OSCEOLA COMMUNITY HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- OSCEOLA COMMUNITY HOSPITAL INC (EIN 42-0890973)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-17
- IRS object ID
- 202301379349300720
- Schema version
- 2021v4.2
- 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 J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-17T09:29:53-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E 10TH ST STE 500 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571046375 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420890973 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OSCE | BusinessNameControlTxt |
| Phone | 7127542574 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 258 | AddressLine1Txt |
| City | SIBLEY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51249 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREA JOHNSON | PersonNm |
| Person Title | DIRECTOR OF FINANCIAL OPS | PersonTitleTxt |
| Phone | 7127542574 | PhoneNum |
| Signature | 2023-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ANDREA | PersonFirstNm |
| Person Last | JOHNSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAURIE HANSON CPA | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2023-05-16 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA REGIONAL HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BEN DAVIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 258 | AddressLine1Txt |
| City | SIBLEY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,800,717 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.OSCEOLARHC.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1960 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTHCARE TO THE CITIZENS OF OSCEOLA COUNTY AND THE SURROUNDING AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 164 | TotalEmployeeCnt |
| Total Volunteers | 206 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,528,946 | PYContributionsGrantsAmt |
| CY Contributions Grants | $795,247 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,335,788 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,733,091 | CYProgramServiceRevenueAmt |
| PY Investment Income | $178,795 | PYInvestmentIncomeAmt |
| CY Investment Income | $125,357 | CYInvestmentIncomeAmt |
| PY Other Revenue | $146,061 | PYOtherRevenueAmt |
| CY Other Revenue | $147,022 | CYOtherRevenueAmt |
| PY Total Revenue | $17,189,590 | PYTotalRevenueAmt |
| CY Total Revenue | $13,800,717 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,391,364 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,630,242 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $34,164 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,149,188 | PYOtherExpensesAmt |
| CY Other Expenses | $7,699,051 | CYOtherExpensesAmt |
| PY Total Expenses | $14,540,552 | PYTotalExpensesAmt |
| CY Total Expenses | $14,329,293 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,649,038 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$528,576 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,185,263 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,149,323 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,226,471 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,951,383 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,958,792 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,197,940 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,059,449 | ExpenseAmt |
| Revenue | $12,727,396 | RevenueAmt |
| Desc | 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 PROVIDES DAY CARE TO THE COMMUNITY. HEALTH SCREENINGS SUCH AS CHOLESTEROL 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. THE FACILITY'S WELLNESS CENTER PROVIDES PROGRAMS TO THE LOCAL SCHOOL SYSTEM, NURSING HOME FACILITIES, OUTPATIENTS, AND THE COMMUNITY AT LARGE. DURING THE 12 MONTHS OF 7/01/2021-6/30/2022 THE HOSPITAL PROVIDED $59,924 OF CHARITY CARE CHARGES TO VARIOUS INDIVIDUALS, WITHOUT REIMBURSEMENT. | Desc |
| Total Program Service Expenses | $11,059,449 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 164 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDREA JOHNSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7127542574 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 9TH AVENUE NORTH | AddressLine1Txt |
| City | SIBLEY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51249 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| BEN DAVIS | ||||||||
| CEO | 40.00 | 0.50 | Yes (X) | $178,611 | $0 | $30,602 | ||
| TODD HELMERS | ||||||||
| PHYSICAL THERAPIST | 40.00 | 0.00 | $130,835 | $0 | $17,366 | Yes (X) | ||
| WENDY MARCO | ||||||||
