2025-08-13T12:23:41-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 421320763 PALMER LUTHERAN HEALTH CENTER INC PALM 5634223811 112 JEFFERSON ST WEST UNION IA 52175 BRENDA MOSER CFO 5634223811 2025-08-12 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-12 2023 2025-03-06 01:10:19Z GUNDERSON PALMER LUTHERAN HOSPITAL AND CLINIC PATRICE KUENNEN 112 JEFFERSON ST WEST UNION IA 52175 50309243 0 X HTTPS://WWW.GUNDERSENHEALTH.ORG/PALMER/ X 1949 IA TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. 5 2 266 3 0 0 164072 46523 30260627 49935944 64834 87084 135305 239692 30624838 50309243 0 0 0 0 17663772 25589979 0 0 0 12638730 18080362 30302502 43670341 322336 6638902 31455908 40830757 10450665 13108038 21005243 27722719 X TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. 1 0 35748753 0 49935944 PALMER LUTHERAN HEALTH CENTER IS A 25-LICENSED BED CRITICAL ACCESS HOSPITAL. THE ONLY HOSPITAL IN WEST UNION, IOWA, AND EMPLOYS ABOUT 225 EMPLOYEES. PALMER LUTHERAN HEALTH CENTER ALSO HAS THREE RURAL HEALTH CLINICS IN THE COMMUNITIES OF WEST UNION, FAYETTE AND POSTVILLE, A HOME CARE DEPARTMENT, HOSPICE DEPARTMENT, AND HOME MEDICAL EQUIPMENT DEPARTMENT, WHICH HAVE OFFICES IN BOTH WEST UNION AND OELWEIN. IN ADDITION, PALMER OPERATES A SAME DAY CLINIC, OPEN AFTER-HOURS AND ON WEEKENDS, ALLOWING PATIENTS TO BE SEEN 7 DAYS A WEEK IN THIS SETTING. THIS IS OFFERED TO SPECIFICALLY MEET COMMUNITY HEALTH NEEDS OF WORKING FAMILIES. ANNUALLY, PALMER HAS ABOUT 400 ADMISSIONS, 100 LIVE BIRTHS; OVER 3,350 EMERGENCY CENTER VISITS, ABOUT 22,850 PATIENT VISITS IN THE CLINICS AND PERFORMS OVER 600 SURGERIES (INCLUDING AMBULATORY).ACCOMPLISHMENTS: WHEN RENOVATED, THE HOSPITAL WAS DESIGNED TO ACHIEVE THREE GOALS - CREATE A HEALING ENVIRONMENT THAT WELCOMES AND SUPPORTS PATIENTS/FAMILIES, DESIGN WORK AREAS TO BETTER ACCOMMODATE CURRENT AND FUTURE TECHNOLOGIES, SYSTEMS AND APPROACHES TO CARE, AND TO COMPLY MORE FULLY WITH HIPPA REGULATIONS. PALMER LUTHERAN HEALTH CENTER LEADS DELIVERY OF HEALTHCARE TO ITS REGION THROUGH OVER 225 ASSOCIATES (INCLUDING 4 PHYSICIANS, 4 PHYSICIANS ASSISTANTS, 5 NURSE PRACTITIONERS AND 3 BEHAVIORAL HEALTH PROVIDERS) WHICH COORDINATE CARE TO DELIVER PATIENT CARE AS AN INTEGRATED UNIT. PALMER LUTHERAN HEALTH CENTER AND ITS AFFILIATES ALSO WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARDS FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO PALMER LUTHERAN HEALTH CENTER'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLY, PALMER LUTHERAN HEALTH CENTER IS GOVERNED BY A BOARD THAT INCLUDES 3 INDEPENDENT BOARD MEMBERS WHO ARE COMMUNITY LEADERS, CONSUMER REPRESENTATIVES, BUSINESS EXPERTS, AND CLINICAL HEALTHCARE EXPERTS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST OF INTEGRITY FOR THE BENEFIT OF THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER ALSO MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. PALMER OPERATES A FULL-TIME EMERGENCY ROOM AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. PALMER PROVIDES CLINICAL SERVICES NEEDED TO OPERATE THE EMERGENCY CENTER AND PROVIDES ON-SITE EMERGENCY MEDICAL, RESCUE AND MEDICAL TRANSPORTATION SERVICES. IN ADDITION, PALMER LUTHERAN HEALTH CENTER, THROUGH ITS INTEGRATED NETWORK OF