2025-04-12T14:34:17-05:00 2024-06-30 450250958 Eide Bailly LLP 345 N Reid Pl Ste 400 Sioux Falls SD 571037034 990 2023-07-01 420796764 Sioux Center Health SIOU 7127221271 1101 9th St SE Sioux Center IA 51250 Cory Nelson CEO 7127221271 2025-04-12 1 1 Laurie Hanson CPA P00851848 6053391999 2025-04-09 2023 2025-03-06 01:10:19Z Cory Nelson 1101 9th St SE Sioux Center IA 51250 77181449 0 X www.siouxcenterhealth.org X 1951 IA To provide medical care for all ages. 36 33 764 36 0 0 7159627 1105282 56286757 66625503 1614855 339991 57398 8976612 65118637 77047388 10000 10000 0 0 33785950 37394984 0 0 0 28951882 33458027 62747832 70863011 2370805 6184377 103990651 112029574 60754321 61983019 43236330 50046555 X Bring hope, health and healing to life. 1 0 60605372 10000 66625503 Sioux Center Health operates a 19-bed acute-care hospital, a 99-bed nursing care facility, medical clinics, specialty physician clinic and independent/assisted living facilities (24 independent, 62 assisted apartments) located in Sioux Center, Iowa. During the fiscal year ending June 30, 2024, patient days were 1,714, swing-bed days were 853, and newborn days were 439.The Center also provides a wide variety of medically-related activities at less than, or at no cost to residents of communities throughout northwest Iowa. These activities include general community education programs and sponsorship of support groups for victims of chronic disease and their families. Other activities designed to measure or enhance the general health status of residents of the community include: classes related to CPR, diabetes, cardiac rehabilitation and childbirth; participation in health fairs at industrial and community sites throughout the area; cost free screenings to alert people with high blood pressure; providing use of meeting facilities at no charge to cancer, Alzheimer's, diabetes, weight maintenance, "senior and hospice support groups; programs for children; providing speakers for various events and education groups; and representation in community education programs.The Health Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Since the Health Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient service revenue. The estimated cost of providing these services was $580,000 for the year ended June 30, 2024, calculated by multiplying the ratio of cost to gross charges for the Health Center by the gross uncompensated charges associated with providing charity care to its patients. 60605372 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 44 0 1 764 1 0 0 0 0 0 0 0 0 0 0 0 0 X 36 33 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X Crystal Richter 7127228153 1101 9th St SE Sioux Center IA 51250 Kyle Hiemstra President 1.00 X X 0 0 0 Nathan Bakker Vice President 1.00 X X 0 0 0 Jennifer Jansen Secretary 1.00 X X 0 0 0 Josh Bowar Treasurer 1.00 X X 0 0 0 Janet Boone Director 1.00 X 0 0 0 Bruce Dooyema Director 1.00 X 0 0 0 Cory Gotto Director 1.00 X 0 0 0 Curt Hohman Director 1.00 X 0 0 0 Neil Van Schouwen Director 1.00 X 0 0 0 Vernon Beernink Director 1.00 X 0 0 0 Terry Boote Director 1.00 X 0 0 0 Leslie Brommer Director 1.00 X 0 0 0 Tim Byl Director 1.00 X 0 0 0 Lisa Christians Director 1.00 X 0 0 0 Paul Clousing Director 1.00 X 0 0 0 Faye DeKam Director 1.00 X 0 0 0 Brenda Dokter Director 1.00 X 0 0 0 David Eekhoff Director 1.00 X 0 0 0 Daniel Finley Director 1.00 X 0 0 0 Dan Hibma Director 1.00 X 0 0 0 Lauren Kaemingk Director 1.00 X 0 0 0 Rick Kattenberg Director 1.00 X 0 0 0 Heidi Kramer Director 1.00 X 0 0 0 Ardith Lein Director 1.00 X 0 0 0 John McDaniel Director 1.00 X 0 0 0 Matt Nice Director 1.00 X 0 0 0 Scott Peterson Director 1.00 X 0 0 0 Jeff Timmer Director 1.00 X 0 0 0 Jaron Vande Hoef Director 1.00 X 0 0 0 Dale Vander Berg Director 1.00 X 0 0 0 Brian Van Engen Director 1.00 X 0 0 0 Doug Van Meetern Director 1.00 X 0 0 0 Lyle Vermeer Director 1.00 X 0 0 0 Marj Wagner Director 1.00 X 0 0 0 Scott Wynja Director 1.00 X 0 0 0 Verdean Wynja Director 1.00 X 0 0 0 Cory Nelson CEO 40.00 X 302718 0 26869 Crystal Richter CFO 40.00 X 129178 0 42354 Julie McKay Physician 40.00 X 405661 0 145805 Scott Rens Physician 40.00 X 449686 0 177213 Lindsay Junk Physician 40.00 X 419228 0 86866 Dr Nicholas Mouw General Surgeon 40.00 X 849617 0 78752 Jason Koelwyn Physician 40.00 X 379954 0 135789 2936042 0 693648 25 0 1 1 Prime Time Healthcare LLC 15380 Weir St Omaha NE 68137 Temp Staffing 1516111 Tri-State Nursing 3100 S Lakeport St Sioux City IA 51106 Temp Staffing 573988 Thomas Posch 234 Marina Dell Ave Yankton SD 57078 Radiology Readings 357692 Michael Tadlock 100 S 11th St Beresford SD 57013 Anesthesia Services 332500 Independent Radiology Services PO Box 2746 Fargo ND 58108 Radiology 