AND OCCUPATIONAL THERAPY 11 - THERAPY - WESTPOORT 2525 WASHINGTON ST PELLA IA 50219 PHYSICAL AND OCCUPATIONAL THERAPY 12 - BUSSEY MEDICAL CLINIC 411 MERRILL STREET BUSSEY IA 50044 PHYSICIAN CLINIC 13 - SULLY CLINIC 704 3RD STREET SULLY IA 50251 PHYSICIAN CLINIC 14 - PRAIRE CITY THERAPY 404 S COMMERCE DR STE 2 PRAIRIE CITY IA 50228 PHYSICAL AND OCCUPATIONAL THERAPY PART I, LINE 3C: SEE RESPONSE TO PART V, LINE 13 FOR A DESCRIPTION OF ALL CRITERIA USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. PART I, LINE 6A: NOT APPLICABLE 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 USED TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSE AND REVENUE AMOUNTS RECORDED FROM THE EVENTS IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART I, LINE 7G: THE ORGANIZATION USED THE MEDICARE COST REPORT AS WELL AS INTERNAL FINANCIAL STATEMENTS TO CALCULATE A COST-TO-CHARGE RATIO FOR EACH DEPARTMENT THAT CONSTITUTES A SUBSIDIZED HEALTH SERVICE ACTIVITY. THE FOLLOWING PHYSICIAN CLINIC COSTS WERE INCLUDED IN COMMUNITY BENEFIT EXPENSE: PELLA MEDICAL CLINIC - $38,405,454, SULLY CLINIC - $743,170, OTTUMWA CLINIC - $5,524,722, BUSSEY - $692,056 AND PRAIRIE CITY CLINIC - $3,043,177. PART I, LINE 7F: NOT APPLICABLE PART II, COMMUNITY BUILDING ACTIVITIES: INFECTION CONTROL SERVES AS A COMMUNITY BENEFIT AS IT TRACKS INFECTIONS THROUGHOUT THE WORLD, NATION, AND LOCAL AREA IN AN EFFORT TO REDUCE OR PREVENT INCIDENCE OR LOCAL OCCURRENCE. ALSO, IT HELPS TO PREPARE FOR THE EVENTUALITY OF INFECTION ISSUES WITHIN THE COMMUNITY AND AT OUR FACILITY. PART III, LINE 2: PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.BAD DEBT EXPENSE ON LINE 2 IS REPORTED AT CHARGES AS PRESENTED ON THE FINANCIAL STATEMENTS. PART III, LINE 3: NOT APPLICABLE PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PELLA REGIONAL HEALTH CENTER PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THAT THEY WILL NOT RECOVER ALL OF THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE. THE ORGANIZATION REPORTED ONLY THOSE ALLOWABLE COSTS AND MEDICARE REIMBURSEMENTS REPORTED IN THE MEDICARE COST REPORT FOR THE YEAR.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 THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: PELLA REGIONAL HEALTH CENTER'S COLLECTION POLICY HAS PROVISIONS FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE OR CHARITY CARE AND FOR PATIENTS IN THE PROCESS OF APPLYING FOR ASSISTANCE. PELLA REGIONAL HEALTH CENTER DOES NOT PURSUE COLLECTION EFFORTS WHILE A PATIENT IS IN THE PROCESS OF APPLYING FOR ANY TYPE OF ASSISTANCE OR FOR ANY PORTION OF A PATIENT'S BILL CONSIDERED CHARITY CARE. AFTER ASSISTANCE IS DETERMINED, ANY PERSONAL PORTION DUE WOULD FOLLOW THE SAME COLLECTION PROCEDURES AS OTHER PATIENTS. IF A PAYMENT PLAN IS ESTABLISHED AND THE PATIENT DEFAULTS, THEIR CHARITY CARE STATUS IS REVOKED AND THE REMAINING BALANCE IS SENT TO COLLECTIONS. PART VI, LINE 2: PELLA REGIONAL HEALTH