HEALTH INC HOSPICE: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HEALTH INC HOSPICE (EIN 38-3320710)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-03-02
- IRS object ID
- 201230629349301018
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-02T08:56:33-06:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENJES CONNER & WILLIAMS PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 FRANCES BLDG | AddressLine1 |
| City | SIOUX CITY | City |
| State | IA | State |
| ZIP Code | 51101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 383320710 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE OF SIOUXLAND | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HOSP | NameControl |
| Phone | 7122334144 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4300 HAMILTON BLVD | AddressLine1 |
| City | SIOUX CITY | City |
| State | IA | State |
| ZIP Code | 51104 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL K LAUER | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 7122529418 | Phone |
| Date Signed | 2012-03-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MELISSA J WILLER | Name |
| Phone | 7122773931 | Phone |
| Date Prepared | 2012-03-02 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DANIEL K LAUER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 NEBRASKA ST | AddressLine1 |
| City | SIOUX CITY | City |
| State | IA | State |
| ZIP Code | 51101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16882150 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HOSPICEOFSIOUXLAND.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1982 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 148 | TotalNbrEmployees |
| Total Nbr Volunteers | 300 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 158063 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 254372 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13725495 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13872793 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 31551 | InvestmentIncomePriorYear |
| Investment Income Current Year | 277190 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 57777 | OtherRevenuePriorYear |
| Other Revenue Current Year | 7507 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 13972886 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14411862 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7068350 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7063017 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 54933 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6431657 | OtherExpensePriorYear |
| Other Expenses Current Year | 6799148 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13500007 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13862165 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 472879 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 549697 | RevenuesLessExpensesCY |
| Total Assets BOY | 10183640 | TotalAssetsBOY |
| Total Assets EOY | 8994012 | TotalAssetsEOY |
| Total Liabilities BOY | 3828093 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3232049 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6355547 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5761963 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 10993820 | Expense |
| Revenue | 14064591 | Revenue |
| Description | 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. | Description |
| Total Program Service Expense | 10993820 | 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 | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | 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 | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| 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 | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 5 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 148 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | 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 | 1 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAN LAUER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7122529418 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 NEBRASKA ST PO BOX 5017 | AddressLine1 |
| City | SIOUX CITY | City |
| State | IA | State |
| ZIP Code | 51101 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CHIC WOLFE | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| MILT AVERY | |||||||
| VICE CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| BOB PEEBLES | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| PETER THOREEN | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| CHARESE YANNEY | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| MARI KAPTAIN-DAHLEN | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| LYNN WOLD | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| STEVE EAVENSON | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| MARK JOHNSON | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| RON PETERSON | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| LINDA TODD | |||||||
| DIRECTOR OF OPERATIONS | 40.00 | X | 104389 | 0 | 18033 | ||
| DALE HOLDIMAN | |||||||
| MEDICAL DIRECTOR | 40.00 | 124000 | 0 | 14981 | X | ||
| TERRI BEERMAN | |||||||
| WEEKEND RN | 20.00 | 108452 | 0 | 18960 | X | ||
| KAREN VAN DE STEEG | |||||||
| EXECUTIVE DIRECTOR | 40.00 | X | 0 | 0 | 0 | ||
| DAN LAUER | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | X | 0 | 0 | 0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 336841 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 51974 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | 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 |
