2020-06-05T11:47:11-05:00 2019-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2018-07-01 420890973 OSCEOLA COMMUNITY HOSPITAL INC D/B/A OSCEOLA REGIONAL HEALTH CENTER OSCE 7127542574 PO BOX 258 SIBLEY IA 51249 BEN DAVIS CEO 7127542574 2020-06-04 1 LAURIE HANSON P00851848 6053391999 2020-06-04 67.130.171.59 2020-06-04 11:29:41 CD P C5ADF3E96DC5FD5E5884512D59AB882B10EDFEC1 F7BA031C655DF5D2BE7843B8A6CBF62E51E7FB61 2018 2020-09-23 17:36:50Z BEN DAVIS PO BOX 258 SIBLEY IA 51249 13844024 0 X HTTPS://WWW.OSCEOLARHC.ORG/ X 1960 IA TO PROVIDE HEALTHCARE TO THE CITIZENS OF OSCEOLA COUNTY AND THE SURROUNDING AREA. 10 10 138 198 0 0 745100 454667 11015329 10804558 133509 142489 220241 215408 12114179 11617122 0 0 0 0 6112553 4847421 0 0 46077 6809080 6694784 12921633 11542205 -807454 74917 17695728 17734737 5273843 5096957 12421885 12637780 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 8381059 10826880 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 7/01/2018-6/30/2019 THE HOSPITAL PROVIDED $79,000 OF CHARITY CARE TO VARIOUS INDIVIDUALS, WITHOUT REIMBURSEMENT. 8381059 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 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 0 0 0 1 28 0 1 138 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CRAIG CARSTENS 7127542574 600 9TH AVENUE NORTH SIBLEY IA 51249 BARB VAN DIEPEN PRESIDENT 1.00 0.00 X X 0 0 0 KEVIN HERTZ VICE PRESIDENT 1.00 0.00 X X 0 0 0 STANLEY JOHNSON TREASURER UNTIL 05/2019 1.00 1.00 X X 0 0 0 BRIAN MINO TREASURER FROM 05/2019 1.00 0.00 X X 0 0 0 PEGGI THIES SECRETARY 1.00 0.00 X X 0 0 0 ROSALI ARENDS TRUSTEE 1.00 1.00 X 0 0 0 SUELLEN SCHUTTE TRUSTEE 1.00 1.00 X 0 0 0 BRUCE OSTERMAN TRUSTEE 1.00 1.00 X 0 0 0 NATHAN ROCKMAN TRUSTEE 1.00 0.00 X 0 0 0 BRIAN MINO TRUSTEE 1.00 0.00 X 0 0 0 BRIAN DREESSEN TRUSTEE 1.00 0.00 X 0 0 0 BEN DAVIS CEO 40.00 0.50 X 147862 0 21610 CRAIG CARSTENS CFO 40.00 0.50 X 79550 0 11354 WILLIAM LEE SURGEON 40.00 0.00 X 368492 0 19755 595904 0 52719 2 1 1 0 AVERA MCKENNAN 800 E 21ST ST SIOUX FALLS SD 57117 ADMINISTRATIVE AND MEDICAL SERVICES 1781194 CARDINAL HEALTH 7000 CARDINAL PL DUBLIN OH 43017 PHARMACY 553281 GREAT LAKE PHYSICAL THERAPY 3301 BERGQUIST AVE SPIRIT LAKE IA 51360 PHYSICAL THERAPY SERVICES 452450 JOURNEY GROUP COMPANIES 4500 W 58TH ST SIOUX FALLS SD 57108 CONSTRUCTION 278835 SANFORD HOSPITAL PO BOX 5074 SIOUX FALLS SD 57117 CRNA COVERAGE, SPEECH THERAPY, LAB 115001 11 52377 402290 454667 PATIENT REVENUE 621400 10022938 10022938 CHILDCARE SERVICES 621400 446222 446222 335398 335398 10804558 41867 41867 111450 0 111450 111450 111450 2252886 74638 2152264 74638 100622 0 100622 100622 81636 0 81636 81636 A/R INTEREST 900099 22322 22322 22322 11617122 10826880 0 335575 X 264786 264786 3315621 2671652 612683 31286 81612 67087 14343 182 938228 663858 269710 4660 247174 209644 35241 2289 13147 13147 68676 68676 2734881 2202950 531203 728 142153 707 141446 330108 201459 