HEALTH INC HOSPICE: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HEALTH INC HOSPICE (EIN 38-3320710)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202321359349313942
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T15:28:05-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E 10TH ST STE 500 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571046375 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 383320710 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE OF SIOUXLAND | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOSP | BusinessNameControlTxt |
| Phone | 7122334144 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 NEBRASKA ST | AddressLine1Txt |
| City | SIOUX CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51103 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KARA WINKER | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 7122334144 | PhoneNum |
| Signature | 2023-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KARA | PersonFirstNm |
| Person Last | WINKER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAURIE HANSON CPA | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2023-05-12 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | JACQUE KREBER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 NEBRASKA ST | AddressLine1Txt |
| City | SIOUX CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51103 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,268,312 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HOSPICEOFSIOUXLAND.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HOSPICE AND PALLIATIVE CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 99 | TotalEmployeeCnt |
| Total Volunteers | 118 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $327,322 | PYContributionsGrantsAmt |
| CY Contributions Grants | $245,106 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,824,267 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,670,908 | CYProgramServiceRevenueAmt |
| PY Investment Income | $468,124 | PYInvestmentIncomeAmt |
| CY Investment Income | $334,168 | CYInvestmentIncomeAmt |
| PY Other Revenue | $866,541 | PYOtherRevenueAmt |
| CY Other Revenue | $18,130 | CYOtherRevenueAmt |
| PY Total Revenue | $9,486,254 | PYTotalRevenueAmt |
| CY Total Revenue | $6,268,312 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $750 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,452,801 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,680,875 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $288 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,044,857 | PYOtherExpensesAmt |
| CY Other Expenses | $3,682,850 | CYOtherExpensesAmt |
| PY Total Expenses | $8,497,658 | PYTotalExpensesAmt |
| CY Total Expenses | $7,364,475 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $988,596 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,096,163 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,817,698 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,216,539 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,165,142 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,097,613 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,652,556 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,118,926 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE HIGH QUALITY, COMPASSIONATE CARE AT THE END OF LIFE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,792,732 | ExpenseAmt |
| Grant | $750 | GrantAmt |
| Revenue | $5,689,038 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES HOSPICE CARE SERVICES TO THOSE AT THE END OF LIFE. DURING THE FISCAL YEAR, 533 PATIENTS IN IOWA, NEBRASKA, AND SOUTH DAKOTA RECEIVED 29,843 DAYS OF HOSPICE CARE. IN ADDITION TO HOSPICE CARE, 294 PATIENTS RECEIVED PALLIATIVE CARE SERVICES DURING THE FISCAL YEAR. | Desc |
| Total Program Service Expenses | $5,792,732 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 99 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KARA WINKER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7122529418 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 NEBRASKA ST PO BOX 5017 | AddressLine1Txt |
| City | SIOUX CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51101 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| DALE HOLDIMAN | ||||||||
| MEDICAL DIRECTOR (END 04/2021) | 40.00 | 0.00 | Yes (X) | $159,588 | $0 | $19,991 | ||
| AMY CALLAGHAN | ||||||||
| MEDICAL DIRECTOR | 15.00 | 0.00 | Yes (X) | $148,483 | $0 | $0 | ||
| STEFANI MOSER WIGTON | ||||||||
| RN | 40.00 | 0.00 | Yes (X) | $102,693 | $0 | $31,262 | ||
| SHERRI MOREY | ||||||||
| RN | 40.00 | 0.00 | Yes (X) | $121,277 | $0 | $1,818 | ||
| RENE GROVER | ||||||||
| RN | 40.00 | 0.00 | Yes (X) | $118,071 | $0 | $2,726 | ||
| KARA WINKER | ||||||||
| DIRECTOR OF FINANCE | 20.00 | 30.00 | $0 | $85,476 | $17,597 | Yes (X) | ||
| JACQUELINE KREBER | ||||||||
| EXECUTIVE DIRECTOR (BEGIN 01/2022) | 40.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| CRAIG BERENSTEIN | ||||||||
| PRESIDENT | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| DOUG SKINNER | ||||||||
| VICE PRESIDENT | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ELIZABETH HUGHES | ||||||||
| TREASURER | 1.00 | 2.10 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LORENZO SUTER | ||||||||
| SECRETARY (BEGIN 07/2021) | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LEAH GLASGO | ||||||||
| SECRETARY (END 07/2021) | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JAMES GOBELL | ||||||||
| DIRECTOR | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | ||
| JESICA HANSON | ||||||||
| DIRECTOR | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | ||
| TRACY LARSON | ||||||||
| DIRECTOR | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | ||
| WENDY LINDLEY | ||||||||