| CNO | 40.00 | 0.00 | $104,793 | $0 | $23,782 | Yes (X) | ||
| CRAIG CARSTENS | ||||||||
| CFO UNTIL MAY 2022 | 40.00 | 0.50 | Yes (X) | $39,571 | $0 | $18,296 | ||
| NATHAN ROCKMAN | ||||||||
| PRESIDENT | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BILL BOER | ||||||||
| PRESIDENT-ELECT BEG 11/21 | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| AMBER BOSMA | ||||||||
| SECRETARY | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BRIAN MINO | ||||||||
| TREASURER | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ABBY DE ZEEUW | ||||||||
| TRUSTEE | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| PEGGI THIES | ||||||||
| TRUSTEE UNTIL 11/21 | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ROSALIE ARENDS | ||||||||
| TRUSTEE | 0.50 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| BRUCE OSTERMAN | ||||||||
| TRUSTEE UNTIL 11/21 | 0.50 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| HOLLY WILSON | ||||||||
| TRUSTEE | 0.50 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GLORIA TORRES | ||||||||
| TRUSTEE | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| BRAD JENSEN | ||||||||
| TRUSTEE BEG 11/21 | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $453,810 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $90,046 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AVERA MCKENNAN | |||||
| 1325 S CLIFF AVE | SIOUX FALLS | SD | 571175045 | IT AND ADMIN SERVICES | $426,532 |
| AVERA HEALTH | |||||
| 3900 W AVERA DR STE 301 | SIOUX FALLS | SD | 57108 | CODING & HIM SERVICES | $364,743 |
| SANFORD USD MEDICAL CENTER | |||||
| PO BOX 5074 | SIOUX FALLS | SD | 571175074 | VARIOUS PROVIDERS | $175,582 |
| MEDICAL SOLUTIONS LLC | |||||
| 1010 N 102ND ST STE 300 | OMAHA | NE | 68114 | TEMP NURSING SERVICE | $161,556 |
| JOUNEY GROUP COMPANY | |||||
| 4500 W 58TH ST | SIOUX FALLS | SD | 57108 | CONSTRUCTION | $144,637 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $705,653 | GovernmentGrantsAmt |
| All Other Contributions | $89,594 | AllOtherContributionsAmt |
| Total Contributions | $795,247 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PATIENT REVENUE | 621400 | $11,702,032 | $11,702,032 | |
| CHILDCARE SERVICES | 624410 | $535,008 | $535,008 | |
| AUXILIARY ACTIVITY | 900099 | $5,695 | $5,695 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $490,356 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $490,356 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,733,091 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,424 | TotalRevenueColumnAmt |
| Exclusion | $3,424 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $91,400 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $91,400 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,400 | TotalRevenueColumnAmt |
| Exclusion | $91,400 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $121,933 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $121,933 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $121,933 | TotalRevenueColumnAmt |
| Exclusion | $121,933 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $55,622 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,622 | TotalRevenueColumnAmt |
| Exclusion | $55,622 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,800,717 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,727,396 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $278,074 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,925 | TotalAmt |
| Management And General | $272,925 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,899,362 | TotalAmt |
| Program Services | $4,041,480 | ProgramServicesAmt |
| Management And General | $837,757 | ManagementAndGeneralAmt |
| Fundraising | $20,125 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,952 | TotalAmt |
| Program Services | $122,045 | ProgramServicesAmt |
| Management And General | $25,299 | ManagementAndGeneralAmt |
| Fundraising | $608 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $938,246 | TotalAmt |
| Program Services | $773,958 | ProgramServicesAmt |
| Management And General | $160,434 | ManagementAndGeneralAmt |
| Fundraising | $3,854 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,757 | TotalAmt |
| Program Services | $284,076 | ProgramServicesAmt |
| Management And General | $86,142 | ManagementAndGeneralAmt |
| Fundraising | $1,539 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,730 | TotalAmt |
| Management And General | $1,730 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,558 | TotalAmt |
| Management And General | $93,558 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,235,260 | TotalAmt |
