2022-03-08T15:36:20-06:00 2020-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2019-07-01 420890973 OSCEOLA COMMUNITY HOSPITAL INC OSCE 7127542574 PO BOX 258 SIBLEY IA 51249 BEN DAVIS CEO 7127542574 2022-03-04 1 LAURIE HANSON CPA P00851848 6053391999 2022-03-03 2019 2022-09-23 18:48:47Z X OSCEOLA REGIONAL HEALTH CENTER BEN DAVIS PO BOX 258 SIBLEY IA 51249 12521588 0 X HTTPS://WWW.OSCEOLARHC.ORG/ X 1960 IA TO PROVIDE HEALTHCARE TO THE CITIZENS OF OSCEOLA COUNTY AND THE SURROUNDING AREA. 9 9 139 210 0 0 454667 536418 10804558 11657315 142489 160311 215408 162806 11617122 12516850 0 0 0 0 4847421 5815033 0 0 37116 6694784 6430513 11542205 12245546 74917 271304 17734737 24101902 5096957 11188640 12637780 12913262 IT IS THE MISSION OF THE OSCEOLA COMMUNITY HOSPITAL TO ENHANCE AND IMPROVE THE QUALITY OF LIFE OF THE POPULATION IT SERVES, TO BE THE AREA'S PREMIER HEALTH CARE SERVICE PROVIDER, AND TO HAVE A POSITIVE IMPACT ON THE LIVES OF THE PEOPLE AND COMMUNITY IT SERVES. 0 0 8896940 11924065 OSCEOLA COMMUNITY HOSPITAL PROVIDED NURSING SERVICES, LAB, RADIOLOGY, AND OTHER RELATED HOSPITAL FUNCTIONS TO RESIDENTS OF OSCEOLA COUNTY, IOWA AND NEARBY COUNTIES. IN ADDITION, THE HOSPITAL PROVIDES DAY CARE TO THE COMMUNITY. HEALTH SCREENINGS SUCH AS CHOLESTEROL AND CARDIAC ARE PROVIDED AS WELL. THE HOSPITAL WORKS HARD TO BRING OUTREACH SPECIALISTS TO THE FACILITY TO MAKE THESE SERVICES AVAILABLE TO THOSE THAT FIND IT DIFFICULT TO TRAVEL. THE FACILITY'S WELLNESS CENTER PROVIDES PROGRAMS TO THE LOCAL SCHOOL SYSTEM, NURSING HOME FACILITIES, OUTPATIENTS, AND THE COMMUNITY AT LARGE. DURING THE 12 MONTHS OF 7/01/2019-6/30/2020 THE HOSPITAL PROVIDED $118,000 OF CHARITY CARE CHARGES TO VARIOUS INDIVIDUALS, WITHOUT REIMBURSEMENT. 8896940 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 29 0 1 139 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CRAIG CARSTENS 7127542574 600 9TH AVENUE NORTH SIBLEY IA 51249 BEN DAVIS CEO 40.00 0.50 X 144163 0 25353 CRAIG CARSTENS CFO 40.00 0.50 X 79550 0 23155 BARB VAN DIEPEN PRESIDENT 1.00 X X 0 0 0 KEVIN HERTZ VICE PRESIDENT 1.00 X X 0 0 0 STANLEY JOHNSON TREASURER 1.00 X X 0 0 0 PEGGI THIES SECRETARY 1.00 1.00 X X 0 0 0 ROSALI ARENDS TRUSTEE 1.00 1.00 X 0 0 0 SUELLEN SCHUTTE TRUSTEE 1.00 1.00 X 0 0 0 BRUCE OSTERMAN TRUSTEE 1.00 1.00 X 0 0 0 NATHAN ROCKMAN TRUSTEE 1.00 X 0 0 0 BRIAN DREESSEN TRUSTEE 1.00 X 0 0 0 223713 0 48508 1 0 1 0 AVERA MCKENNAN 800 E 21ST ST SIOUX FALLS SD 57117 IT SERVICES, ADMINISTRATIVE SERVICES 1586759 GREAT LAKES PHYSICAL THERAPY 3301 BERGQUIST AVE SPIRIT LAKE IA 51360 PHYSICAL THERAPY SERVICES 252345 AVERA HEALTH 3900 W AVERA DRIVE STE 301 SIOUX FALLS SD 57108 CREDENTIALING, PACS, BILLING SERVICES, C 218069 3 460866 75552 536418 PATIENT REVENUE 621400 