128029 620 177925 156952 16446 4527 24318 18366 5952 12757 5948 6809 126453 126453 863230 216377 646691 162 87767 6243 81524 MEDICAL SUPPLIES 1439891 1439891 REPAIR AND MAINTENANCE 217529 202196 15333 BAD DEBT EXPENSES 104177 104177 DUES AND SUBSCRIPTIONS 17054 10928 6126 334718 202624 130471 1623 11542205 8381059 3115069 46077 1987378 1037737 54221 1054704 11800 2101076 1384930 8644 13574 369899 314468 54065 90204 21579765 15316331 6141988 6263434 3968859 5098538 2393454 2391731 85417 604344 0 17695728 17734737 914121 899078 4326222 4160394 33500 0 37485 5273843 5096957 X 12221302 12508095 200583 129685 12421885 12637780 17695728 17734737 X 74917 353109 -212131 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 201490 201490 13200699 8532924 4667775 672391 652467 19924 7484253 6130940 1353313 20932 20932 6263434 INTEREST IN NET ASSETS OF FOUNDATION 2293321 F CLOSELY-HELD EQUITY INVESTMENTS 98410 F 2391731 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 37485 37485 X PART X, LINE 2: THE HOSPITAL IS ORGANIZED AS AN IOWA NONPROFIT ORGANIZATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE SERVICE CODE SECTION 501(C)(3). THE ENTITY IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ENTITY IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. MANAGEMENT HAS DETERMINED THAT THE ENTITY IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. THE HOSPITAL 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 HOSPITAL 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 HOSPITAL'S TAX RETURN IS SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 1 X 1 X 1 X 1 1 0 1 1 41000 41000 0.00360 562139 410139 152000 0.01330 603139 410139 193000 0.01690 6 6279 21346 21346 0.00190 1351392 883223 468169 0.04090 6 6279 1372738 883223 489515 0.04280 6 6279 1975877 1293362 682515 0.05970 1 104177 4979922 5009603 -29681 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 18 1 0 1 1 X SEE 7D X X 1 18 1 SEE PART V PAGE 8 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 1 X 0 0 OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: OSCEOLA COMMUNITY HOSPITAL INC. CONDUCTED FOCUS GROUP MEETINGS AND ALSO CONDUCTED PERSONAL INTERVIEWS. CAREFUL CONSIDERATION WAS GIVEN TO ENSURE INPUT WAS GATHERED FROM PERSONS THAT REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY. THE HOSPITAL ENGAGED THE GENERAL PUBLIC TO INCLUDE VARIOUS AGES, HEALTH STATUS AND INCOME LEVELS, ALONG WITH MEDICAL COMMUNITY AND CIVIC ORGANIZATIONS, BUSINESS OWNERS, PUBLIC HEALTH OFFICIALS, EMERGENCY PERSONAL, CITY AND COUNTY OFFICIALS, SCHOOL PERSONNEL, MENTAL HEALTH PROVIDERS, MINISTERIAL ASSOCIATION MEMBERS, CHAMBER OF COMMERCE MEMBERS AND OTHER REPRESENTING THE UNINSURED AND UNDERINSURED POPULATION. 