| Program Services | $2,335,204 | ProgramServicesAmt |
| Management And General | $900,056 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,064 | TotalAmt |
| Program Services | $2,608 | ProgramServicesAmt |
| Management And General | $142,456 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $385,208 | TotalAmt |
| Program Services | $224,750 | ProgramServicesAmt |
| Management And General | $159,860 | ManagementAndGeneralAmt |
| Fundraising | $598 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,516 | TotalAmt |
| Program Services | $161,130 | ProgramServicesAmt |
| Management And General | $16,446 | ManagementAndGeneralAmt |
| Fundraising | $4,940 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,507 | TotalAmt |
| Program Services | $13,975 | ProgramServicesAmt |
| Management And General | $13,532 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,140 | TotalAmt |
| Program Services | $8,036 | ProgramServicesAmt |
| Management And General | $28,104 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,574 | TotalAmt |
| Program Services | $145,574 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,026,901 | TotalAmt |
| Program Services | $811,062 | ProgramServicesAmt |
| Management And General | $215,109 | ManagementAndGeneralAmt |
| Fundraising | $730 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,948 | TotalAmt |
| Program Services | $134,948 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $1,628,272 | $1,624,476 | $3,796 | |
| REPAIR AND MAINTENANCE | $167,816 | $159,855 | $7,833 | $128 |
| DUE AND SUBSCRIPTION | $14,829 | $1,561 | $13,268 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $473,728 | TotalAmt |
| Program Services | $214,711 | ProgramServicesAmt |
| Management And General | $257,375 | ManagementAndGeneralAmt |
| Fundraising | $1,642 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,329,293 | TotalAmt |
| Program Services | $11,059,449 | ProgramServicesAmt |
| Management And General | $3,235,680 | ManagementAndGeneralAmt |
| Fundraising | $34,164 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $545,725 | BOYAmt |
| EOY | $2,216,659 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,261,095 | BOYAmt |
| EOY | $11,096 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,556,497 | BOYAmt |
| EOY | $1,639,223 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,792 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $293,727 | BOYAmt |
| EOY | $299,130 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,476 | BOYAmt |
| EOY | $131,502 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,106,780 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,999,009 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,496,653 | BOYAmt |
| EOY | $6,107,771 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,254,354 | BOYAmt |
| EOY | $7,927,888 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,771,445 | BOYAmt |
| EOY | $2,556,534 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,750 | BOYAmt |
| EOY | $250,521 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $819,749 | BOYAmt |
| EOY | $8,999 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,185,263 | BOYAmt |
| EOY | $21,149,323 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,058,056 | BOYAmt |
| EOY | $1,178,906 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,837,198 | BOYAmt |
| EOY | $209,902 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,814,672 | BOYAmt |
| EOY | $3,634,199 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $516,545 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $928,376 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,226,471 | BOYAmt |
| EOY | $5,951,383 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,790,368 | BOYAmt |
| EOY | $15,046,519 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $168,424 | BOYAmt |
| EOY | $151,421 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,958,792 | BOYAmt |
| EOY | $15,197,940 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,185,263 | BOYAmt |
| EOY | $21,149,323 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$528,576 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,204,314 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$27,962 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $201,490 | OtherCostOrOtherBasisAmt |
| Book Value | $201,490 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,780,768 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,091,250 | DepreciationAmt |
| Book Value | $3,689,518 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,247,082 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,241,464 | DepreciationAmt |
