OSCEOLA COMMUNITY HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- OSCEOLA COMMUNITY HOSPITAL INC (EIN 42-0890973)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-14
- IRS object ID
- 201321349349301772
- Schema version
- 2011v1.5
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-14T10:29:50-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420890973 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | OSCE | NameControl |
| Phone | 7127542574 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 9TH AVENUE NORTH | AddressLine1 |
| City | SIBLEY | City |
| State | IA | State |
| ZIP Code | 51249 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JANET DYKSTRA | Name |
| Title | CEO | Title |
| Phone | 7127542574 | Phone |
| Date Signed | 2013-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROB SCHILE | Name |
| PTIN | P00068340 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JANET DYKSTRA | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 9TH AVENUE NORTH | AddressLine1 |
| City | SIBLEY | City |
| State | IA | State |
| ZIP Code | 51249 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 10674286 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.OSCEOLACOMMUNITYHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1960 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTHCARE TO THE CITIZENS OF OSCEOLA COUNTY AND THE SURROUNDING AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 127 | TotalNbrEmployees |
| Total Nbr Volunteers | 57 | TotalNbrVolunteers |
| Total Gross UBI | 391798 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -134732 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 302248 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 338451 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6798646 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9529270 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 50441 | InvestmentIncomePriorYear |
| Investment Income Current Year | 101797 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 446275 | OtherRevenuePriorYear |
| Other Revenue Current Year | 704768 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7597610 | TotalRevenuePriorYear |
| Total Revenue Current Year | 10674286 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 24893 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3636485 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4729193 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3934544 | OtherExpensePriorYear |
| Other Expenses Current Year | 5590602 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7571029 | TotalExpensesPriorYear |
| Total Expenses Current Year | 10344688 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 26581 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 329598 | RevenuesLessExpensesCY |
| Total Assets BOY | 20198257 | TotalAssetsBOY |
| Total Assets EOY | 20565655 | TotalAssetsEOY |
| Total Liabilities BOY | 7326166 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7475748 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 12872091 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13089907 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | IT IS THE MISSION OF THE OSCEOLA COMMUNITY HOSPITAL TO ENHANCE AND IMPROVE THE QUALITY OF LIFE OF THE POPULATION IT SERVES, TO BE THE AREA'S PREMIER HEALTH CARE SERVICE PROVIDER, AND TO HAVE A POSITIVE IMPACT ON THE LIVES OF THE PEOPLE AND COMMUNITY IT SERVES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8944864 | Expense |
| Grants | 0 | Grants |
| Revenue | 9628485 | Revenue |
| Description | OSCEOLA COMMUNITY HOSPITAL PROVIDED NURSING SERVICES, LAB, RADIOLOGY AND OTHER RELATED HOSPITAL FUNCTIONS TO RESIDENTS OF OSCEOLA COUNTY, IOWA AND NEARBY COUNTIES. IN ADDITION THE HOSPITAL ALSO PROVIDES HOME HEALTH, INDEPENDANT/ASSISTED LIVING, AND DAY CARE TO THE COMMUNITY. HEALTH SCREENINGS SUCH AS CHOLOSTERAL AND CARDIAC ARE PROVIDED AS WELL. THE HOSPITAL WORKS HARD TO BRING OUTREACH SPECIALISTS TO THE FACILITY TO MAKE THESE SERVICES AVAILABLE TO THOSE THAT FIND IT DIFFICULT TO TRAVEL. WE NOW HAVE CATARAC SURGERY AVAILABLE AT OUR SITE. THE FACILITY'S WELLNESS CENTER PROVIDES PROGRAMS TO THE LOCAL SCHOOL SYSTEM AND NURSING HOME FACILITIES. DURING THE YEAR THE HOSPITAL PROVIDED $76,714 OF CHARITY CARE TO VARIOUS INDIVIDUALS, WITHOUT REIMBURSEMENT, FOR THE YEAR ENDING JUNE 30, 2012. WE ALLOW LOWER INCOME PATIENTS TO SET UP PAYMENTS ACCORDING TO THEIR FINANCIAL ABILITY WITH INTEREST FORGIVENESS. | Description |