CENTER PARTICIPATED IN A COMMUNITY ENGAGEMENT PROJECT IN 2023. THIS PROJECT INCLUDED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), KEY INFORMANT INTERVIEWS, AND SECONDARY DATA ANALYSIS ADMINISTERED BY SARAH PAVELKA OF PALVELKA'S POINT CONSULTING FROM CEDAR FALLS, IOWA. CREATING HEALTHY COMMUNITIES REQUIRES A HIGH LEVEL OF MUTUAL UNDERSTANDING AND COLLABORATION AMONG COMMUNITY LEADERS. THE DEVELOPMENT OF THIS ASSESSMENT BRINGS TOGETHER COMMUNITY HEALTH LEADERS AND PROVIDERS, ALONG WITH LOCAL RESIDENTS, TO RESEARCH AND PRIORITIZE COUNTY HEALTH NEEDS AND DOCUMENT COMMUNITY HEALTH DELIVERY SUCCESSES. THIS HEALTH ASSESSMENT WILL SERVE AS THE FOUNDATION FOR COMMUNITY HEALTH IMPROVEMENT EFFORTS FOR THE NEXT THREE YEARS. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) REQUIRES NOT-FOR-PROFIT HOSPITALS TO CONDUCT A CHNA EVERY THREE YEARS AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED BY THE CHNA. THIS ASSESSMENT WAS COORDINATED AND PRODUCED BY PALVELKA'S POINT CONSULTING (CEDAR FALLS, IOWA) UNDER THE DIRECTION OF SARAH PAVELKA. A CHNA PROVIDES BENEFITS TO LOCAL HEALTH SERVICE ORGANIZATIONS, THE HOSPITAL, THE PUBLIC HEALTH DEPARTMENT, AS WELL AS OTHER COMMUNITY PROVIDERS AND STAKEHOLDERS IN THE FOLLOWING WAYS: 1) INCREASES KNOWLEDGE OF COMMUNITY HEALTH NEEDS AND RESOURCES; 2) CREATES A COMMON UNDERSTANDING OF THE PRIORITIES OF THE COMMUNITY'S HEALTH NEEDS; 3) ENHANCES RELATIONSHIPS AND MUTUAL UNDERSTANDING BETWEEN AND AMONG STAKEHOLDERS; 4) PROVIDES A BASIS UPON WHICH COMMUNITY STAKEHOLDERS CAN MAKE DECISIONS ABOUT HOW THEY CAN CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY; 5) PROVIDES RATIONALE FOR CURRENT AND POTENTIAL FUNDERS TO SUPPORT EFFORTS TO IMPROVE THE HEALTH OF THE COMMUNITY; 6) CREATES OPPORTUNITIES FOR COLLABORATION IN DELIVERY OF SERVICES TO THE COMMUNITY; AND 7) PROVIDES GUIDANCE TO THE HOSPITAL AND LOCAL HEALTH DEPARTMENT FOR HOW THEY CAN ALIGN THEIR SERVICES AND COMMUNITY BENEFIT PROGRAMS TO BEST MEET NEEDS.IN MARCH 2023, PELLA REGIONAL BEGAN ITS FOURTH COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN SUMMER THROUGH FALL 2023, PELLA REGIONAL HEALTH CENTER SPONSORED/CONDUCTED PRIMARY RESEARCH (SURVEY) TO ALL RESIDENTS RESIDING OR RECEIVING SERVICES IN THEIR PRIMARY SERVICE AREA, WITH 420 INDIVIDUAL REPLIES. IN ADDITION, A FOCUS GROUP WITH 15 COMMUNITY LEADERS INCLUDING SENIOR CITIZENS, CONSUMERS, HEALTH CARE PROVIDERS/CLINICIANS, EDUCATORS, BUSINESS OWNERS, CLERGY, AND LAW ENFORCEMENT OFFERED QUALITATIVE INFORMATION TO SUPPLEMENT THE SURVEY.THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED COMMUNITY HEALTH STRENGTHS AND WEAKNESSES. OUR FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT AND HEALTH IMPLEMENTATION PLAN WAS POSTED TO OUR WEBSITE IN DECEMBER 2023. PART VI, LINE 3: PELLA REGIONAL HEALTH CENTER'S PATIENT ADVOCATES ARE AVAILABLE TO WORK WITH PATIENTS PRIOR TO NON-EMERGENCY SERVICES TO REVIEW SPECIFIC INSURANCE