VIRGINIA GAY HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- VIRGINIA GAY HOSPITAL INC (EIN 42-1231996)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-01-17
- IRS object ID
- 201300179349300820
- Schema version
- 2011v1.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-01-17T12:22:07-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | 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 | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421231996 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VIRGINIA GAY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | VIRG | NameControl |
| Phone | 3194726255 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9TH AVENUE | AddressLine1 |
| City | VINTON | City |
| State | IA | State |
| ZIP Code | 523492254 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL RIEGE | Name |
| Title | CEO | Title |
| Phone | 3194726200 | Phone |
| Date Signed | 2013-01-16 | 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 | 2013-01-16 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL RIEGE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9TH AVENUE | AddressLine1 |
| City | VINTON | City |
| State | IA | State |
| ZIP Code | 523492254 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22192582 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.VGHINC.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1923 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | PROVISION FOR HEALTH CARE SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 251 | TotalNbrEmployees |
| Total Nbr Volunteers | 61 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 662237 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 348043 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 20795066 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 21759666 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 58739 | InvestmentIncomePriorYear |
| Investment Income Current Year | 84873 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21516042 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22192582 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 8569 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 9857 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11101951 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11809727 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 55834 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9004957 | OtherExpensePriorYear |
| Other Expenses Current Year | 9239171 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 20115477 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21058755 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1400565 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1133827 | RevenuesLessExpensesCY |
| Total Assets BOY | 23734012 | TotalAssetsBOY |
| Total Assets EOY | 24703437 | TotalAssetsEOY |
| Total Liabilities BOY | 9192210 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9080099 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14541802 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 15623338 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | OUR PURPOSE IS TO PROVIDE QUALITY HEALTH CARE SERVICES BY USING INNOVATIVE, GROWTH-ORIENTED TECHNIQUES AND MAINTAINING A SOUND FINANCIAL BASE. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 18974530 | Expense |
| Grants | 9857 | Grants |
| Revenue | 21759666 | Revenue |
| Description | VIRGINIA GAY HOSPITAL LEADS DELIVERY OF HEALTHCARE TO ITS REGION THROUGH OVER 225 ASSOCIATES (INCLUDING 13 PROVIDERS) WHICH COORDINATE CARE TO DELIVER PATIENT CARE AS AN INTEGRATED UNIT. VIRGINIA GAY HOSPITAL AND ITS AFFILIATES ALSO WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE HOSPITAL PROVIDES CARE TO PATIENTS AND RESIDENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. REVENUE FROM SERVICES TO THESE PATIENTS AND RESIDENTS IS RECORDED IN THE ACCOUNTING SYSTEM AT THE ESTABLISHED RATES, BUT THE HOSPITAL DOES NOT PURSUE COLLECTION OF THE AMOUNTS. THE RESULTING ADJUSTMENTS ARE RECORDED AS ADJUSTMENTS TO PATIENT AND RESIDENT SERVICE REVENUE, DEPENDING ON THE TIMING OF THE CHARITY DETERMINATION.THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE AMOUNTS OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, WERE $258,919 FOR THE YEAR ENDED JUNE 30, 2012. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION, FOR THE YEAR ENDED JUNE 30, 2012 WERE $161,000.IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS, AND FOR SOME SERVICES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED.THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE.VIRGINIA GAY HOSPITAL ALSO MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. THE HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. VIRGINIA GAY HOSPITAL HAD OVER 3,061 EMERGENCY ROOM VISITS THIS YEAR. THE HOSPITAL PROVIDES CLINICAL SERVICES NEEDED TO OPERATE THE EMERGENCY ROOM AND PROVIDES ON-SITE EMERGENCY MEDICAL CARE AND MEDICAL TRANSPORTATION SERVICES THROUGH AN AREA AMBULANCE SERVICE, VAN SERVICE, AND AN ONSITE HELIPAD. | Description |
