KEOKUK AREA HOSPITAL: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: KEOKUK AREA HOSPITAL (EIN 42-0710268)
Tax period: 2018-01-01 to 2018-12-31
Filed: 2019-11-14
IRS object ID: 201913189349310116
Schema version: 2018v3.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-11-14T14:54:41-06:00	ReturnTs
Tax Period End	2018-12-31	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2018-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	420710268	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KEOKUK AREA HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	KEOK	BusinessNameControlTxt
Phone	3195247150	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 MORGAN STREET	AddressLine1Txt
City	KEOKUK	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	52632	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MIKE MAHER	PersonNm
Person Title	BOARD MEMBER	PersonTitleTxt
Phone	3195247150	PhoneNum
Signature	2019-11-11	SignatureDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	205.167.2.34	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-11-11	IPDt
IP Tm	16:27:18	IPTm
IP Timezone	CS	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	4949FBDB2613D44DD524226BE936F6A9962DEEB1	AtSubmissionCreationDeviceId
At Submission Filing Device Id	4949FBDB2613D44DD524226BE936F6A9962DEEB1	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2020-03-31 21:24:44Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	MIKE MAHER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 MORGAN STREET	AddressLine1Txt
City	KEOKUK	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	52632	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$12,535,784	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.UNITYPOINT.ORG/KEOKUK	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1975	FormationYr
Legal Domicile State	IA	LegalDomicileStateCd
Activity Or Mission	IMPROVING COMMUNITY HEALTH & ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY.	ActivityOrMissionDesc
Voting Members Governing Body	10	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	277	TotalEmployeeCnt
Total Volunteers	9	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$13,515	PYContributionsGrantsAmt
CY Contributions Grants	$107,866	CYContributionsGrantsAmt
PY Program Service Revenue	$17,345,146	PYProgramServiceRevenueAmt
CY Program Service Revenue	$12,329,510	CYProgramServiceRevenueAmt
PY Investment Income	-$28,291	PYInvestmentIncomeAmt
CY Investment Income	$5,354	CYInvestmentIncomeAmt
PY Other Revenue	$319,915	PYOtherRevenueAmt
CY Other Revenue	$93,054	CYOtherRevenueAmt
PY Total Revenue	$17,650,285	PYTotalRevenueAmt
CY Total Revenue	$12,535,784	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$11,917,662	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$11,927,087	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$7,520,084	PYOtherExpensesAmt
CY Other Expenses	$11,216,287	CYOtherExpensesAmt
PY Total Expenses	$19,437,746	PYTotalExpensesAmt
CY Total Expenses	$23,143,374	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,787,461	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$10,607,590	CYRevenuesLessExpensesAmt
Total Assets BOY	$13,881,182	TotalAssetsBOYAmt
Total Assets EOY	$12,381,657	TotalAssetsEOYAmt
Total Liabilities BOY	$13,244,072	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$22,352,670	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$637,110	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	-$9,971,013	NetAssetsOrFundBalancesEOYAmt
Mission	IMPROVING COMMUNITY HEALTH AND ENSURING ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$17,791,855	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$12,352,062	RevenueAmt
Desc	KEOKUK AREA HOSPITAL (KAH) IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL FULLY ACCREDITED BY THE JOINT COMMISSION. ANNUALLY, KAH SERVICES APPROXIMATELY 1,000 ADMISSIONS, 230,000 OUTPATIENT PROCEDURES AND 12,000 EMERGENCY ROOM VISITS TO THE RESIDENTS OF KEOKUK, IOWA AND SURROUNDING AREAS. KAH ALSO HAS A HOME HEALTH AGENCY THAT SERVICES OVER 7,200 PATIENTS PER YEAR FROM LEE COUNTY, IA AND HANCOCK COUNTY, IL. THE HOSPITAL HAS APPROXIMATELY 120 CREDENTIALED PHYSICIANS ON THE MEDICAL STAFF AND IS GOVERNED BY THE KEOKUK HEALTH SYSTEMS BOARD OF DIRECTORS WHICH IS MADE UP OF LOCAL COMMUNITY MEMBERS.	Desc
Total Program Service Expenses	$17,791,855	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	29	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	277	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KRIS KARRE DIRECTOR OF FINANCE & ACCOUNTING	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	3195247150	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 MORGAN STREET	AddressLine1Txt
City	KEOKUK	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	52632	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
JESSICA BOWMAN
BOARD MEMBER (FR 4/18)	1.00	1.00	Yes (X)	$0	$0	$0
NEVILLE CRENSHAW DO
BOARD MEMBER (TO 4/18)	1.00	1.00	Yes (X)	$0	$0	$0
PAUL EALEY
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
CAREY GEHL
BOARD MEMBER & UPH EXEC DIR GROWTH	1.00	40.00	Yes (X)	$0	$223,644	$32,641
KIRAN KHANOLKAR MD
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
MIKE MAHER
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
KENT NIXON
BOARD VICE CHAIR/TREASURER	1.00	1.00	Yes (X)	$0	$0	$0	Yes (X)
TOM RICHARDSON
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
RON SCOTT
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
BARB SMIDT
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
JACK SMITH
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
WALT STEPHENS
BOARD CHAIR	1.00	1.00	Yes (X)	$0	$0	$0	Yes (X)
WENDY SWANK
BOARD SECRETARY	1.00	1.00	Yes (X)	$0	$0	$0	Yes (X)
ELIZABETH DAVIS
PHARMACY DIRECTOR	40.00	0.00		$122,061	$0	$20,145		Yes (X)
JAGADAMBA KANTANMENI MD
ANESTHESIOLOGIST	40.00	0.00		$302,862	$0	$1,080		Yes (X)
DONZA WORDEN
CHIEF CLINICAL OFFICER	40.00	0.00		$192,684	$0	$20,857		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$617,607	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$223,644	TotReportableCompRltdOrgAmt
Total Other Compensation	$74,723	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	3	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
SHARED MEDICAL SERVICES INC
209 LIMESTONE PASS	COTTAGE GROVE	WI	53527	HEALTHCARE SERVICES	$195,885
MAYO COLLABORATIVE SERVICES INC
200 SW FIRST STREET	ROCHESTER	MN	55905	LABORATORY SERVICES	$118,196

