2025-11-17T09:59:08-06:00 2024-12-31 420714325 RSM US LLP 4650 EAST 53RD STREET DAVENPORT IA 528073479 990 2024-01-01 421430122 PELLA HOSPITAL FOUNDATION PELL 6416283150 404 JEFFERSON STREET PELLA IA 50219 ROBERT KROESE CEO, PELLA REGIONAL HEALTH CENTER 6416283150 2025-11-12 1 0 JENIFER L CHASE P01306883 5638884000 2025-11-12 2024 2025-03-06 01:10:19Z PELLA REG HEALTH CENTER FDTN ROBERT KROESE 404 JEFFERSON STREET PELLA IA 50219 3704004 0 X WWW.PELLAHEALTH.ORG/ABOUT-US/FOUNDATION X 1994 IA TO SUPPORT PELLA REGIONAL HEALTH CENTER IN ITS MISSION TO PROVIDE HEALTHCARE 8 7 0 47 0 0 872824 1365443 0 0 208380 596005 -16759 -14170 1064445 1947278 1267460 1248104 0 0 0 0 0 0 0 51777 51866 1319237 1299970 -254792 647308 8013384 7823566 1003338 13744 7010046 7809822 X TO SUPPORT PELLA REGIONAL HEALTH CENTER IN ITS MISSION TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION 0 0 1276968 1248104 THE PELLA HOSPITAL FOUNDATION WAS ESTABLISHED IN 1994 TO SUPPORT PELLA REGIONAL HEALTH CENTER IN ITS MISSION TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. WITH OUR STORIED HISTORY, THE STRENGTH AND STABILITY THAT WE HAVE BUILT ENSURES A BRIGHT AND PROMISING LONG-TERM FUTURE, NOT ONLY FOR THE FOUNDATION ITSELF, BUT ALSO FOR THE PEOPLE WE SERVE. FROM SENIORS WHO NEED A LITTLE HELP TO CONTINUE LIVING INDEPENDENTLY, TO NEWBORNS WHO ARE DEPENDENT ON MANY; FROM ADULTS BATTLING CHRONIC DISEASE, TO YOUNGSTERS BENEFITING FROM OUR EDUCATIONAL OFFERINGS, WE STRIVE TO REACH EVERY GENERATION IN EVERY COMMUNITY WE SERVE.SEE SCHEDULE O FOR MORE INFORMATION ABOUT THE LEGACY SOCIETY.THE LEGACY SOCIETY, A SELECT GROUP OF FRIENDS OF THE HOSPITAL, IS GROWING IN MEMBERS. BEGINNING IN 2006, A GROUP OF INDIVIDUALS WHO SHARED A VISION FOR THE HOSPITAL AND ACTIVELY PARTICIPATED FINANCIALLY IN ACHIEVING THIS GOAL WERE RECOGNIZED FOR THEIR SIGNIFICANT CONTRIBUTIONS. IT IS AN EXCITING TIME TO BECOME PART OF THE PELLA REGIONAL LEGACY THAT WILL IMPACT AND LEAD HEALTHCARE IN THE SURROUNDING AREAS FOR MANY YEARS TO COME. 1276968 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X DAWN PLAYLE 6416283150 404 JEFFERSON STREET PELLA IA 50219 BARB BRAAFHART DIRECTOR 0.20 0.00 X 0 0 0 JIM BRANDL DIRECTOR 0.20 0.50 X 0 0 0 JOEL CORNILSEN SECRETARY/TREASURER 0.20 0.00 X X 0 0 0 KYLE EDWARDS DIRECTOR 0.20 0.00 X 0 0 0 MIKE MONTGOMERY VICE PRESIDENT 0.20 0.00 X X 0 0 0 LARRY VAN MAANAN DIRECTOR 0.20 0.00 X 0 0 0 MARK VAN ROEKEL PRESIDENT 0.20 0.00 X X 0 0 0 DR ELIZABETH WOOSTER PIERSON DIRECTOR 0.20 40.00 X 0 218043 52459 ROBERT KROESE CEO, PELLA REGIONAL HEALTH CENTER 2.00 40.00 X 0 456894 53732 0 674937 106191 0 0 1 0 0 57882 1307561 1365443 221502 221502 2117059 1742556 374503 374503 374503 0 57882 14170 -14170 -14170 1947278 0 0 581835 1205635 1205635 42469 42469 22673 22673 4381 4381 PROFESSIONAL FEES 23075 23075 DONOR RECOGNITION EXPEN 1354 1354 BANK FEES 329 329 APPEALS EXPENSE 54 54 1299970 1276968 23002 0 10000 10000 6478020 6088733 1525364 1724833 8013384 7823566 1003338 13744 1003338 13744 X 1266821 1169672 5743225 6640150 7010046 7809822 8013384 7823566 647308 152468 0 X X 0 1 X 0 0 X 206672 268742 292599 872824 1365443 3006280 206672 268742 292599 872824 1365443 3006280 1685418 1320862 147831 152381 162193 187036 221502 870943 3877223 0.34070 0.43200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4654241 437544 259085 23084 311098 5016688 4331526 11805 411379 18261 82208 4654241 5088270 63618 -706819 20310 93233 4331526 4642204 40919 546374 19500 121727 5088270 