HEALTH INC HOSPICE: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
HEALTH INC HOSPICE (EIN 38-3320710)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-02-16
IRS object ID
201540479349301684
Schema version
2013v4.0
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)
Return2015-02-16T14:40:15-06:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN481292483PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HENJES CONNER & WILLIAMS PCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1800 FRANCES BLDGAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN383320710EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF SIOUXLANDBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlHOSPBusinessNameControlTxt
Phone7122334144PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14300 HAMILTON BLVDAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51104ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANIEL K LAUERPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone7122529418PhoneNum
Signature2015-02-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMELISSA J WILLERPreparerPersonNm
PTINP00121904PTIN
Phone7122773931PhoneNum
Preparation2015-02-09PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDANIEL K LAUERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1230 NEBRASKA STAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51101ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$13,489,167GrossReceiptsAmt
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 Employee138TotalEmployeeCnt
Total Volunteers200TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$205,590PYContributionsGrantsAmt
CY Contributions Grants$211,110CYContributionsGrantsAmt
PY Program Service Revenue$11,424,571PYProgramServiceRevenueAmt
CY Program Service Revenue$9,832,095CYProgramServiceRevenueAmt
PY Investment Income$271,336PYInvestmentIncomeAmt
CY Investment Income$592,778CYInvestmentIncomeAmt
PY Other Revenue$89,721PYOtherRevenueAmt
CY Other Revenue$56,741CYOtherRevenueAmt
PY Total Revenue$11,991,218PYTotalRevenueAmt
CY Total Revenue$10,692,724CYTotalRevenueAmt
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$7,388,638PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,388,346CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$31,592CYTotalFundraisingExpenseAmt
PY Other Expenses$5,793,231PYOtherExpensesAmt
CY Other Expenses$4,475,229CYOtherExpensesAmt
PY Total Expenses$13,181,869PYTotalExpensesAmt
CY Total Expenses$9,863,575CYTotalExpensesAmt
PY Revenues Less Expenses-$1,190,651PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$829,149CYRevenuesLessExpensesAmt
Total Assets BOY$8,121,520TotalAssetsBOYAmt
Total Assets EOY$8,646,209TotalAssetsEOYAmt
Total Liabilities BOY$2,859,917TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,552,451TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,261,603NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$6,093,758NetAssetsOrFundBalancesEOYAmt
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$8,109,268ExpenseAmt
Revenue$10,334,240RevenueAmt
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$8,109,268TotalProgramServiceExpensesAmt
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 SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
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
Employee138EmployeeCnt
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 LAUERBusinessNameLine1
FieldValueIRS element (for citing)
Phone7122529418PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1230 NEBRASKA ST PO BOX 5017AddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51101ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (16 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
JAMES FITZPATRICK
SECRETARY1.00Yes (X)Yes (X)$0$0$0
LYNN WOLD
TREASURER1.00Yes (X)Yes (X)$0$0$0
ELLEN KAPLAN
CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
JIM GOBELL
DIRECTOR0.50Yes (X)$0$0$0
DR WAYNE BARNES
DIRECTOR0.50Yes (X)$0$0$0
TRACY LARSON
DIRECTOR0.50Yes (X)$0$0$0
DR JEFFREY KNERL
DIRECTOR0.50Yes (X)$0$0$0
DR CYNTHIA PALS
DIRECTOR0.50Yes (X)$0$0$0
HUGH DEPAULIS
DIRECTOR0.50Yes (X)$0$0$0
SKIP PERLEY
DIRECTOR0.50Yes (X)$0$0$0
CHAD MARKHAM
DIRECTOR0.50Yes (X)$0$0$0
LINDA TODD
DIRECTOR OF OPERATIONS40.00Yes (X)$103,180$0$23,222
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$208,000$0$31,365Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$311,180TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$54,587TotalOtherCompensationAmt
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/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
SUNRISE MANOR INC
5501 GORDON DRIVE EASTSIOUX CITYIA51106ROOM AND BOARD CHARGES$159,592
ST LUKE REGIONAL MED CENTER
2720 STONE PARK BLVDSIOUX CITYIA51104ADDITIONAL HOSPICE SERVICE$142,457
AKRON CARE CENTER INC
991 HWY 3AKRONIA51001ROOM AND BOARD CHARGES$116,077
PLYMOUTH MANOR INC
954 TH AVENUE SELE MARSIA51031ROOM AND BOARD CHARGES$115,102
MATNEY COLONIAL MANOR
3200 G STREETSOUTH SIOUX CITYNE68776ROOM AND BOARD CHARGES$109,694
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
All Other Contributions$211,110AllOtherContributionsAmt
Total Contributions$211,110TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUEDesc
Business621610BusinessCd
Total Revenue Column$9,832,095TotalRevenueColumnAmt
Related Or Exempt Func Income$9,832,095RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$9,832,095TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$147,374TotalRevenueColumnAmt
Exclusion$147,374ExclusionAmt

