2017-05-04T15:18:40-05:00 2016-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2015-07-01 420796764 Sioux Center Health SIOU 7127221271 1101 9th St SE Sioux Center IA 51250 Jackson Schuiteman CFO 7127221271 2017-05-03 1 Laurie Hanson P00851848 6053391999 2017-05-03 2015 2021-01-29 14:40:06Z Kayleen Lee 1101 9th St SE Sioux Center IA 51250 38205138 0 X www.siouxcenterhealth.org X 1951 IA To provide medical care for all ages. 42 40 562 112 0 0 62077 32448 35960765 37921778 -1577803 78714 150647 153839 34595686 38186779 2425 21744 0 0 18313121 19925030 0 0 68028 18092346 18853356 36407892 38800130 -1812206 -613351 82125464 77862177 44631337 40981401 37494127 36880776 X Bring hope, health and healing to life. 0 0 34034223 21744 37921778 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, 2016, patient days were 1,317, swing-bed days were 827, and newborn days were 350.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, 2016, 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. 34034223 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 35 0 1 562 1 1 1 0 0 0 0 0 0 0 0 0 X 42 40 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X Jackson Schuiteman 7127228158 1101 9th St SE Sioux Center IA 51250 Brian VanEngen President 1.00 X X 0 0 0 Tim Byl Vice President 1.00 X X 0 0 0 Marj Wagner Secretary 1.00 X X 0 0 0 Jeffrey Timmer Treasurer 1.00 X X 0 0 0 Vernon Beernink Director 1.00 X 0 0 0 Mary Beimers Director 1.00 X 0 0 0 Janet Boone Director 1.00 X 0 0 0 Terry Boote Director 1.00 X 0 0 0 Delbert Broek Director 1.00 X 0 0 0 Leslie Brommer Director 1.00 X 0 0 0 Bob Bruxvoort Director 1.00 X 0 0 0 Mayra Castelan Director 1.00 X 0 0 0 Lisa Christians Director 1.00 X 0 0 0 Paul Clousing Director 1.00 X 0 0 0 Brenda Dokter Director 1.00 X 0 0 0 Bruce Dooyema Director 1.00 X 0 0 0 David Eekhoff Director 1.00 X 0 0 0 Roger Fedders Director 1.00 X 0 0 0 Randy Feenstra Director 1.00 X 0 0 0 Dan Hibma Director 1.00 X 0 0 0 Kyle Hiemstra Director 1.00 X 0 0 0 Curt Hohman Director 1.00 X 0 0 0 Jennifer Jansen Director 1.00 X 0 0 0 Lauren Kaemingk Director 1.00 X 0 0 0 John Koerselman Director 1.00 X 0 0 0 Ardith Lein Director 1.00 X 0 0 0 Scott Peterson Director 1.00 X 0 0 0 Rich Rikkers Director 1.00 X 0 0 0 Norman Snieder Director 1.00 X 0 0 0 Stan Speer Director 1.00 X 0 0 0 Sherri Ten Napel Director 1.00 X 0 0 0 Janene Van Gorp Director 1.00 X 0 0 0 Doug Van Meeteren Director 1.00 X 0 0 0 Con Van Roekel Director 1.00 X 0 0 0 Neil Van Schouwen Director 1.00 X 0 0 0 Dale Vander Berg Director 1.00 X 0 0 0 Betty Vermeer Director 1.00 X 0 0 0 Lyle Vermeer Director 1.00 X 0 0 0 Virginia Vermeer Director 1.00 X 0 0 0 Dennis Wright Director 1.00 X 0 0 0 Verdean Wynja Director 1.00 X 0 0 0 Gretchen Zomermaand Director 1.00 X 0 0 0 Kayleen Lee CEO 40.00 0.50 X 213812 0 25835 Jackson Schuiteman CFO 40.00 X 92929 0 18702 Dr Julie A McKay MD Diagnostic radiology 24.00 X 303665 0 43564 Dr Jamie J Vitamvas Family Medicine/OB 40.00 X 343407 0 35522 Dr Scott A Rens MD Family Medicine/OB 40.00 X 369361 0 37696 Dr Roy Slice MD ER 40.00 X 276014 0 22181 Dr Jason R Koelewyn MD Family Medicine/OB 40.00 X 278925 0 42556 1878113 0 226056 10 0 1 0 Avera McKennan 1325 S Cliff Avenue Sioux Falls SD 571175045 Management fees & other services 1720589 Jon Clegg 1226 Turnberry Avenue Le Mars IA 51031 Anesthesia 364800 Imaging Solutions Inc 3223 32nd Ave S Ste 201 Fargo ND 58103 MRI Readings 215947 Northwest Iowa Diagnostics 714 Lincoln St Ne Le Mars IA 51031 Ultrasound Readings 162465 Thomas Posch 234 Marina Dell Ave Yankton SD 57078 Radiology Readings 110294 5 26952 5496 32448 Patient Service Revenue 622110 34162722 34162722 Assisted and Independent Living 623990 1847715 1847715 Daycare Revenue 624410 1084074 1084074 Change in Int: Avera Fdtn 900099 162002 162002 Investment in affiliates 900099 51362 51362 613903 613903 37921778 78714 78714 129928 0 129928 129928 129928 42270 18359 23911 23911 38186779 37921778 0 232553 21744 21744 363986 363986 190142 190142 15591944 14220639 1340480 30825 623488 585069 37289 1130 2061497 1898519 160170 2808 1093973 974432 117265 2276 1474941 1474941 41364 41364 3701133 3515062 186071 132527 123205 9322 912749 561220 332693 18836 641481 637656 3825 72203 69707 2496 192104 135938 53664 2502 1396420 1396420 4191485 4191485 463016 79339 383677 Medical Supplies 4126668 4126668 Bad Debt 648410 648410 Food 599645 592280 7036 329 Taxes 156507 156507 102703 32986 69717 38800130 34034223 4697879 68028 9901274 12596826 2482747 1401754 5083493 3922728 165838 366969 396972 420344 357634 74799064 19548983 57464863 55250081 3528372 2196605 333622 311408 2377942 1428169 82125464 