245443 6 125200 980082 728356 1105282 Patient Service Revenue 623990 58967295 58967295 Pharmacy Revenue 900099 3085133 3085133 Assisted and Independent Living 623990 2227405 2227405 Investment in Affiliated 900099 270493 270493 2075177 2075177 66625503 426482 426482 66289 0 66289 66289 66289 12650 99141 -86491 -86491 -86491 67283 34920 32363 32363 Employee Retention Credit 900099 8877960 8877960 8877960 77047388 66625503 0 9316603 X 10000 10000 505501 505501 247547 247547 28225640 26266013 1959627 1144152 1057238 86914 5429197 4962000 467197 1842947 1686709 156238 12395 12395 857492 857492 9645300 7654594 1990706 210203 2222 207981 3583288 1362402 2220886 522810 90086 432724 834218 833064 1154 133503 117255 16248 86528 86528 1783699 1481439 302260 5867090 5098206 768884 397738 135906 261832 Medical Supplies 8343638 8343638 Food 866615 859249 7366 Taxes 192913 192738 175 120597 118538 2059 70863011 60605372 10257639 0 9281107 8477917 7139515 16740670 942545 1238655 594703 740750 112918567 46511436 70747507 66407131 7413477 8382478 4067409 4710390 623970 486893 20002 9029 3160416 4835661 103990651 112029574 5686754 6414186 6331807 6002386 45186709 44591581 3549051 4974866 60754321 61983019 X 42306998 48885224 929332 1161331 43236330 50046555 103990651 112029574 X 6184377 625848 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 247170 247170 247170 247170 247170 247170 247170 247170 247170 247170 0.00000 1.00000 0.00000 1 0 2263964 2205656 4469620 88019222 31476952 56542270 18086153 13819989 4266164 2343572 1214495 1129077 66407131 Deferred Compensation 3723483 Estimated third-party payor settlements 810000 Security deposits 295554 Operating lease liability 145829 4974866 X 77673236 625848 625848 77047388 0 77047388 70863011 0 70863011 0 70863011 Part V, Line 4: The Health Center's endowment consists of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. The Center does not have a formal policy or agreement with the Foundation covering the distribution of endowment fund earnings. The Center expects the Foundation to allow its endowment to grow consistent with the Center's objective to maintain the purchasing power of the endowment assets in order to provide additional real growth through new gifts and investment return. However, there is no current intention of using the permanently endowed funds. 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. Part XI, Line 2d - Other Adjustments: Change in net assets of Avera Health Foundation 625,848. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 35 580000 580000 0.00820 1 3354781 2229785 1124996 0.01590 2 35 3934781 2229785 1704996 0.02410 1754 10515 10515 0.00010 50 15161 15161 0.00020 6 10764 15858650 11791022 4067628 0.05740 58125 58125 0.00080 6 12568 15942451 11791022 4151429 0.05850 8 12603 19877232 14020807 5856425 0.08260 0 1455522 100431 13443925 13689437 -245512 X 1 1 1 1 Sioux Center Health 1101 9th St SE Sioux Center IA 51250 www.siouxcenterhealth.org 840080H X X X X 2 provider based clinics Sioux Center Health 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X See Line 7d X See Line 7d X X 1 21 1 See Part V description in Section C 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X SEE PART V SECTION C X SEE PART V SECTION C X SEE PART V SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 Sioux Center Health Part V, Section B, Line 5: Sioux Center Health conducted its Community Health Needs Assessment (CHNA) partly as a collaborative process with three other hospitals and the public health agency in Sioux County, Community Health Partners of Sioux County. Sioux Center Health, along with Community Health Partners, gathered quantitative and qualitative data to determine the best suitable health initiatives that will make a lasting impact for our communities. Each hospital collected input from individuals representing the community as well as those with public health expertise. In order to avoid duplication of effort, the four critical access hospitals in Sioux County worked collaboratively with Community Health Partners to complete this community health needs assessment with a process that began in October of 2021. Sioux Center Health Part V, Section B, Line 6a: Hegg Memorial Health System Orange City Area Health System Hawarden Regional Healthcare Sioux Center Health Part V, Section B, Line 6b: Community Health Partners of Sioux County, the local public health agency for Sioux County.Promise Community Health Center Sioux Center Health Part V, Section B, Line 7d: https://www.siouxcenterhealth.org/wp-content/uploads/2022-Community-Health-Needs-Assessment.pdfPart V, Section B, Line 10a:https://www.siouxcenterhealth.org/wp-content/uploads/2022-CHNA-Report.pdf Sioux Center