2018-11-14T15:50:51-06:00 2017-12-31 990 2017-01-01 421487967 ST LUKE'SJONES REGIONAL MEDICAL CENTER STLU 3194626131 1795 HIGHWAY 64 EAST ANAMOSA IA 52205 ERIC BRIESEMEISTER CEO 3194626131 2018-11-07 205.167.2.34 2018-11-07 14:32:51 CS P C69FFE27EEBC8ABCAB3DAA7C573007FFE9EEA434 0BFB9BC94ADA8AF3BF63F4A24AA84C65C722C205 2017 2019-02-21 02:37:17Z JONES REGIONAL MEDICAL CENTER ERIC BRIESEMEISTER 1795 HIGHWAY 64 EAST ANAMOSA IA 52205 40446607 0 X WWW.UNITYPOINT.ORG/ANAMOSA X 1998 IA TO PROVIDE QUALITY SERVICES AND TO PROMOTE HEALTHY LIFESTYLES TO OUR CUSTOMERS. 11 5 349 66 0 0 174873 1153537 23473494 29096922 -52165 155855 172355 435096 23768557 30841410 6030 24638 0 0 12917230 17006381 0 0 0 9255908 10857218 22179168 27888237 1589389 2953173 40077194 44986993 12523919 14486807 27553275 30500186 X TO PROVIDE QUALITY SERVICES IN AN EFFICIENT, COST-EFFECTIVE MANNER AND TO PROMOTE HEALTHY LIFESTYLES TO OUR CUSTOMERS. 0 0 23966968 24638 29424361 HEALTH-CARE SERVICESST. LUKE'S/JONES REGIONAL MEDICAL CENTER 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, MENTAL HEALTH CARE, REHABILITATION, SKILLED NURSING, LABORATORY, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2017, ST. LUKE'S/JONES REGIONAL MEDICAL CENTER DISCHARGED 388 PATIENTS RESULTING IN A TOTAL OF 1,954 PATIENT DAYS. OUTPATIENT VISITS TOTALED 87,153 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 1,075. THERE WERE ALSO 8,013 EMERGENCY ROOM VISITS. 778485 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: ST. LUKE'S/JONES REGIONAL MEDICAL CENTER 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 $213,284 IN 2017. OFTENTIMES, ST. LUKE'S/JONES REGIONAL MEDICAL CENTER RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. ST. LUKE'S/JONES REGIONAL MEDICAL CENTER PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $697,713.OTHER BENEFITS: ST. LUKE'S/JONES REGIONAL MEDICAL CENTER PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. ST. LUKE'S/JONES REGIONAL MEDICAL CENTER COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. ST. LUKE'S/JONES REGIONAL MEDICAL CENTER HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $80,772. 24745453 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 349 1 0 0 0 0 0 0 0 0 0 0 X 11 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X ERIC BRIESEMEISTER CEO 3194816232 1795 HIGHWAY 64 EAST ANAMOSA IA 52205 MILTON AUNAN II TO 0617 BOARD MEMBER/INTERIM SR VP/CFO 1.00 40.00 X X 0 197565 29360 CHARLIE BECKER BOARD CHAIR 1.00 0.00 X X 0 0 0 ERIC BRIESEMEISTER BOARD MEMBER/CEO - JRMC 40.00 1.00 X X 0 179617 36700 NICOLE CLAUSSEN BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL HEINRICH FR 0717 BOARD MEMBER/SR VP/CFO 1.00 40.00 X X 0 153346 15921 KATHERINE MEYERS BOARD MEMBER 1.00 1.00 X 0 220667 41359 MICHELLE NIERMANN BOARD SECRETARY/TREASURER/SR VP/COO 1.00 40.00 X X 0 436424 124145 JILL PARHAM BOARD MEMBER 1.00 1.00 