77862177 3157227 2806889 132527 59927 39628597 35324796 99140 99620 26635 982000 1587211 1708169 44631337 40981401 X 36581684 35985420 703803 667416 208640 227940 37494127 36880776 82125464 77862177 -613351 0 X 0 1 X 1 0 X 0 0 328776 -3967 324809 210511 118265 328776 187178 23333 210511 174398 12780 187178 159714 14684 174398 0.70180 0.29820 1 0 630000 2219111 2849111 56353877 11370338 44983539 14802661 7990064 6812597 793415 188581 604834 55250081 Deferred Compensation 1428169 Estimated third-party payor settlements 280000 1708169 X 37555456 -648410 -648410 38203866 -17087 -17087 38186779 38151720 0 38151720 648410 648410 38800130 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. The Health Center's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2013. Part XI, Line 2d - Other Adjustments: Bad Debt Expense -648,410. Part XI, Line 4b - Other Adjustments: Change in net assets of Avera Health Foundation -17,087. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 648,410. 1 1 X 1 X 1 X 1 1 1 0 1 1 159 268000 268000 0.00700 3189994 2520205 669789 0.01760 159 3457994 2520205 937789 0.02460 7 2163 40348 7302 33046 0.00090 1 2 14322 14322 0.00040 3 14730 7579948 6180430 1399518 0.03670 1 24836 24836 0.00070 12 16895 7659454 6187732 1471722 0.03870 12 17054 11117448 8707937 2409511 0.06330 1 1461 1461 0.00000 1 352 1582777 1092071 490706 0.01290 2 352 1584238 1092071 492167 0.01290 0 648410 43054 8542057 8650233 -108176 X 1 1 1 1 Sioux Center Health 1101 9th St SE Sioux Center IA 51250 www.siouxcenterhealth.org 840080H X X X X Sioux Center Health 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X www.siouxcenterhealth.org/financial-assistance/ X www.avera.org X 1 15 1 www.siouxcenterhealth.org/financial-assistance 0 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X 1 X http://www.siouxcenterhealth.org/financial-assistance/ X http://www.siouxcenterhealth.org/financial-assistance/ X http://www.siouxcenterhealth.org/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 0 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 11: Each of the health needs identified are important for overall community health. However due to limited human and financial resources, Sioux Center Health will not be focusing on the following needs as part of its implementation plan: community education-support groups and recreation - things to do. Thanks to several partnerships in Sioux County, a county-wide Health Improvement Planning group has been established and has sub groups working on these areas.The following prioritized needs will be included in the implementation strategy:-Obesity. Sioux Center Health, through collaboration with Community Health Partners has received two grants with an obesity management focus. SCH hired a Registered Dietician who will be implementing an ongoing weight management program that will be open to all community members. SCH continued partnerships with the Sioux Center Trails Council, Healthy Sioux Center community group and other recreational offerings and facilities to remain an active voice for patients and community members.-Mental Health Services. Sioux Center Health will provide 24/7 social worker coverage. In addition, SCH will also use eCare (24 hour behavioral assessments through use of video camera) and Care Match (list of all open beds in Iowa for inpatient care). Ongoing staff training in recognizing signs and/or treatment of mental health concerns will also be provided.-Translation and Interpretation. Sioux Center Health will be working on establishing a Cultural Diversity business plan to address these needs. The team will identify gaps and solutions. 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 16i: 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 22d: Sioux Center Health uses the look-back method to determine the amount to bill individuals eligible under the financial assistance policy. 7 1 - Hull Medical Clinic 807 Main Hull IA 51239 Physician clinic 2 - Chears Home Health & Hospice 1400 7th Ave SE Sioux Center IA 51250 Home health and hospice 3 - Royal Meadows 1400 7th Ave SE Sioux Center IA 51250 Nursing facility 4 - Franken Manor 527 S Main Ave Sioux Center IA 51250 Assisted living 5 - Crown Pointe 1400 7th Ave SE Sioux Center IA 51250 Independent assisted living 6 - SCH Occupational Health Center 38 19th St SW Sioux Center IA 51250 Occupational health 7 - Sioux Center Medical Clinic 1101 9th St SE Sioux Center IA 51250 Physician clinic 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 can be found at Schedule H, Part V, Line 13.