| Total Program Service Expense | 18974530 | 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 | 1 | 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 | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 19 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 251 | 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 | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | 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 |
| States Where Copy Of Return Is Filed | IA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JULIA MEADOWS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3194726255 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9TH AVENUE | AddressLine1 |
| City | VINTON | City |
| State | IA | State |
| ZIP Code | 52349 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MARK MOSSMAN | |||||||
| CHAIR | 0.50 | X | X | 0 | 0 | 0 | |
| JOHN KETCHEN | |||||||
| VICE CHAIR | 0.50 | X | X | 0 | 0 | 0 | |
| DAVID VERMEDAHL | |||||||
| SECRETARY | 0.50 | X | X | 0 | 0 | 0 | |
| JOHN YUNDT | |||||||
| TREASURER | 0.50 | X | X | 0 | 0 | 0 | |
| JAMES HODGSON | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| DR BRIAN MEEKER DO | |||||||
| DIRECTOR | 0.50 | X | 469593 | 0 | 19059 | ||
| MARIE THERESE FOTH | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| JOHN WATSON | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| DR MARK DEARDEN DO | |||||||
| DIRECTOR | 0.50 | X | 302265 | 0 | 18482 | ||
| MICHAEL RIEGE | |||||||
| CEO | 40.00 | X | 133044 | 0 | 18100 | ||
| JULIA MEADOWS | |||||||
| CFO | 40.00 | X | 92459 | 0 | 2415 | ||
| DR MICHELLE ELGIN DO | |||||||
| PHYSICIAN | 20.00 | 156803 | 0 | 15266 | X | ||
| MICHELE BURNES | |||||||
| PHYSICIAN ASSISTANT | 40.00 | 244388 | 0 | 7153 | X | ||
| RITA TAYLOR-STEWART | |||||||
| PHYSICIAN ASSISTANT | 40.00 | 214755 | 0 | 3024 | X | ||
| DR GENE LARIVIERE MD | |||||||
| SURGEON | 40.00 | 333800 | 0 | 20444 | X | ||
| DR MARGARET MANGOLD MD | |||||||
| PHYSICIAN | 40.00 | 270876 | 0 | 18644 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2217983 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 122587 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NATIONAL THERAPEUTIC ASSOCIATION | |||||
| 11623 ARBOR STREET | OMAHA | NE | 68144 | PT, OT, ST | 887203 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | IL | 36695 | COMPUTER SERVICES | 643118 |
| HEALTH ENTERPRISES | |||||
| 4250 GLASS ROAD | CEDAR RAPIDS | IA | 524022513 | CRNA & ULTRASOUND | 363589 |
| WELAND LAB | |||||
| PO BOX 1924 | CEDAR RAPIDS | IA | 524061924 | LAB SERVICES | 167523 |
| ARAMARK | |||||
| 24863 NETWORK PLACE | CHICAGO | IL | 606731248 | FACILITY ENVIRONMENTAL SERVICES | 154131 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Related Organizations | 340638 | RelatedOrganizations |
| Government Grants | 7405 | GovernmentGrants |
| Total Contributions | 348043 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT & RESIDENT REV | 622110 | 21313195 | 21313195 |
| SUPPORTING REVENUE | 900099 | 418082 | 418082 |
| OUTPATIENT CLINICS | 621400 | 28389 | 28389 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 21759666 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 63231 | TotalRevenueColumn |
| Exclusion | $63,231 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 21642 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 21642 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21642 | TotalRevenueColumn |
| Exclusion | $21,642 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22192582 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21759666 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $84,873 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9857 | Total |
| Program Services | 9857 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1095605 | Total |
| Program Services | 846845 | ProgramServices |
| Management And General | 248760 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9114998 | Total |
| Program Services | 8472308 | ProgramServices |
| Management And General | 614205 | ManagementAndGeneral |
| Fundraising | 28485 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94926 | Total |
| Program Services | 65734 | ProgramServices |
| Management And General | 29192 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 856689 | Total |
| Program Services | 811654 | ProgramServices |
