2014-05-14T09:00:33-05:00 2013-06-30 470757164 ALEGENT CREIGHTON HEALTH 12809 W DODGE ROAD OMAHA NE 68154 990 2012-07-01 470733773 HOSPICE OF SOUTHWEST IOWA HOSP 4023434413 12809 WEST DODGE ROAD OMAHA NE 68154 EMMET TINLEY 2014-05-13 true Angela Lea P01051055 4023434413 2012 2015-11-30 17:44:51Z EMMET TINLEY 427 EAST KANESVILLE BLVD COUNCIL BLUFFS IA 51503 1734123 false X HOSPICEOFSOUTHWESTIOWA.ORG X 1990 IA A COMMUNITY WHERE ALL INDIVIDUALS AND FAMILIES HAVE ACCESS TO IMPECCABLE END OF LIFE CARE. 8 8 0 31 0 42812 52828 1584740 1678936 155 262 0 2097 1627707 1734123 0 0 0 0 0 0 0 0 0 1480053 1654471 1480053 1654471 147654 79652 1326165 1376410 39108 16302 1287057 1360108 CHERISHING LIFE'S JOURNEY THROUGH AN EXTRAORDINARY COMMITMENT TO COMPASSION, COMFORT AND HOLISTIC CARE. false false 1322948 0 1678936 HOSPICE OF SOUTHWEST IOWA IS A MEDICARE CERTIFIED HOSPICE PROGRAM THAT SERVES PATIENTS WHO HAVE BEEN DIAGNOSED WITH A LIFE LIMITING CONDITION. THE PROGRAM SERVES PATIENTS THAT RESIDE IN SEVEN SOUTHWEST IOWA COUNTIES. THE MAIN OFFICE IS LOCATED IN COUNCIL BLUFFS WITH A MULTI-SITE LOCATION IN CORNING, IOWA. HOSPICE OF SOUTHWEST IOWA PLANS TO BUILD AN INPATIENT HOSPICE FACILITY UPON THE COMPLETION OF A COMMUNITY CAPITAL CAMPAIGN. 1322948 true false false false false false false false true true false false true false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false true X 0 0 0 false false false false false false false false false false X 8 8 true true false false true true true true true false false true true true true true true false false false X EMMET TINLEY 7123521389 427 EAST KANESVILLE BLVD COUNCIL BLUFFS IA 51503 X EMMET TINLEY 1.00 0 X X 0 0 0 MARIE KNEDLER 1.00 0 X X 0 0 0 HELEN BLEICHER 1.00 0 X 0 0 0 JAMES SUMMERFELT 1.00 0 X 0 0 0 KATHRYNE CUTLER 1.00 0 X 0 0 0 MARIE FERNANDEZ 1.00 0 X 0 0 0 MIKE ADAMS 1.00 0 X 0 0 0 SUSAN TINLEY 1.00 0 X 0 0 0 0 0 0 0 false false false ALEGENT CREIGHTON HEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 MANAGEMENT SERVICES 1077409 1 22534 30294 52828 NET PATIENT SERVICES 621500 1678936 1678936 0 0 0 0 0 0 0 0 1678936 262 262 0 0 0 0 0 0 0 0 0 0 0 MISC REVENUE 900099 2097 2097 0 0 0 0 0 0 2097 1734123 1678936 0 2359 0 0 0 0 0 0 0 0 0 0 1077409 754186 323223 0 8300 8300 0 0 0 20050 20050 0 0 5102 5102 167268 167268 0 0 29936 29936 38515 38515 0 5391 5391 0 0 1659 1659 27549 27549 BAD DEBTS 2588 2588 PURCHASED SERVICES 257922 257922 MEMBERSHIP & DUES 3809 3809 SPECIAL EVENTS 8121 8121 852 852 0 0 1654471 1322948 331523 0 0 97048 152323 90516 68260 200025 138076 0 0 692008 7787 685880 684221 0 0 150000 252696 183530 1326165 1376410 39108 16302 0 0 39108 16302 X 1010995 1088475 276062 271633 1287057 1360108 1326165 1376410 X 79652 -6601 X false false false X 100318 135077 77831 42812 52828 408866 1205838 1176118 1521137 1584740 1678936 7166769 0 0 0 1306156 1311195 1598968 1627552 1731764 7575635 31000 0 0 0 0 31000 0 0 0 0 0 0 31000 0 0 0 0 31000 7544635 5749 322 653 155 262 7141 0 5749 322 653 155 262 7141 0 0 216 2275 0 2097 4588 1311905 1311733 1601896 1627707 1734123 7587364 0.99440 0.99220 0.00090 0.00390 X SCHEDULE A, PART III, LINE 12, OTHER INCOME, DESCRIPTION - OTHER OPERATING INCOME, COLUMN A - , COLUMN B - 