2025-05-02T13:42:02-05:00 2024-06-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2023-07-01 420890973 OSCEOLA COMMUNITY HOSPITAL INC OSCE 7127542574 600 9TH AVE N SIBLEY IA 51249 JOSEPH HEITRITTER CEO 7127542574 2025-05-02 1 1 LAURIE HANSON CPA P00851848 6053391999 2025-05-02 2023 2025-03-06 01:10:19Z OSCEOLA REGIONAL HEALTH CENTER JOSEPH HEITRITTER 600 9TH AVE N SIBLEY IA 51249 16268166 0 X HTTPS://WWW.OSCEOLARHC.ORG/ X 1960 IA TO PROVIDE HEALTHCARE TO THE CITIZENS OF OSCEOLA COUNTY AND THE SURROUNDING AREA. 9 9 159 111 0 0 495572 470679 12721948 14877702 76682 130713 175469 159667 13469671 15638761 275198 4149 0 0 6143819 6269081 0 0 51640 7572237 8249249 13991254 14522479 -521583 1116282 20032462 22156705 4841204 5110614 15191258 17046091 X IT IS THE MISSION OF THE OSCEOLA COMMUNITY HOSPITAL TO ENHANCE AND IMPROVE THE QUALITY OF LIFE OF THE POPULATION IT SERVES, TO BE THE AREA'S PREMIER HEALTH CARE SERVICE PROVIDER, AND TO HAVE A POSITIVE IMPACT ON THE LIVES OF THE PEOPLE AND COMMUNITY IT SERVES. 1 0 11070264 4149 14944567 OSCEOLA COMMUNITY HOSPITAL PROVIDED NURSING SERVICES, LAB, RADIOLOGY, PHYSICAL THERAPY, AND OTHER RELATED HOSPITAL FUNCTIONS TO RESIDENTS OF OSCEOLA COUNTY, IOWA, AND NEARBY COUNTIES. IN ADDITION, THE HOSPITAL PROVIDES BEHAVIORAL HEALTH SERVICES TO PROMOTE MENTAL WELLNESS, OFFER DIAGNOSIS, AND TREATMENT TO PATIENTS IN OUR AREA. HEALTH SCREENINGS, SUCH AS CHOLESTEROL AND CARDIAC, ARE PROVIDED AS WELL. THE HOSPITAL WORKS HARD TO BRING OUTREACH SPECIALISTS TO THE FACILITY TO MAKE THESE SERVICES AVAILABLE TO THOSE THAT FIND IT DIFFICULT TO TRAVEL. THE FACILITY'S WELLNESS CENTER PROVIDES PROGRAMS TO THE LOCAL SCHOOL SYSTEM, NURSING HOME FACILITIES, OUTPATIENTS, AND THE COMMUNITY AT LARGE. DURING THE 12 MONTHS OF 7/01/2023-6/30/2024, THE HOSPITAL PROVIDED $125,020 OF CHARITY CARE CHARGES TO INDIVIDUALS. 11070264 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 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 1 0 0 1 23 0 1 159 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ANDREA JOHNSON 7127542574 600 9TH AVENUE NORTH SIBLEY IA 51249 TASHA JENNINGS PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER 40.00 0.00 X 125865 0 32185 TODD HELMERS PHYSICAL THERAPIST 40.00 0.00 X 127272 0 23540 WENDY MARCO CNO 40.00 0.00 X 109201 0 33931 ANDREA JOHNSON CFO 40.00 0.50 X 112332 0 4956 JOSEPH HEITRITTER CEO FROM 09/2023 40.00 0.50 X 42201 0 8506 NATE MCCORMICK INTERIM CEO UNTIL 09/23 40.00 0.00 X 35532 0 8883 NATHAN ROCKMAN PRESIDENT/TRUSTEE FROM 11/2023 0.50 0.00 X X 0 0 0 BILL BOER PRESIDENT FROM 11/2023 0.50 0.00 X X 0 0 0 AMBER BOSMA SECRETARY/PRES-ELECT FROM 11/2023 0.50 0.00 X X 0 0 0 BRIAN MINO TREASURER 0.50 1.00 X X 0 0 0 BRAD JENSEN TRUSTEE/SECRETARY FROM 11/2023 0.50 0.00 X X 0 0 0 ABBY DE ZEEUW TRUSTEE 0.50 0.00 X 0 0 0 ROSALIE ARENDS TRUSTEE UNTIL 11/2023 0.50 1.00 X 0 0 0 HOLLY WILSON TRUSTEE 0.50 1.00 X 0 0 0 GLORIA TORRES TRUSTEE 