VNA HOSPICE OF SOUTHWEST IOWA: Form 990, tax year 2009
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- Organization
- VNA HOSPICE OF SOUTHWEST IOWA (EIN 47-0733773)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-13
- IRS object ID
- 201131339349302203
- Schema version
- 2009v1.4
- 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 | 2011-05-13T09:43:06-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | TWO CENTRAL PARK PLAZA SUITE 1501 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470733773 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE OF SOUTHWEST IOWA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HOSP | NameControl |
| Phone | 4023434323 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT M WOOTEN | Name |
| Title | ALEGENT HEALTH SVP/CFO | Title |
| Phone | 4023434323 | Phone |
| Date Signed | 2011-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Angela Lea | Name |
| Phone | 4023481450 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SCOTT M WOOTEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1311733 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1990 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | A community where all individuals and families have access to impeccable end of life care. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 62 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 100318 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 135077 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1205838 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1176118 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5749 | InvestmentIncomePriorYear |
| Investment Income Current Year | 322 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 216 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1311905 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1311733 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 349 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 385 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1378802 | OtherExpensePriorYear |
| Other Expenses Current Year | 1273971 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1379151 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1274356 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -67246 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 37377 | RevenuesLessExpensesCY |
| Total Assets BOY | 1511285 | TotalAssetsBOY |
| Total Assets EOY | 1673987 | TotalAssetsEOY |
| Total Liabilities BOY | 83691 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 209016 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1427594 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1464971 | NetAssetsOrFundBalancesEOY |
| Mission Description | Cherishing life's journey through an extraordinary commitment to compassion, comfort and holistic care. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1044410 | Expense |
| Grants | 385 | Grants |
| Revenue | 1176334 | Revenue |
| Description | HOSPICE OF SOUTHWEST IOWA IS A MEDICARE CERTIFIED HOSPICE PROGRAM THAT SERVES PATIENTS WHO HAVE BEEN DIAGNOSED WITH A LIFE LIMITING CONDITION. THE PROGRAM SERVES PATIENTS THAT RESIDE IN SEVEN SOUTHWEST IOWA COUNTIES. THE MAIN OFFICE IS LOCATED IN COUNCIL BLUFFS WITH A MULTI-SITE LOCATION IN CORNING, IOWA. HOSPICE OF SOUTHWEST IOWA PLANS TO BUILD AN INPATIENT HOSPICE FACILITY UPON THE COMPLETION OF A COMMUNITY CAPITAL CAMPAIGN. | Description |
| Total Program Service Expense | 1044410 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 9 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | 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 | SCOTT M WOOTEN ALEGENT HEALTH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4023434323 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| LAWRENCE J BECKMAN | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARIE KNEDLER | ||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| Helen BLEICHER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| RONALD D JOHNSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| EMMET TINLEY | ||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X |
| SUSAN T TINLEY | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARVIN D ARNPRIESTER | ||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X |
| KATHRYNE A CUTLER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| LISA GRONSTAL | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JAMES SUMMERFELT | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEGENT HEALTH | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | Management Services | DescriptionOfServices |
| Compensation | 718757 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| All Other Contributions | 135077 | AllOtherContributions |
| Total Contributions | 135077 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621500 | BusinessCode |