X 0 0 0 THEODORE TOWNSEND JR BOARD MEMBER/PRES/CEO 1.00 40.00 X X 0 616978 513577 MICHAEL WESTON MD BOARD MEMBER/PHYSICIAN 1.00 40.00 X 0 280410 68488 JAY WILLEMS BOARD MEMBER 1.00 0.00 X 0 0 0 WINNIE WILLIAMS BOARD MEMBER 1.00 0.00 X 0 0 0 BRYAN ANDERSON PHARMACY DIRECTOR 40.00 0.00 X 119817 0 31188 DEANNA COOK CHIEF NURSING OFFICER/DON 40.00 0.00 X 109695 0 16225 MELINDA M INGRAHAM PHARMACIST 40.00 0.00 X 108355 0 19266 ALISSA A SCHEPANSKI PHYSICIAN ASSISTANT 40.00 0.00 X 149913 0 31188 LINDSAY R ZYLSTRA PHYSICIAN ASSISTANT 40.00 0.00 X 147478 5226 15619 635258 2090233 943036 6 0 1 0 EAST CENTRAL IOWA ACUTE CARE LLP 1026 A AVE NE CEDAR RAPIDS IA 52402 ER DOCTOR STAFFING 1009108 BROWNS MEDICAL IMAGING 14315 C CIRCLE OMAHA NE 68144 MEDICAL EQUIPMENT 441230 HEALTH ENTERPRISES OF IOWA 5825 DRY CREEK LANE NE CEDAR RAPIDS IA 52402 ECHO AND THERAPIES 428516 OMNICELL INC 590 E MIDDLEFIELD ROAD MOUNTAIN VIEW CA 94043 TECHNOLOGY SUPPORT 259837 TOSHIBA AMERICA MEDICAL SYSTEM PO BOX 775220 CHICAGO IL 60677 EQUIPMENT MAINTENANCE 154500 5 5886 1136644 11007 1153537 NET PATIENT REVENUE 900099 24698186 24698186 PHARMACY REVENUE 446110 4162968 4162968 MGMT & SUPPORT SVCS 561000 154304 154304 RENTAL INCOME 531100 106187 106187 MISCELLANEOUS REVENUE 900099 -24723 -24723 29096922 136214 -68 136282 9296288 328550 9301647 303550 -5359 25000 19641 19641 0 5886 0 0 15175 0 15175 15175 MISCELLANEOUS REVENUE 900099 327507 327507 CAFETERIA/FOOD SVCS 722210 92414 92414 419921 30841410 29424361 0 263512 24638 24638 216317 216317 13893224 12910659 982565 363550 338997 24553 1879102 1741375 137727 654188 606890 47298 976145 100106 876039 16406 26 16380 139136 119057 20079 2202772 1949480 253292 35405 3703 31702 163661 104424 59237 801081 794224 6857 39296 31771 7525 19110 15307 3803 351280 351280 1676857 1656994 19863 70305 2505 67800 MEDICAL SUPPLIES 2386105 2381203 4902 MISCELLANEOUS EXPENSE 1979659 1612814 366845 27888237 24745453 3142784 0 12062742 15608471 493652 670927 3738158 4256074 140836 920428 146204 256981 54757 33012 31349570 10952986 20754694 20396584 958501 1116866 1727650 1727650 40077194 44986993 1875194 1968021 9839847 9299404 218698 25103 590180 3194279 12523919 14486807 X 25829910 28776821 1723365 1723365 27553275 30500186 40077194 44986993 2953173 -6262 0 X 0 1 X 1 0 X 1723365 690911 0 690911 1723365 1731364 143571 151570 1723365 1440480 67243 995874 772233 1731364 1130478 320083 10081 1440480 10726749 1098318 10694589 1130478 0.00000 0.00000 1.00000 0 1 1 297612 297612 16634871 3269456 13365415 14047027 7668422 6378605 370060 15108 354952 20396584 DUE TO AFFILIATES 2646604 HEALTH AND WELFARE BENEFITS RESERVE 189789 MISCELLANEOUS LIABILITY 357886 3194279 X 29704000 -6262 145 -6117 29710117 2565 1128728 1131293 30841410 27886000 328 328 27885672 2565 2565 27888237 PART V, LINE 4: THE ORGANIZATION RETAINS FUNDS FOR INTENDED FUTURE USES, INCLUDING PURCHASE OF EQUIPMENT, INDIGENT CARE, FUNDING OF MISSION RELATED OPERATIONS, AND HEALTH EDUCATION. IN ADDITION, SOME FUNDS ARE HELD FOR INVESTMENT IN PERPETUITY. 