PROVIDERS, PROVIDES NON-EMERGENCY SERVICES TO THE COMMUNITY IT SERVES. IT MAKES THESE SERVICES ACCESSIBLE TO THE COMMUNITY THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS LIKE MEDICARE AND MEDICAID AND BY HELPING THROUGH PALMER'S CHARITY CARE POLICY, AND SOCIAL SERVICES DEPARTMENT. PALMER LUTHERAN HEALTH CENTER UTILIZES TECHNOLOGY THAT PROVIDES A COMPLETE ELECTRONIC MEDICAL RECORD. OUR ELECTRONIC HEALTH RECORD IS CONNECTED TO GUNDERSEN HEALTH SYSTEM, WHICH ALLOWS US TO SHARE TEST RESULTS AND OTHER PATIENT INFORMATION. THIS ENHANCES THE PATIENT CARE AT OUR FACILITY, AS WELL AS OTHER GUNDERSEN ENTITIES THROUGHOUT THE REGION. THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNTS OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE HEALTH CENTER'S CHARITY CARE POLICY WERE $1,852,372 FOR THE YEAR ENDED SEPTEMBER 30, 2024. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION WERE $1,351,122. THE HEALTH CENTER ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. PALMER LUTHERAN HEALTH CENTER TAKES ITS MISSION TO IMPROVE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVICES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE COMMUNITY. IT STRIVES TO IDENTIFY COMMUNITY NEEDS BEYOND BASIC HEALTHCARE, THEN RESPOND TO THEM, AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER TAKES A STRATEGIC, COMMUNITY NEEDS-BASED APPROACH TO DELIVERING BENEFITS TO THE COMMUNITY. 35748753 1 1 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 0 0 0 0 0 0 0 1 1 0 0 0 1 72 0 266 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X BRENDA MOSER 5634223811 112 JEFFERSON ST WEST UNION IA 52175 DR MORDECHAI LEDERMAN SECRETARY/TREASURER (THRU 01/2024) 2.00 48.00 X X 0 292267 67267 RACHEL ALBRECHT DIRECTOR/VP AMBULATORY SERVICES 2.00 40.00 X 0 235056 55101 TOM TORNSTROM SECRETARY/TREASURER 2.00 48.00 X X 0 163870 42385 CHUCK JOHNSON DIRECTOR/ENTERPRISE DIRECTOR 2.00 48.00 X 0 150958 49570 KRISTI FLACK CHAIR 2.00 X X 0 0 0 LYNN LAUER CHAIR (THRU 01/2024) 2.00 X X 0 0 0 ANDREW WENTHE VICE CHAIR (THRU 05/2024) 2.00 X X 0 0 0 NICOLE HAVENSTRITE DIRECTOR 2.00 X 0 0 0 SCOTT RATHGABER CEO-BGHS 2.00 48.00 X 0 1644221 68728 STEVE LITTLE INTERIM CFO-BGHS (THRU 02/2024) 2.00 48.00 X 0 333317 0 PATRICE KUENNEN CEO 50.00 X 0 190270 49974 BRENDA MOSER FINANCE ADMINISTRATOR 40.00 10.00 X 0 177022 51157 JOHN CEELEN CFO-BGHS (BEG. 02/2024) 2.00 48.00 X 0 0 0 KEN BEACH CRNA 50.00 X 216238 0 39980 DEBBIE BRINK RN 40.00 X 163765 0 21394 EMILY MORK PHARMACY DIRECTOR 50.00 X 137235 0 32852 DEB KELLY DIRECTOR OF NURSING 40.00 X 143337 0 8942 CHERYL MITTELSTED RN 40.00 X 128345 0 2532 GERALD OETZEL FORMER CFO-BGHS 0.00 X 0 555068 18108 788920 3742049 507990 37 1 1 0 IOWA EMERGENCY PHYSICIANS 200 CORPORATE BLVD LAFAYETTE LA 70508 EMERGENCY ROOM PROVIDERS 1961080 REHAB VISIONS 11623 ARBOR ST OMAHA NE 68144 CONTRACT PT, OT & ST SERVICES 1774513 PSYCHIATRIC MECICAL CARE LLC PO BOX 734606 DALLAS TX 753734606 CONTRACT BEHAVIORAL HEALTH SERVICE 608196 MCKESSON CORP 12748 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 PHARMACEUTICAL DRUGS 548417 INTEGRATED TELEHEALTH PARTNERS PO BOX 735504 DALLAS TX 753735504 CONTRACT BEHAVIORAL HEALTH PROVIDERS 303790 26 2932 43591 46523 PATIENT SERVICE