Health Part V, Section B, Line 11: A summary of the health issues raised through community input was presented to the collaborative planning group along with the secondary data report. On May 11, 2022, Community Health Partners convened a stakeholder meeting with attendees representing the participating healthcare organizations. Participants reviewed a summary of all assessments (community input, secondary data), identified and prioritized key issues. To determine priorities that healthcare systems will address collaboratively, the collaborative team used the Stakeholder Survey Results, Community Health Status Report, and stakeholder meeting input to generate a list of health needs / issues. Identified issues were: *Health care access*Heart disease*Mental health access *Social determinants While each of the health needs identified is important for overall community health, two additional health needs that came up during the assessment were substance use/abuse and dental services for Medicaid. Thanks to several partnerships in Sioux County, a county-wide Health Improvement Planning group has been established and has sub-groups currently working on these two areas. Sioux Center Health is well represented in this group.In the current year the facility has taken the following actions to address:Mental Health: Provided 24/7 coverage as a resource for those patients needing mental health services. Sioux Center Health utilizes contractual telehealth behavioral services, which have 24-hour behavioral assessments using a video camera. These services provide us with knowledge of available inpatient resources and makes calls to behavioral health facilities to help find placement, should a patient need further treatment. Sioux Center Health continued to build behavioral health programming within our medical clinics. Our Licensed Outpatient Therapists in combination with our Psychiatric-Mental Health Nurse Practitioner works with individuals and families to meet their life-long goals and achieve their emotional well-being. We offer medically managed treatment plans for all ages: children, adolescents, and adults. Sioux Center Health utilizes the mental health resources in Sioux City, Sioux Falls and surrounding areas for those adolescent patients who are requiring inpatient care for mental health needs and detox/treatment. Sioux Center Health has established relationships with local/area mental health agencies and will continue to utilize their services where appropriate. Ongoing staff training in recognizing signs and/or treatment of mental health concerns will continue to be provided.Social Determinants of Health:Sioux Center Health provides a bilingual Care Coordinator to ensure education for how to navigate the health care system, including financial assistance and programs. Financial counselors are on staff at Sioux Center Health to address financial aspects of health care with patients. Sioux Center Health provides on-site certified medical interpreters to provide fluid, transparent, and accurate communication. Our interpreter services are provided free of charge to the individuals being served, are available during clinic hours on weekdays and provide 24-hour video remote interpretation using healthcare appropriate remote audio and visual language service providers. Sioux Center supports All Kids Can, an organization whose mission is to make healthy living activities accessible to children of all ages through monetary assistance and to provide consistent support and encouragement along the way. Through our EMR we have started screening all inpatient admissions for Social Determinants of Health (SDOH). If there is something that flags on the assessment, our social workers are notified and meet with the patients.Heart Disease Prevention:Sioux Center Trails Council is actively developing new trails. Sioux Center Health has worked closely with this community group and has a representative that sits on this committee to provide valuable input. Sioux Center Health is a partner for Siouxperman Triathlon, Harvest Half Marathon and 10k run and community health fair. Sioux Center Health employs a diabetic educator, a registered dietician, and pharmacist who work with patients and community members to manage obesity related issues and provide education surrounding effective weight management and the associated health benefits.Healthcare Access:Sioux Center Health ensures a healthcare provider is at each of its locations. Medical providers from Sioux Center Health visit Crown Pointe Estates (independent, assisted, and care center) on a regular basis, as well as Hillcrest and Pleasant Acres senior living facilities. Sioux Center Health provides translation