SIOUX CENTER HEALTH: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
SIOUX CENTER HEALTH (EIN 42-0796764)
Tax period
2018-07-01 to 2019-06-30
Filed
2020-03-26
IRS object ID
202000869349300025
Schema version
2018v3.1
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

FieldValueIRS element (for citing)
Return2020-03-26T15:16:33-05:00ReturnTs
Tax Period End2019-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 E 10th St Ste 500AddressLine1Txt
CitySioux FallsCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571046375ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN420796764EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sioux Center HealthBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSIOUBusinessNameControlTxt
Phone7127221271PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11101 9th St SEAddressLine1Txt
CitySioux CenterCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51250ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCory NelsonPersonNm
Person TitleCEOPersonTitleTxt
Phone7127221271PhoneNum
Signature2020-03-25SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLaurie HansonPreparerPersonNm
PTINP00851848PTIN
Phone6053391999PhoneNum
Preparation2020-03-25PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.130.171.59IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-03-25IPDt
IP Tm13:24:27IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdC5ADF3E96DC5FD5E5884512D59AB882B10EDFEC1AtSubmissionCreationDeviceId
At Submission Filing Device Id8529E270CED9BF05DA3D232CE7794E4FD1825D85AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-09-23 17:36:50ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCory NelsonPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11101 9th St SEAddressLine1Txt
CitySioux CenterCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51250ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$44,768,281GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.siouxcenterhealth.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1951FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionTo provide medical care for all ages.ActivityOrMissionDesc
Voting Members Governing Body40VotingMembersGoverningBodyCnt
Voting Members Independent39VotingMembersIndependentCnt
Total Employee590TotalEmployeeCnt
Total Volunteers66TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$37,782PYContributionsGrantsAmt
CY Contributions Grants$24,691CYContributionsGrantsAmt
PY Program Service Revenue$40,703,133PYProgramServiceRevenueAmt
CY Program Service Revenue$44,397,819CYProgramServiceRevenueAmt
PY Investment Income$35,760PYInvestmentIncomeAmt
CY Investment Income$148,269CYInvestmentIncomeAmt
PY Other Revenue$47,771PYOtherRevenueAmt
CY Other Revenue$57,368CYOtherRevenueAmt
PY Total Revenue$40,824,446PYTotalRevenueAmt
CY Total Revenue$44,628,147CYTotalRevenueAmt
PY Grants And Similar Paid$35,452PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$38,750CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$21,785,910PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$24,497,605CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$58,211CYTotalFundraisingExpenseAmt
PY Other Expenses$20,184,789PYOtherExpensesAmt
CY Other Expenses$20,404,582CYOtherExpensesAmt
PY Total Expenses$42,006,151PYTotalExpensesAmt
CY Total Expenses$44,940,937CYTotalExpensesAmt
PY Revenues Less Expenses-$1,181,705PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$312,790CYRevenuesLessExpensesAmt
Total Assets BOY$76,047,825TotalAssetsBOYAmt
Total Assets EOY$74,988,976TotalAssetsEOYAmt
Total Liabilities BOY$39,680,570TotalLiabilitiesBOYAmt
Total Liabilities EOY$37,625,147TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$36,367,255NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$37,363,829NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionBring hope, health and healing to life.MissionDesc
Significant New Program SrvcYes (1)SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$39,331,934ExpenseAmt
Grant$38,750GrantAmt
Revenue$44,397,819RevenueAmt
DescSioux Center Health operates a 19-bed acute-care hospital, a 69-bed nursing care facility, a medical clinic, specialty physician clinics, two independent assisted living facilities, and a daycare center located in Sioux Center, Iowa. During the fiscal year ending June 30, 2019, patient days were 1,321, swing-bed days were 552, and newborn days were 388.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 $243,000 for the year ended June 30, 2019, 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$39,331,934TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document36IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee590EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members40GoverningBodyVotingMembersCnt
Independent Voting Member39IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Kari TimmerBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7127228158PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11101 9th St SEAddressLine1Txt
CitySioux CenterCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51250ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (51 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Brian Van Engen
President Until 12/2018/Director1.00Yes (X)Yes (X)$0$0$0
Tim Byl
VP/President From 01/20191.00Yes (X)Yes (X)$0$0$0
Doug Van Meeteren
Vice President From 01/20191.00Yes (X)Yes (X)$0$0$0
Marj Wagner
Secretary Until 12/2018/Director1.00Yes (X)Yes (X)$0$0$0
Kyle Hiemstra
Director/Secretary From 01/20191.00Yes (X)Yes (X)$0$0$0
Jeffrey Timmer