| DIRECTOR | 1.00 | 1.60 | $0 | $0 | $0 | Yes (X) | ||
| MARY ANNE MILLER | ||||||||
| INTERIM EXEC DIR THROUGH 1/28/22 | 40.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $650,112 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $85,476 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $73,394 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MERCY ONE SIOUXLAND MEDICAL | |||||
| 801 5TH ST | SIOUX CITY | IA | 51102 | CONTRACT NURSING | $339,571 |
| SIMITREE HEALTHCARE CONSULTING | |||||
| 4130 WHITNEY AVE | HAMDEN | CT | 06518 | INTERIM DIRECTOR; NURSING CONSULTANT | $282,326 |
| SUNRISE MANOR INC | |||||
| 5501 GORDON DR | SIOUX CITY | IA | 51106 | ROOM & BOARD | $186,465 |
| NETSYS | |||||
| 1915 MORNINGSIDE AVE | SIOUX CITY | IA | 51106 | IT SERVICES | $124,710 |
| CONTINENTAL SPRINGS | |||||
| 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | ROOM & BOARD | $124,304 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $63,020 | GovernmentGrantsAmt |
| All Other Contributions | $182,086 | AllOtherContributionsAmt |
| Total Contributions | $245,106 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT REVENUE | Desc |
| Business | 621610 | BusinessCd |
| Total Revenue Column | $5,670,908 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,670,908 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,670,908 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $163,965 | TotalRevenueColumnAmt |
| Exclusion | $163,965 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $170,203 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $170,203 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,203 | TotalRevenueColumnAmt |
| Exclusion | $170,203 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,130 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,130 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $18,130 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,268,312 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,689,038 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $334,168 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $750 | TotalAmt |
| Program Services | $750 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,653 | TotalAmt |
| Management And General | $111,653 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,818,443 | TotalAmt |
| Program Services | $2,369,609 | ProgramServicesAmt |
| Management And General | $448,834 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,711 | TotalAmt |
| Program Services | $195,779 | ProgramServicesAmt |
| Management And General | $44,932 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $294,556 | TotalAmt |
| Program Services | $253,196 | ProgramServicesAmt |
| Management And General | $41,360 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,512 | TotalAmt |
| Program Services | $175,283 | ProgramServicesAmt |
| Management And General | $40,229 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,173 | TotalAmt |
| Management And General | $172,173 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,523 | TotalAmt |
| Management And General | $5,523 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,208 | TotalAmt |
| Management And General | $43,208 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,390 | TotalAmt |
| Management And General | $65,390 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,042,891 | TotalAmt |
| Program Services | $1,671,008 | ProgramServicesAmt |
| Management And General | $371,883 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,956 | TotalAmt |
| Management And General | $18,956 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,724 | TotalAmt |
| Management And General | $59,724 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,164 | TotalAmt |
| Program Services | $222,217 | ProgramServicesAmt |
| Management And General | $45,947 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,553 | TotalAmt |
| Program Services | $167,512 | ProgramServicesAmt |
| Management And General | $7,041 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,735 | TotalAmt |
| Program Services | $14,626 | ProgramServicesAmt |
| Management And General | $3,109 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,148 | TotalAmt |
| Program Services | $78,157 | ProgramServicesAmt |
| Management And General | $16,991 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,963 | TotalAmt |
| Management And General | $44,963 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| OTHER SUPPLIES | $379,135 | $379,122 | $0 | $13 |
| MEDICATION | $246,072 | $246,072 | $0 | $0 |
| DUES & SUBSCRIPTIONS | $28,972 | $4,583 | $24,389 | $0 |
| OTHER EXPENSES | $20,243 | $14,818 | $5,150 | $275 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,364,475 | TotalAmt |
| Program Services | $5,792,732 | ProgramServicesAmt |
| Management And General | $1,571,455 | ManagementAndGeneralAmt |
| Fundraising | $288 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,617,069 | BOYAmt |
| EOY | $1,687,408 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $492,736 | BOYAmt |
| EOY | $506,291 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,538 | BOYAmt |
| EOY | $99,319 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,218,197 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,290,668 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,022,328 | BOYAmt |
| EOY | $927,529 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,100,805 | BOYAmt |
| EOY | $6,122,333 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,482,222 | BOYAmt |
| EOY | $873,659 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,817,698 | BOYAmt |
| EOY | $10,216,539 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,165,142 | BOYAmt |