| Total Program Service Expense | 8944864 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 46 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 127 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GERALDINE PALSROK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7127542574 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 9TH AVE NORTH | AddressLine1 |
| City | SIBLEY | City |
| State | IA | State |
| ZIP Code | 51249 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| SUE ELLEN SCHUTTE | ||||||
| PRESIDENT | 1.00 | X | X | 0 | 0 | 0 |
| KAREN GLADE | ||||||
| PRESIDENT-ELECT | 1.00 | X | X | 0 | 0 | 0 |
| DARYL BOSMA | ||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| PAUL HIBMA | ||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 |
| BRIAN MINO | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DEB KOHN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| BOB HANSEN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JOHN VANDIEPEN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DENNIS CLARK | ||||||
| TRUSTEE THRU 2011 | 1.00 | X | 0 | 0 | 0 | |
| SHIRLEY CHRISTIANS | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JANET DYKSTRA | ||||||
| CEO | 40.00 | X | 118367 | 0 | 15266 | |
| JULIE SCHRODER | ||||||
| DON/ASSISTANT CEO | 40.00 | X | 79082 | 0 | 8776 | |
| JERRI GERALDINE PALSROK | ||||||
| CFO | 40.00 | X | 55161 | 0 | 11550 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 252610 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 35592 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| AVERA MCKENNAN | |||||
| 800 E 21ST STREET | SIOUX FALLS | SD | 57117 | ADMINISTRATIVE & IT SERVICES | 456956 |
| SANFORD USD MEDICAL CENTER | |||||
| PO BOX 5074 | SIOUX FALLS | SD | 57117 | CRNA SERVICES | 188806 |
| ROBERT THROBROGGER | |||||
| 24376 140TH STREET | SPIRIT LAKE | IA | 51360 | RADIOLOGIST SERVICES | 169622 |
| GREAT LAKE PT LLP | |||||
| 5670 CENTER LAKE | SPIRIT LAKE | IA | 51360 | PHYSICAL THERAPY SERVICES | 138744 |
| DELTA LOCAL TENANS LP | |||||
| 1755 WITTINGTON PLACE SUITE 175 | DALLAS | TX | 75320 | LOCAL TENENS & PHYSICIAN SEARCH SERVICES | 117130 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 125505 | GovernmentGrants |
| All Other Contributions | 212946 | AllOtherContributions |
| Total Contributions | 338451 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REVENUE | 621400 | 9434257 | 9434257 |
| OTHER REVENUE | 621400 | 95013 | 95013 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9529270 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22430 | TotalRevenueColumn |
| Exclusion | $22,430 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 82743 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 82743 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82743 | TotalRevenueColumn |
| Exclusion | $82,743 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77883 | Securities |
| Other | 1484 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77883 | Securities |
| Other | 1484 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 79367 | TotalRevenueColumn |
| Exclusion | $79,367 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 99215 | GrossSalesOfInventory |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 99215 | TotalRevenueColumn |
| Related Or Exempt Function Income | 99215 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| DAYCARE REVENUE | 624410 | 311259 | 311259 | $0 |
| MEALS AND VENDING REV | 621400 | 89187 | $89,187 | |
| WELLNESS CENTER REV | 713940 | 80539 | 80539 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41825 | TotalRevenueColumn |
