SIOUX CENTER HEALTH: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- SIOUX CENTER HEALTH (EIN 42-0796764)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-02-24
- IRS object ID
- 202110559349300111
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-02-24T12:10:09-06:00 | ReturnTs |
| Tax Period End | 2020-06-30 | 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 | 2019-07-01 | 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 | 2021-02-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Laurie Hanson CPA | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2021-02-23 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | 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 | $45,071,421 | 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 | 38 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 36 | VotingMembersIndependentCnt |
| Total Employee | 595 | TotalEmployeeCnt |
| Total Volunteers | 63 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $24,691 | PYContributionsGrantsAmt |
| CY Contributions Grants | $287,586 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $44,397,819 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,453,909 | CYProgramServiceRevenueAmt |
| PY Investment Income | $148,269 | PYInvestmentIncomeAmt |
| CY Investment Income | $234,050 | CYInvestmentIncomeAmt |
| PY Other Revenue | $57,368 | PYOtherRevenueAmt |
| CY Other Revenue | $50,745 | CYOtherRevenueAmt |
| PY Total Revenue | $44,628,147 | PYTotalRevenueAmt |
| CY Total Revenue | $45,026,290 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $38,750 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,497,605 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,487,236 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $76,740 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,404,582 | PYOtherExpensesAmt |
| CY Other Expenses | $20,098,001 | CYOtherExpensesAmt |
| PY Total Expenses | $44,940,937 | PYTotalExpensesAmt |
| CY Total Expenses | $46,595,237 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$312,790 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,568,947 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $74,988,976 | TotalAssetsBOYAmt |
| Total Assets EOY | $89,106,831 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $37,625,147 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $51,835,910 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $37,363,829 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $37,270,921 | 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 | $40,938,675 | ExpenseAmt |
| Grant | $10,000 | GrantAmt |
| Revenue | $44,453,909 | 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, 2020, patient days were 1,276, swing-bed days were 967, and newborn days were 337.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 $247,000 for the year ended June 30, 2020, 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 | $40,938,675 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 595 | 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 | 38 | 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 (48 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| Dr Nicholas Mouw | |||||||
| General Surgeon | 40.00 | Yes (X) | $598,782 | $0 | $67,509 | ||
| Dr Scott A Rens MD | |||||||
| Family Medicine/OB | 40.00 | Yes (X) | $423,853 | $0 | $53,007 | ||
| Alanna Janssen | |||||||
| Physician | 40.00 | Yes (X) | $372,869 | $0 | $40,926 | ||
| Daniel VandenBosch | |||||||
| Physician | 40.00 | Yes (X) | $333,694 | $0 | $42,427 | ||
| David Janssen | |||||||
| Physician | 40.00 | Yes (X) | $336,799 | $0 | $29,715 | ||
| Cory Nelson | |||||||
| CEO | 40.00 | $225,325 | $0 | $41,573 | Yes (X) | ||
| Kari Timmer | |||||||
| CFO | 40.00 | $113,683 | $0 | $10,285 | Yes (X) | ||
| Tim Byl | |||||||
| President | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Doug Van Meeteren | |||||||
| Vice President | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Kyle Hiemstra | |||||||
| Secretary | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Jeffrey Timmer | |||||||
| Treasurer | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Nathan Bakker | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Terry Boote | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Lisa Christians | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Lynne Hagen | |||||||
| Director Until 02/2020 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Neil Van Schouwen | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Curt Hohman | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Vernon Beernink | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Janet Boone | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Delbert Broek | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Leslie Brommer | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Bob Bruxvoort | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Paul Clousing | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Brenda Dokter | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Bruce Dooyema | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| David Eekhoff | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Cory Gotto | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Dan Hibma | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Jennifer Jansen | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Lauren Kaemingk | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Rick Kattenberg | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Jody Kock | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Stacy Koele | |||||||