10750285 10750285 CHILDCARE SERVICES 621400 407565 407565 499465 499465 11657315 66071 66071 97650 0 97650 97650 97650 98978 0 4738 98978 -4738 94240 94240 65156 0 65156 65156 12516850 11657315 0 323117 X 312981 312981 4180145 3514554 642859 22732 63563 56195 7250 118 946992 724534 220934 1524 311352 227525 83348 479 220 220 68900 68900 2391157 1697970 692577 610 176716 157 176559 365200 200189 164492 519 164886 142627 16446 5813 25064 18418 6646 22377 7961 14416 119622 119622 851725 276871 574459 395 85730 85730 MEDICAL SUPPLIES 1731215 1731171 44 REPAIR AND MAINTENANCE 229226 224051 2462 2713 DUES AND SUBSCRIPTIONS 3845 0 3845 194630 74717 117700 2213 12245546 8896940 3311490 37116 1037737 2442847 1054704 2043012 1384930 1333651 13574 16404 314468 286277 90204 78166 21808952 16149070 6263434 5659882 5098538 9270193 2391731 2386269 85417 60417 0 524784 17734737 24101902 899078 955866 5291330 4160394 3990127 951317 37485 0 5096957 11188640 X 12508095 12790171 129685 123091 12637780 12913262 17734737 24101902 X 271304 48921 -44743 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 201490 201490 13240365 9057711 4182654 7653111 6430319 1222792 713986 661040 52946 5659882 INTEREST IN NET ASSETS OF FOUNDATION 2262781 F CLOSELY-HELD EQUITY INVESTMENTS 123488 F 2386269 X 12534628 48921 6877 55798 12478830 38020 38020 12516850 12245546 0 12245546 0 12245546 PART X, LINE 2: THE HEALTH CENTER BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HEALTH CENTER WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE HOSPITAL'S TAX RETURN IS SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER REVENUE PER AUDIT 6,877. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 38,020. 1 1 X 1 X 1 X 1 1 1 0 1 1 59000 59000 0.00480 803542 602539 201003 0.01640 862542 602539 260003 0.02120 13483 13483 0.00110 1471556 916098 555458 0.04540 1485039 916098 568941 0.04650 2347581 1518637 828944 0.06770 0 47228 0 5427753 5449722 -21969 X 1 1 1 1 OSCEOLA COMMUNITY HOSPITAL 600 NINTH AVENUE NORTH SIBLEY IA 51249 HTTPS://WWW.OSCEOLARHC.ORG/ 720109H X X X X OSCEOLA COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE 7D X X 1 18 1 SEE PART V PAGE 8 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X X X X X X 1 X 0 X X X X 1 X 0 0 OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: OSCEOLA COMMUNITY HOSPITAL INC. CONDUCTED FOCUS GROUP MEETINGS AND ALSO CONDUCTED PERSONAL INTERVIEWS. CAREFUL CONSIDERATION WAS GIVEN TO ENSURE INPUT WAS GATHERED FROM PERSONS THAT REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY. THE HOSPITAL ENGAGED THE GENERAL PUBLIC TO INCLUDE VARIOUS AGES, HEALTH STATUS AND INCOME LEVELS, ALONG WITH MEDICAL COMMUNITY AND CIVIC ORGANIZATIONS, BUSINESS OWNERS, PUBLIC HEALTH OFFICIALS, EMERGENCY