HEALTH INC HOSPICE: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
HEALTH INC HOSPICE (EIN 38-3320710)
Tax period
2015-07-01 to 2016-06-30
Filed
2017-02-09
IRS object ID
201700409349300225
Schema version
2015v3.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2017-02-09T12:43:37-06:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN481292483PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HENJES CONNER & WILLIAMS PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1528AddressLine1Txt
CitySIOUX CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51102ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN383320710EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF SIOUXLANDBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHOSPBusinessNameControlTxt
Phone7122334144PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14300 HAMILTON BLVDAddressLine1Txt
CitySIOUX CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51104ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANIEL K LAUERPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone7122529418PhoneNum
Signature2017-02-06SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMELISSA J WILLERPreparerPersonNm
PTINP00121904PTIN
Phone7122773931PhoneNum
Preparation2017-02-04PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDANIEL K LAUERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1230 NEBRASKA STAddressLine1Txt
CitySIOUX CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51101ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$12,111,145GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HOSPICEOFSIOUXLAND.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1982FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionPROVIDE 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.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee102TotalEmployeeCnt
Total Volunteers130TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,295,621PYContributionsGrantsAmt
CY Contributions Grants$195,356CYContributionsGrantsAmt
PY Program Service Revenue$10,036,308PYProgramServiceRevenueAmt
CY Program Service Revenue$9,762,099CYProgramServiceRevenueAmt
PY Investment Income$254,366PYInvestmentIncomeAmt
CY Investment Income$268,879CYInvestmentIncomeAmt
PY Other Revenue$4,303PYOtherRevenueAmt
CY Other Revenue-$43,426CYOtherRevenueAmt
PY Total Revenue$11,590,598PYTotalRevenueAmt
CY Total Revenue$10,182,908CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$4,903,222PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,297,023CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$33,342CYTotalFundraisingExpenseAmt
PY Other Expenses$5,247,851PYOtherExpensesAmt
CY Other Expenses$4,768,072CYOtherExpensesAmt
PY Total Expenses$10,151,073PYTotalExpensesAmt
CY Total Expenses$10,065,095CYTotalExpensesAmt
PY Revenues Less Expenses$1,439,525PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$117,813CYRevenuesLessExpensesAmt
Total Assets BOY$10,050,007TotalAssetsBOYAmt
Total Assets EOY$9,596,149TotalAssetsEOYAmt
Total Liabilities BOY$3,090,869TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,796,222TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,959,138NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,799,927NetAssetsOrFundBalancesEOYAmt
MissionPROVIDE 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$7,111,322ExpenseAmt
Revenue$9,763,057RevenueAmt
DescHOSPICE 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.Desc
Total Program Service Expenses$7,111,322TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document39IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee102EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAN LAUERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7122529418PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1230 NEBRASKA ST PO BOX 5017AddressLine1Txt
CitySIOUX CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51101ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
MILT AVERY
VICE-CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
LYNN WOLD
TREASURER1.00Yes (X)Yes (X)$0$0$0
JAMES FITZPATRICK
SECRETARY1.00Yes (X)Yes (X)$0$0$0
SKIP PERLEY
CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
JIM GOBELL
DIRECTOR0.50Yes (X)$0$0$0
CHAD MARKHAM
DIRECTOR0.50Yes (X)$0$0$0
HUGH DEPAULIS
DIRECTOR0.50Yes (X)$0$0$0
TRACY LARSON
DIRECTOR0.50Yes (X)$0$0$0
WAYNE BARNES
DIRECTOR0.50Yes (X)$0$0$0
JEFFREY KNERL
DIRECTOR0.50Yes (X)$0$0$0
CYNTHIA PALS
DIRECTOR0.50Yes (X)$0$0$0
JON PEACOCK
DIRECTOR0.50Yes (X)$0$0$0
LINDA TODD
DIRECTOR OF OPERATIONS40.00Yes (X)$61,675$0$12,160
KAREN VAN DE STEEG
EXECUTIVE DIRECTOR40.00Yes (X)$0$0$0
DAN LAUER
CHIEF FINANCIAL OFFICER40.00Yes (X)$0$0$0
CARLA THOMPSON
DIRECTOR OF OPERATIONS40.00Yes (X)$84,135$0$16,773
DALE HOLDIMAN
MEDICAL DIRECTOR40.00$224,232$0$26,825Yes (X)
MICHELLE HUBER
PHARMACIST40.00$106,017$0$10,599Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$476,059TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$66,357TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
OPTUM HOSPICE PHARMACY SERVICES
