CENTRAL COMMUNITY HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL COMMUNITY HOSPITAL (EIN 42-0818642)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-01-28
- IRS object ID
- 201130289349300808
- Schema version
- 2009v1.7
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-01-28T13:23:56-06:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2009-07-01 | 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 | Frances Zichal | Name |
| Title | CEO | Title |
| Phone | 5632457000 | Phone |
| Date Signed | 2011-01-25 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| Phone | 5635561790 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Frances Zichal | 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 | 5898901 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| 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 | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 83 | TotalNbrEmployees |
| Total Nbr Volunteers | 12 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 325576 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 113245 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 5898256 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5722442 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 8463 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2317 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 42875 | OtherRevenuePriorYear |
| Other Revenue Current Year | 38493 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6275170 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5876497 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 7651 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2565936 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2439950 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3207690 | OtherExpensePriorYear |
| Other Expenses Current Year | 3239535 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 5773626 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5687136 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 501544 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 189361 | RevenuesLessExpensesCY |
| Total Assets BOY | 6034279 | TotalAssetsBOY |
| Total Assets EOY | 6468661 | TotalAssetsEOY |
| Total Liabilities BOY | 1096350 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1338736 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4937929 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5129925 | NetAssetsOrFundBalancesEOY |
| Mission Description | Working together to provide a personalized, healing experience | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4572340 | Expense |
| Grants | 7651 | Grants |
| Revenue | 5722442 | 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 1300 emergency visits this year. 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 1,291 days of inpatient care and 14,204 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's Charity Care Program provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The Charity Care Policy is designed to ensure the entire community served by Central Community Hospital has access to needed healthcare services. Eligibility is based on income levels and family size. Generally, individuals earning income of up to 200% of the Federal Policy Income Guidelines are eligible for varying levels of discounts, including full discounts. Applications for the Charity Care Program are available from Financial Services or by calling (563) 245-7000.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 four years and updated annually by a county wide multi-disciplinary team and used to prioritize community projects. Financial Summary: Charity Care (at cost) $ 98,000 Bad Debt (at cost) 104,000 Community Benefit Programs: Community Health Improvement Services 12,605 Financial and in-kind contributions 7,651 Community Building Activities 3,818 Subsidized Health Services 107,551 Total Community Benefits $ 333,625 | Description |
| Total Program Service Expense | 4572340 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | 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 | 1 | 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 | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 22 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 83 | 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 |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | 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 |
| 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 | Lisa Manson | 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 (10 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 |
| Mark Zwanziger | ||||||
| Vice President | 0.50 | X | X | 0 | 0 | 0 |
| Tom Neuhaus | ||||||
| Treasurer | 0.50 | X | X | 0 | 0 | 0 |
| Randall Johnson | ||||||
| Secretary | 0.50 | X | X | 0 | 0 | 0 |
| Diane Erickson | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| Hila Garms | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| Darwin Winke | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| Russell Knight | ||||||
| Member | 0.50 | X | 0 | 0 | 0 | |
| Frances Zichal | ||||||
| CEO | 40.00 | X | 118464 | 0 | 7878 | |
| Lisa Manson | ||||||
| CFO | 40.00 | X | 83851 | 0 | 13452 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 202315 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 21330 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Mercy Medical Center - Dubuque | |||||
| 250 Mercy Drive | Dubuque | IA | 52001 | Purchased Services | 614969 |
| Wapiti | |||||
| Box 92 | Newell | SD | 57760 | ER Physicians | 281320 |
| Northern Iowa Therapy | |||||
| 1810 4th St SW Suite 103 | Waverly | IA | 50677 | PT, OT, ST | 269672 |
| Dick Beinborn CRNA | |||||
| 62598 Bluffs of Wildernest | Prairie Du Chien | WI | 53821 | Anesthesia | 101060 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Related Organizations | 10051 | RelatedOrganizations |
| Government Grants | 80764 | GovernmentGrants |
| All Other Contributions | 22430 | AllOtherContributions |
| Total Contributions | 113245 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenu | 622110 | 5647474 | 5647474 |
| Other Supporting Reven | 900099 | 41761 | 41761 |
| Lifeline Revenue | 900099 | 33207 | 33207 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5722442 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9785 | TotalRevenueColumn |
