SIOUX CENTER HEALTH: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: SIOUX CENTER HEALTH (EIN 42-0796764)
Tax period: 2020-07-01 to 2021-06-30
Filed: 2022-03-21
IRS object ID: 202200809349300995
Schema version: 2020v4.2
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule K
Schedule K
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-03-21T15:34:23-05:00	ReturnTs
Tax Period End	2021-06-30	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	2020-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	420796764	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sioux Center Health	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	SIOU	BusinessNameControlTxt
Phone	7127221271	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1101 9th St SE	AddressLine1Txt
City	Sioux Center	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	51250	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Cory Nelson	PersonNm
Person Title	CEO	PersonTitleTxt
Phone	7127221271	PhoneNum
Signature	2022-03-17	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Cory	PersonFirstNm
Person Last	Nelson	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Laurie Hanson CPA	PreparerPersonNm
PTIN	P00851848	PTIN
Phone	6053391999	PhoneNum
Preparation	2022-03-14	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Cory Nelson	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1101 9th St SE	AddressLine1Txt
City	Sioux Center	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	51250	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$58,706,196	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.siouxcenterhealth.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1951	FormationYr
Legal Domicile State	IA	LegalDomicileStateCd
Activity Or Mission	To provide medical care for all ages.	ActivityOrMissionDesc
Voting Members Governing Body	39	VotingMembersGoverningBodyCnt
Voting Members Independent	36	VotingMembersIndependentCnt
Total Employee	620	TotalEmployeeCnt
Total Volunteers	68	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$287,586	PYContributionsGrantsAmt
CY Contributions Grants	$10,020,424	CYContributionsGrantsAmt
PY Program Service Revenue	$44,453,909	PYProgramServiceRevenueAmt
CY Program Service Revenue	$48,453,810	CYProgramServiceRevenueAmt
PY Investment Income	$234,050	PYInvestmentIncomeAmt
CY Investment Income	$103,629	CYInvestmentIncomeAmt
PY Other Revenue	$50,745	PYOtherRevenueAmt
CY Other Revenue	$46,489	CYOtherRevenueAmt
PY Total Revenue	$45,026,290	PYTotalRevenueAmt
CY Total Revenue	$58,624,352	CYTotalRevenueAmt
PY Grants And Similar Paid	$10,000	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$15,070	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$26,487,236	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$28,832,513	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$81,364	CYTotalFundraisingExpenseAmt
PY Other Expenses	$20,098,001	PYOtherExpensesAmt
CY Other Expenses	$20,934,363	CYOtherExpensesAmt
PY Total Expenses	$46,595,237	PYTotalExpensesAmt
CY Total Expenses	$49,781,946	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,568,947	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$8,842,406	CYRevenuesLessExpensesAmt
Total Assets BOY	$89,106,831	TotalAssetsBOYAmt
Total Assets EOY	$104,448,697	TotalAssetsEOYAmt
Total Liabilities BOY	$51,835,910	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$56,658,409	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$37,270,921	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$47,790,288	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Bring hope, health and healing to life.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$43,905,749	ExpenseAmt
Grant	$15,070	GrantAmt
Revenue	$48,453,810	RevenueAmt
Desc	Sioux Center Health operates a 19-bed acute-care hospital, a 69-bed nursing care facility, medical clinics, specialty physician clinics, two independent assisted living facilities, and a daycare center located in Sioux Center, Iowa. During the fiscal year ending June 30, 2021, patient days were 1,595, swing-bed days were 1,042, and newborn days were 383.The Center also provides a wide variety of medically-related activities at less than, or at no cost to residents of communities throughout northwest Iowa. These activities include general community education programs and sponsorship of support groups for victims of chronic disease and their families. Other activities designed to measure or enhance the general health status of residents of the community include: classes related to CPR, diabetes, cardiac rehabilitation and childbirth; participation in health fairs at industrial and community sites throughout the area; cost free screenings to alert people with high blood pressure; providing use of meeting facilities at no charge to cancer, Alzheimer's, diabetes, weight maintenance, "senior and hospice support groups; programs for children; providing speakers for various events and education groups; and representation in community education programs.The Health Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Since the Health Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient service revenue. The estimated cost of providing these services was $270,000 for the year ended June 30, 2021, calculated by multiplying the ratio of cost to gross charges for the Health Center by the gross uncompensated charges associated with providing charity care to its patients.	Desc
Total Program Service Expenses	$43,905,749	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	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	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	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
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	Yes (1)	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	0	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	40	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	620	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
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
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	39	GoverningBodyVotingMembersCnt