services through in-person interpreters. Financial counselors are on staff at Sioux Center Health to address financial aspects of health care with patients. Sioux Center Health continues to evaluate the needs of our communities and continues to hire or contract with additional providers as necessary. Sioux Center Health has also increased access to care through the addition of a Same Day Primary Care Clinic staffed by Advance Practice Providers. This clinic helps create additional access to healthcare providers in a timely manner. Sioux Center Health Part V, Section B, Line 13h: Sioux Center Health provides free care based on meeting presumptive eligibility requirements listed in the policy. Sioux Center Health Part V, Section B, Line 16j: Self pay patients are given a self-pay packet that explains financial assistance. A statement is sent out to all patients indicating financial assistance is available upon request. The charity care and other financial assistance options are discussed with inpatients if requested. Sioux Center Health Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital has confirmed no FAP eligible patients had elective procedures. PART V SECTION B LINE 16 Financial Assistance Policy :siouxcenterhealth.org/patients-visitors/billing-and-financial-assistance/financial-assistance-policy/Financial assistance application:siouxcenterhealth.org/wp-content/uploads/Financial-Assistance-Application-English.pdfFinancial Assistance Plain Language Summary:siouxcenterhealth.org/wp-content/uploads/Summary-of-Financial-Assistance.pdf 4 1 - Hawarden Medical Clinic 920 Avenue F Hawarden IA 51023 Physician clinic 2 - Crown Pointe Estates 1400 7th Ave SE Sioux Center IA 51250 Nursing Facility, Independent and Assisted Living 3 - Home Health & Hospice 1400 7th Ave SE Sioux Center IA 51250 Home health and hospice 4 - Occupational Health Center 38 19th St SW Sioux Center IA 51250 Occupational health Part I, Line 3c: Sioux Center Health (SCH) provides free care based on meeting presumptive eligibility requirements listed in the policy. Federal Poverty Guidelines and financial asset-liabilities are used to determine eligibility for discounted care.Additional factors used to determine financial assistance eligibility include Asset level, medical indigency, and underinsurance status.Part I, Line 6b:The community benefit report is maintained at Sioux Center Health, mailed to community members, and is available to the public upon request. Part I, Line 7: Charity care expense on line 7a and Medicaid on line 7b were converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Lines 7e, 7f, and 7i: Costs are reported based on data from the general ledger accounting system. The general ledger accounting system addresses all patient segments (inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, and self-pay). The cost for subsidized health services reported on line 7g was determined using the facility's cost accounting system. Part I, Line 7g: Physician clinic costs are included in subsidized health services. Revenues of $792,412 and costs of $1,318,700 were included for a net community benefit of $526,288. 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 implicit price concession attributable to patients that could have been eligible for charity care is based on estimated calculations from our collection agency. The agency calculated 6.9% of the total amount in collections could be charity care due to bankruptcy, deceased and charity adjustments on current accounts. Part III, Line 4: The footnote that describes implicit price concessions is on pages 14-15 of the attached audited financial statements. Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for fiscal year ending 6/30/24. 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: Accounts that meet the criteria for the financial assistance policy will be wrien off in accordance with the financial assistance policy. Accounts that do not meet the criteria for financial assistance will proceed through the collection process. If, during the collection process, it is determined that an account in collection belongs to a patient who is eligible for financial assistance, the account will be removed from collection and returned to the hospital for resolution. Part VI, Line 2: Sioux Center Health has a broad based Board of Directors providing community feedback on a quarterly basis. The organization normally holds an open public meeting annually to listen to issues of the community and share information regarding services and programs. The Hospital analyzes statistical data through IHA and Iowa Public Health to determine disease related needs, services and market share. The Hospital works closely with Community Health Partners to identify and address community health related needs. Additionally, the Hospital conducted a community health needs assessment during the year ended 6/30/22 in compliance with 501(r). Part VI, Line 3: Patients are made aware of financial assistance programs (English and Spanish) in a variety of ways:1. Self-pay patients are given a self-pay packet that explains financial assistance, payment plans, and the Hospital's 10% lump sum payment options. The self-pay packet includes a Medicaid application. 