| Exclusion | $9,785 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 53429 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14936 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 38493 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 38493 | TotalRevenueColumn |
| Exclusion | $38,493 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 7468 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -7468 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -7468 | TotalRevenueColumn |
| Exclusion | -$7,468 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5876497 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5722442 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $40,810 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7651 | Total |
| Program Services | 7651 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 218356 | Total |
| Management And General | 218356 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37489 | Total |
| Program Services | 37489 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1703248 | Total |
| Program Services | 1466442 | ProgramServices |
| Management And General | 236806 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41727 | Total |
| Program Services | 35902 | ProgramServices |
| Management And General | 5825 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 308570 | Total |
| Program Services | 284339 | ProgramServices |
| Management And General | 24231 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130560 | Total |
| Program Services | 112444 | ProgramServices |
| Management And General | 18116 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49247 | Total |
| Management And General | 49247 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30061 | Total |
| Management And General | 30061 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1475796 | Total |
| Program Services | 1368419 | ProgramServices |
| Management And General | 107377 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1552 | Total |
| Management And General | 1552 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 515204 | Total |
| Program Services | 399917 | ProgramServices |
| Management And General | 115287 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 151987 | Total |
| Management And General | 151987 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180534 | Total |
| Program Services | 109700 | ProgramServices |
| Management And General | 70834 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27488 | Total |
| Program Services | 27488 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 530011 | Total |
| Program Services | 530011 | ProgramServices |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt Expense | 148341 | 148341 | |
| Miscellaneous Expense | 129314 | 44197 | 85117 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5687136 | Total |
| Program Services | 4572340 | ProgramServices |
| Management And General | 1114796 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1431150 | BOY |
| EOY | 1379378 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15124 | BOY |
| EOY | 38091 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 750580 | BOY |
| EOY | 678978 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71581 | BOY |
| EOY | 79287 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94658 | BOY |
| EOY | 116444 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7860701 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4358083 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3439206 | BOY |
| EOY | 3502618 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27901 | BOY |
| EOY | 529284 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 204079 | BOY |
| EOY | 144581 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6034279 | BOY |
| EOY | 6468661 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 454704 | BOY |
| EOY | 433380 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 415267 | BOY |
| EOY | 360592 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 226379 | BOY |
| EOY | 544764 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1096350 | BOY |
| EOY | 1338736 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4784071 | BOY |
| EOY | 4948503 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153858 | BOY |
| EOY | 181422 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4937929 | BOY |
| EOY | 5129925 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6034279 | BOY |
| EOY | 6468661 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 11536 | BeginningBalance |
| Additions During Year | 9052 | AdditionsDuringYear |
| Distributions During Year | 9989 | DistributionsDuringYear |
| Ending Balance | 10599 | EndingBalance |
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 | 3918621 | OtherCostOrOtherBasis |
| Depreciation | 1526816 | Depreciation |
| Book Value | 2391805 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3916065 | OtherCostOrOtherBasis |
| Depreciation | 2831267 | Depreciation |
| Book Value | 1084798 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3502618 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Accounts payable - Mercy Medical Center-Dubuque | $50,284 |
| Capitalized lease obligations | $83,480 |
| Estimated third-party payor settlements | $411,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 544764 | TotalOfAmounts |
| Total Revenue | 5876497 | TotalRevenue |
| Total Expenses | 5687136 | TotalExpenses |
| Excess Or Deficit For Year | 189361 | ExcessOrDeficitForYear |
| Other | $2,635 | OtherAmount |
| Total Adjustments | 2635 | TotalAdjustments |
| Excess Or Deficit Per FS | 191996 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 5809157 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -50284 | OtherRevenues |
| Revenue Not Rptd F990 | -50284 | RevenueNotRptdF990 |
| Revenue Subtotal | 5859441 | RevenueSubtotal |
| Other Revenues Not Included | 17056 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 17056 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 5876497 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5641799 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 14936 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 14936 | ExpensesNotRptdF990 |
| Expenses Subtotal | 5626863 | ExpensesSubtotal |