Independent Voting Member	36	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	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	0	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	0	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	Kari Timmer	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	7127228158	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1101 9th St SE	AddressLine1Txt
City	Sioux Center	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	51250	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (46 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
Tim Byl
President	1.00	Yes (X)	Yes (X)	$0	$0	$0
Doug Van Meeteren
Vice President	1.00	Yes (X)	Yes (X)	$0	$0	$0
Kyle Hiemstra
Secretary	1.00	Yes (X)	Yes (X)	$0	$0	$0
Nathan Bakker
Treasurer	1.00	Yes (X)	Yes (X)	$0	$0	$0
Terry Boote
Director	1.00	Yes (X)		$0	$0	$0
Josh Bowar
Director	1.00	Yes (X)		$0	$0	$0
Lisa Christians
Director	1.00	Yes (X)		$0	$0	$0
Jennifer Jansen
Director	1.00	Yes (X)		$0	$0	$0
Curt Hohman
Director	1.00	Yes (X)		$0	$0	$0
Yvonne Rayborn MD
Director	1.00	Yes (X)		$216,468	$0	$100,772
Neil Van Schouwen
Director	1.00	Yes (X)		$0	$0	$0
Vernon Beernink
Director	1.00	Yes (X)		$0	$0	$0
Janet Boone
Director	1.00	Yes (X)		$0	$0	$0
Delbert Broek
Director	1.00	Yes (X)		$0	$0	$0
Leslie Brommer
Director	1.00	Yes (X)		$0	$0	$0
Brenda Dokter
Director	1.00	Yes (X)		$0	$0	$0
Bob Bruxvoort
Director	1.00	Yes (X)		$0	$0	$0
Paul Clousing
Director	1.00	Yes (X)		$0	$0	$0
Bruce Dooyema
Director	1.00	Yes (X)		$0	$0	$0
David Eekhoff
Director	1.00	Yes (X)		$0	$0	$0
Cory Gotto
Director	1.00	Yes (X)		$0	$0	$0
Dan Hibma
Director	1.00	Yes (X)		$0	$0	$0
Lauren Kaemingk
Director	1.00	Yes (X)		$0	$0	$0
Rick Kattenberg
Director	1.00	Yes (X)		$0	$0	$0
Jody Kock
Director	1.00	Yes (X)		$0	$0	$0
John Koerselman
Director	1.00	Yes (X)		$0	$0	$0
Ardith Lein
Director	1.00	Yes (X)		$0	$0	$0
Matt Nice
Director	1.00	Yes (X)		$0	$0	$0
Dorinda Oostenink
Director	1.00	Yes (X)		$0	$0	$0
Scott Peterson
Director	1.00	Yes (X)		$0	$0	$0
Stan Speer
Director	1.00	Yes (X)		$0	$0	$0
Jeff Timmer
Director	1.00	Yes (X)		$0	$0	$0
Dale Vander Berg
Director	1.00	Yes (X)		$0	$0	$0
Brian Van Engen
Director	1.00	Yes (X)		$0	$0	$0
Betty Vermeer
Director	1.00	Yes (X)		$0	$0	$0
Lyle Vermeer
Director	1.00	Yes (X)		$0	$0	$0
Marj Wagner
Director	1.00	Yes (X)		$0	$0	$0
Scott Wynja
Director	1.00	Yes (X)		$0	$0	$0
Verdean Wynja
Director	1.00	Yes (X)		$0	$0	$0
Cory Nelson
CEO	40.00		Yes (X)	$250,800	$0	$34,725
Kari Timmer
CFO	40.00		Yes (X)	$122,614	$0	$12,643
Dr Nicholas Mouw
General Surgeon	40.00			$1,019,949	$0	$183,540	Yes (X)
Dr Scott A Rens MD
Family Medicine/OB	40.00			$472,008	$0	$36,467	Yes (X)
Alanna Janssen
Physician	40.00			$417,694	$0	$57,437	Yes (X)
Jason Koelwyn
Physician	40.00			$366,563	$0	$38,738	Yes (X)
David Janssen
Physician	40.00			$361,994	$0	$46,730	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,228,090	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$511,052	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	24	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	Yes (1)	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Michael Tadlock
2183 Ridge Rd	Sioux Center	SD	51250	anesthesia services	$368,730
Northwest Iowa Diagnostics
714 Lincoln St NE	le Mars	IA	51031	Ultrasound Readings	$239,790
Thomas Posch
234 Marina Dell Ave	Yankton	SD	57078	Radiology Readings	$147,034
Creative Dining Services Inc
One Royal Park Dr Ste3	Zeeland	MI	49464	dietary professional fees	$109,893
Independent Radiology Services
PO Box 2746	Fargo	ND	58108	radiology	$100,117

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Government Grants	$9,752,570	GovernmentGrantsAmt
All Other Contributions	$267,854	AllOtherContributionsAmt
Total Contributions	$10,020,424	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Service Revenue	622110	$42,210,328	$42,210,328
Assisted and Independent Living	623990	$2,072,198	$2,072,198
Pharmacy Revenue	900099	$1,949,616	$1,949,616
Daycare Revenue	624410	$1,094,427	$1,094,427
Investment in Affiliates	900099	$201,983	$201,983

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$925,258	TotalRevenueColumnAmt
Related Or Exempt Func Income	$925,258	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$48,453,810	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$164,520	TotalRevenueColumnAmt
Exclusion	$164,520	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$35,931	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$35,931	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$35,931	TotalRevenueColumnAmt
Exclusion	$35,931	ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$60,891	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	-$60,891	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$60,891	TotalRevenueColumnAmt
Exclusion	-$60,891	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$31,511	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$20,953	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$10,558	TotalRevenueColumnAmt
Exclusion	$10,558	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$58,624,352	TotalRevenueColumnAmt
Related Or Exempt Func Income	$48,453,810	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$150,118	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	$15,070	TotalAmt
Program Services	$15,070	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$653,203	TotalAmt
Program Services	$236,873	ProgramServicesAmt
Management And General	$416,330	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$110,791	TotalAmt
Program Services	$110,791	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$22,555,267	TotalAmt
Program Services	$21,016,325	ProgramServicesAmt
Management And General	$1,470,074	ManagementAndGeneralAmt
Fundraising	$68,868	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$743,072	TotalAmt
Program Services	$691,205	ProgramServicesAmt
Management And General	$49,606	ManagementAndGeneralAmt
Fundraising	$2,261	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,287,682	TotalAmt
Program Services	$3,080,760	ProgramServicesAmt
Management And General	$201,028	ManagementAndGeneralAmt
Fundraising	$5,894	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,482,498	TotalAmt
Program Services	$1,351,514	ProgramServicesAmt
Management And General	$126,880	ManagementAndGeneralAmt
Fundraising	$4,104	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$50,662	TotalAmt
Management And General	$50,662	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$5,421,960	TotalAmt
