HEALTH INC HOSPICE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HEALTH INC HOSPICE (EIN 38-3320710)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-02-07
IRS object ID
201430389349300118
Schema version
2012v2.1
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)
Timestamp2014-02-07T10:07:03-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN481292483EIN

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1800 FRANCES BLDGAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN383320710EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF SIOUXLANDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone7122334144Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameDANIEL K LAUERName
TitleCHIEF FINANCIAL OFFICERTitle
Phone7122529418Phone
Date Signed2014-02-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMELISSA J WILLERName
PTINP00121904PTIN
Phone7122773931Phone
Date Prepared2014-01-30DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDANIEL K LAUERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1230 NEBRASKA STAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51101ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14692880GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HOSPICEOFSIOUXLAND.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1982YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionPROVIDE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees143TotalNbrEmployees
Total Nbr Volunteers165TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year327576ContributionsGrantsPriorYear
Contributions Grants Current Year205590ContributionsGrantsCurrentYear
Program Service Revenue Prior Year14697166ProgramServiceRevenuePriorYear
Program Service Revenue CY11424571ProgramServiceRevenueCY
Investment Income Prior Year72912InvestmentIncomePriorYear
Investment Income Current Year271336InvestmentIncomeCurrentYear
Other Revenue Prior Year66512OtherRevenuePriorYear
Other Revenue Current Year89721OtherRevenueCurrentYear
Total Revenue Prior Year15164166TotalRevenuePriorYear
Total Revenue Current Year11991218TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7146055SalariesEtcPriorYear
Salaries Etc Current Year7388638SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year91880TotalFundrsngExpCurrentYear
Other Expense Prior Year6919261OtherExpensePriorYear
Other Expenses Current Year5793231OtherExpensesCurrentYear
Total Expenses Prior Year14065316TotalExpensesPriorYear
Total Expenses Current Year13181869TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1098850RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1190651RevenuesLessExpensesCY
Total Assets BOY9714868TotalAssetsBOY
Total Assets EOY8121520TotalAssetsEOY
Total Liabilities BOY3961678TotalLiabilitiesBOY
Total Liabilities EOY2859917TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5753190NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5261603NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense9982131Expense
Revenue11678122Revenue
DescriptionHOSPICE 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.Description
Total Program Service Expense9982131TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees143NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAN LAUERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7122529418TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MILT AVERY
VICE CHAIRPERSON1.00XX000
BOB PEEBLES
SECRETARY1.00XX000
PETER THOREEN
TREASURER1.00XX000
CHARESE YANNEY
CHAIRPERSON1.00XX000
LYNN WOLD
DIRECTOR0.50X000
JIM GOBELL
DIRECTOR0.50X000
ELLEN KAPLAN
DIRECTOR0.50X000
DR WAYNE BARNES
DIRECTOR0.50X000
STEVE GARY
DIRECTOR0.50X000
TRACY LARSON
DIRECTOR0.50X000
DR JEFFREY KNERL
DIRECTOR0.50X000
DR CYNTHIA PALS
DIRECTOR0.50X000
LINDA TODD
DIRECTOR OF OPERATIONS40.00X99358022118
KAREN VAN DE STEEG
EXECUTIVE DIRECTOR40.00X000
DAN LAUER
CHIEF FINANCIAL OFFICER40.00X000
DALE HOLDIMAN
MEDICAL DIRECTOR40.00209984030851X
FieldValueIRS element (for citing)
Total Reportable Comp From Org309342TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation52969TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HOSPISCRIPT SERVICES LLC
4525 EXECUTIVE PARK DR STE 100MONTGOMERYAL36116ADDITIONAL HOSPICE SERVICE503586
LE HOLDING LLC DBA EMBASSY HEALTHCARE CO
206 PORT NEAL RDSERGEANT BLUFFIA51054ROOM AND BOARD CHARGES229186
TOUCHSTONE LIVING CENTER
1800 INDIAN HILLS DRSIOUX CITYIA51104ROOM AND BOARD CHARGES224298
SUNRISE MANOR INC
5501 GORDON DRIVE EASTSIOUX CITYIA51106ROOM AND BOARD CHARGES201214
SIOUXLAND HEMATOLOGY-ONCOLOGY ASSOCIATES
230 NEBRASKA STREETSIOUX CITYIA51101ADDITIONAL HOSPICE SERVICE172748
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions205590AllOtherContributions
Total Contributions205590TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code621610BusinessCode
Total Revenue Column11424571TotalRevenueColumn
Related Or Exempt Function Income11424571RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue11424571TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column107506TotalRevenueColumn
Exclusion$107,506ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real190468Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real190703Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-235Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-235TotalRevenueColumn
Related Or Exempt Function Income-235RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2674789Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2510959Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities163830Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column163830TotalRevenueColumn
Related Or Exempt Function Income163830RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER INCOME9000998453884538
OTHER INVESTMENT INCOME90009954185418
FieldValueIRS element (for citing)
Total Other Revenue89956TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11991218TotalRevenueColumn
Related Or Exempt Function Income11678122RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$107,506ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total121476Total
Management And General121476ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5229412Total
Program Services4021195ProgramServices
Management And General1188710ManagementAndGeneral
Fundraising19507Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total404683Total
Program Services305382ProgramServices
Management And General97820ManagementAndGeneral
Fundraising1481Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1267458Total
Program Services798970ProgramServices
Management And General464612ManagementAndGeneral
Fundraising3876Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total365609Total
Program Services286397ProgramServices
Management And General78007ManagementAndGeneral
Fundraising1205Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6072Total
Management And General6072ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total47621Total
Management And General47621ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3162267Total
Program Services2822939ProgramServices
Management And General339328ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total70889Total
Management And General70889ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total98468Total
Management And General98468ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total354208Total
Program Services43711ProgramServices
Management And General310497ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total386634Total
Program Services333876ProgramServices
Management And General47152ManagementAndGeneral
Fundraising5606Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total36796Total
Management And General36756ManagementAndGeneral
Fundraising40Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total6468Total
Management And General6468ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total117910Total
Program Services93731ProgramServices
Management And General24179ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total47506Total
Program Services7582ProgramServices
Management And General39924ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MEDICAL SUPPLIES12683481268348
DUES,SUBSCRIPTIONS, MEM5496554965
FUNDRAISING5422254222
REPAIRS AND MAINTENANCE5129351293

