2018-11-14T15:50:51-06:00 2017-12-31 990 2017-01-01 421411630 IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION IOWA 5154719200 8101 BIRCHWOOD COURT NO N JOHNSTON IA 50131 KEITH G SEASHORE EXECUTIVE VP/CFO 5154719305 2018-11-08 205.167.2.34 2018-11-08 11:10:35 CS P 7BA72CF2FC23A5EB6E597A73BA6EA537B1AB5705 7BA72CF2FC23A5EB6E597A73BA6EA537B1AB5705 2017 2019-02-21 02:37:17Z UNITYPOINT CLINIC DAVID WILLIAMS MD 8101 BIRCHWOOD COURT NO N JOHNSTON IA 50131 608888659 0 X WWW.UNITYPOINT.ORG/CLINICS X 1993 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 12 7 4869 7 235645 0 114044729 126377607 388785898 451952823 1062598 2492520 10976964 19581304 514870189 600404254 14585 2979958 0 0 385106984 441306321 0 0 0 119791107 138131551 504912676 582417830 9957513 17986424 168688411 208740943 119758004 139693668 48930407 69047275 X TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 483028616 2942605 471463245 HEALTH-CARE SERVICESIOWA PHYSICIANS CLINIC MEDICAL FOUNDATION IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE IOWA AND WESTERN ILLINOIS COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 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, MENTAL HEALTH CARE, REHABILITATION, SKILLED NURSING, MATERNAL/CHILD CARE, LABORATORY, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2017, IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION HAD 2,456,653 PATIENT ENCOUNTERS. 36676440 37353 0 COMMUNITY BENEFITSCHARITY CARE AND MEANS-TESTED PROGRAMS: IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 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 $1,852,112 IN 2017. OFTENTIMES, IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $33,391,492 FOR 2017. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $35,243,604OTHER BENEFITS: IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONAL'S EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION COLLABORATES WITH OTHER HEALTH-CARE PROVIDERS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. TOTAL OTHER BENEFITS REPORTED VALUE: $1,432,835 519705056 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 4869 1 1 1 0 0 0 0 0 0 0 0 0 X 12 7 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X KEITH G SEASHORE EXEC VPCFO 5154719305 8101 BIRCHWOOD COURT N JOHNSTON IA 50131 KENNETH ANDERSON MD BOARD CHAIR 40.00 1.00 X X 155550 0 91765 DAVID BOYER BOARD SECRETARY 1.00 1.00 X X 467 14008 0 KYLE CHRISTIASON MD BOARD MEMBER 40.00 1.00 X 414645 0 66937 STAN DANIELSON MD BOARD VICE CHAIR 40.00 1.00 X X 376684 0 49584 PAMELA DELAGARDELLE BOARD MEMBER 1.00 40.00 X 0 512308 166005 DEBRA JOHNSON BOARD MEMBER 1.00 1.00 X 0 0 0 PRASAD NADKARNI MD BOARD MEMBER 40.00 1.00 X 521163 0 40471 TODD NICHOLSON TO 717 BOARD MEMBER 1.00 1.00 X 229 271 0 BRIAN SCOTT BOARD MEMBER 1.00 1.00 X 0 0 0 JAN MILLER STRAUB BOARD MEMBER 1.00 1.00 X 113 0 0 KAREN STUMPE BOARD MEMBER 1.00 1.00 X 411 0 0 BEVERLY ZENOR BOARD MEMBER 1.00 1.00 X 524 0 0 KEITH SEASHORE EXEC VP & CFO 40.00 0.00 X 525626 0 123598 DAVID WILLIAMS MD CEO 40.00 1.00 X 694111 0 185790 RUSSELL ADAMS MD PHYSICIAN 40.00 0.00 X 524621 0 63079 DEEPAK AHUJA MD REGIONAL VP MEDICAL DIRECTOR 1.00 40.00 