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	2	CntrctRcvdGreaterThan100KCnt
Related Organizations	$35,000	RelatedOrganizationsAmt
All Other Contributions	$72,866	AllOtherContributionsAmt
Total Contributions	$107,866	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE	900099	$12,209,011	$12,209,011
RENTAL REVENUE	532000	$112,957	$112,957
MGMT & SUPPORT SVCS	561000	$108,349	$108,349
MISCELLANEOUS REVENUE	900099	-$100,807	-$100,807

Field	Value	IRS element (for citing)
Total Program Service Revenue	$12,329,510	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,736	TotalRevenueColumnAmt
Exclusion	$4,736	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$618	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$618	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$618	TotalRevenueColumnAmt
Exclusion	$618	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CAFETERIA/LAUNDRY/MISC	900099	$70,502	$70,502
MISCELLANEOUS REVENUE	900099	$22,552		$22,552

Field	Value	IRS element (for citing)
Other Revenue Total	$93,054	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$12,535,784	TotalRevenueColumnAmt
Related Or Exempt Func Income	$12,352,062	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$75,856	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$10,035,384	TotalAmt
Program Services	$7,966,613	ProgramServicesAmt
Management And General	$2,068,771	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$20,920	TotalAmt
Program Services	$16,607	ProgramServicesAmt
Management And General	$4,313	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,272,137	TotalAmt
Program Services	$1,009,889	ProgramServicesAmt
Management And General	$262,248	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$598,646	TotalAmt
Program Services	$475,237	ProgramServicesAmt
Management And General	$123,409	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$339,318	TotalAmt
Program Services	$339,318	ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$113,314	TotalAmt
Management And General	$113,314	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$4,089,721	TotalAmt
Program Services	$1,560,320	ProgramServicesAmt
Management And General	$2,529,401	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$60,885	TotalAmt
Management And General	$60,885	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$404,644	TotalAmt
Program Services	$266,561	ProgramServicesAmt
Management And General	$138,083	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,491,786	TotalAmt
Program Services	$1,491,786	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$674,064	TotalAmt
Program Services	$662,624	ProgramServicesAmt
Management And General	$11,440	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$47,226	TotalAmt
Program Services	$37,970	ProgramServicesAmt
Management And General	$9,256	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$1,532	TotalAmt
Program Services	$1,532	ProgramServicesAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$550,523	TotalAmt
Program Services	$550,523	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$815,331	TotalAmt
Program Services	$815,331	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$68,458	TotalAmt
Program Services	$68,458	ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$2,528,621	$2,529,086	-$465
MISCELLANEOUS EXPENSE	$30,864		$30,864

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$23,143,374	TotalAmt
Program Services	$17,791,855	ProgramServicesAmt
Management And General	$5,351,519	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,763,628	BOYAmt
EOY	$1,065,605	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,670,174	BOYAmt
EOY	$2,434,955	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$4,231,846	BOYAmt
EOY	$4,276,797	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,009,598	BOYAmt
EOY	$949,243	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$53,268	BOYAmt
EOY	$89,544	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$27,469,289	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$24,081,074	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$3,988,170	BOYAmt
EOY	$3,388,215	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$164,498	BOYAmt
EOY	$177,298	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$13,881,182	BOYAmt
EOY	$12,381,657	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,141,144	BOYAmt
EOY	$5,804,226	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
EOY	-$189,385	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$4,423,297	BOYAmt
EOY	$4,060,547	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$50,000	BOYAmt
EOY	$48,152	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$4,629,631	BOYAmt
EOY	$12,629,130	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$13,244,072	BOYAmt
EOY	$22,352,670	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$638,706	BOYAmt
EOY	-$9,982,159	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	-$1,596	BOYAmt
EOY	$11,146	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$637,110	BOYAmt
EOY	-$9,971,013	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$13,881,182	BOYAmt
EOY	$12,381,657	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$10,607,590	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$533	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$438,675	OtherCostOrOtherBasisAmt
Book Value	$438,675	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$17,122,972	OtherCostOrOtherBasisAmt
Depreciation	$15,461,949	DepreciationAmt
Book Value	$1,661,023	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$7,363,710	OtherCostOrOtherBasisAmt
Depreciation	$6,228,832	DepreciationAmt
Book Value	$1,134,878	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,543,932	OtherCostOrOtherBasisAmt
Depreciation	$2,390,293	DepreciationAmt
Book Value	$153,639	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$3,388,215	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
IOWA HEALTH SYSTEM NOTE PAYABLE	$8,935,683
DUE TO AFFILIATES	$3,679,089
SELF INSURANCE RESERVE	$14,358

Field	Value	IRS element (for citing)
Total Liability	$12,629,130	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$12,523,000	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$12,523,000	RevenueSubtotalAmt
Other Revenues Not Included	$12,784	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$12,784	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$12,535,784	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$21,652,000	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$412	OtherExpensesIncludedAmt