PERSONAL, CITY AND COUNTY OFFICIALS, SCHOOL PERSONNEL, MENTAL HEALTH PROVIDERS, MINISTERIAL ASSOCIATION MEMBERS, CHAMBER OF COMMERCE MEMBERS AND OTHER REPRESENTING THE UNINSURED AND UNDERINSURED POPULATION. OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: OSCEOLA PUBLIC HEALTH OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: HTTPS://WWW.OSCEOLARHC.ORG/ABOUT/QUALITY-COMMITMENT/ OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE PRIOR TAX YEAR AND DUE TO THE ONGOING PANDEMIC THE HOSPITAL HAS NOT TAKEN SPECIFIC ACTIONS WITH RESPECT TO THE CURRENT IMPLEMENTATION STRATEGY. THE FOLLOWING COMMUNITY HEALTH PRIORITY AREAS WERE IDENTIFIED, AND THE FOLLOWING ACTIONS WILL BE TAKEN BY THE HOSPITAL DURING FUTURE YEARS.ACCESS TO HEALTH CARE PROVIDERS- IN PARTNERSHIP WITH AVERA MEDICAL GROUP SIBLEY, RECRUITMENT EFFORTS HAVE AND WILL CONTINUE TO BE A MAIN PRIORITY. OSCEOLA REGIONAL HEALTH CENTER WILL ALSO WORK TO RECRUIT AND RETAIN SPECIALTY PHYSICIANS.- OCH INTENDS TO PARTNER WITH MEDICAL SCHOOLS TO BRING MORE MEDICAL STUDENTS INTO OSCEOLA COUNTY FOR ROTATIONS.ACCESS TO MENTAL HEALTH/SUBSTANCE ABUSE SERVICES- OSCEOLA REGIONAL HEALTH CENTER HAS PARTNERED WITH SEASON CENTER FOR BEHAVIORAL HEALTH TO PROVIDE MENTAL HEALTH CLINICS IN OUR HOSPITAL AND WILL CONTINUE TO PARTNER WITH THEM TO IMPROVE SERVICES FOR OUR POPULATION. - OSCEOLA REGIONAL HEALTH CENTER INTENDS TO PARTNER WITH SENIOR LIFE SOLUTIONS FOR MENTAL HEALTH SERVICES FOR THOSE OVER THE AGE OF 65, AND TO PARTNER WITH OTHER MENTAL HEALTHCARE ORGANIZATIONS TO PROVIDE MENTAL HEALTH SERVICES.EMERGENCY MANAGEMENT SERVICES- MEETINGS HAVE BEEN HELD WITH THE OSCEOLA REGIONAL HEALTH CENTER, AVERA PHYSICIANS, OSCEOLA BOARD OF SUPERVISORS, EMS AND EMT'S, BOARD OF SUPERVISORS TO ENSURE WE HAVE THE BEST POSSIBLE SERVICE FOR OUR COMMUNITIES. - ORHC INTENDS TO BUILD AN AMBULANCE GARAGE ON THE HOSPITAL'S CAMPUS.WORKFORCE DEVELOPMENT- OSCEOLA REGIONAL HEALTH CENTER HAS PARTNERED WITH LOCAL SCHOOL DISTRICTS TO PROVIDE SCHOLARSHIPS FOR HIGH SCHOOL GRADUATES TO PURSUE DEGREES IN HEALTHCARE. - ORHC INTENDS TO PARTNER WITH LOCAL SCHOOL DISTRICTS TO CREATE APPRENTICESHIPS AND PRECEPTOR PROGRAMS IN HEALTHCARE.- ORHC INTENDS TO PARTNER WITH COMMUNITY COLLEGES TO PROMOTE HEALTHCARE FIELDS IN POST-SECONDARY EDUCATION.COMMUNITY WELLNESS- OSCEOLA COMMUNITY WELLNESS AND REHAB, A DIVISION OF ORHC, HAS COMPLETED A REMODEL AND INSTALLED UPDATED EQUIPMENT. THIS IS AN OPPORTUNITY TO PROMOTE WELLNESS. - THE DIABETIC EDUCATION PROGRAM AT OSCEOLA REGIONAL HEALTH CENTER HAS A REGISTERED NURSE (RN) AND A REGISTERED DIETICIAN (RD) THAT PROVIDE COUNSELING SERVICES TO DIABETIC PATIENTS REGARDING KNOWLEDGE OF NUTRITION, EXERCISE, MONITORING AND MEDICATION. - THE PUBLIC HEALTH OFFICE WHICH IS LOCATED ON THE OSCEOLA REGIONAL HEALTH CENTER CAMPUS PROVIDES IMMUNIZATIONS, PRE/POST-NATAL CARE, FOOT CARE AND THE HOMEMAKER PROGRAM, WHICH ALL SUPPORT COMMUNITY WELLNESS. ORHC MAY EXPAND THESE SERVICES IN THE FUTURE.