2017-11-15T08:28:40-06:00 2016-12-31 990 2016-01-01 421019872 NORTHWEST IOWA HOSPITAL CORPORATION NORT 7122793500 2720 STONE PARK BLVD SIOUX CITY IA 51104 JAMES L GOBELL VP/CFO 7122793201 2017-11-15 205.167.2.34 2017-11-15 08:28:24 CS P 5E6E106DF48B9972D6C92B0B0C0F16768180E897 2CDFA0C539A59EBEECABA2BB3574D231EAAE060C 2016 2021-01-29 14:40:06Z ST LUKE'S REGIONAL MEDICAL CENTER LYNN WOLD 2720 STONE PARK BLVD SIOUX CITY IA 51104 187209470 0 X WWW.UNITYPOINT.ORG/SIOUXCITY X 1974 IA TO IMPROVE THE HEALTH OF THE PEOPLE OF SIOUXLAND. 9 7 1794 0 27316 8235 881081 1153764 157104333 165056243 2466869 2226847 3299148 3132614 163751431 171569468 1246101 5582683 0 0 85116649 91910825 0 0 0 71921119 75086740 158283869 172580248 5467562 -1010780 208639254 203007924 73221861 68177591 135417393 134830333 X THE MISSION OF NORTHWEST IOWA HOSPITAL CORPORATION, D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER, IS TO IMPROVE THE HEALTH OF THE PEOPLE OF SIOUXLAND. 0 0 129876074 3515940 166973107 HEALTH-CARE SERVICESNORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER IS AN IMPORTANT ELEMENT OF THE HEALTH CARE DELIVERY SYSTEM THAT SIOUXLAND COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. NORTHWEST IOWA HOSPITAL CORPORATION 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, HOME HEALTH, INTENSIVE CARE AND CRITICAL CARE, MENTAL HEALTH CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, SKILLED NURSING, BEHAVIORAL DISORDER PROGRAMS, MATERNAL/CHILD CARE, LABORATORY, PALLIATIVE CARE, PHARMACEUTICAL DRUGS, 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 ENDING DECEMBER 31, 2016, NORTHWEST IOWA HOSPITAL CORPORATION ADMITTED 10,844 PATIENTS. THE HOSPITAL HAD A TOTAL NUMBER OF 71,539 PATIENT DAYS. OUTPATIENT VISITS TOTALED 143,416 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 2,056. THERE WERE ALSO 30,471 EMERGENCY ROOM VISITS AND 2,051 BABIES DELIVERED. 16671366 2066743 0 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: NORTHWEST IOWA HOSPITAL CORPORATION 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 $2,224,146 IN 2016. OFTENTIMES, NORTHWEST IOWA HOSPITAL CORPORATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES OR SERVICES. NORTHWEST IOWA HOSPITAL CORPORATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT SPONSORED HEALTH-CARE PROGRAMS. NORTHWEST IOWA HOSPITAL CORPORATION'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $9,061,106 FOR 2016. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE WAS $11,285,252. OTHER BENEFITS: NORTHWEST IOWA HOSPITAL CORPORATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; SUBSIDIZED HEALTH SERVICES; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. NORTHWEST IOWA HOSPITAL CORPORATION COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. NORTHWEST IOWA HOSPITAL CORPORATION HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 12,495 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS REPORTED VALUE WAS $5,386,114. 