2022-11-14T10:33:11-06:00 2021-12-31 990 2021-01-01 370692351 PEKIN MEMORIAL HOSPITAL PEKI 3093530700 600 SOUTH 13TH STREET PEKIN IL 61554 JOHN PETERS REGIONAL VP/CFO 3096724893 2022-11-06 JOHN PETERS XXX-XX-XXXX 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z UNITYPOINT HEALTH-PEKIN KEITH KNEPP MD 600 SOUTH 13TH STREET PEKIN IL 61554 120774589 0 X WWW.UNITYPOINT.ORG/PEORIA X 1913 IL IMPROVE HEALTH AND WELL-BEING OF COMMUNITY WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. 17 14 677 130 0 0 1417839 36331 46688854 59670003 75191 176049 508594 794775 48690478 60677158 79786 75993 0 0 20511762 21911327 0 0 0 27957290 26226139 48548838 48213459 141640 12463699 60873924 70050108 37658391 34652257 23215533 35397851 X TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. 0 0 42639168 88 60246106 HEALTH-CARE SERVICESPEKIN MEMORIAL HOSPITAL IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE PEKIN, ILLINOIS AND SURROUNDING COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. PEKIN MEMORIAL HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, INTENSIVE CARE AND CRITICAL CARE AND EMERGENCY SERVICES. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2021, PEKIN MEMORIAL HOSPITAL ADMITTED 1,722 PATIENTS RESULTING IN A TOTAL OF 8,257 PATIENT DAYS. OUTPATIENT VISITS TOTALED 76,684 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 3,903. THERE WERE ALSO 25,376 EMERGENCY ROOM VISITS. 3281729 72651 0 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: PEKIN MEMORIAL HOSPITAL PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE AT A VALUE OF $332,892 IN 2021. OFTENTIMES, PEKIN MEMORIAL HOSPITAL RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. PEKIN MEMORIAL HOSPITAL PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. PEKIN MEMORIAL HOSPITAL'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $2,751,907 FOR 2021. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $3,084,799.OTHER BENEFITS: PEKIN MEMORIAL HOSPITAL PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; SUBSIDIZED HEALTH SERVICES; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. PEKIN MEMORIAL HOSPITAL COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. PEKIN MEMORIAL HOSPITAL HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $196,930. 45920897 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 677 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X MARCY BECKER 3096712100 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 KEVIN BARBIER BOARD MEMBER 1.00 1.00 X 0 0 0 JERRY BELL BOARD MEMBER (FR 07/21) 1.00 1.00 X 0 0 0 RONALD CHAMPAGNE BOARD MEMBER 1.00 1.00 X 0 0 0 RUSTY DUNN BOARD MEMBER 1.00 1.00 X 0 0 0 BOB GATES BOARD MEMBER 1.00 1.00 X 0 0 0 MARTHA HERM BOARD MEMBER 1.00 1.00 X 0 0 0 PETER JOHNSEN PHD BOARD MEMBER 1.00 1.00 X 0 0 0 KEITH KNEPP MD BOARD MEMBER/PRESIDENT & CEO 1.00 40.00 X X 0 761434 160233 RICH KRIEGSMAN BOARD MEMBER 1.00 1.00 X 0 0 0 RON MILLER BOARD CHAIR 1.00 1.00 X X 0 0 0 BRIAN MOOTY BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID MUELLER BOARD MEMBER 1.00 1.00 X 0 0 0 DIRK ROEKER BOARD MEMBER 1.00 1.00 X 0 0 0 JAMIE STEVENSON BOARD MEMBER 1.00 1.00 X 0 20000 0 KAREN STUMPE BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 DENNIS TRIGGS BOARD MEMBER 1.00 1.00 X 0 17000 0 JOHN WIELAND BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN PETERS SECRETARY/TREASURER/CFO 1.00 40.00 X 0 396783 28693 JEANINE SPAIN VP COO & CNO 1.00 40.00 X 0 547536 33513 DESTINY HART NURSING SUPERVISOR 40.00 0.00 X 130149 2611 32908 ASHOKKUMAR PATEL PHARMACIST 40.00 0.00 X 147188 63 16554 KAITLYN SZMANIA PHARMACIST 40.00 0.00 X 127545 0 14745 KAYANN WILLIAMS ULTRASOUND TECHNOLOGIST LEAD 40.00 0.00 X 103711 3296 3348 508593 1748723 289994 4 0 1 0 HEALTH CAROUSEL LLC 3805 EDWARDS RD STE 700 CINCINNATI OH 45209 HEALTHCARE STAFFING 650528 RIVER CITY CONSTRUCTION LLC 101 HOFFR LN EAST PEORIA IL 61611 CONSTRUCTION SERVICES 624772 SIEMENS HEALTHCARE DIAGNOSTICS 511 BENEDICT AVE TARRYTOWN NY 10591 LABORATORY SERVICES 324184 PROFESSIONAL THERAPY SERVICES 2810 FRANK SCOTT PARKWAY WEST BELLEVILLE IL 62223 