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: ROUNDING 145. REVENUES IN TEMPORARY RESTRICTED FUND BALANCE PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 1,128,728. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 328. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 213284 213284 0.00760 675596 191167 484429 0.01740 888880 191167 697713 0.02500 327 44437 570 43867 0.00160 73 36905 36905 0.00130 400 81342 570 80772 0.00290 400 970222 191737 778485 0.02790 1 15 965 965 0.00000 1 15 965 965 0.00000 0 537476 0 0 0 X 1 1 1 1 ST LUKE'SJONES REGIONAL MEDICAL CENTER 1795 HIGHWAY 64 EAST SUITE 2 ANAMOSA IA 52205 WWW.UNITYPOINT.ORG/ANAMOSA 530110H X X X X ST LUKE'SJONES REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.UNITYPOINT.ORG/ANAMOSA X 1 16 1 WWW.UNITYPOINT.ORG/ANAMOSA 0 1 X 200.000000000000 600.000000000000 X X X X X X X 1 1 X X X X 1 X WWW.UNITYPOINT.ORG/ANAMOSA/FINANCIAL-ASSISTANCE.ASPX X WWW.UNITYPOINT.ORG/ANAMOSA/FINANCIAL-ASSISTANCE.ASPX X WWW.UNITYPOINT.ORG/ANAMOSA/FINANCIAL-ASSISTANCE.ASPX X X X X X X 1 X 0 X X X X 1 X 0 0 ST. LUKE'S/JONES REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: JONES REGIONAL MEDICAL CENTER (JRMC) COLLABORATED WITH A JOINT PLANNING TEAM WITHIN UNITYPOINT HEALTH - CEDAR RAPIDS HOSPITAL ENTITIES THAT INCLUDED ST. LUKE'S HOSPITAL AND CONTINUING CARE HOSPITAL. THIS WAS TO ENSURE CONSISTENCY ACROSS THE UNITYPOINT OWNED ENTITIES AS WELL AS TO LEVERAGE OPPORTUNITIES FOR ADDRESSING COMMUNITY HEALTH. IN ADDITION, JRMC COLLABORATED WITH JONES COUNTY PUBLIC HEALTH, OTHER PUBLIC HEALTH ENTITIES IN THE PRIMARY SERVICE AREAS, COMMUNITY ENTITIES AND THROUGH PARTICIPATION IN THE TOGETHER! HEALTHY LINN - ASSESSMENT AND IMPROVEMENT PLANNING PROCESS.THE FOLLOWING WAS THE PROCESS USED COLLECT "INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH":JONES REGIONAL MEDICAL CENTER UTILIZED INFORMATION GATHERED THROUGH JONES COUNTY PUBLIC HEALTH AND TOGETHER! HEALTHY LINN (LED BY LINN COUNTY PUBLIC HEALTH) COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. THESE PROCESSES INCLUDED:- COMMUNITY HEALTH STATUS ASSESSMENT. A COLLECTION OF STATISTICAL DATA FROM MAJOR LEADING HEALTH INDICATORS. - COMMUNITY THEMES AND STRENGTHS ASSESSMENT. FACILITATED DIALOGUES AND FOCUS GROUPS CONDUCTED AMONG DIVERSE POPULATIONS. - LOCAL PUBLIC HEALTH SYSTEMS ASSESSMENT. AN EVENT THAT BRINGS TOGETHER COMMUNITY MEMBERS, AGENCIES AND LEADERS TO IDENTIFY THE PUBLIC HEALTH SYSTEMS' STRENGTHS AND WEAKNESSES. - FORCES OF CHANGE ASSESSMENT. AN IMPORTANT BRAINSTORMING ACTIVITY THAT IDENTIFIES FORCES SUCH AS LEGISLATION, TECHNOLOGY AND OTHER IMPENDING CHANGES THAT HAVE THE POTENTIAL TO AFFECT HEALTH OUTCOMES. BY FOLLOWING THESE STEPS, NECESSARY