X 0 411145 42910 DANIEL ALLEN MD EXEC VP & CMO 40.00 0.00 X 504236 0 122193 MARCEL DEVETTEN CHIEF QUALITY OFFICER 40.00 0.00 X 489678 0 83341 NATHAN FIERCE MD TO 917 PHYSICIAN 40.00 0.00 X 1251604 0 48797 AMY FRANTA MD PHYSICIAN 40.00 1.00 X 581362 0 82528 DANIEL GLASCOCK MD REGIONAL VP MEDICAL DIRECTOR - WL 40.00 1.00 X 391809 0 56259 JITENDRAKUMAR GUPTA MD TO 617 PHYSICIAN 40.00 0.00 X 675988 0 46082 RICHARD HODGE MD PHYSICIAN 40.00 0.00 X 775942 0 102496 AMR KAMHAWY MD CHIEF MEDICAL INFORMATION OFFICER 40.00 0.00 X 519726 0 85643 KISHORE KARAMCHANDANI MD PHYSICIAN 1.00 40.00 X 0 840778 31479 GARY KNEPP VP REGIONAL QUALITY OFFICER 1.00 40.00 X 0 440741 80179 TODD LANGAGER MD PHYSICIAN 40.00 0.00 X 470449 0 42170 TIMOTHY MAYFIELD MD PHYSICIAN 40.00 0.00 X 614304 0 61309 PATRICIA NEWLAND MD PHYSICIAN 40.00 0.00 X 445091 0 45762 MICHELLE NIERMANN SVP/COO VP CLINIC OPERATIONS 1.00 40.00 X 0 436424 124145 MATTHEW ROMANIN EXEC VP & COO 40.00 0.00 X 387625 0 74104 JOHN ROOF MD REGIONAL VP MEDICAL DIRECTOR - CR 40.00 0.00 X 418726 0 69194 LINCOLN WALLACE MD REGIONAL VP MEDICAL DIRECTOR - FD 40.00 0.00 X 447485 0 41538 MICHAEL WILLERTH MD PHYSICIAN 40.00 0.00 X 565352 0 206198 HAMAD AZAM MD PHYSICIAN 40.00 0.00 X 858128 0 51413 STEVEN BROOMHEAD MD PHYSICIAN 40.00 0.00 X 864057 0 56592 MARY HLAVIN MD PHYSICIAN 40.00 0.00 X 998390 0 64762 CRAIG STARK MD PHYSICIAN 40.00 0.00 X 927292 0 46127 HISHAM WAGDY MD PHYSICIAN 40.00 0.00 X 859959 0 36143 ENRIQUE BEDIA MD TO 1216 PHYSICIAN 40.00 0.00 X 685182 0 101612 JASON COGDILL MD TO 1216 PHYSICIAN 40.00 0.00 X 419418 0 57684 DOUGLAS DAWSON MD TO 1216 PHYSICIAN 40.00 1.00 X 475473 0 24150 KIRK PETERSON MD TO 1214 PHYSICIAN 40.00 0.00 X 416849 0 45431 MARK REINERTSON DO TO 1215 PHYSICIAN 40.00 0.00 X 122278 0 36605 18380547 2655675 2754075 880 1 1 0 CHG COMPANIES INC PO BOX 972651 DALLAS TX 753972651 STAFFING SERVICES 2714527 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 2490383 EDGE COMMERCIAL LLC 2910 WESTOWN PKWY WEST DES MOINES IA 50266 PROPERTY MANAGEMENT 1936010 H&R ACCOUNTS INC 360 MILLER RD HIAWATHA IA 522332364 PAYMENT SERVICES 1852178 LAKEVIEW MEDICAL OFFICE BUILDING 6900 WESTOWN PKWY WEST DES MOINES IA 50266 PROPERTY MANAGEMENT 1524562 111 126351531 26076 126377607 NET PATIENT REVENUE 900099 352073509 352073509 MGMT & SUPPORT SVCS 561000 97668473 97668473 RENTAL INCOME 531390 1179186 1179186 MISCELLANEOUS REVENUE 900099 838602 838602 SUBS & JOINT VENTURES 900099 166193 166193 26860 26860 451952823 786926 51788 735138 10177281 12718 8473443 10962 1703838 1756 1705594 1705594 SHARED SAVINGS REVENUE 900099 16991907 16991907 MISCELLANEOUS 900099 2263549 2140879 122670 OTHER HEALTHCARE SVCS 900099 325848 90203 235645 19581304 600404254 471227600 235645 2563402 2979958 2979958 12820288 12820288 2398988 2398988 359493155 339416282 20076873 10566038 9975949 590089 37331206 35246343 2084863 18696646 17652481 1044165 32614038 20202570 12411468 321776 267122 54654 1565 75 1490 621800 512423 109377 15343359 8702102 6641257 240986 113904 127082 3585761 2640965 944796 -2827886 -2827886 32839807 30526273 2313534 1371630 826293 545337 178052 123115 54937 646335 