Expenses Not Reported	$412	ExpensesNotReportedAmt
Expenses Subtotal	$21,651,588	ExpensesSubtotalAmt
Other Expenses Not Included	$1,491,786	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$1,491,786	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$23,143,374	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 2015. 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 4B - OTHER ADJUSTMENTS:	REVENUE IN TEMPORARILY FUND BALANCE 12,742. ROUNDING 42.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	ROUNDING 412.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	EXPENSES IN TEMPORATILY FUND BALANCE 1,491,786.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	600.000000000000	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$228,512	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$228,512	NetCommunityBenefitExpnsAmt
Total Expense	0.00990	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,279,482	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,279,482	NetCommunityBenefitExpnsAmt
Total Expense	0.05530	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$68,920	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$68,920	NetCommunityBenefitExpnsAmt
Total Expense	0.00300	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,576,914	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,576,914	NetCommunityBenefitExpnsAmt
Total Expense	0.06820	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,961	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$14,961	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$131,235	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$131,235	NetCommunityBenefitExpnsAmt
Total Expense	0.00570	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,100	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$20,100	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$166,296	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$166,296	NetCommunityBenefitExpnsAmt
Total Expense	0.00720	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,743,210	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,743,210	NetCommunityBenefitExpnsAmt
Total Expense	0.07540	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$57,643	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$57,643	NetCommunityBenefitExpnsAmt
Total Expense	0.00250	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$57,643	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$57,643	NetCommunityBenefitExpnsAmt
Total Expense	0.00250	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$689,858	BadDebtExpenseAmt
Reimbursed By Medicare	$6,997,843	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$9,622,164	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$2,624,321	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KEOKUK AREA HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 MORGAN STREET	AddressLine1Txt
City	KEOKUK	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	52632	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.KEOKUKHEALTHSYSTEMS.ORG	WebsiteAddressTxt
State License	560054H	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	KEOKUK AREA HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	16	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.UNITYPOINT.ORG/KEOKUK	OwnWebsiteURLTxt
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.UNITYPOINT.ORG/KEOKUK	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	600.000000000000	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.UNITYPOINT.ORG/KEOKUK/FINANCIAL-ASSISTANCE.ASPX	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.UNITYPOINT.ORG/KEOKUK/FINANCIAL-ASSISTANCE.ASPX	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.UNITYPOINT.ORG/KEOKUK/FINANCIAL-ASSISTANCE.ASPX	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
KEOKUK AREA HOSPITAL	PART V, SECTION B, LINE 5: KEOKUK AREA HOSPITAL, LEE COUNTY HEALTH DEPARTMENT AND FORT MADISON COMMUNITY HOSPITAL ONCE AGAIN COLLABORATED TO BRING MULTIPLE COMMUNITY MEMBERS AND PARTNERSHIPS TOGETHER TO COMPLETE THE COUNTY'S COMMUNITY HEALTH NEEDS ASSESSMENT. THE PROCESS IDENTIFIED FOUR SPECIFIC HEALTH NEEDS TO ADDRESS IN THE COUNTY'S HEALTH IMPROVEMENT PLAN FOR THE NEXT THREE YEARS. ON SEPTEMBER 22, 2015, 38 REPRESENTATIVES FROM A VARIETY OF COMMUNITY SECTORS MET TO REVIEW AND EVALUATE COUNTY LEVEL DATA/ HEALTH INDICATORS, COMMUNITY-WIDE SURVEY RESULTS, AND DISCUSS COMMUNITY ASSETS AND RESOURCES AVAILABLE TO ADDRESS THE NEEDS OF THE COUNTY. ATTENDEES INCLUDED REPRESENTATIVES FROM KEOKUK AREA HOSPITAL, LEE COUNTY BOARD OF HEALTH, LEE COUNTY HEALTH DEPARTMENT, FORT MADISON COMMUNITY HOSPITAL, CHILDREN FIRST EARLY CHILDHOOD IOWA, LEE COUNTY COMMUNITY SERVICES/SOUTHEAST IOWA LINK OF DISABILITY SERVICES, FORT MADISON HY-VEE, THE KENSINGTON, ISU EXTENSION AND OUTREACH, FORT MADISON YMCA, FORT MADISON POLICE DEPARTMENT, LEE COUNTY BENEFITS COORDINATOR, GROUP BENEFIT PARTNERS, CITY OF KEOKUK, LEE COUNTY SHERIFF, COUNSELING ASSOCIATES, COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC., AND FORT MADISON PARTNERS.
KEOKUK AREA HOSPITAL	PART V, SECTION B, LINE 6A: KEOKUK AREA HOSPITAL'S CHNA WAS PERFORMED WITH FORT MADISON COMMUNITY HOSPITAL.
KEOKUK AREA HOSPITAL	PART V, SECTION B, LINE 6B: KEOKUK AREA HOSPITAL'S CHNA WAS PERFORMED WITH THE LEE COUNTY HEALTH DEPARTMENT.
KEOKUK AREA HOSPITAL	PART V, SECTION B, LINE 7D: A COPY OF THE CHNA IS AVAILABLE UPON REQUEST.
KEOKUK AREA HOSPITAL	PART V, SECTION B, LINE 11: -INCREASED DIABETES EDUCATION AND TEACHING OFFERINGS AND FOCUSED ON PROMOTION TO TARGETED POPULATIONS.-EVALUATED UNIQUE AND INNOVATIVE OPPORTUNITIES TO INCREASE MENTAL HEALTH/BEHAVIORAL HEALTH SERVICES. -PROVIDED HEALTH INFORMATION AND EDUCATION RANGING FROM TRANSPORTATION ASSISTANCE TO HEALTHY FOOD GUIDES TO CUSTOMERS AND COMMUNITY MEMBERS.-ACTIVELY PARTICIPATED WITH THE LIVE HEALTH LEE COUNTY COALITION INITIATIVES TO PROMOTE HEALTHY BEHAVIORS AND RESOURCES.-WERE ACTIVE MEMBERS OF THE KEOKUK DENTAL RECRUITMENT TASK FORCE AND ACTIVELY ENGAGED IN THE KEOKUK CHAMBER OF COMMERCE RECRUITMENT INITIATIVES.SOME OF THE HEALTH NEEDS IDENTIFIED THROUGH THE ASSESSMENT WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA BY THE LEE COUNTY HEALTH DEPARTMENT AND FORT MADISON COMMUNITY HOSPITAL AND COMMUNITY GROUPS THROUGHOUT LEE COUNTY.
KEOKUK AREA 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.

