CENTRAL COMMUNITY HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL COMMUNITY HOSPITAL (EIN 42-0818642)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-11
- IRS object ID
- 201420429349300227
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-02-11T10:15:02-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420818642 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CENT | NameControl |
| Phone | 5632457000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1 |
| City | Elkader | City |
| State | IA | State |
| ZIP Code | 520439015 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Pat Borel | Name |
| Title | CFO | Title |
| Phone | 5632457000 | Phone |
| Date Signed | 2014-02-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | Phone |
| Date Prepared | 2014-02-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Pat Borel | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1 |
| City | Elkader | City |
| State | IA | State |
| ZIP Code | 520439015 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6000796 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.centralcommunityhospital.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1961 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | Provide healthcare services to the surrounding community | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 84 | TotalNbrEmployees |
| Total Nbr Volunteers | 24 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 150659 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 90572 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6039963 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5845313 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4315 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8333 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 40364 | OtherRevenuePriorYear |
| Other Revenue Current Year | 41922 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6235301 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5986140 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2659091 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2636904 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 26375 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3414638 | OtherExpensePriorYear |
| Other Expenses Current Year | 3240491 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6073729 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5877395 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 161572 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 108745 | RevenuesLessExpensesCY |
| Total Assets BOY | 5897985 | TotalAssetsBOY |
| Total Assets EOY | 6171298 | TotalAssetsEOY |
| Total Liabilities BOY | 389295 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 550101 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5508690 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5621197 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Every patient matters. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4630194 | Expense |
| Revenue | 5845313 | Revenue |
| Description | Central Community Hospital is a 25-Bed Critical Access Hospital serving residents of Clayton County, Iowa. Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Central Community Hospital's charitable mission. Central Community Hospital is governed by an independent Board, which includes community leaders, consumer representatives and business experts. The Board has a history of commitment to acting with the highest integrity. During this year, the Board worked with management to continue to make improvements to assure the organization is in compliance with all rules and regulations governing the healthcare industry and non-profit organizations.Central Community Hospital makes care accessible to the entire community it serves. Central Community Hospital operates a full-time emergency room and provides care regardless of ability to pay. Central Community Hospital had over 970 emergency visits this year with an additional 67 observation days. The Hospital works with the City of Elkader to provide emergency response and emergency transport services for the local communities. This year the Hospital provided 847 days of inpatient care and 7,217 outpatient visits to the residents in the service area. Central Community Hospital provided care at many levels including SCU, Acute, Skilled, Intermediate, Same-Day-Surgery, Observation, Outpatient, and Rehab services. In addition, Central Community Hospital provides non-emergency services. These services are accessible to the community through participation in government programs like Medicare and Medicaid. Financial counseling is available to patients. Central Community Hospital takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the community. It strives to identify community needs beyond basic healthcare, working collaboratively with other community organizations. Needs assessments are completed every three years and updated annually by a county wide multi-disciplinary team and used to prioritize community projects.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were $150,647 for the year ended June 30, 2013. The direct and indirect costs related to these forgone charges were $105,000 at June 30, 2013, based on an average ratio of costs to gross charges.In addition, the Hospital provides services to other patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided.The Hospital also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. | Description |
| Total Program Service Expense | 4630194 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 27 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 84 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pat Borel | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5632457000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1 |
| City | Elkader | City |
| State | IA | State |
| ZIP Code | 520439015 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Robert Bodensteiner | ||||||