| Book Value | $2,005,618 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $877,440 | OtherCostOrOtherBasisAmt |
| Depreciation | $666,295 | DepreciationAmt |
| Book Value | $211,145 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,107,771 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INTEREST IN AVERA HEALTH FOUNDATION | $2,355,065 | F |
| CLOSELY-HELD EQUITY INVESTMENTS | $201,469 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $2,556,534 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENT | $424,232 |
| CAPITAL LEASE LIABILITY | $504,144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $928,376 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,585,444 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$1,204,314 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$1,204,314 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,789,758 | RevenueSubtotalAmt |
| Other Revenues Not Included | $10,959 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $10,959 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,800,717 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,329,293 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $14,329,293 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,329,293 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HEALTH CENTER BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HEALTH CENTER WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE HEALTH CENTER AND AFFILIATE'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS WITH DONOR RESTRICTIONS 5,264. AUXILIARY ACTIVITY 5,695. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $859,701 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $673,069 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $186,632 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $891,701 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $673,069 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $218,632 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,476 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,476 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,392,756 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $728,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $664,130 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04630 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,419,232 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $728,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $690,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,310,933 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,401,695 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $909,238 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06330 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $186,972 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $30,439 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,019,575 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,963,136 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $56,439 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NINTH AVENUE NORTH | AddressLine1Txt |
| City | SIBLEY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.OSCEOLARHC.ORG/ | WebsiteAddressTxt |
| State License | 720109H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE 7D | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V SECTION B | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V SECTION B | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OSCEOLA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: DURING THE FISCAL YEAR ENDED JUNE 30, 2022 A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY OSCEOLA REGIONAL HEALTH CENTER FOR THE APPROXIMATELY 12,000 PEOPLE RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN DEFINING COMMUNITY, OSCEOLA REGIONAL HEALTH CENTER HAS TAKEN INTO CONSIDERATION ALL MEMBERS OF OSCEOLA COUNTY AND OUR LARGER SERVICE AREA (LYON, O'BRIEN, DICKINSON AND NOBLES, MN COUNTIES), REGARDLESS OF SOCIO-ECONOMIC STATUS. OSCEOLA REGIONAL HEALTH CENTER IS COMMITTED TO MEETING THE NEEDS OF ALL WHO NEED CARE REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITIES LOCATED IN THIS GEOGRAPHIC AREA INCLUDE BUT ARE NOT LIMITED TO: ASHTON, BOYDEN, GEORGE, HARRIS, LAKE PARK, LITTLE ROCK, MELVIN, OCHEYEDAN, SHELDON, AND SIBLEY IN IOWA, AND BIGELOW, RUSHMORE, AND WORTHINGTON IN MINNESOTA. QUALITATIVE AND QUANTITATIVE INFORMATION WAS GATHERED AND BASED ON CENSUS DATA, TECHNICAL DATA AND FOCUS GROUP FEEDBACK FROM COMMUNITY ORGANIZATIONS, LEADERS, CONSUMERS, AND HEALTH PROFESSIONALS. |