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	1 - TRI-STATE MEDICAL GROUP	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 MORGAN STREET	AddressLine1Txt
City	KEOKUK	CityNm
State Abbreviation	IA	StateAbbreviationCd
ZIP	52632	ZIPCd

Field	Value	IRS element (for citing)
Facility	PRIMARY CARE CLINIC	FacilityTxt

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	KEOKUK AREA HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM 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 I, LINE 7G:	REPRESENTS THE SUBSIDY TO TRI-STATE MEDICAL GROUP, INC. TO COVER UNCOMPENSATED HEALTHCARE COSTS.
PART II, COMMUNITY BUILDING ACTIVITIES:	KEOKUK AREA HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY THROUGH INCREASED EDUCATION AND TRAINING OF HEALTHCARE RELATED ISSUES AS WELL AS PROMOTING CAREER DEVELOPMENT IN THE HEALTHCARE FIELD.
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'S 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 ALLEN MEMORIAL HOSPITAL. 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 SURPLUS 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:	KEOKUK AREA HOSPITAL PARTICIPATES WITH MANY HEALTH RELATED ORGANIZATIONS TO ASSESS HEALTHCARE NEEDS IN LEE COUNTY, IOWA AND SHARES THE RESULTS IN A WRITTEN COMMUNITY HEALTH NEEDS ASSESSMENT WHICH IS AVAILABLE ON THE WEBSITE OR BY REQUEST.
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:	KEOKUK HOSPITAL IS A 49 BED COMMUNITY HOSPITAL SERVING THE MIDWEST REGION. KEOKUK HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.90% OF KEOKUK HOSPITAL MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIY OF LEE. KEOKUK HOSPITAL ADMITS APPROXIMATELY 530 INPATIENTS AND CARES FOR 10,000 EMERGENCY PATIENTS PER YEAR. MEDIAN HOUSEHOLD INCOME IS $54,605 AND THE AVERAGE POVERTY RATE IS 12.2%.69.4% OF KEOKUK HOSPITAL'S INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID.
PART VI, LINE 5:	KEOKUK AREA HOSPITAL HAS AN ALL VOLUNTEER BOARD OF DIRECTORS MADE UP OF LOCAL COMMUNITY MEMBERS WHO SERVE WITHOUT COMPENSATION. THE MEDICAL STAFF IS OPEN TO ALL INTERESTED PROVIDERS WHO ARE APPROPRIATELY CREDENTIALED. ALL FUNDS GENERATED BY THE HOSPITAL ARE UTILIZED FOR PATIENT RELATED SERVICES AND TO ENSURE THAT ALL PATIENTS IN THE MARKET HAVE ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY.
PART VI, LINE 6:	THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THROUGH RELATIONSHIPS WITH 36 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 280 PHYSICIAN CLINICS, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERN ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY A LARGE NONPROFIT WORKFORCE, WITH MORE THAN 30,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 6.5 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $4.4 BILLION, UNITYPOINT HEALTH IS THE FIFTH LARGEST NONDENOMINATIONAL HEALTH SYSTEM IN AMERICA AND PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES TO IMPROVE THE HEALTH OF PEOPLE IN ITS COMMUNITIES. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES THROUGHOUT IOWA, AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THE STATE. IN 2018, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $559 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	IA

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CAREY GEHL
BOARD MEMBER & UPH EXEC DIR GROWTH	$0	$188,633	$0	$22,596	$0	$12,415	$0	$11,254	$0	$21,387	$0	$256,285	$0	$0
JAGADAMBA KANTANMENI MD
ANESTHESIOLOGIST	$302,283	$0	$0	$0	$579	$0	$0	$0	$1,080	$0	$303,942	$0	$0	$0
DONZA WORDEN
CHIEF CLINICAL OFFICER	$192,105	$0	$0	$0	$579	$0	$0	$0	$20,857	$0	$213,541	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 3	FormAndLineReferenceDesc
Explanation	CEO/EXECUTIVE SALARY IS APPROVED BY THE BOARD OF DIRECTORS AFTER REVIEW BY EXECUTIVE COMMITTEE USING VARIOUS BENCHMARK DATA, INCLUDING 990 DATA OF SIMILAR HOSPITALS, IOWA HOSPITAL ASSOCIATION SALARY SURVEYS AND EXPERIENCE LEVEL OF CANDIDATE.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	KEOKUK HEALTH SYSTEMS INC., A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER, KEOKUK HEALTH SYSTEMS, INC., HAS THE POWER TO NOMINATE AND APPOINT BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER, KEOKUK HEALTH SYSTEMS, INC., HAS THE POWER TO APPROVE CHANGES IN ARTICLES AND BYLAWS, DISSOLUTIONS OR MERGER, AND APPOINT BOARD OF DIRECTORS. IN ADDITION, AT LEAST TWO BOARD MEMBERS MUST ALSO BE BOARD MEMBERS OF KEOKUK HEALTH SYSTEMS, INC.
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 BOARD OF DIRECTORS REVIEWS ALL COMPENSATION ARRANGEMENTS WITH HIGHLY PAID EMPLOYEES UTILIZING BENCHMARK DATA FROM VARIOUS SOURCES INCLUDING THE IOWA HOSPITAL ASSOCIATION WAGE AND SALARY SURVEYS AND PHYSICIAN COMPENSATION SURVEYS.
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 IX, LINE 11G	HEALTHCARE PROFESSIONALS : PROGRAM SERVICE EXPENSES 414,717. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 414,717. PURCHASED HOUSEKEEPING AND LAUNDRY : PROGRAM SERVICE EXPENSES 98,051. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,051. MISC PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 1,047,552. MANAGEMENT AND GENERAL EXPENSES 2,529,401. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,576,953.