4705450 21809 408663 493718 4642204 0.00000 0.57970 0.42030 1 0 0 POOLED AGENCY FUNDS HELD AT THE PELLA COMMUNITY FOUNDATION 1724833 1724833 X PART V, LINE 4: ENDOWMENT FUNDS HELP FUND HEALTH CARE NEEDS AND ADVANCE AND PROMOTE THE HEALTH AND WELL-BEING OF PEOPLE IN THE COMMUNITY AND SURROUNDING AREAS. THE SPECIFIC ENDOWMENTS ARE GENERAL ENDOWMENT, SPIRITUAL SERVICES ENDOWMENT, EDUCATION ENDOWMENT, AND HOSPICE ENDOWMENT. PART X, LINE 2: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) AND PELLA HEALTH FOUNDATION (FOUNDATION) ARE ORGANIZED AS IOWA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HEALTH CENTER AND FOUNDATION ARE EACH ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THEY ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE HEALTH CENTER AND FOUNDATION BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HEALTH CENTER AND FOUNDATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. FORM 990 AND FORM 990T FILED BY THE HOSPITAL AND FOUNDATION ARE GENERALLY SUBJECT TO EXAMINATION BY THE IRS UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. PELLA IN PINK 38583 38583 304 9171 HEARTS FOR HOSPICE 10414 10414 1164 1 8885 8885 3531 57882 57882 304 13866 14170 -14170 1 PELLA REGIONAL HEALTH CENTER 404 JEFFERSON STREET PELLA IA 50219 420842204 501(C)(3) 1132669 0 FACILITY IMPROVEMENTS 1 0 TUITION SCHOLARSHIPS 20 15890 HOSPICE DAY OF CARE 4 23400 PART I, LINE 2: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) PROVIDES PELLA HOSPITAL FOUNDATION (FOUNDATION) WITH RECEIPTS AFTER APPROVED PURCHASES HAVE BEEN MADE. RECEIPTS ARE MATCHED WITH PURCHASE APPROVALS TO ENSURE THAT THE FUNDS ARE USED AS INTENDED. SCHOLARSHIPS ARE AWARDED BY THE EDUCATION COMMITTEE. INDIVIDUALS SELECTED EITHER BROUGHT BILLING INFORMATION TO THE FINANCE OFFICE AND THE INSTITUTION WAS PAID DIRECTLY OR THEY PROVIDED A RECEIPT FROM THE INSTITUTION AND THEN THEY WERE REIMBURSED. THIS WAS TO ENSURE THE FUNDS WERE USED APPROPRIATELY. THE DAY OF CARE PROGRAM PROVIDES ASSISTANCE TO INDIVIDUALS WHO ARE IN NEED OF COMPASSIONATE HOSPICE CARE AT THE COMFORT HOUSE. THE ASSISTANCE PROVIDED IS PAID DIRECTLY TO THE INDIVIDUAL'S ACCOUNT TO RELIEVE SOME OF THE COSTS OF THE CARE PROVIDED TO THEM. 0 0 0 0 0 0 0 0 0 ROBERT KROESE CEO, PELLA REGIONAL HEALTH CENTER 0 399658 0 56512 0 724 0 20700 0 33032 0 510626 0 0 DR ELIZABETH WOOSTER PIERSON DIRECTOR 0 208043 0 10000 0 0 0 14034 0 38425 0 270502 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE PRESIDENT, VICE PRESIDENT, SECRETARY, TREASURER, AND ONE MEMBER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN DOES NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD, AND IT MUST REFER ALL EXTRAORDINARY MATTERS OF IMPORTANCE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PELLA HOSPITAL FOUNDATION IS PELLA REGIONAL HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS ARE SELECTED BY PELLA REGIONAL HEALTH CENTER, THE SOLE MEMBER OF PELLA HOSPITAL FOUNDATION, FROM AMONG PERSONS WHO POSSESS THE ABILITY TO PARTICIPATE EFFECTIVELY IN THE BOARD'S RESPONSIBILITIES, AND INCLUDE, BUT ARE NOT LIMITED TO, PERSONS WHO ARE RESIDENTS OF THE COMMUNITY SERVED BY PELLA REGIONAL HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO PELLA REGIONAL HEALTH CENTER, THE SOLE MEMBER OF PELLA HOSPITAL FOUNDATION, AND NO ATTEMPTED EXERCISE OF SUCH POWERS BY ANYONE OTHER THAN PELLA REGIONAL HEALTH CENTER ARE VALID: 1) TO CHANGE OR ALTER THE PHILOSOPHY, OBJECTIVES, AND PURPOSES OF PELLA REGIONAL HEALTH CENTER