| OSCEOLA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6B: OSCEOLA PUBLIC HEALTH |
| OSCEOLA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 7D: HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/OSCEOLA-COUNTY-CHNA/ |
| OSCEOLA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS COMPLETED DURING FY22, THE FOLLOWING HEALTH NEED PRIORITIES WERE IDENTIFIED: ACCESS TO CARE (DENTAL CARE, PEDIATRIC CARE, SPECIALTY CARE) ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES COMMUNITY WELLNESS/PREVENTION EMERGENCY MEDICAL SERVICES (EMS) NON-HEALTHCARE - HOUSINGMANY OF THE NEEDS ARE CONTINUATIONS OF NEEDS IDENTIFIED IN THE FY19 CHNA PROCESS. FOLLOWING ARE THE ACTIONS THAT OCH TOOK DURING THE YEAR TO ADDRESS NEEDS IDENTIFIED IN ITS FY19 CHNA:ACCESS TO CARE DENTAL CARE: IN PARTNERSHIP WITH THE OSCEOLA COUNTY ECONOMIC DEVELOPMENT, A RECRUITMENT STRATEGY HAS BEEN DEVELOPED TO ATTRACT A DENTAL PROVIDER TO OSCEOLA COUNTY. RECRUITMENT EFFORTS HAVE AND WILL CONTINUE TO BE A MAIN PRIORITY. SPECIALTY CARE: AREA SPECIALISTS HAVE BEEN IDENTIFIED AND CONTACTED. ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES OSCEOLA REGIONAL HEALTH CENTER HAS PARTNERED WITH INTERCONNECTIONS THERAPY TO HAVE A FULL TIME MENTAL HEALTH COUNSELOR WHO PROVIDES INDIVIDUAL, FAMILY, AND COUPLES THERAPY/COUNSELING. IN APRIL 2022, OSCEOLA REGIONAL HEALTH CENTER RECRUITED A PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER (PMHNP) TO MEET THE ONGOING NEEDS OF THE COMMUNITY. THE PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER HELD COMMUNITY EDUCATION EVENTS AT A LOCAL BUSINESS TO EDUCATE THE PUBLIC ON THE IMPORTANCE OF MENTAL HEALTH IN OUR COMMUNITY. COMMUNITY WELLNESS/PREVENTION THE OSCEOLA REGIONAL HEALTH CENTER WELLNESS CENTER PARTNERED WITH LIVE HEALTHY IOWA TO PROMOTE PHYSICAL FITNESS. THE OSCEOLA COUNTY PUBLIC HEALTH OFFICE WHICH IS LOCATED ON THE OSCEOLA REGIONAL HEALTH CENTER CAMPUS PROVIDES IMMUNIZATIONS, BEST CARE FOR BETTER BABIES PROGRAM, FOOT CARE AND THE HOMEMAKER PROGRAM, WHICH ALL SUPPORT COMMUNITY HEALTH AND PREVENTION. EMERGENCY MANAGEMENT SERVICES (EMS) SUPPORT THE NEED FOR ADDITIONAL FUNDING FOR EMERGENCY MEDICAL SERVICES. OSCEOLA COUNTY CURRENT OWNS AND OPERATES THE EMS SERVICES IN THE COUNTY. OSCEOLA COUNTY HAS BEEN COMMITTED TO ENSURING THE LONG-TERM VIABILITY OF THE EMS SERVICES AND HAS PROVIDED FUNDING FOR EDUCATIONAL OPPORTUNITIES. NON-HEALTHCARE HOUSING OSCEOLA REGIONAL HEALTH CENTER IS ACTIVELY ENGAGED IN THE SIBLEY HOUSING DEVELOPMENT COMMITTEE AND IS IDENTIFYING OPPORTUNITIES FOR ADDITIONAL HOUSING.OCH IS WORKING WITH THE CITY OF SIBLEY, SIBLEY-OCHEYEDAN SCHOOL DISTRICT, AND THE OSCEOLA COUNTY BOARD OF SUPERVISORS AS WELL AS LOCAL ORGANIZATIONS TO ADDRESS THE NEED FOR ADDITIONAL DAYCARE PROVIDERS AND TO PROMOTE DAYCARE SERVICES. A CHILDCARE STRATEGIC PLANNING COMMITTEE WAS CREATED TO ADDRESS THE CHILDCARE SERVICES SHORTAGE. OCH ACTIVELY PARTICIPATES IN THE PLANNING AND IMPLEMENTATION. RECREATIONAL ACTIVITIES, PARKS AND TRAILS, AND HOUSING WERE IDENTIFIED AS NEEDS OF THE COMMUNITY. DUE TO LIMITED RESOURCES, THESE NEEDS HAVE NOT BEEN ADDRESSED BY OCH. |
| OSCEOLA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 13H: THE HOSPITAL WILL PRESUMPTIVELY DETERMINE THAT AN INDIVIDUAL QUALIFIES FOR 100% FINANCIAL ASSISTANCE IF THE HOSPITAL OR ITS AGENT OBTAINS EVIDENCE OF ANY OF THE FOLLOWING SITUATIONS. IF A PERSON IS PRESUMPTIVELY DETERMINED TO QUALIFY, THE HOSPITAL WILL SEND A WRITTEN NOTICE INFORMING THE INDIVIDUAL THAT THEIR LIABILITY HAS BEEN FORGIVEN AND NO FURTHER PAYMENTS ARE DUE.-HOMELESSNESS OR RECEIVED CARE FROM A HOMELESS CLINIC;-NO INCOME;-PARTICIPATE IN THE WOMEN'S, INFANT'S, AND CHILDREN'S PROGRAM ("WIC");-ELIGIBLE FOR FOOD STAMPS;-PARTICIPATE IN A SUBSIDIZED SCHOOL LUNCH PROGRAM;-ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED, SUCH AS MEDICAID SPEND-DOWN;-FAMILY OR FRIENDS OF THE INDIVIDUAL PROVIDE INFORMATION ESTABLISHING THE INDIVIDUAL'S INABILITY TO PAY;-LOW-INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;-PATIENT IS DECEASED WITH NO KNOWN ESTATE; OR-PATIENT/GRANTOR IS INCARCERATED, HAS NO ASSETS, AND IS NOT ELIGIBLE FOR PAROLE WITHIN THE NEXT 18 MONTHS. |
| PART V, SECTION B, LINE 10A | THE IMPLEMENTATION STRATEGY IS AVAILABLE AT: HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/OSCEOLA-COUNTY-CHNA/ |
| PART V, SECTION B, LINE 7B | THE COMMUNITY HEALTH NEEDS ASSESSMENT (AS WELL AS THE IMPLEMENTATION STRATEGY) CAN ALSO BE FOUND AT: HTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO USING FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE FACILITY USES AN ASSET TEST AND MAY PROVIDE PRESUMPTIVE ELIGIBILITY IF WARRANTED. |