| Management And General | 45035 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 647509 | Total |
| Program Services | 584524 | ProgramServices |
| Management And General | 59761 | ManagementAndGeneral |
| Fundraising | 3224 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69972 | Total |
| Program Services | 30000 | ProgramServices |
| Management And General | 39972 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70540 | Total |
| Management And General | 70540 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3374752 | Total |
| Program Services | 3059550 | ProgramServices |
| Management And General | 313244 | ManagementAndGeneral |
| Fundraising | 1958 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80571 | Total |
| Program Services | 69508 | ProgramServices |
| Fundraising | 11063 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 990709 | Total |
| Program Services | 801922 | ProgramServices |
| Management And General | 177862 | ManagementAndGeneral |
| Fundraising | 10925 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 382116 | Total |
| Program Services | 382116 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73433 | Total |
| Program Services | 59758 | ProgramServices |
| Management And General | 13675 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47334 | Total |
| Program Services | 41433 | ProgramServices |
| Management And General | 5722 | ManagementAndGeneral |
| Fundraising | 179 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 337580 | Total |
| Program Services | 67522 | ProgramServices |
| Management And General | 270058 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1711291 | Total |
| Program Services | 1711291 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 165450 | Total |
| Program Services | 38400 | ProgramServices |
| Management And General | 127050 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 1191414 | 1191414 | |
| PROVISION FOR BAD DEBTS | 677250 | 677250 | |
| GRANT EXPENDITURES | 22529 | 9214 | 13315 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44230 | Total |
| Program Services | 44230 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21058755 | Total |
| Program Services | 18974530 | ProgramServices |
| Management And General | 2028391 | ManagementAndGeneral |
| Fundraising | 55834 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2797948 | BOY |
| EOY | 2193808 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3012522 | BOY |
| EOY | 2884473 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 308103 | BOY |
| EOY | 305757 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50927 | BOY |
| EOY | 55471 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 26182811 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11679151 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15319617 | BOY |
| EOY | 14503660 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2168841 | BOY |
| EOY | 4698377 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7150 | BOY |
| EOY | 4784 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8171 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60733 | BOY |
| EOY | 57107 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23734012 | BOY |
| EOY | 24703437 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1559363 | BOY |
| EOY | 1569197 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 416826 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5382756 | BOY |
| EOY | 5105914 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1819804 | BOY |
| EOY | 1562130 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 430287 | BOY |
| EOY | 426032 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9192210 | BOY |
| EOY | 9080099 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14425142 | BOY |
| EOY | 15506678 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116660 | BOY |
| EOY | 116660 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14541802 | BOY |
| EOY | 15623338 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23734012 | BOY |
| EOY | 24703437 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1133827 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -52291 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1628126 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 14308 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 14471 | GrantsOrScholarships |
| End Of Year Balance | 1627963 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1617150 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 46377 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 35401 | GrantsOrScholarships |
| End Of Year Balance | 1628126 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1617150 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 33261 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 33261 | GrantsOrScholarships |