| Director Until 12/2019 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| John Koerselman | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Ardith Lein | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Dorinda Oostenink | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Scott Peterson | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Stan Speer | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Dale Vander Berg | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Betty Vermeer | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Lyle Vermeer | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Scott Wynja | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Verdean Wynja | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Josh Bowar | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Marj Wagner | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Brian Van Engen | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Gretchen Zomermaand | |||||||
| Director Until 12/2019 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Matt Nice | |||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,405,005 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $285,442 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 21 | 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 |
|---|---|---|---|---|---|
| Avera McKennan | |||||
| 1325 S Cliff Avenue | Sioux Falls | SD | 57110 | Management fees & other services | $1,900,783 |
| Michael Tadlock | |||||
| 2183 Ridge Rd | Sioux Center | SD | 51250 | anesthesia services | $427,440 |
| Creative Dining Services Inc | |||||
| One Royal Park Dr Ste3 | Zeeland | MI | 49464 | dietary professional fees | $238,504 |
| Northwest Iowa Diagnostics | |||||
| 714 Lincoln St NE | le Mars | IA | 51031 | Ultrasound Readings | $208,475 |
| Thomas Posch | |||||
| 234 Marina Dell Ave | Yankton | SD | 57078 | Radiology Readings | $140,423 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $287,586 | GovernmentGrantsAmt |
| Total Contributions | $287,586 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 622110 | $38,349,205 | $38,349,205 |
| Assisted and Independent Living | 623990 | $2,279,983 | $2,279,983 |
| Pharmacy Revenue | 900099 | $1,986,158 | $1,986,158 |
| Daycare Revenue | 624410 | $1,041,685 | $1,041,685 |
| Investment in Affiliates | 900099 | $175,973 | $175,973 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $620,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $620,905 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,453,909 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $250,030 | TotalRevenueColumnAmt |
| Exclusion | $250,030 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,423 | 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 | $36,423 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,423 | TotalRevenueColumnAmt |
| Exclusion | $36,423 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $15,980 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$15,980 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,980 | TotalRevenueColumnAmt |
| Exclusion | -$15,980 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $43,473 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $29,151 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,322 | TotalRevenueColumnAmt |
| Exclusion | $14,322 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,026,290 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,453,909 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $284,795 | 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 | $10,000 | TotalAmt |
| Program Services | $10,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $403,436 | TotalAmt |
| Management And General | $403,436 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,775 | TotalAmt |
| Program Services | $58,775 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,907,345 | TotalAmt |
| Program Services | $19,448,723 | ProgramServicesAmt |
| Management And General | $1,393,542 | ManagementAndGeneralAmt |
| Fundraising | $65,080 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $739,325 | TotalAmt |
| Program Services | $677,107 | ProgramServicesAmt |
| Management And General | $59,891 | ManagementAndGeneralAmt |
| Fundraising | $2,327 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,979,083 | TotalAmt |
| Program Services | $2,784,047 | ProgramServicesAmt |
| Management And General | $191,456 | ManagementAndGeneralAmt |
| Fundraising | $3,580 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,399,272 | TotalAmt |
| Program Services | $1,275,192 | ProgramServicesAmt |
| Management And General | $119,404 | ManagementAndGeneralAmt |
| Fundraising | $4,676 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,569 | TotalAmt |
| Management And General | $2,569 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,621 | TotalAmt |
| Management And General | $104,621 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,191,514 | TotalAmt |
| Program Services | $3,504,963 | ProgramServicesAmt |
| Management And General | $1,686,551 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,677 | TotalAmt |
| Management And General | $245,677 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,308,287 | TotalAmt |
| Program Services | $932,521 | ProgramServicesAmt |
| Management And General | $375,766 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $734,328 | TotalAmt |
| Program Services | $727,283 | ProgramServicesAmt |
| Management And General | $7,045 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,882 | TotalAmt |
| Program Services | $83,029 | ProgramServicesAmt |
| Management And General | $2,853 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,092 | TotalAmt |
| Program Services | $132,907 | ProgramServicesAmt |
| Management And General | $18,885 | ManagementAndGeneralAmt |