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/ABOUT/QUALITY-COMMITMENT/ OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE TAX YEAR AND AS SUCH THE HOSPITAL HAS NOT TAKEN SPECIFIC ACTIONS WITH RESPECT TO THE CURRENT IMPLEMENTATION STRATEGY. THE FOLLOWING COMMUNITY HEALTH PRIORITY AREAS WERE IDENTIFIED, AND THE FOLLOWING ACTIONS WILL BE TAKEN BY THE HOSPITAL DURING FUTURE YEARS.ACCESS TO HEALTH CARE PROVIDERS- IN PARTNERSHIP WITH AVERA MEDICAL GROUP SIBLEY, RECRUITMENT EFFORTS HAVE AND WILL CONTINUE TO BE A MAIN PRIORITY. OSCEOLA REGIONAL HEALTH CENTER WILL ALSO WORK TO RECRUIT AND RETAIN SPECIALTY PHYSICIANS.- OCH INTENDS TO PARTNER WITH MEDICAL SCHOOLS TO BRING MORE MEDICAL STUDENTS INTO OSCEOLA COUNTY FOR ROTATIONS.ACCESS TO MENTAL HEALTH/SUBSTANCE ABUSE SERVICES- OSCEOLA REGIONAL HEALTH CENTER HAS PARTNERED WITH SEASON CENTER FOR BEHAVIORAL HEALTH TO PROVIDE MENTAL HEALTH CLINICS IN OUR HOSPITAL AND WILL CONTINUE TO PARTNER WITH THEM TO IMPROVE SERVICES FOR OUR POPULATION. - OSCEOLA REGIONAL HEALTH CENTER INTENDS TO PARTNER WITH SENIOR LIFE SOLUTIONS FOR MENTAL HEALTH SERVICES FOR THOSE OVER THE AGE OF 65, AND TO PARTNER WITH OTHER MENTAL HEALTHCARE ORGANIZATIONS TO PROVIDE MENTAL HEALTH SERVICES.EMERGENCY MANAGEMENT SERVICES- MEETINGS HAVE BEEN HELD WITH THE OSCEOLA REGIONAL HEALTH CENTER, AVERA PHYSICIANS, OSCEOLA BOARD OF SUPERVISORS, EMS AND EMT'S, BOARD OF SUPERVISORS TO ENSURE WE HAVE THE BEST POSSIBLE SERVICE FOR OUR COMMUNITIES. - ORHC INTENDS TO BUILD AN AMBULANCE GARAGE ON THE HOSPITAL'S CAMPUS.WORKFORCE DEVELOPMENT- OSCEOLA REGIONAL HEALTH CENTER HAS PARTNERED WITH LOCAL SCHOOL DISTRICTS TO PROVIDE SCHOLARSHIPS FOR HIGH SCHOOL GRADUATES TO PURSUE DEGREES IN HEALTHCARE. - ORHC INTENDS TO PARTNER WITH LOCAL SCHOOL DISTRICTS TO CREATE APPRENTICESHIPS AND PRECEPTOR PROGRAMS IN HEALTHCARE.- ORHC INTENDS TO PARTNER WITH COMMUNITY COLLEGES TO PROMOTE HEALTHCARE FIELDS IN POST-SECONDARY EDUCATION.COMMUNITY WELLNESS- OSCEOLA COMMUNITY WELLNESS AND REHAB, A DIVISION OF ORHC, HAS COMPLETED A REMODEL AND INSTALLED UPDATED EQUIPMENT. THIS IS AN OPPORTUNITY TO PROMOTE WELLNESS. - THE DIABETIC EDUCATION PROGRAM AT OSCEOLA REGIONAL HEALTH CENTER HAS A REGISTERED NURSE (RN) AND A REGISTERED DIETICIAN (RD) THAT PROVIDE COUNSELING SERVICES TO DIABETIC PATIENTS REGARDING KNOWLEDGE OF NUTRITION, EXERCISE, MONITORING AND MEDICATION. - THE PUBLIC HEALTH OFFICE WHICH IS LOCATED ON THE OSCEOLA REGIONAL HEALTH CENTER CAMPUS PROVIDES IMMUNIZATIONS, PRE/POST-NATAL CARE, FOOT CARE AND THE HOMEMAKER PROGRAM, WHICH ALL SUPPORT COMMUNITY WELLNESS. ORHC MAY EXPAND THESE SERVICES IN THE FUTURE.- ORHC INTENDS TO DEVELOP TRAINING SESSIONS TO PROMOTE WELLNESS AND EDUCATION FOR COMMUNITY MEMBERS.DAYCARE SERVICES- ORHC WILL WORK WITH THE CITY OF SIBLEY AND OSCEOLA COUNTY BOARD OF SUPERVISORS AS WELL AS LOCAL ORGANIZATIONS TO ADDRESS THE NEED FOR ADDITIONAL DAYCARE PROVIDERS AND TO PROMOTE DAYCARE SERVICES.MANY OF THESE ACTIVITIES ARE CONTINUATIONS OF ACTIVITIES THE HOSPITAL HAS BEEN CONDUCTING RELATED TO THE PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT. RECREATIONAL