QUALITATIVE AND QUANTITATIVE INPUT WERE GATHERED TO IDENTIFY KEY NEEDS IN THE COMMUNITY. ST. LUKE'S/JONES REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL, UNITYPOINT HEALTH - CONTINUING CARE HOSPITAL, MERCY MEDICAL CENTER ST. LUKE'S/JONES REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: JONES COUNTY PUBLIC HEALTH AND LINN COUNTY PUBLIC HEALTH. ST. LUKE'S/JONES REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, JONES REGIONAL MEDICAL CENTER IS "ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA" THROUGH THE FOLLOWING ACTION PLAN:COMMUNITY NEED: SOCIAL DETERMINANTS OF HEALTHACCESS TO CARE AND COMMUNITY RESOURCESGOAL: INCREASE ACCESS TO CARE AND COMMUNITY RESOURCES FOR VULNERABLE POPULATIONSACTIONS: - CERTIFIED APPLICATION COUNSELORS WILL ASSIST 12,000 INDIVIDUALS IN JONES, LINN AND SURROUNDING COUNTIES TO NAVIGATE OPPORTUNITIES TO ENROLL IN MEDICAID OR OTHER APPROPRIATE INSURANCE OPTIONS. - ACTIVELY MONITOR AND RESPOND ACCORDINGLY TO INCREASES IN PATIENT SELF-PAY RELATED STATE OR NATIONAL POLICY CHANGES.- INCREASE ACCESS THROUGH CONTINUED IMPLEMENTATION OF THE UNITYPOINT CLINIC PROVIDER RECRUITMENT PLAN FOR ADDITIONAL PRIMARY, URGENT, SPECIALTY AND MENTAL HEALTH ACCESS.- INCREASE ACCESS TO MENTAL HEALTH SERVICES THROUGH EXPLORING TELEPSYCH OPPORTUNITIES IN THE EMERGENCY DEPARTMENT AND OUTPATIENT CLINICS.- ENHANCE ACCESS TO SUPPORT THROUGH FURTHER DEVELOPMENT OF SUPPORT GROUPS THAT ADDRESS COMMUNITY NEEDS INCLUDING CARE FOR THE CAREGIVER.COMMUNITY NEED: BEHAVIORAL HEALTHMENTAL HEALTHGOAL: INCREASE ACCESS TO MENTAL HEALTH SERVICES.ACTIONS: - INTEGRATE AND OPTIMIZE OPPORTUNITIES THROUGH THE ABBE HEALTH AFFILIATION- A COMMON CARE PLAN, INCLUDING DEPRESSION SCREENING, WILL BE IN PLACE FOR 100% OF HIGH RISK HOSPITALIZED PATIENTS.- CARE PROVIDERS WILL PARTNER WITH PATIENTS AND FAMILIES TO PROMOTE EARLY IDENTIFICATION OF DEPRESSION AND CARE PLANNING AS DEMONSTRATED BY ACHIEVING DEPRESSION SCREENING TARGETS.- EDUCATE EMPLOYEES ON MENTAL HEALTH RESOURCES.SUICIDEGOAL: DECREASE THE RATE OF SUICIDE BY 5% IN JONES COUNTY.ACTIONS: - ASSESS CURRENT SUICIDE PREVENTION PRACTICES CONDUCTED IN COMMUNITY AND EXPLORE PARTNERSHIPS.- INCREASE COMMUNITY AWARENESS AND RESPONSE TO RISK FACTORS RELATED TO SUICIDE BY ADDING ONE RESOURCE (EVENT, PUBLICATION, GROUP, ETC).COMMUNITY NEED: HEALTH PROMOTIONCOMMUNITY EDUCATIONGOAL: DECREASE PREVENTABLE DISEASES THROUGH HEALTH EDUCATION IN THE COMMUNITY.ACTIONS: - PARTICIPATE IN COMMUNITY DATA COLLECTION EFFORTS TO ASSESS THE TYPES OF SUBSTANCE ABUSE EDUCATION BEING PROVIDED AND THE NUMBER OF INDIVIDUALS REACHED.- CONTINUE CLOSE PARTNERSHIPS AND REFERRALS TO PUBLIC HEALTH AND EASTERN IOWA HEALTH CENTER FOR SERVICES RELATED TO SEXUAL HEALTH AND SEXUALLY TRANSMITTED DISEASES.CHRONIC DISEASEGOAL: DECREASE THE INCIDENCE OF CHRONIC DISEASE IN THE COMMUNITY (DIABETES, HEART FAILURE, STROKE, AND OBESITY).ACTIONS: - PROVIDERS OF ADULT CARE WILL PARTNER WITH THEIR PATIENTS ON HEALTHY BEHAVIORS, EARLY PREVENTION AND MANAGEMENT FOR OBESITY, DIABETES AND HEART FAILURE AS DEMONSTRATED BY ACHIEVEMENT OF RELATED YEARLY QUALITY TARGETS.