456243 190092 6542602 6172553 370049 7910602 7770364 140238 MEDICAL SUPPLIES 38211223 38214464 -3241 MISCELLANEOUS EXPENSE 441483 733013 -291530 INCOME TAXES 87968 87968 BAD DEBT EXPENSE 450 450 582417830 519705056 62712774 0 4679785 10738273 205974 569311 36488845 42294065 18092652 29888535 4201636 4431152 4171958 2995687 85148386 47662485 34199065 37485901 49946269 61403934 151339 141924 16550888 18792161 168688411 208740943 39428731 38420899 275000 414691 7857039 7442002 72197234 93416076 119758004 139693668 X 48832421 68936282 97986 110993 48930407 69047275 168688411 208740943 X 17986424 2102059 28385 X 0 1 X 1 0 X 45761623 24219736 21541887 36008280 23442749 12565531 3378483 3378483 37485901 LONG-TERM DUE FROM AFFILIATE - PHYSICIAN RETENTION 18792161 18792161 SELF INSURANCE RESERVE 20172879 LONG-TERM RETENTION INCENTIVES 37740949 DUE TO AFFILIATES 32376380 HEALTH AND WELFARE BENEFITS RESERVE 3057665 MISCELLANEOUS LIABILITY 68203 93416076 X 476080000 2102059 15378 2117437 473962563 109377 126332314 126441691 600404254 582111000 0 582111000 109377 197453 306830 582417830 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 2014. 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. H.R. 1, ORIGINALLY KNOWN AS THE TAX CUTS AND JOBS ACT (THE ACT), WAS SIGNED INTO LAW ON DECEMBER 22, 2017. THE ACT CONTAINS VARIOUS PROVISIONS AFFECTING BOTH TAXABLE AND TAX-EXEMPT ENTITIES. TAX EXEMPT ENTITIES ARE IMPACTED IN PART BY THE INCLUSION OF A NEW EXCISE TAX ON EXCESS COMPENSATION FOR COVERED EMPLOYEES, CHANGES TO UNRELATED BUSINESS INCOME, CHANGES TO TAX RATES, AS WELL AS THEIR ABILITY TO ADVANCE REFUND BONDS. IN ADDITION, TAX-EXEMPT ENTITIES MAY BE IMPACTED THROUGH CERTAIN FOR-PROFIT SUBSIDIARIES AND/OR JOINT VENTURES BASED ON THE ACT'S PROVISIONS FOR TAX RATES, ELIMINATION OF THE CORPORATE ALTERNATIVE MINIMUM TAX, CHANGES TO NET OPERATING LOSS UTILIZATION AND CARRYOVER/CARRYBACK PERIOD, AND MEASUREMENT OF DEFERRED TAXES AS WELL AS OTHER LIMITATIONS ON DEDUCTIONS. THE ACT'S PROVISIONS MAY ALSO IMPACT DONOR TAX INCENTIVES FOR CHARITABLE GIVING. THE SYSTEM IS CURRENTLY ASSESSING THE OVERALL IMPACT OF THE ACT AND ITS IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 15,378. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 126,331,277. ROUNDING 1,037. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 195,987. ROUNDING 1,466. 1 IOWA PRESCRIPTION DRUG CORPORATION 11100 AURORA AVE BUILDING 13 URBANDALE IA 50322 421518875 501(C)(3) 10000 PROGRAM SUPPORT ST LUKE'SJONES REGIONAL MEDICAL CENTER 1795 HIGHWAY 64 EAST ANAMOSA IA 52205 421487967 501(C)(3) 445733 PROGRAM SUPPORT ST LUKE'S METHODIST HOSPITAL 1026 A AVENUE NE CEDAR RAPIDS IA 52402 420504780 501(C)(3) 2489958 PROGRAM SUPPORT UNITYPOINT HEALTH AT WORK 1776 WEST LAKES PKWY WEST DES MOINES IA 50266 810872241 501(C)(3) 22500 PROGRAM SUPPORT 4 0 PART I, LINE 2: IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PARTS II & III (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINES A SERIES OF ELIGIBILITY STANDARDS THAT ARE REQUIRED TO BE MET. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION THEN REVIEWS THESE APPLICATIONS, AND BASED UPON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 KENNETH ANDERSON MD BOARD CHAIR 137281 0 14896 0 3373 0 73751 0 18014 0 247315 0 0 0 KYLE CHRISTIASON MD BOARD MEMBER 380338 0 31269 0 3038 0 40802 0 26135 0 481582 0 0 0 STAN DANIELSON MD BOARD VICE CHAIR 338769 0 31190 0 6725 0 39023 0 10561 0 426268 0 0 0 PAMELA DELAGARDELLE BOARD MEMBER 0 382739 0 83947 0 45622 0 139845 0 26160 0 678313 0 0 PRASAD NADKARNI MD BOARD MEMBER 488963 0 28432 0 3768 0 25623 0 14848 0 561634 0 0 0 KEITH SEASHORE EXEC VP & CFO 346244 0 145691 0 33691 0 99904 0 23694 0 649224 0 0 0 DAVID WILLIAMS MD CEO 509063 0 123852 0 61196 0 162268 0 23522 0 879901 0 0 0 RUSSELL ADAMS MD PHYSICIAN 500741 0 20750 0 3130 0 45859 0 17220 0 587700 0 0 0 DEEPAK AHUJA MD REGIONAL VP MEDICAL DIRECTOR 0 346226 0 48621 0 16298 0 18279 0 24631 0 454055 0 0 DANIEL ALLEN MD EXEC VP & CMO 348408 0 123550 0 32278 0 104738 0 17455 0 626429 0 0 0 MARCEL DEVETTEN CHIEF QUALITY OFFICER 336922 0 119474 0 33282 0 66313 0 17028 0 573019 0 0 0 NATHAN FIERCE MD TO 917 PHYSICIAN 1191153 0 59419 0 1032 0 20712 0 28085 0 1300401 0 0 0 AMY FRANTA MD PHYSICIAN 545765 0 34517 0 1080 0 50671 0 31857 0 663890 0 0 0 DANIEL GLASCOCK MD REGIONAL VP MEDICAL DIRECTOR - WL 340170 0 43208 0 8431 0 30947 0 25312 0 448068 0 0 0 JITENDRAKUMAR GUPTA MD TO 617 PHYSICIAN 405250 0 269418 0 1320 0 18552 0 27530 0 722070 0 0 0 RICHARD HODGE MD PHYSICIAN 687505 0 81115 0 7322 0 81903 0 20593 0 878438 0 0 0 AMR KAMHAWY MD CHIEF MEDICAL INFORMATION OFFICER 453464 0 62318 0 3944 0 60311 0 25332 0 605369 0 0 0 KISHORE KARAMCHANDANI MD PHYSICIAN 0 827272 0 1202 0 12304 0 18011 0 13468 0 872257 0 0 GARY KNEPP VP REGIONAL QUALITY OFFICER 0 294652 0 86786 0 59303 0 64160 0 16019 0 520920 0 0 TODD LANGAGER MD PHYSICIAN 455417 0 6740 0 8292 0 13500 0 28670 0 512619 0 0 0 TIMOTHY MAYFIELD MD PHYSICIAN 580241 0 32983 0 1080 0 28776 0 32533 0 675613 0 0 0 PATRICIA NEWLAND MD PHYSICIAN 376069 0 61222 0 7800 0 20428 0 25334 0 490853 0 0 0 MICHELLE NIERMANN SVP/COO VP CLINIC OPERATIONS 0 350846 0 52500 0 33078 0 100469 0 23676 0 560569 0 0 MATTHEW ROMANIN EXEC VP & COO 297250 0 58299 0 32076 0 50879 0 23225 0 461729 0 0 0 JOHN ROOF MD REGIONAL VP MEDICAL DIRECTOR - CR 356018 0 50540 0 12168 0 51934 0 17260 0 487920 0 0 0 LINCOLN WALLACE MD REGIONAL VP MEDICAL DIRECTOR - FD 406209 0 33422 0 7854 0 13500 0 28038 0 489023 0 0 0 MICHAEL WILLERTH MD PHYSICIAN 543916 0 18107 0 3329 0 184693 0 21505 0 771550 0 0 0 HAMAD AZAM MD PHYSICIAN 812955 0 44141 0 1032 0 24807 0 26606 0 909541 0 0 0 STEVEN BROOMHEAD MD PHYSICIAN 837125 0 25852 0 1080 0 30068 0 26524 0 920649 0 0 0 MARY HLAVIN MD PHYSICIAN 880892 0 113794 0 3704 0 42280 0 22482 0 1063152 0 0 0 CRAIG STARK MD PHYSICIAN 774363 0 38521 0 114408 0 33134 0 12993 0 973419 0 0 0 HISHAM WAGDY MD PHYSICIAN 818222 0 40617 0 1120 0 14209 0 21934 0 896102 0 0 0 ENRIQUE BEDIA MD TO 1216 PHYSICIAN 650818 0 32660 0 1704 0 72168 0 29444 0 786794 0 0 0 JASON COGDILL MD TO 1216 PHYSICIAN 394331 0 22213 0 2874 0 24477 0 33207 0 477102 0 0 0 DOUGLAS DAWSON MD TO 1216 PHYSICIAN 432417 0 36360 0 6696 0 18243 0 5907 0 499623 0 0 0 KIRK PETERSON MD TO 1214 PHYSICIAN 375779 0 