| Exclusion | $41,825 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 522810 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10674286 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9628485 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 391798 | UnrelatedBusinessRevenue |
| Exclusion | $315,552 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24893 | Total |
| Program Services | 24893 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276522 | Total |
| Management And General | 276522 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3034335 | Total |
| Program Services | 2808940 | ProgramServices |
| Management And General | 225395 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80691 | Total |
| Program Services | 66115 | ProgramServices |
| Management And General | 14576 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1105583 | Total |
| Program Services | 889203 | ProgramServices |
| Management And General | 216380 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 232062 | Total |
| Program Services | 196602 | ProgramServices |
| Management And General | 35460 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58401 | Total |
| Management And General | 58401 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7395 | Total |
| Management And General | 7395 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103572 | Total |
| Management And General | 103572 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1459240 | Total |
| Program Services | 1459240 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68858 | Total |
| Program Services | 482 | ProgramServices |
| Management And General | 68376 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80513 | Total |
| Program Services | 34956 | ProgramServices |
| Management And General | 45557 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90660 | Total |
| Management And General | 90660 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 471928 | Total |
| Program Services | 333683 | ProgramServices |
| Management And General | 138245 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40928 | Total |
| Program Services | 38193 | ProgramServices |
| Management And General | 2735 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305220 | Total |
| Program Services | 305220 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1094140 | Total |
| Program Services | 1094140 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70669 | Total |
| Program Services | 11083 | ProgramServices |
| Management And General | 59586 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| DRUG COST | 676700 | 676700 | |
| MEDICAL SUPPLIES | 577491 | 558187 | 19304 |
| FOOD COST | 103902 | 103678 | 224 |
| BAD DEBTS EXPENSE | 100000 | 100000 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 280985 | Total |
| Program Services | 243549 | ProgramServices |
| Management And General | 37436 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10344688 | Total |
| Program Services | 8944864 | ProgramServices |
| Management And General | 1399824 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 624730 | BOY |
| EOY | 1092556 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2568565 | BOY |
| EOY | 2266784 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 206783 | BOY |
| EOY | 146609 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2049050 | BOY |
| EOY | 2589164 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 87500 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 278488 | BOY |
| EOY | 279789 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31466 | BOY |
| EOY | 37819 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19425611 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8529652 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11174455 | BOY |
| EOY | 10895959 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2770378 | BOY |
| EOY | 2738076 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 494342 | BOY |
| EOY | 431399 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20198257 | BOY |