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 $648,410. Part II, Community Building Activities: The Hospital 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 for 352 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 statements. 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 6.64% 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: The current year shortfall was due to an increase in sequestration. A 2% reduction began 4/10/13. The decrease in reimbursement contributed to the shortfall. Sioux Center Health will continue to provide services to Medicare patients as access to healthcare and individual's health is important to the Organization. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicaid and Medicare Services. Part III, Line 9b: Sioux Center Health provides free care based on meeting presumptive eligibility requirements listed in the financial assistance policy. The Hospital does not pursue collection efforts to patients in the process of applying for assistance or persons meeting the presumptive eligibility requirements. Any personal portion due follows normal collection procedures. Sioux Center Health provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The Hospital does not pursue collections of amounts determined to qualify as charity care. Part VI, Line 2: Sioux Center Health has a broad based Board of Directors providing community feedback on a quarterly basis. An open public meeting is conducted annually to listen to issues of the community and share information regarding services and programs. The Hospital analyzes statistical data through IHA and Iowa Public Health to determine disease related needs, services and market share. The Hospital works closely with Community Health Partners to identify and address community health related needs. Additionally, the Hospital conducted a community health needs assessment during the year ended 6/30/16 in compliance with 501(r). Part VI, Line 3: Patients are made aware of financial assistance programs 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 that 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 "mommy and me" visit.5. The financial assistance application is available on the Hospital website.Additionally, the financial assistance policy is available upon request. 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, support groups, health screenings, flu-shot clinics, and various other activities. 1 Northwest Iowa Community College Foundation 603 W Park Street Sheldon IA 51201 421275893 501(c)3 14322 Scholarships 1 Part I, Line 2: 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. X X 0 0 0 0 0 0 0 0 0 Kayleen Lee CEO 209290 0 0 0 4522 0 4330 0 22280 0 240422 0 0 0 Dr Julie A McKay MD Diagnostic radiology 192812 0 109998 0 855 0 26409 0 17639 0 347713 0 0 0 Dr Jamie J Vitamvas Family Medicine/OB 251597 0 33658 0 58152 0 17252 0 18753 0 379412 0 0 0 Dr Scott A Rens MD Family Medicine/OB 365844 0 2940 0 577 0 18949 0 19231 0 407541 0 0 0 Dr Roy Slice MD ER 197767 0 0 0 78247 0 2800 0 19865 0 298679 0 0 0 Dr Jason R Koelewyn MD Family Medicine/OB 234892 0 27089 0 16944 0 24934 0 18106 0 321965 0 0 0 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. A City of Sioux Center 426005218 2005-04-11 4000000 Acquisition, renovation, construction, equipping, & furnishing nursing home 0 0 0 B City of Hull 426004780 444784AR3 2012-10-18 10000000 Hospital Replacement 0 0 0 A 2500000 4000000 4000000 2005 0 0 1 1 B 575000 10055050 744112 623609 200000 8487329 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 Schedule K Part II Column B The 2005 revenue note matures in 2026. The amount on line 1 represents the amount of principal reduction of the underlying note payable to the financial institutions rather than actual retirement of bonds in the issue. Schedule K Part II Line 11 Column A The amount on line 11 represents the amount of bond proceeds spent to refund prior issues. Irene Schuiteman Family member of Jackson Schuiteman, CFO 52008 Compensation as an employee 0 Jerry Zomermaand Family member of Gretchen Zomermaand, Director 120324 Compensation as an employee 0 Tammy Byl Family member of Tim Byl, Vice President of the Board 17810 Compensation as an employee 0 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 B, line 11 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. Northwest Iowa Diagnostics 714 Lincoln St NE Le Mars IA 51031 820559254 Diagnostic radiology IA Sioux Center Community Hospital & Health Related -1439 32195 0 1 0.36990 Avera Home Medical Equipment of Sioux Center LLC 38 19th Street SW Sioux Center IA 51250 753203100 Home medical supplies SD N/A Related 56282 174166 0 0 0.50000 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0