SITUATIONS AND THE DOCTOR'S RECOMMENDED SERVICE FOR THE PATIENT. THE ADVOCATE ESTIMATES EACH PATIENT'S ACTUAL COST AND WORKS WITH THEM TO FIND THE BEST METHOD OF PAYMENT OR HELPS DETERMINE ELIGIBILITY FOR CHARITY CARE FROM PELLA REGIONAL HEALTH CENTER OR THROUGH GOVERNMENT PROGRAMS. PART VI, LINE 4: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) IS A CRITICAL ACCESS, NOT-FOR-PROFIT PROVIDER OF HEALTHCARE THAT IS ACCREDITED BY THE JOINT COMMISSION. IT EARNED A 4-STAR RATING FOR OVERALL HOSPITAL QUALITY FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IT IS RECOGNIZED BY WELLMARK BLUE CROSS AND BLUE SHIELD AS A BLUE DISTINCTION CENTER+ FOR KNEE AND HIP DESIGNATIONS. THE HEALTH CENTER'S MISSION IS TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION.THE HEALTH CENTER OFFERS A LARGE ARRAY OF INPATIENT AND OUTPATIENT SERVICES, A LIST OF SERVICES CAN BE FOUND AT PELLAHEALTH.ORG. THE HEALTH CENTER PRIMARILY SERVES MARION, MAHASKA, JASPER AND WAPELLO COUNTIES. THE HEALTH CENTER IS A THRIVING COMMUNITY APPROXIMATELY 40 MILES SOUTHEAST OF DES MOINES, IOWA AND IS HOME TO THE HEALTH CENTER AS WELL AS THE CORPORATE HEADQUARTERS FOR PELLA CORP, A LARGE MANUFACTURER OF WINDOWS AND DOORS AND VERMEER CORPORATION, A MANUFACTURER OF INDUSTRIAL AND AGRICULTURAL EQUIPMENT.THE POPULATION IN MARION COUNTY WAS 33,414. THE MEDIAN HOUSEHOLD INCOME WAS $78,059 AND 8.1% OF PEOPLE HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL. PERSONS WITHOUT HEALTH INSURANCE WAS 2.5%. 11.9% OF INSURED ARE MEDICAID RECIPIENTS. THE HEALTH CENTER AND KNOXVILLE HOSPITAL AND CLINICS ARE LOCATED IN MARION COUNTY. THIS INFORMATION WAS OBTAINED FROM HTTPS://DATA.CENSUS.GOV/PROFILE/MARION_COUNTY,_IOWA?G=050XX00US19125THE POPULATION IN WAPELLO COUNTY WAS 35,437. THE MEDIAN HOUSEHOLD INCOME WAS $60,034 AND 13.8% OF PEOPLE HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL, AND 7.2% ARE LIVING WITHOUT HEALTH CARE COVERAGE. 20.6% OF INSURED ARE MEDICAID RECIPIENTS. PELLA REGIONAL MEDICAL CLINIC - OTTUMWA AND OTTUMWA REGIONAL HEALTH CENTER ARE LOCATED IN WAPELLO COUNTY. RIVER HILLS COMMUNITY HEALTH CENTER AND MERCYONE OTTUMWA FAMILY CLINIC ARE FEDERALLY DESIGNATED PROVIDERS LOCATED IN WAPELLO COUNTY.THE POPULATION IN JASPER COUNTY WAS 37,813. THE MEDIAN HOUSEHOLD INCOME WAS $70,128 AND 4.1% ARE LIVING WITHOUT HEALTHCARE COVERAGE AND 8.8% OF PEOPLE HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL. 12.4% OF INSURED ARE MEDICAID RECIPIENTS PELLA REGIONAL MEDICAL CLINIC PRAIRIE CITY IS LOCATED IN JASPER COUNTY.THE POPULATION OF MAHASKA COUNTY WAS 22,190. THE MEDIAN HOUSEHOLD INCOME WAS $68,019 AND 4.7% ARE LIVING WITHOUT HEALTHCARE COVERAGE AND 14.4% OF PEOPLE HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL. 18.6% OF INSURED ARE MEDICAID RECIPIENTS MAHASKA HEALTH IS THE HOSPITAL LOCATED IN MAHASKA COUNTY. PART VI, LINE 5: THE BOARD MEMBERS ALL RESIDE IN THE SERVICE AREA. A MAJORITY OF THE BOARD