2. A statement is sent out to all patients indicating financial assistance is available upon request.3. The financial assistance application is available on the Hospital website in English and Spanish versions.4. The financial assistance application is available at the registration and ER desk in English and Spanish versions.5. Financial assistance information is included in SCH Facebook posts to increase awareness.Additionally, the financial assistance policy is available upon request and on the Sioux Center Health website. Part VI, Line 4: Sioux Center Health serves both the local Sioux Center community and the surrounding area of Sioux County, Iowa, which is primarily rural and located in the northwest part of the state. According to the U.S. Census Bureau Quick Facts, the population of Sioux County in 2023 is 36,246. The county is home to three other critical access hospitals, and Sioux Center is also served by a Federally Qualified Health Center (FQHC). Nearly 90% of Sioux Center Health's discharges come from Sioux County. The 2023 population of Sioux Center is 8,543 as reported by the US Census Bureau Quick Facts, with the median family income of $84,736. The workforce in Sioux Center is primarily composed of management, business, science, and arts professionals, making up the largest share of workers. Among the population aged 16 and older, 71.5% are employed, with a negligible unemployment rate. Additionally, 6.9% of the population lives below the poverty line, and 6% lacks health insurance. Part VI, Line 5: Sioux Center Health has a strong community focused perspective. The governing board is comprised of 36 volunteer members that reside in the community and primary service area. The Hospital is focused on its mission and serving people regardless of their ability to pay. The Hospital participates in mission projects throughout the year yielding support for various causes from local missions that provide after school activities, counseling, or domestic abuse services. This support comes in the form of paid staff volunteering their time, Hospital sponsored fundraisers, and direct financial support from the Hospital and its employees. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are used to make improvements in patient care, medical education, and research.Sioux Center Health has a strong mission to bring hope, health and healing to life. The Hospital offers services for our patients, residents and family to support the mind, body and spirit. The Hospital operates an emergency room and is available to anyone, regardless of their ability to pay. The Hospital supports continuing education and training of all the healthcare professionals and assist in providing both internal and external opportunities. Sioux Center Health supports the communities it serves by being an active participant in the community. The hospital offers opportunities to volunteer for community events, has staff that participate in governance through chambers, businesses and churches. Also, the staff participate in various advisory groups supporting all ranges of ages and educational levels. The hospital supports advocacy activities focused on improved public health from organization walks, educational seminars and information shared with the public through various communication means. Part VI, Line 6: The Hospital is a managed facility of Avera Health. Avera Health and the Hospital work cooperatively to enhance healthcare throughout the community served by the Hospital. The 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 the Hospital could otherwise achieve. In turn, local caregivers are able to devote more resources to patient and resident care. Avera Health and the 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. 