216, COLUMN C - 2275, COLUMN D - , COLUMN E - 2097, COLUMN F - 4588; 276062 2172 6601 271633 258118 17944 276062 667563 33972 443417 258118 590336 110765 33538 667563 673447 75193 158304 590336 1.00000 false false 206000 206000 0 0 11096 7787 3309 474912 474912 684221 DUE FROM AFFILIATE 183530 183530 0 0 Intended uses of endowment funds Schedule D, Part V, Line 4 ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF HOSPICE OF SOUTHWEST IOWA. FORM 990, PART V, LINE 1A FORM 990, PART V, LINE 1A AS PART OF THE COORDINATION OF SERVICES AGREEMENT WITH ALEGENT CREIGHTON HEALTH, ALEGENT CREIGHTON HEALTH PERFORMS THE ACCOUNTS PAYABLE FUNCTION FOR HOSPICE OF SOUTHWEST IOWA. HOSPICE OF SOUTHWEST IOWA REIMBURSES ALEGENT CREIGHTON HEALTH FOR VENDOR PAYMENTS; THEREFORE, NO FORM 1099'S ARE ISSUED BY HOSPICE OF SOUTHWEST IOWA. ALEGENT CREIGHTON HEALTH ISSUES THE FORM 1099'S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. ANY 1099'S ISSUED BY ALEGENT CREIGHTON HEALTH ON BEHALF OF HOSPICE OF SOUTHWEST IOWA AR REPORTED TO THE IRS. FORM 990, PART I, LINE 5 AND PART V, LINE 2A FORM 990, PART V, LINE 2A HOSPICE OF SOUTHWEST IOWA DOES NOT HAVE ANY EMPLOYEES. INDIVIDUALS PROVIDING SERVICES TO PATIENTS OF HOSPICE OF SOUTHWEST IOWA ARE LEASED FROM ALEGENT CREIGHTON HEALTH. Family/business relationships amongst interested persons Form 990, Part VI, Section A, Line 2 EMMET TINLEY AND SUSAN TINLEY - FAMILY RELATIONSHIP, KATHRYNE CUTLER, SUSAN TINLEY, JAMES SUMMERFELT AND EMMET TINLEY - BUSINESS RELATIONSHIP Delegation of management duties Form 990, Part VI, Section A, Line 3 HOSPICE OF SOUTHWEST IOWA ENTERED INTO A COORDINATION OF SERVICES AGREEMENT WITH ALEGENT CREIGHTON HEALTH FOR ALEGENT CREIGHTON HEALTH TO PERFORM AND MANAGE FINANCIAL SERVICES FOR A MONTHLY FEE. SERVICES INCLUDE BUT ARE NOT LIMITED TO FINANCIAL REPORTING, BUDGETING, BILLING AND COLLECTION, FIXED ASSET MANAGEMENT AND TAX RETURN PREPARATION. IN ADDITION TO FINANCIAL SERVICES, ALEGENT CREIGHTON HEALTH PROVIDES INFORMATION SYSTEMS SUPPORT, SECURITY, RISK MANAGEMENT AND CORPORATE COMPLIANCE, PURCHASING, MAINTENANCE AND VARIOUS OTHER SUPPORT SERVICES. IN ADDITION, HOSPICE OF SOUTHWEST IOWA LEASES ALL EMPLOYEES FROM ALEGENT CREIGHTON HEALTH. ALEGENT CREIGHTON HEALTH IS THE PARENT OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM, ONE OF HOSPICE OF SOUTHWEST IOWA CORPORATE MEMBERS. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE CORPORATE MEMBERS OF HOSPICE OF SOUTHWEST IOWA ARE ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION POTTAWATTAMIE COUNTY, IOWA SHALL APPOINT ONE HALF OF THE VOTING MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION OF EACH MEMBER'S APPOINTMENTS BY THE OTHER MEMBER. IF A CORPORATE MEMBER DOES NOT RATIFY THE APPOINTMENT OF ONE OR MORE OF THE DIRECTORS APPOINTED BY THE OTHER CORPORATE MEMBER, THEN THE PROCESS SET FORTH ABOVE WILL BE REPEATED UNTIL SUCH TIME AS ALL OF THE DIRECTOR POSITIONS ARE FILLED. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE BUSINESS AFFAIRS OF HOSPICE OF SOUTHWEST IOWA SHALL BE MANAGED BY OR UNDER THE DIRECTION OF THE BOARD OF DIRECTORS EXCEPT THAT THE FOLLOWING ACTIONS SHALL BE EFFECTIVE ONLY IF APPROVED BY THE BOARD OF DIRECTORS OF THE CORPORATION AND BY BOTH ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA: 1. ADOPTION OR AMENDMENT OF THE UNIFIED PHILOSOPHY AND MISSION. 