2024-05-15T13:39:45-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 420859940 BURGESS HEALTH CENTER BURG 7124232311 1600 DIAMOND STREET ONAWA IA 51040 LYNN WOLD PRESIDENT/CEO 7124232311 2024-05-15 1 LYNN WOLD 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-05-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z LYNN WOLD 1600 DIAMOND STREET ONAWA IA 51040 38157447 0 X WWW.BURGESSHC.ORG X 1959 IA TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY 11 9 331 10 1688523 0 836856 1976616 31528831 30801308 1557177 878770 225599 255371 34148463 33912065 17979 0 0 0 18961696 20177252 0 0 0 16303170 15481513 35282845 35658765 -1134382 -1746700 54579039 63607419 16443738 24627480 38135301 38979939 X BURGESS HEALTH CENTER IS COMMITTED TO IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES IT SERVES BY PROVIDING EXCELLENT HEALTHCARE AND EXCEPTIONAL PATIENT EXPERIENCES. 0 0 27231414 24812681 BURGESS HEALTH CENTER INCLUDES A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. OUR PHYSICIANS AND STAFF ARE COMMITTED TO PROVIDING PATIENTS WITH COMPASSIONATE, KNOWLEDGEABLE AND TRUSTWORTHY CARE. WE PROVIDE THE FOLLOWING SERVICES: CANCER CARE AND INFUSION, CARDIAC REHABILITATION, DIABETES CENTER, EMERGENCY SERVICES, HOME HEALTH, HOSPICE, PRIVATE DUTY AND LIFE ASSIST CARE, ON-SITE LABORATORY, MENTAL HEALTH, SURGERY, FAMILY BEGINNINGS, ORTHOPEDICS, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, PULMONARY REHAB, RADIOLOGY, SCREENINGS, AND VARIOUS OUTPATIENT SPECIALTY CLINICS. 3631503 3282025 BURGESS HEALTH CENTER INCLUDES FIVE RURAL HEALTH CLINICS IN A FOUR COUNTY SERVICE AREA. CLINICS ARE LOCATED IN SLOAN, WHITING, AND MAPLETON, IOWA; WHICH ARE STAFFED BY DEDICATED PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS TO PROVIDE A COMPLETE SPECTRUM OF HEALTHCARE SERVICES FOR THE WHOLE FAMILY. 1532293 1174163 BURGESS HEALTH CENTER INCLUDES HOME HEALTH SERVICES. STAFF ARE DEDICATED TO ADD COMFORT TO PATIENTS' RECOVERY, EASE THE IMPACT ON FRIENDS AND FAMILY, AND HELP PATIENTS' TRANSITION TO LIFESTYLE ADJUSTMENTS NECESSARY FOR THE ILLNESS. SERVICES INCLUDE I.V. MEDICATIONS, NOURISHMENT, WOUND CARE, HYGIENE AND DAILY LIVING ASSISTANCE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES, SUPPORT THROUGH SOCIAL WORKERS, SKILLED NURSING VISITS, AND HOMEMAKER SERVICES.BURGESS HOSPICE STAFF PROVIDE PROFESSIONAL GRIEF COUNSELORS AND SKILLED VOLUNTEERS TO PATIENTS (TYPICALLY WITH A LIFE-LIMITING ILLNESS WITH A SHORT-TERM SURVIVAL ESTIMATE). ENSURING THE PATIENT IS AS COMFORTABLE AND PAIN-FREE AS POSSIBLE. THEY, ALSO, HELP FAMILY MEMBERS COPE WITH END OF LIFE ISSUES. 32395210 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 62 0 1 331 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X LYNN WOLD 7124239206 1600 DIAMOND STREET ONAWA IA 51040 JOHN GARRED JR MD BOARD MEMBER 40.00 0.00 X 376344 0 10270 PAUL DUDLEY MD BOARD MEMBER 2.00 0.00 X 19025 0 0 KEITH SCHRUNK OD CHAIRMAN 2.00 0.00 X X 0 0 0 MARI MILLER VICE CHAIRMAN 2.00 0.00 X X 0 0 0 STEVE PRATT SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 SHEILA DUARTE DDS BOARD MEMBER 2.00 0.00 X 