2023-05-15T15:28:05-05:00 2022-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2021-07-01 383320710 HOSPICE OF SIOUXLAND HOSP 7122334144 230 NEBRASKA ST SIOUX CITY IA 51103 KARA WINKER CHIEF FINANCIAL OFFICER 7122334144 2023-05-12 1 KARA WINKER XXX-XX-XXXX LAURIE HANSON CPA P00851848 6053391999 2023-05-12 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z X JACQUE KREBER 230 NEBRASKA ST SIOUX CITY IA 51103 6268312 0 X WWW.HOSPICEOFSIOUXLAND.COM X 1982 IA PROVIDE HOSPICE AND PALLIATIVE CARE. 8 8 99 118 0 0 327322 245106 7824267 5670908 468124 334168 866541 18130 9486254 6268312 0 750 0 0 4452801 3680875 0 0 288 4044857 3682850 8497658 7364475 988596 -1096163 12817698 10216539 1165142 1097613 11652556 9118926 TO PROVIDE HIGH QUALITY, COMPASSIONATE CARE AT THE END OF LIFE. 0 0 5792732 750 5689038 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. 5792732 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 47 0 1 99 1 0 0 0 0 0 0 0 0 0 0 X 8 8 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 X KARA WINKER 7122529418 230 NEBRASKA ST PO BOX 5017 SIOUX CITY IA 51101 DALE HOLDIMAN MEDICAL DIRECTOR (END 04/2021) 40.00 0.00 X 159588 0 19991 AMY CALLAGHAN MEDICAL DIRECTOR 15.00 0.00 X 148483 0 0 STEFANI MOSER WIGTON RN 40.00 0.00 X 102693 0 31262 SHERRI MOREY RN 40.00 0.00 X 121277 0 1818 RENE GROVER RN 40.00 0.00 X 118071 0 2726 KARA WINKER DIRECTOR OF FINANCE 20.00 30.00 X 0 85476 17597 JACQUELINE KREBER EXECUTIVE DIRECTOR (BEGIN 01/2022) 40.00 0.00 X 0 0 0 CRAIG BERENSTEIN PRESIDENT 1.00 1.60 X X 0 0 0 DOUG SKINNER VICE PRESIDENT 1.00 1.60 X X 0 0 0 ELIZABETH HUGHES TREASURER 1.00 2.10 X X 0 0 0 LORENZO SUTER SECRETARY (BEGIN 07/2021) 1.00 1.60 X X 0 0 0 LEAH GLASGO SECRETARY (END 07/2021) 1.00 1.60 X X 0 0 0 JAMES GOBELL DIRECTOR 1.00 1.60 X 0 0 0 JESICA HANSON DIRECTOR 1.00 1.60 X 0 0 0 TRACY LARSON DIRECTOR 1.00 1.60 X 0 0 0 WENDY LINDLEY DIRECTOR 1.00 1.60 X 0 0 0 MARY ANNE MILLER INTERIM EXEC DIR THROUGH 1/28/22 40.00 0.00 X 0 0 0 650112 85476 73394 5 0 1 0 MERCY ONE SIOUXLAND MEDICAL 801 5TH ST SIOUX CITY IA 51102 CONTRACT NURSING 339571 SIMITREE HEALTHCARE CONSULTING 4130 WHITNEY AVE HAMDEN CT 06518 INTERIM DIRECTOR; NURSING CONSULTANT 282326 SUNRISE MANOR INC 5501 GORDON DR SIOUX CITY IA 51106 ROOM & BOARD 186465 NETSYS 1915 MORNINGSIDE AVE SIOUX CITY IA 51106 IT SERVICES 124710 CONTINENTAL SPRINGS 3200 G STREET SOUTH SIOUX CITY NE 68776 ROOM & BOARD 124304 7 63020 182086 245106 PATIENT REVENUE 621610 5670908 5670908 5670908 163965 163965 170203 0 170203 170203 170203 18130 18130 18130 6268312 5689038 0 334168 X 750 750 111653 111653 2818443 2369609 448834 240711 195779 44932 294556 253196 41360 215512 175283 40229 172173 172173 5523 5523 43208 43208 65390 65390 2042891 1671008 371883 18956 18956 59724 59724 268164 222217 45947 174553 167512 7041 17735 14626 3109 95148 78157 16991 44963 44963 OTHER SUPPLIES 379135 379122 0 13 MEDICATION 246072 246072 0 0 DUES & SUBSCRIPTIONS 28972 4583 24389 0 OTHER EXPENSES 20243 14818 5150 275 7364475 5792732 1571455 288 2617069 1687408 492736 506291 102538 99319 3218197 2290668 1022328 927529 7100805 6122333 1482222 873659 12817698 10216539 1165142 933309 0 164304 1165142 1097613 X 10022891 7384206 1629665 1734720 11652556 9118926 12817698 10216539 X -1096163 -1243807 -193660 X 0 1 X 1 0 X 218186 199905 312322 1173657 245106 2149176 10178345 11189805 11694538 7859249 5689038 46610975 10396531 11389710 12006860 9032906 5934144 48760151 0 0 0 48760151 373200 396685 273587 468124 163965 1675561 373200 396685 273587 468124 163965 1675561 20291 21299 0 0 0 41590 10790022 11807694 12280447 9501030 6098109 50477302 0.96600 0.96700 0.03320 0.03220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 973551 -100459 14525 858567 805973 167578 973551 782509 23464 805973 743765 38744 782509 704611 39154 743765 0.00000 0.58000 0.42000 0 0 2595864 1690529 905335 7455 6123 1332 614878 594016 20862 927529 BENEFICIAL INTEREST IN TRUSTS 873659 873659 PENSION CONTRIBUTION 164304 164304 X 4765455 -1243807 -193660 -1437467 6202922 65390 65390 6268312 7299085 0 7299085 65390 65390 7364475 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. X X 1 0 0 0 0 0 0 0 0 DALE HOLDIMAN MEDICAL DIRECTOR (END 04/2021) 121899 0 0 0 37689 0 12119 0 8023 0 179730 0 0 0 PART I, LINE 4A DALE HOLDIMAN TERMINATED WITH THE COMPANY IN APRIL OF 2021 AND RECEIVED A SEVERANCE PAYMENT OF $37,688.72. 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. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0