2. THE SALE, LEASE, TRANSFER, ENCUMBRANCE OR DISPOSITION OF THE TANGIBLE PROPERTY OR INVESTMENTS OF THE CORPORATION HAVING A FAIR MARKET VALUE IN ANY INDIVIDUAL TRANSACTION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000) OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. 3. INCURRENCE, ASSUMPTION OR GUARANTY BY THE CORPORATION IN ANY INDIVIDUAL TRANSACTION OF LONG-TERM INDEBTEDNESS, INCLUDING CAPITAL LEASES OUTSTANDING FOR MORE THAN 365 DAYS, IN EXCESS OF THE GREATER OF FIVE HUNDRED THOUSAND DOLLARS ($500,000), OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. 4. MERGER, DISSOLUTION, CONSOLIDATION OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, EXCEPT FOR A MERGER IN WHICH HOSPICE OF SOUTHWEST IOWA IS THE SURVIVING ENTITY, AND THE TOTAL BOOK VALUE OF THE ASSETS OF THE MERGING ENTITY DOES NOT EXCEED TWENTY-FIVE PERCENT OF THE TOTAL BOOK VALUE OF THE ASSETS OF THE CORPORATION, OR SUCH GREATER VALUE AS MAY BE DETERMINED FROM TIME TO TIME BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b HOSPICE OF SOUTHWEST IOWA AND ALEGENT CREIGHTON HEALTH HAVE A COORDINATION OF SERVICE AGREEMENT IN WHICH ALEGENT PROVIDES THE ACCOUNTING AND FINANCE FUNCTIONS FOR HOSPICE OF SOUTHWEST IOWA FOR A MONTHLY FEE. THE TAX DEPARTMENT OF ALEGENT CREIGHTON HEALTH PREPARES THE FORM 990 FOR HOSPICE OF SOUTHWEST IOWA. FOLLOWING THE PREPARATION OF FORM 990 BY ALEGENT CREIGHTON HEALTH INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE ALEGENT CREIGHTON HEALTH TAX DIRECTOR AND HOSPICE OF SOUTHWEST IOWA'S MANAGEMENT. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED AN ELECTRONIC VERSION OF THE FINAL TAX RETURN AND ALL REQUIRED SCHEDULES. QUESTIONS ARE REFERRED TO THE ALEGENT CREIGHTON HEALTH TAX DIRECTOR AND THE BOARD IS NOTIFIED OF THE DATE THE TAX RETURN WILL BE FILED. Conflict of interest policy Form 990, Part VI, Section B, Line 12c WRITTEN CONFLICT OF INTEREST POLICY - HOSPICE OF SOUTHWEST IOWA HAS ADOPTED THE CONFLICT INVESTIGATION PROCESS OF ALEGENT CREIGHTON HEALTH. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY AN APPOINTED DISINTERESTED PERSON OR COMMITTEE THAT IS SELECTED BY THE CHAIRMAN OF THE BOARD. AFTER EXERCISING DUE DILIGENCE, THE BOARD SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION. FINALLY, THE BOARD MAKES ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGMENT IN CONFORMITY WITH SUCH DETERMINATION. AT ANY TIME A BOARD MEMBER MAY DECLARE A CONFLICT OF INTEREST AND RECUSE HIM/HERSELF FROM THE DISCUSSION. THE INDIVIDUAL IS ALSO REQUIRED TO DISCLOSE ANY KNOWN OR POSSIBLE CONFLICTS OF INTEREST THAT ARISE DURING THE CALENDAR YEAR. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 HOSPICE OF SOUTHWEST IOWA HAS ADOPTED THE CONFLICT OF INTEREST POLICY OF ALEGENT CREIGHTON HEALTH, WHICH IS AVAILABLE TO THE PUBLIC AT WWW.ALEGENTCREIGHTON.COM. HOSPICE OF SOUTHWEST IOWA DOES NOT MAKE THE GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE ARTICLES OF INCORPORATION ARE AVAILABLE AT WWW.SOS.STATE.NE.US. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 NET ASSETS RELEASED FROM RESTRICTIONS - -6601;