146547440 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 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 X 0 0 1 1794 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X JAMES L GOBELL VPCFO 7122793201 2720 STONE PARK BLVD SIOUX CITY IA 51104 CRAIG BERNSTEIN BOARD MEMBER 1.00 1.00 X 0 0 0 DARIN DABY BOARD SECRETARY 1.00 1.00 X X 0 1001 0 JAMES JENSEN BOARD MEMBER 1.00 1.00 X 0 0 0 LYNN MILLS BOARD TREASURER 1.00 1.00 X X 0 0 0 JON PEACOCK BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 KG SKIP PERLEY BOARD MEMBER 1.00 1.00 X 0 0 0 STEVE SHOOK MD BOARD MEMBER 1.00 1.00 X 0 0 0 GARRETT SMITH BOARD CHAIR 1.00 1.00 X X 0 8102 0 RICH WALLER BOARD MEMBER 1.00 1.00 X 0 200 0 LEAH GLASGO VP/CLINICAL OPERATIONS 40.00 1.00 X 286011 0 66454 JAMES GOBELL VP/CFO 40.00 1.00 X 290616 0 90430 CHAD MARKHAM VP/CLINIC & NETWORK DEVELOPMENT 40.00 1.00 X 268277 0 63739 PRISCILLA STOKES VP/ATOEMT CARE 40.00 1.00 X 223745 0 28634 SUSAN UNGER VP FUNDRAISING DEVELOPMENT 40.00 1.00 X 206737 0 21991 LYNN WOLD PRESIDENT/CEO 40.00 1.00 X 474716 0 102892 RICK COLWELL MD PHYSICIAN 40.00 0.00 X 438297 0 65712 ALFRED FLEMING MD PHYSICIAN 40.00 0.00 X 547276 0 35087 FADY JABRE MD PHYSICIAN 40.00 0.00 X 575519 0 38903 DOUGLAS MARTIN MD PHYSICIAN 40.00 0.00 X 557124 0 45112 JEFFREY O'TOOL MD PHYSICIAN 40.00 0.00 X 598165 0 39618 RICHARD HILDEBRAND MD TO 1215 FORMER VP/MEDICAL AFFAIRS 0.00 0.00 X 155264 0 10760 MARK JOHNSON TO 1211 FORMER VP/CFO 0.00 40.00 X 0 952589 205373 PETER THOREEN TO 615 FORMER PRESIDENT/CEO 0.00 0.00 X 895959 0 71674 5517706 961892 886379 61 1 1 0 CARDIOVASCULAR ASSOC PC PO BOX 3128 SIOUX CITY IA 51102 CONTRACT PHYSICIAN SERVICES 6080476 SIOUXLAND HOSPITALISTS PLLC 2720 STONE PARK BLVD SIOUX CITY IA 51104 MEDICAL SERVICES 1734574 AMN HEALTHCARE INC 4150 WESTOWN PARKWAY SUITE 106 WEST DES MOINES IA 50266 MEDICAL STAFFING 1192385 ARAMARK HEALTHCARE 3303 REBECCA ST SIOUX CITY IA 51104 MANAGEMENT SERVICES 1140688 MAYO COLLABORATIVE SERVICES 3050 SUPERIOR DR NW ROCHESTER MN 55905 PURCHASED LAB SERVICES 816236 74 587133 53100 513531 1153764 NET PATIENT REVENUE 900099 157875576 157875576 EDUCATION & RESEARCH 900099 3320952 3320952 SUBS & JOINT VENTURES 900099 2953997 2953997 RENTAL INCOME 531110 429920 429920 MISCELLANEOUS REVENUE 900099 252050 252050 223748 223748 165056243 794751 439 794312 16710796 107322 15348021 38001 1362775 69321 1432096 1432096 348345 253980 94365 94365 MISCELLANEOUS REVENUE 900099 1916426 1889110 27316 CAFETERIA/FOOD SVCS 722210 1121823 1121823 3038249 171569468 166945792 27316 3442596 5582683 5582683 2124242 2124242 224138 224138 73355219 64486897 8868322 2575156 2263831 311325 9522465 8371241 1151224 4109605 3612772 496833 15790055 8612193 7177862 419720 480 419240 435206 216979 218227 9724657 7911814 1812843 876485 275402 601083 3924907 3479983 444924 -708514 -708514 5607954 4680124 927830 318456 197702 120754 203064 189864 13200 2789425 2788794 631 7642809 7575636 67173 896171 114162 782009 MEDICAL SUPPLIES 26765655 26577858 187797 MISCELLANEOUS EXPENSE 357176 313533 43643 BAD