2014-02-07T10:07:03-06:00 2013-06-30 481292483 HENJES CONNER & WILLIAMS PC 800 FRANCES BLDG SIOUX CITY IA 51101 990 2012-07-01 383320710 HOSPICE OF SIOUXLAND HOSP 7122334144 4300 HAMILTON BLVD SIOUX CITY IA 51104 DANIEL K LAUER 7122529418 2014-02-05 1 MELISSA J WILLER P00121904 7122773931 2014-01-30 2012 2015-11-30 17:44:51Z DANIEL K LAUER 230 NEBRASKA ST SIOUX CITY IA 51101 14692880 0 X WWW.HOSPICEOFSIOUXLAND.ORG X 1982 IA PROVIDE COMFORT, SUPPORT, AND COMPASSIONATE CARE TO TERMINALLY ILL PEOPLE AND THEIR FAMILIES THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL, AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. 12 12 143 165 0 0 327576 205590 14697166 11424571 72912 271336 66512 89721 15164166 11991218 0 0 0 0 7146055 7388638 0 0 91880 6919261 5793231 14065316 13181869 1098850 -1190651 9714868 8121520 3961678 2859917 5753190 5261603 PROVIDE COMFORT, SUPPORT, AND COMPASSIONATE CARE TO TERMINALLY ILL PEOPLE AND THEIR FAMILIES THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL, AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. 0 0 9982131 11678122 HOSPICE OF SIOUXLAND'S MISSION IS TO PROVIDE COMFORT, SUPPORT AND COMPASSIONATE CARE TO PEOPLE WITH LIFE-LIMITING ILLNESSES AND TO THEIR FAMILIES IN A MANNER THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. ALL PATIENTS WHO MEET ADMISSION CRITERIA ARE ELIGIBLE FOR HOSPICE CARE, NO MATTER WHAT THEIR FINANCIAL CIRCUMSTANCES, OR ABILITY TO PAY. 9982131 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 143 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 X DAN LAUER 7122529418 230 NEBRASKA ST PO BOX 5017 SIOUX CITY IA 51101 MILT AVERY 1.00 X X 0 0 0 BOB PEEBLES 1.00 X X 0 0 0 PETER THOREEN 1.00 X X 0 0 0 CHARESE YANNEY 1.00 X X 0 0 0 LYNN WOLD 0.50 X 0 0 0 JIM GOBELL 0.50 X 0 0 0 ELLEN KAPLAN 0.50 X 0 0 0 DR WAYNE BARNES 0.50 X 0 0 0 STEVE GARY 0.50 X 0 0 0 TRACY LARSON 0.50 X 0 0 0 DR JEFFREY KNERL 0.50 X 0 0 0 DR CYNTHIA PALS 0.50 X 0 0 0 LINDA TODD 40.00 X 99358 0 22118 KAREN VAN DE STEEG 40.00 X 0 0 0 DAN LAUER 40.00 X 0 0 0 DALE HOLDIMAN 40.00 X 209984 0 30851 309342 0 52969 1 0 1 0 HOSPISCRIPT SERVICES LLC 4525 EXECUTIVE PARK DR STE 100 MONTGOMERY AL 36116 ADDITIONAL HOSPICE SERVICE 503586 LE HOLDING LLC DBA EMBASSY HEALTHCARE CO 206 PORT NEAL RD SERGEANT BLUFF IA 51054 ROOM AND BOARD CHARGES 229186 TOUCHSTONE LIVING CENTER 1800 INDIAN HILLS DR SIOUX CITY IA 51104 ROOM AND BOARD CHARGES 224298 SUNRISE MANOR INC 5501 GORDON DRIVE EAST SIOUX CITY IA 51106 ROOM AND BOARD CHARGES 201214 SIOUXLAND HEMATOLOGY-ONCOLOGY ASSOCIATES 230 NEBRASKA STREET SIOUX CITY IA 51101 ADDITIONAL HOSPICE SERVICE 172748 5 205590 205590 PATIENT SERVICE REVENUE 621610 11424571 11424571 11424571 107506 107506 190468 190703 -235 -235 -235 2674789 2510959 163830 163830 163830 OTHER INCOME 900099 84538 84538 OTHER INVESTMENT INCOME 900099 5418 5418 89956 11991218 11678122 0 107506 X 121476 121476 5229412 4021195 1188710 19507 404683 305382 97820 1481 1267458 798970 464612 3876 365609 286397 78007 1205 6072 6072 47621 47621 3162267 2822939 339328 70889 70889 98468 98468 354208 43711 310497 386634 333876 47152 5606 36796 36756 40 6468 6468 117910 93731 24179 47506 7582 39924 MEDICAL SUPPLIES 1268348 1268348 DUES,SUBSCRIPTIONS, MEM 54965 54965 FUNDRAISING 54222 54222 REPAIRS AND MAINTENANCE 51293 51293 29564 23621 5943 13181869 9982131 3107858 91880 847340 867162 2350603 1080544 154960 167495 2480767 1215981 1401736 1264786 4952971 4741533 7258 0 9714868 8121520 