SIOUX CENTER HEALTH: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SIOUX CENTER HEALTH (EIN 42-0796764)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-14
- IRS object ID
- 201811349349300406
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-14T06:42:45-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH ST PO BOX 5125 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571175125 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420796764 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sioux Center Health | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SIOU | BusinessNameControlTxt |
| Phone | 7127221271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 9th St SE | AddressLine1Txt |
| City | Sioux Center | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51250 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jackson Schuiteman | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7127221271 | PhoneNum |
| Signature | 2018-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Laurie Hanson | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2018-05-11 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Kayleen Lee | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 9th St SE | AddressLine1Txt |
| City | Sioux Center | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,617,903 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.siouxcenterhealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1951 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | To provide medical care for all ages. | ActivityOrMissionDesc |
| Voting Members Governing Body | 41 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 38 | VotingMembersIndependentCnt |
| Total Employee | 565 | TotalEmployeeCnt |
| Total Volunteers | 144 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $32,448 | PYContributionsGrantsAmt |
| CY Contributions Grants | $128,505 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,921,778 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,270,011 | CYProgramServiceRevenueAmt |
| PY Investment Income | $78,714 | PYInvestmentIncomeAmt |
| CY Investment Income | $36,930 | CYInvestmentIncomeAmt |
| PY Other Revenue | $153,839 | PYOtherRevenueAmt |
| CY Other Revenue | $153,130 | CYOtherRevenueAmt |
| PY Total Revenue | $38,186,779 | PYTotalRevenueAmt |
| CY Total Revenue | $40,588,576 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $21,744 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $42,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,925,030 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $21,353,259 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $65,900 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,853,356 | PYOtherExpensesAmt |
| CY Other Expenses | $19,270,323 | CYOtherExpensesAmt |
| PY Total Expenses | $38,800,130 | PYTotalExpensesAmt |
| CY Total Expenses | $40,666,082 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$613,351 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$77,506 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $77,862,177 | TotalAssetsBOYAmt |
| Total Assets EOY | $78,325,823 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $40,981,401 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $41,522,553 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $36,880,776 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $36,803,270 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Bring hope, health and healing to life. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $35,510,191 | ExpenseAmt |
| Grant | $42,500 | GrantAmt |
| Revenue | $40,346,987 | RevenueAmt |
| Desc | Sioux 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, 2017, patient days were 1,448, swing-bed days were 520, and newborn days were 362.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 $268,000 for the year ended June 30, 2017, 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 | $35,510,191 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 565 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 41 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 38 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jackson Schuiteman | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7127228158 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 9th St SE | AddressLine1Txt |
| City | Sioux Center | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51250 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (48 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Brian VanEngen | |||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tim Byl | |||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Marj Wagner | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jeffrey Timmer | |||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Vernon Beernink | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mary Beimers | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Janet Boone | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Terry Boote | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Delbert Broek | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Leslie Brommer | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Bob Bruxvoort | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mayra Castelan | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Lisa Christians | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Paul Clousing | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Brenda Dokter | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Bruce Dooyema | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| David Eekhoff | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Roger Fedders | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Randy Feenstra | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dan Hibma | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kyle Hiemstra | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Curt Hohman | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jennifer Jansen | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Lauren Kaemingk | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| John Koerselman | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ardith Lein | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Scott Peterson | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Rich Rikkers | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Stan Speer | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Doug Van Meeteren | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Con Van Roekel | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Neil Van Schouwen | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dale Vander Berg | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Betty Vermeer | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Lyle Vermeer | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dennis Wright | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Verdean Wynja | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Gretchen Zomermaand | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Josh Bowar | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Cory Gotto | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Stacy Koele | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kayleen Lee | |||||||
| CEO | 40.00 | Yes (X) | $226,423 | $0 | $28,270 | ||
| Jackson Schuiteman | |||||||
| CFO | 40.00 | Yes (X) | $98,602 | $0 | $20,111 | ||
| Dr Julie A McKay MD | |||||||
| Diagnostic radiology | 24.00 | $342,394 | $0 | $67,756 | Yes (X) | ||
| Dr Jamie J Vitamvas | |||||||
| Family Medicine/OB | 40.00 | $338,106 | $0 | $39,261 | Yes (X) | ||
| Dr Scott A Rens MD | |||||||
| Family Medicine/OB | 40.00 | $402,511 | $0 | $74,165 | Yes (X) | ||
| Dr Lorianne S Andersen MD | |||||||
| Family Medicine/OB | 40.00 | $294,148 | $0 | $46,067 | Yes (X) | ||
| Dr Jason R Koelewyn MD | |||||||
| Family Medicine/OB | 40.00 | $323,900 | $0 | $54,701 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,026,084 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $330,331 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Avera McKennan | |||||
| 1325 S Cliff Avenue | Sioux Falls | SD | 571175045 | Management fees & other services | $1,738,184 |
| Schelling Construction | |||||
| 44 14th St NW | Sioux Center | IA | 51250 | construction contractor | $448,167 |
| Jon Clegg | |||||
| 1226 Turnberry Avenue | Le Mars | IA | 51031 | Anesthesia | $336,660 |
| Northwest Iowa Diagnostics | |||||
| 714 Lincoln St Ne | Le Mars | IA | 51031 | Ultrasound Readings | $201,165 |
| Thomas Posch | |||||
| 234 Marina Dell Ave | Yankton | SD | 57078 | Radiology Readings | $114,967 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $51,529 | GovernmentGrantsAmt |
| All Other Contributions | $76,976 | AllOtherContributionsAmt |
| Total Contributions | $128,505 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 622110 | $35,605,328 | $35,605,328 |
| Assisted and Independent Living | 623990 | $1,892,274 | $1,892,274 |
| Daycare Revenue | 624410 | $1,166,518 | $1,166,518 |
| Change in Int: Avera Fdtn | 900099 | $389,482 | $389,482 |
| Investment in affiliates | 900099 | $20,938 | $20,938 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,195,471 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,195,471 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,270,011 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,930 | TotalRevenueColumnAmt |
| Exclusion | $36,930 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $128,603 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $128,603 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $128,603 | TotalRevenueColumnAmt |
| Exclusion | $128,603 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $53,854 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $29,327 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,527 | TotalRevenueColumnAmt |
| Exclusion | $24,527 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,588,576 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,270,011 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $190,060 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,500 | TotalAmt |
| Program Services | $12,500 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,000 | TotalAmt |
| Program Services | $30,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $389,435 | TotalAmt |
| Management And General | $389,435 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,303 | TotalAmt |
| Program Services | $223,303 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,616,823 | TotalAmt |
| Program Services | $15,135,949 | ProgramServicesAmt |
| Management And General | $1,446,994 | ManagementAndGeneralAmt |
| Fundraising | $33,880 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $634,674 | TotalAmt |
| Program Services | $600,965 | ProgramServicesAmt |
| Management And General | $32,249 | ManagementAndGeneralAmt |
| Fundraising | $1,460 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,308,201 | TotalAmt |
| Program Services | $2,117,782 | ProgramServicesAmt |
| Management And General | $184,980 | ManagementAndGeneralAmt |
| Fundraising | $5,439 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,180,823 | TotalAmt |
| Program Services | $1,040,136 | ProgramServicesAmt |
| Management And General | $138,240 | ManagementAndGeneralAmt |
| Fundraising | $2,447 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,495,100 | TotalAmt |
| Management And General | $1,495,100 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,223 | TotalAmt |
| Management And General | $81,223 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,736,688 | TotalAmt |
| Program Services | $3,492,323 | ProgramServicesAmt |
| Management And General | $244,365 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $201,439 | TotalAmt |
| Management And General | $184,789 | ManagementAndGeneralAmt |
| Fundraising | $16,650 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $940,905 | TotalAmt |
| Program Services | $530,753 | ProgramServicesAmt |
| Management And General | $408,191 | ManagementAndGeneralAmt |
| Fundraising | $1,961 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $676,501 | TotalAmt |
| Program Services | $676,501 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,868 | TotalAmt |
| Program Services | $65,015 | ProgramServicesAmt |
| Management And General | $3,853 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,787 | TotalAmt |