Treasurer1.00Yes (X)Yes (X)$0$0$0
Nathan Bakker
Director1.00Yes (X)$0$0$0
Terry Boote
Director1.00Yes (X)$0$0$0
Lisa Christians
Director1.00Yes (X)$0$0$0
Lynne Hagen
Director1.00Yes (X)$0$0$0
Neil Van Schouwen
Director1.00Yes (X)$0$0$0
Curt Hohman
Director1.00Yes (X)$0$0$0
M Yvonne Rayborn MD
Director1.00Yes (X)$0$0$0
Vernon Beernink
Director1.00Yes (X)$0$0$0
Janet Boone
Director1.00Yes (X)$0$0$0
Delbert Broek
Director1.00Yes (X)$0$0$0
Leslie Brommer
Director1.00Yes (X)$0$0$0
Bob Bruxvoort
Director1.00Yes (X)$0$0$0
Paul Clousing
Director1.00Yes (X)$0$0$0
Brenda Dokter
Director1.00Yes (X)$0$0$0
Bruce Dooyema
Director1.00Yes (X)$0$0$0
David Eekhoff
Director1.00Yes (X)$0$0$0
Cory Gotto
Director1.00Yes (X)$0$0$0
Dan Hibma
Director1.00Yes (X)$0$0$0
Jennifer Jansen
Director1.00Yes (X)$0$0$0
Lauren Kaemingk
Director1.00Yes (X)$0$0$0
Rick Kattenberg
Director1.00Yes (X)$0$0$0
Jody Kock
Director1.00Yes (X)$0$0$0
Stacy Koele
Director1.00Yes (X)$0$0$0
John Koerselman
Director1.00Yes (X)$0$0$0
Ardith Lein
Director1.00Yes (X)$0$0$0
Dorinda Oostenink
Director1.00Yes (X)$0$0$0
Scott Peterson
Director1.00Yes (X)$0$0$0
Stan Speer
Director1.00Yes (X)$0$0$0
Dale Vander Berg
Director1.00Yes (X)$0$0$0
Betty Vermeer
Director1.00Yes (X)$0$0$0
Lyle Vermeer
Director1.00Yes (X)$0$0$0
Scott Wynja
Director1.00Yes (X)$0$0$0
Verdean Wynja
Director1.00Yes (X)$0$0$0
Josh Bowar
Director1.00Yes (X)$0$0$0
Gretchen Zomermaand
Director Until 06/20191.00Yes (X)$0$0$0
Mary Beimers
Director Until 10/20181.00Yes (X)$0$0$0
Kayleen Lee
CEO Until 03/201840.00Yes (X)$266,869$0$40,954
Cory Nelson
CEO From 09/201840.00Yes (X)$51,099$0$6,182
Jackson Schuiteman
CFO Until 09/201840.00Yes (X)$96,081$0$16,683
Kari Timmer
CFO From 09/201840.00Yes (X)$11,538$0$0
Dr Julie A McKay MD
Diagnostic radiology24.00$290,651$0$30,250Yes (X)
Dr Jamie J Vitamvas
Family Medicine/OB40.00$332,467$0$33,877Yes (X)
Dr Scott A Rens MD
Family Medicine/OB40.00$407,372$0$28,460Yes (X)
Dr Nicholas Mouw
General Surgeon40.00$392,093$0$24,829Yes (X)
Dr Jason R Koelewyn MD
Family Medicine/OB40.00$324,053$0$29,592Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,172,223TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$210,827TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K22IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Avera McKennan
1325 S Cliff AvenueSioux FallsSD571175045Management fees & other services$2,501,218
Schelling Construction
44 14th St NWSioux CenterIA51250construction contractor$448,167
Jon Clegg
1226 Turnberry AvenueLe MarsIA51031Anesthesia$336,660
Northwest Iowa Diagnostics
714 Lincoln St NeLe MarsIA51031Ultrasound Readings$201,165
Thomas Posch
234 Marina Dell AveYanktonSD57078Radiology Readings$114,967
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$24,691GovernmentGrantsAmt
Total Contributions$24,691TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Service Revenue622110$38,665,796$38,665,796
Assisted and Independent Living623990$2,257,352$2,257,352
Pharmacy Revenue900099$1,655,550$1,655,550
Daycare Revenue624410$1,213,048$1,213,048
Investment in Affiliates900099$97,221$97,221

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$508,852TotalRevenueColumnAmt
Related Or Exempt Func Income$508,852RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$44,397,819TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$220,757TotalRevenueColumnAmt
Exclusion$220,757ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$36,479RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$36,479RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$36,479TotalRevenueColumnAmt
Exclusion$36,479ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$35,059OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$107,547OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$72,488OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$72,488TotalRevenueColumnAmt
Exclusion-$72,488ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$53,476GrossSalesOfInventoryAmt
Cost Of Goods Sold$32,587CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,889TotalRevenueColumnAmt
Exclusion$20,889ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$44,628,147TotalRevenueColumnAmt
Related Or Exempt Func Income$44,397,819RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$205,637ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$12,500TotalAmt
Program Services$12,500ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$26,250TotalAmt
Program Services$26,250ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$584,584TotalAmt
Management And General$584,584ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$208,482TotalAmt
Program Services$208,482ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$18,842,764TotalAmt
Program Services$17,582,488ProgramServicesAmt
Management And General$1,220,832ManagementAndGeneralAmt
Fundraising$39,444FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$699,650TotalAmt
Program Services$646,718ProgramServicesAmt
Management And General$52,877ManagementAndGeneralAmt
Fundraising$55FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,858,748TotalAmt
Program Services$2,639,505ProgramServicesAmt
Management And General$219,243ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,303,377TotalAmt
Program Services$1,190,680ProgramServicesAmt
Management And General$112,509ManagementAndGeneralAmt
Fundraising$188FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$86,060TotalAmt
Management And General$86,060ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,331,694TotalAmt
Program Services$3,798,027ProgramServicesAmt
