HEALTH INC HOSPICE: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
HEALTH INC HOSPICE (EIN 38-3320710)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-02-15
IRS object ID
201640469349301999
Schema version
2014v6.0
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)
Return2016-02-15T00:00:00-06:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

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 Begin2014-07-01TaxPeriodBeginDt

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
Signature2016-02-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMELISSA J WILLERPreparerPersonNm
PTINP00121904PTIN
Phone7122773931PhoneNum
Preparation2016-02-15PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

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$12,835,399GrossReceiptsAmt
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 Employee112TotalEmployeeCnt
Total Volunteers231TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$211,110PYContributionsGrantsAmt
CY Contributions Grants$1,295,621CYContributionsGrantsAmt
PY Program Service Revenue$9,832,095PYProgramServiceRevenueAmt
CY Program Service Revenue$10,036,308CYProgramServiceRevenueAmt
PY Investment Income$592,778PYInvestmentIncomeAmt
CY Investment Income$254,366CYInvestmentIncomeAmt
PY Other Revenue$56,741PYOtherRevenueAmt
CY Other Revenue$4,303CYOtherRevenueAmt
PY Total Revenue$10,692,724PYTotalRevenueAmt
CY Total Revenue$11,590,598CYTotalRevenueAmt
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$5,388,346PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,903,222CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$56,919CYTotalFundraisingExpenseAmt
PY Other Expenses$4,475,229PYOtherExpensesAmt
CY Other Expenses$5,247,851CYOtherExpensesAmt
PY Total Expenses$9,863,575PYTotalExpensesAmt
CY Total Expenses$10,151,073CYTotalExpensesAmt
PY Revenues Less Expenses$829,149PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,439,525CYRevenuesLessExpensesAmt
Total Assets BOY$8,646,209TotalAssetsBOYAmt
Total Assets EOY$10,050,007TotalAssetsEOYAmt
Total Liabilities BOY$2,552,451TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,090,869TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,093,758NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$6,959,138NetAssetsOrFundBalancesEOYAmt
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$7,677,416ExpenseAmt
Revenue$10,040,611RevenueAmt
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$7,677,416TotalProgramServiceExpensesAmt
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 Document49IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee112EmployeeCnt
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 (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
MILT AVERY
CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
LYNN WOLD
SECRETARY1.00Yes (X)Yes (X)$0$0$0
JAMES FITZPATRICK
TREASURER1.00Yes (X)Yes (X)$0$0$0
SKIP PERLEY
VICE-CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
JIM GOBELL
DIRECTOR0.50Yes (X)$0$0$0
PETER THOREEN
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)$110,267$0$27,297
KAREN VAN DE STEEG
EXECUTIVE DIRECTOR40.00Yes (X)$0$0$0
DAN LAUER
CHIEF FINANCIAL OFFICER40.00Yes (X)$0$0$0
DALE HOLDIMAN
MEDICAL DIRECTOR40.00$214,720$0$32,396Yes (X)
MICHELLE HUBER
PHARMACIST40.00$101,564$0$28,471Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$426,551TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$88,164TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
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
HOSPISCRIPT SERVICES LLC
4525 EXECUTIVE PARK DRMONTGOMERYAL36116PHARMACY AND EDUCATION$700,973
NATIONAL HME INC
7451 AIRPORT FREEWAYRICHLAND HILLSTX76118EQUIPMENT AND TECHNOLOGY SERVICES$377,442
MERCY MEDICAL CENTER
801 5TH STSIOUX CITYIA51101ADDITIONAL HOSPITAL SERVICES$303,916
AKRON CARE CENTER INC
991 HWY 3AKRONIA51001ROOM AND BOARD CHARGES$131,100
ST LUKES REGIONAL MED CENTER
2720 STONE PARK BLVDSIOUX CITYIA51104ADDITIONAL HOSPITAL SERVICES$125,831
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K12CntrctRcvdGreaterThan100KCnt
All Other Contributions$1,295,621AllOtherContributionsAmt
Total Contributions$1,295,621TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUEDesc
Business621610BusinessCd
Total Revenue Column$10,036,308TotalRevenueColumnAmt
Related Or Exempt Func Income$10,036,308RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$10,036,308TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$172,082TotalRevenueColumnAmt
Exclusion$172,082ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$183,824RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$183,824RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,143,261SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,060,977SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$82,284SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$82,284TotalRevenueColumnAmt
Exclusion$82,284ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$4,303TotalRevenueColumnAmt
Related Or Exempt Func Income$4,303RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,303OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,590,598TotalRevenueColumnAmt
Related Or Exempt Func Income$10,040,611RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$254,366ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$137,563TotalAmt
Management And General$137,563ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,628,298TotalAmt
Program Services$2,907,596ProgramServicesAmt
Management And General$720,702ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$226,979TotalAmt
Program Services$176,528ProgramServicesAmt
Management And General$50,451ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$652,475TotalAmt
Program Services$499,638ProgramServicesAmt
Management And General$152,837ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$257,907TotalAmt
Program Services$205,010ProgramServicesAmt
Management And General$52,897ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$873,000TotalAmt
Management And General$873,000ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$49,053TotalAmt
Management And General$49,053ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,087,156TotalAmt
Program Services$2,036,229ProgramServicesAmt
Management And General$50,927ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$370,678TotalAmt
Program Services$272,192ProgramServicesAmt
Management And General$93,596ManagementAndGeneralAmt
Fundraising$4,890FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$260,187TotalAmt
Program Services$228,987ProgramServicesAmt
Management And General$31,200ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$37,593TotalAmt
Management And General$37,593ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$101,103TotalAmt
Program Services$80,065ProgramServicesAmt
Management And General$21,038ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$35,650TotalAmt
Program Services$10,120ProgramServicesAmt
Management And General$25,530ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL / OFFICE SUPPLI$1,324,667$1,261,051$63,564$52
FUNDRAISING$48,757$48,757
DUES AND SUBSCRIPTIONS$42,392$42,392
OTHER COSTS$17,615$14,395$3,220