38846 0 2224 0 24727 0 20704 0 462280 0 0 0 MARK REINERTSON DO TO 1215 PHYSICIAN 79643 0 40210 0 2425 0 26588 0 10017 0 158883 0 0 0 PART I, LINE 1A FIRST-CLASS OR CHARTER TRAVEL: CEO AND/OR BOARD MEMBERS USE PRIVATE CHARTER FOR BUSINESS TRAVEL BETWEEN AFFILIATE CITIES AND/OR FOR BOARD OF DIRECTOR MEETINGS. THIS TRAVEL IS FOR BUSINESS PURPOSES ONLY. NO FIRST CLASS COMMERCIAL TRAVEL IS REIMBURSED. TRAVEL FOR COMPANIONS: SPOUSES SOMETIMES ACCOMPANY BOARD MEMBERS AND/OR OFFICERS ON ORGANIZATIONAL ACTIVITIES, INCLUDING BOARD RELATED TRAVEL. THE ADDITIONAL COST ATTRIBUTABLE TO THE SPOUSE IS TREATED AS TAXABLE COMPENSATION TO THE BOARD MEMBER OR OFFICER AND REPORTED AS APPROPRIATE TO THE IRS. PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN EARNINGS: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: RUSSELL ADAMS, MD $38,245; DANIEL ALLEN, MD $90,922; KENNETH ANDERSON, MD $49,252; ENRIQUE BEDIA, MD $46,811; KYLE CHRISTIASON, MD $27,302; STAN DANIELSON, MD $14,788; PAMELA DELAGARDELLE $121,139; MARCEL DEVETTEN $48,612; DANIEL GLASCOCK, MD $17,447; RICHARD HODGE, MD $49,252; AMR KAMHAWY, MD $46,811; GARY KNEPP $50,660; PATRICIA NEWLAND, MD $6,928; MICHELLE NIERMANN $86,969; KIRK PERTERSON, MD $11,227; MARK REINERTSON, MD $22,609; MATTHEW ROMANIN $35,464; JOHN ROOF, MD $38,434; CLAYTON SCHUETT, DO $14,423; KEITH SEASHORE $69,752; MICHAEL WILLERTH, MD $171,193; AND DAVID WILLIAMS, MD $145,921. SAMANTHA DANIELSON FAMILY MEMBER OF BOARD MEMBER STAN DANIELSON, MD 13890 EMPLOYMENT 0 FORM 990, PART V, LINES 1A & 1B CASH DISBURSEMENTS ARE CENTRALIZED THROUGH THE PARENT ORGANIZATION, IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THE PARENT MAKES THE PAYMENTS AND FILES THE RELATED FORMS 1099 AND 1096 ON BEHALF OF ALL UNITYPOINT HEALTH SYSTEM RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 4 IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION INCREASED THE MAXIMUM NUMBER OF DIRECTORS ON THE GOVERNING BOARD TO 15 VOTING MEMBERS. FORM 990, PART VI, SECTION A, LINE 6 IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO NOMINATE AND APPOINT BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO APPROVE CHANGES IN ARTICLES AND BYLAWS, STRATEGIC PLANNING, BUSINESS PLANS, OPERATING AND/OR CAPITAL BUDGETS, SELECTION AND REMOVAL OF THE CEO, INCURRING INDEBTEDNESS, MANAGED CARE STRATEGY, TRANSFER OF ASSETS, TRANSFER, SALE OR CLOSURE OF ANY FACILITY OR DEPARTMENT, AND DIRECT THE TRANSFER OR SALE OF ASSETS. 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 2017 FOR THE FOLLOWING INDIVIDUALS: DEEPAK AHUJA, M.D., DANIEL ALLEN, M.D., PAM DELAGARDELLE, MARCEL DEVETTEN, M.D., DAN GLASCOCK, M.D., GARY KNEPP, PATRICIA NEWLAND, M.D., MICHELLE NIERMANN, MATTHEW ROMANIN, JOHN ROOF, M.D., KEITH SEASHORE, LINCOLN WALLACE, M.D., AND DAVID WILLIAMS, M.D. 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: CHANGE IN BENEFICIAL INTEREST 13,007. MISCELLANEOUS OTHER ADJUSTMENTS 15,378. 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CENTRAL IOWA HEALTH PROPERTIES CORPORATION K 1185041 BASED ON GAAP, CASH, AND/OR FMV. SCHEDULE R, PARTS I - IV: IOWA 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).