FORM 990, PART XI, LINE 9:	ROUNDING -533.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (78 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
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
EYERLY-BALL FOUNDATION INC
945 19TH STREET	DES MOINES	IA	50314	352515479	CHARITABLE FUNDRAISING	IA	501(C)(3)	170(B)(1) (A)(VI)	EYERLY-BALL COMMUNITY MENTAL HEALTH SERVICES	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
HANCOCK COUNTY SENIOR SERVICES ASSOCIATION
PO BOX 160	CARTHAGE	IL	62321	370902248	SENIOR SERVICES	IL	501(C)(3)	509(A)(2)	MEMORIAL HOSPITAL ASSOCIATION	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
IOWA HEALTH FOUNDATION
1415 WOODLAND AVE SUITE E-200	DES MOINES	IA	50309	421467682	CHARITABLE FUNDRAISING	IA	501(C)(3)	170(B)(1) (A)(VI)	CENTRAL IOWA HEALTH SYSTEM	0
IOWA HEALTH SYSTEM
1776 WEST LAKES PKWY 400	WEST DES MOINES	IA	50266	421435199	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE III		0
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
8101 BIRCHWOOD COURT	JOHNSTON	IA	50131	421411630	PRIMARY HEALTH CARE SERVICES	IA	501(C)(3)	170(B)(1) (A)(III)	IOWA HEALTH SYSTEM	0
KEOKUK AREA HOSPITAL
1600 MORGAN STREET	KEOKUK	IA	52632	420710268	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	KEOKUK HEALTH SYSTEMS INC	0
KEOKUK AREA HOSPITAL FOUNDATION
1600 MORGAN STREET	KEOKUK	IA	52632	421202608	CHARITABLE FUNDRAISING	IA	501(C)(3)	509(A)(3) TYPE II	KEOKUK HEALTH SYSTEMS INC	0
KEOKUK HEALTH SYSTEMS INC
1600 MORGAN STREET	KEOKUK	IA	52632	421237361	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	0
MEMORIAL FOUNDATION OF ALLEN HOSPITAL
1825 LOGAN AVENUE	WATERLOO	IA	50703	421201138	CHARITABLE FUNDRAISING	IA	501(C)(3)	170(B)(1) (A)(VI)	ALLEN HEALTH SYSTEMS INC	0
MEMORIAL HOSPITAL ASSOCIATION
PO BOX 160	CARTHAGE	IL	62321	370684691	HOSPITAL	IL	501(C)(3)	170(B)(1) (A)(III)	IOWA HEALTH SYSTEM	0
MERITER FOUNDATION INC
202 SOUTH PARK STREET	MADISON	WI	53715	237098688	CHARITABLE FUNDRAISING	WI	501(C)(3)	170(B)(1) (A)(VI)	MERITER HEALTH SERVICES INC	0
MERITER HEALTH SERVICES INC
202 SOUTH PARK STREET	MADISON	WI	53715	391412318	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	WI	501(C)(3)	509(A)(3), TYPE III	IOWA HEALTH SYSTEM	0
MERITER HOSPITAL INC
202 SOUTH PARK STREET	MADISON	WI	53715	390806367	HOSPITAL	WI	501(C)(3)	170(B)(1) (A)(III)	MERITER HEALTH SERVICES INC	0
MERITER MEDICAL GROUP INC
202 SOUTH PARK STREET	MADISON	WI	53715	050545222	SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES	WI	501(C)(3)	509(A)(3), TYPE III	MERITER HOSPITAL INC	0
METHODIST HEALTH SERVICES CORPORATION
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	371111135	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IL	501(C)(3)	509(A)(3), TYPE III	IOWA HEALTH SYSTEM	0
METHODIST MEDICAL CENTER FOUNDATION
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	510186460	CHARITABLE FUNDRAISING	IL	501(C)(3)	170(B)(1) (A)(VI)	METHODIST HEALTH SERVICES CORPORATION	0
METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	370661223	HOSPITAL	IL	501(C)(3)	170(B)(1) (A)(III)	METHODIST HEALTH SERVICES CORPORATION	0
METHODIST SERVICES INC
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	371111134	OFFICE RENTAL	IL	501(C)(3)	509(A)(2)	METHODIST HEALTH SERVICES CORPORATION	0
NELLIE R SHERWOOD TRUST
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	426061621	PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY	IA	501(C)(3)	509(A)(3), TYPE I	ST LUKE'S METHODIST HOSPITAL	0
NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED
720 KENYON DRIVE	FORT DODGE	IA	50501	420937390	MENTAL HEALTH CARE	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY HEALTH SYSTEMS INC	0
NORTHWEST IOWA HOSPITAL CORPORATION
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421019872	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTH SYSTEM INC	0
PARK COURT LIMITED
600 SOUTH 13TH STREET	PEKIN	IL	61554	371178386	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IL	501(C)(3)	509(A)(3), TYPE II	PROGRESSIVE HEALTH SYSTEMS	0
PEKIN MEMORIAL HOSPITAL
600 SOUTH 13TH STREET	PEKIN	IL	61554	370692351	HOSPITAL	IL	501(C)(3)	170(B)(1) (A)(III)	PROGRESSIVE HEALTH SYSTEMS	0
PENN CENTER INC
740 N 15TH AVE NO A	HIAWATHA	IA	52233	421421803	RESIDENTIAL TREATMENT SERVICES FOR INDEPENDENT LIVING	IA	501(C)(3)	509(A)(2)	ABBEHEALTH INC	0