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$10,151,073TotalAmt
Program Services$7,677,416ProgramServicesAmt
Management And General$2,416,738ManagementAndGeneralAmt
Fundraising$56,919FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$776,040BOYAmt
EOY$925,036EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,327,049BOYAmt
EOY$1,866,718EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$151,393BOYAmt
EOY$142,280EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,359,807LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,596,027LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,013,763BOYAmt
EOY$763,780EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$5,377,964BOYAmt
EOY$5,453,389EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$898,804EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,646,209BOYAmt
EOY$10,050,007EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,552,451BOYAmt
EOY$3,090,869EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,552,451BOYAmt
EOY$3,090,869EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,590,728BOYAmt
EOY$5,560,334EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,030BOYAmt
EOY$898,804EOYAmt

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$6,093,758BOYAmt
EOY$6,959,138EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,646,209BOYAmt
EOY$10,050,007EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,439,525ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$130,189NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$443,956OtherChangesInNetAssetsAmt
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$852,067BeginningYearBalanceAmt
Investment Earnings Or Losses$7,804InvestmentEarningsOrLossesAmt
End Year Balance$859,871EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$684,578BeginningYearBalanceAmt
Investment Earnings Or Losses-$13,202InvestmentEarningsOrLossesAmt
End Year Balance$671,376EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$558,179BeginningYearBalanceAmt
Investment Earnings Or Losses$126,399InvestmentEarningsOrLossesAmt
End Year Balance$684,578EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.41850BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.58150PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,684,856OtherCostOrOtherBasisAmt
Depreciation$1,196,163DepreciationAmt
Book Value$488,693BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$674,951OtherCostOrOtherBasisAmt
Depreciation$399,864DepreciationAmt
Book Value$275,087BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$763,780TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescBENEFICIAL INTERESTS IN TRUSTSDesc
Book Value$898,804BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$898,804TotalBookValueOtherAssetsAmt
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. TAX RETURNS OF THE ENTITY ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE DATE THE RETURNS ARE FILED.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$214,720BaseCompensationFilingOrgAmt
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$32,396NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$247,116TotalCompensationFilingOrgAmt
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 2,036,229. MANAGEMENT AND GENERAL EXPENSES 50,927. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,087,156.
FORM 990, PART XI, LINE 9:PENSION ADJUSTMENT -443,956.
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 OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
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 (6 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
SIOUXLAND REGIONAL CANCER CENTER
M$5,544
SIOUXLAND PARAMEDICS
M$25,137
HEALTH INC
M$873,000
MEMBER ORGANIZATIONS
M$555,760
MERCY HEALTH SERVICES
K$150,640
NORTHWEST IOWA HOSPITAL CORPORATION
J$183,824

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