0.50 0.00 X 0 0 0 CHERYL PETERS TRUSTEE FROM 11/2023 0.50 1.00 X 0 0 0 552403 0 112001 4 0 1 0 AVERA MCKENNAN 1325 S CLIFF AVE SIOUX FALLS SD 571175045 IT AND ADMIN SERVICES 1928882 FOCUSONE-MEDICAL SOLUTIONS INC PO BOX 850737 MINNEAPOLIS MN 55485 TEMP. NURSING SERVICE 396448 QUORUM- QHR 1573 MALLORY LN STE 200 BRENTWOOD TN 37027 BILLING SERVICE 182146 GOODCARE 1000 N WEST AVE STE210 SIOUX FALLS SD 57104 OCCUPATIONAL SERVICES 151548 CMDI(CENTRAL MINNESOTA DIAGNOSTIC) PO BOX 64756 ST PAUL MN 55164 MAMMOGRAPHY & ULTRASOUND LEASE 143382 5 307422 163257 470679 PATIENT REVENUE 621400 14436086 14436086 ANCILLARY ACTIVITY 900099 441616 441616 14877702 20575 20575 92802 0 92802 92802 92802 732802 6741 629405 0 103397 6741 110138 110138 66865 0 66865 66865 15638761 14944567 0 223515 X 4149 4149 324075 324075 4616875 3841496 752973 22406 127192 101647 25376 169 857860 671342 185404 1114 343079 259487 83161 431 1640 1640 107221 107221 3376555 2513701 862854 34126 34126 347134 217004 129464 666 197685 171008 19838 6839 26422 18947 7475 9108 9101 7 119021 119021 972663 744602 227021 1040 190364 190364 MEDICAL SUPPLIES 1781875 1779677 2198 REPAIR AND MAINTENANCE 228628 228150 478 DUE AND SUBSCRIPTION 13686 1574 12112 843121 389358 435266 18497 14522479 11070264 3400575 51640 768720 2629240 11042 11048 2127050 2201291 224018 197969 103675 118987 20286740 15613557 5220577 4673183 8442495 9158923 2716040 2977501 355729 139062 63116 49501 20032462 22156705 802797 1451721 66577 3448844 3258162 522986 400731 4841204 5110614 X 15081688 17035486 109570 10605 15191258 17046091 20032462 22156705 X 1116282 849631 -111080 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 201490 201490 12953957 10203606 2750351 6362770 4864556 1498214 768523 545395 223128 4673183 INTEREST IN AVERA HEALTH FOUNDATION 2773536 F INVESTMENT IN COUNTRY VIEW MANOR 203185 F OTHER INVESTMENTS 780 F 2977501 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 158522 FINANCE LEASE LIABILITY 213531 OPERATING LEASE LIABILITY 28678 400731 X 16471647 849631 849631 15622016 16745 16745 15638761 14517849 0 14517849 4630 4630 14522479 PART X, LINE 2: THE HEALTH CENTER BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HEALTH CENTER WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE HEALTH CENTER AND AFFILIATE'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 16,745. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY ACTIVITY 4,630. 1 1 X 1 X 1 X 1 1 1 0 1 1 58000 58000 0.00400 58000 58000 0.00400 92915 92915 0.00640 1264553 870262 394291 0.02720 2164 2164 0.00010 1359632 870262 489370 0.03370 1417632 870262 547370 0.03770 1 617595 146494 6708619 6731855 -23236 X 1 1 1 1 OSCEOLA COMMUNITY HOSPITAL 600 NINTH AVENUE NORTH SIBLEY IA 51249 HTTPS://WWW.OSCEOLARHC.ORG/ 720109H X X X X ONE PROVIDER BASED CLINIC OSCEOLA COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE 7D X SEE PART V SECTION B X X 1 21 1 SEE PART V SECTION