| Program Services | $129,911 | ProgramServicesAmt |
| Management And General | $62,107 | ManagementAndGeneralAmt |
| Fundraising | $3,769 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,334,873 | TotalAmt |
| Program Services | $1,334,873 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,318,848 | TotalAmt |
| Program Services | $4,318,848 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,111 | TotalAmt |
| Program Services | $83,724 | ProgramServicesAmt |
| Management And General | $326,387 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Medical Supplies | $4,232,224 | $4,232,224 | ||
| Bad Debt | $663,185 | $663,185 | ||
| Food | $626,832 | $608,630 | $17,908 | $294 |
| Taxes | $164,917 | $164,917 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,822 | TotalAmt |
| Program Services | $48,652 | ProgramServicesAmt |
| Management And General | $74,170 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,666,082 | TotalAmt |
| Program Services | $35,510,191 | ProgramServicesAmt |
| Management And General | $5,089,991 | ManagementAndGeneralAmt |
| Fundraising | $65,900 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,801,085 | BOYAmt |
| EOY | $8,730,581 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,401,754 | BOYAmt |
| EOY | $987,498 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,922,728 | BOYAmt |
| EOY | $4,883,502 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $64,320 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $396,972 | BOYAmt |
| EOY | $451,172 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $357,634 | BOYAmt |
| EOY | $391,625 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $75,520,276 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $23,830,991 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,250,081 | BOYAmt |
| EOY | $51,689,285 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,802,847 | BOYAmt |
| EOY | $9,024,922 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,907 | BOYAmt |
| EOY | $446,931 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,428,169 | BOYAmt |
| EOY | $1,655,987 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,862,177 | BOYAmt |
| EOY | $78,325,823 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,806,889 | BOYAmt |
| EOY | $4,111,708 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,927 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,925,000 | BOYAmt |
| EOY | $10,472,500 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,620 | BOYAmt |
| EOY | $93,620 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,381,796 | BOYAmt |
| EOY | $24,708,738 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,708,169 | BOYAmt |
| EOY | $2,135,987 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,981,401 | BOYAmt |
| EOY | $41,522,553 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,985,420 | BOYAmt |
| EOY | $35,814,975 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $667,416 | BOYAmt |
| EOY | $756,675 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,940 | BOYAmt |
| EOY | $231,620 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,880,776 | BOYAmt |
| EOY | $36,803,270 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,862,177 | BOYAmt |
| EOY | $78,325,823 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$77,506 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $324,809 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $31,223 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $356,032 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $328,776 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$3,967 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $324,809 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $210,511 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $118,265 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $328,776 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $187,178 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $23,333 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $210,511 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $174,398 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $12,780 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $187,178 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.65060 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.34940 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $630,000 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $2,219,111 | OtherCostOrOtherBasisAmt |
| Book Value | $2,849,111 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,315,080 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,636,308 | DepreciationAmt |
| Book Value | $42,678,772 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,124,855 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,469,589 | DepreciationAmt |
| Book Value | $5,655,266 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,231,230 | OtherCostOrOtherBasisAmt |
| Depreciation | $725,094 | DepreciationAmt |
| Book Value | $506,136 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $51,689,285 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (4 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Investment in Northwest Iowa Diagnostics | $40,584 | F |
| Interest in Avera Health Foundation | $2,812,713 | F |
| Investment in Avera Home Medical of Sioux Center LLC | $121,131 | F |
| Other investment | $6,050,494 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $9,024,922 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $1,655,987 |
| Estimated third-party payor settlements | $480,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,135,987 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $39,832,452 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$663,185 | OtherRevenueAmt |
| Revenue Not Reported | -$663,185 | RevenueNotReportedAmt |
| Revenue Subtotal | $40,495,637 | RevenueSubtotalAmt |