- ORHC INTENDS TO DEVELOP TRAINING SESSIONS TO PROMOTE WELLNESS AND EDUCATION FOR COMMUNITY MEMBERS.DAYCARE SERVICES- ORHC WILL WORK WITH THE CITY OF SIBLEY AND OSCEOLA COUNTY BOARD OF SUPERVISORS AS WELL AS LOCAL ORGANIZATIONS TO ADDRESS THE NEED FOR ADDITIONAL DAYCARE PROVIDERS AND TO PROMOTE DAYCARE SERVICES.MANY OF THESE ACTIVITIES ARE CONTINUATIONS OF ACTIVITIES THE HOSPITAL HAS BEEN CONDUCTING RELATED TO THE PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT. RECREATIONAL ACTIVITIES, PARKS AND TRAILS, AND HOUSING WERE IDENTIFIED AS NEEDS OF THE COMMUNITY. DUE TO LIMITED RESOURCES, THESE NEEDS WILL NOT BE ADDRESSED BY ORHC. OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: THE HOSPITAL WILL PRESUMPTIVELY DETERMINE THAT AN INDIVIDUAL QUALIFIES FOR 100% FINANCIAL ASSISTANCE IF THE HOSPITAL OR ITS AGENT OBTAINS EVIDENCE OF ANY OF THE FOLLOWING SITUATIONS. IF A PERSON IS PRESUMPTIVELY DETERMINED TO QUALIFY, THE HOSPITAL WILL SEND A WRITTEN NOTICE INFORMING THE INDIVIDUAL THAT THEIR LIABILITY HAS BEEN FORGIVEN AND NO FURTHER PAYMENTS ARE DUE.-HOMELESSNESS OR RECEIVED CARE FROM A HOMELESS CLINIC;-NO INCOME;-PARTICIPATE IN THE WOMEN'S, INFANT'S, AND CHILDREN'S PROGRAM ("WIC");-ELIGIBLE FOR FOOD STAMPS;-PARTICIPATE IN A SUBSIDIZED SCHOOL LUNCH PROGRAM;-ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED, SUCH AS MEDICAID SPEND-DOWN;-FAMILY OR FRIENDS OF THE INDIVIDUAL PROVIDE INFORMATION ESTABLISHING THE INDIVIDUAL'S INABILITY TO PAY;-LOW-INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;-PATIENT IS DECEASED WITH NO KNOWN ESTATE; OR-PATIENT/GRANTOR IS INCARCERATED, HAS NO ASSETS, AND IS NOT ELIGIBLE FOR PAROLE WITHIN THE NEXT 18 MONTHS. SCHEDULE H, PART V, SECTION B, LINE 10 AVERA.ORG/APP/FILES/PUBLIC/75774/2019-CHNA-OSCEOLA-IMPLEMENTATION-PLAN.PDF PART I, LINE 3C: IN ADDITION TO USING FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE FACILITY USES AN ASSET TEST AND MAY PROVIDE PRESUMPTIVE ELIGIBILITY IF WARRANTED. PART I, LINE 6A: THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS INCLUDED IN A REPORT PREPARED BY THE IOWA HOSPITAL ASSOCIATION, RATHER THAN IN A SEPARATE REPORT PREPARED BY THE ORGANIZATION. THIS REPORT IS MADE AVAILABLE BY THE IOWA HOSPITAL ASSOCIATION TO THE PUBLIC THROUGH THEIR WEBSITE. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7B: UNREIMBURSED MEDICAID WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORT. ACTUAL COSTS FROM THE GENERAL LEDGER WERE USED FOR LINE 7E.LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION SUPPORTED THE COMMUNITY THROUGH PROVIDING EMERGENCY PREPAREDNESS, DISEASE SURVEILLANCE AND BEST CARE FOR BETTER BABIES PROGRAMS. 