Management And General$1,533,667ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$212,620TotalAmt
Management And General$211,490ManagementAndGeneralAmt
Fundraising$1,130FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,298,883TotalAmt
Program Services$1,034,213ProgramServicesAmt
Management And General$251,209ManagementAndGeneralAmt
Fundraising$13,461FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$697,825TotalAmt
Program Services$693,665ProgramServicesAmt
Management And General$4,160ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$88,185TotalAmt
Program Services$74,103ProgramServicesAmt
Management And General$14,082ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$193,254TotalAmt
Program Services$147,687ProgramServicesAmt
Management And General$42,429ManagementAndGeneralAmt
Fundraising$3,138FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,134,977TotalAmt
Program Services$905,308ProgramServicesAmt
Management And General$229,669ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,092,780TotalAmt
Program Services$3,549,153ProgramServicesAmt
Management And General$543,627ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$427,844TotalAmt
Program Services$106,684ProgramServicesAmt
Management And General$321,160ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Medical Supplies$5,072,034$5,072,034
Bad Debt$713,438$713,438
Food$691,236$658,829$31,612$795
Taxes$166,129$166,129

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$197,623TotalAmt
Program Services$106,041ProgramServicesAmt
Management And General$91,582ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$44,940,937TotalAmt
Program Services$39,331,934ProgramServicesAmt
Management And General$5,550,792ManagementAndGeneralAmt
Fundraising$58,211FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,928,794BOYAmt
EOY$4,516,664EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$733,660BOYAmt
EOY$300,222EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,330,417BOYAmt
EOY$5,058,474EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$500,305BOYAmt
EOY$597,273EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$409,239BOYAmt
EOY$479,563EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$75,723,751LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$29,866,844LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$48,246,513BOYAmt
EOY$45,856,907EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$10,614,670BOYAmt
EOY$9,590,108EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$3,980,693BOYAmt
EOY$5,673,285EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$453,474BOYAmt
EOY$731,057EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$99,758EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,850,060BOYAmt
EOY$2,085,665EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$76,047,825BOYAmt
EOY$74,988,976EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,388,973BOYAmt
EOY$4,426,062EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,322,662BOYAmt
EOY$7,815,406EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$109,120BOYAmt
EOY$113,220EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$23,859,755BOYAmt
EOY$22,739,794EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,000,060BOYAmt
EOY$2,530,665EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$39,680,570BOYAmt
EOY$37,625,147EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$35,255,764BOYAmt
EOY$36,214,588EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$874,371BOYAmt
EOY$902,071EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$237,120BOYAmt
EOY$247,170EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$36,367,255BOYAmt
EOY$37,363,829EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$76,047,825BOYAmt
EOY$74,988,976EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$312,790ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$1,309,364OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab0InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$328,776BeginningYearBalanceAmt
Investment Earnings Or Losses-$3,967InvestmentEarningsOrLossesAmt
End Year Balance$324,809EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$210,511BeginningYearBalanceAmt
Investment Earnings Or Losses$118,265InvestmentEarningsOrLossesAmt
End Year Balance$328,776EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

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

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$56,858,901OtherCostOrOtherBasisAmt
Depreciation$18,754,103DepreciationAmt
Book Value$38,104,798BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$807,468OtherCostOrOtherBasisAmt
Depreciation$384,803DepreciationAmt
Book Value$422,665BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,198,271OtherCostOrOtherBasisAmt
Depreciation$10,727,938DepreciationAmt
Book Value$4,470,333BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$45,856,907TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
Investment in Northwest Iowa Diagnostics$29,791F
Interest in Avera Health Foundation$5,477,233F
Investment in Avera Home Medical of Sioux Center LLC$166,261F
FieldValueIRS element (for citing)
Total Book Value Securities$5,673,285TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Deferred Compensation$2,085,665
Estimated third-party payor settlements$445,000
FieldValueIRS element (for citing)
Total Liability$2,530,665TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$45,186,323TotalRevEtcAuditedFinclStmtAmt
Other Revenue$558,176OtherRevenueAmt
Revenue Not Reported$558,176RevenueNotReportedAmt