| Other Revenues Not Included | $92,939 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $92,939 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $40,588,576 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $40,002,897 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $40,002,897 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $663,185 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $663,185 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $40,666,082 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The Health Center's endowment consists of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. The Center does not have a formal policy or agreement with the Foundation covering the distribution of endowment fund earnings. The Center expects the Foundation to allow its endowment to grow consistent with the Center's objective to maintain the purchasing power of the endowment assets in order to provide additional real growth through new gifts and investment return. However, there is no current intention of using the permanently endowed funds. |
| Part X, Line 2: | The Health Center 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 -663,185. |
| Part XI, Line 4b - Other Adjustments: | Change in net assets of Avera Health Foundation 92,939. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense 663,185. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 217 | PersonsServedCnt |
| Total Community Benefit Expns | $208,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $208,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,297,144 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,623,989 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $673,155 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 217 | PersonsServedCnt |
| Total Community Benefit Expns | $4,505,144 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,623,989 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $881,155 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02200 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 1836 | PersonsServedCnt |
| Total Community Benefit Expns | $12,516 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $360 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 2 | PersonsServedCnt |
| Total Community Benefit Expns | $14,554 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,554 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 14532 | PersonsServedCnt |
| Total Community Benefit Expns | $7,953,831 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,437,275 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,516,556 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03790 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $22,119 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,119 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 16370 | PersonsServedCnt |
| Total Community Benefit Expns | $8,003,020 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,437,635 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,565,385 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03920 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 16587 | PersonsServedCnt |
| Total Community Benefit Expns | $12,508,164 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,061,624 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,446,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06120 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,419 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,419 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 347 | PersonsServedCnt |
| Total Community Benefit Expns | $1,654,468 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,171,518 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $482,950 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 347 | PersonsServedCnt |
| Total Community Benefit Expns | $1,655,887 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,171,518 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $484,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $663,185 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $17,906 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,157,101 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,270,320 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$113,219 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sioux Center Health | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 9th St SE | AddressLine1Txt |
| City | Sioux Center | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.siouxcenterhealth.org | WebsiteAddressTxt |
| State License | 840080H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sioux Center Health | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Line 10a | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Line 7d | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://siouxcenterhealth.org/patient-rights/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.siouxcenterhealth.org/financial-assistance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.siouxcenterhealth.org/financial-assistance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.siouxcenterhealth.org/financial-assistance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Sioux Center Health | Part V, Section B, Line 5: Sioux Center Health, along with Community Health Partners, gathered quantitative and qualitative data to determine the best suitable health initiatives that will make a lasting impact for our communities. The data gathered includes demographic (population, race, sex, age and household) information as well as in-depth assessments from community stakeholders through focus group interviews. Stakeholders representing the county participated in county-wide focus groups between January and March 2015. Four county level focus groups were conducted ranging from 2 - 15 participants and lasting approximately 1 hour each. 3 of the focus groups were comprised of a cross section of providers who serve a variety of roles throughout the county including school nurses, social service providers, mental health providers, and public health providers. The fourth group was the Latina Health Coalition of Sioux County, which includes residents of several local communities, including Sioux Center, who represent the Hispanic/Latino community. Stakeholders provided information and perspective about the health needs specific to the county and in some cases relevant to particular communities within Sioux County. In addition to these county level groups, each participating hospital identified stakeholders and convened local focus groups. In Sioux Center, Sioux Center Health staff identified stakeholders that represented parents of young children, adults age 60+, and healthcare system representatives and mailed invitations to potential participants and used reminder phone calls. Groups met at Sioux Center Health or a community meeting room. |