B 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X X X X X X 1 X 0 X X X X 1 X 0 0 OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: DURING THE FISCAL YEAR ENDED JUNE 30, 2022 A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY OSCEOLA REGIONAL HEALTH CENTER FOR THE APPROXIMATELY 12,000 PEOPLE RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN DEFINING COMMUNITY, OSCEOLA REGIONAL HEALTH CENTER HAS TAKEN INTO CONSIDERATION ALL MEMBERS OF OSCEOLA COUNTY AND OUR LARGER SERVICE AREA (LYON, O'BRIEN, DICKINSON AND NOBLES, MN COUNTIES), REGARDLESS OF SOCIO-ECONOMIC STATUS. OSCEOLA REGIONAL HEALTH CENTER IS COMMITTED TO MEETING THE NEEDS OF ALL WHO NEED CARE REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITIES LOCATED IN THIS GEOGRAPHIC AREA INCLUDE BUT ARE NOT LIMITED TO: ASHTON, BOYDEN, GEORGE, HARRIS, LAKE PARK, LITTLE ROCK, MELVIN, OCHEYEDAN, SHELDON, AND SIBLEY IN IOWA, AND BIGELOW, RUSHMORE, AND WORTHINGTON IN MINNESOTA. QUALITATIVE AND QUANTITATIVE INFORMATION WAS GATHERED AND BASED ON CENSUS DATA, TECHNICAL DATA AND FOCUS GROUP FEEDBACK FROM COMMUNITY ORGANIZATIONS, LEADERS, CONSUMERS, AND HEALTH PROFESSIONALS. OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: OSCEOLA PUBLIC HEALTH OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/OSCEOLA-COUNTY-CHNA/ OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS COMPLETED DURING FY22, THE FOLLOWING HEALTH NEED PRIORITIES WERE IDENTIFIED: ACCESS TO CARE (DENTAL CARE, PEDIATRIC CARE, SPECIALTY CARE) ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES COMMUNITY WELLNESS/PREVENTION EMERGENCY MEDICAL SERVICES (EMS) NON-HEALTHCARE - HOUSINGFOLLOWING ARE THE ACTIONS THAT OCH TOOK DURING THE YEAR TO ADDRESS NEEDS IDENTIFIED IN ITS FY22 CHNA:ACCESS TO CARE: DENTAL CARE-- IN PARTNERSHIP WITH THE OSCEOLA COUNTY ECONOMIC DEVELOPMENT, A RECRUITMENT STRATEGY HAS BEEN DEVELOPED TO ATTRACT A DENTAL PROVIDER TO OSCEOLA COUNTY. RECRUITMENT EFFORTS HAVE AND WILL CONTINUE TO BE A PRIORITY. SPECIALTY CARE-- HAVING RECRUITED A CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) IN THE PRIOR YEAR, OSCEOLA REGIONAL HEALTH CENTER WAS ABLE TO CONTINUE OFFERING PAIN MANAGEMENT SERVICES THROUGHOUT FY24. ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES: OSCEOLA REGIONAL HEALTH CENTER HAS PARTNERED WITH INTERCONNECTIONS THERAPY TO HAVE A FULL-TIME MENTAL HEALTH COUNSELOR WHO PROVIDES INDIVIDUAL, FAMILY, AND COUPLES THERAPY/COUNSELING. WE CONTINUE TO ASSESS THE GROWING BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY. ONE IDENTIFIED NEED THAT OUR PMHNP WAS ABLE TO ADDRESS DURING FISCAL YEAR 2024 WAS TO BEGIN PROVIDING BEHAVIORAL HEALTH SERVICES THROUGH OUTREACH OPPORTUNITIES AT AREA SCHOOLS AND NURSING HOMES. COMMUNITY WELLNESS/PREVENTION: OSCEOLA REGIONAL HEALTH CENTER OFFERS DIABETES EDUCATION, WELLNESS CHALLENGES, AND PHYSICAL ACTIVITY CLASSES FOR THE COMMUNITY AS WELL AS PARTNERING WITH LIVE HEALTHY