0 0 0 TERRY MURRELL BOARD MEMBER 2.00 0.00 X 0 0 0 AMY MAULE BOARD MEMBER 2.00 0.00 X 0 0 0 BRENT MCCALL BOARD MEMBER 2.00 0.00 X 0 0 0 MATTHEW MINNIHAN BOARD MEMBER 2.00 0.00 X 0 0 0 ANDY TIREVOLD BOARD MEMBER 2.00 0.00 X 0 0 0 MARY BLACK BOARD MEMBER THRU 11/2022 2.00 0.00 X 0 0 0 CARL BEHNE CEO THRU 6/2023 39.00 1.00 X 275793 0 21164 JOHN WILKER VICE PRESIDENT OF FINANCE 39.00 1.00 X 176533 0 47 TERESA BUTLER VP OF CLINICAL SERVICES/INTERIM CEO 39.00 1.00 X 148606 0 10649 WASEEM ALOUNK MD PHYSICIAN 40.00 0.00 X 429412 0 26461 PETER DAHER MD PHYSICIAN 40.00 0.00 X 382986 0 23070 MONTY MCKINVEN CRNA 40.00 0.00 X 331484 0 20852 LYNN CHARRLIN MD PHYSICIAN 40.00 0.00 X 247669 0 13691 RACHEL KNUDSON DO GENERAL SURGERY SPECIALIST 40.00 0.00 X 185864 0 9310 2573716 0 135514 32 0 1 0 GRAHAM CONSTRUCTION CO 421 GRAND AVENUE DES MOINES IA 50309 CONTRACTOR FOR BUILDING 7084435 FAMILY MEDICINE CLINIC PC 1614 DIAMOND STREET PLACE ONAWA IA 51040 ER PHYSICIAN COVERAGE 401468 JOHN D TERRY MD 414 N 61ST STREET OMAHA NE 68132 RADIOLOGY PHYSICIAN 350000 GRAPETREE MEDICAL STAFFING INC 2501 BOJI BEND DRIVE MILFORD IA 51351 STAFFING 219958 CMBA ARCHITECTS 302 JONES STREET SIOUX CITY IA 51101 ARCHITECTS FOR BUILDING 126075 11 1956680 19936 1976616 NET PATIENT SERVICE REVENUE 624100 28890801 28890801 RETAIL PHARMACY 456110 1688523 1688523 221984 221984 30801308 843995 843995 229708 119328 110380 110380 95522 14858 4155906 4923 4126054 0 29852 4923 34775 34775 CAFETERIA / DIETARY 722514 84429 84429 REBATES / DISCOUNTS 900099 60562 60562 144991 33912065 29268869 1688523 978057 961015 7527 953488 157338 157338 15523641 14649161 874480 359201 326436 32765 2087362 1846125 241237 1088695 970992 117703 78840 78840 113038 113038 2991466 2614182 377284 77004 8171 68833 2290407 2150082 140325 9538 9538 551723 502823 48900 139329 125498 13831 48660 46348 2312 1873652 1786809 86843 228090 217258 10832 MEDICAL SUPPLIES 4933371 4933371 RETAIL PHARMACY EXPENSE 1771440 1771440 FOOD 136752 136752 DUES & SUBSCRIPTIONS 114521 71997 42524 123682 63362 60320 35658765 32395210 3263555 0 304313 297454 7254788 8050493 3049923 3525420 22769 48656 1407559 1234398 473349 551592 53566487 28030158 18042361 25536329 22209825 22264283 1814152 2098794 54579039 63607419 4892671 4736593 1247268 661492 6382607 18349542 3921192 879853 16443738 24627480 X 38135301 38979939 38135301 38979939 54579039 63607419 X -1746700 1925426 665912 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 6528 6528 0 PART II-B, LINE 1: BURGESS HEALTH CENTER PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. 397937 397937 34333069 15432829 18900240 16393821 11984978 4408843 2441660 612351 1829309 25536329 DEFERRED COMPENSATION 656450 REFUNDABLE ADVANCE 1852 RIGHT OF USE LEASE LIABILITY 107582 THIRD PARTY SETTLEMENT 113969 879853 X PART X, LINE 2: THE HEALTH CENTER AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2023 AND 2022, THE HEALTH CENTER AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 245.000000000000 1 1 0 1 1 126696 126696 0.00360 4334185 4241934 92251 0.00260 4460881 4241934 218947 0.00620 1124 1124 0.00000 2768240 2429963 338277 0.00950 2769364 2429963 339401 0.00950 7230245 6671897 558348 0.01570 1 379680 265776 10960278 11122458 -162180 X 1 1 1 1 BURGESS HEALTH CENTER 1600 DIAMOND STREET ONAWA IA 61040 WWW.BURGESSHC.ORG 670082H X X X X BURGESS HEALTH CENTER 1 0 0 1 X X X X X X X 21 1 0 0 1 X WWW.BURGESSHC.