| EOY | 20565655 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 894954 | BOY |
| EOY | 951372 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4710000 | BOY |
| EOY | 5620454 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1721212 | BOY |
| EOY | 903922 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7326166 | BOY |
| EOY | 7475748 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11562996 | BOY |
| EOY | 12872873 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1309095 | BOY |
| EOY | 217034 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12872091 | BOY |
| EOY | 13089907 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20198257 | BOY |
| EOY | 20565655 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 329598 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -111782 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 274148 | OtherCostOrOtherBasis |
| Book Value | 274148 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12817032 | OtherCostOrOtherBasis |
| Depreciation | 4285358 | Depreciation |
| Book Value | 8531674 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5770403 | OtherCostOrOtherBasis |
| Depreciation | 3863496 | Depreciation |
| Book Value | 1906907 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 564028 | OtherCostOrOtherBasis |
| Depreciation | 380798 | Depreciation |
| Book Value | 183230 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10895959 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (6 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN COUNTRY VIEW MANOR, INC | 77664 | F |
| NORTHWEST IOWA CO-OP ALLOCATED PATRONAGE DIVIDENDS | 780 | F |
| AVERA FOUNDATION POOLED INVESTMENT | 2218832 | F |
| US BANK INVESTMENT ACCOUNT | 10660 | F |
| BOND SINKING FUND | 74967 | F |
| DEBT RESERVE FUND | 355173 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 2738076 | TotalOfBookValueSecurities |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | INCOME TAXES THE HOSPOTAL AND AFFILIATE HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO INTERNAL REVENUE SERVICE CODE SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, THUS THERE IS NO PROVISION FOR INCOME TAXES AT JUNE 30, 2012 AND 2011. THE HOSPITAL AND AFFILIATE HAVE ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HOSPITAL AND AFFILIATE FOLLOW THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND AFFILIATE'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 133.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 185.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54662 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 54662 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 320355 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 229072 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 91283 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 375017 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 229072 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 145945 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01410 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 227829 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13750 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 214079 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 32719 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 32719 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00320 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105034 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105034 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 365582 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13750 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 351832 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03410 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 740599 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 242822 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 497777 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04820 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 125013 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 125013 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.01210 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4784 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4784 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 129797 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 129797 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.01260 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $100,000 | BadDebtExpenseAmount |
