2023-05-17T09:29:53-05:00 2022-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2021-07-01 420890973 OSCEOLA COMMUNITY HOSPITAL INC OSCE 7127542574 PO BOX 258 SIBLEY IA 51249 ANDREA JOHNSON DIRECTOR OF FINANCIAL OPS 7127542574 2023-05-16 1 ANDREA JOHNSON 999009999 LAURIE HANSON CPA P00851848 6053391999 2023-05-16 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z OSCEOLA REGIONAL HEALTH CENTER BEN DAVIS PO BOX 258 SIBLEY IA 51249 13800717 0 X HTTPS://WWW.OSCEOLARHC.ORG/ X 1960 IA TO PROVIDE HEALTHCARE TO THE CITIZENS OF OSCEOLA COUNTY AND THE SURROUNDING AREA. 9 9 164 206 0 0 4528946 795247 12335788 12733091 178795 125357 146061 147022 17189590 13800717 0 0 0 0 7391364 6630242 0 0 34164 7149188 7699051 14540552 14329293 2649038 -528576 24185263 21149323 7226471 5951383 16958792 15197940 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. 0 0 11059449 12727396 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. 11059449 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 28 0 1 164 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ANDREA JOHNSON 7127542574 600 9TH AVENUE NORTH SIBLEY IA 51249 BEN DAVIS CEO 40.00 0.50 X 178611 0 30602 TODD HELMERS PHYSICAL THERAPIST 40.00 0.00 X 130835 0 17366 WENDY MARCO CNO 40.00 0.00 X 104793 0 23782 CRAIG CARSTENS CFO UNTIL MAY 2022 40.00 0.50 X 39571 0 18296 NATHAN ROCKMAN PRESIDENT 0.50 0.00 X X 0 0 0 BILL BOER PRESIDENT-ELECT BEG 11/21 0.50 0.00 X X 0 0 0 AMBER BOSMA SECRETARY 0.50 0.00 X X 0 0 0 BRIAN MINO TREASURER 0.50 1.00 X X 0 0 0 ABBY DE ZEEUW TRUSTEE 0.50 0.00 X 0 0 0 PEGGI THIES TRUSTEE UNTIL 11/21 0.50 0.00 X 0 0 0 ROSALIE ARENDS TRUSTEE 0.50 1.00 X 0 0 0 BRUCE OSTERMAN TRUSTEE UNTIL 11/21 0.50 1.00 X 0 0 0 HOLLY WILSON TRUSTEE 0.50 1.00 X 0 0 0 GLORIA TORRES TRUSTEE 0.50 0.00 X 0 0 0 BRAD JENSEN TRUSTEE BEG 11/21 0.50 0.00 X 0 0 0 453810 0 90046 3 0 1 0 AVERA MCKENNAN 1325 S CLIFF AVE SIOUX FALLS SD 571175045 IT AND ADMIN SERVICES 426532 AVERA HEALTH 3900 W AVERA DR STE 301 SIOUX FALLS SD 57108 CODING & HIM SERVICES 364743 SANFORD USD MEDICAL CENTER PO BOX 5074 SIOUX FALLS SD 571175074 VARIOUS PROVIDERS 175582 MEDICAL SOLUTIONS LLC 1010 N 102ND ST STE 300 OMAHA NE 68114 TEMP NURSING SERVICE 161556 JOUNEY GROUP COMPANY 4500 W 58TH ST SIOUX FALLS SD 57108 CONSTRUCTION 144637 7 705653 89594 795247 PATIENT REVENUE 621400 11702032 11702032 CHILDCARE SERVICES 624410 535008 535008 AUXILIARY ACTIVITY 900099 5695 5695 490356 490356 12733091 3424 3424 91400 0 91400 91400 91400 121933 0 121933 121933 121933 55622 0 55622 55622 13800717 12727396 0 278074 X 272925 272925 4899362 4041480 837757 20125 147952 122045 25299 608 938246 773958 160434 3854 371757 284076 86142 1539 1730 1730 93558 93558 3235260 2335204 900056 145064 2608 142456 385208 224750 159860 598 182516 161130 16446 4940 27507 13975 13532 36140 8036 28104 145574 145574 1026901 811062 215109 730 134948 134948 MEDICAL SUPPLIES 1628272 1624476 3796 REPAIR AND MAINTENANCE 167816 159855 7833 128 DUE AND SUBSCRIPTION 14829 1561 13268 473728 214711 257375 1642 14329293 11059449 3235680 34164 545725 2216659 1261095 11096 1556497 1639223 9792 0 293727 299130 57476 131502 24106780 17999009 6496653 6107771 10254354 7927888 2771445 2556534 118750 250521 819749 8999 24185263 21149323 1058056 1178906 1837198 209902 3814672 3634199 516545 0 0 928376 7226471 5951383 X 16790368 15046519 168424 151421 16958792 15197940 24185263 21149323 X -528576 -1204314 -27962 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 201490 201490 13780768 10091250 3689518 9247082 7241464 2005618 877440 666295 211145 6107771 INTEREST IN AVERA HEALTH FOUNDATION 2355065 F CLOSELY-HELD EQUITY INVESTMENTS 201469 F 2556534 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 424232 CAPITAL LEASE LIABILITY 504144 928376 X 12585444 -1204314 -1204314 13789758 10959 10959 13800717 14329293 0 14329293 0 14329293 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 32000 32000 0.00220 859701 673069 186632 0.01300 891701 673069 218632 0.01520 26476 26476 0.00180 1392756 728626 664130 0.04630 1419232 728626 690606 0.04810 2310933 1401695 909238 0.06330 1 186972 30439 7019575 6963136 56439 X 1 1 1 1 OSCEOLA COMMUNITY HOSPITAL 600 NINTH AVENUE NORTH SIBLEY IA 51249 HTTPS://WWW.OSCEOLARHC.ORG/ 720109H X X X X OSCEOLA COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE 7D X SEE PART V SECTION B X X 1 21 1 SEE PART V SECTION B 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X HTTPS://WWW.OSCEOLARHC.ORG/PATIENTS-VISITORS/PAY-MY-BILL/ X X X X X X 1 X 0 X X X X 1 X 0 0 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/ 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. X X X 0 0 0 0 0 0 0 0 0 BEN DAVIS CEO 178611 0 0 0 0 0 17366 0 18867 0 214844 0 0 0 A CITY OF SIBLEYIA 426005203 2016-02-24 4776000 TO REFINANCE SERIES 2001 AND 2007 BONDS 0 0 0 A 1076131 4776000 95520 4680101 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 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. HEARTWOOD HEIGHTS 409 9TH AVE NORTH SIBLEY IA 51249 421495686 INDEPENDENT;ASSISTED LIVING IA 501(C)(3) PF OSCEOLA COMMUNITY HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 HEARTWOOD HEIGHTS O 529041 ACTUAL COST