| Fundraising | $300 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,077,712 | TotalAmt |
| Program Services | $855,111 | ProgramServicesAmt |
| Management And General | $222,601 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,816,439 | TotalAmt |
| Program Services | $3,425,340 | ProgramServicesAmt |
| Management And General | $391,099 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409,063 | TotalAmt |
| Program Services | $120,476 | ProgramServicesAmt |
| Management And General | $288,587 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Medical Supplies | $5,387,670 | $5,387,670 | ||
| Food | $635,656 | $613,771 | $21,108 | $777 |
| Bad Debts Expense | $590,139 | $590,139 | ||
| Taxes | $293,827 | $293,827 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,525 | TotalAmt |
| Program Services | $17,794 | ProgramServicesAmt |
| Management And General | $44,731 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,595,237 | TotalAmt |
| Program Services | $40,938,675 | ProgramServicesAmt |
| Management And General | $5,579,822 | ManagementAndGeneralAmt |
| Fundraising | $76,740 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,516,664 | BOYAmt |
| EOY | $22,053,588 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,222 | BOYAmt |
| EOY | $83,791 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,058,474 | BOYAmt |
| EOY | $4,924,030 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $597,273 | BOYAmt |
| EOY | $708,823 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $479,563 | BOYAmt |
| EOY | $413,964 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $76,857,964 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $32,004,139 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,856,907 | BOYAmt |
| EOY | $44,853,825 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,590,108 | BOYAmt |
| EOY | $5,936,829 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,673,285 | BOYAmt |
| EOY | $7,383,062 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $731,057 | BOYAmt |
| EOY | $377,674 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,758 | BOYAmt |
| EOY | $79,819 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,085,665 | BOYAmt |
| EOY | $2,291,426 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,988,976 | BOYAmt |
| EOY | $89,106,831 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,426,062 | BOYAmt |
| EOY | $4,278,741 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10,284,184 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,815,406 | BOYAmt |
| EOY | $7,791,532 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,220 | BOYAmt |
| EOY | $111,720 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,739,794 | BOYAmt |
| EOY | $22,348,307 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $4,388,200 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,530,665 | BOYAmt |
| EOY | $2,633,226 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,625,147 | BOYAmt |
| EOY | $51,835,910 | 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 | $36,214,588 | BOYAmt |
| EOY | $35,563,074 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,149,241 | BOYAmt |
| EOY | $1,707,847 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,363,829 | BOYAmt |
| EOY | $37,270,921 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,988,976 | BOYAmt |
| EOY | $89,106,831 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,568,947 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,476,039 | 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 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 | $385,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $24,315 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $162,645 | OtherExpendituresAmt |
| End Year Balance | $247,170 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $328,776 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$3,967 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $324,809 | 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 | $56,428,136 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,021,675 | DepreciationAmt |
| Book Value | $35,406,461 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,613,295 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,376,875 | DepreciationAmt |
| Book Value | $4,236,420 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,957,422 | OtherCostOrOtherBasisAmt |
| Depreciation | $605,589 | DepreciationAmt |
| Book Value | $2,351,833 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $44,853,825 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (3 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Investment in Northwest Iowa Diagnostics | $44,866 | F |
| Interest in Avera Health Foundation | $7,143,520 | F |
| Investment in Avera Home Medical of Sioux Center LLC | $194,676 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $7,383,062 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $2,291,426 |
| Estimated third-party payor settlements | $341,800 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,633,226 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $45,353,584 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $327,294 | OtherRevenueAmt |
| Revenue Not Reported | $327,294 | RevenueNotReportedAmt |
| Revenue Subtotal | $45,026,290 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $45,026,290 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $46,005,098 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $46,005,098 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $590,139 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $590,139 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $46,595,237 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 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: | Bad Debt Expense -590,139. Change in net assets of Avera Health Foundation 917,433. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense 590,139. |