PROCTOR HEALTH CARE INCORPORATED
5409 N KNOXVILLE AVE	PEORIA	IL	61614	371133412	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IL	501(C)(3)	509(A)(3), TYPE II	METHODIST HEALTH SERVICES CORPORATION	0
PROCTOR HEALTH SYSTEMS
5409 N KNOXVILLE AVE	PEORIA	IL	61614	364147437	PRIMARY HEALTH CARE SERVICES	IL	501(C)(3)	170(B)(1) (A)(III)	PROCTOR HEALTH CARE INCORPORATED	0
PROCTOR HOSPITAL
5409 N KNOXVILLE AVE	PEORIA	IL	61614	370681540	HOSPITAL	IL	501(C)(3)	170(B)(1) (A)(III)	PROCTOR HEALTH CARE INCORPORATED	0
PROGRESSIVE HEALTH SYSTEMS
600 SOUTH 13TH STREET	PEKIN	IL	61554	371200263	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IL	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	0
SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	376181831	FUND SELF-INSURANCE PLAN	IL	501(C)(3)	509(A)(3), TYPE I	METHODIST MEDICAL CENTER OF ILLINOIS	0
SHARED MAGNETIC RESONANCE IMAGING FACILITY INC
1104 JOHN NOLEN DRIVE	MADISON	WI	53713	391534744	MEDICAL TECHNOLOGY	WI	501(C)(3)	509(A)(3), TYPE I		0
SIOUXLAND PACE INC
313 COOK STREET	SIOUX CITY	IA	51103	261120134	ALL-INCLUSIVE CARE FOR THE ELDERLY	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTH SYSTEM INC	0
ST LUKE'S HEALTH RESOURCES
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421059182	OUTPATIENT CLINICS AND HEALTHCARE SERVICES	IA	501(C)(3)	509(A)(2)	ST LUKE'S HEALTH SYSTEM INC	0
ST LUKE'S HEALTH SYSTEM INC
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421294091	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE III	IOWA HEALTH SYSTEM	0
ST LUKE'S HEALTHCARE
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	421487968	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	0
ST LUKE'S METHODIST HOSPITAL
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	420504780	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTHCARE	0
ST LUKE'SJONES REGIONAL MEDICAL CENTER
1795 HIGHWAY 64 EAST	ANAMOSA	IA	52205	421487967	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTHCARE	0
STL CARE COMPANY
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	421276632	IMPROVE PUBLIC HEALTH SERVICES	IA	501(C)(3)	509(A)(2)	ST LUKE'S HEALTHCARE	0
THE DUBUQUE VISITING NURSE ASSOCIATION
350 NORTH GRANDVIEW AVENUE	DUBUQUE	IA	52001	420680410	PUBLIC HEALTH SERVICES/HOME CARE	IA	501(C)(3)	509(A)(2)	FINLEY TRI-STATES HEALTH GROUP INC	0
THE FINLEY HOSPITAL
350 NORTH GRANDVIEW AVENUE	DUBUQUE	IA	52001	420680354	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	FINLEY TRI-STATES HEALTH GROUP INC	0
THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
2701 17TH STREET	ROCK ISLAND	IL	61201	363678909	MENTAL HEALTH CARE	IL	501(C)(3)	170(B)(1) (A)(VI)	TRINITY REGIONAL HEALTH SYSTEM	0
TRIMARK PHYSICIANS GROUP
802 KENYON ROAD	FORT DODGE	IA	50501	453791448	SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY HEALTH SYSTEMS INC	0
TRINITY BUILDING CORPORATION
802 KENYON ROAD	FORT DODGE	IA	50501	421376187	PROPERTY HOLDING COMPANY	IA	501(C)(2)		TRINITY HEALTH SYSTEMS INC	0
TRINITY COLLEGE OF NURSING & HEALTH SCIENCES
2122 25TH AVE	ROCK ISLAND	IL	61201	810994377	EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS	IL	501(C)(3)	170(B)(1) (A)(II)	TRINITY MEDICAL CENTER	0
TRINITY HEALTH FOUNDATION
802 KENYON ROAD	FORT DODGE	IA	50501	421222381	CHARITABLE FUNDRAISING	IA	501(C)(3)	170(B)(1) (A)(VI)	TRINITY HEALTH SYSTEMS INC	0
TRINITY HEALTH FOUNDATION
2701 17TH STREET	ROCK ISLAND	IL	61201	363321751	CHARITABLE FUNDRAISING	IL	501(C)(3)	170(B)(1) (A)(VI)	TRINITY REGIONAL HEALTH SYSTEM	0
TRINITY HEALTH SYSTEMS INC
802 KENYON ROAD	FORT DODGE	IA	50501	421222877	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	0
TRINITY MEDICAL CENTER
2701 17TH STREET	ROCK ISLAND	IL	61201	362739299	HOSPITAL	IL	501(C)(3)	170(B)(1) (A)(III)	TRINITY REGIONAL HEALTH SYSTEM	0
TRINITY REGIONAL HEALTH SYSTEM
2701 17TH STREET	ROCK ISLAND	IL	61201	363351952	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IL	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	0
TRINITY REGIONAL HOSPITAL AUXILIARY
802 KENYON ROAD	FORT DODGE	IA	50501	426081474	CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES	IA	501(C)(3)	509(A)(2)	TRINITY REGIONAL MEDICAL CENTER	0
TRINITY REGIONAL MEDICAL CENTER
