2021-02-24T12:10:09-06:00 2020-06-30 450250958 Eide Bailly LLP 200 E 10th St Ste 500 Sioux Falls SD 571046375 990 2019-07-01 420796764 Sioux Center Health SIOU 7127221271 1101 9th St SE Sioux Center IA 51250 Cory Nelson CEO 7127221271 2021-02-23 1 Laurie Hanson CPA P00851848 6053391999 2021-02-23 2019 2022-09-23 18:48:47Z Cory Nelson 1101 9th St SE Sioux Center IA 51250 45071421 0 X www.siouxcenterhealth.org X 1951 IA To provide medical care for all ages. 38 36 595 63 0 0 24691 287586 44397819 44453909 148269 234050 57368 50745 44628147 45026290 38750 10000 0 0 24497605 26487236 0 0 76740 20404582 20098001 44940937 46595237 -312790 -1568947 74988976 89106831 37625147 51835910 37363829 37270921 X Bring hope, health and healing to life. 0 0 40938675 10000 44453909 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. 40938675 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 41 0 1 595 1 0 0 0 0 0 0 0 0 0 0 0 0 X 38 36 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X Kari Timmer 7127228158 1101 9th St SE Sioux Center IA 51250 Dr Nicholas Mouw General Surgeon 40.00 X 598782 0 67509 Dr Scott A Rens MD Family Medicine/OB 40.00 X 423853 0 53007 Alanna Janssen Physician 40.00 X 372869 0 40926 Daniel VandenBosch Physician 40.00 X 333694 0 42427 David Janssen Physician 40.00 X 336799 0 29715 Cory Nelson CEO 40.00 X 225325 0 41573 Kari Timmer CFO 40.00 X 113683 0 10285 Tim Byl President 1.00 X X 0 0 0 Doug Van Meeteren Vice President 1.00 X X 0 0 0 Kyle Hiemstra Secretary 1.00 X X 0 0 0 Jeffrey Timmer Treasurer 1.00 X X 0 0 0 Nathan Bakker Director 1.00 X 0 0 0 Terry Boote Director 1.00 X 0 0 0 Lisa Christians Director 1.00 X 0 0 0 Lynne Hagen Director Until 02/2020 1.00 X 0 0 0 Neil Van Schouwen Director 1.00 X 0 0 0 Curt Hohman Director 1.00 X 0 0 0 Vernon Beernink Director 1.00 X 0 0 0 Janet Boone Director 1.00 X 0 0 0 Delbert Broek Director 1.00 X 0 0 0 Leslie Brommer Director 1.00 X 0 0 0 Bob Bruxvoort Director 1.00 X 0 0 0 Paul Clousing Director 1.00 X 0 0 0 Brenda Dokter Director 1.00 X 0 0 0 Bruce Dooyema Director 1.00 X 0 0 0 David Eekhoff Director 1.00 X 0 0 0 Cory Gotto Director 1.00 X 0 0 0 Dan Hibma Director 1.00 X 0 0 0 Jennifer Jansen Director 1.00 X 0 0 0 Lauren Kaemingk Director 1.00 X 0 0 0 Rick Kattenberg Director 1.00 X 0 0 0 Jody Kock Director 1.00 X 0 0 0 Stacy Koele Director Until 12/2019 1.00 X 0 0 0 John Koerselman Director 1.00 X 0 0 0 Ardith Lein Director 1.00 X 0 0 0 Dorinda Oostenink Director 1.00 X 0 0 0 Scott Peterson Director 1.00 X 0 0 0 Stan Speer Director 1.00 X 0 0 0 Dale Vander Berg Director 1.00 X 0 0 0 Betty Vermeer Director 1.00 X 0 0 0 Lyle Vermeer Director 1.00 X 0 0 0 Scott Wynja Director 1.00 X 0 0 0 Verdean Wynja Director 1.00 X 0 0 0 Josh Bowar Director 1.00 X 0 0 0 Marj Wagner Director 1.00 X 0 0 0 Brian Van Engen Director 1.00 X 0 0 0 Gretchen Zomermaand Director Until 12/2019 1.00 X 0 0 0 Matt Nice Director 1.00 X 0 0 0 2405005 0 285442 21 0 1 1 Avera McKennan 1325 S Cliff Avenue Sioux Falls SD 57110 Management fees & other services 1900783 Michael Tadlock 2183 Ridge Rd Sioux Center SD 51250 anesthesia services 427440 Creative Dining Services Inc One Royal Park Dr Ste3 Zeeland MI 49464 dietary professional fees 238504 Northwest Iowa Diagnostics 714 Lincoln St NE le Mars IA 51031 Ultrasound Readings 208475 Thomas Posch 234 Marina Dell Ave Yankton SD 57078 Radiology Readings 140423 6 287586 287586 Patient Service Revenue 622110 38349205 38349205 Assisted and Independent Living 623990 2279983 2279983 Pharmacy Revenue 900099 1986158 1986158 Daycare Revenue 624410 1041685 1041685 Investment in Affiliates 900099 175973 175973 620905 620905 44453909 250030 250030 36423 0 36423 36423 36423 15980 -15980 -15980 -15980 43473 29151 14322 14322 45026290 44453909 0 284795 X 10000 10000 403436 403436 58775 58775 20907345 19448723 1393542 65080 739325 677107 59891 2327 2979083 2784047 191456 3580 1399272 1275192 119404 4676 2569 2569 104621 104621 5191514 3504963 1686551 245677 245677 1308287 932521 375766 734328 727283 7045 85882 83029 2853 152092 132907 18885 300 1077712 855111 222601 3816439 3425340 391099 409063 120476 288587 Medical Supplies 5387670 5387670 Food 635656 613771 21108 777 Bad Debts Expense 590139 590139 Taxes 293827 293827 62525 17794 44731 46595237 40938675 5579822 76740 4516664 22053588 300222 83791 5058474 4924030 