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 21 1 WWW.BURGESSHC.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 245.000000000000 X X X X 1 1 X X X 1 X WWW.BURGESSHC.ORG/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE/ X WWW.BURGESSHC.ORG/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE/ X WWW.BURGESSHC.ORG/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X X 1 X 0 0 BURGESS HEALTH CENTER PART V, SECTION B, LINE 5: COMMUNITY STAKEHOLDERS WERE ASKED TO DETERMINE KEY AREAS THEY SEE AS A CONCERN. STAKEHOLDERS WERE CHOSEN TO SHOWCASE A UNIQUE PERSPECTIVE OF COUNTY BARRIERS BASED ON THEIR PROFESSIONS, CHILDREN, HEALTHCARE SERVICES, COUNTY AND SURROUNDING COUNTY SERVICES AND INDIVIDUAL TOWN NEEDS. STAKEHOLDERS INCLUDED:- SCHOOL ADMINISTRATORS - BURGESS HEALTH CENTER DIRECTORS- MONONA COUNTY WELLNESS COALITION - ONAWA CHAMBER OF COMMERCE- MONONA COUNTY CHILD ABUSE PREVENTION COUNCIL - MONONA COUNTY BOARD OF HEALTH- MONONA COUNTY COMMUNITY MAYORSTHE INFORMATION COLLECTED WAS ANALYZED AND A COMMUNITY SURVEY WAS CREATED TO DETERMINE WHAT RESIDENTS OF MONONA COUNTY FELT WERE AREAS OF GREATEST CONCERN. THE SURVEY INCLUDED DEMOGRAPHICS AND FOUR QUESTIONS TO HELP NARROW THE BARRIERS FACED BY MONONA COUNTY RESIDENTS. THE SURVEY WAS MADE AVAILABLE ONLINE AND IN PRINT. IT WAS ADVERTISED ON SOCIAL MEDIA, IN NEWSPAPERS AND FLYERS WERE PLACED IN LOCAL ESTABLISHMENTS. A TOTAL OF 104 RESIDENT RESPONDED TO THE SURVEY, ACCOUNTING FOR 1.2% OF THE POPULATION. BURGESS HEALTH CENTER PART V, SECTION B, LINE 11: TO ADDRESS, EDUCATE AND PREVENT THE PRIMARY CONCERNS OF THE CHNA, BURGESS HEALTH CENTER HAS DEVELOPED THE FOLLOWING GOALS AND PROGRAMS TO ADDRESS THE NEEDS IDENTIFIED IN OUR SERVICE AREA:1) MENTAL HEALTH & MENTAL HEALTH DISORDERS:BURGESS HEALTH WILL PROMOTE MENTAL HEALTH WALK-IN CLINICS AND IMPROVE ACCESS TO RESOURCES, CLINICS, AND ERS WHERE THOSE AFFECTED CAN RECEIVE HELP FOR MENTAL HEALTH ISSUES AND CONCERNS. THE HEALTH CENTER ENCOURAGED THE COMMUNITY TO ATTEND AND SOCIALIZE IN SAFE ENVIRONMENTS AND WILL ALSO WORK TO IMPROVE PROCESSES AND ACCESS TO MENTAL HEALTH PROVIDERS.2) OVERWEIGHT & OBESITY:BURGESS HEALTH CENTER WILL INCREASE OPPORTUNITIES TO IMPROVE OVERALL HEALTH AND INCREASE AWARENESS OF PREVENTATIVE HEALTH RESOURCES AND SERVICES. HEALTHY LIFESTYLE CHOICES WILL BE PROMOTED ON SOCIAL MEDIA AND THE HEALTH CENTER HAS PARTNERED WITH THE LOCAL YMCA TO PROMOTE EXERCISE CLASSES AND SOCIALIZATION WITH OTHERS. THE HEALTH CENTER IS ALSO WORKING TOWARDS STARTING EDUCATIONAL PROGRAMS IN THE LOCAL SCHOOLS TO PROMOTE HEALTHY LIFESTYLE CHOICES AND ACTIVITIES.3) OLDER ADULT HEALTH/AGING ISSUES:BURGESS HEALTH CENTER WILL IMPROVE UTILIZATION OF PREVENTATIVE HEALTH RESOURCES AND SERVICES. THE HEALTH CENTER ALSO ADVERTISED THE IMPORTANCE OF ROUTINE MEETINGS