Revenue Subtotal$44,628,147RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$44,628,147TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$44,227,499TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$44,227,499ExpensesSubtotalAmt
Other Expenses Not Included$713,438OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$713,438ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$44,940,937TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 is an Iowa nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Health Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Health Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Health Center files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. 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 -713,438. Change in net assets of Avera Health Foundation 1,271,614.
Part XII, Line 4b - Other Adjustments:Bad Debt Expense 713,438.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served231PersonsServedCnt
Total Community Benefit Expns$243,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$243,000NetCommunityBenefitExpnsAmt
Total Expense0.00550TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,115,791TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,696,974DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,418,817NetCommunityBenefitExpnsAmt
Total Expense0.03210TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served231PersonsServedCnt
Total Community Benefit Expns$5,358,791TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,696,974DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,661,817NetCommunityBenefitExpnsAmt
Total Expense0.03760TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs7ActivitiesOrProgramsCnt
Persons Served2288PersonsServedCnt
Total Community Benefit Expns$28,525TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,278DirectOffsettingRevenueAmt
Net Community Benefit Expns$23,247NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served2PersonsServedCnt
Total Community Benefit Expns$13,861TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$13,861NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Persons Served10549PersonsServedCnt
Total Community Benefit Expns$8,307,806TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,049,958DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,257,848NetCommunityBenefitExpnsAmt
Total Expense0.02840TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$33,915TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$33,915NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs12ActivitiesOrProgramsCnt
Persons Served12839PersonsServedCnt
Total Community Benefit Expns$8,384,107TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,055,236DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,328,871NetCommunityBenefitExpnsAmt
Total Expense0.03000TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs12ActivitiesOrProgramsCnt
Persons Served13070PersonsServedCnt
Total Community Benefit Expns$13,742,898TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,752,210DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,990,688NetCommunityBenefitExpnsAmt
Total Expense0.06760TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$1,012TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,012NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served347PersonsServedCnt
Total Community Benefit Expns$1,588,723TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,218,048DirectOffsettingRevenueAmt
Net Community Benefit Expns$370,675NetCommunityBenefitExpnsAmt
Total Expense0.00840TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served347PersonsServedCnt
Total Community Benefit Expns$1,589,735TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,218,048DirectOffsettingRevenueAmt
Net Community Benefit Expns$371,687NetCommunityBenefitExpnsAmt
Total Expense0.00840TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$713,438BadDebtExpenseAmt
Bad Debt Expense Attributable$71,344BadDebtExpenseAttributableAmt
Reimbursed By Medicare$9,229,502ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,448,798CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$219,296MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sioux Center HealthBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11101 9th St SEAddressLine1Txt
CitySioux CenterCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51250ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.siouxcenterhealth.orgWebsiteAddressTxt
State License840080HStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Sioux Center HealthBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSee Line 10aOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSee Line 7dOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt18ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLhttp://siouxcenterhealth.org/patient-rights/StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttp://www.siouxcenterhealth.org/financial-assistance/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttp://www.siouxcenterhealth.org/financial-assistance/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttp://www.siouxcenterhealth.org/financial-assistance/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Sioux Center HealthPart 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 HealthPart V, Section B, Line 6a: Hegg Memorial Health System Orange City Area Health System Hawarden Regional Healthcare
Sioux Center HealthPart V, Section B, Line 6b: Community Health Partners of Sioux County, the local public health agency for Sioux County.