REHAB SERVICES 280991 MIDWEST HEALTHCARE LINEN SERVI 1600 E WASHINGTON STE 10 DES MOINES IA 50316 LAUNDRY SERVICES 217223 7 14525 21806 36331 NET PATIENT REVENUE 900099 59669167 59669167 MGMT & SUPPORT SVCS 561000 836 836 59670003 269419 269419 60003961 100 60094587 2844 -90626 -2744 -93370 -93370 SHARED SAVINGS REVENUE 900099 511150 511150 CAFETERIA/FOOD SVCS 722514 250615 31943 218672 MISCELLANEOUS 900099 33010 33010 794775 60677158 60246106 0 394721 72739 72739 3254 3254 96351 96351 18006899 16303455 1703444 544464 492958 51506 2164760 1959975 204785 1098853 994902 103951 5080000 5080000 -23055 -23055 56455 8084 48371 3734226 3720467 13759 905966 873664 32302 821248 821220 28 1251 860 391 2125 2125 521614 521614 2558706 2517522 41184 1057084 1057084 MEDICAL SUPPLIES 7778256 7767047 11209 MEDICAID PROVIDER ASSES 3694388 3694388 MISCELLANEOUS EXPENSE 38767 29539 9228 INCOME TAXES -892 -892 48213459 45920897 2292562 0 6462772 8305279 1767411 3822827 5060766 6809938 14471776 15577927 1360853 1440646 443330 157067 100181671 74971721 26477949 25209950 4829067 8726474 60873924 70050108 2964095 3273031 6290064 4242184 4892166 5923134 23512066 21213908 37658391 34652257 X 23215533 35397851 0 23215533 35397851 60873924 70050108 X 12463699 -154381 -127000 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2250000 2250000 38192463 27033054 11159409 56746464 46058989 10687475 2992744 1879678 1113066 25209950 ESTIMATED SELF-INSURANCE COSTS 165754 DUE TO AFFILIATES 13372631 SELF-INSURANCE RESERVE 7675523 21213908 X 60494000 -154381 1821 -152560 60646560 10708 19890 30598 60677158 48205000 2249 2249 48202751 10708 10708 48213459 PART X, LINE 2: UNITYPOINT HEALTH AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) AND 501(C)(2) OF THE INTERNAL REVENUE CODE (THE CODE). TAX-EXEMPT ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME AS DESCRIBED UNDER PROVISIONS OF SECTION 511 OF THE CODE. THE SYSTEM FILES FORM 990 FOR SUBSTANTIALLY ALL OF ITS OPERATING ENTITIES IN THE U.S. FEDERAL JURISDICTION AND IS NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES FOR THE YEARS BEFORE 2018. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1,821. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN NET ASSETS WITHOUT DONOR RESTRICTIONS 19,890. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 2,249. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 332892 332892 0.00690 14389534 11637627 2751907 0.05710 14722426 11637627 3084799 0.06400 27589 27589 0.00060 169341 169341 0.00350 196930 196930 0.00410 14919356 11637627 3281729 0.06810 0 450706 0 12557494 13170812 -613318 X 1 1 1 1 PEKIN MEMORIAL HOSPITAL 600 SOUTH 13TH STREET PEKIN IL 61554 UNITYPOINT.ORG/PEORIA/DEFAULT.ASPX 001834 X X X PEKIN MEMORIAL HOSPITAL 0 0 1 X X X X X X X X X 19 1 1 1 1 X UNITYPOINT.ORG/PEORIA/DEFAULT.ASPX X 1 19 1 UNITYPOINT.ORG/PEORIA/DEFAULT.ASPX 0 1 X 200.000000000000 600.000000000000 X X X X X X 1 1 X X X X 1 X UNITYPOINT.ORG/PEORIA/ADDITIONAL-FINANCIAL-ASSISTANCE-INFORMATION.ASPX X UNITYPOINT.ORG/PEORIA/ADDITIONAL-FINANCIAL-ASSISTANCE-INFORMATION.ASPX X UNITYPOINT.ORG/PEORIA/ADDITIONAL-FINANCIAL-ASSISTANCE-INFORMATION.ASPX X X X X X X 1 X 0 X X X X 1 X 0 0 PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE PARTNERSHIP FOR A HEALTHY COMMUNITY (PFHC) IS A COMMUNITY-DRIVEN EFFORT TO IMPROVE HEALTH AND WELLNESS IN THE CENTRAL ILLINOIS TRI-COUNTY REGION. MULTIPLE ORGANIZATIONS, SECTORS, AND THE PUBLIC PARTICIPATE IN POPULATION HEALTH PLANNING TO IDENTIFY AND PRIORITIZE HEALTH NEEDS AND QUALITY OF LIFE ISSUES, MAP AND LEVERAGE COMMUNITY RESOURCES, AND FORM EFFECTIVE PARTNERSHIPS TO IMPLEMENT HEALTH IMPROVEMENT STRATEGIES IN PEORIA, TAZEWELL, AND WOODFORD COUNTIES. USING ACTIONABLE DATA TO IDENTIFY HEALTH NEEDS AND PRIORITIES, INCLUDING THOSE RELATED TO HEALTH DISPARITIES, HEALTH INEQUITIES, AND THE SOCIAL DETERMINANTS OF HEALTH, MEMBERS OF THE PFHC DEVELOP SUBSEQUENT COMMUNITY HEALTH IMPROVEMENT PLANS. THIS COLLABORATIVE EFFORT ALLOWS MEMBERS OF THE PFHC TO SHARE RESOURCES, TO ALIGN STRATEGIES TO ADDRESS HEALTH NEEDS AND TO WORK AS PARTNERS IN IMPROVING COMMUNITY HEALTH. A TEAM OF PROFESSIONALS FROM THE PFHC WAS CREATED TO GUIDE THE CHNA PROCESS. MEMBERS OF THE PFHC WERE CAREFULLY SELECTED TO ENSURE REPRESENTATION OF THE BROAD INTERESTS OF THE COMMUNITY. IN ADDITION, MEMBERS OF THE COLLABORATIVE TEAM CONSISTED OF INDIVIDUALS WITH SPECIAL KNOWLEDGE OF AND EXPERTISE IN THE HEALTH OF THE COMMUNITY. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: PROCTOR HOSPITAL, METHODIST MEDICAL CENTER OF ILLINOIS, PEKIN HOSPITAL, OSF SAINT FRANCIS MEDICAL CENTER, ADVOCATE EUREKA HOSPITAL, AND HOPEDALE MEDICAL COMPLEX. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: PEORIA CITY/COUNTY HEALTH DEPARTMENT, TAZEWELL COUNTY HEALTH DEPARTMENT, WOODFORD COUNTY HEALTH DEPARTMENT, HEART OF ILLINOIS UNITY WAY, HEARTLAND HEALTH SERVICES AND BRADLEY UNIVERSITY. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE 2016 CHNA IDENTIFIED SIGNIFICANT HEALTH NEEDS: ACCESS TO HEALTHCARE, HEALTHY BEHAVIORS & LIFESTYLE CHOICES. SPECIFIC ACTIONS WERE TAKEN TO ADDRESS THESE NEEDS AS FOLLOWS.1. ACCESS TO HEALTHCARE MEASUREMENT AND IMPACT- PEKIN PATIENT NAVIGATORS ENROLLED 209 PATIENTS INTO COMMERCIAL PLANS IN 2017 AND 2018 AND MADE OVER 800 PUBLIC AID ENROLLMENTS- PEKIN PROVIDED OVER $2.4M IN CHARITY CARE IN 2017 AND 201- PEKIN INCREASED THE NUMBER OF PRIMARY CARE AND PEDIATRIC VISITS OVER FY 2016 THE BASE YEAR =33,764; 2017 = 33,215 PRIMARY AND PEDIATRIC VISITS; 2018 = 38,368 PRIMARY AND PEDIATRIC VISITS; *2019 PROJECTED (BASED ON MAY YTD) = 40,740 PRIMARY AND PEDIATRIC VISITS- OTHER INITIATIVES:- PEKIN HOSPITAL OPENED A MEDICAL OFFICE BUILDING [PEKIN EAST] IN JANUARY 2018 AND WITH UPH EXPANDED THE NUMBER OF PRIMARY CARE PROVIDERS IN THE MARKET. THE MEDICAL OFFICE BUILDING LOCATED AT THE CORNER OF VETERANS DRIVE AND GRIFFIN AVENUE IS 52,000-SQUARE-FOOT, THREE STORY FACILITY. THE BUILDING WAS DESIGNED FOR EASE OF ACCESS TO AMBULATORY CARE FOR THE COMMUNITY. EACH FLOOR HAS 26 EXAM ROOMS AND TWO PROCEDURE ROOMS. PEDIATRICS IS LOCATED ON THE FIRST FLOOR AND OFFERS EXTENDED HOURS TO CATER TO WORKING PARENTS. FAMILY MEDICINE PROVIDERS ARE LOCATED ON THE FIRST AND SECOND FLOOR. THE BUILDING ALSO CONTAINS LAB AND RADIOLOGY SERVICES FOR ONE STOP HEALTH CARE. THE FIRST FLOOR ALSO CONTAINS A FIRST CARE CLINIC WHICH ACCEPTS WALK-IN AND PRIMARY CARE PATIENTS AS PER FIRST CARE'S OPEN ACCESS MODEL. THE BUILDING ALSO HAS A COMMUNITY ROOM FOR HEALTH EDUCATION CLASSES AND PHYSICIAN PRESENTATIONS.- THE THIRD FLOOR IS RESERVED FOR SPECIALTY SERVICES TO BE STAFFED BY AFFILIATED SPECIALISTS WITH UNITYPOINT HEALTH IN ORDER TO PROVIDE GREATER ACCESS TO SPECIALISTS FOR THE PEKIN COMMUNITY.- PEKIN IN-SCHOOL HEALTH PROGRAM EXPANDED TO ADDITIONAL SITES.2. HEALTHY BEHAVIORS AND LIFESTYLE CHOICES MEASUREMENT AND IMPACT- COMMUNITY SCREENINGS: PEKIN HOSPITAL PROVIDED A VARIETY OF FREE COMMUNITY SCREENINGS WITHIN THE PEKIN AREA. THE FOLLOWING SCREENINGS WERE PROVIDED: SKIN SCREENING, BONE DENSITY, HEEL SCANS, BLOOD PRESSURE CHECKS, BODY COMPOSITION, SPIROMETRY TESTING, AND PHYSICAL THERAPY FITNESS. THE FOLLOWING SCREENINGS WERE OFFERED AT VARIETY OF COMPANIES INCLUDING: PARKSIDE ATHLETICS CLUB, MILLER CENTER,MACKINAW COMMUNITY CENTER, PEKIN PARK DISTRICT FOR HEART OF ILLINOIS 50+ GAMES, RIVERPLEX IN PEORIA FOR THE NEW MILLENNIUM INSTITUTE COMMUNITY HEALTH AND WELLNESS EXPO, CEFCU IN PEORIA, CITY /COUNTY OF PEKIN HEALTH FAIR, AND PEKIN INSURANCE.- HULT CENTER EDUCATION PROGRAMS: OVER 6,000 PEKIN STUDENTS WERE PROVIDED HEALTHY EATING ACTIVE LIVING EDUCATION IN 2017 AND 2018 AND OVER 1,000 PEKIN PRE-K STUDENTS WERE PROVIDED HEALTH AND FITNESS EDUCATION THROUGH THE HULT CENTER'S 'YOUR AMAZING BODY' PROGRAM.- IN THE LAST 12 MONTHS [AUG 2018 THRU JUN 2019] UPH PEKIN IN-SCHOOL HEALTH EXPANDED TO ELEVEN SCHOOL SITES WITH OVER 50,000 VISITS TO THE HEALTH CENTERS AND 6,000 VISITS RELATED TO DIABETES AND HEALTHY EATING/ACTIVE LIVING PROGRAMS.- 2018 AND 2019: OVER 250 PEKIN ADULT PARTICIPANTS REGISTERED IN THE HULT ENCORE PROGRAM.