REVENUE 621110 39353548 39353548 PHARMACY REVENUE 621110 10305717 10305717 276679 276679 49935944 87084 87084 26813 0 26813 26813 26813 CAFETERIA REVENUE 900099 63795 63795 149084 149084 212879 50309243 49935944 0 326776 X 422787 422787 20057012 16926173 3130839 1641311 1354059 287252 2357706 1871527 486179 1111163 886507 224656 1168628 1168628 19122 19122 58450 58450 3953 3953 6211597 5880022 331575 49299 136 49163 389370 214524 174846 1061216 1061216 1043121 595095 448026 189026 163981 25045 40369 31947 8422 167547 167547 1293541 816522 477019 82760 82760 MEDICAL SUPPLIES 4921615 4890954 30661 BAD DEBT 680425 680425 MEDICAL EQUIPMENT 308058 276672 31386 FOOD 141709 2543 139166 250556 96450 154106 43670341 35748753 7921588 0 1935 1934 12633163 21924313 5941776 7220035 783616 811021 80918 68689 19961055 11136693 9659643 8824362 2354857 1980403 31455908 40830757 3529475 4613648 0 13568 3854844 3126438 2372779 1824602 693567 3529782 10450665 13108038 X 19834644 26536546 1170599 1186173 21005243 27722719 31455908 40830757 X 6638902 78574 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3953 3953 0 PART II-B, LINE 1: PALMER LUTHERAN HEALTH CENTER PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA), THE IOWA HOSPITAL ASSOCIATION (IHA) AND THE NATIONAL ASSOCIATION OF RURAL HEALTH CLINICS. THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THESE ORGANIZATIONS HAVE NOTIFIED PALMER LUTHERAN HEALTH CENTER THAT $3,953 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. 168281 168281 9702706 3841303 5861403 9993892 7225668 2768224 96176 69722 26454 8824362 3RD PARTY SETTLEMENTS PAYABLE 3367567 DUE TO RELATED PARTY 162215 3529782 X PART X, LINE 2: THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. 1 1 X 1 X 1 X 1 1 1 0 1 1 1115544 1115544 0.02590 5745053 4994373 750680 0.01750 6860597 4994373 1866224 0.04340 111705 111705 0.00260 3000 3000 0.00010 15678493 7882930 7795563 0.18130 15793198 7882930 7910268 0.18400 22653795 12877303 9776492 0.22740 0 409768 204884 14430300 14541726 -111426 X 1 1 1 1 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 WWW.GUNDERSENHEALTH.ORG/PALMER X X X X RURAL HEALTH CLINIC PALMER LUTHERAN HEALTH CENTER 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL SECTION X 1 22 1 SEE SUPPLEMENTAL SECTION 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X X 1 X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X X 1 X 0 0 PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 5: IN PARTNERSHIP WITH FAYETTE COUNTY PUBLIC HEALTH, GUNDERSEN PALMER DEVELOPED A SURVEY TO DISSEMINATE WITHIN THE SERVICE AREA- SEE APPENDIX A. THE FAYETTE COUNTY HEALTH ASSESSMENT DATA COLLECTION PROCESS WAS CONDUCTED BY FIRST SURVEYING THE CITIZENS OF FAYETTE COUNTY AT THE FAYETTE COUNTY FAIR IN JULY OF 2022. A TEAM CONSISTING OF A UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH STRIKE TEAM AND A COMMUNITY HEALTH INTERN UTILIZED SOCIAL MEDIA, IPADS, AND PAPER SURVEYS IN ORDER TO CONNECT WITH THE PUBLIC AT THE COUNTY FAIR. FOLLOWING THE FAIR, THE SURVEY WAS DISSEMINATED WITHIN THE FAYETTE COUNTY COMMUNITY AND SENT THE SURVEY OUT THROUGH SOCIAL MEDIA AND EMAIL, WHERE COMMUNITY MEMBERS AND ORGANIZATIONS CONTINUALLY SHARED IT. FOR THE ASSESSMENT, GUNDERSEN