|---|---|---|---|---|---|
| MERCY MEDICAL CENTER | |||||
| 801 5TH STREET | SIOUX CITY | IA | 51101 | INPATIENT AND OUTPATIEN HOSPITAL CHARGES | 426019 |
| SIOUXLAND HEMOTOLOGY ONCOLOGY ASSOCIATES | |||||
| 230 NEBRASKA STREET | SIOUX CITY | IA | 51101 | MEDICAL ONCOLOGY SERVICES | 378525 |
| JUNE E NYLEN CANCER CENTER | |||||
| 230 NEBRASKA STREET | SIOUX CITY | IA | 51101 | MANAGEMENT FEES AND INSURANCE REBILLS | 342509 |
| HOLY SPIRIT RETIREMENT HOME | |||||
| 1701 W 25TH ST | SIOUX CITY | IA | 51103 | ROOM AND BOARD CHARGES | 302068 |
| ST LUKES REGIONAL MEDICAL CENTER | |||||
| 2720 STONE PARK BLVD | SIOUX CITY | IA | 51104 | INPATIENT AND OUTPATIENT HOSPITAL CHARGE | 296037 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 254372 | AllOtherContributions |
| Total Contributions | 254372 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 621610 | BusinessCode |
| Total Revenue Column | 13872793 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13872793 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13872793 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92899 | TotalRevenueColumn |
| Exclusion | $92,899 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2654579 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2470288 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 184291 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 184291 | TotalRevenueColumn |
| Related Or Exempt Function Income | 184291 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER INCOME | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 7507 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7507 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 7507 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14411862 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14064591 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $92,899 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122422 | Total |
| Management And General | 122422 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5151960 | Total |
| Program Services | 3920584 | ProgramServices |
| Management And General | 1192319 | ManagementAndGeneral |
| Fundraising | 39057 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 351024 | Total |
| Program Services | 257254 | ProgramServices |
| Management And General | 93770 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1079138 | Total |
| Program Services | 790863 | ProgramServices |
| Management And General | 288275 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 358473 | Total |
| Program Services | 292945 | ProgramServices |
| Management And General | 64293 | ManagementAndGeneral |
| Fundraising | 1235 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5053 | Total |
| Management And General | 5053 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52854 | Total |
| Management And General | 52854 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4075776 | Total |
| Program Services | 3818596 | ProgramServices |
| Management And General | 257180 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52267 | Total |
| Management And General | 52267 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91142 | Total |
| Management And General | 86414 | ManagementAndGeneral |
| Fundraising | 4728 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 244498 | Total |
| Management And General | 244498 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440138 | Total |
| Program Services | 385488 | ProgramServices |
| Management And General | 54269 | ManagementAndGeneral |
| Fundraising | 381 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34458 | Total |
| Management And General | 32571 | ManagementAndGeneral |
| Fundraising | 1887 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85603 | Total |
| Management And General | 85603 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23339 | Total |
| Management And General | 23339 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES | 1404778 | 1404778 | ||
| BAD DEBTS | 123261 | 123261 | ||
| REPAIRS AND MAINTENANCE | 94147 | 94147 | ||
| DUES, SUBSCRIPTIONS, ME | 42105 | 42105 | ||
| OTHER COSTS | 25289 | 51 | 22033 | 3205 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4440 | Total |
| Fundraising | 4440 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13862165 | Total |
| Program Services | 10993820 | ProgramServices |
| Management And General | 2813412 | ManagementAndGeneral |
| Fundraising | 54933 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2146191 | BOY |
| EOY | 1124250 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1599156 | BOY |
| EOY | 1503733 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1145000 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 134185 | BOY |
| EOY | 144389 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 714066 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 614435 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 154274 | BOY |
| EOY | 99631 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3597565 | BOY |
| EOY | 5063995 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1407269 | BOY |
| EOY | 1058014 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10183640 | BOY |
| EOY | 8994012 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2683093 | BOY |
| EOY | 2422049 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1145000 | BOY |