| President | 0.50 | X | X | 0 | 0 | 0 |
| Jennifer Cowsert | ||||||
| Vice President | 0.50 | X | X | 0 | 0 | 0 |
| Tom Neuhaus | ||||||
| Treasurer | 0.50 | X | X | 0 | 0 | 0 |
| Randall Johnson | ||||||
| Secretary until 09/2012 | 0.50 | X | X | 0 | 0 | 0 |
| Kevin Ihde | ||||||
| Secretary commenced 09/2012 | 0.50 | X | X | 0 | 0 | 0 |
| Darwin Winke | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| Russell Knight | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| William Reimer | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| Max Winemiller | ||||||
| Member served Jan-Feb 2013 | 0.50 | X | 0 | 0 | 0 | |
| Frances Zichal | ||||||
| CEO | 40.00 | X | 122282 | 0 | 14099 | |
| Pat Borel | ||||||
| CFO | 40.00 | X | 82255 | 0 | 7977 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 204537 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 22076 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Wapiti | |||||
| Box 92 | Newell | SD | 57760 | ER physicians | 438099 |
| Mercy Medical Center - Dubuque | |||||
| 250 Mercy Drive | Dubuque | IA | 52001 | Purchased services | 398583 |
| Northern Iowa Therapy | |||||
| 1810 4th St SW Suite 103 | Waverly | IA | 50677 | PT, OT, ST | 386012 |
| Medical Associates Clinic | |||||
| 1500 Associates Drive | Dubuque | IA | 52002 | Purchased services | 123836 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Government Grants | 34958 | GovernmentGrants |
| All Other Contributions | 55614 | AllOtherContributions |
| Total Contributions | 90572 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenu | 622110 | 5785481 | 5785481 |
| Supporting revenue | 900099 | 41142 | 41142 |
| Affiliation agreement | 900099 | 18690 | 18690 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5845313 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8333 | TotalRevenueColumn |
| Exclusion | $8,333 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56578 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14656 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 41922 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41922 | TotalRevenueColumn |
| Exclusion | $41,922 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5986140 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5845313 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $50,255 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 226057 | Total |
| Management And General | 226057 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1950975 | Total |
| Program Services | 1607287 | ProgramServices |
| Management And General | 322233 | ManagementAndGeneral |
| Fundraising | 21455 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42685 | Total |
| Program Services | 35007 | ProgramServices |
| Management And General | 7218 | ManagementAndGeneral |
| Fundraising | 460 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 264005 | Total |
| Program Services | 210363 | ProgramServices |
| Management And General | 50823 | ManagementAndGeneral |
| Fundraising | 2819 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153182 | Total |
| Program Services | 120541 | ProgramServices |
| Management And General | 31000 | ManagementAndGeneral |
| Fundraising | 1641 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64551 | Total |
| Management And General | 64551 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50080 | Total |
| Management And General | 50080 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1720338 | Total |
| Program Services | 1614855 | ProgramServices |
| Management And General | 105483 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20327 | Total |
| Management And General | 20327 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 177814 | Total |
| Program Services | 53225 | ProgramServices |
| Management And General | 124589 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101310 | Total |
| Management And General | 101310 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96023 | Total |
| Program Services | 93042 | ProgramServices |
| Management And General | 2981 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34431 | Total |
| Program Services | 13649 | ProgramServices |
| Management And General | 20782 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1280 | Total |
| Program Services | 1280 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 413561 | Total |
| Program Services | 413561 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67910 | Total |
| Management And General | 67910 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Patient supplies | 387136 | 387136 |
| Bad Debt Expense | 57275 | 57275 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48455 | Total |
| Program Services | 22973 | ProgramServices |
| Management And General | 25482 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5877395 | Total |
| Program Services | 4630194 | ProgramServices |
| Management And General | 1220826 | ManagementAndGeneral |
| Fundraising | 26375 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 816415 | BOY |
| EOY | 372489 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2765 | BOY |
| EOY | 11367 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 706546 | BOY |
| EOY | 594523 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89913 | BOY |
| EOY | 90357 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 182189 | BOY |
| EOY | 104287 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 8688004 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5596657 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3069275 | BOY |
| EOY | 3091347 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 629281 | BOY |
| EOY | 1723565 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 168953 | BOY |
| EOY | 172715 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 232648 | BOY |
| EOY | 10648 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5897985 | BOY |