| End Of Year Balance | 1617150 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1617150 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 13589 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 13589 | GrantsOrScholarships |
| End Of Year Balance | 1617150 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 151876 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 63494 | OtherCostOrOtherBasis |
| Book Value | 215370 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16754105 | OtherCostOrOtherBasis |
| Depreciation | 6347667 | Depreciation |
| Book Value | 10406438 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7982687 | OtherCostOrOtherBasis |
| Depreciation | 4936211 | Depreciation |
| Book Value | 3046476 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1230649 | OtherCostOrOtherBasis |
| Depreciation | 395273 | Depreciation |
| Book Value | 835376 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14503660 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | Description |
| Amount | $426,032 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 426032 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | $1,435,490 ENDOWMENT FUND WITH THE INCOME TO BE USED FOR REPAIRS AND MAINTENANCE AND CAPITAL IMPROVEMENTS. $116,660 ENDOWMENT FUND WHICH CAN BE LOANED TO THE GENERAL FUND FOR OPERATING NEEDS. $75,813 ENDOWMENT FUND WITH THE DISTRIBUTIONS TO BE USED FOR THE BENEFIT OF VIRGINIA GAY HEALTH CARE FOUNDATION. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. |
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 |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| 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 | 161000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 161000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00790 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 187532 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 182612 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4920 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 348532 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 182612 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 165920 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1297 | PersonsServed |
| Total Community Benefit Expense | 51255 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 51255 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 66 | PersonsServed |
| Total Community Benefit Expense | 64100 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 64100 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3908186 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3735884 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 172302 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00850 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1000 | PersonsServed |
| Total Community Benefit Expense | 520 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 520 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2363 | PersonsServed |
| Total Community Benefit Expense | 4024061 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3735884 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 288177 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01410 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2363 | PersonsServed |
| Total Community Benefit Expense | 4372593 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3918496 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 454097 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02220 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $677,250 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5814311 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5730727 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 83584 | 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 | VIRGINIA GAY HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 502 N 9TH AVENUE | AddressLine1 |
| City | VINTON | City |
| State | IA | State |
| ZIP Code | 523492254 | 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 |
| Other | 3 PROVIDER BASED RURAL HEALTH CLINICS | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VIRGINIA GAY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 350.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| VIRGINIA GAY NURSING & REHAB | ||||
| 502 N 9TH AVENUE | VINTON | IA | 52349 | INTERMEDIATE CARE FACILITY |
| VIRGINIA GAY HOSPITAL HOME HEALTH AGENCY | ||||