DEBT EXPENSE 40708 4276 36432 INCOME TAXES 2806 -270 3076 172580248 146547440 26032808 0 952317 549085 -1035505 5083 23046251 23750655 54716570 55158216 4147189 3761481 726925 1554415 192688274 128534544 65362091 64153730 53050288 46199161 7673128 7876098 208639254 203007924 10911162 11052230 2268265 2250234 734656 683968 1608359 1360916 57699419 52830243 73221861 68177591 X 130761518 129939380 3038522 2908508 1617353 1982445 135417393 134830333 208639254 203007924 X -1010780 247683 176037 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 44055081 53100 3480900 8504276 121092 38963713 43726995 117132 319137 1603 106580 44055081 44032288 34312 3238843 3505294 73154 43726995 44271700 3157156 5722694 9012351 1 106910 44032288 37872570 2529250 3954660 4165 8 80606 44271700 0.87450 0.05090 0.07470 1 0 5533665 5533665 115268581 73982823 41285758 1352216 855725 496491 64700210 50607147 14093063 5833602 3088849 2744753 64153730 DUE TO AFFILIATES 1289027 ASBESTOS REMOVAL LIABILITY 3071410 SELF-INSURANCE RESERVE 2899851 LONG-TERM RETENTION INCENTIVES 1658685 IOWA HEALTH SYSTEM NOTE PAYABLE 42880806 HEALTH AND WELFARE BENEFITS RESERVE 993655 MISCELLANEOUS LIABILITY 36809 52830243 X 170986000 247683 253980 501663 170484337 121092 964039 1085131 171569468 167460000 253980 253980 167206020 121092 5253136 5374228 172580248 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 2013. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP EXPENSES 253,980. PART XI, LINE 4B - OTHER ADJUSTMENTS: IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATE 587,133. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 63,317. ROUNDING 484. REVENUES IN UNRESTRICTED FUND BALANCE 313,105. PART XII, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP EXPENSES 253,980. PART XII, LINE 4B - OTHER ADJUSTMENTS: IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATE 587,133. EXPENSES IN TEMPORARILY RESTRICTED FUND BALANCE 4,276. EXPENSES IN UNRESTRICTED FUND BALANCE 4,660,921. ROUNDING 806. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 2224146 2224146 0.01290 38165750 29104644 9061106 0.05250 40389896 29104644 11285252 0.06540 1436536 3000 1433536 0.00830 4626127 4277025 349102 0.00200 10200011 8718491 1481520 0.00860 3827274 1705318 2121956 0.01230 20089948 14703834 5386114 0.03120 60479844 43808478 16671366 0.09660 0 2121949 0 37470747 28330422 9140325 X 1 1 1 PIERCE STREET SAME DAY SURGERY LC AMBULATORY SURGERY CENTER 0.50000 0.05500 0.44500 1 1 ST LUKE'S REGIONAL MEDICAL CENTER 2720 STONEPARK BLVD SIOUX CITY IA 51104 WWW.UNITYPOINT.ORG/SIOUXCITY 970180H X X X X ST LUKE'S 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/SIOUXCITY X 1 16 1 WWW.UNITYPOINT.ORG/SIOUXCITY 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/SIOUXCITY/DISCOUNTS-AND-FINANCIAL-ASSISTANCE.ASP X WWW.UNITYPOINT.ORG/SIOUXCITY/DISCOUNTS-AND-FINANCIAL-ASSISTANCE.ASP X WWW.UNITYPOINT.ORG/SIOUXCITY/DISCOUNTS-AND-FINANCIAL-ASSISTANCE.ASP X X X X X X 1 X 0 X X X X 1 X 0 0 