PALMER LUTHERAN HEALTH CENTER INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PALMER LUTHERAN HEALTH CENTER INC (EIN 42-1320763)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-08-12
- IRS object ID
- 201402249349300715
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-08-12T08:14:17-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421320763 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Palmer Lutheran Health Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PALM | BusinessNameControlTxt |
| Phone | 5634223811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 Jefferson Street | AddressLine1 |
| City | West Union | City |
| State | IA | State |
| ZIP Code | 52175 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Steve Stark | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 5634223811 | PhoneNum |
| Signature | 2014-08-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carmen Krantz | PreparerPersonNm |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2014-08-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steve Stark | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 Jefferson Street | AddressLine1 |
| City | West Union | City |
| State | IA | State |
| ZIP Code | 52175 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,354,088 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.palmerlutheran.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | Acute care health center | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 254 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $418,009 | PYContributionsGrantsAmt |
| CY Contributions Grants | $374,559 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,515,207 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,943,187 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$3,957 | PYInvestmentIncomeAmt |
| CY Investment Income | -$252,024 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,850 | PYOtherRevenueAmt |
| CY Other Revenue | $12,926 | CYOtherRevenueAmt |
| PY Total Revenue | $22,938,109 | PYTotalRevenueAmt |
| CY Total Revenue | $22,078,648 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,509,710 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,552,895 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,234,535 | PYOtherExpensesAmt |
| CY Other Expenses | $11,201,202 | CYOtherExpensesAmt |
| PY Total Expenses | $22,744,245 | PYTotalExpensesAmt |
| CY Total Expenses | $22,754,097 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $193,864 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$675,449 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,342,133 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,398,809 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,738,946 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,796,970 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,603,187 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,601,839 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Meet the health care needs of our communities, recognizing that people, knowledge and technology are our greatest assets. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $20,221,070 | ExpenseAmt |
| Revenue | $21,943,187 | RevenueAmt |
| Desc | Palmer Lutheran Health Center is a 25-licensed bed critical access hospital, the only hospital in West Union, Iowa and employs over 215 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 390 admissions, over 85 live births; over 3,350 Emergency Center visits; over 1,350 Urgent Care visits; and performs over 560 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 3,350 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 $177,965 for the year ended December 31, 2013. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended December 31, 2013 was $138,000.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. | Desc |
| Total Program Service Expenses | $20,221,070 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 24 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 254 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Joni Gisleson | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5634223811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 Jefferson Street | AddressLine1 |
| City | West Union | City |
| State | IA | State |
| ZIP Code | 52175 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Kent McElvania | |||||||
| Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tobin Britt | |||||||
| Vice Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mark Klinkefus | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Lynn Lauer | |||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Rick Hofmeyer | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Trudy Campbell | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Judy Hanson | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Debrah Chensvold | |||||||
| President/CEO | 40.00 | Yes (X) | $179,228 | $0 | $35,620 | ||
| Joni Gisleson | |||||||
| CFO | 40.00 | Yes (X) | $105,660 | $0 | $8,990 | ||
| Steve Stark | |||||||
| CEO commenced August 2013 | 40.00 | Yes (X) | $42,747 | $0 | $8,496 | ||
| Ken Beach | |||||||
| Anesthetist | 40.00 | $164,231 | $0 | $32,137 | Yes (X) | ||
| Richard Kreiman | |||||||
| Anesthetist | 40.00 | $158,296 | $0 | $31,139 | Yes (X) | ||
| Katie Koehn | |||||||
| Pharmacist | 40.00 | $102,659 | $0 | $31,870 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $752,821 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $148,252 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Rehab Visions | |||||
| 11623 Arbor Street | Omaha | NE | 68144 | Contracted therapy | $820,146 |
| Martin Fletcher & Associates | |||||
| Box 742499 | Atlanta | GA | 30374 | Contracted hospitalist | $397,417 |
| Genesis Emergency | |||||
| 122 Carlyle Ave | Belleville | IL | 62220 | Contracted ER physicians | $367,998 |
| Larson Construction | |||||
| Box 112 | Independence | IA | 50644 | Construction | $276,929 |
| Alliance Imaging | |||||
| PO Box 6600 | Newport Beach | CA | 92658 | Contracted MRI | $181,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,817 | GovernmentGrantsAmt |
| All Other Contributions | $366,742 | AllOtherContributionsAmt |
| Total Contributions | $374,559 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $21,126,913 | $21,126,913 |
| Supporting revenue | 900099 | $633,464 | $633,464 |