597273 708823 479563 413964 76857964 32004139 45856907 44853825 9590108 5936829 5673285 7383062 731057 377674 99758 79819 2085665 2291426 74988976 89106831 4426062 4278741 10284184 7815406 7791532 113220 111720 22739794 22348307 4388200 2530665 2633226 37625147 51835910 X 36214588 35563074 1149241 1707847 37363829 37270921 74988976 89106831 X -1568947 1476039 X 0 1 X 1 0 X 0 0 247170 247170 385500 24315 162645 247170 356032 29468 385500 324809 31223 356032 328776 -3967 324809 0.00000 1.00000 0.00000 1 0 630000 2229111 2859111 56428136 21021675 35406461 14613295 10376875 4236420 2957422 605589 2351833 44853825 Investment in Northwest Iowa Diagnostics 44866 F Interest in Avera Health Foundation 7143520 F Investment in Avera Home Medical of Sioux Center LLC 194676 F 7383062 Deferred Compensation 2291426 Estimated third-party payor settlements 341800 2633226 X 45353584 327294 327294 45026290 0 45026290 46005098 0 46005098 590139 590139 46595237 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. 1 1 X 1 X 1 X 1 1 0 1 1 233 247000 247000 0.00540 5506260 3957223 1549037 0.03370 233 5753260 3957223 1796037 0.03910 9 2504 23935 23935 0.00050 1 2 13474 13474 0.00030 2 11457 6677335 5745907 931428 0.02020 1 53894 53894 0.00120 13 13963 6768638 5745907 1022731 0.02220 13 14196 12521898 9703130 2818768 0.06130 1 1610 1610 0.00000 1 250 1569403 1053014 516389 0.01120 2 250 1571013 1053014 517999 0.01120 0 590139 45618 10048001 10192003 -144002 X 1 1 1 1 Sioux Center Health 1101 9th St SE Sioux Center IA 51250 www.siouxcenterhealth.org 840080H X X X X Sioux Center Health 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X See Line 7d X See Line 7d X X 1 18 1 See 7D 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance X siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance X siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance X X X X X X X 1 X 0 X X X X 1 X 0 0 Sioux Center Health Part V, Section B, Line 5: Sioux Center Health, along with Community Health Partners, gathered quantitative and qualitative data to determine the best suitable health initiatives that will make a lasting impact for our communities. The data gathered includes demographic (population, race, sex, age and household) information as well as in-depth assessments from community stakeholders through focus group interviews. In order to avoid duplication of effort, the four critical access hospitals in Sioux County worked collaboratively with Community Health Partners to complete this community health needs assessment with a process that began in October of 2018. Sioux Center Health Part V, Section B, Line 6a: Hegg Memorial Health System Orange City Area Health System Hawarden Regional Healthcare Sioux Center Health Part V, Section B, Line 6b: Community Health Partners of Sioux County, the local public health agency for Sioux County. Sioux Center Health Part V, Section B, Line 7d: siouxcenterhealth.org/patients-visitors/patient-guide/patient-rights/ Sioux Center Health Part V, Section B, Line 11: A Community Health Needs Assessment was completed in 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. 9 1 - Sioux Center Medical Clinic 1101 9th St SE Sioux Center IA 51250 Physician clinic 2 - Royal Meadows 1400 7th Ave SE Sioux Center IA 51250 Nursing facility 3 - Hull Medical Clinic 807 Main Hull IA 51239 Physician clinic and physical therapy 4 - Chears Home Health & Hospice 1400 7th Ave SE Sioux Center IA 51250 Home health and hospice 5 - Crown Pointe 1400 7th Ave SE Sioux Center IA 51250 Independent and assisted living 6 - Franken Manor 527 S Main Ave Sioux Center IA 51250 Independent and assisted living 7 - SCH Occupational Health Center 38 19th St SW Sioux Center IA 51250 Occupational health 8 - Early Childhood Center 1400 7th Ave SE Sioux Center IA 51250 Community daycare 9 - Hawarden Medical Clinic 1122 Ave L Hawarden Hawarden IA 51023 Physician clinic Part I, Line 3c: Sioux Center Health (SCH) provides free care based on meeting presumptive eligibility requirements listed in the policy. Federal Poverty Guidelines and financial asset-liabilities are used to determine eligibility for discounted care.Additional factors used to determine financial assistance eligibility include Asset level, medical indigency, and underinsurance status.Part I, Line 6b:The community benefit report is maintained at