802 KENYON ROAD	FORT DODGE	IA	50501	421009175	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY HEALTH SYSTEMS INC	0
TRI-STATE MEDICAL GROUP INC
1600 MORGAN STREET	KEOKUK	IA	52632	421435525	PRIMARY HEALTH CARE SERVICES	IA	501(C)(3)	170(B)(1)(A)(III)	KEOKUK HEALTH SYSTEMS INC	0
UNITY HEALTHCARE
1518 MULBERRY AVENUE	MUSCATINE	IA	52761	420680337	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY REGIONAL HEALTH SYSTEM	0
UNITY HEALTHCARE FOUNDATION
1518 MULBERRY AVENUE	MUSCATINE	IA	52761	421525031	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE I	UNITY HEALTHCARE	0
UNITYPOINT HEALTH - MARSHALLTOWN
1825 LOGAN AVENUE	WATERLOO	IA	50703	815034179	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	ALLEN HEALTH SYSTEMS INC	0
UNITYPOINT AT HOME
11333 AURORA AVENUE	URBANDALE	IA	50322	421477471	HOME HEALTH CARE	IA	501(C)(3)	509(A)(2)	IOWA HEALTH SYSTEM	0
UNITYPOINT HEALTH AT WORK
1776 WEST LAKES PKWY 400	WEST DES MOINES	IA	50266	810872241	EMPLOYER ONSITE MEDICAL SERVICES AND OCCUPATIONAL MEDICINE	IA	501(C)(3)	170(B)(1) (A)(III)	IOWA HEALTH SYSTEM	0
WISCONSIN DIALYSIS INC
3034 FISH HATCHERY ROAD	MADISON	WI	53713	300072647	OUTPATIENT KIDNEY DIALYSIS	WI	501(C)(3)	509(A)(3), TYPE III		0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (24 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd
ADVANCED IMAGING CENTER LLC
615 VALLEY VIEW DRIVE	MOLINE	IL	61265	364356301	DIAGNOSTIC RADIOLOGY CENTER	IA	N/A
ALLEN MEMORIAL HOSPITAL ORTHOPEDIC CO-MANAGEMENT CO LLC
1825 LOGAN AVE	WATERLOO	IA	50703	453237125	ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES	IA	N/A
ANKENY MEDICAL PARK SURGERY CENTER LC
3625 NORTH ANKENY BLVD STE J	ANKENY	IA	50021	831281114	AMBULATORY SURGERY CENTER	IA	N/A
CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC
1200 PLEASANT ST	DES MOINES	IA	50309	273625869	CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES	IA	N/A
CENTRAL IOWA ONCOLOGY CO-MANAGEMENT COMPANY
1200 PLEASANT STREET	DES MOINES	IA	50309	453017991	ONCOLOGY MANAGEMENT & ADMINISTRATIVE SERVICES	IA	N/A
CENTRAL IOWA PHYSIO LLC
4714 GETTYSBURG ROAD	MECHANICSBURG	PA	17055	364799633	PHYSICAL THERAPY SERVICES	IA	N/A
CENTRAL IOWA SURGICAL SERVICES CO-MANAGEMENT CO LLC
1200 PLEASANT ST	DES MOINES	IA	50309	471608704	SURGICAL MANAGEMENT & ADMINISTRATIVE SERVICES	IA	N/A
DUBUQUE ENDOSCOPY CENTER LC
1515 DELHI STREET SUITE 500	DUBUQUE	IA	52001	201597161	AMBULATORY SURGERY CENTER	IA	N/A
FINLEY DEPT OF SURGERY CO-MGMT CO LLC
350 N GRANDVIEW AVE	DUBUQUE	IA	52001	422808785	SURGERY DEPARTMENT MANAGEMENT SERVICES	IA	N/A
HANCOCK COUNTY SLF LLP
403 S ADAMS	CARTHAGE	IL	62321	204445121	ASSISTED LIVING FACILITY	IL	N/A
HEALTH CARE AFFILIATES OF THE TRI-STATES LLC
350 N GRANDVIEW AVE	DUBUQUE	IA	52001	421428503	PROVIDE ACCESS TO LICENSED SOFTWARE	IA	N/A
IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC
1200 PLEASANT STREET	DES MOINES	IA	50309	030482623	OUTPATIENT DIAGNOSTIC IMAGING	IA	N/A
IOWA HEALTH SYSTEM CONTRACTING SERVICES LC
1776 WEST LAKES PKWY 400	WEST DES MOINES	IA	50266	421511142	GROUP PURCHASING	IA	N/A
LAKEVIEW SURGERY CENTER LC
1200 PLEASANT STREET	DES MOINES	IA	50309	421516120	SURGERY CENTER	IA	N/A
MERITER UW PHYSICIANS CONTRACTING COMPANY LLC
202 SOUTH PARK STREET	MADISON	WI	53715	391998819	HEALTH SERVICES	WI	N/A
MISSISSIPPI VALLEY SLEEP DISORDER CENTER LC
3400 DEXTER COURT	DAVENPORT	IA	52807	421489697	MEDICAL LABORATORY SERVICES	IA	N/A
MMCI ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
221 NE GLEN OAK AVE	PEORIA	IL	61636	461219459	ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES	IL	N/A
MR ASSOCIATES LLP
1956 1ST AVENUE NE	CEDAR RAPIDS	IA	52402	421260463	OWN AND OPERATE MR UNIT	IA	N/A
ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC
1200 PLEASANT STREET	DES MOINES	IA	50309	421508092	AMBULATORY SURGERY CENTER	IA	N/A
REHABILITATION THERAPY SERVICES LLC
416 ST MARKS CT 110	PEORIA	IL	61603	810584193	REHABILATION THERAPY	IL	N/A
THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC
1075 FIRST AVENUE SE	CEDAR RAPIDS	IA	52403	721550812	AMBULATORY SURGERY CENTER.	IA	N/A
UPHT-SCA HOLDINGS LLC
569 BROOKWOOD VILLAGE SUITE 901	BIRMINGHAM	AL	35209	473564984	AMBULATORY SURGERY CENTER INVESTMENT	DE	N/A
WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