| Total Revenue Column | 1176118 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1176118 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1176118 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 322 | TotalRevenueColumn |
| Exclusion | $322 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER OPERATING REVENU | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 216 | TotalRevenueColumn |
| Related Or Exempt Function Income | 216 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 216 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1311733 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1176334 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $322 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 385 | Total |
| Program Services | 385 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 718757 | Total |
| Program Services | 539068 | ProgramServices |
| Management And General | 179689 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13700 | Total |
| Management And General | 13700 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270 | Total |
| Program Services | 270 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56140 | Total |
| Program Services | 19583 | ProgramServices |
| Management And General | 36557 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5165 | Total |
| Program Services | 5165 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 141679 | Total |
| Program Services | 141679 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18301 | Total |
| Program Services | 18301 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54535 | Total |
| Program Services | 54535 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4244 | Total |
| Program Services | 4244 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1690 | Total |
| Program Services | 1690 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36777 | Total |
| Program Services | 36777 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Purchased Services | 215208 | 215208 |
| BAD DEBTS | 4671 | 4671 |
| MEMBERSHIPS & DUES | 2382 | 2382 |
| Other Misc Expenses | 277 | 277 |
| Taxes & Licenses | 175 | 175 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1274356 | Total |
| Program Services | 1044410 | ProgramServices |
| Management And General | 229946 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46110 | BOY |
| EOY | 116150 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 528652 | BOY |
| EOY | 590917 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132045 | BOY |
| EOY | 130593 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 689075 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2748 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 654478 | BOY |
| EOY | 686327 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 150000 | BOY |
| EOY | 150000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1511285 | BOY |
| EOY | 1673987 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32884 | BOY |
| EOY | 17150 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50807 | BOY |
| EOY | 191866 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83691 | BOY |
| EOY | 209016 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 837258 | BOY |
| EOY | 797408 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 590336 | BOY |
| EOY | 667563 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1427594 | BOY |
| EOY | 1464971 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1511285 | BOY |
| EOY | 1673987 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 500125 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1182338 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 100318 | CurrentTaxYearMinus1Year |
| Current Tax Year | 135077 | CurrentTaxYear |
| Total | 1917858 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 466819 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1205838 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1176118 | CurrentTaxYear |
| Total | 2848775 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 500125 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1649157 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1306156 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1311195 | CurrentTaxYear |
| Total | 4766633 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 31000 | CurrentTaxYearMinus1Year |
| Total | 31000 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 31000 | CurrentTaxYearMinus1Year |
| Total | 31000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 4735633 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 5 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 17988 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5749 | CurrentTaxYearMinus1Year |
| Current Tax Year | 322 | CurrentTaxYear |
| Total | 24064 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 5 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 17988 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5749 | CurrentTaxYearMinus1Year |