| Comm & Co public health | 900099 | $182,810 | $182,810 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,943,187 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,692 | TotalRevenueColumnAmt |
| Exclusion | $5,692 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,650 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,724 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,926 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,926 | TotalRevenueColumnAmt |
| Exclusion | $12,926 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $257,716 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$257,716 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$257,716 | TotalRevenueColumnAmt |
| Exclusion | -$257,716 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,078,648 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,943,187 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$239,098 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380,741 | TotalAmt |
| Management And General | $380,741 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,422,432 | TotalAmt |
| Program Services | $7,462,851 | ProgramServicesAmt |
| Management And General | $959,581 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $391,201 | TotalAmt |
| Program Services | $350,998 | ProgramServicesAmt |
| Management And General | $40,203 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,754,215 | TotalAmt |
| Program Services | $1,533,346 | ProgramServicesAmt |
| Management And General | $220,869 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $604,306 | TotalAmt |
| Program Services | $505,834 | ProgramServicesAmt |
| Management And General | $98,472 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,441 | TotalAmt |
| Management And General | $31,441 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,390 | TotalAmt |
| Management And General | $55,390 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,761,709 | TotalAmt |
| Program Services | $3,486,895 | ProgramServicesAmt |
| Management And General | $274,814 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,225 | TotalAmt |
| Management And General | $78,225 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $950,319 | TotalAmt |
| Program Services | $583,912 | ProgramServicesAmt |
| Management And General | $366,407 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,110 | TotalAmt |
| Program Services | $311,110 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,828 | TotalAmt |
| Program Services | $218,944 | ProgramServicesAmt |
| Management And General | $26,884 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $540,918 | TotalAmt |
| Program Services | $540,918 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,689,749 | TotalAmt |
| Program Services | $1,689,749 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,894 | TotalAmt |
| Program Services | $77,894 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Patient supplies | $2,339,896 | $2,339,896 |
| Bad debt expense | $1,117,316 | $1,117,316 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,407 | TotalAmt |
| Program Services | $1,407 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,754,097 | TotalAmt |
| Program Services | $20,221,070 | ProgramServicesAmt |
| Management And General | $2,533,027 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,128,770 | BOYAmt |
| EOY | $915,774 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,099,033 | BOYAmt |
| EOY | $5,085,431 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $591,401 | BOYAmt |
| EOY | $586,629 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,838 | BOYAmt |
| EOY | $18,771 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $28,382,881 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,555,107 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,247,376 | BOYAmt |
| EOY | $13,827,774 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $781,833 | BOYAmt |
| EOY | $779,017 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,133,636 | BOYAmt |
| EOY | $805,906 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,000 | BOYAmt |
| EOY | $6,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $106,246 | BOYAmt |
| EOY | $373,507 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,342,133 | BOYAmt |
| EOY | $22,398,809 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,733,695 | BOYAmt |
| EOY | $1,705,214 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $71,232 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,101,194 | BOYAmt |
| EOY | $10,536,021 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $432,057 | BOYAmt |
| EOY | $1,021,503 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $204,000 | BOYAmt |
| EOY | $144,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $268,000 | BOYAmt |
| EOY | $319,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,738,946 | BOYAmt |
| EOY | $13,796,970 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,469,551 | BOYAmt |
| EOY | $7,795,933 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,133,636 | BOYAmt |
| EOY | $805,906 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,603,187 | BOYAmt |
| EOY | $8,601,839 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,342,133 | BOYAmt |
| EOY | $22,398,809 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$675,449 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$325,899 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $4,937 | BeginningBalanceAmt |
| Additions During Year | $4,637 | AdditionsDuringYearAmt |
| Distributions During Year | $6,468 | DistributionsDuringYearAmt |
| Ending Balance | $3,106 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $183,609 | OtherCostOrOtherBasisAmt |
| Book Value | $183,609 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $352,568 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $18,308,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,414,757 | DepreciationAmt |
| Book Value | $10,245,963 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,738,033 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,723,977 | DepreciationAmt |
| Book Value | $3,014,056 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $800,519 | OtherCostOrOtherBasisAmt |
| Depreciation | $416,373 | DepreciationAmt |
| Book Value | $384,146 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,827,774 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated health claims payable | $292,000 |