WITH A PRIMARY CARE PROVIDER AND STAYING UP TO DATE ON VACCINES.4) CANCER BURGESS HEALTH CENTER WILL IMPROVE UTILIZATION OF PREVENTATIVE HEALTH RESOURCES AND SERVICES. THEY HAVE STARTED PROMOTING A "CARE FOR YOURSELF" PROGRAM AND ADVERTISED THE IMPORTANCE OF ROUTINE MEETINGS WITH A PRIMARY CARE PROVIDER. THEY ARE ALSO PROMOTING ROUTINE MAMMOGRAMS FOR EARLY BREAST CANCER DETECTION.THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED. BURGESS HEALTH CENTER PART V, SECTION B, LINE 13B: BURGESS HEALTH CENTER USES HUD GUIDELINES FOR IOWA WHICH ARE LESS RESTRICTIVE FOR THE PATIENTS. THESE GUIDELINES CAN BE FOUND AT HUDUSER.GOV. 5 1 - BURGESS FAMILY CLINIC - MAPLE VALLEY 513 SOUTH MUCKEY STREET MAPLETON IA 51304 FAMILY MEDICAL CLINIC 2 - BURGESS CLINIC WHITING 153 BLAIR STREET WHITING IA 51063 FAMILY MEDICAL CLINIC 3 - BURGESS FAMILY CLINIC - SLOAN 409 EVANS SLOAN IA 51055 FAMILY MEDICAL CLINIC 4 - BURGESS FAMILY CLINIC - DUNLAP 612 IOWA AVENUE DUNLAP IA 51529 FAMILY MEDICAL CLINIC 5 - BURGESS FAMILY CLINIC - DECATUR 823 S BROADWAY ST 120 DECATUR NE 68020 FAMILY MEDICAL CLINIC PART I, LINE 3C: BURGESS HEALTH CENTER USES HUD GUIDELINES WHICH ARE LESS RESTRICTIVE FOR OUR PATIENTS. THE HOSPITAL DOES NOT USE ASSET TESTING OR OTHER FACTORS REGARDLESS OF INCOME AS A FACTOR TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. OTHER FACTORS USED INCLUDE MEDICAL INDIGENCY, INSURANCE STATUS AND UNDERINSURANCE STATUS. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED PARTY. PART I, LINE 7: BURGESS HEALTH CENTER USES LYONS SOFTWARE TO TRACK ALL PROGRAMS THROUGHOUT THE YEAR. WHEN A PROGRAM IS USED, THE PERSON IN CHARGE WILL TRACK THE PROGRAM IN THE SOFTWARE BY RECORDING THE CATEGORY, THE RELATED COSTS AND REVENUE AND THE NUMBER OF PARTICIPANTS. PART I, LINE 7G: ALL COSTS REPORTED ON PART I, LINE 7G ARE ATTRIBUTABLE TO THE PHYSICIAN CLINICS. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL HAD NO COMMUNITY BUILDING ACTIVITIES DURING THE CURRENT YEAR. PART III, LINE 2: THE HEALTH CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: THE BAD DEBT RECOGNIZED OF $379,680, IS 1.24% OF NET PATIENT SERVICE REVENUE FOR THE FISCAL YEAR. BURGESS HEALTH CENTER ESTIMATES THAT THE MAJORITY (70%) OF SERVICES THAT END IN BAD DEBT ARE FOR PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE IF THEY WOULD APPLY. ALL OF THIS AMOUNT IS INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10, 11 AND 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES", "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: THE MEDICARE SHORTFALL IS BASED ON THE INFORMATION FROM THE COST REPORT. THE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THE SERVICES ARE PROVIDED WITHOUT THE EXPECTATION THAT MEDICARE REVENUES WILL COVER OUR COSTS. THE ORGANIZATION USED THE COST REPORT AND MEDICARE PS&R FOR THE YEAR ENDED JUNE 30, 2023. PART III, LINE 9B: BURGESS HEALTH CENTER HAS TWO FINANCIAL COUNSELORS WHO WILL REVIEW OUTSTANDING ACCOUNTS WITH PATIENTS TO HELP THEM QUALIFY FOR ASSISTANCE IN PAYING THE OUTSTANDING BILL. THIS ASSISTANCE INCLUDES COMPLETING PAPERWORK AND GATHERING SOURCE