1660 60TH STREET	WEST DES MOINES	IA	50266	271414600	ORTHOPEDIC SERVICE LINES MANAGEMENT	IA	N/A
WEST LAKES SLEEP CENTER LLC
5950 UNIVERSITY AVENUE SUITE 2	WEST DES MOINES	IA	50266	263193923	SLEEP DISORDER DIAGNOSTIC TESTING FACILITY	IA	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (26 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
ABBE MANAGEMENT CORPORATION
740 N 15TH AVE NO A	HIAWATHA	IA	52233	421361755	MANAGEMENT SERVICES	IA	N/A	C	0
BELCREST SERVICES LTD
5409 N KNOXVILLE AVE	PEORIA	IL	61614	371196307	MEDICAL SERVICES	IL	N/A	C	0
BROADBAND INC
1776 WEST LAKES PKWY 400	WEST DES MOINES	IA	50266	273819741	INFORMATION TECHNOLOGY MGMT.	IA	N/A	C	0
DELHI POINT CONDO ASSOCIATION
350 N GRANDVIEW	DUBUQUE	IA	52001	421467002	REAL ESTATE MANAGEMENT	IA	N/A	C	0
HCP CORPORATION
202 SOUTH PARK STREET	MADISON	WI	53715	391177562	REAL ESTATE RENTAL	WI	N/A	C	0
HANCOCK AREA MEDICAL SUPPLY INC
1204 BUCHANAN ST	CARTHAGE	IL	62321	371180373	RETAIL HOME HEALTH MEDICAL EQUIPMENT	IL	N/A	C	0
HANSEN CHARITABLE REMAINDER ANNUITY TRUST
210 FOURTH AVENUE	GRINNELL	IA	50112	396770806	INVESTMENT	IA	N/A	T	0
HANSEN CHARITABLE REMAINDER UNITRUST
210 FOURTH AVENUE	GRINNELL	IA	50112	396770807	INVESTMENT	IA	N/A	T	0
HEALTH ADVANTAGE PLUS INC
210 4TH AVENUE	GRINNELL	IA	50112	421436490	PHYSICAL THERAPY	IA	N/A	C	0
HEALTH PLUS INC
5409 N KNOXVILLE AVE	PEORIA	IL	61614	371295532	MANAGED CARE ADMINISTRATION	IL	N/A	C	0
HNC SERVICES
1776 WEST LAKES PKWY 400	WEST DES MOINES	IA	50266	270987243	FIBER OPTIC NETWORK SERVICES	IA	N/A	C	0
HOME HEALTH PLUS SERVICES INC
PO BOX 87	PEORIA	IL	61650	364053068	HOME HEALTH SERVICES	IL	N/A	C	0
KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY INC
420 NORTH 17TH STREET	KEOKUK	IA	52632	421237312	RETAIL DURABLE MEDICAL EQUIPMENT	IA	N/A	C	0
MARIGOLD CITY LAND TRUST NO ONE
2956 COURT STREET	PEKIN	IL	61554	272750273	PROPERTY MANAGEMENT	IL	N/A	T	0
MEDIMORE INC
1776 WEST LAKES PKWY 400	WEST DES MOINES	IA	50266	421414390	MANAGED CARE	IA	N/A	C	0
MERITER HEALTH ENTERPRISES INC
202 SOUTH PARK STREET	MADISON	WI	53715	391293620	MANAGEMENT SERVICES	WI	N/A	C	0
MERITER MANAGEMENT SERVICES INC
202 SOUTH PARK STREET	MADISON	WI	53715	391458235	ADMINISTRATIVE SERVICES	WI	N/A	C	0
METHODIST HEALTH VENTURES INC
PO BOX 87	PEORIA	IL	61650	371140939	PHARMACY/OFFICE STAFFING	IL	N/A	C	0
METHODIST PHYSICIAN SERVICES INC
PO BOX 87	PEORIA	IL	61650	363858550	MEDICAL SERVICES	IL	N/A	C	0
OPTIMUM HEALTH SOLUTIONS INC
221 NORTHEAST GLEN OAK AVE	PEORIA	IL	61636	205430137	HEALTH & WELLNESS CONSULTING	IA	N/A	C	0
PEKIN PROHEALTH INC
600 SOUTH 13TH STREET	PEKIN	IL	61554	371117052	CLINIC	IL	N/A	C	0
PRECEDENCE INC
4622 PROGRESS DRIVE STE A	DAVENPORT	IA	52807	371288604	MANAGED MENTAL CARE	IA	N/A	C	0
PROVIDER RESOURCE MANAGEMENT INC
PO BOX 87	PEORIA	IL	61650	371223550	RESOURCE MANAGEMENT	IL	N/A	C	0
STL HEALTH RESOURCES CO
1026 A AVE NE	CEDAR RAPIDS	IA	52402	421193499	PHYSICIAN OFFICE RENTAL	IA	N/A	C	0
TRINITY HEALTH ENTERPRISES INC
2701 17TH ST	ROCK ISLAND	IL	61201	363320141	RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY	IL	N/A	C	0
TRINITY PHYSICIAN HOSPITAL ORGANIZATION LTD
4622 PROGRESS DRIVE STE A	DAVENPORT	IA	52807	363924720	MANAGED HEALTH CARE	IA	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE R, PARTS I - IV:	FormAndLineReferenceDesc
Explanation	OWA HEALTH SYSTEM AND SUBSIDIARIES (D/B/A UNITYPOINT HEALTH) IOWA HEALTH SYSTEM IS AN IOWA NONPROFIT CORPORATION FORMED IN DECEMBER 1994. IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM 36 HOSPITAL FACILITIES AND OVER 400 OUTPATIENT SITES IN IOWA, ILLINOIS AND WISCONSIN. PRIMARY, SECONDARY AND TERTIARY CARE SERVICES ARE PROVIDED TO RESIDENTS OF IOWA, ILLINOIS, WISCONSIN AND ADJACENT STATES. ON APRIL 16, 2013, IOWA HEALTH SYSTEM BEGAN BEING PUBLICLY KNOWN AS UNITYPOINT HEALTH (THE SYSTEM). THIS NAME CHANGE REFLECTS THE TRANSFORMATION OF CLINICAL PROCESSES UNDERWAY WITHIN THE SYSTEM AND THE ADAPTATION TO BETTER ADDRESS THE HEALTH CARE NEEDS OF COMMUNITIES, INCLUDING BUILDING A MODEL OF DELIVERING HEALTH CARE THAT COORDINATES CARE AROUND THE PATIENT WHILE FOCUSING ON IMPROVING THE QUALITY OF CARE AND REDUCING COSTS. THE LEGAL NAME OF THE PARENT REMAINS IOWA HEALTH SYSTEM, WITH THE UNITYPOINT HEALTH NAME REFLECTING A DOING BUSINESS AS (D/B/A).	ExplanationTxt