- PROVIDERS OF PEDIATRIC CARE WILL PARTNER WITH PATIENTS AND FAMILIES TO PROMOTE HEALTHY STARTS AND HEALTHY BEHAVIORS AS DEMONSTRATED BY ACHIEVEMENT OF WEIGHT ASSESSMENT/COUNSELING AND WELL CHILD VISIT YEARLY QUALITY TARGETS.- EVIDENCE BASED STANDARDIZED PATIENT EDUCATION WILL BE IN PLACE ACROSS THE CONTINUUM FOR DIABETES, HEART FAILURE AND STROKE.- SUPPORT PATIENTS WHO WANT TO QUIT SMOKING DEMONSTRATED BY GROWTH THE SMOKING CESSATION REFERRALS - 100% OF CARE COORDINATORS WILL BE TRAINED IN MOTIVATIONAL INTERVIEWING TO ENGAGE PATIENTS IN GOAL SETTING, PREVENTION AND SELF MANAGEMENT INCLUDING HEALTH LIVING AND CHRONIC DISEASE MANAGEMENT.- PARTNER WITH EMPLOYERS TO DEVELOP APPLICABLE HEALTHY LIVING, MENTAL HEALTH, CARING FOR THE CAREGIVER AND DISEASE MANAGEMENT SESSIONS FOR THEIR EMPLOYEES.- 100% OF IDENTIFIED CARE COORDINATORS IN THE CLINIC WILL BE TRAINED IN STANDARDIZED DIABETES EDUCATION, INCLUDING WHEN TO REFER TO THE DIABETES EDUCATION CENTER. - THE DIABETES PROVIDER ADVISORY GROUP WILL IMPLEMENT A PROVIDER CONTINUING EDUCATION PROGRAM ON THE CHANGING DIABETES MEDICATIONS.- PROVIDE CERTIFIED EATING DISORDER AND WEIGHT MANAGEMENT SERVICES.- UTILIZE PREDICTIVE ANALYTICS TO IDENTIFY INDIVIDUALS WITH DIABETES OR HEART FAILURE WITH A LIKELIHOOD OF AN ADMISSION WITHIN SIX MONTHS AND INITIATE SUBSEQUENT PROTOCOLS. - CONTINUE STRONG RELATIONSHIPS WITH ST. LUKE'S HOSPITAL ON TRIAGING PATIENTS WITH STROKES APPROPRIATELY AND QUICKLY.THERE WERE A FEW COMMUNITY NEEDS IDENTIFIED THROUGH THE ASSESSMENT PROCESS THAT AREN'T BEING ADDRESSED IN THE JONES REGIONAL MEDICAL CENTER IMPROVEMENT PLAN BECAUSE COMMUNITY ENTITIES CURRENTLY EXIST TO ADDRESS THOSE NEEDS. JONES REGIONAL MEDICAL CENTER WORKS CLOSELY WITH THESE COMMUNITY ENTITIES TO MAKE SURE THE NEEDS OF THEIR PATIENTS ARE BEING MET:- SAFE AND AFFORDABLE HOUSING - REFER INDIVIDUALS FOR COMMUNITY RESOURCES- ADVERSE CHILDHOOD EXPERIENCES (ACES) - REFER INDIVIDUALS TO ST. LUKE'S AND ABBE COMMUNITY MENTAL HEALTH- SUBSTANCE ABUSE - REFER TO ST. LUKE'S SUBSTANCE ABUSE SERVICES AND OTHER COMMUNITY AGENCIES.- DATA SHARING ST. LUKE'S/JONES REGIONAL MEDICAL CENTER 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. PART I, LINE 6A: ST. LUKE'S/JONES REGIONAL MEDICAL CENTER'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 II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH. 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 ST. LUKE'S JONES REGIONAL MEDICAL CENTER. 