| 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: www.avera.org/about/community-health-needs-assessments/ |
| Sioux Center Health | Part V, Section B, Line 11: The Summary of Health Needs identified in the implementation strategy of our CHNA include: Obesity, Mental Health Services, Translation and Interpretation, Community Education and Support Groups and Recreation. With limited financial and human resources, Sioux Center Health has not directly focused on the identified needs of Community Education and Support and Recreation. Through several partnerships in Sioux County, various Health Improvement Planning groups have been established and are creating action plans to address these needs.The following prioritized needs have been more directly addressed within Sioux Center Health:-Obesity: Sioux Center Health Physician, Dr. Scott Rens, received his certification as an American Board of Obesity Medicine Diplomate which distinguishes him as having specialized knowledge in the practice of obesity medicine. He is developing weight management programming and seeing patients to address these concerns. Sioux Center Health Dietician provided a program on weight management to identify the behaviors behind eating habits. Sioux Center Health continued partnerships with the Sioux Center Trials Council, Siouxperman Triathlon Committee, Health Sioux Center community group and other recreational offerings and events to remain an active voice for wellness in our community.-Mental Health: Sioux Center Health continued to provide 24/7 social worker coverage and also utilizes virtual telemedicine work through Avera eCare for Behavioral Health. Mental Health training for staff is ongoing to identify signs and treatment options.-Translation: Sioux Center Health created a Diversity Advisory Committee which focuses on the needs of translation and interpretation services offered to our patients and community. This team has been working on action plans to create more opportunities for staff to assist with interpretation within the clinic and also ensuring a culturally diverse mindset on communication, marketing and services. |
| Sioux Center Health | Part V, Section B, Line 13b: 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 before discharge. The charity care and other financial assistance options are discussed with OB patients during their "mommy and me" visit. |
| Sioux Center Health | Part V, Section B, Line 24: The policy does not cover elective procedures and they have confirmed no FAP patients had elective procedures. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Sioux Center Medical Clinic | ||||
| 1101 9th St SE | Sioux Center | IA | 51250 | Physician clinic |
| 2 - Hull Medical Clinic | ||||
| 807 Main | Hull | IA | 51239 | Physician clinic Physician clinic and physical therapy |
| 3 - Royal Meadows | ||||
| 1400 7th Ave SE | Sioux Center | IA | 51250 | Nursing facility |
| 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 | ID | 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 |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Sioux Center Health (SCH) provides free care based on meeting presumptive eligibility requirements listed in the policy. Federal Poverty Guidelines and financial asset-liabilities are used to determine eligibility for discounted care.Additional factors used to determine financial assistance eligibility include Asset level, medical indigency, and underinsurance status.Part I, Line 6b:The community benefit report is maintained at Sioux Center Health, but submitted to Avera and is included in their annual community benefit report. |
| 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 Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $663,185. |
| 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 2.7% of the total amount in collections could be charity care. |
| Part III, Line 4: | The footnote that describes bad debt expense is on pages 7 and 8 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 6/30/17. 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 V, Line 16i Financial Assistance Policy | Description of failureType of failure: 501(r)(4) - The hospital is required to translate the financial assistance policy, plain language summary and financial assistance policy application into Spanish as more than the lesser of 1,000 individuals or 5% of the community served by the hospital speaks Spanish as a primary language. The hospital did not translate the financial assistance policy into Spanish. Cause of the failure: The hospital facility was not aware of the requirement to translate the full financial assistance policy into Spanish. The facility has staff available who are able to translate the policy to assist limited English proficiency (LEP) patients with questions related to the financial assistance policy.Facility or facilities where the failure occurred: The failure occurred in the hospital facility. The date(s) of the failure and its discovery: March 1, 2018The number of occurrences: UnknownDescription of the correction of the failureMethod of correction: The financial assistance policy was translated into Spanish. The documents were made available at each facility and on the website.Date of correction: May 14, 2018Description of the practices or procedures put into placeThe financial assistance policy was translated into Spanish and posted on the website at http://www.siouxcenterhealth.org/financial-assistance/. The translated documents are also available at the hospital facility. In addition, Sioux Center Health continues to provide translation services to assist LEP patients with questions they may have regarding financial assistance. |