DOCUMENTS TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WILL ALSO ASSIST PATIENTS IN COMPLETING PAPERWORK IN ORDER FOR THEM TO QUALIFY FOR GOVERNMENT ASSISTANCE. PART VI, LINE 2: BURGESS HEALTH CENTER REVIEWS DATA FROM THE IOWA DEPARTMENT OF PUBLIC HEALTH. BURGESS HEALTH CENTER FOCUSES ON TOP ADMISSIONS TO THE HOSPITAL AND REVIEWS THE AGGREGATE DATA FROM WELLNESS SCREENS. PART VI, LINE 3: PATIENTS' BILLS CONTAIN INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND GIVES CONTACT INFORMATION FOR OBTAINING THIS ASSISTANCE. IF A PATIENT HAS NOT RESPONDED TO THE BILL, THE FINANCIAL COUNSELOR WILL CONTACT THE PATIENT TO MAKE ARRANGEMENTS TO HELP THE PATIENT APPLY FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: BURGESS HEALTH CENTER IS SITUATED IN MONONA COUNTY, IA. THE SERVICE AREA IS CONSIDERED A RURAL SETTING WITH A POPULATION OF APPROXIMATELY 9,000. OF THIS POPULATION, 24.7% OF MONONA COUNTY IS OVER AGE 65. THE SERVICE AREA RANKS LOW REGARDING THE MEDIAN HOUSEHOLD INCOME. THE IOWA AVERAGE HOUSEHOLD INCOME IS $62,000 WITH MONONA COUNTY HAVING AN AVERAGE HOUSEHOLD INCOME OF $53,000, $9,000 LOWER. THE UNEMPLOYMENT RATE IN MONONA COUNTY IS 3%, HIGHER THAN THE STATE AVERAGE OF 2.7%. PART VI, LINE 5: PROMOTING THE HEALTH OF THE COMMUNITIES BURGESS HEALTH CENTER SERVES IS IMPORTANT TO BURGESS HEALTH CENTER. FURTHERMORE, IT IS PART OF THE MISSION STATEMENT OF BURGESS HEALTH CENTER. - "BURGESS HEALTH CENTER IS COMMITTED TO IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE BY PROVIDING EXCELLENT HEALTHCARE AND EXCEPTIONAL PATIENT EXPERIENCES." TO HELP SUPPORT THAT MISSION BURGESS HEALTH CENTER HAS OPENED UP MEDICALLY ORIENTED GYMS (MOGS) IN 2 COMMUNITIES OF OUR SERVICE AREA, MAPLETON AND ONAWA. THROUGH FITNESS, WELLNESS AND GUIDANCE, THE MOGS ARE SPECIFICALLY DESIGNED TO IMPROVE THE LIFE AND HEALTH OF OUR COMMUNITY MEMBERS. THE PROFESSIONAL STAFF DEVELOP CUSTOMIZED FITNESS PROGRAMS TO HELP PEOPLE OF ALL AGES OBTAIN A HEALTHY LIFESTYLE.BURGESS HEALTH CENTER ALSO PARTNERS WITH OTHER ORGANIZATIONS IN THE COMMUNITY TO IMPROVE COMMUNITY HEALTH AND WELL BEING. BURGESS HEALTH CENTER PARTICIPATES IN MEDICARE, MEDICAID CHAMPUS AND TRICARE. PART VI, LINE 6: BURGESS HEALTH CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X 0 0 0 0 0 0 0 1 0 WASEEM ALOUNK MD PHYSICIAN 429412 0 0 0 0 0 13306 0 13155 0 455873 0 0 0 PETER DAHER MD PHYSICIAN 382986 0 0 0 0 0 9968 0 13102 0 406056 0 0 0 JOHN GARRED JR MD BOARD MEMBER 376344 0 0 0 0 0 9997 0 273 0 386614 0 0 0 MONTY MCKINVEN CRNA 331484 0 0 0 0 0 7791 0 13061 0 352336 0 0 0 CARL BEHNE CEO THRU 6/2023 259532 0 7261 0 9000 0 8136 0 13028 0 296957 0 0 0 LYNN CHARRLIN MD PHYSICIAN 247669 0 0 0 0 0 7524 0 6167 0 261360 0 0 0 RACHEL KNUDSON DO GENERAL SURGERY SPECIALIST 185864 0 0 0 0 0 5575 0 3735 0 195174 0 0 0 JOHN WILKER VICE PRESIDENT OF FINANCE 176533 0 0 0 0 0 0 0 47 0 176580 0 0 0 TERESA BUTLER VP OF CLINICAL SERVICES/INTERIM CEO 148606 0 0 0 0 0 4569 0 6080 0 159255 0 0 0 PART I, LINE 7 CARL BEHNE'S BONUS IS EVALUATED AND DETERMINED BY THE BOARD. HIS ANNUAL BONUS CAN BE UP TO 20% OF HIS BASE SALARY, BASED