| EOY | 6171298 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 359195 | BOY |
| EOY | 460600 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30100 | BOY |
| EOY | 89501 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 389295 | BOY |
| EOY | 550101 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5315393 | BOY |
| EOY | 5396429 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 193297 | BOY |
| EOY | 224768 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5508690 | BOY |
| EOY | 5621197 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5897985 | BOY |
| EOY | 6171298 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 108745 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 3762 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26015 | OtherCostOrOtherBasis |
| Book Value | 26015 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4026113 | OtherCostOrOtherBasis |
| Depreciation | 1995871 | Depreciation |
| Book Value | 2030242 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4370858 | OtherCostOrOtherBasis |
| Depreciation | 3600786 | Depreciation |
| Book Value | 770072 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 265018 | OtherCostOrOtherBasis |
| Book Value | 265018 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3091347 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 5915812 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -55705 | OtherRevenues |
| Revenue Not Rptd F990 | -55705 | RevenueNotRptdF990 |
| Revenue Subtotal | 5971517 | RevenueSubtotal |
| Other Revenues Not Included | 14623 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 14623 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 5986140 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5834776 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 14656 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 14656 | ExpensesNotRptdF990 |
| Expenses Subtotal | 5820120 | ExpensesSubtotal |
| Other Expenses Not Included | 57275 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 57275 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5877395 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X, Line 2: | The Hospital is organized as an Iowa nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Interanl Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined that it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Bad debt expense included in expenses on Form 990 -57,275. Net assets released from restrictions included in revenue for financial stmt 1,570. | |
| Part XI, Line 4b - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990 -14,656. Restricted donations recorded in fund balance for financial statements 29,279. | |
| Part XII, Line 2d - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990 14,656. | |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense included in expenses on Form 990 57,275. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01800 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01800 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14543 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 14543 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 887287 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 733922 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 153365 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02640 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 901830 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 733922 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 167908 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1006830 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 733922 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 272908 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04690 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 793 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 793 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 90 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 90 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 6447 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6447 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7330 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7330 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $57,275 | BadDebtExpenseAmount |
| Amount Attributable To | 5727 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3072075 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3056081 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 15994 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1 |
| City | Elkader | City |
| State | IA | State |
| ZIP Code | 520439015 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| Other Needs Addressed | X | OtherNeedsAddressed |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 3c: Income Criteria as a % of US Government poverty income guidelines:Less than or equal to 150% 0% paid by patient151% - 175% 30% paid by patient176% - 200% 50% paid by patientGreater than 200% 100% paid by patientThere are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. Central Community Hospital may use outside agencies to determine eligibility. These resources may use demographic and household information and/or credit scoring technology to determine eligibility. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application. Presumptive eligibility awards must be 100% discounts. Other forms of presumptive eligibility include: Eligible for the Iowa Cares Program, bankruptcy, death with no estate resources, and Title XIX eligible and receiving non-covered services. | ||
| Part I, Line 6a: The community benefit report is available upon request. | ||
| Part I, Line 7: Charity care expense was reported at cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. Medicaid is cost reimbursed therefore there is no community benefit expense reported. Community health improvement services, line 7e, and cash and in-kind contributions, line 7f, were reported based on actual expenses recorded in the Organization's general ledger. The cost for subsidized health services on line 7g was determined using the Medicare Cost Report. | ||
