2012-03-02T08:56:33-06:00 2011-06-30 HENJES CONNER & WILLIAMS PC 800 FRANCES BLDG SIOUX CITY IA 51101 990 2010-07-01 383320710 HOSPICE OF SIOUXLAND HOSP 7122334144 4300 HAMILTON BLVD SIOUX CITY IA 51104 DANIEL K LAUER 7122529418 2012-03-02 1 MELISSA J WILLER 7122773931 2012-03-02 2010 2016-02-24 21:20:13Z DANIEL K LAUER 230 NEBRASKA ST SIOUX CITY IA 51101 16882150 0 X WWW.HOSPICEOFSIOUXLAND.ORG X 1982 IA PROVIDE COMFORT, SUPPORT, AND COMPASSIONATE CARE TO TERMINALLY ILL PEOPLE AND THEIR FAMILIES THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL, AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. 10 10 148 300 0 0 158063 254372 13725495 13872793 31551 277190 57777 7507 13972886 14411862 0 0 0 0 7068350 7063017 0 0 54933 6431657 6799148 13500007 13862165 472879 549697 10183640 8994012 3828093 3232049 6355547 5761963 PROVIDE COMFORT, SUPPORT, AND COMPASSIONATE CARE TO TERMINALLY ILL PEOPLE AND THEIR FAMILIES THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL, AND TO FOSTER COMMUNITY ACCEPTANCE THAT DYING IS AN INTEGRAL PART OF LIVING. 0 0 10993820 14064591 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. 10993820 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 5 0 148 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 X DAN LAUER 7122529418 230 NEBRASKA ST PO BOX 5017 SIOUX CITY IA 51101 CHIC WOLFE 1.00 X X 0 0 0 MILT AVERY 1.00 X X 0 0 0 BOB PEEBLES 1.00 X X 0 0 0 PETER THOREEN 1.00 X X 0 0 0 CHARESE YANNEY 0.50 X 0 0 0 MARI KAPTAIN-DAHLEN 0.50 X 0 0 0 LYNN WOLD 0.50 X 0 0 0 STEVE EAVENSON 0.50 X 0 0 0 MARK JOHNSON 0.50 X 0 0 0 RON PETERSON 0.50 X 0 0 0 LINDA TODD 40.00 X 104389 0 18033 DALE HOLDIMAN 40.00 X 124000 0 14981 TERRI BEERMAN 20.00 X 108452 0 18960 KAREN VAN DE STEEG 40.00 X 0 0 0 DAN LAUER 40.00 X 0 0 0 336841 0 51974 3 0 0 0 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 5 254372 254372 PATIENT SERVICE REVENU 621610 13872793 13872793 13872793 92899 92899 2654579 2470288 184291 184291 184291 OTHER INCOME 900099 7507 7507 7507 14411862 14064591 0 92899 122422 122422 5151960 3920584 1192319 39057 351024 257254 93770 1079138 790863 288275 358473 292945 64293 1235 5053 5053 52854 52854 4075776 3818596 257180 52267 52267 91142 86414 4728 244498 244498 440138 385488 54269 381 34458 32571 1887 85603 85603 23339 23339 MEDICAL SUPPLIES 1404778 1404778 BAD DEBTS 123261 123261 REPAIRS AND MAINTENANCE 94147 94147 DUES, SUBSCRIPTIONS, ME 42105 42105 OTHER COSTS 25289 51 22033 3205 4440 4440 13862165 10993820 2813412 54933 2146191 1124250 1599156 1503733 1145000 0 134185 144389 714066 614435 154274 99631 3597565 5063995 1407269 1058014 10183640 8994012 2683093 2422049 1145000 810000 3828093 3232049 X 5855350 5239459 197 22504 500000 500000 6355547 5761963 10183640 8994012 X 549697 -1143281 X X 0 1 1 X 0 X X 0 0 0 MERCY MEDICAL CENTER AND SUBSIDIARIES 311373080 3 0 0 1 0 NORTHWEST IOWA HOSPITAL CORPORATION 421019872 3 0 0 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 558179 126399 684578 491289 65905 557194 0.26960 0.73030 0 0 37168 34799 2369 676898 579636 97262 0 99631 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 5063995 OTHER RECEIVABLES 1058014 1058014 14411862 13862165 549697 504848 -1648129 -1143281 -593584 14863856 504848 504848 14359008 52854 52854 14411862 15604451 1795140 1795140 13809311 52854 52854 13862165 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. 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 FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A FORM DETAILING ANY AND ALL BUSINESS RELATIONSHIPS WITH HEALTH INC AND RELATED ENTITIES. ALL COMPLETED FORMS ARE REVIEWED AND DISCUSSED WITH THE BOARD AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 TOP MANAGEMENT EMPLOYEES PROVIDE INDEPENDENT DOCUMENTATION FROM TRADE SOURCES TO SUBSTANTIATE PAY LEVELS. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION'S DOCUMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: 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 2C NO CHANGES HEALTH INC 230 NEBRASKA STREET SIOUX CITY IA 51101 311712115 SERVE AS THE CENTRAL ORGANIZATION FOR OTHER 501(C) (3) ENTITIES IA 501(C)(3) PF 0 SIOUXLAND REGIONAL CANCER CENTER PO BOX 5017 SIOUX CITY IA 51102 421411233 DEDICATED TO CANCER TREATMENT, RESEARCH AND EDUCATION & SERVICES ALL PATIENT IA 501(C)(3) 170(B)(1)(A)(I) 0 SIOUXLAND 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 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 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