- PROVIDED YEAR-LONG EVIDENCE BASED NATIONAL DIABETES PREVENTION PROGRAM IN 2018 TO NEARLY 20 PEKIN AREA HIGH-RISK PRE-DIABETIC ADULTS TO IMPLEMENT HEALTHY LIFESTYLE CHANGES FOR THE PREVENTION OF TYPE 2 DIABETES. TO DATE, THIS COHORT HAS LOST A TOTAL OF NEARLY 200 POUNDS TO REDUCE THEIR RISK FOR TYPE 2 DIABETES BY UP TO 71%.- AS PART OF NATIONAL MAMMOGRAPHY DAY, PEKIN HOSPITAL PARTNERED WITH TAZEWELL COUNTY HEALTH DEPARTMENT TO OFFER FREE MAMMOGRAMS TO TAZEWELL COUNTY WOMEN AGES 40 AND OVER WHO ARE UNINSURED. THERE WERE 17 FREE MAMMOGRAMS PROVIDED, WITH 13 NORMAL AND 4 ABNORMAL RESULTS. THIS WAS THE 15TH YEAR FOR THE ANNUAL EVENT.- HEALTH FAIRS: PEKIN HOSPITAL PARTICIPATED BY PROVIDING SCREENINGS AT A NUMBER OF LOCAL HEALTH FAIRS. - NEW MILLENNIUM INSTITUTE COMMUNITY HEALTH AND WELLNESS EXPO HELD IN PEORIA: 7 WERE SCREENED FOR BONE DENSITY, 13 FOR SPIROMETRY SCREENING AND 7 FOR FITNESS TESTING.- CEFCU EMPLOYEE HEALTH FAIR: 38 SCREENED FOR BONE DENSITY, 36 SCREENED FOR SPIROMETRY.- CITY OF PEKIN/TAZEWELL COUNTY HEALTH FAIR: 23 RECEIVED BONE DENSITY SCREENINGS, 27 HAD SKIN SCREENINGS, 7 SPIROMETRY SCREENINGS AND 35 HAD PHYSICAL THERAPY FITNESS SCREENINGS.- MILLER CENTER SENIOR FITNESS EVENT- DIABETES WORKSHOPS: ELEVEN (THREE-HOUR) COMMUNITY DIABETES CLASSES WERE OFFERED TO INCLUDE A TOTAL OF 80 PARTICIPANTS.- MEDICATION RECONCILIATION: TO RAISE COMMUNITY AWARENESS ON THIS TOPIC, WALLET CARDS THAT ASSIST PATIENTS IN KEEPING ACCURATE LISTS OF MEDICATIONS WERE PLACED IN ALL INPATIENT FOLDERS. THE WALLET CARDS WERE ALSO PROVIDED AT OUR RETAIL PHARMACY, SENIOR EXPO EVENTS, AND OTHER COMMUNITY EVENTS.- OVER 600 STUDENTS EDUCATED ON HEALTH AND WELLNESS THROUGH HULT DURING THE PEKIN HIGH SCHOOL HEALTH FAIR - APRIL 2019.- PUBLIC LECTURES AND PROGRAMS:- PEKIN HEAD START SCHOOL: SPOKE TO 120 PRESCHOOL CHILDREN AND THEIR TEACHERS ABOUT HEART HEALTH.- PHN LEAP INTO WELLNESS PROGRAM: OFFERED A FREE NINE WEEK WEIGHT LOSS PROGRAM TO 7 LOCAL BUSINESSES IN THE PHN NETWORK.- PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: PEKIN HOSPITAL REGISTERED DIETICIAN SPOKE TO 22 PARTICIPANTS ON MY PLATE GUIDELINES AND HOW TO READ FOOD LABELS.- PEKIN INSURANCE RETIREMENT GROUP SPEAKING ENGAGEMENT: DR. JOHN LINDELL SPOKE TO 38 RETIREES ABOUT HEALTHY EATING AND THE IMPORTANCE OF EXERCISE.- PEKIN HEAD START SCHOOL: SPOKE TO 120 PRESCHOOLERS ABOUT THE IMPORTANCE OF HEALTHY EATING AND THE MY PLATE GUIDELINES.- PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: DR. JOHN LINDELL SPOKE TO 14 PROGRAM PARTICIPANTS ABOUT FAST AND SLOW OXIDIZERS.- PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: FINANCIAL ADVISOR FROM UNLAND COMPANIES SPOKE TO PARTICIPANTS ABOUT FINANCIAL WELLNESS.- YWCA OF PEKIN: SPOKE TO 10 PARTICIPANTS ABOUT VOLUNTEERING IN THE LOCAL COMMUNITY.- PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: PROFESSIONAL THERAPY SERVICES SPOKE TO 10 PROGRAM PARTICIPANTS ABOUT ERGONOMICS IN THE WORKPLACE.- PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: FINANCIAL ADVISOR FROM UNLAND COMPANIES SPOKE TO 5 PROGRAM PARTICIPANTS ABOUT FINANCIAL WELLNESS.- PEKIN PAIN MANAGEMENT/MIDWEST ORTHOPAEDIC COMMUNITY PRESENTATION: HIP AND JOINT AWARENESS 25 PARTICIPANTS.- 5K DASH AT DUSK- 465 PARTICIPANTS IN THE 2017 AND 2018 DASH TO DUSK- NUMBER OF PARTICIPANTS IN THE WEIGHT LOSS PROGRAM- 860 PARTICIPANTS IN THE 2017 AND 2018 WEIGHT LOSS PROGRAMS WITH OVER 2,130 LBS LOST - NUMBER OF PARTICIPANTS IN WELLNESS COACHING:- 2017: 598- 2018: 602 PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM THE FOLLOWING PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSISTANCE: THE US. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE FOOD STAMP PROGRAM; WOMEN, INFANTS & CHILDREN (WIC); AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. THIRD PARTY AGENCIES ARE USED TO ASSIST WITH COLLECTIONS AND, IF THOSE AGENCIES PROVIDE A STATEMENT REGARDING A PATIENT'S LIKELY INCOME LEVEL, THAT INFORMATION IS USED IN DETERMINING THE ELIGIBILITY STATUS AND THE LEVEL OF DISCOUNT AVAILABLE. STATE LAW REQUIREMENTS THAT OFFER ADDITIONAL AND/OR MORE STRINGENT ELIGIBILITY REQUIREMENTS WILL BE FOLLOWED FOR THOSE STATES. 