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total29564Total
Management And General23621ManagementAndGeneral
Fundraising5943Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13181869Total
Program Services9982131ProgramServices
Management And General3107858ManagementAndGeneral
Fundraising91880Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY847340BOY
EOY867162EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2350603BOY
EOY1080544EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY154960BOY
EOY167495EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2480767LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1215981LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1401736BOY
EOY1264786EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4952971BOY
EOY4741533EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7258BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9714868BOY
EOY8121520EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3546678BOY
EOY2859917EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY415000BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3961678BOY
EOY2859917EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5251866BOY
EOY4761603EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1324BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY500000BOY
EOY500000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5753190BOY
EOY5261603EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9714868BOY
EOY8121520EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1190651ReconcilationRevenueExpenses
Reconciliation Unrealized Invest253057ReconciliationUnrealizedInvest
Reconcilation Other Changes446007ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (2 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
MERCY MEDICAL CENTER AND SUBSIDIARIES
3113730803001$0
NORTHWEST IOWA HOSPITAL CORPORATION
4210198723001$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs2TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance671376BeginningOfYearBalance
Investment Earnings Or Losses84210InvestmentEarningsOrLosses
End Of Year Balance755586EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance684578BeginningOfYearBalance
Investment Earnings Or Losses-13202InvestmentEarningsOrLosses
End Of Year Balance671376EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance558179BeginningOfYearBalance
Investment Earnings Or Losses126399InvestmentEarningsOrLosses
End Of Year Balance684578EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance491289BeginningOfYearBalance
Investment Earnings Or Losses65905InvestmentEarningsOrLosses
End Of Year Balance557194EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.33830BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.66170PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1684856OtherCostOrOtherBasis
Depreciation861077Depreciation
Book Value823779BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis795911OtherCostOrOtherBasis
Depreciation354904Depreciation
Book Value441007BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1264786TotalOfBookValueLandBuildings

Other Securities OtherSecurities (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
MUTUAL FUNDS1699324F
U.S. GOVERNMENT SECURITIES671926F
CORPORATE SECURITIES2350165F
CERTIFICATES OF DEPOSIT20118F
FieldValueIRS element (for citing)
Total Of Book Value Securities4741533TotalOfBookValueSecurities
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt12387357TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments253057NetUnrealizedGainsInvestments
Other Revenues190703OtherRevenues
Revenue Not Rptd F990443760RevenueNotRptdF990
Revenue Subtotal11943597RevenueSubtotal
Investment Expenses Not Included47621InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt47621RevenueNotRptdOnFinStmt
Total Revenue Per Form99011991218TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13324951TotExpensesEtcAuditedFinclStmt
Other Expenses Included190703OtherExpensesIncluded
Expenses Not Rptd F990190703ExpensesNotRptdF990
Expenses Subtotal13134248ExpensesSubtotal
Investment Expenses Not Included247621InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt47621ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013181869TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: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 190,703.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENT EXPENSES 190,703.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonDALE HOLDIMANNamePerson
TitleMEDICAL DIRECTORTitle
Base Compensation Filing Org209984BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org30851NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org240835TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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 2,822,939. MANAGEMENT AND GENERAL EXPENSES 339,328. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,162,267.OTHER FEES
FORM 990, PART XI, LINE 9:PENSION ADJUSTMENT 446,007.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CNO CHANGES

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
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 Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
SIOUXLAND REGIONAL CANCER CENTER
L21400
SIOUXLAND REGIONAL CANCER CENTER
O219000
SIOUXLAND REGIONAL CANCER CENTER
M100835
SIOUXLAND PARAMEDICS
M41425
MERCY HEALTH SERVICES
M718011
NORTHWEST IOWA HOSPITAL CORPORATION
J190468
MERCY HEALTH SERVICES
K141993
NORTHWEST IOWA HOSPITAL CORPORATION
M429294

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