| Part I, L7 Col(f): The amount of bad debt expense backed out of total expenses to determine the percentage was $57,275. | ||
| Part II: We make every effort to have a constant presence at the community level to promote health related activities and report on the value a hospital brings to a small community. Based on our health needs assessment, we encourage the involvement of all community organizations in activities to promote better health for our service area residents. We have a strong presence in our local school systems by developing school wellness policies and trying to promote good health habits at an early age. Central Community Hospital is also involved in public health emergency preparedness activities including drills and exercises, Mission Health Drug Program, community health work groups, infection control meetings on policies and procedures, and NE Iowa Leadership and economic development meetings to try to create additional employment opportunities. We are also active in the Northeast Iowa Food and Fitness Initiative. | ||
| Part III, Line 4: All forms of payment, including self-pay, insurance, contractual allowances, and discounts, are applied to the patient's account before the account is classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Central Community Hospital does not refuse services to patients that generate bad debt.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 the percentage of incomplete applications. Approximately 10% were not completed and therefore the accounts were written off to bad debt. The footnote to the Organization's financial statements can be found on pages 8 and 9 of the attached audited financial statements. | ||
| Part III, Line 8: Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. | ||
| Part III, Line 9b: We make every effort to determine if a patient is eligible for financial assistance. If a patient cannot pay their balance in full in 30 days, a financial counselor is available to discuss payment options. After financial assistance is determined, any personal portion due follows the same debt collection policy as other patients without financial assistance. If a bankruptcy notice is received on any account, all collection activities will cease immediately. Central Community Hospital will not harass a patient for their past due account, nor make false statements to get the patient to pay their account. There are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. Central Community Hospital may use outside agencies to determine eligibility. These resources may use demographic and household information and/or credit scoring technology to determine eligibility. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application. Presumptive eligibility awards must be 100% discount. Other forms of presumptive eligibility include: eligible for the Iowa Cares Program, bankruptcy, death with no estate resources, and Title XIX eligible and receiving non-covered services (reviewed case by case). | ||
| Part V, Section B, Line 3: The following individuals and groups were consulted as individuals representing the community interests: Board of Health, Board of Supervisors, Central Community Hospital Board, Elkader Manager and Mayor. They were identified by the CHNA-HIP committee. | Central Community Hospital | |
| Part V, Section B, Line 4: The community health needs assessment was conducted with Guttenberg Municipal Hospital in Guttenberg, Iowa. | Central Community Hospital | |
| Part V, Section B, Line 5c: The community health needs assessment can be accessed at www.centralcommunityhospital.com. | Central Community Hospital | |
| Part V, Section B, Line 6i: Central Community Hospital 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.centralcommunityhospital.com. | Central Community Hospital | |
| Part V, Section B, Line 14g: At the time of registrations, CCH staff makes every effort to determine if a patient may possibly need or qualify for any financial assistance. We notify patients of the availability of these programs by posting information in our registration and emergency room areas. We offer a private meeting with a financial counselor. Inpatients are offered an opportunity to meet with the counselor upon discharge. Financial assistance information is provided in all correspondence regarding patient bills. Our financial counselor attempts phone contact whenever possible. We do an annual article about the service in our newsletter. | Central Community Hospital | |
| Part V, Section B, Line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. | Central Community Hospital | |
| Part VI, Line 2: The Community Health Needs Assessment was completed and posted to the website by June 30, 2013. The assessment was conducted with Guttenberg Municipal Hospital in Guttenberg, Iowa. Representatives of 18 facilities compiled Clayton County data on their services and populations served. The Board of Health, Board of Supervisors, Central Community Hospital's Board of Directors and Elkader's Manager and Mayor were consulted as individuals representing the communities' interests. Six priorities for health care needs were established including: obesity, substance abuse, falls, lead poisoning, mental health and care coordination. | ||
| Part VI, Line 3: At the time of registrations, CCH staff makes every effort to determine if a patient may possibly need or qualify for any financial assistance. We notify patients of the availability of these programs by posting information in our registration and emergency room areas. We offer a private meeting with a financial counselor. Inpatients are offered an opportunity to meet with the counselor upon discharge. Financial assistance information is provided in all correspondence regarding patient bills. Our financial counselor attempts phone contact whenever possible. Our "Mission Health" charity program information is available on our website. We do an annual article about the service in our newsletter. Our financial counselor will also assist with enrollment in external programs. | ||