| 309 1ST AVENUE | VINTON | IA | 52349 | SKILLED NURSING CARE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: DISCOUNT CURRENT YEAR'S FEDERAL FPI FOR FAMILY SIZE100% FAMILY INCOME IS LESS OR EQUAL TO 200% OF FPIG80% FAMILY INCOME IS 201% TO 225% OF FPIG60% FAMILY INCOME IS 226% TO 250% OF FPIG40% FAMILY INCOME IS 251% TO 300% OF FPIG20% FAMILY INCOME IS 301% TO 350% OF FPIG0% FAMILY INCOME IS GREATER THAN 350% OF FPIG | ||
| PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. | ||
| PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO WHICH ADDRESSES ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS, LINES 7E, 7F, AND 7I ARE REPORTED BASED ON COSTS REPORTED IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. | ||
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE BACKED OUT OF TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $677,250. | ||
| PART II: COMMUNITY HEALTH IMPROVEMENT ADVOCACY EXPENSES INCLUDE OUTREACH FOR SENIOR CITIZENS, MEDICAL VOLUNTEER FOR HIGHSCHOOL FOOTBALL SIDELINES, AND BOARD OF HEALTH MEETINGS. THESE PROGRAMS PROMOTE THE HEALTH OF THE COMMUNITY BY PROVIDING ACCESS TO HEALTH CARE SERVICES. | ||
| PART III, LINE 4: PRIOR TO ANY ACCOUNT BEING CLASSIFIED AS BAD DEBT, ALL PAYMENTS ARE APPLIED INCLUDING CONTRACTUAL ALLOWANCES AND DISCOUNTS, AND EVERY EFFORT IS MADE WITH THE PATIENT IN AN ATTEMPT TO COLLECT THE OUTSTANDING BALANCE. PAYMENTS ON ACCOUNTS THAT WERE WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR. VIRGINIA GAY HOSPITAL CONTINUES TO SERVE PATIENTS IN EMERGENCY SITUATIONS EVEN AFTER THE PATIENTS HAVE GENERATED SIGNIFICANT BAD DEBT.VIRGINIA GAY HOSPITAL MONITORS THE LEVEL OF CHARITY CARE IT PROVIDES. VIRGINIA GAY HOSPITAL HAS SEVERAL PROCEDURES IN PLACE TO DETERMINE WHICH PATIENTS WOULD QUALIFY FOR CHARITY EVEN IF THE APPLICATIONS ARE NOT COMPLETED. THEREFORE, THE HOSPITAL FEELS CONFIDENT THAT NO AMOUNT OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOOTNOTE TO FINANCIAL STATEMENTS:THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. MANAGEMENT ALSO REVIEWS ACCOUNTS TO DETERMINE IF CLASSIFICATION AS CHARITY CARE IS APPROPRIATE. | ||
| 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 THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. | ||
| PART III, LINE 9B: FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND WHO QUALIFY FOR 100% DISCOUNT, THERE WILL BE NO COLLECTION EFFORTS. IF A PATIENT QUALIFIES FOR A PARTIAL WRITE-OFF OF THEIR BILL, ANY PERSONAL PORTION DUE THAT IS DELINQUENT WOULD FOLLOW THE SAME COLLECTION PROCEDURES AS OTHER PATIENTS. VIRGINIA GAY HOSPITAL TRIES TO IDENTIFY PATIENTS WHO ARE UNINSURED OR UNDER-INSURED AND PATIENTS WHO MEET THE PRESUMPTIVE ELIGIBILITY CRITERIA. ACCEPTABLE PROGRAMS ARE: THE FOOD STAMP PROGRAM, MOTHERS AND CHILDREN (MAC), IOWA FAMILY PLANNING NETWORK (IFPN), MEDICALLY NEEDY PROGRAM, LIMITED ELIGIBILITY, COUNTY RELIEF PROGRAMS, AND DECEASED PATIENTS WITH NO KNOWN ESTATE. IF A PATIENT QUALIFIES FOR ASSISTANCE AFTER THEIR ACCOUNT HAS ALREADY BEEN SENT TO COLLECTIONS, ALL COLLECTION EFFORTS CEASE IMMEDIATELY AND ALL CREDIT ISSUES ARE REVERSED. IF A PATIENT ENTERS INTO AN EXTENDED PAYMENT PLAN, VIRGINIA GAY HOSPITAL WILL NOT IMPOSE WAGE GARNISHMENTS, OR LIENS ON PRIMARY RESIDENCES, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS, AS LONG AS THE PATIENT COMPLIES WITH THEIR PAYMENT AGREEMENT, OR CONTACTS VIRGINIA GAY HOSPITAL WITH CHANGED FINANCIAL INFORMATION. | ||
| PART V, SECTION B, LINE 13G: A SUMMARY OF THE POLICY AND FINANCIAL ASSISTANCE INFORMATION IS POSTED IN THE EMERGENCY, ADMITTING AND WAITING ROOMS, ADMISSIONS AND BUSINESS OFFICES, INCLUDED WITH PATIENT BILLS AND INFORMATION IS AVAILABLE ON OUR WEBSITE. | VIRGINIA GAY HOSPITAL, INC. | |
| PART VI, LINE 2: EVERY THREE TO FIVE YEARS, VIRGINIA GAY HOSPITAL AND THE BENTON COUNTY PUBLIC HEALTH DIVISION MEET WITH OTHER LOCAL AGENCIES AND BUSINESS LEADERS FOR THEIR OPINIONS ON MEETING THE NEEDS OF OUR COMMUNITY. THE INTENT OF THIS MEETING IS TO ASSESS THE NEEDS OF THE UNDERSERVED AND THE MOST VULNERABLE POPULATIONS THAT WOULD IMPACT THEIR ECONOMIC, SOCIAL AND HEALTH NEEDS. THE MOST RECENT MEETING WAS HELD IN SEPTEMBER OF 2010. DURING THIS ASSESSMENT MEETING, THE ORGANIZATIONS IDENTIFIED FOUR AREAS TO BE FOCUSED ON. THOSE AREAS OF CONCERN ARE EDUCATING TEENS ON SEX AND PROMISCUITY, STD'S, TEEN DRINKING AND THE AREA OF EDUCATING THE CITIZENS OF BENTON COUNTY ON PUBLIC HEALTH ISSUES. AN AREA THAT SHOWED GREAT IMPROVEMENT SINCE THE LAST NEEDS ASSESSMENT WAS IN THE AREA OF IDENTIFYING AND REDUCING THE NUMBER OF PATIENTS WITH COLON CANCER. THE REDUCTION IN COLON CANCER FOR THIS AREA WAS IN PART DUE TO THE AGGRESSIVE PLAN ESTABLISHED THROUGH THE NEEDS ASSESSMENT PROCESS WHEREBY VIRGINIA GAY HOSPITAL INCREASED THE NUMBER OF COLONOSCOPY SCREENINGS.THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE COMPLETED IN THE SPRING OF 2013 TO COMPLY WITH THE 501(R) REQUIREMENTS. | ||