PALMER PARTNERED WITH THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH, THE IOWA DEPARTMENT OF PUBLIC HEALTH, FAYETTE COUNTY PUBLIC HEALTH, THE HEALTHY FAYETTE COUNTY COALITION, AND MERCYONE. IN ADDITION TO UTILIZING THE DATA COLLECTED FOR OUR ASSESSMENT, WE HAVE ALSO REFERENCED MERCYONE'S, ANOTHER HOSPITAL WITHIN OUR COUNTY, COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN. INFORMATION PROVIDED BY PARTNERS AT LOCAL ORGANIZATIONS, GUNDERSEN HEALTH SYSTEM, IOWA DEPARTMENT OF PUBLIC HEALTH, HELPING SERVICES, NORTH FAYETTE VALLEY COMMUNITY COALITION, AND FAYETTE COUNTY PUBLIC HEALTH WAS UTILIZED AS WELL. DURING THE ASSESSMENT PROCESS, INPUT WAS GATHERED FROM A NUMBER OF SOURCES WORKING AS PUBLIC HEALTH PROFESSIONALS, INCLUDING INDIVIDUALS EMPLOYED AT FAYETTE COUNTY PUBLIC HEALTH AND THE IOWA DEPARTMENT OF PUBLIC HEALTH, AS WELL AS AN INDIVIDUAL WORKING IN THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH. INPUT FOR THE SURVEY WAS GATHERED BY SENDING OUT DRAFTS OF THE ASSESSMENT FOR FEEDBACK, ALONG WITH CONDUCTING ZOOM MEETINGS TO GO OVER POTENTIAL REVISIONS. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY, WITH OPPORTUNITIES FOR PAPER COPIES, WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, AND NUMEROUS OTHER INDIVIDUALS AND ORGANIZATIONS THROUGHOUT THE SERVICE AREA. A TOTAL OF 193 ELECTRONIC AND PAPER SURVEYS WERE COLLECTED, WITH PAPER RESPONSES BEING ENTERED INTO THE ELECTRONIC SURVEY DATABASE. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY.THE COLLECTED DATA FROM THE SURVEY, COMBINED WITH SECONDARY DATA COLLECTED, HELPED IN IDENTIFYING OPPORTUNITIES TO IMPROVE THE HEALTH OF FAYETTE COUNTY. SECONDARY DATA SOURCES INCLUDE, BUT ARE NOT LIMITED TO, ROBERT WOOD JOHNSON FOUNDATION (RWJF) COUNTY HEALTH RANKINGS & ROADMAPS; PREVIOUS DATA COLLECTED FROM FAYETTE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT; OTHER LOCAL HOSPITAL HEALTH NEEDS ASSESSMENT; IOWA DEPARTMENT OF PUBLIC HEALTH; THE CENTER FOR DISEASE CONTROL AND PREVENTION; US CENSUS BUREAU; GUNDERSEN HEALTH SYSTEM; NORTH FAYETTE VALLEY COMMUNITY COALITION; DATA USA; NORTH CAROLINA RURAL HEALTH RESEARCH; IOWA HOSPITAL ASSOCIATION; AND OTHER SOURCES NOTED WITHIN THE REPORT.GUNDERSEN PALMER LEADERS CONTRIBUTED EXPERTISE IN EVALUATING DATA, RESEARCH, AND OTHER INFORMATION, WHILE TAKING INTO ACCOUNT TRENDS WITHIN THE COMMUNITY AND INDIVIDUALIZED PRACTICE SETTING, PATIENT FEEDBACK AND HOSPITAL UTILIZATION DATA TO HELP FINALIZE THE STRATEGIES. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 6A: MERCY ONE PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 6B: FAYETTE COUNTY PUBLIC HEALTHUNIVERSITY OF IOWA PUBLIC HEALTHIOWA DEPARTMENT OF PUBLIC HEALTHHEALTHY FAYETTE COUNTY COALITION PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 11: PALMER LUTHERAN HEALTH CENTER HAS SEVERAL INITIATIVES IN PLACE TO HELP ADDRESS THE TOP THREE PRIORITIES SELECTED IN THE CHNA. THE HOSPITAL WORKS WITH A VARIETY OF COMMUNITY PARTNERS TO DEVELOP, IMPLEMENT, AND SUSTAIN THESE PROGRAMS AND ACTIVITIES. A LIST OF THE CURRENT ACTIONS AND GOALS FOR EACH OF THE TOP THREE PRIORITIES IS INCLUDED IN THE IMPLEMENTATION PLAN POSTED ON THE HOSPITAL'S WEBSITE. AS WITH ALL HEALTH CARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITY'S PALMER LUTHERAN HEALTH CENTER SERVES. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED; HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, THE HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 13H: THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 15E: ALL SELF-PAY PATIENTS ARE GIVEN INFORMATION ON THE HOSPITAL'S CHARITY CARE POLICY AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. PALMER LUTHERAN HEALTH CENTER PART V, SECTION B, LINE 16J: OUR SELF-PAY COLLECTION AGENCY UTILIZES INFORMATION TO IDENTIFY ACCOUNTS THAT SHOULD QUALIFY FOR THE FAP. WE WRITE THESE ACCOUNTS OFF WITHOUT REQUIRING ANY PAPERWORK OR APPLICATION. PART VI, SECTION B, LINE 7A & 10: HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 9 1 - GUNDERSEN PALMER - WEST UNION CLINIC 112 JEFFERSON STREET WEST UNION IA 52175 RURAL HEALTH CLINIC 2 - GUNDERSEN PALMER MEDICAL SUPPLY-W UNION 200 JEFFERSON STREET WEST UNION IA 52175 MEDICAL SUPPLY AND EQUIPMENT 3 - GUNDERSEN PALMER MEDICAL SUPPLY-OELWEIN 230 2ND AVE SE OELWEIN IA 50662 MEDICAL SUPPLY AND EQUIPMENT 4 - GUNDERSEN PALMER - POSTVILLE CLINIC 111 SOUTH REYNOLDS STREET POSTVILLE IA 52162 RURAL HEALTH CLINIC 5 - GUNDERSEN PALMER HOSPICE - WEST UNION 200 JEFFERSON STREET WEST UNION IA 52175 HOSPICE SERVICES 6 - GUNDERSEN PALMER HOSPICE - OELWEIN 230 2ND AVE SE OELWEIN IA 50662 HOSPICE SERVICES 7 - GUNDERSEN PALMER HOME HEALTH 200 JEFFERSON STREET WEST UNION IA 52175 HOME HEALTH 8 - GUNDERSEN PALMER HOME HEALTH - OELWEIN 230 2ND AVE SE OELWEIN IA 50662 HOME HEALTH 9 - GUNDERSEN PALMER - FAYETTE CLINIC 110 KING STREET FAYETTE IA 52142 RURAL HEALTH CLINIC PART I, LINE 3C: CATASTROPHIC CARE ASSISTANCE:FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME.DISCOUNTED CARE:FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL. POVERTY LEVEL.1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE.2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE.3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE.4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE.FREE CARE:A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT:PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING:1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY, NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY.2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES.3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY.4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT PALMER LUTHERAN HEALTH CENTER INCLUDE THE OPERATION OF ROUTINE INPATIENT ADULTS AND PEDIATRICS AS WELL AS THE COMMUNITY-BASED HOSPICE AND HOMECARE PROGRAMS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE SURROUNDING AREA. ALL THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF THE HOSPITAL AND SHARE MANY OF THE SUPPORT FUNCTIONS OF THE HOSPITAL TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON A COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF PALMER LUTHERAN HEALTH CENTER TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATE TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR FORM 990 PURPOSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 680,425. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT ADVOCACY PROMOTES THE HEALTH OF THE COMMUNITY BY ADDRESSING THE NEEDS OF THE COMMUNITY, SUCH AS JOBS, CLEAN WATER/SEWER, INDUSTRY ATTRACTION, ADDRESSING THE NEEDS OF THE SCHOOL AND COUNTY, AND INSURING WE OFFER THE SERVICES THAT ARE IMPORTANT TO THE COMMUNITY. WE ALSO PROVIDE EDUCATION FOR SCHOOL AGE CHILDREN HOPING TO REACH THOSE THAT DON'T HAVE ACCESS TO HEALTH INFORMATION. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY:PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.THE ORGANIZATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: PALMER LUTHERAN HEALTH CENTER IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS URGENT CARE OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT PALMER LUTHERAN HEALTH CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: BEFORE BILLS ARE SENT TO COLLECTION, PALMER LUTHERAN HEALTH CENTER UTILIZES A "FAST TAX" PROGRAM TO SEE WHAT PATIENT ACCOUNTS ARE "PRESUMPTIVE CHARITY." ANY PATIENT THAT QUALIFIES FOR PRESUMPTIVE CHARITY IS ABLE TO RECEIVE A WRITE-OFF WITHOUT HAVING TO FILE ANY PAPERWORK. ONCE AN ACCOUNT IS IDENTIFIED, ALL COLLECTION PROCEEDINGS STOP, AND THE APPROPRIATE CHARITY PERCENTAGE IS APPLIED. ALSO, COLLECTION EFFORTS CEASE ON ACCOUNTS THAT ARE SENT TO COLLECTIONS AND LATER FOUND TO BE ELIGIBLE FOR ASSISTANCE. ONLY THEIR PERSONAL PORTION DUE WOULD FOLLOW NORMAL COLLECTION PROCEDURES. PART VI, LINE 2: IN PARTNERSHIP WITH FAYETTE COUNTY PUBLIC HEALTH, GUNDERSEN PALMER DEVELOPED A SURVEY TO DISSEMINATE WITHIN THE SERVICE AREA- SEE APPENDIX A. THE FAYETTE COUNTY HEALTH ASSESSMENT DATA COLLECTION PROCESS WAS CONDUCTED BY FIRST SURVEYING THE CITIZENS OF FAYETTE COUNTY AT THE FAYETTE COUNTY FAIR IN JULY OF 2022. A TEAM CONSISTING OF A UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH STRIKE TEAM AND A COMMUNITY HEALTH INTERN UTILIZED SOCIAL MEDIA, IPADS, AND PAPER SURVEYS IN ORDER TO CONNECT WITH THE PUBLIC AT THE COUNTY FAIR. FOLLOWING THE FAIR, THE SURVEY WAS DISSEMINATED WITHIN THE FAYETTE COUNTY COMMUNITY AND SENT THE SURVEY OUT THROUGH SOCIAL MEDIA AND EMAIL, WHERE COMMUNITY MEMBERS AND ORGANIZATIONS CONTINUALLY SHARED IT. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY, WITH OPPORTUNITIES FOR PAPER COPIES, WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, AND NUMEROUS OTHER INDIVIDUALS AND ORGANIZATIONS THROUGHOUT THE SERVICE AREA. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY. AS A CRITICAL ACCESS HOSPITAL, WE HAVE AN ADVISORY BOARD THAT INCLUDES A MEMBER OF THE COMMUNITY. THIS GROUP REVIEWS ALL SERVICES OF THE CAH TO ASSURE SERVICES OFFERED ARE EFFECTIVE AND EFFICIENT AND MEET THE COMMUNITY'S NEEDS. OUR CAH HAS BEEN DESIGNATED AS BEING IN A HPSA REGION. WE ALSO HAVE A PATIENT SATISFACTION COMMITTEE THAT MEETS QUARTERLY. THIS COMMITTEE INCLUDES REPRESENTATIVES FROM ALL THE COMMUNITIES IN OUR COUNTY, AND PROVIDES FEEDBACK REGARDING SERVICES, HEALTH CARE CONCERNS, ETC. PART VI, LINE 3: THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. ALL SELF-PAY PATIENTS ARE REFERRED TO SOCIAL SERVICES FOR INFORMATION ON ABOVE PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. ALL PATIENT STATEMENTS REFERENCE THE AVAILABILITY OF FINANCIAL ASSISTANCE. PART VI, LINE 4: PALMER LUTHERAN HEALTH CENTER IS A 25-BED ACUTE CARE HEALTH CENTER SERVING A RURAL POPULATION OF 2,468 PER THE 2022 U.S. CENSUS. AS THE ONLY HOSPITAL IN WEST UNION, IOWA, IT ALSO SERVES A 30 TO 40-MILE RADIUS AROUND WEST UNION. THE CLOSEST HOSPITAL IS MERCY ONE OELWEIN MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL, LOCATED ABOUT 19 MILES FROM WEST UNION. IN ADDITION, OUR HOMECARE DEPARTMENT SERVES A POPULATION IN A 50-MILE RADIUS. WE ARE A MEDICARE DEPENDENT HOSPITAL AND HAVE A LARGE MEDICAID POPULATION AS WELL. THE MOST COMMON INDUSTRIES IN WEST UNION ARE MANUFACTURING AND CONSTRUCTION. 14.2% OF RESIDENTS IN WEST UNION HAD INCOME BELOW THE POVERTY LEVEL IN 2022. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2023 WAS $48,030 WHICH IS DOWN COMPARED TO THE NATIONAL AVERAGE OF $69,021. UNEMPLOYMENT WAS 5.1% IN 2023 COMPARED TO THE NATIONAL AVERAGE OF 6%. PART VI, LINE 5: SEVERAL MEMBERS OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL ITS DEPARTMENTS. THE ORGANIZATION APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE BY PURCHASING UP-TO-DATE EQUIPMENT, AND A STATE-OF-THE-ART FACILITY. CREATE MORE COMMUNITY OUTREACH, AWARENESS AND EDUCATION" IS ONE OF OUR STRATEGIC OBJECTIVES. TO MEET THAT OBJECTIVE, WE HAVE AN ONGOING PROCESS IN PLACE TO MONITOR OUR THREATS AND OUR OPPORTUNITIES IN OUR SERVICE AREA. WE UTILIZE THE IOWA HOSPITAL ASSOCIATION DIMENSIONS SOFTWARE TO DETERMINE THE ORIGIN AND DESTINATION OF OUR PATIENT POPULATION. OUR STRATEGIC PLANNING TEAM INCLUDES OUR GOVERNING BOARD AND SENIOR MANAGEMENT WHO HAVE AN EXTENSIVE KNOWLEDGE BASE OF THE ORGANIZATION. THE SENIOR MANAGEMENT TEAM INCLUDES REPRESENTATION FROM FINANCE, NURSING, HUMAN RESOURCES, MARKETING, FAMILY PRACTICE PROVIDERS AND DIRECTORS OF HOSPITAL OUTPATIENT SERVICES. THE GOVERNING BOARD HAS AN ACTIVE ROLE IN THIS PROCESS AS WELL. THEY HAVE THE BENEFIT OF BEING OUT IN THE COMMUNITY AND GAINING A UNIQUE INSIGHT AND THE PULSE OF THE COMMUNITY. IN ADDITION, WE ARE A CLINICAL SITE FOR STUDENTS OF PHARMACY, NURSING, HIM, PA, AND MEDICAL STUDENTS. PART VI, LINE 6: THE ORGANIZATION IS A PART OF EMPLIFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X 0 0 0 0 0 0 0 0 0 SCOTT RATHGABER CEO-BGHS 0 1274504 0 200000 0 169717 0 45225 0 23503 0 1712949 0 0 GERALD OETZEL FORMER CFO-BGHS 0 480094 0 70000 0 4974 0 12220 0 5888 0 573176 0 0 DR MORDECHAI LEDERMAN SECRETARY/TREASURER (THRU 01/2024) 0 284893 0 77 0 7297 0 42533 0 24734 0 359534 0 0 STEVE LITTLE INTERIM CFO-BGHS (THRU 02/2024) 0 258317 0 75000 0 0 0 0 0 0 0 333317 0 0 RACHEL ALBRECHT DIRECTOR/VP AMBULATORY SERVICES 0 227280 0 25 0 7751 0 34017 0 21084 0 290157 0 0 KEN BEACH CRNA 213100 0 54 0 3084 0 10524 0 29456 0 256218 0 0 0 PATRICE KUENNEN CEO 0 186366 0 237 0 3667 0 27690 0 22284 0 240244 0 0 BRENDA MOSER FINANCE ADMINISTRATOR 0 169831 0 5736 0 1455 0 26423 0 24734 0 228179 0 0 TOM TORNSTROM SECRETARY/TREASURER 0 160902 0 954 0 2014 0 24013 0 18372 0 206255 0 0 CHUCK JOHNSON DIRECTOR/ENTERPRISE DIRECTOR 0 142701 0 533 0 7724 0 22566 0 27004 0 200528 0 0 DEBBIE BRINK RN 151348 0 3697 0 8720 0 8253 0 13141 0 185159 0 0 0 EMILY MORK PHARMACY DIRECTOR 135607 0 437 0 1191 0 6408 0 26444 0 170087 0 0 0 DEB KELLY DIRECTOR OF NURSING 