MEMBERS ARE NOT EMPLOYED BY PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) AND NONE ARE FAMILY MEMBERS. PHYSICIANS ARE ENCOURAGED TO PARTICIPATE ON THE BOARD AS THEY HAVE DIRECT CONTACT WITH OUR PATIENTS AND KNOW FIRSTHAND THE NEEDS OF THE COMMUNITY. THE HEALTH CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY EXCEPT FOR PHYSICIANS WITH PENDING QUALITY ISSUES. THE HEALTH CENTER APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH THROUGH THE NORMAL BUDGET AND CAPITAL BUDGET PROCESSES. ALSO, THE HEALTH CENTER PROMOTES THE HEALTH OF THE COMMUNITY BY OPERATING AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY, PARTICIPATING IN GOVERNMENT-SPONSORED HEALTH PROGRAMS AND VOLUNTEERING IN THE COMMUNITY. PART VI, LINE 6: NOT APPLICABLE PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X 0 0 0 0 0 0 0 0 0 NATHAN NICHOLSON DO PHYSICIAN 847155 0 0 0 104 0 20700 0 44661 0 912620 0 0 0 RUSSELL BANDSTRA MD PHYSICIAN 827827 0 0 0 792 0 6900 0 28876 0 864395 0 0 0 MATT MORGAN DO PHYSICIAN 775034 0 0 0 276 0 20700 0 46188 0 842198 0 0 0 CRAIG WITTENBERG MD BOARD MEMBER, PHYSICIAN 706561 0 15159 0 792 0 20700 0 47938 0 791150 0 0 0 JOHN WELANDER MD PHYSICIAN 708336 0 0 0 120 0 20700 0 47384 0 776540 0 0 0 STEWART KANIS DO PHYSICIAN 642868 0 10300 0 180 0 20700 0 39440 0 713488 0 0 0 STEPHEN BARNES DO BOARD MEMBER, PHYSICIAN 467665 0 0 0 120 0 20700 0 43723 0 532208 0 0 0 ROBERT KROESE CHIEF EXECUTIVE OFFICER 399658 0 56512 0 724 0 20700 0 33032 0 510626 0 0 0 BRUCE HEIFNER CHIEF FINANCIAL OFFICER 230396 0 9709 0 792 0 15109 0 34537 0 290543 0 0 0 JODY VAN VEEN CHIEF NURSING OFFICER 204378 0 8275 0 276 0 12883 0 16661 0 242473 0 0 0 LEZLIE MORRIS CHIEF OF CLINIC SERVICES 206011 0 8275 0 516 0 12883 0 8509 0 236194 0 0 0 A HEALTH FACILITIES REVENUE REFUNDING BOND 521699886 NONEAVAIL 2017-06-08 41734118 REFUND BONDS ISSUED 09/28/06 0 1 0 A 41734118 3836530 703275 44867373 2009 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 PCBB 15.000000000000 0 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: HEALTH FACILITIES REVENUE REFUNDING BOND DATE THE REBATE COMPUTATION WAS PERFORMED: 10/03/2017 JAMIE STEENHOEK ARNP SEE BELOW IN PART V 138842 JAMIE STEENHOEK RECEIVES COMPENSATION AS AN ADVANCED PRACTICE PROVIDER. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - JAMIE STEENHOEK, ARNPJAMIE STEENHOAK, ARNP IS THE SISTER OF JODY VAN VEEN, KEY EMPLOYEE OF PELLA REGIONAL HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT, VICE PRESIDENT, SECRETARY, AND TREASURER. THE COMMITTEE ACTS FOR THE BOARD OF TRUSTEES AND DIRECTS AND CONTROLS THE AFFAIRS OF THE CORPORATION DURING THE INTERIM BETWEEN BOARD MEETINGS BUT IS SUBJECT TO THE SUPERVISION OF THE BOARD AND PROVIDED ANY ACTION TAKEN DOES NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD. THE EXECUTIVE COMMITTEE KEEPS AN ACCURATE AND COMPLETE RECORD OF ALL OF ITS PROCEEDINGS AND THE RECORD MUST BE SUBMITTED FOR CONFIRMATION