ST. LUKE'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: IN CONDUCTING THE MOST RECENT CHNA, UNITYPOINT HEALTH - ST. LUKE'S PARTNERED WITH SIOUXLAND DISTRICT HEALTH DEPARTMENT, MERCY MEDICAL CENTER, AND DUNES SURGICAL HOSPITAL TO COMPLETE THE FIRST EVER JOINT COMMUNITY HEALTH NEEDS ASSESSMENT TO DETERMINE THE COMMUNITY'S GREATEST HEALTH NEEDS, AND TO COORDINATE EFFORTS TO IMPROVE POPULATION HEALTH OUTCOMES FOR THE SIOUXLAND AREA. THE YEARLONG PROCESS INCLUDED COLLABORATION FROM REPRESENTATIVES WITH EACH OF THESE ORGANIZATION AS WELL AS SEVERAL COMMUNITY PARTNERS. A COMPREHENSIVE SEARCH OF ALL AVAILABLE DATA SOURCES WAS CONDUCTED AND THEN DATA WAS COLLECTED AND ANALYZED. AFTER CAREFUL ANALYSIS OF THIS DATA THE COLLABORATIVE PARTNERS IDENTIFIED THE TOP SEVEN AREAS OF NEED AND TOOK THESE TO A COMMUNITY MEETING FOR VALIDATION. APPROXIMATELY 50 COMMUNITY PARTNERS ATTENDED THE MEETING AND WERE ASKED TO REVIEW AND CONFIRM THE TOP AREAS OF NEED IN OUR SERVICE AREA. ST. LUKE'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: MERCY MEDICAL CENTER - SIOUX CITY & DUNES SURGICAL HOSPITAL ST. LUKE'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: SIOUXLAND DISTRICT HEALTH DEPARTMENT ST. LUKE'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: ST. LUKE'S COMMUNITY HEALTH IMPROVEMENT PLAN ADDRESSES THE HEALTH NEEDS OF THE BROADER POPULATION WITH A CONCENTRATED FOCUS ON THOSE AREAS WHERE ST. LUKE'S CAN HAVE THE GREATEST IMPACT. ST. LUKE'S HEALTH PRIORITIES WITH RESPECT TO THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE:OBESITY, TEEN BIRTHS, ACCESS TO CARE, MENTAL ILLNESS, & CANCER SCREENINGS.TWO OF THE HEALTH NEEDS OUTLINED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT ARE NOT SPECIFICALLY ADDRESSED IN ST. LUKE'S COMMUNITY HEALTH IMPROVEMENT PLAN. EVEN THOUGH THESE HEALTH NEEDS FALL OUTSIDE THE SCOPE OF THE HOSPITAL'S EXPERTISE AND RESOURCES, ST. LUKE'S STILL SUPPORTS THESE NEEDS ON A SMALLER SCALE. THE TWO HEALTH NEEDS NOT SPECIFICALLY ADDRESSED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES: ALCOHOL AND TOBACCO; HOUSING. ST. LUKE'S 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. 1 1 - PIERCE STREET SAME DAY SURGERY 2730 PIERCE STREET SIOUX CITY IA 51104 FREESTANDING OUTPATIENT SURGERY CENTER (JOINT VENTURE) PART I, LINE 6A: NORTHWEST IOWA HOSPITAL CORPORATION'S D/B/A/ ST. LUKE'S 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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 36,000. 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 AFFECTING 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. AS SUCH, NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) SUPPORTS AND CONTRIBUTES TO COMMUNITY ORGANIZATIONS, EVENTS, AND PROGRAMS SUCH AS THE LOCAL CHAMBER, SIOUX CITY GROWTH ORGANIZATION, AND OTHER ECONOMIC DEVELOPMENT ACTIVITIES. ST. LUKE'S ALSO CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF SIOUXLAND ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER LOCAL, NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL-BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH. ACCESS