| Estimated third-party payor settlements | $27,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $319,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,625,051 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,117,316 | OtherRevenueAmt |
| Revenue Not Reported | -$1,117,316 | RevenueNotReportedAmt |
| Revenue Subtotal | $21,742,367 | RevenueSubtotalAmt |
| Other Revenues Not Included | $336,281 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $336,281 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $22,078,648 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $21,630,313 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $21,630,313 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,123,784 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,123,784 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,754,097 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 -1,117,316. |
| Part XI, Line 4b - Other Adjustments: | Contributions recorded in fund balance for financial statements 331,644. Palmer Lutheran Health Center Auxiliary revenue included on Form 990 4,637. |
| Part XII, Line 4b - Other Adjustments: | Palmer Lutheran Health Center Auxiliary expenses included on Form 990 6,468. Provision for bad debts included in expenses on Form 990 1,117,316. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $138,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $138,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00640 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $862,583 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $581,007 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $281,576 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,000,583 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $581,007 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $419,576 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01940 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $28,251 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,251 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,800 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $37,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $214,666 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $133,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $81,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,040 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,040 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $284,757 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $133,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $151,460 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,285,340 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $714,304 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $571,036 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $42,908 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,908 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $42,908 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,908 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,117,316 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $7,429 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,455,575 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,500,340 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$44,765 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Palmer Lutheran Health Center Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 Jefferson Street | AddressLine1 |
| City | West Union | City |
| State | IA | State |
| ZIP Code | 52175 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.palmerlutheran.org | WebsiteAddressTxt |
| State License | 330070H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Palmer Lutheran Health Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.palmerlutheran.org | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Palmer Lutheran Health Center Inc. | Part V, Section B, Line 3: 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 6i: Palmer Lutheran Health Center has adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to the Hospital's website at www.palmerlutheran.org. |
| Palmer Lutheran Health Center Inc. | Part V, Section B, Line 7: 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 12i: We write off a percentage of gross charges that is determined by using the patient's annual gross income compared to the Federal Poverty Level. 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 14g: 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 10 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $1,117,316. |
| 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 2013 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: | We are currently in the process of completing our community health needs assessment. The 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Debrah Chensvold | ||||||||||||||
| President/CEO | $179,228 | $0 | $0 | $0 | $0 | $0 | $11,232 | $0 | $24,388 | $0 | $214,848 | $0 | $0 | $0 |
| Ken Beach | ||||||||||||||
| Anesthetist | $164,231 | $0 | $0 | $0 | $0 | $0 | $7,749 | $0 | $24,388 | $0 | $196,368 | $0 | $0 | $0 |
| Richard Kreiman | ||||||||||||||
| Anesthetist | $158,296 | $0 | $0 | $0 | $0 | $0 | $7,451 | $0 | $23,688 | $0 | $189,435 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| City of West Union Iowa | |||||||
| A | 426005366 | 2006-08-31 | $1,815,000 | Hospital facility improvements | 0 | 0 | 0 |
| Fayette County Iowa | |||||||
| B | 426005367 | 2006-08-31 | $10,000,000 | Hospital facility improvements | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $318,943 | $1,815,000 | $36,300 | $1,778,700 | 2007 | 0 | 0 | Yes (1) | Yes (1) |
| B | $1,757,387 | $10,000,000 | $200,000 | $9,800,000 | 2007 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 3,486,895. Management and general expenses 197,243. Fundraising expenses 0. Total expenses 3,684,138. Collection services: Program service expenses 0. Management and general expenses 77,571. Fundraising expenses 0. Total expenses 77,571. |
| Form 990, Part XI, line 9: | Change in Palmer Lutheran Health Center Auxiliary assets 1,831. Change in interest in net assets of Palmer Memorial Foundaton -327,730. |
| 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. |
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