| EOY | 810000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3828093 | BOY |
| EOY | 3232049 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5855350 | BOY |
| EOY | 5239459 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 197 | BOY |
| EOY | 22504 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 500000 | BOY |
| EOY | 500000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6355547 | BOY |
| EOY | 5761963 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10183640 | BOY |
| EOY | 8994012 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 549697 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1143281 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| MERCY MEDICAL CENTER AND SUBSIDIARIES | |||||
| 311373080 | 3 | 0 | 0 | 1 | $0 |
| NORTHWEST IOWA HOSPITAL CORPORATION | |||||
| 421019872 | 3 | 0 | 0 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 558179 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 126399 | InvestmentEarningsOrLosses |
| End Of Year Balance | 684578 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 491289 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 65905 | InvestmentEarningsOrLosses |
| End Of Year Balance | 557194 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.26960 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.73030 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37168 | OtherCostOrOtherBasis |
| Depreciation | 34799 | Depreciation |
| Book Value | 2369 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 676898 | OtherCostOrOtherBasis |
| Depreciation | 579636 | Depreciation |
| Book Value | 97262 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 99631 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (6 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| MUTUAL FUNDS | 2444477 | F |
| U. S. GOVERNMENT SECURITIES | 539279 | F |
| CORPORATE SECURITIES | 1149829 | F |
| MORTGAGE BACKED SECURITIES | 154172 | F |
| CASH AND EQUIVALENTS | 1092 | F |
| CERTIFICATES OF DEPOSIT | 775146 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 5063995 | TotalOfBookValueSecurities |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER RECEIVABLES | Description |
| Book Value | 1058014 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1058014 | TotalBookValueOtherAssets |
| Total Revenue | 14411862 | TotalRevenue |
| Total Expenses | 13862165 | TotalExpenses |
| Excess Or Deficit For Year | 549697 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 504848 | NetUnrealizedGLOnInvestments |
| Other | -$1,648,129 | OtherAmount |
| Total Adjustments | -1143281 | TotalAdjustments |
| Excess Or Deficit Per FS | -593584 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 14863856 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 504848 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 504848 | RevenueNotRptdF990 |
| Revenue Subtotal | 14359008 | RevenueSubtotal |
| Investment Expenses Not Included | 52854 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 52854 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 14411862 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 15604451 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 1795140 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1795140 | ExpensesNotRptdF990 |
| Expenses Subtotal | 13809311 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 52854 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 52854 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 13862165 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | 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 8 - OTHER ADJUSTMENTS: | PENSION ADJUSTMENT 147,011. LOSS ON INTERCOMPANY ACTIVITY -1,795,140. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON INTERCOMPANY ACTIVITY 1,795,140. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 | NORTHWEST IOWA HOSPITAL CORPORATION AND MERCY MEDICAL CENTER APPOINT THEIR REPRESENTATIVES TO BE ON THE BOARD | |
| 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 | |
| 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 12C | |
| TOP MANAGEMENT EMPLOYEES PROVIDE INDEPENDENT DOCUMENTATION FROM TRADE SOURCES TO SUBSTANTIATE PAY LEVELS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| ORGANIZATION'S DOCUMENTS ARE AVAILABLE UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 504,848. PENSION ADJUSTMENT 147,011. LOSS ON INTERCOMPANY ACTIVITY -1,795,140. TOTAL TO FORM 990, PART XI, LINE 5: -1,143,281. | FORM 990, PART XI, LINE 5: |
| NO CHANGES | FORM 990, PART XI, LINE 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| 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 PACE | |||||||||
| 313 COOK STREET | SIOUX CITY | IA | 51103 | 261120134 | PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY | IA | 501(C)(3) | 170(B)(1)(A)(III) | 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 |
| 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 | 1 | 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 | 1 | 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 | 1 | 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 (7 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| SIOUXLAND REGIONAL CANCER CENTER | |
| N | 162300 |
| SIOUXLAND REGIONAL CANCER CENTER | |
| O | 105342 |
| SIOUXLAND PARAMEDICS | |
| O | 67890 |
| SIOUXLAND PACE | |
| D | 810000 |
| MERCY HEALTH SERVICES | |
| O | 515521 |
| NORTHWEST IOWA HOSPITAL CORPORATION | |
| O | 429666 |
| MERCY HEALTH SERVICES | |
| J | 134724 |
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