0 Northwest Iowa Community College 603 W park St Sheldon IA 51201 421275893 501(C)(3) 10000 0 SCHOLARSHIP 1 Part I, Line 2: SCH provides the money for scholarships directly to Northwest Iowa Community College Foundation (NICCF). NICCF determines and processes the scholarship funding. Applications and supporting materials are received directly from the applicant. The health instructors at Northwest Iowa Community College make the selection of who receives the money from the group of eligible applicants. X X X 0 1 0 0 0 0 0 0 0 Dr Nicholas Mouw General Surgeon 685009 0 141152 0 23456 0 43748 0 35649 0 929014 0 0 0 Scott Rens Physician 443607 0 4766 0 1313 0 125689 0 52169 0 627544 0 0 0 Julie McKay Physician 378945 0 25662 0 1054 0 106448 0 40002 0 552111 0 0 0 Jason Koelwyn Physician 329079 0 27319 0 23556 0 86776 0 49658 0 516388 0 0 0 Lindsay Junk Physician 364020 0 6628 0 48580 0 61506 0 25722 0 506456 0 0 0 Cory Nelson CEO 298571 0 3000 0 1147 0 7472 0 20139 0 330329 0 0 0 Crystal Richter CFO 128953 0 225 0 0 0 4800 0 38194 0 172172 0 0 0 Part I, Line 4b Lindsay Junk $24,521 Schedule J, Part II: Cory Nelson, CEO, was compensated through an arrangement with Avera McKennan, 800 E 21st Street, Sioux Falls, SD 57105, through June 30, 2023. Effective July 1, 2023, the CEO became an employee of Sioux Center Health. A City of Hull Iowa 426004780 2017-12-18 8300000 Hospital Facility Revenue Refunding Bond, Series 2017(2012 issue). 0 0 0 A 2160594 8300000 156681 8143319 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 Kim Bosma Family member of Cory Gotto, Director 71291 Compensation as an employee 0 Val Hiemstra Family member of Cory Gotto, Director 56459 Compensation as an employee 0 Heather Van Engen Family member of Brian Van Engen, Director 18539 Compensation as an employee 0 Matt De Kam Family member of Faye De Kam, Director 101259 Compensation as an employee 0 X 1 728356 Market value 1 0 0 0 Part I, Column (b): Column B represents the number of contribution received. Form 990, Part III, line 2 Inspire sleep apnea surgery. Sports medicine. Couples therapy. Form 990, Part VI, Section A, line 1a The Executive Committee is composed of four officers: President, Vice President, Secretary, Treasurer, and seven board members. The Executive Committee shall have power to transact all regular business of the facility during the interim between the meetings of the Board of Directors, provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors and that it shall refer all matters of major importance to the Board of Directors. Form 990, Part VI, Section A, line 2 Board members Verdean Wynja and Scott Wynja have a family relationship. Board members Dale Vander Berg and Cory Gotto have a business relationship. Form 990, Part VI, Section A, line 7a One member of the governing body is appointed by Avera McKennan. Form 990, Part VI, Section B, line 11b The 990 is emailed to members of the Board of Directors for review and any questions are addressed prior to filing the return with the IRS. Form 990, Part VI, Section B, line 12c Officers, Directors and Trustees are required to complete conflict of interest questionnaires which are monitored and tracked. The questionnaires are reviewed by the Board for any possible conflicts with any noted conflicts being brought to management's attention. Conflicts are also reviewed at the Board level. After a conflict is deemed to exist, the individual(s) involved must abstain from the discussion and vote related to the issue. Form 990, Part VI, Section B, line 15a Through July 1, 2023, the CEO was employed through a management agreement with Avera McKennan. The CEO was considered a common law employee of Sioux Center Health. Avera McKennan annually reviewed the compensation of the CEO, using comparability data and a performance rating system, and met with the Board of Directors of SCH. Avera Mckennan recommended a salary adjustment for the CEO. The Board of Directors was responsible for approval of the salary adjustment. The deliberation and decision was documented at Avera McKennan and in the board minutes. Effective July 1, 2023, the CEO became an employee of SCH. Compensation for the CEO is determined by the board of directors after his performance review is completed. Compensation for the CFO is reviewed and approved annually by the CEO and Human Resources. Market data is used to determine an appropriate salary range. The review process and salary adjustment is documented in the personnel file. Form 990, Part VI, Section C, line 19 The documents are made available upon request. Form 990, Part IX, line 11g Professional Fees: Program service expenses 747,597. Management and general expenses 595,164. Fundraising expenses 0. Total expenses 1,342,761. Purchased services: Program service expenses 6,476,839. Management and general expenses 1,377,057. Fundraising expenses 0. Total expenses 7,853,896. Repairs and maintenance: Program service expenses 430,158. Management and general expenses 18,485. Fundraising expenses 0. Total expenses 448,643. Form 990, Part XI, line 9: Change in interest in net assets of Avera Health Foundation 625,848.