Sioux Center HealthPart V, Section B, Line 7d: www.avera.org/about/community-health-needs-assessments/
Sioux Center HealthPart V, Section B, Line 11: A Community Health Needs Assessment was completed in 2019 and while Sioux County has numerous positive attributes and scores well in the county health rankings for Iowa, there are several well defined areas of prioritized need that the hospital plans to address based on our findings from the community health needs assessment. The following prioritized health needs were identified and as the most significant needs for our community: Obesity, Mental Health, Translation and Interpretation, and Senior Adult Services. Sioux Center Health is addressing these needs by:Obesity: Through 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. 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 will continue with Sioux Center Health remaining an active voice on behalf of our patients and community members where physical activity and healthy eating are concerned. Additionally, Sioux Center Health has partnered with our local Federally Qualified Health Center (FQHC), Promise Community Health, 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. Sioux Center Health will provide a Kids Cooking Camp "Eat the Rainbow" for kids 6-9 years old to learn age-appropriate cooking skills and how to prepare simple healthy recipes and learn the importance of eating the rainbow. 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. SCCH will continue to participate in the county-wide group of interpreters to identify needs throughout our community. Staff will be tested for their language knowledge and wear a "Habla Espaol" identification badge once approved. Sioux Center Health will provide a Certified Healthcare Interpreter (CHI) to assist non-English speaking patients through their healthcare journey. Collaboration with other local/area agencies who also serve those of ethnic minorities will be done in effort to provide the best care for our patients no matter what their health needs are.Senior Adult Services: Sioux Center Health will work with the building committee, staff and board of directors to identify the needs within our growing community. Plans will be developed to increase the number of beds available on the senior living campus and also identify any additional services needed on campus. Memory care services continue to be a needed service within our community and plans are being developed to create a memory care unit for assisted living residents needing this level of care.
Sioux Center HealthPart V, Section B, Line 13b: Sioux Center Health provides free care based on meeting presumptive eligibility requirements listed in the policy.
Sioux Center HealthPart 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 HealthPart 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.
FieldValueIRS element (for citing)
Facility9FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - Sioux Center Medical Clinic
1101 9th St SESioux CenterIA51250Physician clinic
2 - Hull Medical Clinic
807 MainHullIA51239Physician clinic and physical therapy
3 - Royal Meadows
1400 7th Ave SESioux CenterIA51250Nursing facility
4 - Chears Home Health & Hospice
1400 7th Ave SESioux CenterIA51250Home health and hospice
5 - Crown Pointe
1400 7th Ave SESioux CenterIA51250Independent and assisted living
6 - Franken Manor
527 S Main AveSioux CenterIA51250Independent and assisted living
7 - SCH Occupational Health Center
38 19th St SWSioux CenterIA51250Occupational health
8 - Early Childhood Center
1400 7th Ave SESioux CenterIA51250Community daycare
9 - Hawarden Medical Clinic
1122 Ave L HawardenHawardenIA51023Physician clinic

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 $713,438.
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 347 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 10% 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 6/30/19. 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. Sioux Center Health provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The Hospital does not pursue collections of amounts determined to qualify as charity care.