| EOY | $933,309 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $164,304 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,165,142 | BOYAmt |
| EOY | $1,097,613 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,022,891 | BOYAmt |
| EOY | $7,384,206 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,629,665 | BOYAmt |
| EOY | $1,734,720 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,652,556 | BOYAmt |
| EOY | $9,118,926 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,817,698 | BOYAmt |
| EOY | $10,216,539 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,096,163 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,243,807 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$193,660 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $218,186 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $199,905 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $312,322 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,173,657 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $245,106 | CurrentTaxYearAmt |
| Total | $2,149,176 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,178,345 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,189,805 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,694,538 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,859,249 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,689,038 | CurrentTaxYearAmt |
| Total | $46,610,975 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,396,531 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,389,710 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,006,860 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,032,906 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,934,144 | CurrentTaxYearAmt |
| Total | $48,760,151 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $48,760,151 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $373,200 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $396,685 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $273,587 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $468,124 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $163,965 | CurrentTaxYearAmt |
| Total | $1,675,561 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $373,200 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $396,685 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $273,587 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $468,124 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $163,965 | CurrentTaxYearAmt |
| Total | $1,675,561 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $20,291 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $21,299 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $41,590 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,790,022 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,807,694 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,280,447 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,501,030 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,098,109 | CurrentTaxYearAmt |
| Total | $50,477,302 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.96600 | PublicSupportCY509Pct |
| Public Support PY509 | 0.96700 | PublicSupportPY509Pct |
| Investment Income CY | 0.03320 | InvestmentIncomeCYPct |
| Investment Income PY | 0.03220 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $973,551 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$100,459 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $14,525 | AdministrativeExpensesAmt |
| End Year Balance | $858,567 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $805,973 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $167,578 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $973,551 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $782,509 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $23,464 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $805,973 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $743,765 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $38,744 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $782,509 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $704,611 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $39,154 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $743,765 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.58000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.42000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,595,864 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,690,529 | DepreciationAmt |
| Book Value | $905,335 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,455 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,123 | DepreciationAmt |
| Book Value | $1,332 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $614,878 | OtherCostOrOtherBasisAmt |
| Depreciation | $594,016 | DepreciationAmt |
| Book Value | $20,862 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $927,529 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST IN TRUSTS | Desc |
| Book Value | $873,659 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $873,659 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PENSION CONTRIBUTION | Desc |
| Amt | $164,304 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $164,304 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,765,455 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$1,243,807 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$193,660 | OtherRevenueAmt |
| Revenue Not Reported | -$1,437,467 | RevenueNotReportedAmt |