| PART I, LINE 6A: | THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS INCLUDED IN A REPORT PREPARED BY THE IOWA HOSPITAL ASSOCIATION, RATHER THAN IN A SEPARATE REPORT PREPARED BY THE ORGANIZATION. THIS REPORT IS MADE AVAILABLE BY THE IOWA HOSPITAL ASSOCIATION TO THE PUBLIC THROUGH THEIR WEBSITE. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7B: UNREIMBURSED MEDICAID WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORT. ACTUAL COSTS FROM THE GENERAL LEDGER WERE USED FOR LINE 7E.LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. |
| PART III, LINE 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2021. THEREFORE, 16.28% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. |
| PART III, LINE 4: | THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGE 13 AND 14 OF THE ATTACHED AUDIT REPORT. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/22. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | IF AN INDIVIDUAL SUBMITS A FINANCIAL ASSISTANCE APPLICATION, THE HOSPITAL WILL CEASE ALL COLLECTION EFFORTS UNTIL A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IS MADE.IF THE HOSPITAL OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION, THE EXTRAORDINARY COLLECTION ACTION WILL BE SUSPENDED. SUSPENDING AN ACTION MEANS THAT NO FURTHER STEPS ARE TAKEN ON THAT EXTRAORDINARY COLLECTION ACTION AND NO NEW EXTRAORDINARY COLLECTION ACTIONS ARE INITIATED. THIS SUSPENSION MAY BE LIFTED WHEN THE HOSPITAL DETERMINES THE INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFIES THE INDIVIDUAL AS PRESCRIBED IN THE FINANCIAL ASSISTANCE POLICY.IF THE HOSPITAL OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL AND/OR THE OTHER AUTHORIZED PARTY WILL TAKE ALL REASONABLY AVAILABLE MEASURES TO REVERSE THE EXTRAORDINARY COLLECTION ACTION. SUCH STEPS INCLUDE, BUT ARE NOT LIMITED TO, VACATING A JUDGEMENT AGAINST THE INDIVIDUAL, LIFTING A LEVY OR LIEN ON THE INDIVIDUAL'S PROPERTY, AND REMOVING FROM THE INDIVIDUAL'S CREDIT REPORT ANY ADVERSE INFORMATION THAT WAS REPORTED.IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION, THE HOSPITAL WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS, AND PROVIDE A WRITTEN NOTICE TO THE RESPONSIBLE PARTY THAT INCLUDES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION THAT MUST BE SUBMITTED, THE PHYSICAL LOCATION AND PHONE NUMBER OF A HOSPITAL EMPLOYEE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, THE PHYSICAL LOCATION AND PHONE NUMBER OF AN ORGANIZATION OR HOSPITAL EMPLOYEE/OFFICE/DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. THE HOSPITAL WILL ALLOW A REASONABLE AMOUNT OF TIME FOR THE RESPONSIBLE PARTY TO SUBMIT A COMPLETE FINANCIAL ASSISTANCE APPLICATION. SUCH PERIOD OF TIME WILL BE AT LEAST 30 DAYS FROM THE DATE THE WRITTEN NOTICE IS SENT TO THE RESPONSIBLE PARTY. IF THE RESPONSIBLE PARTY FAILS TO PROVIDE THE REQUESTED INFORMATION WITHIN THE STATED TIME, THE HOSPITAL MAY RENEW THE PREVIOUSLY INITIATED EXTRAORDINARY COLLECTION ACTIONS. IF AN INDIVIDUAL HAS MADE FULL OR PARTIAL PAYMENT, AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, ANY PAYMENTS IN EXCESS OF THEIR NEWLY CALCULATED REMAINING LIABILITY WILL BE REFUNDED TO THE PATIENT WITHIN 30 DAYS OF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION. IF THE REFUNDABLE AMOUNT IS LESS THAN $5.00, IT WILL NOT BE REFUNDED. |
| 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 AND 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 REQUESTED 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 APPROVE 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. 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: | DURING FISCAL YEAR 2022 A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY OSCEOLA COMMUNITY HOSPITAL FOR THE APPROXIMATELY 12,000 PEOPLE RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN DEFINING COMMUNITY, OSCEOLA COMMUNITY HOSPITAL HAS TAKEN IN TO CONSIDERATION ALL MEMBERS OF OSCEOLA COUNTY AND OUR LARGER SERVICE AREA (LYON, O'BRIEN, DICKINSON AND NOBLES, MN COUNTIES) REGARDLESS OF SOCIO-ECONOMIC STATUS. OSCEOLA COMMUNITY HOSPITAL IS COMMITTED TO MEETING THE NEEDS OF ALL WHO NEED CARE REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITIES LOCATED IN THIS GEOGRAPHIC AREA INCLUDE BUT ARE NOT LIMITED TO: ASHTON, BOYDEN, GEORGE, HARRIS, LAKE PARK, LITTLE ROCK, MELVIN, OCHEYEDAN, SHELDON, AND SIBLEY IN IOWA, AND BIGELOW, RUSHMORE, AND WORTHINGTON IN MINNESOTA.THE CURRENT POPULATION IN SIBLEY IS 2,817. THE MEDIAN AGE OF THE POPULATION IS 41.1 AND 93.61% BEING CAUCASIAN. THE AVERAGE HOUSEHOLD INCOME IS $70,682 AND A POVERTY RATE OF 16.28%. THE AVERAGE HOUSEHOLD SIZE IS 2.9. |