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 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: ST. LUKE'S/JONES REGIONAL MEDICAL CENTER CONTINUALLYMONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT. ALSO, MANY STAFF MEMBERS SERVE ON COMMITTEES OR BOARDS FOR ORGANIZATIONS IN THE COUNTY AND GATHER FEEDBACK FOR HEALTH NEEDS THROUGH THOSE RELATIONSHIPS. IN ADDITION, STAFF MEMBERS PRESENT TO MANY COMMUNITY GROUPS THROUGHOUT THE YEAR AND RECEIVE FEEDBACK ON HEALTH NEEDS THROUGH THESE VENUES. 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: ST. LUKE'S JONES REGIONAL MEDICAL CENTER IS A 22-BED COMMUNITY HOSPITAL SERVING EAST CENTRAL IOWA. ST. LUKE'S JONES REGIONAL MEDICAL CENTER IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF ST. LUKE'S JONES REGIONAL MEDICAL CENTER MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF JONES. ST. LUKE'S JONES REGIONAL MEDICAL CENTER ADMITS APPROXIMATELY 444 INPATIENTS AND CARES FOR 8,802 EMERGENCY PATIENTS PER YEAR. THE MEDIAN HOUSEHOLD INCOME IS $58,661 AND THE AVERAGE POVERTY RATE IS 9.4%. 87.1% OF ST. LUKE'S JONES REGIONAL MEDICAL CENTER INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. ST. LUKE'S JONES REGIONAL DEMOGRAPIC REGION IS COMPRISED OF 95% CAUCASION, 2% AFRICAN AMERICAN AND 2% HISPANIC. PART VI, LINE 5: THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE. 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 400 OUTPATIENT SITES, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERN ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY THE STATE'S LARGEST 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 6.2 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $4.2 BILLION, UNITYPOINT HEALTH IS THE FOURTH 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 2017, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $524 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 1 JONES REGIONAL MEDICAL CENTER FOUNDATION 1795 HIGHWAY 64 EAST ANAMOSA IA 52205 421429225 501(C)(3) 22250 PROGRAM SERVICES 1 0 PART I, LINE 2: THE ORGANIZATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART II & III (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINES A SERIES OF ELIGIBLITY STANDARDS THAT ARE REQUIRED TO BE MET. THE ORGANIZATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. X X 0 1 0 0 0 0 0 0 0 MILTON AUNAN II TO 0617 BOARD MEMBER/INTERIM SR VP/CFO 0 115982 0 39514 0 42069 0 21595 0 7765 0 226925 0 0 ERIC BRIESEMEISTER BOARD MEMBER/CEO - JRMC 0 166410 0 8576 0 4631 0 9520 0 27180 0 216317 0 0 MICHAEL HEINRICH FR 0717 BOARD MEMBER/SR VP/CFO 0 122000 0 25000 0 6346 0 15662 0 259 0 169267 0 0 KATHERINE MEYERS BOARD MEMBER 0 219811 0 0 0 856 0 11571 0 29788 0 262026 0 0 MICHELLE NIERMANN BOARD SECRETARY/TREASURER/SR VP/COO 0 350846 0 52500 0 33078 0 100469 0 23676 0 560569 0 0 THEODORE TOWNSEND JR BOARD MEMBER/PRES/CEO 0 472891 0 80764 0 63323 0 487683 0 25894 0 1130555 0 0 MICHAEL WESTON MD BOARD MEMBER/PHYSICIAN 0 256532 0 21212 0 2666 0 43477 0 25011 0 348898 0 0 BRYAN ANDERSON PHARMACY DIRECTOR 116319 0 0 0 3498 0 6277 0 24911 0 151005 