2022-03-21T15:34:23-05:00 2021-06-30 450250958 Eide Bailly LLP 200 E 10th St Ste 500 Sioux Falls SD 571046375 990 2020-07-01 420796764 Sioux Center Health SIOU 7127221271 1101 9th St SE Sioux Center IA 51250 Cory Nelson CEO 7127221271 2022-03-17 1 Cory Nelson 999009999 Laurie Hanson CPA P00851848 6053391999 2022-03-14 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Cory Nelson 1101 9th St SE Sioux Center IA 51250 58706196 0 X www.siouxcenterhealth.org X 1951 IA To provide medical care for all ages. 39 36 620 68 0 0 287586 10020424 44453909 48453810 234050 103629 50745 46489 45026290 58624352 10000 15070 0 0 26487236 28832513 0 0 81364 20098001 20934363 46595237 49781946 -1568947 8842406 89106831 104448697 51835910 56658409 37270921 47790288 X Bring hope, health and healing to life. 0 0 43905749 15070 48453810 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. 43905749 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 40 0 1 620 1 0 0 0 0 0 0 0 0 0 0 0 0 X 39 36 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X Kari Timmer 7127228158 1101 9th St SE Sioux Center IA 51250 Tim Byl President 1.00 X X 0 0 0 Doug Van Meeteren Vice President 1.00 X X 0 0 0 Kyle Hiemstra Secretary 1.00 X X 0 0 0 Nathan Bakker Treasurer 1.00 X X 0 0 0 Terry Boote Director 1.00 X 0 0 0 Josh Bowar Director 1.00 X 0 0 0 Lisa Christians Director 1.00 X 0 0 0 Jennifer Jansen Director 1.00 X 0 0 0 Curt Hohman Director 1.00 X 0 0 0 Yvonne Rayborn MD Director 1.00 X 216468 0 100772 Neil Van Schouwen Director 1.00 X 0 0 0 Vernon Beernink Director 1.00 X 0 0 0 Janet Boone Director 1.00 X 0 0 0 Delbert Broek Director 1.00 X 0 0 0 Leslie Brommer Director 1.00 X 0 0 0 Brenda Dokter Director 1.00 X 0 0 0 Bob Bruxvoort Director 1.00 X 0 0 0 Paul Clousing Director 1.00 X 0 0 0 Bruce Dooyema Director 1.00 X 0 0 0 David Eekhoff Director 1.00 X 0 0 0 Cory Gotto Director 1.00 X 0 0 0 Dan Hibma Director 1.00 X 0 0 0 Lauren Kaemingk Director 1.00 X 0 0 0 Rick Kattenberg Director 1.00 X 0 0 0 Jody Kock Director 1.00 X 0 0 0 John Koerselman Director 1.00 X 0 0 0 Ardith Lein Director 1.00 X 0 0 0 Matt Nice Director 1.00 X 0 0 0 Dorinda Oostenink Director 1.00 X 0 0 0 Scott Peterson Director 1.00 X 0 0 0 Stan Speer Director 1.00 X 0 0 0 Jeff Timmer Director 1.00 X 0 0 0 Dale Vander Berg Director 1.00 X 0 0 0 Brian Van Engen Director 1.00 X 0 0 0 Betty Vermeer Director 1.00 X 0 0 0 Lyle Vermeer Director 1.00 X 0 0 0 Marj Wagner Director 1.00 X 0 0 0 Scott Wynja Director 1.00 X 0 0 0 Verdean Wynja Director 1.00 X 0 0 0 Cory Nelson CEO 40.00 X 250800 0 34725 Kari Timmer CFO 40.00 X 122614 0 12643 Dr Nicholas Mouw General Surgeon 40.00 X 1019949 0 183540 Dr Scott A Rens MD Family Medicine/OB 40.00 X 472008 0 36467 Alanna Janssen Physician 40.00 X 417694 0 57437 Jason Koelwyn Physician 40.00 X 366563 0 38738 David Janssen Physician 40.00 X 361994 0 46730 3228090 0 511052 24 0 1 1 Michael Tadlock 2183 Ridge Rd Sioux Center SD 51250 anesthesia services 368730 Northwest Iowa Diagnostics 714 Lincoln St NE le Mars IA 51031 Ultrasound Readings 239790 Thomas Posch 234 Marina Dell Ave Yankton SD 57078 Radiology Readings 147034 Creative Dining Services Inc One Royal Park Dr Ste3 Zeeland MI 49464 dietary professional fees 109893 Independent Radiology Services PO Box 2746 Fargo ND 58108 radiology 100117 5 9752570 267854 10020424 Patient Service Revenue 622110 42210328 42210328 Assisted and Independent Living 623990 2072198 2072198 Pharmacy Revenue 900099 1949616 1949616 Daycare Revenue 624410 1094427 1094427 Investment in Affiliates 900099 201983 201983 925258 925258 48453810 164520 164520 35931 0 35931 35931 35931 60891 -60891 -60891 -60891 31511 20953 10558 10558 58624352 48453810 0 150118 X 15070 15070 653203 236873 416330 110791 110791 22555267 21016325 1470074 68868 743072 691205 49606 2261 3287682 3080760 201028 5894 1482498 1351514 126880 4104 50662 50662 5421960 3700659 1721301 272429 3284 269145 1533787 889276 644398 113 766508 761532 4976 76617 71440 5177 69879 67968 1911 803332 640049 163283 3984278 3558163 426115 410896 212863 198033 Medical Supplies 6597237 6597237 Food 520587 