TO THE BOARD OF TRUSTEES AT THE BOARD'S NEXT MEETING AND MADE A PART OF THE MINUTES. THE EXECUTIVE COMMITTEE HAS THE RIGHT TO APPROVE OR REJECT THE CEO'S RECOMMENDATIONS ON EMPLOYMENT OF PERSONNEL, PLAN OF INTERNAL ORGANIZATION OF THE CORPORATION, AND RULES AND REGULATIONS DEFINING DUTIES, HOURS AND INTERDEPARTMENTAL RELATIONSHIPS OF PERSONNEL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS DISTRIBUTED TO THE BOARD'S FINANCE COMMITTEE AND PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS ALSO REVIEWED BY THE CEO AND CFO. FORM 990, PART VI, SECTION B, LINE 12C PELLA REGIONAL HEALTH CENTER HAS CONFLICT OF INTEREST POLICIES COMPLETED EACH YEAR BY ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES THUS MONITORING ANY POTENTIAL CONFLICTS OF INTEREST. THE CEO AND CFO REVIEW THE COMPLETED STATEMENTS. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE CEO FOLLOWS UP. ANY ACTUAL OR POTENTIAL DUALITY OR CONFLICT OF INTEREST, INCLUDING BUT NOT LIMITED TO, OWNERSHIP OR CONTROL OF ANY ENTITY THAT CONTRACTS WITH PELLA REGIONAL HEALTH CENTER FOR ANY PRODUCTS OR SERVICES MUST BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD IN THE MINUTES WHEN THE SUBJECT OF SUCH INTEREST BECOMES A MATTER OF BOARD ACTION. WHEN CONFLICT ARISES, THE MEMBER IS ASKED TO BE EXCUSED FROM THE MEETING. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY ADJUSTMENT RECOMMENDATIONS BASED ON AN ANNUAL EVALUATION AND INPUT FROM HUMAN RESOURCES. THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS SET BY THE CEO WITH SALARY ADJUSTMENTS BASED ON ANNUAL EVALUATIONS AND DIRECTION FROM HUMAN RESOURCES. COMPARABILITY DATA IS USED TO DETERMINE COMPENSATION FOR TOP MANAGEMENT OFFICIALS, OFFICERS, AND EMPLOYEES IN NON-MANAGEMENT POSITIONS. SEVERAL SURVEYS ARE USED FOR COMPARABILITY INCLUDING THE IOWA HOSPITAL ASSOCIATION, IOWA HEALTH SYSTEM, IOWA INTEGRATED HEALTHCARE STRATEGIES, COMPDATA SURVEYS, IOWA ASSOCIATION OF HOMES AND SERVICES FOR THE AGING, IOWA MEDICAL GROUP MANAGEMENT ASSOCIATION, AND SOUTHEAST IOWA COMP CLUB. THE ORGANIZATION DOCUMENTS AND PROVIDES SUBSTANTIATION FOR ITS COMPENSATION PROCESS FOR ALL EMPLOYEES. THIS PROCESS WAS LAST UNDERTAKEN IN 2024. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AS THEY ARE ATTACHED TO THE FORM 990. FORM 990, PART VII, SECTION A: THE PHYSICIANS/DIRECTORS ARE COMPENSATED FOR THEIR SERVICES AS PHYSICIANS. THEIR TIME SERVED AS BOARD MEMBERS IS ON A VOLUNTEER BASIS, AND NO COMPENSATION IS RECEIVED FOR THOSE SERVICES. FORM 990, PART XI, LINE 9: CHANGE IN INVESTMENT IN PELLA HOSPITAL FOUNDATION 7,809,822. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM PRIOR TAX YEARS. PELLA HOSPITAL FOUNDATION 404 JEFFERSON STREET PELLA IA 50219 421430122 SOLICIT FUNDS AND SUPPORT PELLA REGIONAL HEALTH CENTER IA 501(C)(3) LINE 7 PELLA REGIONAL HEALTH CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 PELLA HOSPITAL FOUNDATION C 1132669 FAIR MARKET VALUE