| Revenue Subtotal | $6,202,922 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $65,390 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $65,390 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $6,268,312 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,299,085 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,299,085 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $65,390 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $65,390 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,364,475 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS ARE USED FOR PALLIATIVE CARE PROGRAM AND EDUCATION. |
| PART X, LINE 2: | THE CORPORATION 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 CORPORATION 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. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST IN TRUSTS -253,052. PENSION ADJUSTMENT 59,392. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DALE HOLDIMAN | PersonNm |
| Title | MEDICAL DIRECTOR (END 04/2021) | TitleTxt |
| Base Compensation Filing Org | $121,899 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $37,689 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $12,119 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $8,023 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $179,730 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4A | FormAndLineReferenceDesc |
| Explanation | DALE HOLDIMAN TERMINATED WITH THE COMPANY IN APRIL OF 2021 AND RECEIVED A SEVERANCE PAYMENT OF $37,688.72. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. TO THE EXTENT PERMITTED BY LAW AND SUBJECT TO ANY APPROVAL OF THE MEMBER AS REQUIRED BY THE BYLAWS, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE ALL THE AUTHORITY OF THE BOARD OF DIRECTORS DURING THE PERIOD OF TIME BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 2 | CRAIG BERENSTEIN, LORENZO SUTER, LEAH GIASGO, JIM GOBELL, AND WENDY LINDLEY HAVE A BUSINESS RELATIONSHIP. DOUG SKINNER, BETH HUGHES, JESICA HANSON, AND TRACY LARSON HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 3 | SIMITREE HEALTHCARE CONSULTING, 4130 WHITNEY AVE, HAMDEN, CT WAS CONTRACTED FOR INTERIM EXECUTIVE DIRECTOR SERVICES FROM APRIL 26, 2021 THROUGH JANUARY 28, 2022. DURING 2021, HOSPICE OF SIOUXLAND PAID SIMITREE HEALTHCARE CONSULTING $196,770 FOR INTERIM EXECUTIVE DIRECTOR SERVICES PERFORMED BY MARY ANNE MILLER. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS HEALTH, INC., AN IOWA NON-PROFIT, EXEMPT UNDER INTERNAL REVENUE CODE 501(C)(3). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE NUMBER OF DIRECTORS SHALL BE DETERMINED BY THE MEMBER AND BE COMPOSED OF FOUR MEMBER DIRECTORS. ADDITIONAL DIRECTORS MAY BE APPOINTED BY THE MEMBER'S SPONSORING ORGANZATIONS ON A ONE FOR ONE BASIS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING DUTIES ARE RESERVED FOR THE MEMBER: - SELECTION AND REMOVAL OF DIRECTORS - APPROVAL OF MONTHLY FINANCIAL REPORTS - APPROVAL OF AN ANNUAL BUDGET, CAPITAL EXPENDITURES BUDGET, LONG-RANGE PLAN - APPROVAL OF CAPITAL EXPENDITURES AND ANY UNBUDGETED EXPENDITURES WHEN EITHER EXCEED THE THRESHOLD AMOUNTS DETERMINED BY THE MEMBER FROM TIME TO TIME, THE INCURRENCE OF ALL DEBT PRIOR TO ITS INCURRENCE, AND SUCH OTHER FINANCIAL ACTIVIES AS THE MEMBER DEEMS APPROPRIATE - APPOINTMENT AND REMOVAL OF THE EXECUTIVE DIRECTOR - APPROVAL OF ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS - APPROVAL OF CORPORATE MISSION STATEMENT AND ALL AMENDMENTS TO SUCH MISSION STATEMENT - APPROVAL OF ANY TAXABLE OR TAX-EXEMPT SUBSIDIARY ORGANIZATION - APPOINTMENT OF OUTSIDE AUDITORS AND INTERNAL AUDITORS - ADOPTION OF RESOLUTIONS FOR THE GENERAL GUIDANCE AND DIRECTION OF THE CORPORATION AT ANY ANNUAL OR SPECIAL MEETING OF THE BOARD OF DIRECTORS, AND - TO CARRY OUT SUCH OTHER POWERS AS ARE PROVIDED BY LAW. SUCH ACTIONS SHALL BE DEEMED TO BE AUTHORIZED BY THE MEMBER IF THEY ARE APPROVED IN WRITING BY THE PRESIDENT/CEO OF BOTH OF THE MEMBER'S SPONSORING ORGANIZATIONS OR THEIR RESPECTIVE DESIGNEES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CFO REVIEWS THE 990. A COPY OF THE RETURN IS PROVIDED TO BOARD MEMBERS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A FORM DETAILING ANY AND ALL BUSINESS RELATIONSHIPS WITH HEALTH, INC. AND RELATED ENTITIES. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE BOARD OF DIRECTORS. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENTS OR BOARD APPOINTMENT. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE AFFECTED BOARD MEMBER WILL BE REQUIRED TO ABSTAIN FROM VOTING ON THE MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15 | TWO TO THREE DESIGNATED BOARD MEMBERS DETERMINE REASONABLE COMPENSATION FOR THE EXECUTIVE DIRECTOR AND FINANCE DIRECTOR USING AN INDEPENDENT COMPENSATION CONSULTANT AND COMPENSATION SURVEYS. |
| FORM 990, PART VI, SECTION C, LINE 19 | ORGANIZATION'S DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 138,196. MANAGEMENT AND GENERAL EXPENSES 371,883. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 510,079. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 582,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 582,167. NURSING HOME ROOM & BOARD: PROGRAM SERVICE EXPENSES 863,036. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 863,036. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 87,609. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,609. |
| FORM 990, PART XI, LINE 9: | PENSION ADJUSTMENT 59,392. CHANGE IN BENEFICIAL INTEREST IN TRUST -253,052. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HEALTH INC | |||||||||
| 230 NEBRASKA STREET | SIOUX CITY | IA | 51101 | 311712115 | HEALTHCARE SERVICES | IA | 501(C)(3) | PF | 0 |
| SIOUXLAND REGIONAL CANCER CENTER | |||||||||
| POBOX 5017 | SIOUX CITY | IA | 51102 | 421411233 | CANCER CARE | IA | 501(C)(3) | LINE 10 | 0 |
| SIOUXLAND PARAMEDICS | |||||||||
| 1701 TERMINAL DRIVE | SIOUX CITY | IA | 51105 | 421185707 | MEDICAL TRANSPORTATION SERVICES | IA | 501(C)(3) | LINE 12A, I | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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