ON PERFORMANCE DURING THE YEAR. A CITY OF ONAWA IOWA 426005064 2012-07-13 6259250 REFUND PRIOR ISSUE (06/08/05) 0 0 0 A 5588548 6259250 125185 6134065 2007 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 SCHEDULE K, PART IV, ARBITRAGE, LINE 2C DATE THE REBATE COMPUTATION WAS PERFORMED: 01/13/2013 NOTE REGARDING THE REBATE COMPUTATION; SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. KATHRYN GARRED EMPLOYEE OF ORGANIZATION AND SPOUSE OF JOHN GARRED JR., MD, BOARD MEMBER 62130 EMPLOYEES W-2 WAGES 0 FAMILY MEDICINE CLINIC DR. PAUL DUDLEY OWNS 100% OF THE CLINIC AND IS A CURRENT BOARD MEMBER 401468 CONTRACTED SERVICES PROVIDED FOR ER COVERAGE 0 MATTHEW GARRED EMPLOYEE OF ORGANIZATION AND SON OF JOHN GARRED JR., MD, BOARD MEMBER 95208 EMPLOYEES W-2 WAGES 0 FORM 990, PART IV, LINE 20B: THE MOST RECENT AUDITED FINANCIAL STATEMENTS ATTACHED TO THE RETURN ARE FOR THE FISCAL YEAR ENDED JUNE 30, 2022 AS THE CURRENT FISCAL YEAR AUDIT WAS NOT COMPLETED AT THE TIME OF FILING. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 6 BURGESS HEALTH CENTER HAS MEMBERS. A PERSON MAY BECOME A MEMBER IF HE OR SHE (1) IS AT THAT TIME A RESIDENT OF THE GEOGRAPHIC AREA SERVED BY THE CORPORATION; (2) COMPLETES A MEMBERSHIP REGISTRATION FORM, AND (3) PAYS A LIFE MEMBERSHIP FEE OF $10. FORM 990, PART VI, SECTION A, LINE 7B THERE IS AN ANNUAL MEETING OF THE MEMBERS. AT THE MEETING, THE MEMBERS RECEIVE AN ANNUAL REPORT ON THE AFFAIRS OF THE CORPORATION AND HAVE THE OPPORTUNITY TO OFFER THEIR INPUT ON ANY MATTER AFFECTING THE CORPORATION. THE MEMBERS SHALL ALSO CARRY OUT ANY DUTIES RESERVED TO MEMBERS UNDER THE IOWA NONPROFIT CORPORATION ACT. EACH MEMBER HAS ONE VOTE. THE ACT OF A MAJORITY OF MEMBERS PRESENT AND VOTING SHALL BE THE ACT OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS E-MAILED TO THE ENTIRE BOARD; ALL QUESTIONS AND COMMENTS ARE ADDRESSED PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON A ANNUAL BASIS, ALL BOARD MEMBERS ALONG WITH THE MANAGEMENT STAFF (MANAGERS, DIRECTORS, OFFICERS) COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THE RESULTS ARE REVIEWED AT ONE OF THE BOARD MEETINGS. IF THERE IS A CONFLICT, THE BOARD MEMBER REFRAINS FROM VOTING ON THAT ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO SALARY IS DETERMINED BASED ON GRADE, NUMBER OF YEARS IN THE POSITION AND COMPARED TO IOWA HOSPITAL ASSOCIATION DATA SHOWING MARKET RATES FOR THE BURGESS CUSTOM GROUP. THIS INFORMATION IS PASSED ON TO THE EXECUTIVE COMMITTEE OF THE BOARD WHO MAKES A RECOMMENDATION TO THE COMPLETE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINAL DECISION. OFFICER'S COMPENSATION OTHER THAN THE CEO IS DETERMINED BY THE IHA SALARY SURVEY, CAH GROUP AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 BURGESS HEALTH CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SWAP AGREEMENT 665,912. FORM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BURGESS FOUNDATION 1600 DIAMOND STREET ONAWA IA 51040 421188964 RAISING FUNDS FOR BURGESS HEALTH CENTER IA 501(C)(3) LINE 7 BURGESS HEALTH CENTER 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0