2018-02-20T08:55:55-06:00 2017-06-30 481292483 HENJES CONNER & WILLIAMS PC PO BOX 1528 SIOUX CITY IA 51102 990 2016-07-01 383320710 HOSPICE OF SIOUXLAND HOSP 7122334144 4300 HAMILTON BLVD SIOUX CITY IA 51104 DANIEL K LAUER CHIEF FINANCIAL OFFICER 7122529418 2018-02-15 1 MELISSA J WILLER P00121904 7122773931 2018-02-15 192.30.185.22 2018-02-15 10:26:59 CS P 218AFE1164C54EC742846DF0C2C2004D2A020A2C F4849073982E2CEC7C065CC25B23D064E764DD15 2016 2021-01-29 14:40:06Z DANIEL K LAUER 230 NEBRASKA ST SIOUX CITY IA 51101 13220940 0 X WWW.HOSPICEOFSIOUXLAND.ORG X 1982 IA PROVIDE COMFORT, SUPPORT, AND COMPASSIONATE CARE TO TERMINALLY ILL PEOPLE AND THEIR FAMILIES THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL, AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. 12 12 106 137 0 0 195356 216167 9762099 10806164 268879 278721 -43426 -123135 10182908 11177917 0 0 0 0 5297023 5778757 0 0 84057 4768072 5305895 10065095 11084652 117813 93265 9596149 9690923 3796222 3025537 5799927 6665386 PROVIDE COMFORT, SUPPORT, AND COMPASSIONATE CARE TO TERMINALLY ILL PEOPLE AND THEIR FAMILIES THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL, AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. 0 0 8195405 10667068 HOSPICE OF SIOUXLAND'S MISSION IS TO PROVIDE COMFORT, SUPPORT AND COMPASSIONATE CARE TO PEOPLE WITH LIFE-LIMITING ILLNESSES AND TO THEIR FAMILIES IN A MANNER THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. ALL PATIENTS WHO MEET ADMISSION CRITERIA ARE ELIGIBLE FOR HOSPICE CARE, NO MATTER WHAT THEIR FINANCIAL CIRCUMSTANCES, OR ABILITY TO PAY. 8195405 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 37 0 106 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 X DAN LAUER 7122529418 230 NEBRASKA ST PO BOX 5017 SIOUX CITY IA 51101 MILT AVERY CHAIRPERSON 1.00 X X 0 0 0 LYNN WOLD SECRETARY 1.00 X X 0 0 0 JAMES FITZPATRICK TREASURER 1.00 X X 0 0 0 GARRETT SMITH VICE CHAIRPERSON 1.00 X X 0 0 0 JIM GOBELL DIRECTOR 0.50 X 0 0 0 CHAD MARKHAM DIRECTOR 0.50 X 0 0 0 HUGH DEPAULIS DIRECTOR 0.50 X 0 0 0 TRACY LARSON DIRECTOR 0.50 X 0 0 0 WAYNE BARNES DIRECTOR 0.50 X 0 0 0 CYNTHIA PALS DIRECTOR 0.50 X 0 0 0 JON PEACOCK DIRECTOR 0.50 X 0 0 0 STEVEN JOYCE DIRECTOR 0.50 X 0 0 0 KAREN VAN DE STEEG EXECUTIVE DIRECTOR 40.00 X 0 0 0 DAN LAUER CHIEF FINANCIAL OFFICER 40.00 X 0 0 0 CARLA THOMPSON DIRECTOR OF OPERATIONS 40.00 X 128616 0 17683 DALE HOLDIMAN MEDICAL DIRECTOR 40.00 X 230828 0 22110 MICHELLE HUBER PHARMACIST 40.00 X 109517 0 6893 468961 0 46686 3 0 1 0 OPTUM HOSPICE PHARMACY SERVICES 11000 OPTUM CIRCLE EDEN PRAIRIE MN 55344 PHARMACY AND EDUCATION 573231 NATIONAL HME INC 7451 AIRPORT FREEWAY RICHLAND HILLS TX 76118 EQUIPMENT AND TECHNOLOGY SERVICES 397749 MERCY MEDICAL CENTER 801 5TH ST SIOUX CITY IA 51101 ADDITIONAL HOSPITAL SERVICES 254033 RVP ENTERPRISES INC 3501 DAKOTA AVE SOUTH SIOUX CITY NE 68776 NURSING HOME CARE FOR PATIENTS 178850 TOUCHSTONE LIVING CENTER 1800 INDIAN HILLS DR SIOUX CITY IA 51104 NURSING HOME CARE FOR PATIENTS 173436 14 216167 216167 PATIENT SERVICE REVENUE 621610 10806164 10806164 10806164 141769 141769 34906 182252 -147346 -147346 -147346 1986041 1849089 136952 136952 136952 27643 11682 15961 15961 OTHER INCOME 900009 8250 8250 8250 11177917 10667068 0 294682 X 146298 146298 4343836 3221337 1122499 234771 174103 60668 744388 543884 200504 309464 226937 82527 484500 484500 48280 48280 2415738 2238194 177544 44109 44109 532287 285700 222539 24048 247184 195974 51210 44889 297 43672 920 83014 56126 26888 47570 14550 33020 MEDICAL SUPPLIES 635515 635515 MEDICATIONS 589144 589144 FUNDRAISING 58081 58081 DUES,SUBSCRIPTIONS, MEM 50258 50258 25326 13644 10674 1008 11084652 8195405 2805190 84057 405313 1133641 2185551 1398826 120473 137481 2288216 1986999 542696 301217 5452601 5815867 889515 903891 9596149 9690923 