Program Services	$3,700,659	ProgramServicesAmt
Management And General	$1,721,301	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$272,429	TotalAmt
Program Services	$3,284	ProgramServicesAmt
Management And General	$269,145	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,533,787	TotalAmt
Program Services	$889,276	ProgramServicesAmt
Management And General	$644,398	ManagementAndGeneralAmt
Fundraising	$113	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$766,508	TotalAmt
Program Services	$761,532	ProgramServicesAmt
Management And General	$4,976	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$76,617	TotalAmt
Program Services	$71,440	ProgramServicesAmt
Management And General	$5,177	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$69,879	TotalAmt
Program Services	$67,968	ProgramServicesAmt
Management And General	$1,911	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$803,332	TotalAmt
Program Services	$640,049	ProgramServicesAmt
Management And General	$163,283	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,984,278	TotalAmt
Program Services	$3,558,163	ProgramServicesAmt
Management And General	$426,115	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$410,896	TotalAmt
Program Services	$212,863	ProgramServicesAmt
Management And General	$198,033	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical Supplies	$6,597,237	$6,597,237
Food	$520,587	$517,566	$2,897	$124
Taxes	$294,912	$294,912

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$131,279	TotalAmt
Program Services	$88,262	ProgramServicesAmt
Management And General	$43,017	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$49,781,946	TotalAmt
Program Services	$43,905,749	ProgramServicesAmt
Management And General	$5,794,833	ManagementAndGeneralAmt
Fundraising	$81,364	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$22,053,588	BOYAmt
EOY	$22,481,637	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$83,791	BOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,924,030	BOYAmt
EOY	$5,520,531	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$708,823	BOYAmt
EOY	$788,171	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$413,964	BOYAmt
EOY	$565,922	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$91,552,432	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$35,313,028	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$44,853,825	BOYAmt
EOY	$56,239,404	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$5,936,829	BOYAmt
EOY	$6,385,297	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$7,383,062	BOYAmt
EOY	$9,345,797	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$377,674	BOYAmt
EOY	$234,489	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$79,819	BOYAmt
EOY	$59,880	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$2,291,426	BOYAmt
EOY	$2,827,569	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$89,106,831	BOYAmt
EOY	$104,448,697	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,278,741	BOYAmt
EOY	$8,427,567	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$10,284,184	BOYAmt
EOY	$4,949,972	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,791,532	BOYAmt
EOY	$16,120,297	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$111,720	BOYAmt
EOY	$105,120	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$22,348,307	BOYAmt
EOY	$22,921,884	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$4,388,200	BOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,633,226	BOYAmt
EOY	$4,133,569	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$51,835,910	BOYAmt
EOY	$56,658,409	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	$35,563,074	BOYAmt
EOY	$45,218,697	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,707,847	BOYAmt
EOY	$2,571,591	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$37,270,921	BOYAmt
EOY	$47,790,288	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$89,106,831	BOYAmt
EOY	$104,448,697	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$8,842,406	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$1,676,961	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)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

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)
Hospital	Yes (X)	HospitalInd

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

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	0	InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$247,170	BeginningYearBalanceAmt
End Year Balance	$247,170	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$247,170	BeginningYearBalanceAmt
End Year Balance	$247,170	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$385,500	BeginningYearBalanceAmt
Investment Earnings Or Losses	$24,315	InvestmentEarningsOrLossesAmt
Other Expenditures	$162,645	OtherExpendituresAmt
End Year Balance	$247,170	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$356,032	BeginningYearBalanceAmt
Investment Earnings Or Losses	$29,468	InvestmentEarningsOrLossesAmt
End Year Balance	$385,500	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$324,809	BeginningYearBalanceAmt
Investment Earnings Or Losses	$31,223	InvestmentEarningsOrLossesAmt
End Year Balance	$356,032	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.00000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	Yes (1)	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$630,000	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$2,229,111	OtherCostOrOtherBasisAmt
Book Value	$2,859,111	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$56,655,316	OtherCostOrOtherBasisAmt
Depreciation	$23,523,617	DepreciationAmt
Book Value	$33,131,699	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,716,635	OtherCostOrOtherBasisAmt
Depreciation	$11,143,378	DepreciationAmt
Book Value	$5,573,257	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$15,321,370	OtherCostOrOtherBasisAmt
Depreciation	$646,033	DepreciationAmt
Book Value	$14,675,337	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$56,239,404	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Investment in Northwest Iowa Diagnostics	$39,209	F
Interest in Avera Health Foundation	$9,172,126	F
Investment in Avera Home Medical of Sioux Center LLC	$134,462	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$9,345,797	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
Deferred Compensation	$2,827,569