| Part VI, Line 4: Central Community Hospital serves the residents of Clayton County. It is a rural, agricultural community. Employers in the area are generally small and often do not offer employee health benefits. The county has one of the lowest income per capita levels in the state. Residents would have to travel approximately 70 to 90 miles to reach a larger health facility. The area is accessed via state and county two-lane roads, often difficult to travel in the winter.The 2012 population for Clayton County was 17,835. The 2009 median household income for a family was $41,469. Approximately 8.60% of the population in Clayton County were below the poverty level. | ||
| Part VI, Line 5: Our Organization has a Board of Directors representing the entire service area and with varied backgrounds. We have an open medical staff. In addition to our local physicians, we encourage specialty physicians to hold clinics at our facility to improve access to our local residents. We have made great efforts to minimize long-term debt and instead take the approach of reinvesting cash flow back into the organization. | ||
| Part VI, Line 6: Central Community Hospital is affiliated with Mercy Medical Center - Dubuque, a private, non-profit organization. The Hospital entered into a Master Affiliation Agreement with Mercy Medical Center - Dubuque to provide hospital, physician, and other health care services in Elkader, Iowa. Mercy is committed to supporting health care in rural areas, as demonstrated by their joint operations and subsidy of medical clinics as well as their rural outreach programs. | ||
| IA | Reports Filed With States | Part VI, Line 7 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the officers of the Board. The President of the Board chairs the Committee. The Committee has the power to exercise authority of the Board when necessary or advisable between meetings of the Board. The Committee reports all of its actions to the Board at the next regular or special meeting of the Board, and such actions are subject to revision and alteration by the Board; provided however, that the rights of third parties are not affected by any revision or alteration. The Committee has the duty of reviewing the Bylaws of the Board at least annually and recommending to the Board the amendment of the Bylaws of the Hospital. The Executive Committee oversees compliance of the Hospital with requirements of regulatory bodies and meets on the call of the President. Minutes are kept of all meetings. | |
| Form 990, Part VI, Section A, line 2 | Fran Zical, CEO, and Russel Knight, Board member, have a business relationship. | |
| Form 990, Part VI, Section A, line 3 | Fran Zichal, CEO, is employed by Mercy Medical Center - Dubuque. Central Community Hospital has a Master Affiliation Agreement with Mercy Medical Center - Dubuque. The Board of Directors of the reporting organization retains all authority over decisions made. | |
| Form 990, Part VI, Section A, line 6 | The Organization has members, all of one class and resident citizens of the Central Community Hospital service area. | |
| Form 990, Part VI, Section A, line 7a | Members of the Board are elected by the resident citizens of the Central Community Hospital service area at the annual meeting to serve for a term of four years. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is made available to all Board Members before it is filed. The CEO and CFO review and approve the 990. | |
| Form 990, Part VI, Section B, line 12c | Any duality of interest or possible conflict of interest on the part of any Board member and officer is disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any individual having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter, and should not be counted in determining the quorum for the meeting, even where permitted by law. The minutes of the meeting reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing board, CEO and CFO complete and sign the conflict of interest form yearly. The forms are reviewed by the Board President, and if a potential conflict is identified the Board President follows up. | |
| Form 990, Part VI, Section B, line 15 | The process for determining compensation for the CEO is based on salary adjustment recommendations based on an annual evaluation, use of wage scales, committee approval (Board Chair and Mercy Medical Center - Dubuque's CEO), and Board approval. Also, Mercy Medical Center - Dubuque's compensation system is utilized. This includes review of wages in comparison to comparable positions. The organization documents and provides substantiation for their compensation process for the CEO. The process was last undertaken in FY 2013. The Hospital's Board determines compensation for the CFO through an annual evaluation and use of wage scales. The process is documented and was last undertaken in FY 2013. | |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents and conflict of interest policy are available upon written request. The financial statements are attached to the Form 990 and therefore available for public inspection. | |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 1,393,408. Management and general expenses 103,296. Fundraising expenses 0. Total expenses 1,496,704. Repairs and maintenance: Program service expenses 220,407. Management and general expenses 2,187. Fundraising expenses 0. Total expenses 222,594. Equipment rent and lease: Program service expenses 1,040. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,040. | Other Fees |
| Form 990, Part XI, line 9: | Change in interest in net assets of Central Community Hospital Foundation 3,762. | Changes in Net Assets or Fund Balances: |
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