3796222 3025537 3796222 3025537 X 4410027 5261109 889900 904277 500000 500000 5799927 6665386 9596149 9690923 X 93265 332656 439538 X X 0 1 X 1 0 X X 2 MERCY MEDICAL CENTER AND SUBSIDIARIES 311373080 3 1 0 0 UNITYPOINT HEALTH AND SUBSIDIARIES 421019872 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 840612 63999 200000 704611 859871 -19259 840612 852067 7804 859871 755586 96481 852067 671376 84210 755586 0.29000 0.71000 0 0 1684856 1522604 162252 603360 464395 138965 301217 BENEFICIAL INTERESTS IN TRUSTS 903891 903891 X PART X, LINE 2: HEALTH, INC. AND ITS SUBSIDIARIES ARE NON-PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, INCOME EARNED IN THE PERFORMANCE OF ITS EXEMPT PURPOSE IS NOT SUBJECT TO INCOME TAX AND ACCORDINGLY, THE FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION FOR INCOME TAXES. MANAGEMENT HAS CONCLUDED THAT ANY UNCERTAIN TAX POSITIONS WOULD BE IMMATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT INCLUDE ANY PROVISION FOR UNCERTAIN TAX POSITIONS, AND NO RELATED INTEREST OR PENALTIES HAVE BEEN RECORDED IN THE STATEMENTS OF ACTIVITIES OR ACCRUED IN THE STATEMENTS OF FINANCIAL POSITION. SPECIAL EVENT 27643 27643 11682 27643 27643 11682 11682 15961 X X X X 0 0 0 0 0 0 0 0 0 DALE HOLDIMAN MEDICAL DIRECTOR 230828 0 0 0 0 0 0 0 22110 0 252938 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 HALF OF THE BOARD WORKS FOR UNITYPOINT HEALTH OR IS ON THE UNITYPOINT HEALTH BOARD AND HALF OF THE BOARD WORKS FOR MERCY MEDICAL CENTER OR IS ON THE MERCY MEDICAL CENTER BOARD. FORM 990, PART VI, SECTION A, LINE 6 HEALTH INC., UNITYPOINT HEALTH AND SUBSIDIARIES, MERCY MEDICAL CENTER AND SUBSIDIARIES FORM 990, PART VI, SECTION A, LINE 7A HOSPITAL BOARDS HAVE TO APPOINT/ELECT THEIR REPRESENTATIVES. FORM 990, PART VI, SECTION A, LINE 7B UNITYPOINT HEALTH AND MERCY MEDICAL CENTER HAVE TO APPROVE LARGE CAPITAL PROJECTS FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION REVIEWED AND SUBMITTED RETURN UPON COMPLETION BY PREPARER FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A FORM DETAILING ANY AND ALL BUSINESS RELATIONSHIPS WITH HEALTH INC AND RELATED ENTITIES. ALL COMPLETED FORMS ARE REVIEWED AND DISCUSSED WITH THE BOARD AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 TOP MANAGEMENT EMPLOYEES PROVIDE INDEPENDENT DOCUMENTATION FROM TRADE SOURCES TO SUBSTANTIATE PAY LEVELS. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION'S DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 2,238,194. MANAGEMENT AND GENERAL EXPENSES 177,544. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,415,738. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT 380,913. CHANGE IN VALUE OF BENEFICIAL INTERESTS IN TRUSTS 58,625. FORM 990, PART XI, LINE 2C NO CHANGES HEALTH INC 230 NEBRASKA STREET SIOUX CITY IA 51101 311712115 SERVE AS THE CENTRAL ORGANIZATION FOR OTHER 501(C) (3) ENTITIES IA 501(C)(3) PF 0 SIOUXLAND REGIONAL CANCER CENTER PO BOX 5017 SIOUX CITY IA 51102 421411233 DEDICATED TO CANCER TREATMENT, RESEARCH AND EDUCATION & SERVICES ALL PATIENT IA 501(C)(3) 170(B)(1)(A)(I) 0 SIOUXLAND PARAMEDICS 1701 TERMINAL DRIVE SIOUX CITY IA 51105 421185707 MEDICAL TRANSPORTATION SERVICE IA 501(C)(3) 509(A)(3) TYPE I 0 MERCY MEDICAL CENTER 801 5TH STREET SIOUX CITY IA 51102 311373080 PROVIDES A FULL CONTINUUM OF WELLNESS, PRIMARY, ACUTE AND TERTIARY SERVICES IA 501(C)(3) 170(B)(1)(A)(III) 0 UNITYPOINT HEALTH 2720 STONE PARK BOULEVARD SIOUX CITY IA 51104 421019872 STRIVES TO PROVIDE THE MOST PATIENT-CENTERED CARE IN SIOUXLAND IA 501(C)(3) 170(B)(1)(A)(III) 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 SIOUXLAND REGIONAL CANCER CENTER M 1001 SIOUXLAND PARAMEDICS M 35635 HEALTH INC M 484500 MERCY MEDICAL CENTER M 284450 MERCY MEDICAL CENTER K 159903 JUNE E NYLEN CANCER CENTER J 34906 UNITYPOINT HEALTH M 166466