IOWA TO PROMOTE PHYSICAL FITNESS. THE OSCEOLA COUNTY PUBLIC HEALTH OFFICE WHICH IS LOCATED ON THE OSCEOLA REGIONAL HEALTH CENTER CAMPUS PROVIDES IMMUNIZATIONS, BEST CARE FOR BETTER BABIES PROGRAM, FOOT CARE AND THE HOMEMAKER PROGRAM, WHICH ALL SUPPORT COMMUNITY HEALTH AND PREVENTION. TWENTY-FOUR HOUR ACCESS TO THE OSCEOLA COMMUNITY WELLNESS AND REHAB CENTER ALLOWS INDIVIDUALS AND FAMILIES TO WORKOUT TOGETHER IN A SAFE ENVIRONMENT. EMERGENCY MANAGEMENT SERVICES (EMS): OSCEOLA COMMUNITY HOSPITAL LEADERSHIP AND OSCEOLA COUNTY LEADERSHIP CONTINUE TO WORK TOGETHER ON DEVELOPING LONG-TERM STRATEGIES FOR RECRUITMENT AND PROGRAM STABILITY TO ENSURE THE LONG-TERM VIABILITY OF THE EMS SERVICES. NON-HEALTHCARE HOUSING: OSCEOLA REGIONAL HEALTH CENTER IS ACTIVELY ENGAGED IN THE SIBLEY HOUSING DEVELOPMENT COMMITTEE AND IS IDENTIFYING OPPORTUNITIES FOR ADDITIONAL HOUSING. OCH IS EXPLORING OPPORTUNITIES TO UTILIZE CURRENT LAND OWNED BY THE HOSPITAL IN A WAY THAT MIGHT HELP WITH THIS NEED. OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL WILL PRESUMPTIVELY DETERMINE THAT AN INDIVIDUAL QUALIFIES FOR 100% FINANCIAL ASSISTANCE IF THE HOSPITAL OR ITS AGENT OBTAINS EVIDENCE OF ANY OF THE FOLLOWING SITUATIONS. IF A PERSON IS PRESUMPTIVELY DETERMINED TO QUALIFY, THE HOSPITAL WILL SEND A WRITTEN NOTICE INFORMING THE INDIVIDUAL THAT THEIR LIABILITY HAS BEEN FORGIVEN AND NO FURTHER PAYMENTS ARE DUE.- HOMELESSNESS OR RECEIVED CARE FROM A HOMELESS CLINIC;- NO INCOME;- PARTICIPATE IN THE WOMEN'S, INFANT'S, AND CHILDREN'S PROGRAM ("WIC");- ELIGIBLE FOR FOOD STAMPS;- PARTICIPATE IN A SUBSIDIZED SCHOOL LUNCH PROGRAM;- ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED, SUCH AS MEDICAID SPEND-DOWN;- FAMILY OR FRIENDS OF THE INDIVIDUAL PROVIDE INFORMATION ESTABLISHING THE INDIVIDUAL'S INABILITY TO PAY;- LOW-INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;- PATIENT IS DECEASED WITH NO KNOWN ESTATE; OR- PATIENT/GRANTOR IS INCARCERATED, HAS NO ASSETS, AND IS NOT ELIGIBLE FOR PAROLE WITHIN THE NEXT 18 MONTHS. PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY IS AVAILABLE AT: HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/OSCEOLA-COUNTY-CHNA/ PART V, SECTION B, LINE 7B THE COMMUNITY HEALTH NEEDS ASSESSMENT (AS WELL AS THE IMPLEMENTATION STRATEGY) CAN ALSO BE FOUND AT: HTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ PART I, LINE 3C: IN ADDITION TO USING FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE FACILITY USES AN ASSET TEST AND MAY PROVIDE PRESUMPTIVE ELIGIBILITY IF WARRANTED. PART I, LINE 6A: THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS INCLUDED IN A REPORT PREPARED BY THE IOWA HOSPITAL ASSOCIATION, RATHER THAN IN A SEPARATE REPORT PREPARED BY THE ORGANIZATION. THIS REPORT IS MADE AVAILABLE BY THE IOWA HOSPITAL ASSOCIATION TO THE PUBLIC THROUGH THEIR WEBSITE.HTTPS://WWW.IHAONLINE.ORG/INFORMATION/ECONOMIC-IMPACT-COMMUNITY-BENEFITS/FIND-REPORTS/ PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. ACTUAL COSTS FROM THE GENERAL LEDGER WERE USED FOR LINE 7E AND 7I.LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2023. THEREFORE, 23.72% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGE 13 AND 14 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/24. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $118,910.MEDICARE FEE SCHEDULE REVENUE: $124,920MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS $(243,829)NET (SHORTAGE) $(118,910) PART III, LINE 9B: ACCOUNTS THAT MEET THE CRITERIA FOR THE FINANCIAL ASSISTANCE POLICY WILL BE WRITTEN OFF IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS THAT DO NOT MEET THE CRITERIA FOR FINANCIAL ASSISTANCE WILL PROCEED THROUGH THE COLLECTION PROCESS. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT AN ACCOUNT IN COLLECTION BELONGS TO A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT WILL BE REMOVED FROM COLLECTION AND RETURNED TO THE HOSPITAL FOR RESOLUTION. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH FORMAL PROCESSES THAT INCLUDE MEETINGS, SURVEY AND COMMUNITY INPUT PRIOR TO UNDERTAKING ANY LARGE PROJECTS. THROUGHOUT THE YEAR, COMMUNITY NEEDS ARE ASSESSED INFORMALLY AT VARIOUS COMMUNITY MEETINGS AND THROUGH PATIENT SURVEYS. THE ORGANIZATION ALSO ASSISTS THE HOME HEALTH DEPARTMENT/PUBLIC HEALTH WITH A COMMUNITY NEEDS ASSESSMENT AND INFORMATION FROM THE CHNA IS UTILIZED TO HELP PLAN SERVICES THE ORGANIZATION OFFERS. PART VI, LINE 3: DURING THE COURSE OF PRE-REGISTRATION A MODE OF PAYMENT IS RECORDED ON THE ADMISSION FORM. IF INSURANCE IS INDICATED, BENEFITS ARE REQUESTED FROM THE INSURANCE COMPANY. IF IT IS NOTED THAT THE ACCOUNT HAS A LARGE DEDUCTIBLE OR IS SELF-PAY, THE INFORMATION IS FORWARDED TO THE COLLECTION STAFF AND SOCIAL SERVICES. OPTIONS FOR HANDLING PAYMENT OF THE ACCOUNT ARE THEN DISCUSSED WITH THE PATIENT OR THE RESPONSIBLE PARTY. IF THE PATIENT OR RESPONSIBLE PARTY IS NOT AVAILABLE AT THE TIME THE INFORMATION IS RECEIVED BY THE BUSINESS OFFICE OR SOCIAL SERVICE STAFF, EFFORTS TO CONTACT THEM INCLUDE PHONE AND WRITTEN CORRESPONDENCE. IF THE PARTY DOES NOT RESPOND, THE ACCOUNT IS HANDED OVER TO THE COLLECTION AREA. THIS PROCESS OFTEN REQUIRES A COMBINATION OF BUSINESS OFFICE AND SOCIAL SERVICE STAFF WORKING TOGETHER.OPTIONS FOR ANY SELF-PAY OBLIGATIONS INCLUDE PAYMENT IN FULL, PAYMENT PLANS, VARIOUS ASSISTANCE PROGRAMS, AND THE FINANCIAL ASSISTANCE OFFERED BY OSCEOLA COMMUNITY HOSPITAL'S CHARITY CARE. INFORMATION REGARDING THESE OPTIONS IS MADE AVAILABLE AT THIS TIME.DURING THE DISCUSSIONS, INFORMATION IS REQUESTED TO ASSESS AND APPROVE FINANCIAL STATUS IF PAYMENTS, PROGRAM APPLICATION, OR CHARITY ARE INDICATED. ASSISTANCE IS OFFERED FOR COMPLETION OF APPLICATIONS AND INSTRUCTIONS ARE GIVEN FOR COMPLETION OF FINANCIAL ASSESSMENTS. PARTICULAR ACCOUNTS MAY ALSO BE BROUGHT TO THE ATTENTION OF THE BUSINESS OFFICE OR SOCIAL SERVICES BY THE COLLECTIONS