Estimated third-party payor settlements	$1,306,000

Field	Value	IRS element (for citing)
Total Liability	$4,133,569	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$60,301,313	TotalRevEtcAuditedFinclStmtAmt
Other Revenue	$1,676,961	OtherRevenueAmt
Revenue Not Reported	$1,676,961	RevenueNotReportedAmt
Revenue Subtotal	$58,624,352	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$58,624,352	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$49,781,946	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$49,781,946	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$49,781,946	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part V, Line 4:	The Health Center's endowment consists of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. The Center does not have a formal policy or agreement with the Foundation covering the distribution of endowment fund earnings. The Center expects the Foundation to allow its endowment to grow consistent with the Center's objective to maintain the purchasing power of the endowment assets in order to provide additional real growth through new gifts and investment return. However, there is no current intention of using the permanently endowed funds.
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.
Part XI, Line 2d - Other Adjustments:	Change in net assets of Avera Health Foundation 1,676,961.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent100	Yes (X)	Percent100Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent200 D	Yes (X)	Percent200DInd
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	419	PersonsServedCnt
Total Community Benefit Expns	$270,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$270,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00540	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,582,184	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,003,143	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$579,041	NetCommunityBenefitExpnsAmt
Total Expense	0.01160	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	419	PersonsServedCnt
Total Community Benefit Expns	$3,852,184	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,003,143	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$849,041	NetCommunityBenefitExpnsAmt
Total Expense	0.01700	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	6	ActivitiesOrProgramsCnt
Persons Served	1143	PersonsServedCnt
Total Community Benefit Expns	$21,360	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,339	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$16,021	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	2	PersonsServedCnt
Total Community Benefit Expns	$9,173	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$9,173	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Persons Served	13903	PersonsServedCnt
Total Community Benefit Expns	$6,339,462	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,033,290	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,306,172	NetCommunityBenefitExpnsAmt
Total Expense	0.02620	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$75,755	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$75,755	NetCommunityBenefitExpnsAmt
Total Expense	0.00150	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	11	ActivitiesOrProgramsCnt
Persons Served	15048	PersonsServedCnt
Total Community Benefit Expns	$6,445,750	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,038,629	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,407,121	NetCommunityBenefitExpnsAmt
Total Expense	0.02820	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	11	ActivitiesOrProgramsCnt
Persons Served	15467	PersonsServedCnt
Total Community Benefit Expns	$10,297,934	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,041,772	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,256,162	NetCommunityBenefitExpnsAmt
Total Expense	0.04520	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$2,145	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$2,145	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	206	PersonsServedCnt
Total Community Benefit Expns	$1,545,692	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,141,127	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$404,565	NetCommunityBenefitExpnsAmt
Total Expense	0.00810	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	206	PersonsServedCnt
Total Community Benefit Expns	$1,547,837	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,141,127	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$406,710	NetCommunityBenefitExpnsAmt
Total Expense	0.00810	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$501,781	BadDebtExpenseAmt
Bad Debt Expense Attributable	$6,021	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$11,537,132	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$11,618,430	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$81,298	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sioux Center Health	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1101 9th St SE	AddressLine1Txt
City	Sioux Center	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	51250	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.siouxcenterhealth.org	WebsiteAddressTxt
State License	840080H	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Sioux Center Health	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	See Line 7d	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	See Line 7d	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	See 7D	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	100.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	200.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Sioux Center Health	Part V, Section B, Line 5: Sioux Center Health, along with Community Health Partners, gathered quantitative and qualitative data to determine the best suitable health initiatives that will make a lasting impact for our communities. The data gathered includes demographic (population, race, sex, age and household) information as well as in-depth assessments from community stakeholders through focus group interviews. In order to avoid duplication of effort, the four critical access hospitals in Sioux County worked collaboratively with Community Health Partners to complete this community health needs assessment with a process that began in October of 2018.