| Other Expenses Not Included | 60273 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 60273 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5687136 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Part IV, Line 1b: | Central Community Hospital Auxiliary uses the Hospital's FEIN but has its own checking account. The Auxiliary accounts balances were not included in the financial statements. | |
| Part X: | The Hospital has adopted the provisions of FASB Accounting Standards Codification Topic ASC 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes) on July 1, 2009. The implementation of this standard had no impact on the financial statements. Due to the nature of the Hospital, as of both the date of adoption, and as of June 30, 2010, there is no unrecognized tax benefit/liability accrual. If incurred, the Hospital will recognize future accrued interest and penalties related to the unrecognized tax liabilities in income tax expense. The Hospital is no longer subject to Federal or state tax examinations by tax authorities for years before 2006. | Description of Uncertain Tax Positions Under FIN 48: |
| Part XI, Line 8 - Other Adjustments: | Change in interest in net assets of Central Community Hospital Foundation: 18624. Auxiliary beginning of year cash balance reclassified to custodial account: -16926. Change in Central Community Hospital Auxiliary assets: 937. | |
| Part XII, Line 2d - Other Adjustments: | Affiliation agreement expense included in revenue for financial statements: -50284. | |
| Part XII, Line 4b - Other Adjustments: | Contributions recorded in fund balance for financial statements: 14000. Monona Clinic rent expenses included in revenue on Form 990: -14936. Restricted donations recorded in fund balance for financial statements: 8940. Central Community Hospital Auxiliary revenue included on Form 990: 9052. | |
| Part XIII, Line 2d - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990: 14936. | |
| Part XIII, Line 4b - Other Adjustments: | Affiliation agreement expense included in revenue for financial statements: 50284. Central Community Hospital Auxiliary expenses included on Form 990: 9989. |
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 | 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) |
|---|---|---|
| Persons Served | 176 | PersonsServed |
| Total Community Benefit Expense | 98000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 98000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01780 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 136301 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 136301 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 176 | PersonsServed |
| Total Community Benefit Expense | 234301 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 136301 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 98000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01780 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2283 | PersonsServed |
| Total Community Benefit Expense | 12605 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12605 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 500315 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 392764 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 107551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 260 | PersonsServed |
| Total Community Benefit Expense | 7651 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7651 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2543 | PersonsServed |
| Total Community Benefit Expense | 520571 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 392764 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 127807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02330 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2719 | PersonsServed |
| Total Community Benefit Expense | 754872 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 529065 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 225807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04110 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 154 | PersonsServed |
| Total Community Building Expense | 2108 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2108 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 89 | PersonsServed |
| Total Community Building Expense | 1574 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1574 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 136 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 136 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 243 | PersonsServed |
| Total Community Building Expense | 3818 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3818 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $104,000 | BadDebtExpenseAmount |
| Amount Attributable To | 1966 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3093655 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3143464 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -49809 | 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 |
Form990 Schedule H Part V Form990ScheduleHPartV
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 VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services and cash and in-kind contributions to community groups, lines 7e and 7i, are 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.Total community benefit expense as a percentage of total expenses is 13.27%. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: The organization did not include as subsidized health services any costs attributable to a physician clinic. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: The amount of bad debt expense backed out of total expenses to determine the percentage was $148,341. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: The organization's bad debt expense was converted to cost using the cost to charge ratio derived from Worksheet 2.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 an estimate of charity care to gross charges.Financial Statement footnote: The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected fromthird parties under contractual agreements and amounts that will not be collected from patients 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. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: Central Community Hospital provides services to Medicare patients understanding there will be write-offs and knowing the organization will not recover the costs of the services provided. Providing these services is essential to the community and therefore increases access to healthcare services, which is a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. The costing methodology used is the cost accounting system. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: 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 there is no payment on an account after 30 days the account is sent to HR Pre-Collect. The patient will have 30 days to correct this before being sent to regular collections. Before an account is turned over to the collection agency, approval must be obtained from the Financial Services Manager. Legal suits may be instructed by the collection agency in accordance with standard collection practices and good business ethics. Once a bankruptcy notice has been received, 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. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Central Community Hospital meets quarterly with all health care providers in Clayton County to prepare a county-wide health needs assessment, creative plan of action, and monitor implementation. This document is reviewed annually and rewritten every three years. The needs assessment is utilized by all Clayton County providers to plan community programs and look for opportunities to offer programs focused on the county-wide needs. | NeedsAssessment |
| Patient Education Assistance | 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 frequent articles about the service in our newsletter. Our financial counselor will also assist with enrollment in external programs. | PatientEducationAssistance |
| Community Information | 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 approx. 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. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: 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, trying to promote good health habits at an early age. Central Community Hospital is also involved in public health emergency readiness, 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. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: 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. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: 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. | AffiliatedHealthCareSystem |
| Reports Filed With States | IA | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Central Community Hospital provides cash donations and in-kind contributions to local organizations in need of medical supplies. The Hospital maintains records of who receives the support. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Frances Zichal | |||||||||||||
| 117576 | 0 | 0 | 0 | 888 | 0 | 4297 | 0 | 3581 | 0 | 126342 | 0 | 0 | 0 |
| Lisa Manson | |||||||||||||
| 83630 | 0 | 0 | 0 | 221 | 0 | 3279 | 0 | 10173 | 0 | 97303 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Supplemental Information | Part III | Part I, Question 3: Central Community Hospital does not pay compensation to the CEO and CFO directly. The CEO and CFO are compensated by an unrelated mangagement company. The Hospital board of directors uses the processes described in Part I, Question 3 to help determine appropriate compensation for the CEO and CFO. The board of directors also approves the organization's contract with the Management Company. |
| Supplemental Information | Part III | Part II: Frances Zichal, CEO, and Lisa Manson, CFO are compensated by Mercy Medical Center - Dubuque, an unrelated management company, for services provided to Central Community Hospital. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Haleisa Johnson | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Wife of board member of organization | Relationship |
| Amount Of Transaction | 37489 | AmountOfTransaction |
| Description Of Transaction | Salary and benefits as an employee | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part III, line 2 | New Program Services | Reclast Clinic was offered for patients to receive an osteoporosis drug and education. Service began in May, 2010. |
| Form 990, Part VI, Section A, line 3 | The CEO and CFO of Central Community Hospital are employed by Mercy Medical Center - Dubuque. Central Community Hospital has a Master Affiliation Agreement with Mercy Medical Center - Dubuque. Daily management is the responsibility of Mercy Medical Center - Dubuque through delegation of duties to the CEO and CFO. 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 are 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 | A copy of the Form 990 is e-mailed to all board members and presented by the accounting firm at the annual board meeting. The CEO and CFO review and approve the 990 before it is filed. | |
| 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 is based on salary adjustment recommendations based on annual evaluations, wage scales, committee approval (Board Chair and Mercy Medical Center - Dubuque 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 and CFO. The process was last undertaken in fiscal year 2010. | |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest policy, and financial statements are available upon written request. | |
| Form 990, Part VI, Section A, Line 1a: The Executive committee consists of the officers of the board. The President of the board chairs the Committee. The Committee has and may exercise the power and authority of the Board when necessary or advisable between the 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 at such meeting; provided however, that the rights of third parties are not affected by any such revision or alteration. | ||
| Form 990, Part VII, Section A | The following individual devoted time providing services to Central Community Hospital Foundation, a related organization. Frances Zichal 1 hour |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1 |
| City | Elkader | City |
| State | IA | State |
| ZIP Code | 52043 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421239401 | EIN |
| Primary Activities | To support Central Community Hospital and health education | PrimaryActivities |
| Legal Domicile State | IA | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 7 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| 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 |
Comments