| PART VI, LINE 3: VIRGINIA GAY HOSPITAL IS COMMITTED TO PROVIDING CHARITY CARE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. VIRGINIA GAY HOSPITAL STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. PATIENTS ARE EXPECTED TO COOPERATE WITH VIRGINIA GAY HOSPITAL'S PROCEDURES FOR OBTAINING CHARITY CARE OR OTHER FORMS OF PAYMENT OF FINANCIAL ASSISTANCE, AND TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR INDIVIDUAL ABILITY TO PAY. THE CHARITY CARE POLICY INCLUDES ALL DEPARTMENTS OF THE FACILITY, INCLUDING THE VINTON FAMILY MEDICAL CLINIC, THE URBANA FAMILY MEDICAL CLINIC, THE VAN HORNE FAMILY MEDICAL CLINIC, AND THE NURSING AND REHAB. THE VIRGINIA GAY HOSPITAL HOME HEALTH AGENCY HAS A SEPARATE FINANCIAL ASSISTANCE PROCEDURE, DUE TO THEIR PUBLIC HEALTH ROLE IN THE COMMUNITY.NOTIFICATION ABOUT CHARITY CARE IS AVAILABLE BY THE PUBLICATION OF NOTICES IN PATIENT BILLS, POSTING OF NOTICES IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, THE BUSINESS OFFICE, AND OTHER PUBLIC PLACES THE HOSPITAL MAY ELECT. INFORMATION IS ALSO INCLUDED ON THE FACILITY WEBSITE, AND IN THE PATIENT INFORMATION PACKETS. A REQUEST FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO THE APPLICABLE PRIVACY LAWS. | ||
| PART VI, LINE 4: VIRGINIA GAY HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING AN ESTIMATED POPULATION OF 27,000. VIRGINIA GAY HOSPITAL IS LOCATED IN VINTON, IOWA, THE COUNTY SEAT OF BENTON COUNTY. VINTON HAS A POPULATION OF APPROXIMATELY 5,200 PEOPLE. THE CLOSEST HOSPITALS ARE LOCATED 37 MILES AWAY IN CEDAR RAPIDS, IOWA. VIRGINIA GAY HOSPITAL CURRENTLY OPERATES THREE SEPARATE CLINICS; ONE CLINIC IS LOCATED ON THE HOSPITAL CAMPUS IN VINTON, ANOTHER CLINIC IS LOCATED IN THE RURAL TOWN OF VAN HORNE, IOWA WHICH IS 15 MILES FROM VINTON AND THE OTHER CLINIC IS LOCATED IN THE RURAL COMMUNITY OF URBANA, 13 MILES FROM VINTON. THE HOSPITAL AND CLINICS SERVE A LARGE NUMBER OF MEDICARE AND MEDICAID PATIENTS THAT REPRESENT ADMISSIONS AND REGISTRATIONS OF 67% AND 20% RESPECTIVELY. THE MEDIAN HOUSEHOLD INCOME IN 2010 WAS $55,810 AND 6.8% OF THE POPULATION WAS BELOW THE POVERTY LEVEL. MANUFACTURING IS THE LARGEST INDUSTRY IN THE AREA AND THE RECESSION HAS HAD A HEAVY IMPACT ON VINTON AND BENTON COUNTY AND UNEMPLOYMENT RATES ARE UP AS A RESULT. | ||
| PART VI, LINE 5: VIRGINIA GAY HOSPITAL IS PROUDLY RECOGNIZED AS HAVING ONE OF THE LOWEST COSTS PER STAY RATES IN THE STATE OF IOWA. THE HOSPITAL OFFERS TWENTY-FIVE BEDS IN AN ACUTE CARE SETTING WITH STATE OF THE ART TECHNOLOGY AND PROFESSIONAL SERVICES. VIRGINIA GAY HOSPITAL ALSO OFFERS 24 HOUR ACUTE CARE, SHORT TERM SKILLED NURSING SERVICES, RADIOLOGY, RESPIRATORY CARE, CARDIO-PULMONARY REHABILITATION, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, LABORATORY SERVICES, SURGICAL SERVICES, OUTPATIENT CLINICS AND EMERGENCY CARE. IN ADDITION, OUR STAFF HAS CONTRIBUTED MULTIPLE HOURS PROVIDING UNCOMPENSATED TIME IN AREAS SUCH AS FAMILY/PARENTING/SIBLING EDUCATION, MEDICAL EXPERTISE FOR THE SCHOOLS ATHLETIC TEAMS, HEALTH FAIRS, INFORMATION AND REFERRALS TO COMMUNITY SERVICES, SAFETY CLASSES, SPORTS PHYSICALS AND MANY OTHER UNCOMPENSATED SERVICES. REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO THE HOSPITAL'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLY, VIRGINIA GAY HOSPITAL IS GOVERNED BY AN INDEPENDENT BOARD INCLUDING COMMUNITY LEADERS, PHYSICIANS, CONSUMER REPRESENTATIVES, BUSINESS EXPERTS AND CLINICAL HEALTHCARE EXPERTS WHO RESIDE IN OUR PRIMARY SERVICE AREA. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO VOLUNTARILY ADOPT GOVERNANCE BEST PRACTICES TO ENSURE THE ORGANIZATION CONTINUES TO OPERATE WITH THE HIGHEST OF INTEGRITY FOR THE BENEFIT OF THE COMMUNITY. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOSPITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED THROUGH LICENSURE IN THE STATE OF IOWA. EXCESS FUNDS ARE REINVESTED AND USED FOR PATIENT CARE AND FACILITY UPGRADES.VIRGINIA GAY'S HOME HEALTH AGENCY OFFERS A VARIETY OF SERVICES TO THE AGING RURAL POPULATION OF BENTON COUNTY. THE HOSPITAL ALSO OFFERS SUCH SERVICES AS SKILLED SERVICE HOME CARE, IMMUNIZATION CLINICS, WELL CHILD AND GROUP TEACHING CLASSES SUCH AS CARDIOPULMONARY RESUSCITATION (CPR), ADVANCED LIFE SUPPORT (ALS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS). IN ADDITION, VIRGINIA GAY HOSPITAL, THROUGH ITS INTEGRATED NETWORK OF PROVIDERS, PROVIDES NON-EMERGENCY SERVICES TO THE COMMUNITY IT SERVES. IT MAKES THESE SERVICES ACCESSIBLE TO THE COMMUNITY THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS LIKE MEDICARE AND MEDICAID AND BY OFFERING ASSISTANCE THROUGH THEIR FINANCIAL ASSISTANCE PROGRAM. VIRGINIA GAY HOSPITAL'S FINANCIAL ASSISTANCE POLICY PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTH CARE THEY RECEIVE. THE FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ENSURE THE ENTIRE COMMUNITY SERVED BY THE HOSPITAL HAS ACCESS TO NEEDED HEALTHCARE SERVICES. VIRGINIA GAY HOSPITAL TAKES ITS MISSION TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE COMMUNITY. IT STRIVES TO IDENTIFY COMMUNITY NEEDS BEYOND BASIC HEALTHCARE, RESPOND TO THEM, AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE COMMUNITY. CONTRIBUTING TO COMMUNITY EDUCATION: THE NURSING STAFF AND HOME HEALTH AGENCY NURSES PARTICIPATE IN COUNTY WIDE COMMUNITY HEALTH FAIRS. THESE EVENTS PROVIDE INFORMATION AND GUIDELINES TO THOSE IN NEED OF MEDICAL INFORMATION.PREVENTIVE CARE A PRIORITY: THE HOSPITAL HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE FOR PEOPLE OF ALL AGES BY ENSURING THAT THOSE WHO COME HERE FOR PREVENTIVE CARE RECEIVE THE SCREENINGS AND RECOMMENDATIONS APPROPRIATE TO THEIR PERSONAL AND FAMILY HISTORY. | ||
| IA | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| ACADEMIC SUPPORT TO NURSING STUDENTS | 5 | 5000 |
| STUDENT LOAN REPAYMENT | 2 | 4857 |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: INTERESTED HIGH SCHOOL SENIORS ENTERING THE FIELD OF HEALTH CARE MUST COMPLETE AN APPLICATION. A COMMITTEE OF THE HOSPITAL BOARD REVIEWS THE APPLICATIONS, SELECTS THE RECIPIENTS, AND FORWARDS THE APPLICATIONS TO THE FULL BOARD FOR REVIEW. THE SCHOLARSHIP MONEY IS GIVEN TO DOLLARS FOR SCHOLARS AND THEY HANDLE THE DISTRIBUTION OF FUNDS. DOLLARS FOR SCHOLARS IS A NON-PROFIT ORGANIZATION ESTABLISHED TO HELP STUDENTS GOING INTO THE HEALTH CARE FIELD WITH ACADEMIC EXPENSES. THE ORGANIZATION MATCHES THE FUNDS THEY RECEIVE TO DISTRIBUTE TO STUDENTS. |
| SCHEDULE I, PART III: | THE NUMBER OF RECIPIENTS IS THE ACTUAL NUMBER OF STUDENTS RECEIVING A SCHOLARSHIP OR STUDENT LOAN REPAYMENT ASSISTANCE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR BRIAN MEEKER DO | |||||||||||||
| 274358 | 0 | 195235 | 0 | 0 | 0 | 4653 | 0 | 14406 | 0 | 488652 | 0 | 0 | 0 |
| DR MARK DEARDEN DO | |||||||||||||
| 180171 | 0 | 122094 | 0 | 0 | 0 | 2752 | 0 | 15730 | 0 | 320747 | 0 | 0 | 0 |
| MICHAEL RIEGE | |||||||||||||
| 133044 | 0 | 0 | 0 | 0 | 0 | 12876 | 0 | 5224 | 0 | 151144 | 0 | 0 | 0 |
| DR MICHELLE ELGIN DO | |||||||||||||
| 116987 | 0 | 39816 | 0 | 0 | 0 | 1345 | 0 | 13921 | 0 | 172069 | 0 | 0 | 0 |
| MICHELE BURNES | |||||||||||||
| 89640 | 0 | 154748 | 0 | 0 | 0 | 1662 | 0 | 5491 | 0 | 251541 | 0 | 0 | 0 |
| RITA TAYLOR-STEWART | |||||||||||||
| 78638 | 0 | 136117 | 0 | 0 | 0 | 1662 | 0 | 1362 | 0 | 217779 | 0 | 0 | 0 |
| DR GENE LARIVIERE MD | |||||||||||||
| 333800 | 0 | 0 | 0 | 0 | 0 | 5439 | 0 | 15005 | 0 | 354244 | 0 | 0 | 0 |
| DR MARGARET MANGOLD MD | |||||||||||||
| 167821 | 0 | 103055 | 0 | 0 | 0 | 1839 | 0 | 16805 | 0 | 289520 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF VINTON IOWA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 426005303 | IssuerEIN |
| Date Issued | 2008-02-28 | DateIssued |
| Issue Price | 6800000 | IssuePrice |
| Description Of Purpose | NEW PATIENT UNIT, EMERGENCY, PHYSICAL/OCCUPATIONAL THERAPY, & IMAGING DEPT | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 1694086 | AmountRetired |
| Total Proceeds | 6800000 | TotalProceeds |
| Other Spent Proceeds | 6800000 | OtherSpentProceeds |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | DIGITAL MAMMOGRAPHY WAS ADDED IN FEBRUARY 2012. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE GOVERNING BOARD, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE GOVERNING BOARD AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE GOVERNING BOARD. THE EXECUTIVE COMMITTEE MUST SUBMIT TO THE GOVERNING BOARD AT ITS LAST MEETING BEFORE THE END OF THE FISCAL YEAR, A BUDGET SHOWING THE EXPECTED RECEIPTS, INCOME, AND EXPENSE FOR THE COMING YEAR. MINUTES OF THE EXECUTIVE COMMITTEE MEETINGS MUST BE SUBMITTED TO THE BOARD, AND ITS ACTIONS ARE SUBJECT TO APPROVAL OR DISAPPROVAL AT THE NEXT REGULAR BOARD MEETING. | |
| FORM 990, PART VI, SECTION A, LINE 2 | JOHN KETCHEN, VICE CHAIR OF THE BOARD, AND MARK MOSSMAN, CHAIR OF THE BOARD, HAVE A BUSINESS RELATIONSHIP. MARK MOSSMAN, DAVID VERMEDAHL, JOHN KETCHEN, ALL BOARD MEMBERS, MICHAEL RIEGE, CEO, AND JULIA MEADOWS, CFO, HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 7A | ONE OF THE DIRECTORS OF THE BOARD IS THE MAYOR OF THE CITY OF VINTON, IOWA. TWO DIRECTORS ARE APPOINTED BY THE MAYOR AND APPROVED BY THE CITY COUNCIL OF THE CITY OF VINTON FOR SUCH TERMS AS THE CITY COUNCIL DETERMINES. ONE OF THESE APPOINTMENTS IS A PHYSICIAN IN ACTIVE PRACTICE AND A RESIDENT OF BENTON COUNTY, IOWA. THE SECOND DIRECTOR APPOINTED BY THE CITY OF VINTON IS A RESIDENT OF BENTON COUNTY, IOWA. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS DISTRIBUTED TO THE BOARD MEMBERS PRIOR TO FILING. THE 990 IS REVIEWED BY THE HOSPITAL'S CEO AND CFO. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DIRECTOR, OFFICER, KEY EMPLOYEE, MEDICAL STAFF MEMBER OR COMMITTEE MEMBER HAVING AN EXISTING OR POTENTIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS FOR DELIBERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION, OR ANY SUCH PERSON WHO REASONABLY BELIEVES SUCH AN INTEREST EXISTS IN ANOTHER PERSON SHOULD MAKE A PROMPT DISCLOSURE OF THE INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. THE INTERESTED PARTY IS REQUIRED TO DISCLOSE THE NATURE AND EXTENT OF HIS/HER INTEREST AND ANY RELEVANT AND MATERIAL FACTS KNOWN TO HIM/HER ABOUT THE CONTRACT OR TRANSACTION WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE TO THE ORGANIZATION'S INTEREST. THE BOARD REQUIRES ANNUAL STATEMENTS FROM OFFICERS, DIRECTORS, KEY EMPLOYEES, AND KEY MEMBERS OF THE MEDICAL STAFF. THE BODY TO WHICH SUCH DISCLOSURE IS MADE DETERMINES, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT THE NON-VOTING AND NON-PARTICIPATION PROVISIONS BELOW MUST BE OBSERVED. IF SO, SUCH PERSONS SHOULD NOT VOTE ON, NOR USE HIS/HER PERSONAL INFLUENCE ON, NOR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION OR TO RESPOND TO QUESTIONS) IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTION. SUCH PERSONS MAY NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT OR TRANSACTION IS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING REFLECT THE DISCLOSURE MADE AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION AND WHETHER A QUORUM WAS PRESENT. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD WAGE & SALARY COMMITTEE AND FULL BOARD REVIEWS COMPENSATION INCREASES FOR THE CEO BASED ON ANNUAL EVALUATIONS AND THE IHA SALARY SURVEY. COMPARISONS TO STATE AVERAGES ARE USED. SUBSTANTIATION OF THE DELIBERATION AND DECISION IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS IS COMPLETED ANNUALLY AND WAS LAST COMPLETED IN MAY 2012. THE CEO DETERMINES COMPENSATION FOR THE CFO AND KEY EMPLOYEES, WITH APPROVAL FROM THE BOARD WAGE & SALARY COMMITTEE AND FULL BOARD, BASED ON ANNUAL PERFORMANCE EVALUATIONS AND THE IHA SALARY SURVEY. CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION IS PROVIDED FOR ANY ACTIONS TAKEN REGARDING COMPENSATION. THE PROCESS IS COMPLETED ANNUALLY AND WAS LAST COMPLETED IN MAY 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FINANCIAL INFORMATION IS AVAILABLE THROUGH THE PUBLIC DISCLOSURE COPY OF THE 990. | |
| FORM 990, PAGE 7, PART VII: | THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO RELATED ORGANIZATIONS. VIRGINIA GAY HEALTH CARE FOUNDATION DR. MICHELLE ELGIN <1 HOUR PER WEEK DR. MARK DEARDEN, DO <1 HOUR PER WEEK JAMES HODGSON <1 HOUR PER WEEK MICHAEL RIEGE 2 HOURS PER WEEK JULIA MEADOWS 2 HOURS PER WEEK VIRGINIA GAY TRUST MARK MOSSMAN <1 HOUR PER WEEK DAVID VERMEDAHL <1 HOUR PER WEEK JOHN KETCHEN <1 HOUR PER WEEK JOHN WATSON <1 HOUR PER WEEK JAMES HODGSON <1 HOUR PER WEEK DR. MARK DEARDEN, DO <1 HOUR PER WEEK MARIE THERESE FOTH <1 HOUR PER WEEK MICHAEL RIEGE 1 HOUR PER WEEK JULIA MEADOWS 1 HOUR PER WEEK CEDAR VIEW, INC. MARK MOSSMAN <1 HOUR PER WEEK JOHN KETCHEN <1 HOUR PER WEEK DAVID VERMEDAHL <1 HOUR PER WEEK JOHN YUNDT <1 HOUR PER WEEK MICHAEL RIEGE 1 HOUR PER WEEK JULIA MEADOWS 1 HOUR PER WEEK | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -52,291. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| VIRGINIA GAY TRUST | |||||||||||
| 502 N 9TH AVENUE | VINTON | IA | 52349 | 426367590 | PROVIDE FINANCIAL SUPPORT FOR VIRGINIA GAY HOSPITAL, INC. | IA | 501(C)(3) | LINE 11B, II | VIRGINIA GAY HOSPITAL INC | 1 | |
| VIRGINIA GAY HOSPITAL HEALTH CARE FOUNDATION | |||||||||||
| 502 N 9TH AVENUE | VINTON | IA | 52349 | 421391891 | DEVELOP & EXTEND FACILITIES & SERVICES OF VIRGINIA GAY HOSPITAL INC. | IA | 501(C)(3) | LINE 7 | 0 | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| VERNON S FLECHNER TRUST | |||||||||||
| 502 N 9TH AVENUE | VINTON | IA | 52349 | 426351376 | PROVIDE INCOME FOR MAINT OF THE HOSPITAL AND ANNEX BUILDINGS | IA | VIRGINIA GAY HOSPITAL INC | T | 99002 | 1430465 | 1.00000 |
| JW FRY TRUST | |||||||||||
| 502 N 9TH AVENUE | VINTON | IA | 52349 | 426287710 | PROVIDE UNRESTRICTED AND CORPUS RESTRICTED INCOME FOR HOSPITAL ADDITIONS | IA | VIRGINIA GAY HOSPITAL INC | T | 122894 | 1358965 | 1.00000 |
| CEDAR VIEW INC | |||||||||||
| 502 N 9TH AVENUE | VINTON | IA | 52349 | 421398570 | PROVIDE AN 18-UNIT HOUSING ALTERNATIVE FOR THE ELDERLY | IA | VIRGINIA GAY HOSPITAL INC | C | 284189 | 1202113 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON S FLECHNER TRUST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 105000 | AmountInvolved |
| Method Of Amt Determination | GENERAL LEDGER | MethodOfAmtDetermination |