Sioux Center Health	Part V, Section B, Line 6a: Hegg Memorial Health System Orange City Area Health System Hawarden Regional Healthcare
Sioux Center Health	Part V, Section B, Line 6b: Community Health Partners of Sioux County, the local public health agency for Sioux County.
Sioux Center Health	Part V, Section B, Line 7d: siouxcenterhealth.org/patients-visitors/patient-guide/patient-rights/
Sioux Center Health	Part V, Section B, Line 11: A Community Health Needs Assessment was completed in 2019 and while Sioux County has numerous positive attributes and scores well in the county health rankings for Iowa, there are several well defined areas of prioritized need that the hospital plans to address based on our findings from the community health needs assessment. The following prioritized health needs were identified and as the most significant needs for our community: Obesity, Mental Health, Translation and Interpretation, and Senior Adult Services. Sioux Center Health is addressing these needs by:Obesity: Through the continued collaboration with Community Health Partners, Sioux Center Health is part of the National Diabetes Prevention Program (DPP). The DPP is a year long weight management program aimed at those who are prediabetic or are at high risk of developing diabetes sometime during their life. The county has 12 trained program instructors, with 3 of them being Sioux Center Health staff. Continued partnerships with the Sioux Center Trails Council, Siouxperman committee and the Harvest Half Committee, along with various other community recreational offerings and facilities in Sioux Center continued with Sioux Center Health remaining an active voice on behalf of our patients and community members where physical activity and healthy eating are concerned. Additionally Sioux Center Health has partnered with our local Federally Qualified Health Center (FQHC), Promise Community Health, and provided a Healthy Hero's Family Fun 1k Walk and 5k run for our community members. This event focused on being active through exercising and offered a health fair to provide education on various topics. Mental Health: Sioux Center Health provided 24/7 social worker coverage as a resource for those patients needingmental health services. Along with this, Sioux Center Health continued to use Avera eCARE Behavioral Health, which has 24 hour behavioral assessments through the use of a video camera. This service provides us with knowledge of available beds and makes calls to behavioral health facilities to assist in finding placement, should a patient need further treatment. Sioux Center Health continued to build behavioral health programming within our medical clinics. Our Licensed Master Social Workers, in combination with our Board Certified Psychiatric Mental Health Nurse Practitioner, worked with individuals and families to meet their lifelong goals and achieve their emotional wellbeing. We offered medically managed treatment plans for all ages: children, adolescents and adults. Sioux Center Health also utilized the mental health resources in Sioux City for those adolescent patients who are requiring inpatient care for mental health needs and detox/treatment. Sioux Center Health has established relationships with local/area mental health agencies and continued to utilize their services where appropriate. Ongoing staff training in recognizing signs and/or treatment of mental health concerns was provided.Translation and Interpretation: Sioux Center Health created a Cultural Diversity Team to address translation/interpretation needs. Throughout this process, the team engaged not only our staff, but our Board of Directors as well. Sioux Center Health provided education to the community and healthcare staff for increased knowledge and certification for Healthcare Interpretation. Continued participation in the countywide group of interpreters helped identify needs throughout our community. Additionally staff were tested for their language knowledge and wear a "Habla Espaol" identification badge once approved. Sioux Center Health provided Certified Healthcare Interpreter (CHI) staff interpreters to assist nonEnglish speaking patients through their healthcare journey. Collaboration with other local/area agencies who also serve those of ethnic minorities was done in effort to provide the best care for our patients no matter what their health needs are.Senior Adult Services: Sioux Center is working to expand its senior living campus.