TO HEALTHY FOOD IS CRITICAL FOR GOOD HEALTH IS ONE EXAMPLE. ST. LUKE'S WORKS WITH A NONPROFIT ORGANIZATION TO HELP FUND A LOCAL FARMER'S MARKET. THE MARKET OFFERS FARM-FRESH FOOD TO THE COMMUNITY, INCLUDING EBT PARTICIPANTS.WORKING THROUGHOUT THE COMMUNITY IS ALSO IMPORTANT IN DELIVERING COMMUNITY HEALTH. ST. LUKE'S REGIONAL MEDICAL CENTER ALONG WITH OTHER HEALTHCARE AND MENTAL HEALTH AGENCIES MEET TO ASSESS AND PLAN FOR IMPROVED ACCESS AND SERVICES FOR PATIENTS WITH MENTAL ILLNESS; MOST OF WHOM ARE UNDERSERVED. HEALTHY SIOUXLAND INITIATIVE IS ANOTHER COLLABORATIVE GROUP ST. LUKE'S PARTICIPATES IN WITH OTHER HEALTH PROVIDERS AND SOCIAL SERVICE ORGANIZATIONS TO HELP MEET THE COMMUNITY'S HEALTH NEEDS. IN ADDITION, ST. LUKE'S IS ACTIVELY INVOLVED WITH SIOUXLAND COMMUNITY HEALTH CENTER TO RESPOND TO THE UNMET HEALTH CARE NEEDS AMONG THE UNDERSERVED IN THE COMMUNITY. WITH THE GOALS OF INCREASED AWARENESS AND INCREASED NUMBER OF PARTICIPANTS THROUGHOUT THE TRI-STATE AREA, ST. LUKE'S WORKS WITH OTHER HEALTH ORGANIZATIONS TO PROMOTE COLORECTAL CANCER AND MAMMOGRAPHY SCREENINGS.ST. LUKE'S EMPLOYEES, AND IN PARTICULAR ST. LUKE'S LEADERSHIP, ARE ACTIVE IN VOLUNTEERISM FOR NON-PROFIT ORGANIZATIONS, FROM SUPPORT TO LEADERSHIP ROLES. THIS ALLOWS EMPLOYEES TO USE THEIR HEALTHCARE EDUCATION AND EXPERTISE TO IMPACT THE COMMUNITY'S OVERALL HEALTH STATUS. ST. LUKE'S EMPLOYEES ARE PROACTIVE IN EDUCATING THE PEOPLE WE SERVE ABOUT PERTINENT HEALTH INFORMATION THROUGH PUBLIC HEALTH CLASSES, PROFESSIONAL HEALTH EDUCATION PROGRAMS AND PARTICIPATION IN HEALTH FAIRS ACROSS THE TRI-STATE AREA. THE HOSPITAL'S WEBSITE AT WWW.UNITYPOINT.ORG/SIOUXCITY ALSO CONTAINS AN UP-TO-DATE LISTING OF PROGRAMS AND SCREENINGS AS WELL AS PERTINENT HEALTH INFORMATION TO EDUCATE CONSUMERS ABOUT SYMPTOMS, TREATMENT AND HEALTHCARE OPTIONS THEY HAVE IN SIOUXLAND. BY SUPPORTING THE COMMUNITY AND OTHER NON-PROFIT ORGANIZATIONS, ST. LUKE'S IS ABLE TO MOVE ONE STEP CLOSER TO FULFILLING ITS MISSION TO IMPROVE THE HEALTH OF THE PEOPLE OF SIOUXLAND. 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 NIHC. 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. IN ADDITION TO THESE ITEMS THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM DO NOT INCLUDE MEDICARE PHYSICIAN FEE SCHEDULE EXPENSE AND REVENUE.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: NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) CONTINUALLY WORKS WITH COMMUNITY PARTNERS TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY AND THEN ENGAGES IN PRIORITIES THAT MATCH ITS MISSION AND CAPACITY. SIOUXLAND DISTRICT HEALTH, LOCATED IN SIOUX CITY, ASSESSES THE COMMUNITY'S HEALTHCARE NEEDS AT LEAST ONCE EVERY FIVE YEARS. THROUGH A PLANNED AND ORGANIZED EFFORT, SIOUXLAND DISTRICT HEALTH DEVELOPS A HEALTH AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES AND SHARES THAT INFORMATION THROUGH A COMPREHENSIVE REPORT TO THE COMMUNITY. IN COLLABORATION WITH THIS AGENCY, ST. LUKE'S