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$3,058,023SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,612,619SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$445,404SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$445,404TotalRevenueColumnAmt
Related Or Exempt Func Income$445,404RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$56,741TotalRevenueColumnAmt
Related Or Exempt Func Income$56,741RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$56,741OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,692,724TotalRevenueColumnAmt
Related Or Exempt Func Income$10,334,240RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$147,374ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$126,402TotalAmt
Management And General$126,402ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,050,305TotalAmt
Program Services$3,147,304ProgramServicesAmt
Management And General$903,001ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$301,751TotalAmt
Program Services$236,727ProgramServicesAmt
Management And General$65,024ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$621,152TotalAmt
Program Services$537,158ProgramServicesAmt
Management And General$81,109ManagementAndGeneralAmt
Fundraising$2,885FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$288,736TotalAmt
Program Services$221,821ProgramServicesAmt
Management And General$66,915ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,932TotalAmt
Management And General$1,932ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$52,044TotalAmt
Management And General$52,044ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,223,533TotalAmt
Program Services$2,172,568ProgramServicesAmt
Management And General$50,965ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$85,717TotalAmt
Management And General$85,717ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$63,968TotalAmt
Management And General$63,968ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$371,023TotalAmt
Program Services$300,615ProgramServicesAmt
Management And General$70,408ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$260,670TotalAmt
Program Services$236,175ProgramServicesAmt
Management And General$24,495ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$24,720TotalAmt
Management And General$24,720ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$107,233TotalAmt
Program Services$90,504ProgramServicesAmt
Management And General$16,729ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$45,936TotalAmt
Program Services$8,636ProgramServicesAmt
Management And General$37,300ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$1,156,154$1,156,154
DUES,SUBSCRIPTIONS, MEM$42,030$42,030
FUNDRAISING$24,712$24,712
OTHER COSTS$15,557$1,606$9,956$3,995

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$9,863,575TotalAmt
Program Services$8,109,268ProgramServicesAmt
Management And General$1,722,715ManagementAndGeneralAmt
Fundraising$31,592FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$867,162BOYAmt
EOY$776,040EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,080,544BOYAmt
EOY$1,327,049EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$167,495BOYAmt
EOY$151,393EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,344,863LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,331,100LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,264,786BOYAmt
EOY$1,013,763EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$4,741,533BOYAmt
EOY$5,377,964EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,121,520BOYAmt
EOY$8,646,209EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,859,917BOYAmt
EOY$2,552,451EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,859,917BOYAmt
EOY$2,552,451EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,761,603BOYAmt
EOY$5,590,728EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,030EOYAmt

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$5,261,603BOYAmt
EOY$6,093,758EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,121,520BOYAmt
EOY$8,646,209EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$829,149ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$91,936NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$88,930OtherChangesInNetAssetsAmt
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
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Supported Org Information SupportedOrgInformationGrp (2 entries)

EINEINOrganization TypeOrganizationTypeDescGoverning Document ListedGoverningDocumentListedIndSupported Org NotifiedSupportedOrgNotifiedIndUS OrganizedUSOrganizedIndSupportSupportAmt
MERCY MEDICAL CENTER AND SUBSIDIARIES
311373080300Yes (1)$0
NORTHWEST IOWA HOSPITAL CORPORATION
421019872300Yes (1)$0
FieldValueIRS element (for citing)
Supported Organizations Total2SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt

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$755,586BeginningYearBalanceAmt
Investment Earnings Or Losses$96,481InvestmentEarningsOrLossesAmt
End Year Balance$852,067EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$558,179BeginningYearBalanceAmt
Investment Earnings Or Losses$126,399InvestmentEarningsOrLossesAmt
End Year Balance$684,578EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$491,289BeginningYearBalanceAmt
Investment Earnings Or Losses$65,905InvestmentEarningsOrLossesAmt
End Year Balance$557,194EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.41320BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.58680PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,684,856OtherCostOrOtherBasisAmt
Depreciation$1,029,262DepreciationAmt
Book Value$655,594BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$660,007OtherCostOrOtherBasisAmt
Depreciation$301,838DepreciationAmt
Book Value$358,169BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,013,763TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
MUTUAL FUNDS$2,989,835F
U.S. GOVERNMENT SECURITIES$642,601F
CORPORATE SECURITIES$1,735,488F
CERTIFICATES OF DEPOSIT$10,040F
FieldValueIRS element (for citing)
Total Book Value Securities$5,377,964TotalBookValueSecuritiesAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$10,916,440TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$91,936NetUnrealizedGainsInvstAmt
Other Revenue$183,824OtherRevenueAmt
Revenue Not Reported$275,760RevenueNotReportedAmt
Revenue Subtotal$10,640,680RevenueSubtotalAmt
Investment Expenses Not Incld$52,044InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$52,044RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$10,692,724TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$9,995,355TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$183,824OtherExpensesIncludedAmt
Expenses Not Reported$183,824ExpensesNotReportedAmt
Expenses Subtotal$9,811,531ExpensesSubtotalAmt
Investment Expenses Not Incld2$52,044InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$52,044ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$9,863,575TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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. 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.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENT EXPENSES 183,824.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENT EXPENSES 183,824.

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$208,000BaseCompensationFilingOrgAmt
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$31,365NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$239,365TotalCompensationFilingOrgAmt
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 CENTEROR 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 11GPROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,172,568. MANAGEMENT AND GENERAL EXPENSES 50,965. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,223,533.
FORM 990, PART XI, LINE 9:PENSION ADJUSTMENT -88,930.
FORM 990, PART XI, LINE 2CNO CHANGES

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary 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 (8 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
SIOUXLAND REGIONAL CANCER CENTER
L$21,600
SIOUXLAND REGIONAL CANCER CENTER
O$324,000
SIOUXLAND REGIONAL CANCER CENTER
M$67,390
SIOUXLAND PARAMEDICS
M$35,484
MERCY HEALTH SERVICES
M$312,563
NORTHWEST IOWA HOSPITAL CORPORATION
J$183,824
MERCY HEALTH SERVICES
K$146,256
NORTHWEST IOWA HOSPITAL CORPORATION
M$256,744

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