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 | 0 | ExpensesExceedBudgetInd |
| 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 | 233 | PersonsServedCnt |
| Total Community Benefit Expns | $247,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $247,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,506,260 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,957,223 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,549,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03370 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 233 | PersonsServedCnt |
| Total Community Benefit Expns | $5,753,260 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,957,223 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,796,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03910 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Persons Served | 2504 | PersonsServedCnt |
| Total Community Benefit Expns | $23,935 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,935 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 2 | PersonsServedCnt |
| Total Community Benefit Expns | $13,474 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,474 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 11457 | PersonsServedCnt |
| Total Community Benefit Expns | $6,677,335 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,745,907 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $931,428 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02020 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $53,894 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $53,894 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 13 | ActivitiesOrProgramsCnt |
| Persons Served | 13963 | PersonsServedCnt |
| Total Community Benefit Expns | $6,768,638 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,745,907 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,022,731 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02220 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 13 | ActivitiesOrProgramsCnt |
| Persons Served | 14196 | PersonsServedCnt |
| Total Community Benefit Expns | $12,521,898 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,703,130 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,818,768 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06130 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,610 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,610 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 250 | PersonsServedCnt |
| Total Community Benefit Expns | $1,569,403 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,053,014 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $516,389 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 250 | PersonsServedCnt |
| Total Community Benefit Expns | $1,571,013 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,053,014 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $517,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $590,139 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $45,618 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,048,001 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,192,003 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$144,002 | 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 2018 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 pre-diabetic 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 allows Sioux Center Health to remain 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, to provide a Healthy Hero's Family Fun 1k Walk and 5k run for our community members. This event focuses on being active through exercising and offers a health fair to provide education on various topics. Mental Health: Sioux Center Health will provide 24/7 social worker coverage as a resource for those patients needing mental health services. Along with this, Sioux Center Health will continue 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 will continue 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 will work with individuals and families to meet their life-long goals and achieve their emotional well-being. We offer medically managed treatment plans for all ages: children, adolescents and adults. Sioux Center Health will also utilize 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 will continue to utilize their services where appropriate. Ongoing staff training in recognizing signs and/or treatment of mental health concerns will be provided.Translation and Interpretation: Sioux Center Health will create a Cultural Diversity Team to address translation/interpretation needs. Throughout this process, the team will be engaging not only our staff, but our Board of Directors as well. Sioux Center Health will provide education to the community and healthcare staff for increased knowledge and certification for Healthcare Interpretation. We will continue to work with the county-wide group of interpreters to identify needs throughout our community. Additionally, staff will be tested for their language knowledge and wear a "Habla Espanol" identification badge once approved.Sioux Center Health will provide a Certified Healthcare Interpreter (CHI) to assist non-English speaking patients through their healthcare journey. We will continue to collaborate with other local/area agencies who serve ethnic minorities in an effort to provide the best care for our patients no matter what their health needs are.Senior Adult Services: Sioux Center Health's Growing Community expansion project to our senior living campus will expand services with different levels of care in one location, provide additional living space of 32 skilled nursing rooms and 24 assisted living apartments with more features and amenities; create greater capacity to allow seniors to live and stay in our community and provide more accommodations to live maintenance free with access to health care services. In addition to the expansion project, 16 memory care apartments for assisted living residents will be available to continue to support the needs within our community. |