STAFF, PATIENTS THEMSELVES, OR RELATIVES OF PATIENTS. THIS USUALLY OCCURS WHEN THE CIRCUMSTANCES OF THE PATIENT CHANGES AFTER A TIME PERIOD HAS PASSED. WHEN NOTIFICATION IS RECEIVED, THESE CASES ARE REASSESSED. PART VI, LINE 4: SIBLEY IS LOCATED IN OSCEOLA COUNTY IOWA. SIBLEY HAS A POPULATION OF 2,697. IT IS ALSO THE COUNTY SEAT OF OSCEOLA COUNTY. SIBLEY IS CURRENTLY DECLINING AT A RATE OF 1.17% ANNUALLY AND ITS POPULATION HAS DECREASED BY 5.6% SINCE THE MOST RECENT CENSUS. THE AVERAGE HOUSEHOLD INCOME IN SIBLEY IS $73,547 WITH A POVERTY RATE OF 23.72%. THE MEDIAN AGE IN SIBLEY IS 39 YEARS. PART VI, LINE 5: OSCEOLA COMMUNITY HOSPITAL IS FOCUSED ON SERVING THE NEEDS OF THE COMMUNITY. THE GOVERNING BODY OF THE HOSPITAL IS MADE UP ENTIRELY OF VOLUNTEERS FROM THE COMMUNITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN ITS COMMUNITY. EXCESS FUNDS ARE USED FOR THE IMPROVEMENT OF PATIENT CARE AND FACILITIES. THE HOSPITAL IS CONTRACTED WITH SEVERAL HIGHER LEARNING HEALTH CARE RELATED INSTITUTIONS TO BE A CLINICAL SITE FOR VARIOUS HEALTH CARE FIELDS. THE FACILITY IS OPEN TO ANYONE WHO WANTS TO LEARN ABOUT CAREERS IN THE HEALTH CARE INDUSTRY THROUGH THE CLINICAL PROGRAM AND THROUGH A HIGH SCHOOL SHADOWING PROGRAM. THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL ADMINISTRATION IS VERY RECEPTIVE TO INPUT FROM THE COMMUNITY. OSCEOLA COMMUNITY HOSPITAL DEDICATES RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU SHOT CLINICS, BLOOD DRIVES, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. WE ALSO HAVE A FITNESS CENTER SO PATIENTS AND THE COMMUNITY CAN MAINTAIN A HEALTHY LIFESTYLE. PART VI, LINE 6: OSCEOLA COMMUNITY HOSPITAL IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND OSCEOLA COMMUNITY HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. OSCEOLA COMMUNITY HOSPITAL ALSO HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCE ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO THE HOSPITAL AT A COST BELOW THAT WHICH OSCEOLA COMMUNITY HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. AVERA HEALTH AND OSCEOLA COMMUNITY HOSPITAL DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. X 1 1 X X X 0 0 0 0 0 0 0 0 0 TASHA JENNINGS PSYCHIATRIC MENTAL HEALTH NURSE PRAC 122115 0 3750 0 0 0 0 0 32609 0 158474 0 0 0 TODD HELMERS PHYSICAL THERAPIST 124922 0 2350 0 0 0 4013 0 20360 0 151645 0 0 0 PART I, LINE 1A ORHC PAID THE 2024 FAMILY MEMBERSHIP DUES TO THE 2024 SIBLEY MUNICIPAL GOLF COURSE FOR THE CEO. THE BENEFIT WAS INCLUDED IN TAXABLE INCOME ON JOE'S W-2. A CITY OF SIBLEYIA 426005203 2016-02-24 4776000 TO REFINANCE SERIES 2001 AND 2007 BONDS 0 0 0 A 1461719 4776000 95520 4680101 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 FORM 990, PART III, LINE 2 JULY 2023, PAIN MANAGEMENT SERVICES WERE OFFERED FOR PATIENTS WITH THE HOPE OF HELPING PATIENTS REDUCE THE NEED TO USE OPIOIDS FOR PAIN TREATMENT. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE ORGANIZATION. THE PRESIDENT SHALL SERVE AS THE CHAIR OF THE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF TRUSTEES, AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 REGULAR MEMBERS ARE THOSE PERSONS, CORPORATIONS, ASSOCIATIONS OR PARTNERSHIPS WHO HAVE CONTRIBUTED AND PAID INTO THE CORPORATION A MINIMUM OF $100 OR MORE TO FURTHER THE OBJECTIVES OF THE CORPORATION. MEMBERSHIP SHALL BE LIFELONG AND NONTRANSFERABLE. EACH MEMBER WHOSE NAME IS ENDORSED ON THE MEMBERSHIP CERTIFICATES SHALL BE QUALIFIED TO ORIGINATE AND TAKE PART IN THE DISCUSSION OF ANY SUBJECT THAT MAY PROPERLY COME BEFORE THE ANNUAL MEETING OF THE CORPORATION, TO VOTE ON SUCH SUBJECTS, AND TO HOLD ANY OFFICE TO WHICH THE MEMBER MAY TO ELECTED OR APPOINTED. NO EMPLOYEE OR EMPLOYEE'S SPOUSE OF THE CORPORATION MAY BE ELECTED TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A TRUSTEES ARE ELECTED TO THE BOARD OF TRUSTEES FROM THE MEMBERS AT THE ANNUAL MEETING OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT OF THE HOSPITAL. A COPY OF THE 990 WILL BE PROVIDED TO BOARD MEMBERS PRIOR TO FILING IT WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR/TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A CONFLICT OF INTEREST STATEMENT. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF A FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE DIRECTORS/TRUSTEES AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER THE INTERESTED PERSON LEAVES THE MEETING, THE REMAINING BOARD OR COMMITTEE MEMBERS WILL DISCUSS AND VOTE UPON WHETHER A CONFLICT OF INTEREST EXISTS. ALSO, IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A DIRECTOR, TRUSTEE, OR MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION SHALL BE TAKEN IF NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION SPECIALIST REVIEWS THE COMPENSATION WITH THE BOARD OF TRUSTEES ANNUALLY. THE SPECIALIST REVIEWS MARKET VALUE AND PRESENTS A RECOMMENDATION TO THE BOARD OF TRUSTEES. THE BOARD MAKES THEIR DECISION ON THE INFORMATION PRESENTED. THE COMPENSATION REVIEW PROCESS IS COMPLETED ANNUALLY FOR ALL OFFICERS AND TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AND THE FORM 990 IS AVAILABLE AT THE ANNUAL MEETING AND UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,235,982. MANAGEMENT AND GENERAL EXPENSES 862,854. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,098,836. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,277,719. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,277,719. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 10,899. NET ASSETS RELEASED FROM RESTRICTIONS -126,609. AUXILIARY ACTIVITY 4,630. HEARTWOOD HEIGHTS 409 9TH AVE NORTH SIBLEY IA 51249 421495686 INDEPENDENT;ASSISTED LIVING IA 501(C)(3) PF OSCEOLA COMMUNITY HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 HEARTWOOD HEIGHTS O 442174 ACTUAL COST HEARTWOOD HEIGHTS Q 71639 ACTUAL COST HEARTWOOD HEIGHTS L 162123 ACTUAL COST