Sioux Center Health	Part V, Section B, Line 13h: Sioux Center Health provides free care based on meeting presumptive eligibility requirements listed in the policy.
Sioux Center Health	Part V, Section B, Line 16j: Self pay patients are given a self-pay packet that explains financial assistance. A statement is sent out to all patients indicating financial assistance is available upon request. The charity care and other financial assistance options are discussed with inpatients if requested.
Sioux Center Health	Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital has confirmed no FAP eligible patients had elective procedures.

Field	Value	IRS element (for citing)
Facility	9	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Sioux Center Medical Clinic
1101 9th St SE	Sioux Center	IA	51250	Physician clinic
2 - Royal Meadows
1400 7th Ave SE	Sioux Center	IA	51250	Nursing facility
3 - Hull Medical Clinic
807 Main	Hull	IA	51239	Physician clinic and physical therapy
4 - Chears Home Health & Hospice
1400 7th Ave SE	Sioux Center	IA	51250	Home health and hospice
5 - Crown Pointe
1400 7th Ave SE	Sioux Center	IA	51250	Independent and assisted living
6 - Franken Manor
527 S Main Ave	Sioux Center	IA	51250	Independent and assisted living
7 - SCH Occupational Health Center
38 19th St SW	Sioux Center	IA	51250	Occupational health
8 - Early Childhood Center
1400 7th Ave SE	Sioux Center	IA	51250	Community daycare
9 - Hawarden Medical Clinic
1122 Ave L Hawarden	Hawarden	IA	51023	Physician clinic

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	Sioux Center Health (SCH) provides free care based on meeting presumptive eligibility requirements listed in the policy. Federal Poverty Guidelines and financial asset-liabilities are used to determine eligibility for discounted care.Additional factors used to determine financial assistance eligibility include Asset level, medical indigency, and underinsurance status.Part I, Line 6b:The community benefit report is maintained at Sioux Center Health and mailed to community members.
Part I, Line 7:	Charity care expense on line 7a and Medicaid on line 7b were converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Lines 7e, 7f, and 7i: Costs are reported based on data from the general ledger accounting system. The general ledger accounting system addresses all patient segments (inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, and self-pay). The cost for subsidized health services reported on line 7g was determined using the facility's cost accounting system.
Part II, Community Building Activities:	Sioux Center Health provides benefits to the community through the Hospital's membership in the local Chamber of Commerce and the recruitment of qualified professional staff. Daycare availability and affordability continues to be an issue in Sioux Center. Sioux Center health provides benefit to the community by offering quality daycare to 206 children.
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 implicit price concessions attributable to patients that could have been eligible for charity care is based on estimated calculations from our collection agency. The agency calculated 1.2% of the total amount in collections could be charity care due to bankruptcy, deceased and charity adjustments on current accounts.
Part III, Line 4:	The footnote that describes implicit price concessions is on pages 9 and 10 of the attached audited financial statements.
Part III, Line 8:	Medicare allowable cost of care was calculated from the Medicare cost report for fiscal year ending 6/30/21. 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.
Part III, Line 9b:	Sioux Center Health provides free care based on meeting presumptive eligibility requirements listed in the financial assistance policy. The Hospital does not pursue collection efforts to patients in the process of applying for assistance or persons meeting the presumptive eligibility requirements. Any personal portion due follows normal collection procedures.
Part VI, Line 2:	Sioux Center Health has a broad based Board of Directors providing community feedback on a quarterly basis. The organization normally holds an open public meeting annually to listen to issues of the community and share information regarding services and programs. However, because of COVID-19, the meeting was not held in FY21. The Hospital analyzes statistical data through IHA and Iowa Public Health to determine disease related needs, services and market share. The Hospital works closely with Community Health Partners to identify and address community health related needs. Additionally, the Hospital conducted a community health needs assessment during the year ended 6/30/19 in compliance with 501(r).
Part VI, Line 3:	Patients are made aware of financial assistance programs (English and Spanish) in a variety of ways:1. Self-pay patients are given a self-pay packet that explains financial assistance, payment plans, and the Hospital's 10% lump sum payment options. The self-pay packet includes a Medicaid application. 2. A statement is sent out to all patients indicating financial assistance is available upon request.3. The financial assistance application is available on the Hospital website in English and Spanish versions.4. The financial assistance application is available at the registration and ER desk in English and Spanish versions.5. Financial assistance information is included in SCH Facebook posts to increase awareness.Additionally, the financial assistance policy is available upon request and on the Sioux Center Health website.