| Current Tax Year | 322 | CurrentTaxYear |
| Total | 24064 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 280 | CurrentTaxYearMinus2Years |
| Current Tax Year | 216 | CurrentTaxYear |
| Total | 496 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 500130 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1667425 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1311905 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1311733 | CurrentTaxYear |
| Total | 4791193 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.98840 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.98420 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00500 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00680 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | 0 | PoliticalExpenditures |
| Volunteer Hours | 0 | VolunteerHours |
| Amt Of4955 Tax | 0 | AmtOf4955Tax |
| Amt Of4955 Tax On Managers | 0 | AmtOf4955TaxOnManagers |
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $270 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 270 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 590336 | BeginningOfYearBalance |
| Contributions | 110765 | Contributions |
| Other Expenditures | 33538 | OtherExpenditures |
| End Of Year Balance | 667563 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 673447 | BeginningOfYearBalance |
| Contributions | 75193 | Contributions |
| Other Expenditures | 158304 | OtherExpenditures |
| End Of Year Balance | 590336 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 1.00000 | BoardDesignatedEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 206000 | OtherCostOrOtherBasis |
| Book Value | 206000 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11096 | OtherCostOrOtherBasis |
| Depreciation | 2748 | Depreciation |
| Book Value | 8348 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 471979 | OtherCostOrOtherBasis |
| Book Value | 471979 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 686327 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | GOODWILL | Description |
| Book Value | 150000 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 150000 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO MEMBER | Description |
| Amount | $191,866 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 191866 | TotalOfAmounts |
| Total Revenue | 1311733 | TotalRevenue |
| Total Expenses | 1274356 | TotalExpenses |
| Excess Or Deficit For Year | 37377 | ExcessOrDeficitForYear |
| Other | -$110,765 | OtherAmount |
| Total Adjustments | -110765 | TotalAdjustments |
| Excess Or Deficit Per FS | -73388 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1200968 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -110765 | OtherRevenues |
| Revenue Not Rptd F990 | -110765 | RevenueNotRptdF990 |
| Revenue Subtotal | 1311733 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1311733 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1274356 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1274356 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1274356 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF HOSPICE OF SOUTHWEST IOWA. |
| PART X - Hospice of Southwest Iowa HAs ADOPTED FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY, INCLUDED IN FASB ASC SUBTOPIC 740-10, INCOME TAXES - OVERALL, HOSPICE OF SOUTHWEST IOWA RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. DURING 2010 AND 2009, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. PART XII, LINE 2D - RESTRICTED CONTRIBUTIONS RECLASS - ($110,765). |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARIE KNEDLER-BOARD MEMBER | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | PEOPLE'S BANK-DIRECTOR | Relationship |
| Amount Of Transaction | 116946 | AmountOfTransaction |
| Description Of Transaction | BANKING SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | EMMET TINLEY AND SUSAN TINLEY - FAMILY RELATIONSHIP. MARVIN ARNPRIESTER, KATHRYNE CUTLER, SUSAN TINLEY, JAMES SUMMERFELT AND EMMET TINLEY - BUSINESS RELATIONSHIP. |
| Form 990, Part VI, Section A, line 3 | HOSPICE OF SOUTHWEST IOWA entered into a Coordination of Services agreement with Alegent Health for Alegent Health to perform AND MANAGE FINANCIAL SERVICES FOR A MONTHLY FEE. SERVICES INCLUDE BUT ARE NOT LIMITED TO FINANCIAL REPORTING, BUDGETING, BILLING AND COLLECTION, FIXED ASSET MANAGEMENT AND TAX RETURN PREPARATION. IN ADDITION TO FINANCIAL SERVICES, ALEGENT HEALTH PROVIDES INFORMATION SYSTEMS SUPPORT, SECURITY, RISK MANAGEMENT AND CORPORATE COMPLIANCE, PURCHASING, MAINTENANCE AND VARIOUS OTHER SUPPORT SERVICES. IN ADDITION, HOSPICE OF SOUTHWEST IOWA LEASES ALL EMPLOYEES FROM ALEGENT HEALTH. ALEGENT HEALTH IS THE PARENT OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM, ONE OF HOSPICE OF SOUTHWEST IOWA CORPORATE MEMBERS. |
| Form 990, Part VI, Section A, line 6 | THE CORPORATE MEMBERS OF HOSPICE OF SOUTHWEST IOWA ARE ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION of POTTAWATTAMIE COUNTY, IOWA. |