ACTIVITIES, PARKS AND TRAILS, AND HOUSING WERE IDENTIFIED AS NEEDS OF THE COMMUNITY. DUE TO LIMITED RESOURCES, THESE NEEDS WILL NOT BE ADDRESSED BY ORHC. OSCEOLA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: 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. SCHEDULE H, PART V, SECTION B, LINE 10 HTTPS://WWW.AVERA.ORG/APP/FILES/PUBLIC/75774/2019-CHNA-OSCEOLA-IMPLEMENTATION-PLAN.PDF 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 I, LN 7 COL(F): BAD DEBT EXPENSE OF $104,177 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION SUPPORTED THE COMMUNITY THROUGH PROVIDING EMERGENCY PREPAREDNESS, DISEASE SURVEILLANCE AND BEST CARE FOR BETTER BABIES PROGRAMS. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS ON PAGE 9 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 6/30/19. 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 2019 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.ACCORDING TO THE 2000 AND 2010 CENSUS, THE POPULATION HAS DECREASED 6.5% OVER THE PREVIOUS 8 YEARS. THE MEDIAN AGE OF THE POPULATION WAS 40 AND WAS MADE UP OF 96.7% CAUCASIANS. THE MEDIAN HOUSEHOLD INCOME WAS $53,604 WITH AN AVERAGE HOUSEHOLD OF 2.5." 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. AS A MANAGED FACILITY, OSCEOLA COMMUNITY HOSPITAL IS ABLE TO PARTICIPATE IN AVERA E-CARE SERVICES. THESE SERVICES INCLUDE AVERA E-EMERGENCY, E-PHARMACY AND E-CONSULT. THESE SERVICES ALLOW RURAL PATIENTS TO BE CARED FOR AT THEIR LOCAL HOSPITALS, PROVIDE RURAL HOSPITALS ACCESS TO IMMEDIATE SPECIALTY CARE AND SUPPORT, AND HELP REDUCE HEALTH CARE COSTS AND TRAVEL.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 147862 0 0 0 0 0 2146 0 20720 0 170728 0 0 0 WILLIAM LEE SURGEON 368492 0 0 0 0 0 10439 0 10154 0 389085 0 0 0 A CITY OF SIBLEYIA 426005203 2016-02-24 4776000 TO REFINANCE SERIES 2001 AND 2007 BONDS 0 0 0 A 535608 4776000 95520 4680101 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 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 6 REGULAR MEMBERS ARE THOSE PERSONS, CORPORATIONS, ASSOCIATIONS OR PARTNERSHIPS WHO HAVE CONTRIBUTED AND PAID INTO THE CORPORATION A MINIMUM OF $75 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 WAS REVIEWED IN DETAIL BY MANAGEMENT OF THE HOSPITAL. UPON APPROVAL, THE FORM 990 WAS THEN PRESENTED TO THE BOARD MEMBERS AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING 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 MOST RECENT PROCESS WAS COMPLETED IN 2017 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 591,937. MANAGEMENT AND GENERAL EXPENSES 531,203. FUNDRAISING EXPENSES 728. TOTAL EXPENSES 1,123,868. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,611,013. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,611,013. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 87,869. GRANTS RESTRICTED FOR CAPITAL PURPOSES -300,000. 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 178136 ACTUAL COST