2 1 - PEKIN HOSPITAL MRI BUILDING 1300 PARK AVENUE PEKIN IL 61554 DIAGNOSTIC CENTER 2 - PEKIN HOSPITAL PAIN MANAGEMENT LLC 600 SOUTH 13TH STREET PEKIN IL 61554 PAIN CLINIC PART I, LINE 6A: PEKIN MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE UNITYPOINT HEALTH COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT' LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR CENTRAL IOWA HOSPITAL CORPORATION. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 8: AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. PART VI, LINE 2: PEKIN HOSPITAL CONTRACTED WITH BKD, TO ASSIST WITH THE CREATION OF ITS STRATEGIC PLAN. THE COMMUNITY ASSESSMENT WAS PERFORMED THROUGH A SERIES OF FOCUS GROUPS, COMMUNITY SURVEYS, INTERNAL STATISTICAL DATA, AND COUNTY AND SERVICE AREA DEMOGRAPHICS. PART VI, LINE 3: THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE TO ALL PATIENTS AND WITHIN THE COMMUNITY. COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. THE CENTRAL BILLING OFFICE IS AVAILABLE BY PHONE TO ANSWER QUESTIONS ABOUT THE POLICY, OR PATIENTS SHOULD GO TO THE CASHIER'S OFFICE AT THE HOSPITAL TO OBTAIN THIS INFORMATION. THE PLAIN LANGUAGE SUMMARY IS OFFERED AS PART OF THE PATIENT INTAKE AND/OR DISCHARGE PROCESS AND INCLUDED WHEN A PATIENT IS SENT WRITTEN NOTICE THAT EXTRAORDINARY COLLECTION ACTIONS MAY BE TAKEN AGAINST HIM/HER. THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND ALL FINANCIAL ASSISTANCE FORMS ARE AVAILABLE IN ENGLISH AND IN ANY OTHER LANGUAGE IN WHICH LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS CONSTITUTE THE LESSER OF 1,000 PERSONS OR MORE THAN 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. THESE TRANSLATED DOCUMENTS WILL BE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. PART VI, LINE 4: PEKIN HOSPITAL PRIMARILY SERVES TAZEWELL, MASON AND PEORIA COUNTIES IN THE STATE OF ILLINOIS. IT IS ONE OF THE LARGEST EMPLOYERS IN THE CITY OF PEKIN AND IN TAZEWELL COUNTY. THE SERVICE AREA SITS TO THE SOUTH AND EAST OF THE GREATER PEORIA AREA, WHERE CATERPILLAR IS A MAJOR INDUSTRIAL EMPLOYER. ITS PRIMARY SERVICE AREA HAS A POPULATION OF 34,000 WITH A SECONDARY SERVICE AREA OF APPROXIMATELY 78,000. THE MEDIAN AGE OF ITS SERVICE AREA IS 41 YEARS, WHILE THE MEDIAN HOUSEHOLD INCOME IS $53,000. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2021, PEKIN MEMORIAL HOSPITAL ADMITTED 1,722 PATIENTS, OUTPATIENT VISITS TOTALED 76,684 AND A TOTAL OF 25,376 EMERGENCY ROOM VISITS. PART VI, LINE 5: PEKIN HOSPITAL PROVIDES MANY FREE HEALTH SCREENINGS THROUGHOUT THE YEAR TO PROMOTE EARLY DETECTION AND PREVENTION. THIS INCLUDES BUT IS NOT LIMITED TO MAMMOGRAPHY, BONE DENSITY, BLOOD PRESSURE, COLON, OBESITY AND SPIROMETRY. PEKIN HOSPITAL HAS ENGAGED ITS PHYSICIANS TO SPEAK AT DIFFERENT COMMUNITY ORGANIZATIONS, TO SHARE INFORMATION ON HEALTH AND WELL-BEING. IT HAS ALSO SENT REPRESENTATIVES OUT TO DISCUSS HEALTHCARE REFORM. PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). AS THE NATION'S 13TH LARGEST NONPROFIT HEALTH SYSTEM, UNITYPOINT HEALTH PROVIDES PROGRESSIVE AND HIGH QUALITY SERVICES ACROSS ITS 9 REGIONS WHICH SPAN IOWA, WESTERN ILLINOIS AND SOUTHERN WISCONSIN. THIS REGIONAL CARE MODEL HAS BEEN SUCCESSFUL IN ACHIEVING STANDARDIZED LEVELS OF PERFORMANCE AND KEEPING CARE LOCAL. WITH $4.9B IN TOTAL OPERATING REVENUE, UNITYPOINT HEALTH EMPLOYS APPROXIMATELY 33,000 TEAM MEMBERS AND OPERATES 20 REGIONAL HOSPITALS, 19 COMMUNITY NETWORK HOSPITALS AND OVER 435 CLINICS. AS A KEY COMPONENT OF UNITYPOINT HEALTH, UNITYPOINT CLINIC IS A 1,180 PROVIDER MULTISPECIALTY GROUP THAT IS BUILT ON THE FOUNDATION OF CARE DELIVERY, INNOVATION AND EXPERIENCE. REPRESENTED BY OVER 40 SPECIALTIES, UPC IS A FORWARD-THINKING DELIVERY PROVIDER AND IS ON THE LEADING EDGE OF CARE DELIVERY WITH ITS TELEHEALTH, AMBULATORY AND URGENT CARE PROGRAMS. THE DIVERSIFIED HEALTH SYSTEM ALSO INCLUDES UNITYPOINT ACCOUNTABLE CARE, UNITYPOINT HEALTH COLLEGES, UNITYPOINT AT HOME AND EXTENDS HEALTH COVERAGE THROUGH THE HEALTHPARTNERS UNITYPOINT INSURANCE PLAN. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THEIR REGIONS. IN 2021, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $672 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY UNITYPOINT HEALTH AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 PEKIN MEMORIAL HOSPITAL FOUNDATION 600 S 13TH STREET PEKIN IL 61554 371200267 501(C)(3) 72739 0 PROGRAM SUPPORT 1 0 PART I, LINE 2: THE ORGANIZATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART II & III (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINES A SERIES OF ELIGIBLITY STANDARDS THAT ARE REQUIRED TO BE MET. THE ORGANIZATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. 0 1 0 0 0 0 0 0 0 KEITH KNEPP MD BOARD MEMBER/PRESIDENT & CEO 0 545914 0 200654 0 14866 0 135732 0 24501 0 921667 0 0 JEANINE SPAIN VP COO & CNO 0 356575 0 94421 0 96540 0 14500 0 19013 0 581049 0 0 JOHN PETERS SECRETARY/TREASURER/CFO 0 356428 0 20352 0 20003 0 11048 0 17645 0 425476 0 0 DESTINY HART NURSING SUPERVISOR 115562 2611 11799 0 2788 0 6122 115 26211 460 162482 3186 0 0 ASHOKKUMAR PATEL PHARMACIST 144196 63 2932 0 60 0 7117 3 9429 5 163734 71 0 0 PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED CONTRIBUTIONS IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: KEITH KNEPP, MD $121,232. JACOB MILLER FAMILY MEMBER OF BOARD MEMBER RONALD MILLER 32288 EMPLOYMENT 0 MADISON DUNN FAMILY MEMBER OF BOARD MEMBER RUSTY DUNN 64063 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 METHODIST HEALTH SERVICES CORPORATION IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, METHODIST HEALTH SERVICES CORPORATION, HAS THE POWER TO ELECT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, METHODIST HEALTH SERVICES CORPORATION, HAS THE RIGHT TO APPROVE THE FOLLOWING DECISIONS BY THE GOVERNING BODY: A) ESTABLISHMENT OR MODIFICATION OF COMPENSATION AND BENEFIT POLICIES; AND B) DEVELOPMENT OR MODIFICATION OF CORPORATE COMPLIANCE PROGRAMS, INCLUDING PROGRAMS DESIGNED TO DETECT OR PREVENT HEALTH CARE FRAUD OR IMPROPER THIRD PARTY BILLING, ACTIVITIES REGARDING LEGAL AND REGULATORY COMPLIANCE RELATING TO THE CODE, ENVIRONMENTAL ISSUES, OCCUPATIONAL SAFETY AND HEALTH, ANTITRUST, FEDERAL ELECTION LAWS, AND ALL OTHER LAWS APPLICABLE TO THE CORPORATION. VARIOUS OTHER POWERS ARE RESERVED EXCLUSIVELY TO THE SOLE MEMBER, AS OUTLINED IN THE BYLAWS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND REPORTING PHYSICIANS ARE REQUESTED TO COMPLETE A QUESTIONNAIRE TO REPORT POTENTIAL CONFLICTS OF INTEREST. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE ANNUAL QUESTIONNAIRES INCLUDE AN ACKNOWLEDGEMENT THAT THE OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN: 1) HAS ACCESS TO A COPY OF THE CONFLICT OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. SENIOR ADMINISTRATIVE STAFF AT ALL RELATED ORGANIZATIONS PROVIDE INFORMATION TO A CENTRAL COORDINATOR RELATED TO THE IDENTIFICATION OF WHICH INDIVIDUALS SHOULD RECEIVE THE QUESTIONNAIRE FOR COMPLETION. THE RESULTS ARE COMPILED CENTRALLY AND REVIEWED BY THE IOWA HEALTH SYSTEM COMPLIANCE OFFICER AND DIRECTOR OF INTERNAL AUDIT. THE DETAIL RESULTS ARE REPORTED TO A COMMITTEE OF THE SYSTEM BOARD. THE RESULTS RELATED TO SPECIFIC REGIONAL PARENT COMPANIES, THEIR HOSPITALS AND RELATED ORGANIZATIONS, ARE DISTRIBUTED IN DETAIL TO THE CHAIRPERSON OF THE REGIONAL PARENT ORGANIZATION, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND COMPLIANCE MANAGER. THESE INDIVIDUALS ARE ALSO REMINDED OF THE APPROPRIATE PROCESS TO BE FOLLOWED DURING THE YEAR TO ADDRESS POTENTIAL CONFLICTS OF INTEREST THAT RELATE TO MATTERS THAT ARE BROUGHT TO THE BOARD OF DIRECTORS FOR ACTION. THE INFORMATION DISCLOSED IS USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICAID QUESTIONNAIRES. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN TOGETHER WITH ALL MATERIAL FACTS, SHOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST OCCURS OR BECOMES A MATTER OF BOARD ACTION. ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN HAVING A CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT BE PRESENT DURING GENERAL DISCUSSION NOR VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM FOR PURPOSES OF THE MATTER OR ITEM AS TO WHICH A CONFLICT EXISTS. THE BOARD SHOULD EXCLUDE THE INDIVIDUAL FROM ANY DISCUSSION OR VOTE IN WHICH THE BOARD DECIDES WHETHER OR NOT A CONFLICT OF INTEREST EXISTS. IN CASES IN WHICH AN OFFICER, DIRECTOR, KEY EMPLOYEE, REPORTING PHYSICIAN OR THE INDIVIDUAL'S HOUSEHOLD MEMBER HAS A CONFLICT OF INTEREST IN AN ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN AT THE DIRECTION OF THE BOARD OF DIRECTORS: 1) AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL 1) DECIDE IF A CONFLICT OF INTEREST EXISTS, 2) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION; 3) IN ORDER TO APPROVE THE ARRANGEMENT OR TRANSACTION, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED MEMBERS, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED MEMBERS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS SHALL CONTAIN: 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; 2) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH; IN ORDER TO PROTECT THE ORGANIZATION'S BEST INTERESTS, APPROPRIATE DISCIPLINARY ACTION MAY BE TAKEN WITH RESPECT TO AN OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN WHO VIOLATES THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS ("COMMITTEE") CONDUCTS A COMPREHENSIVE REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS REVIEW COMPARES THE TOTAL COMPENSATION AND VALUE OF BENEFITS PROVIDED TO EACH EXECUTIVE, ON A POSITION BY POSITION BASIS, TO THAT PROVIDED TO FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED ORGANIZATIONS. THIS REVIEW IS CONDUCTED BY THE COMMITTEE WITH THE ASSISTANCE OF A NATIONAL, INDEPENDENT COMPENSATION CONSULTANT REPORTING DIRECTLY TO THE COMMITTEE. THE COMMITTEE HAS BEEN DELEGATED THE RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION AND IS MADE UP ENTIRELY OF INDEPENDENT DIRECTORS WITHIN THE MEANING OF THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE FEDERAL INCOME TAX INTERMEDIATE SANCTIONS RULES. THE COMPENSATION CONSULTANT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT, PERFORMS THESE VALUATIONS ON A REGULAR BASIS, IS QUALIFIED TO MAKE THE VALUATIONS OF THE SERVICES INVOLVED, AND HAS SO INDICATED IN A WRITTEN CERTIFICATION TO THE COMMITTEE. BASED UPON THE ADVICE OF THE COMPENSATION CONSULTANT, AND APPLYING THE BOARD'S COMPENSATION PHILOSOPHY, THE COMMITTEE ESTABLISHES THE OVERALL ADJUSTMENT IN COMPENSATION AND BENEFITS FOR THE TOP EXECUTIVES IN THE ENTIRE HEALTH SYSTEM (SEVERAL OF WHICH ARE EMPLOYEES OF THE FILING ORGANIZATION) AND DELEGATES TO THE CEO THE AUTHORITY TO MAKE ADJUSTMENTS, CONSISTENT WITH THE COMMITTEE'S DIRECTION, FOR THE OTHER EXECUTIVES. THE COMMITTEE DETERMINES ALL ASPECTS OF THE COMPENSATION AND BENEFITS OF THE CEO. THE COMMITTEE INTENTIONALLY TAKES ALL THE STEPS NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES, INCLUDING CONTEMPORANEOUS SUBSTANTIATION OF ALL COMMITTEE MEETINGS AND ACTIONS. THE ORGANIZATION BELIEVES IT IS IN FULL COMPLIANCE WITH SECTION 4958 OF THE IRC, PROVIDES NO MORE THAN REASONABLE AND FAIR MARKET VALUE COMPENSATION AND BENEFITS FOR ITS EMPLOYEES AND DOES NOT PROVIDE ANY EXCESS COMPENSATION OR BENEFITS AS PROHIBITED BY SECTION 4958. THE REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2021 FOR THE FOLLOWING INDIVIDUALS: KEITH KNEPP, MD, JOHN PETERS, AND JEANINE SPAIN. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, LEGAL DEPARTMENT. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE ON THE IOWA HEALTH SYSTEM WEBSITE, WWW.UNITYPOINT.ORG. FORM 990, PART XI, LINE 9: FUND BALANCE TRANSFER-PEKIN PROHEALTH, INC. -75,000. FUND BALANCE TRANSFER-PARK COURT LIMITED -52,000. ABBE CENTER FOR COMMUNITY MENTAL HEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421045257 MENTAL HEALTH CARE IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 0 ABBEHEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421373123 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III ST LUKE'S HEALTHCARE 0 AGING SERVICES INC 740 N 15TH AVE NO A HIAWATHA IA 52233 237085316 SENIOR SERVICES IA 501(C)(3) 170(B)(1) (A)(VI) ABBEHEALTH INC 0 ALLEN COLLEGE 1825 LOGAN AVENUE WATERLOO IA 50703 421351526 EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS IA 501(C)(3) 170(B)(1) (A)(II) ALLEN HEALTH SYSTEMS INC 0 ALLEN