| Form 990, Part VI, Section A, line 7a | ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION POTTAWATTAMIE COUNTY, IOWA SHALL APPOINT ONE HALF OF THE VOTING MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION OF EACH MEMBER'S APPOINTMENTS BY THE OTHER MEMBER. IF A CORPORATE MEMBER DOES NOT RATIFY THE APPOINTMENT OF ONE OR MORE OF THE DIRECTORS APPOINTED BY THE OTHER CORPORATE MEMBER, THEN THE PROCESS SET FORTH ABOVE WILL BE REPEATED UNTIL SUCH TIME AS ALL OF THE DIRECTOR POSITIONS ARE FILLED. |
| Form 990, Part VI, Section A, line 7b | THE BUSINESS AFFAIRS OF HOSPICE OF SOUTHWEST IOWA SHALL BE MANAGED BY OR UNDER THE DIRECTION OF THE BOARD OF DIRECTORS EXCEPT THAT THE FOLLOWING ACTIONS SHALL BE EFFECTIVE ONLY IF APPROVED BY THE BOARD OF DIRECTORS OF THE CORPORATION AND BY BOTH ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA: 1. ADOPTION OR AMENDMENT OF THE UNIFIED PHILOSOPHY AND MISSION. 2. THE SALE, LEASE, TRANSFER, ENCUMBRANCE OR DISPOSITION OF THE TANGIBLE PROPERTY OR INVESTMENTS OF THE CORPORATION HAVING A FAIR MARKET VALUE IN ANY INDIVIDUAL TRANSACTION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000) OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. 3. INCURRENCE, ASSUMPTION OR GUARANTY BY THE CORPORATION IN ANY INDIVIDUAL TRANSACTION OF LONG-TERM INDEBTEDNESS, INCLUDING CAPITAL LEASES OUTSTANDING FOR MORE THAN 365 DAYS, IN EXCESS OF THE GREATER OF FIVE HUNDRED THOUSAND DOLLARS ($500,000), OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. 4. MERGER, DISSOLUTION, CONSOLIDATION OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, EXCEPT FOR A MERGER IN WHICH HOSPICE OF SOUTHWEST IOWA IS THE SURVIVING ENTITY, AND THE TOTAL BOOK VALUE OF THE ASSETS OF THE MERGING ENTITY DOES NOT EXCEED TWENTY-FIVE PERCENT OF THE TOTAL BOOK VALUE OF THE ASSETS OF THE CORPORATION, OR SUCH GREATER VALUE AS MAY BE DETERMINED FROM TIME TO TIME BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, IOWA. |
| Form 990, Part VI, Section B, line 11 | Hospice of Southwest Iowa and Alegent Health have a Coordination of Service agreement in which Alegent provides the accounting and finance functions for Hospice of Southwest Iowa for a monthly fee. The tax department of Alegent Health prepares the Form 990 for Hospice of Southwest Iowa. Following the preparation of Form 990 by Alegent Health internal tax staff, the return is reviewed by the Alegent Health Tax Director, Chief Financial Officer, External Tax Advisor, and Hospice of Southwest IOWA'S Executive Director. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED A WEB LINK THAT DIRECTS THEM TO THE FINAL TAX RETURN AND all required schedules. Questions are REFERRED TO THE ALEGENT HEALTH TAX DIRECTOR and the Board is notified OF THE DATE THE tax return will be filed. |
| Form 990, Part VI, Section B, line 12c | Written Conflict of Interest Policy - HOSPICE OF SOUTHWEST IOWA has adopted the conflict of interest policy and conflict investigation process of Alegent Health. Annual completion of the disclosure statement is required By the Board of DIRECTORS. Stated disclosures are investigated by the Alegent Health Compliance Officer and reported to the Conflicts of Interest Committee. The Conflicts of Interest Committee reviews the investigation and makes recommendations to the Governance Committee. The Governance Committee makes the final determination of whether or not there is a disqualifying event and communicates it to the HOSPICE OF SOUTHWEST IOWA Board OF DIRECTORS. At any time a Board Member may declare a conflict of interest and recuse his/herself from the discussion. The individual is also required to disclose any known or possible conflicts of interest that arise during the calendar year. |
| Form 990, Part VI, Section C, line 19 | HOSPICE OF SOUTHWEST IOWA HAS ADOPTED THE CONFLICT OF INTEREST POLICY OF ALEGENT HEALTH, WHICH IS AVAILABLE TO THE PUBLIC AT WWW.ALEGENT.COM. HOSPICE OF SOUTHWEST IOWA DOES NOT MAKE THE GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. However, the Articles of Incorporation are available at www.sos.state.ne.us. |
| FORM 990, PART I, LINE 5 AND PART V, LINE 2A: | HOSPICE OF SOUTHWEST IOWA DOES NOT HAVE ANY EMPLOYEES. INDIVIDUALS PROVIDING SERVICES TO PATIENTS OF HOSPICE OF SOUTHWEST IOWA ARE LEASED FROM ALEGENT HEALTH. |
| FORM 990, PART V, LINE 1A: | AS PART OF THE COORDINATION OF SERVICES AGREEMENT WITH ALEGENT HEALTH, ALEGENT HEALTH PERFORMS THE ACCOUNTS PAYABLE FUNCTION FOR HOSPICE OF SOUTHWEST IOWA. HOSPICE OF SOUTHWEST IOWA REIMBURSES ALEGENT HEALTH FOR VENDOR PAYMENTS, THEREFORE NO FORM 1099S ARE ISSUED BY HOSPICE OF SOUTHWEST IOWA. ALEGENT HEALTH ISSUES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. HOWEVER, PER THE INSTRUCTIONS, THOSE 1099S ISSUED BY ALEGENT HEALTH ON BEHALF OF HOSPICE OF SOUTHWEST IOWA ARE REPORTED. |
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