517566 2897 124 Taxes 294912 294912 131279 88262 43017 49781946 43905749 5794833 81364 22053588 22481637 83791 4924030 5520531 708823 788171 413964 565922 91552432 35313028 44853825 56239404 5936829 6385297 7383062 9345797 377674 234489 79819 59880 2291426 2827569 89106831 104448697 4278741 8427567 10284184 4949972 7791532 16120297 111720 105120 22348307 22921884 4388200 2633226 4133569 51835910 56658409 X 35563074 45218697 1707847 2571591 37270921 47790288 89106831 104448697 X 8842406 1676961 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 247170 247170 247170 247170 385500 24315 162645 247170 356032 29468 385500 324809 31223 356032 0.00000 1.00000 0.00000 1 0 630000 2229111 2859111 56655316 23523617 33131699 16716635 11143378 5573257 15321370 646033 14675337 56239404 Investment in Northwest Iowa Diagnostics 39209 F Interest in Avera Health Foundation 9172126 F Investment in Avera Home Medical of Sioux Center LLC 134462 F 9345797 Deferred Compensation 2827569 Estimated third-party payor settlements 1306000 4133569 X 60301313 1676961 1676961 58624352 0 58624352 49781946 0 49781946 0 49781946 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 419 270000 270000 0.00540 3582184 3003143 579041 0.01160 419 3852184 3003143 849041 0.01700 6 1143 21360 5339 16021 0.00030 1 2 9173 9173 0.00020 4 13903 6339462 5033290 1306172 0.02620 75755 75755 0.00150 11 15048 6445750 5038629 1407121 0.02820 11 15467 10297934 8041772 2256162 0.04520 1 2145 2145 0.00000 1 206 1545692 1141127 404565 0.00810 2 206 1547837 1141127 406710 0.00810 0 501781 6021 11537132 11618430 -81298 X 1 1 1 1 Sioux Center Health 1101 9th St SE Sioux Center IA 51250 www.siouxcenterhealth.org 840080H X X X X Sioux Center Health 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X See Line 7d X See Line 7d X X 1 18 1 See 7D 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance X siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance X siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance X X X X X X X 1 X 0 X X X X 1 X 0 0 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. 9 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 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. X X X 0 1 0 0 0 0 0 0 0 Dr Nicholas Mouw General Surgeon 562109 0 255765 0 202075 0 154282 0 29927 0 1204158 0 0 0 Dr Scott A Rens MD Family Medicine/OB 464688 0 7235 0 85 0 2800 0 34336 0 509144 0 0 0 Alanna Janssen Physician 359768 0 8101 0 49825 0 28469 0 29638 0 475801 0 0 0 David Janssen Physician 306742 0 6114 0 49138 0 30214 0 16888 0 409096 0 0 0 Jason Koelwyn Physician 322747 0 25199 0 18617 0 2800 0 36607 0 405970 0 0 0 Yvonne Rayborn MD Director 210404 0 6064 0 0 0 74026 0 27415 0 317909 0 0 0 Cory Nelson CEO 248031 0 0 0 2769 0 9356 0 26596 0 286752 0 0 0 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. A City of Hull Iowa 426004780 2017-12-18 8300000 Hospital Facility Revenue Refunding Bond, Series 2017(2012 issue). 0 0 0 B City of Hull Iowa 426004780 2019-12-30 9500000 Short term Construction Financing 0 0 0 C Sioux County Iowa 426005069 2019-12-30 8000000 Short term Construction Financing 0 0 0 D City of Hull Iowa 426004780 2020-11-18 8000000 Health Facility Revenue Bond (Sioux Center Health Project), Series 2020B 0 0 0 A 1151069 8300000 156681 8143319 1 0 1 1 B 9500000 144006 100082 9255912 0 0 0 1 C 8000000 121268 84279 7794453 0 0 0 1 D 8000000 102865 4738416 3158719 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 D 0 0 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 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. A Sioux County Iowa 426005069 2020-11-18 4500000 Health Facility Revenue Bond (Sioux Center Health Project), Series 2020BB 0 0 0 A 4500000 57657 4442343 2020 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 Brooke Van Engen Family member of Brian Van Engen, Director 21285 Compensation as an employee 0 Kim Bosma Family member of Cory Gotto, Board member 44062 Compensation as an employee 0 Val Hiemstra Family member of Cory Gotto, Board member 45444 Compensation as an employee 0 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.