11000 OPTUM CIRCLEEDEN PRAIRIEMN55344PHARMACY AND EDUCATION$573,947
TOUCHSTONE LIVING CENTER
1800 INDIAN HILLS DRIVESIOUX CITYIA51104ROOM AND BOARD CHARGES$368,151
NATIONAL HME INC
7451 AIRPORT FREEWAYRICHLAND HILLSTX76118EQUIPMENT AND TECHNOLOGY SERVICES$326,735
MERCY MEDICAL CENTER
801 5TH STSIOUX CITYIA51101ADDITIONAL HOSPITAL SERVICES$255,210
SUNRISE MANOR INC
5501 GORDON DRIVE EASTSIOUX CITYIA51106ROOM AND BOARD CHARGES$198,335
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
All Other Contributions$195,356AllOtherContributionsAmt
Total Contributions$195,356TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUEDesc
Business621610BusinessCd
Total Revenue Column$9,762,099TotalRevenueColumnAmt
Related Or Exempt Func Income$9,762,099RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$9,762,099TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$178,851TotalRevenueColumnAmt
Exclusion$178,851ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$137,868RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$182,252RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$44,384RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$44,384TotalRevenueColumnAmt
Related Or Exempt Func Income-$44,384RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,836,013SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,745,985SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$90,028SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$90,028TotalRevenueColumnAmt
Exclusion$90,028ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$958TotalRevenueColumnAmt
Related Or Exempt Func Income$958RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$958OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,182,908TotalRevenueColumnAmt
Related Or Exempt Func Income$9,718,673RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$268,879ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$174,744TotalAmt
Management And General$174,744ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,922,912TotalAmt
Program Services$2,412,771ProgramServicesAmt
Management And General$1,510,141ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$226,979TotalAmt
Program Services$134,600ProgramServicesAmt
Management And General$92,379ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$724,743TotalAmt
Program Services$528,770ProgramServicesAmt
Management And General$192,871ManagementAndGeneralAmt
Fundraising$3,102FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$247,645TotalAmt
Program Services$170,064ProgramServicesAmt
Management And General$77,581ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$48,606TotalAmt
Management And General$48,606ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,556,312TotalAmt
Program Services$2,132,778ProgramServicesAmt
Management And General$423,534ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$453,760TotalAmt
Program Services$309,149ProgramServicesAmt
Management And General$140,898ManagementAndGeneralAmt
Fundraising$3,713FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$276,331TotalAmt
Program Services$208,677ProgramServicesAmt
Management And General$67,654ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$52,485TotalAmt
Management And General$52,485ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$88,194TotalAmt
Program Services$61,672ProgramServicesAmt
Management And General$26,522ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$40,415TotalAmt
Program Services$10,992ProgramServicesAmt
Management And General$29,423ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL / OFFICE SUPPLI$1,177,820$1,141,613$36,207
DUES AND SUBSCRIPTIONS$32,015$32,015
OTHER COSTS$22,130$236$15,371$6,523
FUNDRAISING$20,004$20,004

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$10,065,095TotalAmt
Program Services$7,111,322ProgramServicesAmt
Management And General$2,920,431ManagementAndGeneralAmt
Fundraising$33,342FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$925,036BOYAmt
EOY$405,313EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,866,718BOYAmt
EOY$2,185,551EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$142,280BOYAmt
EOY$120,473EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,389,170LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,846,474LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$763,780BOYAmt
EOY$542,696EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$5,453,389BOYAmt
EOY$5,452,601EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$898,804BOYAmt
EOY$889,515EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$10,050,007BOYAmt
EOY$9,596,149EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,090,869BOYAmt
EOY$3,796,222EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,090,869BOYAmt
EOY$3,796,222EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,560,334BOYAmt
EOY$4,410,027EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$898,804BOYAmt
EOY$889,900EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$500,000BOYAmt
EOY$500,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,959,138BOYAmt
EOY$5,799,927EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,050,007BOYAmt