| PART VI, LINE 5: | OSCEOLA COMMUNITY HOSPITAL IS FOCUSED ON SERVING THE NEEDS OF THE COMMUNITY. THE GOVERNING BODY OF THE HOSPITAL IS MADE UP ENTIRELY OF VOLUNTEERS FOR THE COMMUNITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN ITS COMMUNITY. EXCESS FUNDS ARE USED FOR THE IMPROVEMENT OF PATIENT CARE AND FACILITIES. THE HOSPITAL IS CONTRACTED WITH SEVERAL HIGHER LEARNING HEALTH CARE RELATED INSTITUTIONS TO BE A CLINICAL SITE FOR VARIOUS HEALTH CARE FIELDS. THE FACILITY IS OPEN TO ANYONE WHO WANTS TO LEARN ABOUT CAREERS IN THE HEALTH CARE INDUSTRY THROUGH THE CLINICAL PROGRAM AND THROUGH A HIGH SCHOOL SHADOWING PROGRAM. THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL ADMINISTRATION IS VERY RECEPTIVE TO INPUT FROM THE COMMUNITY. OSCEOLA COMMUNITY HOSPITAL DEDICATES RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU SHOT CLINICS, BLOOD DRIVES, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. WE ALSO HAVE A FITNESS CENTER SO PATIENTS AND THE COMMUNITY CAN MAINTAIN A HEALTHY LIFESTYLE. |
| PART VI, LINE 6: | OSCEOLA COMMUNITY HOSPITAL IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND OSCEOLA COMMUNITY HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. OSCEOLA COMMUNITY HOSPITAL ALSO HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCE ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO THE HOSPITAL AT A COST BELOW THAT WHICH OSCEOLA COMMUNITY HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. AVERA HEALTH AND OSCEOLA COMMUNITY HOSPITAL DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BEN DAVIS | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $178,611 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $17,366 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $18,867 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $214,844 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF SIBLEYIA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 426005203 | BondIssuerEIN |
| Bond Issued | 2016-02-24 | BondIssuedDt |
| Issue Price | $4,776,000 | IssuePriceAmt |
| Purpose | TO REFINANCE SERIES 2001 AND 2007 BONDS | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,076,131 | RetiredAmt |
| Total Proceeds | $4,776,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $95,520 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $4,680,101 | OtherSpentProceedsAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | 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 BUSINESS 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 4 | ARTICLE I OF THE BYLAWS WAS AMENDED TO UPDATE WHO CAN BE CLASSIFIED AS REGULAR MEMBERS, AND THE THRESHOLD IT TAKES TO BECOME A REGULAR MEMBER. THE MINIMUM AMOUNT TO BECOME A MEMBER WAS $75, AND NOW THE MINIMUM IS $100. THE AMENDMENT WAS ADOPTED IN AUGUST OF 2021 BY 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 $100 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 TO 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 | TRUSTEES ARE ELECTED TO THE BOARD OF TRUSTEES FROM THE MEMBERS AT THE ANNUAL MEETING OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT OF THE HOSPITAL. A COPY OF THE 990 WILL BE PROVIDED TO BOARD MEMBERS PRIOR TO FILING IT WITH THE IRS. |
| 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 CONFLICTS 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 SEMI-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 COMPENSATION REVIEW PROCESS IS COMPLETED ANNUALLY 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 IS AVAILABLE AT THE ANNUAL MEETING AND UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,052,735. MANAGEMENT AND GENERAL EXPENSES 900,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,952,791. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,282,469. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,282,469. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -8,998. NET ASSETS RELEASED FROM RESTRICTIONS -13,269. AUXILIARY ACTIVITY -5,695. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEARTWOOD HEIGHTS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 409 9TH AVE NORTH | AddressLine1Txt |
| City | SIBLEY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421495686 | EIN |
| Primary Activities | INDEPENDENT;ASSISTED LIVING | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | PF | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEARTWOOD HEIGHTS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | O | TransactionTypeTxt |
| Involved | $529,041 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL COST | MethodOfAmountDeterminationTxt |