| 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 6/30/16 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 charity care and other financial assistance options are discussed with inpatients before discharge.4. The charity care and other financial assistance options are discussed with OB patients during their initial prenatal visits and the "mommy and me" visit.5. The financial assistance application is available on the Hospital website.6. The financial assistance application is available and the registration and ER desk.7. 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 is located in northwest Iowa. As of 2010, the county's population was just over 33,700. The county is also home to three other critical access hospitals. Nearly 90% of Sioux Center Health's discharges come from Sioux County. According to 2009-2013 American Community Survey profiles, Sioux Center had a population of just over 7,000 with median family income of $59,214. 6.5% of the families in Sioux Center were below the poverty level. The 2010 census shows a Hispanic population record of 13.1% in Sioux Center, and this number does not take into account undocumented aliens. |
| Part VI, Line 5: | Sioux Center Health has a strong community focused perspective. The governing board is comprised of 42 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 cancer research via Relay for Life activities, to 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. |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northwest Iowa Community College Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 603 W Park Street | AddressLine1Txt |
| City | Sheldon | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 421275893 | RecipientEIN |
| IRC Section | 501(c)3 | IRCSectionDesc |
| Cash Grant | $12,500 | CashGrantAmt |
| Purpose Of Grant | Scholarships | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships | GrantTypeTxt |
| Recipient | 27 | RecipientCnt |
| Cash Grant | $30,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | SCH 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 health instructors 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kayleen Lee | ||||||||||||||
| CEO | $221,388 | $0 | $0 | $0 | $5,035 | $0 | $4,588 | $0 | $24,832 | $0 | $255,843 | $0 | $0 | $0 |
| Dr Julie A McKay MD | ||||||||||||||
| Diagnostic radiology | $192,322 | $0 | $148,867 | $0 | $1,205 | $0 | $48,922 | $0 | $19,318 | $0 | $410,634 | $0 | $0 | $0 |
| Dr Jamie J Vitamvas | ||||||||||||||
| Family Medicine/OB | $230,492 | $0 | $49,223 | $0 | $58,391 | $0 | $20,015 | $0 | $19,730 | $0 | $377,851 | $0 | $0 | $0 |
| Dr Scott A Rens MD | ||||||||||||||
| Family Medicine/OB | $397,817 | $0 | $3,961 | $0 | $733 | $0 | $54,033 | $0 | $20,615 | $0 | $477,159 | $0 | $0 | $0 |
| Dr Lorianne S Andersen MD | ||||||||||||||
| Family Medicine/OB | $245,612 | $0 | $30,294 | $0 | $18,242 | $0 | $26,446 | $0 | $20,105 | $0 | $340,699 | $0 | $0 | $0 |
| Dr Jason R Koelewyn MD | ||||||||||||||
| Family Medicine/OB | $253,009 | $0 | $51,181 | $0 | $19,710 | $0 | $35,676 | $0 | $19,508 | $0 | $379,084 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | Sioux Center Health provides a nonqualified deferred compensation plan for its physicians. The following individual had amounts deferred into the account as reported in column C on Schedule J: Dr. Jamie J. Vitamvas $17,215 |
| Form 990, Part VII, Section A, Line 5 & Form 990, Schedule J, Part II: | Kayleen Lee, CEO, is compensated by Avera McKennan, 800 E 21st Street, Sioux Falls, SD 57105. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd | CUSIPCUSIPNum |
|---|---|---|---|---|---|---|---|---|
| City of Sioux Center | ||||||||
| A | 426005218 | 2005-04-11 | $4,000,000 | Acquisition, renovation, construction, equipping, & furnishing nursing home | 0 | 0 | 0 | |
| City of Hull Iowa | ||||||||
| B | 426004780 | 2012-10-18 | $10,000,000 | Hospital Replacement | 0 | 0 | 0 | 444784AR3 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $2,662,500 | $4,000,000 | $4,000,000 | 2005 | 0 | 0 | Yes (1) | Yes (1) | |||
| B | $865,000 | $10,055,050 | $8,487,328 | 2013 | 0 | 0 | Yes (1) | Yes (1) | $689,063 | $623,609 | $200,000 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule K, Part IV, Line 2C: | 2005 Bond proceeds have all be spent. No further arbitrage calculations are required for the 2005 bond. |
| Schedule K, Part II line 3 | 2012 bond total proceeds of issue included $55,050 of interest earned on reserves. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dr Jamie Vitamvas | PersonNm |
| Relationship With Org | Physician | RelationshipWithOrgTxt |
| Loan Purpose | Recruitment Loan | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $250,000 | OriginalPrincipalAmt |
| Balance Due | $64,320 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $64,320 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Irene Schuiteman | |||
| Family member of Jackson Schuiteman, CFO | $55,736 | Compensation as an employee | 0 |
| Jerry Zomermaand | |||
| Family member of Gretchen Zomermaand, Director | $121,219 | Compensation as an employee | 0 |
| Tammy Byl | |||
| Family member of Tim Byl, Vice President of the Board | $19,013 | Compensation as an employee | 0 |
| Kim Bosma | |||
| Family member of Cory Gotto, Director | $27,335 | Compensation as employee | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | New Specialty Clinics: Pediatric Cardiology (Eric Towe, MD) and Psychiatry-consultative (Grace LaFollette, APRN) |
| 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 | Brian Van Engen, Board President, and Stan Speer, Director, have a business relationship. Jennifer Jansen, Director, and Lauren Kaemingk, Director, have a business 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 CFO reviews the 990 in detail. After his review and prior to filing the return with the IRS, the 990 is emailed to board members of the organization. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Northwest Iowa Diagnostics | ||||||||||||||
| 714 Lincoln St NE | Le Mars | IA | 51031 | 820559254 | Diagnostic radiology | IA | Sioux Center Community Hospital & Health | Related | $7,915 | $57,900 | 0 | Yes (1) | 0.36990 | |
| Avera Home Medical Equipment of Sioux Center LLC | ||||||||||||||
| 38 19th Street SW | Sioux Center | IA | 51250 | 753203100 | Home medical supplies | SD | Related | $28,407 | $161,380 | 0 | 0 | 0.50000 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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