136830 0 4379 0 2128 0 8459 0 483 0 152279 0 0 0 PART I, LINE 3 A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. A CITY OF WEST UNION IOWA 426005366 2023-06-30 619608 SEE PART IV 0 0 0 B FAYETTE COUNTY IOWA 426005367 2023-06-30 3413195 SEE PART IV 0 0 0 A 139256 619608 619608 2007 1 0 1 1 B 767109 3413195 3413195 2007 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 FORM 990, SCHEDULE K, PART I, (A), (F): CONVERSION AND REISSUANCE OF THE 2006 NOTES, ORIGINALLY ISSUED 8/31/2006 TO FINANCE CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES, AND PREVIOUSLY REISSUED ON 8/29/2018. FORM 990, SCHEDULE K, PART I, (A), (F): CONVERSION AND REISSUANCE OF THE 2006 NOTES, ORIGINALLY ISSUED 8/31/2006 TO FINANCE CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES, AND PREVIOUSLY REISSUED ON 8/29/2018. FORM 990, PART III, LINE 2 IN MARCH 2024, WE BEGAN PERFORMING ORTHOPEDIC SURGERIES, INCLUDING TOTAL JOINT REPLACEMENTS. FORM 990, PART VI, SECTION A, LINE 6 THE ARTICLES OF INCORPORATION OF PALMER LUTHERAN HEALTH CENTER PROVIDE FOR ONE MEMBER OF THE CORPORATION. THE SOLE CORPORATE MEMBER OF PALMER LUTHERAN HEALTH CENTER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER AND UNDER TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. GUNDERSEN LUTHERAN HEALTH SYSTEM INC. MAY APPOINT FOUR MEMBERS TO THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN THE APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND PRESIDENT/CEO REVIEW THE 990 BEFORE IT IS FILED. THE ENTIRE BOARD OF DIRECTORS RECEIVES A COPY OF THE 990 AFTER IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REQUIRED TO BE SIGNED ANNUALLY BY OFFICERS, DIRECTORS AND KEY EMPLOYEES. THE SIGNED POLICIES ARE THEN REVIEWED BY PALMER LUTHERAN HEALTH CENTER'S COMPLIANCE COMMITTEE TO DETERMINE IF THERE IS A DEEMED CONFLICT OF INTEREST. BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON AREAS WHERE THERE IS A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE CEO, OTHER OFFICERS AND KEY EMPLOYEES WAGES ARE SET BY THE COMPENSATION COMMITTEE AT GUNDERSEN HEALTH SYSTEM. INDUSTRY DATA IS UTILIZED TO SET THE WAGE SCALES UTILIZED TO SET THESE WAGES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990. FORM 990, PART IX, LINE 11G SURGERY SERVICES: PROGRAM SERVICE EXPENSES 288,911. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 288,911. EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 40,818. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,818. LAB SERVICES: PROGRAM SERVICE EXPENSES 539,413. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 539,413. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,444,050. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,444,050. HOME HEALTH SERVICES: PROGRAM SERVICE EXPENSES 282,989. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 282,989. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,961,591. MANAGEMENT AND GENERAL EXPENSES 331,575. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,293,166. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 322,250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,250. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 78,574. 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