HEALTH SYSTEMS INC 1825 LOGAN AVENUE WATERLOO IA 50703 421201924 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 ALLEN MEMORIAL HOSPITAL CORPORATION 1825 LOGAN AVENUE WATERLOO IA 50703 420698265 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ALLEN HEALTH SYSTEMS INC 0 ANAMOSA AREA AMBULANCE SERVICE 101 GRANT WOOD DRIVE ANAMOSA IA 52205 421466284 PROVIDE AMBULANCE SERVICES IA 501(C)(3) 509(A)(3), TYPE III ST LUKE'SJONES REGIONAL MEDICAL CENTER 0 BLACK HAWK-GRUNDY MENTAL HEALTH CENTER INC 3251 WEST NINTH STREET WATERLOO IA 50702 420733463 MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 0 CENTER FOR ALCOHOL AND DRUG SERVICES INC 4869 FOREST GROVE DRIVE BETTENDORF IA 52722 421134273 SUBSTANCE ABUSE SERVICES IA 501(C)(3) 170(B)(1) (A)(VI) THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH 0 CENTRAL IOWA HEALTH PROPERTIES CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 421233759 PROPERTY HOLDING COMPANY IA 501(C)(2) CENTRAL IOWA HEALTH SYSTEM 0 CENTRAL IOWA HEALTH SYSTEM 1200 PLEASANT STREET DES MOINES IA 50309 421189791 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 CENTRAL IOWA HOSPITAL CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 420680452 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) CENTRAL IOWA HEALTH SYSTEM 0 CHATHAM OAKS 740 N 15TH AVE NO A HIAWATHA IA 52233 421302928 MENTAL HEALTH AND/OR DISABILITY RESIDENTIAL TREATMENT SERVICES IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 0 DES MOINES AREA MEDICAL EDUCATION CONSORTIUM INC 1415 WOODLAND AVE SUITE 130 DES MOINES IA 50309 421412497 COORDINATION OF MEDICAL EDUCATION PROGRAMS IA 501(C)(3) 509(A)(3), TYPE III 0 EYERLY-BALL COMMUNITY MENTAL HEALTH SERVICES 945 19TH STREET DES MOINES IA 50314 420942273 MENTAL HEALTH CARE IA 501(C)(3) 509(A)(2) CENTRAL IOWA HEALTH SYSTEM 0 FINLEY TRI-STATES HEALTH GROUP INC 350 NORTH GRANDVIEW AVENUE DUBUQUE IA 52001 421307495 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 FRIENDS OF THE BLACK HAWK-GRUNDY MENTAL HEALTH CENTER 3820 HILLSIDE DRIVE CEDAR FALLS IA 50613 421372380 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 0 GRINNELL REGIONAL MEDICAL CENTER 210 FOURTH AVENUE GRINNELL IA 50112 420933383 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) CENTRAL IOWA HEALTH SYSTEM 0 GRINNELL REGIONAL MEDICAL CENTER AUXILIARY 210 FOURTH AVENUE GRINNELL IA 50112 237075505 CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES IA 501(C)(3) 509(A)(3), TYPE I GRINNELL REGIONAL MEDICAL CENTER 0 GRINNELL REGIONAL MEDICAL CENTER FOUNDATION 210 FOURTH AVENUE GRINNELL IA 50112 421454737 CHARITABLE FUNDRAISING IA 501(C)(3) 509(A)(3), TYPE I GRINNELL REGIONAL MEDICAL CENTER 0 HULT CENTER FOR HEALTHY LIVING INC 5409 N KNOXVILLE AVE PEORIA IL 61614 363510390 HEALTH EDUCATION TO THE COMMUNITY IL 501(C)(3) 170(B)(1) (A)(VI) PROCTOR HOSPITAL 0 HUMAN SERVICE CENTER 600 FAYETTE PO BOX 1346 PEORIA IL 61654 371004882 MENTAL HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(VI) UNITYPOINT HEALTH - 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AS THE NATION'S 13TH LARGEST NONPROFIT HEALTH SYSTEM, UNITYPOINT HEALTH PROVIDES PROGRESSIVE AND HIGH QUALITY SERVICES ACROSS ITS 9 REGIONS WHICH SPAN IOWA, WESTERN ILLINOIS AND SOUTHERN WISCONSIN. THIS REGIONAL CARE MODEL HAS BEEN SUCCESSFUL IN ACHIEVING STANDARDIZED LEVELS OF PERFORMANCE AND KEEPING CARE LOCAL. WITH $4.9B IN TOTAL OPERATING REVENUE, UNITYPOINT HEALTH EMPLOYS APPROXIMATELY 33,000 TEAM MEMBERS AND OPERATES 20 REGIONAL HOSPITALS, 19 COMMUNITY NETWORK HOSPITALS AND OVER 435 CLINICS. AS A KEY COMPONENT OF UNITYPOINT HEALTH, UNITYPOINT CLINIC IS A 1,180 PROVIDER MULTISPECIALTY GROUP THAT IS BUILT ON THE FOUNDATION OF CARE DELIVERY, INNOVATION AND EXPERIENCE. REPRESENTED BY OVER 40 SPECIALTIES, UPC IS A FORWARD-THINKING DELIVERY PROVIDER AND IS ON THE LEADING EDGE OF CARE DELIVERY WITH ITS TELEHEALTH, AMBULATORY AND URGENT CARE PROGRAMS. THE DIVERSIFIED HEALTH SYSTEM ALSO INCLUDES UNITYPOINT ACCOUNTABLE CARE, UNITYPOINT HEALTH COLLEGES, UNITYPOINT AT HOME AND EXTENDS HEALTH COVERAGE THROUGH THE HEALTHPARTNERS UNITYPOINT INSURANCE PLAN.