3546678 2859917 415000 0 3961678 2859917 X 5251866 4761603 1324 0 500000 500000 5753190 5261603 9714868 8121520 X -1190651 253057 446007 X X 0 1 X 1 0 X X 0 0 0 MERCY MEDICAL CENTER AND SUBSIDIARIES 311373080 3 0 0 1 0 NORTHWEST IOWA HOSPITAL CORPORATION 421019872 3 0 0 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 671376 84210 755586 684578 -13202 671376 558179 126399 684578 491289 65905 557194 0.33830 0.66170 0 0 1684856 861077 823779 795911 354904 441007 1264786 MUTUAL FUNDS 1699324 F U.S. GOVERNMENT SECURITIES 671926 F CORPORATE SECURITIES 2350165 F CERTIFICATES OF DEPOSIT 20118 F 4741533 X 12387357 253057 190703 443760 11943597 47621 47621 11991218 13324951 190703 190703 13134248 47621 47621 13181869 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. X X X X 0 0 0 0 0 0 0 0 0 DALE HOLDIMAN 209984 0 0 0 0 0 0 0 30851 0 240835 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 HALF OF THE BOARD WORKS FOR NORTHWEST IOWA HOSPITAL CORPORATION OR IS ON THE NORTHWEST IOWA HOSPITAL CORPORATION BOARD AND HALF OF THE BOARD WORKS FOR MERCY MEDICAL CENTEROR IS ON THE MERCY MEDICAL CENTER BOARD. FORM 990, PART VI, SECTION A, LINE 6 HEALTH INC., NORTHWEST IOWA HOSPITAL CORPORATION AND SUBSIDIARIES, MERCY MEDICAL CENTER AND SUBSIDIARIES FORM 990, PART VI, SECTION A, LINE 7A HOSPITAL BOARDS HAVE TO APPOINT/ELECT THEIR REPRESENTATIVES. FORM 990, PART VI, SECTION A, LINE 7B TRINITY HEALTH AND IOWA HEALTH SYSTEMS HAVE TO APPROVE LARGE CAPITAL PROJECTS FORM 990, PART VI, SECTION B, LINE 11 ORGANIZATION REVIEWED AND SUBMITTED RETURN UPON COMPLETION BY PREPARER FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A FORM DETAILING ANY AND ALL BUSINESS RELATIONSHIPS WITH HEALTH INC AND RELATED ENTITIES. ALL COMPLETED FORMS ARE REVIEWED AND DISCUSSED WITH THE BOARD AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 TOP MANAGEMENT EMPLOYEES PROVIDE INDEPENDENT DOCUMENTATION FROM TRADE SOURCES TO SUBSTANTIATE PAY LEVELS. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION'S DOCUMENTS ARE AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,822,939. MANAGEMENT AND GENERAL EXPENSES 339,328. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,162,267. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT 446,007. FORM 990, PART XI, LINE 2C NO CHANGES HEALTH INC 230 NEBRASKA STREET SIOUX CITY IA 51101 311712115 SERVE AS THE CENTRAL ORGANIZATION FOR OTHER 501(C) (3) ENTITIES IA 501(C)(3) PF 0 SIOUXLAND REGIONAL CANCER CENTER PO BOX 5017 SIOUX CITY IA 51102 421411233 DEDICATED TO CANCER TREATMENT, RESEARCH AND EDUCATION & SERVICES ALL PATIENT IA 501(C)(3) 170(B)(1)(A)(I) 0 SIOUXLAND PARAMEDICS 1701 TERMINAL DRIVE SIOUX CITY IA 51105 421185707 MEDICAL TRANSPORTATION SERVICE IA 501(C)(3) 509(A)(3) TYPE I 0 MERCY MEDICAL CENTER 801 5TH STREET SIOUX CITY IA 51102 311373080 PROVIDES A FULL CONTINUUM OF WELLNESS, PRIMARY, ACUTE AND TERTIARY SERVICES IA 501(C)(3) 170(B)(1)(A)(III) 0 NORTHWEST IOWA HOSPITAL CORPORATION 2720 STONE PARK BOULEVARD SIOUX CITY IA 51104 421019872 STRIVES TO PROVIDE THE MOST PATIENT-CENTERED CARE IN SIOUXLAND IA 501(C)(3) 170(B)(1)(A)(III) 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 SIOUXLAND REGIONAL CANCER CENTER L 21400 SIOUXLAND REGIONAL CANCER CENTER O 219000 SIOUXLAND REGIONAL CANCER CENTER M 100835 SIOUXLAND PARAMEDICS M 41425 MERCY HEALTH SERVICES M 718011 NORTHWEST IOWA HOSPITAL CORPORATION J 190468 MERCY HEALTH SERVICES K 141993 NORTHWEST IOWA HOSPITAL CORPORATION M 429294