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. 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:The governing board is comprised of 40 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 thatprovide 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 I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Northwest Iowa Community College FoundationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1603 W Park StreetAddressLine1Txt
CitySheldonCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51201ZIPCd
FieldValueIRS element (for citing)
Recipient EIN421275893RecipientEIN
IRC Section501(c)3IRCSectionDesc
Cash Grant$10,000CashGrantAmt
Purpose Of GrantscholarshipsPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeScholarshipGrantTypeTxt
Recipient23RecipientCnt
Cash Grant$26,250CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationSCH provides the money for scholarships directly to Northwest Iowa Community College Foundation (NICCF). NICCF determines and processes the scholarship funding. Applications and supporting materials are received directly from the applicant. The health instructors at Northwest Iowa Community College make the selection of who receives the money from the group of eligible applicants. Regarding scholarships reported in Part III, the Sioux Center Health Foundation, which is part of Sioux Center Health, receives the scholarship applications. The applications are reviewed for completeness and eligibility criteria. Applicants that are employees or dependents of employees of Sioux Center Health are automatically approved. If there are no employees or dependents within the applicant pool, the application packets are edited for anonymity and given to SCH personnel for review and selection. Scholarship checks are written jointly to the college and student. Refunds are to be returned to SCH should the student not attend college as planned.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Kayleen Lee
CEO Until 03/2018$23,353$0$195,895$0$47,621$0$13,750$0$28,392$0$309,011$0$0$0
Dr Julie A McKay MD
Diagnostic radiology$190,069$0$99,500$0$1,082$0$2,800$0$27,907$0$321,358$0$0$0
Dr Jamie J Vitamvas
Family Medicine/OB$244,490$0$32,497$0$55,480$0$2,800$0$31,534$0$366,801$0$6,030$0
Dr Scott A Rens MD
Family Medicine/OB$395,847$0$9,965$0$1,560$0$2,800$0$26,117$0$436,289$0$0$0
Dr Nicholas Mouw
General Surgeon$341,452$0$18,885$0$31,756$0$2,800$0$22,486$0$417,379$0$0$0
Dr Jason R Koelewyn MD
Family Medicine/OB$277,657$0$27,801$0$18,595$0$2,800$0$27,249$0$354,102$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Lines 4a-bCompensation for Kayleen Lee includes $195,895 of severance pay. 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 $29,507
Schedule J, Part II:Kayleen Lee, CEO Until 03/2018 and Cory Nelson, CEO from 09/2018 are compensated through an arrangement with Avera McKennan, 800 E 21st Street, Sioux Falls, SD 57105.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Hull IowaBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN426004780BondIssuerEIN
Bond Issued2017-12-18BondIssuedDt
Issue Price$8,300,000IssuePriceAmt
PurposeHospital Facility Revenue Refunding Bond, Series 2017(2012 issue).PurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$484,594RetiredAmt
Total Proceeds$8,300,000TotalProceedsAmt
Issuance Costs From Proceeds$156,681IssuanceCostsFromProceedsAmt
Other Spent Proceeds$8,143,319OtherSpentProceedsAmt
Refunding Tax Exempt BondsYes (1)RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
Irene Schuiteman
Family member of Jackson Schuiteman, CFO$50,527Compensation as an employee0
Jerry Zomermaand
Family member of Gretchen Zomermaand, Director$123,235Compensation as an employee0
Kim Bosma
Family member of Cory Gotto, Board member$34,720Compensation as an employee0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, line 2Behavioral Health Services (clinic) Parkinson Wellness Class (therapy) Running Clinic (therapy) Dry Needling (therapy)
Form 990, Part VI, Section A, line 1The 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 2Board members Verdean Wynja and Scott Wynja have a family relationship.
Form 990, Part VI, Section A, line 7aOne member of the governing body is appointed by Avera McKennan.
Form 990, Part VI, Section B, line 11bThe 990 is emailed to the executive board members for review and any questions addressed prior to filing the return with the IRS.
Form 990, Part VI, Section B, line 12cOfficers, 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 15aThe 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 19The documents are made available upon request.
Form 990, Part IX, line 11gProfessional Fees: Program service expenses 1,224. Management and general expenses 56,767. Fundraising expenses 0. Total expenses 57,991. Purchased services: Program service expenses 3,055,333. Management and general expenses 1,259,149. Fundraising expenses 0. Total expenses 4,314,482. Repairs and maintenance: Program service expenses 741,470. Management and general expenses 217,751. Fundraising expenses 0. Total expenses 959,221.
Form 990, Part XI, line 9:Change in interest in net assets of Avera Health Foundation 1,309,364.

Schedule R IRS990ScheduleR

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPctDirect Controlling NADirectControllingNACd
Northwest Iowa Diagnostics
714 Lincoln St NELe MarsIA51031820559254Diagnostic radiologyIASioux Center Community Hospital & HealthRelated-$3,782$29,8050Yes (1)0.36990
Avera Home Medical Equipment of Sioux Center LLC
38 19th Street SWSioux CenterIA51250753203100Home medical suppliesSDRelated$85,780$176,659000.50000N/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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