Sioux Center Health and mailed to community members. Part I, Line 7: Charity care expense on line 7a and Medicaid on line 7b were converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Lines 7e, 7f, and 7i: Costs are reported based on data from the general ledger accounting system. The general ledger accounting system addresses all patient segments (inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, and self-pay). The cost for subsidized health services reported on line 7g was determined using the facility's cost accounting system. Part 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. X X X 0 1 0 0 0 0 0 0 0 Dr Nicholas Mouw General Surgeon 399071 0 167955 0 31756 0 58931 0 8578 0 666291 0 0 0 Dr Scott A Rens MD Family Medicine/OB 422293 0 0 0 1560 0 26151 0 27331 0 477335 0 0 0 Alanna Janssen Physician 320515 0 2167 0 50187 0 18691 0 22709 0 414269 0 0 0 Daniel VandenBosch Physician 305068 0 0 0 28626 0 17068 0 25821 0 376583 0 0 0 David Janssen Physician 287219 0 25 0 49555 0 17593 0 12584 0 366976 0 0 0 Cory Nelson CEO 211179 0 0 0 14146 0 11582 0 31197 0 268104 0 0 0 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. A City of Hull Iowa 426004780 2017-12-18 8300000 Hospital Facility Revenue Refunding Bond, Series 2017(2012 issue). 0 0 0 B City of Hull Iowa 426004780 2019-12-30 9500000 Short term Construction Financing 0 0 0 C Sioux City Iowa 426005069 2019-12-30 8000000 Short term Construction Financing 0 0 0 A 809341 8300000 156681 8143319 1 0 1 1 B 9500000 144006 449635 9355994 0 0 0 1 C 8000000 121268 7878732 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 Form 990, Schedule K, Part II, Bond B, Line 10: The Hospital is drawing on the The City of Hull, Iowa and Sioux City, Iowa 12/30/19 bonds as needed. As of 6/30/2020, only $449,635 has been drawn. Brooke Van Engen Family member of Brian Van Engen, Director 19050 Compensation as an employee 0 Kim Bosma Family member of Cory Gotto, Board member 39725 Compensation as an employee 0 Form 990, Part VI, Section A, line 1 The Executive Committee is composed of four officers: President, Vice President, Secretary, Treasurer, and seven board members. The Executive Committee shall have power to transact all regular business of the facility during the interim between the meetings of the Board of Directors, provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors and that it shall refer all matters of major importance to the Board of Directors. Form 990, Part VI, Section A, line 2 Board members Verdean Wynja and Scott Wynja have a family relationship. Form 990, Part VI, Section A, line 7a One member of the governing body is appointed by Avera McKennan. Form 990, Part VI, Section B, line 11b The 990 is emailed to members of the Board of Directors for review and any questions are addressed prior to filing the return with the IRS. Form 990, Part VI, Section B, line 12c Officers, Directors and Trustees are required to complete conflict of interest questionnaires which are monitored and tracked. The questionnaires are reviewed by the Board for any possible conflicts with any noted conflicts being brought to management's attention. Conflicts are also reviewed at the Board level. After a conflict is deemed to exist, the individual(s) involved must abstain from the discussion and vote related to the issue. Form 990, Part VI, Section B, line 15a The CEO is employed through a management agreement with Avera McKennan but is considered a common law employee of Sioux Center Health. Avera McKennan annually reviews the compensation of the CEO, using comparability data and a performance rating system and meets with the Board of Directors of Sioux Center Health. Avera McKennan recommends a salary adjustment for the CEO. The Board of Directors is responsible for approval of the salary adjustment. The deliberation and decision is documented at Avera McKennan and in the board minutes. Compensation for the CFO is reviewed and approved annually by the CEO and Human Resources. Market data is used to determine an appropriate salary range. The review process and salary adjustment is documented in the personnel file. Form 990, Part VI, Section C, line 19 The documents are made available upon request. Form 990, Part IX, line 11g Professional Fees: Program service expenses 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.