FOUNDATION FOR WHICH IT WAS AND IS FORMED AND EXISTS 2) TO ELECT MEMBERS OF THE BOARD OF DIRECTORS AND TO REMOVE THE SAME WITH OR WITHOUT CAUSE 3) TO AMEND, ALTER, MODIFY, OR REPEAL THE ARTICLES OF INCORPORATION 4) TO AMEND, ALTER, MODIFY, OR REPEAL BYLAWS 5) TO CONSOLIDATE PELLA REGIONAL HEALTH CENTER FOUNDATION WITH ANOTHER CORPORATION, ORGANIZATION, PROGRAM, OR TO AFFILIATE PELLA REGIONAL HEALTH CENTER FOUNDATION WITH ANOTHER CORPORATION, ORGANIZATION, OR PROGRAM WHERE THE AFFILIATION INVOLVES THE EXERCISE OF THE POWERS TO PELLA REGIONAL HEALTH CENTER 6) TO TERMINATE THE EXISTENCE OF PELLA REGIONAL HEALTH CENTER FOUNDATION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON SUCH TERMINATION 7) TO REQUIRE A CERTIFIED AUDIT OF CORPORATE FUNDS AT ANY TIME AND TO APPOINT THE FISCAL AUDITOR OF PELLA REGIONAL HEALTH CENTER FOUNDATION ANNUALLY. ACTIONS INITIATED BY THE BOARD OF DIRECTORS ON THE FOLLOWING MATTERS CAN BE AUTHORIZED BY AND BE EFFECTIVE ONLY WITH THE APPROVAL OF PELLA REGIONAL HEALTH CENTER: 1) THE APPOINTMENT OF THE CHIEF EXECUTIVE OFFICER OF PELLA REGIONAL HOSPITAL FOUNDATION 2) THE ACQUISITION, PURCHASE, SALE, LEASE, TRANSFER, OR ENCUMBRANCE OF ANY REAL ESTATE OR ANY SUBSTANTIAL PART OF OTHER ASSETS OF PELLA REGIONAL HEALTH CENTER FOUNDATION 3) THE APPROVAL OF ANY DISSOLUTION, MERGER, AFFILIATION, RESTRUCTURING, FINANCING, OR REFINANCING OF PELLA REGIONAL HEALTH CENTER FOUNDATION OR OF ANY CORPORAITON OF WHICH PELLA REGIONAL HEALTH CENTER IS A MEMBER OR CONTROLLING SHAREHOLDER OR OTHER ENTITY 4) ANY BORROWING NOT INDICIATED IN THE CAPITAL OR OPERATING BUDGET OF PELLA REGIONAL HEALTH CENTER FOUNDATION 5) THE ADOPTION OF THE ANNUAL OPERATING AND CAPITAL BUDGETS OF PELLA REGIONAL HEALTH CENTER FOUNDATION 6) ANY CONTRACT OF PELLA REGIONAL HEALTH CENTER FOUNDATION WHERE THE AMOUNT OF THE FUNDS TO BE EXPENDED OR THE OBLIGATION INCURRED IS IN EXCESS OF $100,000 7) EXPENDITURE OF FUNDS HELD AS AN ENDOWMENT BY PELLA REGIONAL HEALTH CENTER FOUNDATION FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS DISTRIBUTED TO ALL CURRENT BOARD MEMBERS AND IS REVIEWED BY THE CEO, CFO, AND FINANCE MANAGER OF PELLA REGIONAL HEALTH CENTER, THE SOLE MEMBER OF PELLA HOSPITAL FOUNDATION, BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY ALL BOARD MEMBERS AND OFFICERS ANNUALLY. THE STATEMENTS ARE REVIEWED BY THE PRESIDENT OF THE BOARD. IF A POTENTIAL CONFLICT ARISES THE PRESIDENT OF THE BOARD FOLLOWS UP. PELLA HOSPITAL FOUNDATION DOES NOT HAVE ANY KEY EMPLOYEES THAT WOULD BE SUBJECT TO THIS POLICY. ANY DUALITY OF INTEREST OR POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY MEMBER OF THE BOARD OF DIRECTORS OR OFFICER SHOULD BE DISCLOSED TO THE OTHER DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH THE ANNUAL DISCLOSURE PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY DIRECTOR HAVING AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON ANY SUCH MATTER, AND HE/SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR MEETING, EVEN WHEN PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE DIRECTOR'S ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XII, LINE 2C: PELLA REGIONAL HEALTH CENTER, THE SOLE MEMBER OF PELLA HOSPITAL FOUNDATION, HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT. THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM PRIOR TAX YEAR. PELLA REGIONAL HEALTH CENTER 404 JEFFERSON STREET PELLA IA 50219 420842204 HEALTHCARE SERVICES IA 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0