Part VI, Line 4:	Sioux Center Health serves the local Sioux Center community and the surrounding area of Sioux County, IA. Sioux County is primarily rural and located in northwest Iowa. The US Census Bureau estimated the county's population of just over 35,800. Sioux Center Health has a strong community focused perspective. The county is also home to three other critical access hospitals and Sioux Center also has a FQHC. Nearly 90% of Sioux Center Health's discharges come from Sioux County. According to 2015-2019 American Community Survey profiles, Sioux Center had a population of just over 7,500 with median family income of $74,313. 7.2% of the families in Sioux Center were below the poverty level. The 2020 census shows a Hispanic population record of 15.1% in Sioux Center, and this number does not take into account undocumented aliens.
Part VI, Line 5:	Sioux Center Health has a strong community focused perspective. The governing board is comprised of 39 volunteer members that reside in the community and primary service area. The Hospital is focused on its mission and serving people regardless of their ability to pay. The Hospital participates in mission projects throughout the year yielding support for various causes from local missions that provide after school activities, counseling, or domestic abuse services. This support comes in the form of paid staff volunteering their time, Hospital sponsored fundraisers, and direct financial support from the Hospital and its employees. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are used to make improvements in patient care, medical education, and research.Sioux Center Health has a strong mission to bring hope, health and healing to life. We offer services for our patients, residents and family to support the mind, body and spirit. The Hospital operates an emergency room and is available to anyone, regardless of their ability to pay. The Hospital supports continuing education and training of all the healthcare professionals and assists in providing both internal and external opportunities. Sioux Center Health supports the communities it serves by being an active participant in the community. The hospital offers opportunities to volunteer for community events, has staff that participate in governance through chambers, businesses and churches. Also, the staff participate in various advisory groups supporting all ranges of ages and educational levels. The hospital supports advocacy activities focused on improved public health from organization walks, educational seminars and information shared with the public through various communication means.
Part VI, Line 6:	The Hospital is a managed facility of Avera Health. Avera Health and the Hospital work cooperatively to enhance healthcare throughout the community served by the Hospital. The 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 the Hospital could otherwise achieve. In turn, local caregivers are able to devote more resources to patient and resident care. Avera Health and the 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.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	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 (7 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Dr Nicholas Mouw
General Surgeon	$562,109	$0	$255,765	$0	$202,075	$0	$154,282	$0	$29,927	$0	$1,204,158	$0	$0	$0
Dr Scott A Rens MD
Family Medicine/OB	$464,688	$0	$7,235	$0	$85	$0	$2,800	$0	$34,336	$0	$509,144	$0	$0	$0
Alanna Janssen
Physician	$359,768	$0	$8,101	$0	$49,825	$0	$28,469	$0	$29,638	$0	$475,801	$0	$0	$0
David Janssen
Physician	$306,742	$0	$6,114	$0	$49,138	$0	$30,214	$0	$16,888	$0	$409,096	$0	$0	$0
Jason Koelwyn
Physician	$322,747	$0	$25,199	$0	$18,617	$0	$2,800	$0	$36,607	$0	$405,970	$0	$0	$0
Yvonne Rayborn MD
Director	$210,404	$0	$6,064	$0	$0	$0	$74,026	$0	$27,415	$0	$317,909	$0	$0	$0
Cory Nelson
CEO	$248,031	$0	$0	$0	$2,769	$0	$9,356	$0	$26,596	$0	$286,752	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 4b	Sioux Center Health provides a nonqualified deferred compensation plan for its physicians. The following individuals had an amount included in reportable compensation, column B(iii) under a 457(f) plan: Dr. Nicholas Mouw $151,482 Alanna Janssen $25,669 David Janssen $27,414
Schedule J, Part II:	Cory Nelson, CEO is compensated through an arrangement with Avera McKennan, 800 E 21st Street, Sioux Falls, SD 57105.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
City of Hull Iowa
A	426004780	2017-12-18	$8,300,000	Hospital Facility Revenue Refunding Bond, Series 2017(2012 issue).	0	0	0
City of Hull Iowa
B	426004780	2019-12-30	$9,500,000	Short term Construction Financing	0	0	0
Sioux County Iowa
C	426005069	2019-12-30	$8,000,000	Short term Construction Financing	0	0	0
City of Hull Iowa
D	426004780	2020-11-18	$8,000,000	Health Facility Revenue Bond (Sioux Center Health Project), Series 2020B	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Other Spent ProceedsOtherSpentProceedsAmt	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Capital ExpendituresCapitalExpendituresAmt	UnspentUnspentAmt
A	$1,151,069	$8,300,000	$156,681	$8,143,319	Yes (1)	Yes (1)	Yes (1)
B		$9,500,000	$144,006		0	0	Yes (1)	$100,082	$9,255,912
C		$8,000,000	$121,268		0	0	Yes (1)	$84,279	$7,794,453
D		$8,000,000	$102,865		0	0	Yes (1)	$4,738,416	$3,158,719

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Any Research AgreementsAnyResearchAgreementsInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Private Bus Concerning UBIPrivateBusConcerningUBIPct	Total Private Business UseTotalPrivateBusinessUsePct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	0	0	0	0	0.00000	0.00000	0.00000	0	0	Yes (1)
B	0	0	0	0	0.00000	0.00000	0.00000	0	0	Yes (1)
C	0	0	0	0	0.00000	0.00000	0.00000	0	0	Yes (1)
D	0	0	0	0	0.00000	0.00000	0.00000	0	0	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Variable Rate IssueVariableRateIssueInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A	Yes (1)	Yes (1)
B	0	Yes (1)
C	0	Yes (1)
D	Yes (1)	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Schedule K, Part II, Bond B and C, Line 10:	The Hospital is drawing on the The City of Hull, Iowa and Sioux City, Iowa 12/30/19 bonds as needed. As of 6/30/2021, only $449,635 has been drawn.