| 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 (14 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 I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $590,139. |
| 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 250 children. |
| Part III, Line 2: | All discounts and payments including contractual allowances, uninsured discounts, and charity care adjustments are applied to a patient's account before the account is written off to bad debt. Bad debt recoveries are applied to bad debt expense in the current year.Bad debt expense on line 2 is reported at charges as presented on the financial statement. |
| Part III, Line 3: | The estimated amount of bad debt expense attributable to patients that could have been eligible for charity care is based on estimated calculations from our collection agency. The agency estimated 7.73% of the total amount in collections could be charity care. |
| Part III, Line 4: | The footnote that describes bad debt expense 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 6/30/20. 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: | 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. An open public meeting is conducted annually to listen to issues of the community and share information regarding services and programs. 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 at just over 34,500 as of July 1, 2018. The county is also home to three other critical access hospitals and Sioux Center also has a Federally Qualified Health Center (FQHC). Nearly 90% of Sioux Center Health's discharges come from Sioux County. According to 2013-2017 American Community Survey profiles, Sioux Center had a population of just over 7,500 with median family income of $73,185. 7.0% of the families in Sioux Center were below the poverty level. The 2017 census shows a Hispanic population record of 13.10% 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 38 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. As a managed facility, the Hospital is able to participate in Avera eCARE services. These services include Avera eICU, eEmergency, ePharmacy and eConsult. 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.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 (6 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 | $399,071 | $0 | $167,955 | $0 | $31,756 | $0 | $58,931 | $0 | $8,578 | $0 | $666,291 | $0 | $0 | $0 |
| Dr Scott A Rens MD | ||||||||||||||
| Family Medicine/OB | $422,293 | $0 | $0 | $0 | $1,560 | $0 | $26,151 | $0 | $27,331 | $0 | $477,335 | $0 | $0 | $0 |
| Alanna Janssen | ||||||||||||||
| Physician | $320,515 | $0 | $2,167 | $0 | $50,187 | $0 | $18,691 | $0 | $22,709 | $0 | $414,269 | $0 | $0 | $0 |
| Daniel VandenBosch | ||||||||||||||
| Physician | $305,068 | $0 | $0 | $0 | $28,626 | $0 | $17,068 | $0 | $25,821 | $0 | $376,583 | $0 | $0 | $0 |
| David Janssen | ||||||||||||||
| Physician | $287,219 | $0 | $25 | $0 | $49,555 | $0 | $17,593 | $0 | $12,584 | $0 | $366,976 | $0 | $0 | $0 |
| Cory Nelson | ||||||||||||||
| CEO | $211,179 | $0 | $0 | $0 | $14,146 | $0 | $11,582 | $0 | $31,197 | $0 | $268,104 | $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 individual had an amount included in reportable compensation, column B(iii) under a 457(f) plan: Dr. Nicholas Mouw $56,131 |
| 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 (3 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 City Iowa | |||||||
| C | 426005069 | 2019-12-30 | $8,000,000 | Short term Construction Financing | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Capital ExpendituresCapitalExpendituresAmt | UnspentUnspentAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $809,341 | $8,300,000 | $156,681 | $8,143,319 | Yes (1) | 0 | Yes (1) | Yes (1) | ||
| B | $9,500,000 | $144,006 | 0 | 0 | 0 | Yes (1) | $449,635 | $9,355,994 | ||
| C | $8,000,000 | $121,268 | 0 | 0 | 0 | Yes (1) | $7,878,732 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 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) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule K, Part II, Bond B, Line 10: | FormAndLineReferenceDesc |
| Explanation | The Hospital is drawing on the The City of Hull, Iowa and Sioux City, Iowa 12/30/19 bonds as needed. As of 6/30/2020, only $449,635 has been drawn. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Brooke Van Engen | |||
| Family member of Brian Van Engen, Director | $19,050 | Compensation as an employee | 0 |
| Kim Bosma | |||
| Family member of Cory Gotto, Board member | $39,725 | 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 75,734. Management and general expenses 474,091. Fundraising expenses 0. Total expenses 549,825. Purchased services: Program service expenses 2,888,080. Management and general expenses 1,040,073. Fundraising expenses 0. Total expenses 3,928,153. Repairs and maintenance: Program service expenses 541,149. Management and general expenses 172,387. Fundraising expenses 0. Total expenses 713,536. |
| Form 990, Part XI, line 9: | Change in interest in net assets of Avera Health Foundation 1,476,039. |
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