0 0 0 ALISSA A SCHEPANSKI PHYSICIAN ASSISTANT 133611 0 12339 0 3963 0 7760 0 23428 0 181101 0 0 0 LINDSAY R ZYLSTRA PHYSICIAN ASSISTANT 136827 5183 6610 0 4041 43 7442 261 7879 37 162799 5524 0 0 PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN EARNINGS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: MICHAEL HEINRICH $12,722, MICHELLE NIERMANN $86,969, CLAYTON SCHUETT $14,423, THEODORE TOWNSEND, JR. $419,246, AND MICHAEL WESTON, MD $35,223. A CITY OF ANAMOSA IOWA 426004229 2014-08-29 8250000 CONSTRUCT AND EQUIP HOSPITAL AND CLINIC FACILITIES OF THE ORGANIZATION 0 0 0 A 802798 8250000 8250000 2015 0 0 1 1 A 0 0 1 1 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 FORM 990, PART V, LINES 1A & 1B CASH DISBURSEMENTS ARE CENTRALIZED THROUGH THE PARENT ORGANIZATION, IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH SYSTEM). 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 6 ST. LUKE'S HEALTHCARE, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A ST. LUKE'S HEALTHCARE CAN APPOINT SEVEN BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B ST. LUKE'S HEALTHCARE, AS SOLE MEMBER SHALL APPROVE ARTICLE AND BYLAW AMENDMENTS, DISSOLUTIONS, APPOINT SEVEN BOARD MEMBERS AND APPROVE APPOINTMENT OF PRESIDENT. 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: MICHAEL HEINRICH, MICHELLE NIERMANN, AND THEODORE TOWNSEND, JR. 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. 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)(2) 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)(2) ST LUKE'SJONES REGIONAL MEDICAL CENTER 1 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 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 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 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 II 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 II 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 PEKIN MEMORIAL HOSPITAL FOUNDATION 600 SOUTH 13TH STREET PEKIN IL 61554 371200267 CHARITABLE FUNDRAISING IL 501(C)(3) 509(A)(3), TYPE II PEKIN MEMORIAL HOSPITAL 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 CENER 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 TRINITY REGIONAL HEALTH SYSTEM 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 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 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 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 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 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 RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC 700 E UNIVERSITY AVE DES MOINES IA 50316 261271143 SPECIALTY PHYSICIANS MEDICAL CARE IA 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 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 ANAMOSA AREA AMBULANCE SERVICE A 22392 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).