| Amount Attributable To | 50000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3437321 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3408310 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 29011 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NINTH AVENUE NORTH | AddressLine1 |
| City | SIBLEY | City |
| State | IA | State |
| ZIP Code | 51249 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 2 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 133.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 185.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: COSTING METHODOLOGY:A COST-TO-CHARGE RATIO WAS USED TO REPORT BAD DEBT FIGURES IN PART III, SECTION A. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE IRS INSTRUCTIONS FOR SCHEDULE H, WORKSHEET 2. | |
| PART I, L7 COL(F): THERE WAS $100,000 OF BAD DEBT EXPENSE THAT WAS EXCLUDED BEFORE ARRIVING AT TOTAL EXPENSES FOR CALCULATING PERCENTAGE OF COMMUNITY BENEFIT | |
| PART II: APPROXIMATELY 80% OF THE ACTIVITY REPORTED IN PART II AS COMMUNITY BUILDING ACTIVITIES RELATES TO CHILD CARE PROVIDED BY THE ORGANIZATION THAT IS MADE AVAILABLE TO VULNERABLE POPULATIONS. THIS COMMUNITY SUPPORT ACTIVITY PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING THE COMMUNITY WITH A HEALTHY, SAFE ENVIRONMENT FOR CHILDREN TO DEVELOP IN WHILE THEIR PARENTS ARE WORKING OR UNABLE TO CARE FOR THEM.THE ORGANIZATION ALSO INCLUDES ACTIVITY RELATED TO NEIGHBORHOOD SUPPORT GROUPS. THESE PROGRAMS PROMOTE THE HEALTH OF THE COMMUNITY BY ESTABLISHING SOCIAL NETWORKS FOR ITS RESIDENTS THAT PROVIDE THEM WITH; A NETWORK OF SIMILAR EXPERIENCES, SYMPATHETIC AND UNDERSTANDING MEMBERS, EMOTIONAL COMFORT, AND MORAL SUPPORT. ALL OF THESE CAN LEAD TO A REDUCTION IN STRESS AND ANXIETY. | |
| PART III, LINE 4: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS CHARITY CARE POLICY IS 50%. THIS IS BASED ON RECORD REVIEWS AND ANALYSIS OF DEMOGRAPHICS.FINANCIAL STATEMENT BAD DEBT EXPENSE FOOTNOTE:ACCOUNT RECEIVABLE ARE SHOWN AT THE AMOUNT EXPECTED TO BE COLLECTED AFTER DETERMINING THAT ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS FROM THIRD-PARTY PAYORS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON MANAGEMENT'S JUDGMENT. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF INVOICE OR CLAIM SUBMITTED. ACCOUNTS OVER 125 DAYS PAST DUE ARE TURNED OVER TO COLLECTION AGENTS OR FILED TO SMALL CLAIMS COURT. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE WITH THE HOSPITAL. | |
| PART III, LINE 8: THERE WASNT A MEDICARE SHORTFALL REPORTED IN PART III, LINE 8. THE SURPLUS APPEARS REASONABLE AS THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED AT 101% OF COST. | |
| PART V, SECTION B, LINE 13G: IF THE PATIENTS ARE UNINSURED OR HAVE A LARGE DEDUCTIBLE OR CO-PAY, OCH WILL TRY TO CONTACT THE PATIENT PRIOR TO DISCHARGE AND INFORM THEM OF THE FINANCIAL ASSISTANCE POLICY. IF THE PATIENT HAS ALREADY BEEN DISCHARGED, OCH WILL CONTACT THEM VIA PHONE OR LETTER TO INFORM THEM OF THE FINANCIAL ASSISTANCE POLICY. | OSCEOLA COMMUNITY HOSPITAL |
| PART V, SECTION B, LINE 19D: THE HOSPITAL UTILIZES THE SAME METHOD FOR BILLING PATIENTS FOR EMERGENCY AND NON-EMERGENCY CARE. THE DISCOUNTED OR FREE CARE IS DETERMINED THROUGH THE FINANCIAL ASSISTANCE POLICIES THAT ARE DEPENDENT UPON THE PATIENT'S INCOME AND THE FPG LEVELS. | OSCEOLA COMMUNITY HOSPITAL |
| PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH FORMAL PROCESSES THAT INCLUDE, MEETINGS, SURVEY AND COMMUNITY INPUT PRIOR TO UNDERTAKING ANY LARGE PROJECTS. THROUGHOUT THE YEAR, COMMUNITY NEEDS ARE ASSESSED INFORMALLY AT VARIOUS COMMUNITY MEETINGS AND THROUGH PATIENT SURVEYS. THE ORGANIZATION ALSO ASSISTS THE HOME HEALTH DEPARTMENT/PUBLIC HEALTH WITH A COMMUNITY NEEDS ASSESSMENT INFORMATION FROM THE CHNA IS UTILIZED TO HELP PLAN SERVICES THE ORGANIZATION OFFERS. | |
| PART VI, LINE 3: DURING THE COURSE OF PRE-REGISTRATION A MODE OF PAYMENT IS RECORDED ON THE ADMISSION FORM. IF INSURANCE IS INDICATED, BENEFITS ARE REQUEST FROM THE INSURANCE COMPANY. IF IT IS NOTED THAT THE ACCOUNT HAS A LARGE DEDUCTIBLE OR IS SELF PAY, THE INFORMATION IS FORWARDED TO THE COLLECTION STAFF AND SOCIAL SERVICES. OPTIONS FOR HANDLING PAYMENT OF THE ACCOUNT ARE THEN DISCUSSED WITH THE PATIENT OR THE RESPONSIBLE PARTY. IF THE PATIENT OR RESPONSIBLE PARTY IS NOT AVAILABLE AT THE TIME THE INFORMATION IS RECEIVED BY THE BUSINESS OFFICE OR SOCIAL SERVICE STAFF, EFFORTS TO CONTACT THEM INCLUDE PHONE AND WRITTEN CORRESPONDENCE. IF THE PARTY DOES NOT RESPOND, THE ACCOUNT IS HANDED OVER TO THE COLLECTION AREA. THIS PROCESS OFTEN REQUIRES A COMBINATION OF BUSINESS OFFICE AND SOCIAL SERVICE STAFF WORKING TOGETHER. OPTIONS FOR ANY SELF PAY OBLIGATIONS INCLUDE PAYMENT IN FULL, PAYMENT PLANS, VARIOUS ASSISTANCE PROGRAMS, AND THE FINANCIAL ASSISTANCE OFFERED BY OSCEOLA COMMUNITY HOSPITAL'S CHARITY CARE. INFORMATION REGARDING THESE OPTIONS IS MADE AVAILABLE AT THIS TIME. DURING THE DISCUSSIONS, INFORMATION IS REQUESTED TO ASSESS AND PROVE FINANCIAL STATUS IF PAYMENTS, PROGRAM APPLICATION, OR CHARITY ARE INDICATED. ASSISTANCE IS OFFERED FOR COMPLETION OF APPLICATIONS AND INSTRUCTIONS ARE GIVEN FOR COMPLETION OF FINANCIAL ASSESSMENTS. ATTENTION TO PARTICULAR ACCOUNTS MAY ALSO BE BROUGHT TO THE ATTENTION OF THE BUSINESS OFFICE OR SOCIAL SERVICES BY THE COLLECTIONS STAFF, PATIENTS THEMSELVES, OR RELATIVES OF PATIENTS. THIS USUALLY OCCURS WHEN THE CIRCUMSTANCES OF THE PATIENT CHANGES AFTER A TIME PERIOD HAS PASSED. WHEN NOTIFICATION IS RECEIVED, THESE CASES ARE REASSESSED. | |
| PART VI, LINE 4: OSCEOLA COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE CITIZENS OF OSCEOLA COUNTY, IOWA. THE SECONDARY SERVICE AREA INCLUDES THE SURROUNDING COUNTIES OF NOBLES (MN), JACKSON (MN), DICKINSON (IA), O'BRIEN (IA), AND LYON (IA). ACCORDING TO THE 2000 AND 2010 CENSUS, THE POPULATION HAS DECREASED 8% OVER THE PREVIOUS 10 YEARS. THE MEDIAN AGE OF THE POPULATION WAS 40 AND WAS MADE UP OF 98% CAUCASIANS. THE MEDIAN HOUSEHOLD INCOME WAS $34,274 WITH AN AVERAGE HOUSEHOLD OF 2.5. | |
| PART VI, LINE 6: THE HOSPITAL IS A MEMBER OF AVERA HEALTH. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YMCA | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2721 W 41ST ST PLAZA 41 | AddressLine1 |
| City | SIOUX FALLS | City |
| State | SD | State |
| ZIP Code | 57104 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 460452300 | EINOfRecipient |
| Amount Of Cash Grant | 24893 | AmountOfCashGrant |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| CITY OF SIBLEY IOWA | |||||||
| 426005203 | 825759AM5 | 2007-12-01 | 4800000 | CAPITAL PROJECTS | 0 | 0 | 0 |
| CITY OF SIBLEY IOWA | |||||||
| 426005203 | 2007-12-14 | 1000000 | CAPITAL PROJECTS | 0 | 0 | 0 | |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| 90000 | 4800000 | 88603 | 142554 | 4657446 | 0 | 0 | 1 | 1 |
| 56519 | 1000000 | 21463 | 978537 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 1 | 0 | 0 | 0 | 0 |
| 0 | 1 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | BONDS A AND B DESCRIPTION OF PROJECT: THE PROJECT CONSISTS OF EXPANDING AND RENOVATING BORROWER'S EXISTING HOSPITAL FACILITIES, AND ACQUIRING MAJOR MEDICAL EQUIPMENT, INCLUDING WITHOUT LIMITAION, A NEW OPERATING ROOM, NEW PATIENT ROOMS, A RENOVATED AND EXPANDED EMERGENCY ROOM, AN EXPANDED WELLNESS AREA, NEW EXAM ROOMS, NEW SUPPORT AREAS, A NEW NURSING STATION, AND NEW NURSERY OBSTETRICAL SUITES FOR USE AT THE BORROWER'S EXISTING HOSPITAL FACILITIES AT 600 9TH AVENUE NORTH IN SIBLEY, IOWA. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE ORGANIZATION. THE PRESIDENT SHALL SERVE AS THE CHAIR OF THE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINSS OF THE ORGANIZATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF TRUSTEES, AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 6 | REGULAR MEMBERS ARE THOSE PERSONS, CORPORATIONS, ASSOCIATIONS OR PARTNERSHIPS WHO HAVE CONTRIBUTED AND PAID INTO THE CORPORATION A MINIMUM OF $75 OR MORE TO FURTHER THE OBJECTIVES OF THE CORPORATION. MEMBERSHIP SHALL BE LIFELONG AND NONTRANSFERABLE. EACH MEMBER WHOSE NAME IS ENDORSED ON THE MEMBERSHIP CERTIFICATES SHALL BE QUALIFIED TO ORIGINATE AND TAKE PART IN THE DISCUSSION OF ANY SUBJECT THAT MAY PROPERLY COME BEFORE THE ANNUAL MEETING OF THE CORPORATION, TO VOTE ON SUCH SUBJECTS, AND TO HOLD ANY OFFICE TO WHICH THE MEMBER MAY BE ELECTED OR APPOINTED. NO EMPLOYEE OR EMPLOYEE'S SPOUSE OF THE CORPORATION MAY BE ELECTED TO THE BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF TRUSTEES ARE ELECTED FROM THE MEMBERS AT THE ANNUAL MEETING OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE MANAGEMENT OF THE ORGANIZATION REVIEWS THE FORM 990 PRIOR TO FILING. THE BOARD OF DIRECTORS REVIEW THE 990 SUBSEQUENT TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR/TRUSTEE, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A CONFLICT OF INTEREST STATEMENT. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF A FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE DIRECTORS/TRUSTEES AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER THE INTERESTED PERSON LEAVES THE MEETING, THE REMAINING BOARD OR COMMITTEE MEMBERS WILL DISCUSS AND VOTE UPON WHETHER A CONFLICT OF INTEREST EXISTS. ALSO, IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A DIRECTOR, TRUSTEE, OR MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM SUCH PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION SHALL BE TAKEN IF NECESSARY. | |
| FORM 990, PART VI, SECTION B, LINE 15 | A COMPENSATION SPECIALIST FROM AN AFFILIATE ORGANIZATION REVIEWS THE COMPENSATION WITH THE BOARD OF TRUSTEES ANNUALLY. THE SPECIALIST REVIEWS MARKET VALUE AND PRESENTS A RECOMMENDATION TO THE BOARD OF TRUSTEES. THE BOARD MAKES THEIR DECISION ON THE INFORMATION PRESENTED. THE MOST RECENT PROCESS WAS COMPLETED IN MAY 2012 FOR ALL OFFICERS AND TOP MANAGEMENT. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AND THE FORM 990 AND 990T ARE AVAILABLE AT THE ANNUAL MEETING AND UPON REQUEST. | |
| FORM 990, PART VII | JANET DYKSTRA SERVES AS THE CEO OF OSCEOLA COMMUNITY HOSPITAL AND A BOARD MEMBER OF ITS RELATED ORGANIZATION, HEARTWOOD HEIGHTS. SHE SPENDS APPROXIMATELY 40 HOURS PER WEEK WORKING FOR OSCEOLA COMMUNITY HOSPITAL AND 1 HOUR PER WEEK FOR HEARTWOOD HEIGHTS. BRIAN MINO, DARRYL BOSMA, AND DEB KOHN EACH SERVE ON THE BOARD OF OSCEOLA COMMUNITY HOSPITAL AND ITS RELATED ORGANIZATION, HEARTWOOD HEIGHTS. EACH INDIVIDUAL SPENDS APPROXIMATELY 1 HOUR PER WEEK WORKING FOR EACH OF THE ORGANIZATIONS. | ALLOCATION OF HOURS |
| FORM 990, PART XI, LINE 5: | DONATED SERVICES AND USE OF FACILITIES: -19,994. PRIOR PERIOD ADJUSTMENTS: 29,404. UNRESTRICTED:NET ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL EXPENDITURES 1,212,243. TEMP REST: NET ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL EXPENDITURES -1,224,818. CHANGE IN UNREALIZED GAINS -108,617. TOTAL TO FORM 990, PART XI, LINE 5: -111,782. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEARTWOOD HEIGHTS | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 409 9TH AVE NORTH | AddressLine1 |
| City | SIBLEY | City |
| State | IA | State |
| ZIP Code | 51249 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421495686 | EIN |
| Primary Activities | INDEPENDENT/ASSISTED LIVING COMPLEX | PrimaryActivities |
| Legal Domicile State | IA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | PF | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEARTWOOD HEIGHTS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | N | TransactionType |
| Amount Involved | 168727 | AmountInvolved |
| Method Of Amt Determination | ACTUAL COST | MethodOfAmtDetermination |
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