2017-02-09T12:43:37-06:00 2016-06-30 481292483 HENJES CONNER & WILLIAMS PC PO BOX 1528 SIOUX CITY IA 51102 990 2015-07-01 383320710 HOSPICE OF SIOUXLAND HOSP 7122334144 4300 HAMILTON BLVD SIOUX CITY IA 51104 DANIEL K LAUER CHIEF FINANCIAL OFFICER 7122529418 2017-02-06 1 MELISSA J WILLER P00121904 7122773931 2017-02-04 2015 2021-01-29 14:40:06Z DANIEL K LAUER 230 NEBRASKA ST SIOUX CITY IA 51101 12111145 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 12 102 130 0 0 1295621 195356 10036308 9762099 254366 268879 4303 -43426 11590598 10182908 0 0 0 0 4903222 5297023 0 0 33342 5247851 4768072 10151073 10065095 1439525 117813 10050007 9596149 3090869 3796222 6959138 5799927 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 7111322 9763057 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. 7111322 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 39 0 102 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 VICE-CHAIRPERSON 1.00 X X 0 0 0 LYNN WOLD TREASURER 1.00 X X 0 0 0 JAMES FITZPATRICK SECRETARY 1.00 X X 0 0 0 SKIP PERLEY 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 JEFFREY KNERL 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 LINDA TODD DIRECTOR OF OPERATIONS 40.00 X 61675 0 12160 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 84135 0 16773 DALE HOLDIMAN MEDICAL DIRECTOR 40.00 X 224232 0 26825 MICHELLE HUBER PHARMACIST 40.00 X 106017 0 10599 476059 0 66357 2 0 1 0 OPTUM HOSPICE PHARMACY SERVICES 11000 OPTUM CIRCLE EDEN PRAIRIE MN 55344 PHARMACY AND EDUCATION 573947 TOUCHSTONE LIVING CENTER 1800 INDIAN HILLS DRIVE SIOUX CITY IA 51104 ROOM AND BOARD CHARGES 368151 NATIONAL HME INC 7451 AIRPORT FREEWAY RICHLAND HILLS TX 76118 EQUIPMENT AND TECHNOLOGY SERVICES 326735 MERCY MEDICAL CENTER 801 5TH ST SIOUX CITY IA 51101 ADDITIONAL HOSPITAL SERVICES 255210 SUNRISE MANOR INC 5501 GORDON DRIVE EAST SIOUX CITY IA 51106 ROOM AND BOARD CHARGES 198335 11 195356 195356 PATIENT SERVICE REVENUE 621610 9762099 9762099 9762099 178851 178851 137868 182252 -44384 -44384 -44384 1836013 1745985 90028 90028 90028 OTHER INCOME 900099 958 958 958 10182908 9718673 0 268879 X 174744 174744 3922912 2412771 1510141 226979 134600 92379 724743 528770 192871 3102 247645 170064 77581 48606 48606 2556312 2132778 423534 453760 309149 140898 3713 276331 208677 67654 52485 52485 88194 61672 26522 40415 10992 29423 MEDICAL / OFFICE SUPPLI 1177820 1141613 36207 DUES AND SUBSCRIPTIONS 32015 32015 OTHER COSTS 22130 236 15371 6523 FUNDRAISING 20004 20004 10065095 7111322 2920431 33342 925036 405313 1866718 2185551 142280 120473 2389170 1846474 763780 542696 5453389 5452601 898804 889515 10050007 9596149 3090869 3796222 3090869 3796222 X 5560334 4410027 898804 889900 500000 500000 6959138 5799927 10050007 9596149 X 117813 -221090 -1055934 X X 0 1 X 1 0 X X 2 MERCY MEDICAL CENTER AND SUBSIDIARIES 311373080 3 1 0 0 NORTHWEST IOWA HOSPITAL CORPORATION 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 859871 -19259 840612 852067 7804 859871 755586 96481 852067 671376 84210 755586 684578 -13202 671376 0.40520 0.59480 0 0 1684856 1360352 324504 704314 486122 218192 542696 BENEFICIAL INTERESTS IN TRUSTS 889515 889515 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 OPERATING STATEMENT OR ACCRUED IN THE BALANCE SHEET. X X X X 0 0 0 0 0 0 0 0 0 DALE HOLDIMAN MEDICAL DIRECTOR 224232 0 0 0 0 0 0 0 26825 0 251057 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 HALF 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 6 HEALTH INC., NORTHWEST IOWA HOSPITAL CORPORATION 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 TRINITY HEALTH AND IOWA HEALTH SYSTEMS HAVE TO APPROVE LARGE CAPITAL PROJECTS FORM 990, PART VI, SECTION B, LINE 11 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 2,132,778. 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 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 NORTHWEST IOWA HOSPITAL CORPORATION 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 0 0 1 1 0 0 0 0 0 0 SIOUXLAND REGIONAL CANCER CENTER M 5177 SIOUXLAND PARAMEDICS M 14637 HEALTH INC M 378000 MERCY HEALTH SERVICES M 297451 MERCY HEALTH SERVICES K 150640 NORTHWEST IOWA HOSPITAL CORPORATION J 137868 NORTHWEST IOWA HOSPITAL CORPORATION M 145282