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 4: THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGE 9 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/20. 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: IF AN INDIVIDUAL SUBMITS A FINANCIAL ASSISTANCE APPLICATION, THE HOSPITAL WILL CEASE ALL COLLECTION EFFORTS UNTIL A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IS MADE.IF THE HOSPITAL OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION, THE EXTRAORDINARY COLLECTION ACTION WILL BE SUSPENDED. SUSPENDING AN ACTION MEANS THAT NO FURTHER STEPS ARE TAKEN ON THAT EXTRAORDINARY COLLECTION ACTION AND NO NEW EXTRAORDINARY COLLECTION ACTIONS ARE INITIATED. THIS SUSPENSION MAY BE LIFTED WHEN THE HOSPITAL DETERMINES THE INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFIES THE INDIVIDUAL AS PRESCRIBED IN THE FINANCIAL ASSISTANCE POLICY.IF THE HOSPITAL OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL AND/OR THE OTHER AUTHORIZED PARTY WILL TAKE ALL REASONABLY AVAILABLE MEASURES TO REVERSE THE EXTRAORDINARY COLLECTION ACTION. SUCH STEPS INCLUDE, BUT ARE NOT LIMITED TO, VACATING A JUDGEMENT AGAINST THE INDIVIDUAL, LIFTING A LEVY OR LIEN ON THE INDIVIDUAL'S PROPERTY, AND REMOVING FROM THE INDIVIDUAL'S CREDIT REPORT ANY ADVERSE INFORMATION THAT WAS REPORTED.IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION, THE HOSPITAL WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS, AND PROVIDE A WRITTEN NOTICE TO THE RESPONSIBLE PARTY THAT INCLUDES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION THAT MUST BE SUBMITTED, THE PHYSICAL LOCATION AND PHONE NUMBER OF A HOSPITAL EMPLOYEE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, THE PHYSICAL LOCATION AND PHONE NUMBER OF AN ORGANIZATION OR HOSPITAL EMPLOYEE/OFFICE/DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. THE HOSPITAL WILL ALLOW A REASONABLE AMOUNT OF TIME FOR THE RESPONSIBLE PARTY TO SUBMIT A COMPLETE FINANCIAL ASSISTANCE APPLICATION. SUCH PERIOD OF TIME WILL BE AT LEAST 30 DAYS FROM THE DATE THE WRITTEN NOTICE IS SENT TO THE RESPONSIBLE PARTY. IF THE RESPONSIBLE PARTY FAILS TO PROVIDE THE REQUESTED INFORMATION WITHIN THE STATED TIME, THE HOSPITAL MAY RENEW THE PREVIOUSLY INITIATED EXTRAORDINARY COLLECTION ACTIONS. IF AN INDIVIDUAL HAS MADE FULL OR PARTIAL PAYMENT, AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, ANY PAYMENTS IN EXCESS OF THEIR NEWLY CALCULATED REMAINING LIABILITY WILL BE REFUNDED TO THE PATIENT WITHIN 30 DAYS OF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION. IF THE REFUNDABLE AMOUNT IS LESS THAN $5.00, IT WILL NOT BE REFUNDED. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH FORMAL PROCESSES THAT INCLUDE MEETINGS, SURVEY AND COMMUNITY INPUT PRIOR TO UNDERTAKING ANY LARGE PROJECTS. THROUGHOUT THE YEAR, COMMUNITY NEEDS ARE ASSESSED INFORMALLY AT VARIOUS COMMUNITY MEETINGS AND THROUGH PATIENT SURVEYS. THE ORGANIZATION ALSO ASSISTS THE HOME HEALTH DEPARTMENT/PUBLIC HEALTH WITH A COMMUNITY NEEDS ASSESSMENT AND INFORMATION FROM THE CHNA IS UTILIZED TO HELP PLAN SERVICES THE ORGANIZATION OFFERS. PART VI, LINE 3: DURING THE COURSE OF PRE-REGISTRATION A MODE OF PAYMENT IS RECORDED ON THE ADMISSION FORM. IF INSURANCE IS INDICATED, BENEFITS ARE REQUESTED FROM THE INSURANCE COMPANY. IF IT IS NOTED THAT THE ACCOUNT HAS A LARGE DEDUCTIBLE OR IS SELF-PAY, THE INFORMATION IS FORWARDED TO THE COLLECTION STAFF AND SOCIAL SERVICES. OPTIONS FOR HANDLING PAYMENT OF THE ACCOUNT ARE THEN DISCUSSED WITH THE PATIENT OR THE RESPONSIBLE PARTY. IF THE PATIENT OR RESPONSIBLE PARTY IS NOT AVAILABLE AT THE TIME THE INFORMATION IS RECEIVED BY THE BUSINESS OFFICE OR SOCIAL SERVICE STAFF, EFFORTS TO CONTACT THEM INCLUDE PHONE AND WRITTEN CORRESPONDENCE. IF THE PARTY DOES NOT RESPOND, THE ACCOUNT IS HANDED OVER TO THE COLLECTION AREA. THIS PROCESS OFTEN REQUIRES A COMBINATION OF BUSINESS OFFICE AND SOCIAL SERVICE STAFF WORKING TOGETHER.OPTIONS FOR ANY SELF-PAY OBLIGATIONS INCLUDE PAYMENT IN FULL, PAYMENT PLANS, VARIOUS ASSISTANCE PROGRAMS, AND THE FINANCIAL ASSISTANCE OFFERED BY OSCEOLA COMMUNITY HOSPITAL'S CHARITY CARE. INFORMATION REGARDING THESE OPTIONS IS MADE AVAILABLE AT THIS TIME.DURING THE DISCUSSIONS, INFORMATION IS REQUESTED TO ASSESS AND APPROVE FINANCIAL STATUS IF PAYMENTS, PROGRAM APPLICATION, OR CHARITY ARE INDICATED. ASSISTANCE IS OFFERED FOR COMPLETION OF APPLICATIONS AND INSTRUCTIONS ARE GIVEN FOR COMPLETION OF FINANCIAL ASSESSMENTS. PARTICULAR ACCOUNTS MAY ALSO BE BROUGHT TO THE ATTENTION OF THE BUSINESS OFFICE OR SOCIAL SERVICES BY THE COLLECTIONS STAFF, PATIENTS THEMSELVES, OR RELATIVES OF PATIENTS. THIS USUALLY OCCURS WHEN THE CIRCUMSTANCES OF THE PATIENT CHANGES AFTER A TIME PERIOD HAS PASSED. WHEN NOTIFICATION IS RECEIVED, THESE CASES ARE REASSESSED. PART VI, LINE 4: DURING FISCAL YEAR 2019 A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY OSCEOLA COMMUNITY HOSPITAL FOR THE APPROXIMATELY 12,000 PEOPLE RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN DEFINING COMMUNITY, OSCEOLA COMMUNITY HOSPITAL HAS TAKEN IN TO CONSIDERATION ALL MEMBERS OF OSCEOLA COUNTY AND OUR LARGER SERVICE AREA (LYON, O'BRIEN, DICKINSON AND NOBLES, MN COUNTIES) REGARDLESS OF SOCIO-ECONOMIC STATUS. OSCEOLA COMMUNITY HOSPITAL IS COMMITTED TO MEETING THE NEEDS OF ALL WHO NEED CARE REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITIES LOCATED IN THIS GEOGRAPHIC AREA INCLUDE BUT ARE NOT LIMITED TO: ASHTON, BOYDEN, GEORGE, HARRIS, LAKE PARK, LITTLE ROCK, MELVIN, OCHEYEDAN, SHELDON, AND SIBLEY IN IOWA, AND BIGELOW, RUSHMORE, AND WORTHINGTON IN MINNESOTA.ACCORDING TO THE 2000 AND 2010 CENSUS, THE POPULATION HAS DECREASED 6.5% OVER THE PREVIOUS 8 YEARS. THE MEDIAN AGE OF THE POPULATION WAS 40 AND WAS MADE UP OF 96.7% CAUCASIANS. THE MEDIAN HOUSEHOLD INCOME WAS $53,604 WITH AN AVERAGE HOUSEHOLD OF 2.5." PART VI, LINE 6: OSCEOLA COMMUNITY HOSPITAL IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND OSCEOLA COMMUNITY HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. AS A MANAGED FACILITY, OSCEOLA COMMUNITY HOSPITAL IS ABLE TO PARTICIPATE IN AVERA E-CARE SERVICES. THESE SERVICES INCLUDE AVERA E-EMERGENCY, E-PHARMACY AND E-CONSULT. THESE SERVICES ALLOW RURAL PATIENTS TO BE CARED FOR AT THEIR LOCAL HOSPITALS, PROVIDE RURAL HOSPITALS ACCESS TO IMMEDIATE SPECIALTY CARE AND SUPPORT, AND HELP REDUCE HEALTH CARE COSTS AND TRAVEL.OSCEOLA COMMUNITY HOSPITAL ALSO HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCE ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO THE HOSPITAL AT A COST BELOW THAT WHICH OSCEOLA COMMUNITY HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. AVERA HEALTH AND OSCEOLA COMMUNITY HOSPITAL DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. X X X 0 0 0 0 0 0 0 0 0 BEN DAVIS CEO 144163 0 0 0 0 0 4797 0 21812 0 170772 0 0 0 A CITY OF SIBLEYIA 426005203 2016-02-24 4776000 TO REFINANCE SERIES 2001 AND 2007 BONDS 0 0 0 A 710651 4776000 95520 4680101 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE ORGANIZATION. THE PRESIDENT SHALL SERVE AS THE CHAIR OF THE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF TRUSTEES, AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 REGULAR MEMBERS ARE THOSE PERSONS, CORPORATIONS, ASSOCIATIONS OR PARTNERSHIPS WHO HAVE CONTRIBUTED AND PAID INTO THE CORPORATION A MINIMUM OF $75 OR MORE TO FURTHER THE OBJECTIVES OF THE CORPORATION. MEMBERSHIP SHALL BE LIFELONG AND NONTRANSFERABLE. EACH MEMBER WHOSE NAME IS ENDORSED ON THE MEMBERSHIP CERTIFICATES SHALL BE QUALIFIED TO ORIGINATE AND TAKE PART IN THE DISCUSSION OF ANY SUBJECT THAT MAY PROPERLY COME BEFORE THE ANNUAL MEETING OF THE CORPORATION, TO VOTE ON SUCH SUBJECTS, AND TO HOLD ANY OFFICE TO WHICH THE MEMBER MAY TO ELECTED OR APPOINTED. NO EMPLOYEE OR EMPLOYEE'S SPOUSE OF THE CORPORATION MAY BE ELECTED TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A TRUSTEES ARE ELECTED TO THE BOARD OF TRUSTEES FROM THE MEMBERS AT THE ANNUAL MEETING OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT OF THE HOSPITAL. UPON APPROVAL, THE FORM 990 WAS THEN PRESENTED TO THE BOARD MEMBERS AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR/TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A CONFLICT OF INTEREST STATEMENT. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF A FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE DIRECTORS/TRUSTEES AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER THE INTERESTED PERSON LEAVES THE MEETING, THE REMAINING BOARD OR COMMITTEE MEMBERS WILL DISCUSS AND VOTE UPON WHETHER A CONFLICT OF INTEREST EXISTS. ALSO, IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A DIRECTOR, TRUSTEE, OR MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION SHALL BE TAKEN IF NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION SPECIALIST FROM AN AFFILIATE ORGANIZATION REVIEWS THE COMPENSATION WITH THE BOARD OF TRUSTEES SEMI-ANNUALLY. THE SPECIALIST REVIEWS MARKET VALUE AND PRESENTS A RECOMMENDATION TO THE BOARD OF TRUSTEES. THE BOARD MAKES THEIR DECISION ON THE INFORMATION PRESENTED. THE COMPENSATION REVIEW PROCESS IS COMPLETED ANNUALLY FOR ALL OFFICERS AND TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AND THE FORM 990 IS AVAILABLE AT THE ANNUAL MEETING AND UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 573,874. MANAGEMENT AND GENERAL EXPENSES 692,577. FUNDRAISING EXPENSES 610. TOTAL EXPENSES 1,267,061. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,124,096. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,124,096. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -13,382. NET ASSETS RELEASED FROM RESTRICTIONS -31,361. AMENDEND RETURN THE FY 2020 990 RETURN WAS AMENDED TO ATTACH THE AUDITED FINANCIAL STATEMENT AND REPORT CHANGES TO FORM 990, PARTS VIII, X AND XI AS A RESULT OF CHANGES MADE TO THE FINANCIAL STATEMENT UPON COMPLETION OF THE AUDIT. THE CHANGES ARE AS FOLLOWS: PART VIII STATEMENT OF REVENUE: LINE 1E CHANGED FROM $72,105 TO $460,866. LINE 2G CHANGED FROM $766,215 TO $499,465. LINE 12 COLUMN A CHANGED FROM $12,394,839 TO $12,516,850. LINE 12 COLUMN B CHANGED FROM $11,924,065 TO $11,657,315. PART X BALANCE SHEET: LINE 19 CHANGED FROM $5,413,342 TO $5,291,330 DUE TO CHANGES ON REFUNDABLE ADVANCE. LINE 26 CHANGED FROM $11,310,652 TO $11,188,640. LINE 27 CHANGED FROM $12,668,160 TO $12,790,171. LINE 32 CHANGED FROM $12,791,251 TO $12,913,262. PART XI RECONCILIATION OF NET ASSETS: LINE 1 CHANGED FROM $12,394,839 TO $12,516,850. LINE 3 CHANGED FROM $149,293 TO $271,304. LINE 10 CHANGED FROM $12,791,251 TO $12,913,262. SCHDULE D PART XI: LINE 1 CHANGED FROM $12,412,617 TO $12,534,628 DUE TO CHANGES MADE ON AUDIT REPORT. HEARTWOOD HEIGHTS 409 9TH AVE NORTH SIBLEY IA 51249 421495686 INDEPENDENT;ASSISTED LIVING IA 501(C)(3) PF OSCEOLA COMMUNITY HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 HEARTWOOD HEIGHTS O 241771 ACTUAL COST