EOY$9,596,149EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$117,813ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$221,090NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$1,055,934OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations2SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (2 entries)

EINEINOrganization TypeOrganizationTypeCdGoverning Document ListedGoverningDocumentListedIndSupportSupportAmtOther SupportOtherSupportAmt
MERCY MEDICAL CENTER AND SUBSIDIARIES
3113730803Yes (1)$0$0
NORTHWEST IOWA HOSPITAL CORPORATION
4210198723Yes (1)$0$0
FieldValueIRS element (for citing)
Supported Organizations Total2SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$859,871BeginningYearBalanceAmt
Investment Earnings Or Losses-$19,259InvestmentEarningsOrLossesAmt
End Year Balance$840,612EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$852,067BeginningYearBalanceAmt
Investment Earnings Or Losses$7,804InvestmentEarningsOrLossesAmt
End Year Balance$859,871EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$755,586BeginningYearBalanceAmt
Investment Earnings Or Losses$96,481InvestmentEarningsOrLossesAmt
End Year Balance$852,067EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$671,376BeginningYearBalanceAmt
Investment Earnings Or Losses$84,210InvestmentEarningsOrLossesAmt
End Year Balance$755,586EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$684,578BeginningYearBalanceAmt
Investment Earnings Or Losses-$13,202InvestmentEarningsOrLossesAmt
End Year Balance$671,376EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.40520BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.59480PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,684,856OtherCostOrOtherBasisAmt
Depreciation$1,360,352DepreciationAmt
Book Value$324,504BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$704,314OtherCostOrOtherBasisAmt
Depreciation$486,122DepreciationAmt
Book Value$218,192BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$542,696TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescBENEFICIAL INTERESTS IN TRUSTSDesc
Book Value$889,515BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$889,515TotalBookValueOtherAssetsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationHEALTH, 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 OPERATING STATEMENT OR ACCRUED IN THE BALANCE SHEET.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonDALE HOLDIMANPersonNm
TitleMEDICAL DIRECTORTitleTxt
Base Compensation Filing Org$224,232BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$26,825NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$251,057TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$0TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2HALF OF THE BOARD WORKS FOR NORTHWEST IOWA HOSPITAL CORPORATION OR IS ON THE NORTHWEST IOWA HOSPITAL CORPORATION 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 6HEALTH INC., NORTHWEST IOWA HOSPITAL CORPORATION AND SUBSIDIARIES, MERCY MEDICAL CENTER AND SUBSIDIARIES
FORM 990, PART VI, SECTION A, LINE 7AHOSPITAL BOARDS HAVE TO APPOINT/ELECT THEIR REPRESENTATIVES.
FORM 990, PART VI, SECTION A, LINE 7BTRINITY HEALTH AND IOWA HEALTH SYSTEMS HAVE TO APPROVE LARGE CAPITAL PROJECTS
FORM 990, PART VI, SECTION B, LINE 11ORGANIZATION REVIEWED AND SUBMITTED RETURN UPON COMPLETION BY PREPARER
FORM 990, PART VI, SECTION B, LINE 12CALL 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 15TOP MANAGEMENT EMPLOYEES PROVIDE INDEPENDENT DOCUMENTATION FROM TRADE SOURCES TO SUBSTANTIATE PAY LEVELS.
FORM 990, PART VI, SECTION C, LINE 19ORGANIZATION'S DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GOTHER: PROGRAM SERVICE EXPENSES 2,132,778. MANAGEMENT AND GENERAL EXPENSES 423,534. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,556,312.
FORM 990, PART XI, LINE 9:PENSION ADJUSTMENT -1,055,934.
FORM 990, PART XI, LINE 2CNO CHANGES

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationInd
HEALTH INC
230 NEBRASKA STREETSIOUX CITYIA51101311712115SERVE AS THE CENTRAL ORGANIZATION FOR OTHER 501(C) (3) ENTITIESIA501(C)(3)PF0
SIOUXLAND REGIONAL CANCER CENTER
PO BOX 5017SIOUX CITYIA51102421411233DEDICATED TO CANCER TREATMENT, RESEARCH AND EDUCATION & SERVICES ALL PATIENTIA501(C)(3)170(B)(1)(A)(I)0
SIOUXLAND PARAMEDICS
1701 TERMINAL DRIVESIOUX CITYIA51105421185707MEDICAL TRANSPORTATION SERVICEIA501(C)(3)509(A)(3) TYPE I0
MERCY MEDICAL CENTER
801 5TH STREETSIOUX CITYIA51102311373080PROVIDES A FULL CONTINUUM OF WELLNESS, PRIMARY, ACUTE AND TERTIARY SERVICESIA501(C)(3)170(B)(1)(A)(III)0
NORTHWEST IOWA HOSPITAL CORPORATION
2720 STONE PARK BOULEVARDSIOUX CITYIA51104421019872STRIVES TO PROVIDE THE MOST PATIENT-CENTERED CARE IN SIOUXLANDIA501(C)(3)170(B)(1)(A)(III)0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
SIOUXLAND REGIONAL CANCER CENTER
M$5,177
SIOUXLAND PARAMEDICS
M$14,637
HEALTH INC
M$378,000
MERCY HEALTH SERVICES
M$297,451
MERCY HEALTH SERVICES
K$150,640
NORTHWEST IOWA HOSPITAL CORPORATION
J$137,868
NORTHWEST IOWA HOSPITAL CORPORATION
M$145,282

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.