Form 990, Schedule K, Part II, Bond D and E, Line 10:	The Hospital is drawing on the The City of Hull, Iowa and Sioux City, Iowa 11/18/20 bonds as needed. As of 6/30/2021, $9,341,281 has been drawn.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	Sioux County Iowa	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	426005069	BondIssuerEIN
Bond Issued	2020-11-18	BondIssuedDt
Issue Price	$4,500,000	IssuePriceAmt
Purpose	Health Facility Revenue Bond (Sioux Center Health Project), Series 2020BB	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$4,500,000	TotalProceedsAmt
Issuance Costs From Proceeds	$57,657	IssuanceCostsFromProceedsAmt
Capital Expenditures	$4,442,343	CapitalExpendituresAmt
Substantial Completion	2020	SubstantialCompletionYr
Refunding Tax Exempt Bonds	0	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	0	RefundingTaxableBondsInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.00000	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00000	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Brooke Van Engen
Family member of Brian Van Engen, Director	$21,285	Compensation as an employee	0
Kim Bosma
Family member of Cory Gotto, Board member	$44,062	Compensation as an employee	0
Val Hiemstra
Family member of Cory Gotto, Board member	$45,444	Compensation as an employee	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Section A, line 1	The Executive Committee is composed of four officers: President, Vice President, Secretary, Treasurer, and seven board members. The Executive Committee shall have power to transact all regular business of the facility during the interim between the meetings of the Board of Directors, provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors and that it shall refer all matters of major importance to the Board of Directors.
Form 990, Part VI, Section A, line 2	Board members Verdean Wynja and Scott Wynja have a family relationship.
Form 990, Part VI, Section A, line 7a	One member of the governing body is appointed by Avera McKennan.
Form 990, Part VI, Section B, line 11b	The 990 is emailed to members of the Board of Directors for review and any questions are addressed prior to filing the return with the IRS.
Form 990, Part VI, Section B, line 12c	Officers, Directors and Trustees are required to complete conflict of interest questionnaires which are monitored and tracked. The questionnaires are reviewed by the Board for any possible conflicts with any noted conflicts being brought to management's attention. Conflicts are also reviewed at the Board level. After a conflict is deemed to exist, the individual(s) involved must abstain from the discussion and vote related to the issue.
Form 990, Part VI, Section B, line 15a	The CEO is employed through a management agreement with Avera McKennan but is considered a common law employee of Sioux Center Health. Avera McKennan annually reviews the compensation of the CEO, using comparability data and a performance rating system and meets with the Board of Directors of Sioux Center Health. Avera McKennan recommends a salary adjustment for the CEO. The Board of Directors is responsible for approval of the salary adjustment. The deliberation and decision is documented at Avera McKennan and in the board minutes. Compensation for the CFO is reviewed and approved annually by the CEO and Human Resources. Market data is used to determine an appropriate salary range. The review process and salary adjustment is documented in the personnel file.
Form 990, Part VI, Section C, line 19	The documents are made available upon request.
Form 990, Part IX, line 11g	Professional Fees: Program service expenses 65,111. Management and general expenses 507,331. Fundraising expenses 0. Total expenses 572,442. Purchased services: Program service expenses 3,081,162. Management and general expenses 1,112,143. Fundraising expenses 0. Total expenses 4,193,305. Repairs and maintenance: Program service expenses 554,386. Management and general expenses 101,827. Fundraising expenses 0. Total expenses 656,213.
Form 990, Part XI, line 9:	Change in interest in net assets of Avera Health Foundation 1,676,961.