UTILIZES THIS INFORMATION TO MONITOR LOCAL HEALTH, ENSURING THE HOSPITAL'S PROGRAMS, SERVICES AND HEALTH EDUCATION SUPPORTS PRIORITIES IDENTIFIED BY SIOUXLAND DISTRICT HEALTH. ST. LUKE'S ALSO PARTICIPATES IN HEALTHY SIOUXLAND INITIATIVE, A COLLECTION OF PUBLIC HEALTH PARTNERS THAT CONVENES MONTHLY, AND OTHER COMMUNITY HEALTH COLLABORATIONS, DESIGNED TO BUILD PARTNERSHIPS AMONG COMMUNITY HEALTHCARE ORGANIZATIONS TO BUILD A HEALTHY AND SAFE COMMUNITY. UNITED WAY IS ANOTHER PROGRAM ST. LUKE'S PARTICIPATES IN THROUGH THE UNITED WAY COMMUNITY IMPACT TEAMS. THIS GROUP ACTIVELY ADDRESSES NEED AND STRATEGIES ASSOCIATED WITH HEALTH. MORE SPECIFICALLY, THE SOCIAL DETERMINANTS OF HEALTH AND HOW TO IMPACT THEM IN THE EFFORT TO RAISE COMMUNITY HEALTH STATUS IS THE FOCUS OF THIS GROUP. THIS WIDE BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR ST. LUKE'S TO ENGAGE IN VARIOUS AREAS OF SERVICE TO THE COMMUNITY THAT MAY BE OUTSIDE OF ITS TYPICAL EXPERTISE BUT WITHIN ITS EXISTING RESOURCES. IN ADDITION TO THESE EFFORTS, ST. LUKE'S CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS ALSO WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATIONS THEY AFFECT. 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 REGIONAL MEDICAL CENTER IS AN URBAN, ACUTE-CARE COMMUNITY HOSPITAL LICENSED FOR 346 BEDS AND STAFFED FOR 151 BEDS SERVING THE SIOUXLAND AREA. THE SIOUXLAND AREA IS A TRI-STATE AREA CONSISTING OF NORTHWEST IOWA, NORTHEAST NEBRASKA, AND SOUTHEAST SOUTH DAKOTA. ST. LUKE'S IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE. ST. LUKE'S DISCHARGES APPROXIMATELY 11,000 INPATIENTS AND OVERSEES OVER 72,000 OUTPATIENTS VISITS PER YEAR INCLUDING EMERGENCY PATIENTS. WITHIN THE SIOUXLAND AREA, ST. LUKE'S SERVES A PRIMARY AND SECONDARY MARKET DEFINED BY COUNTIES. THE PRIMARY MARKETS ARE PLYMOUTH AND WOODBURY COUNTIES IN IOWA, DAKOTA COUNTY IN NEBRASKA AND UNION COUNTY IN SOUTH DAKOTA. THE PRIMARY COUNTIES ACCOUNT FOR 85% OF ST. LUKE'S INPATIENT DISCHARGES. WITHIN THE PRIMARY MARKET, TWO COMMUNITY HOSPITALS ARE LOCATED IN WOODBURY COUNTY, IOWA, AND ONE SURGICAL SPECIALTY HOSPITAL THAT IS PHYSICIAN-OWNED IS LOCATED IN UNION COUNTY, SOUTH DAKOTA. WOODBURY COUNTY IS THE LARGEST COUNTY IN THE SIOUXLAND AREA WITH APPROXIMATELY 102,000 RESIDENTS, WITH SIOUX CITY AS THE LARGEST CITY IN THE AREA WITH A 2016 ESTIMATED POPULATION OF 82,900. THE SECONDARY MARKETS ARE CHEROKEE, MONONA AND SIOUX COUNTIES IN IOWA AND THURSTON COUNTY IN NEBRASKA. WITH THE EXCEPTION OF THURSTON, A SEPARATE CRITICAL ACCESS HOSPITAL IS HOUSED IN EACH OF THESE COUNTIES.FOCUSING ON THE PRIMARY MARKET, THE HISPANIC POPULATION HAS THE LARGEST IMPACT IN TWO OF THE FOUR PRIMARY COUNTIES WITH DAKOTA COUNTY'S POPULATION HAVING 28% HISPANIC ETHNICITY AND WOODBURY COUNTY WITH OVER 13%. DAKOTA COUNTY AND WOODBURY COUNTY ALSO HAVE THE HIGHEST PERCENTAGE OF FAMILIES BELOW THE FEDERAL POVERTY LEVEL AT 17.2% AND 14.6% RESPECTIVELY. PART VI, LINE 5: NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. ST. LUKE'S SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. ST. LUKE'S IS THE REGION'S ONLY IOWA LEVEL II REGIONAL OBSTETRICAL TRANSPORT CENTER FOR HIGH-RISK OBSTETRICS AND IOWA LEVEL II NEONATOLOGY CENTER.ST. LUKE'S IS ALSO INVOLVED IN THE NW IOWA'S AMERICAN HEART TASK FORCE, TRI-STATE DISASTER COMMITTEE, IOWA'S DISASTER MEDICAL ASSISTANCE TEAM AND EMERGENCY CONFERENCE COMMITTEE. ST. LUKE'S SUPPORTS THE SIOUXLAND MEDICAL EDUCATION FOUNDATION, A FAMILY PRACTICE RESIDENCY AS WELL AS ST. LUKE'S COLLEGE, WHICH IS THE REGION'S ONLY MEDICAL CENTER BASED HEALTH SCIENCES COLLEGE. THE COLLEGE OFFERS ASSOCIATE OF SCIENCE DEGREES IN NURSING, RADIOLOGY, AND RESPIRATORY CARE AS WELL AS CERTIFICATES IN MEDICAL LABORATORY SCIENCES AND PHLEBOTOMY.THE BOARD OF DIRECTORS OF ST. LUKE'S 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 33 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 400 OUTPATIENT SITES, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERM ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH MORE THAN 31,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 5.9 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $4.1 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 2016, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $519 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 ALZHEMIERS ASSOCIATION 225 N MICHIGAN AVE CHICAGO IL 60617 133039601 501(C)(3) 5300 PROGRAM SUPPORT AMERICAN HEART ASSOCATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 8500 PROGRAM SUPPORT BIG BROTHERS BIG SISTERS 3650 GLEN OAKS BLVD SIOUX CITY IA 51104 421121154 501(C)(3) 6200 PROGRAM SUPPORT BUY FRESH BUY LOCAL 505 FIFTH STREET SIOUX CITY IA 51101 263295404 501(C)(3) 6000 PROGRAM SUPPORT CAMP HIGH HOPES 5804 CORRECTIONVILLE ROAD SIOUX CITY IA 51106 201314242 501(C)(3) 10000 PROGRAM SUPPORT CRITTENTON CENTER 814 PIERCE ST 100 SIOUX CITY IA 51101 420698246 501(C)(3) 5000 PROGRAM SUPPORT IOWA HEALTH SYSTEM 1200 PLEASANT ST DES MOINES IA 50309 421435199 501(C)(3) 4276484 PROGRAM SUPPORT IOWA LEGAL AID 1111 9TH ST NO 230 DES MOINES IA 50314 421079227 501(C)(3) 5000 PROGRAM SUPPORT IOWA POSION CONTROL CENTER 401 DOUGLAS ST 501 SIOUX CITY IA 51101 421509040 501(C)(3) 7500 PROGRAM SUPPORT SIOUX CITY SYMPHONY 375 ORPHEUM ELECTRIC BUILDING SIOUX CITY IA 51102 426006580 501(C)(3) 5000 PROGRAM SUPPORT SIOUXLAND CHAMBER OF COMMERCE 101 PIERCE STREET SIOUX CITY IA 51101 421229237 501(C)(3) 6200 PROGRAM SUPPORT SIOUXLAND COMMUNITY FOUNDATION 505 FIFTH STREET SIOUX CITY IA 51101 421323904 501(C)(3) 5000 PROGRAM SUPPORT SIOUXLAND COMMUNITY HEALTH CENTER 1021 NEBRASKA ST SIOUX CITY IA 51105 421374894 501(C)(3) 5700 PROGRAM SUPPORT SIOUXLAND HUMAN INVESTMENT PARTNERSHIP 1250 MORNINGSIDE AVE SUITE 200 SIOUX CITY IA 51106 421495836 501(C)(3) 16500 PROGRAM SUPPORT SIOUXLAND INITIATIVE 101 PIERCE STREET SIOUX CITY IA 51101 421328697 501(C)(6) 5000 PROGRAM SUPPORT SIOUXLAND MEDICAL EDUCATION FOUNDATION 2501 PIERCE ST SIOUX CITY IA 51104 421301885 501(C)(3) 1109951 PROGRAM SUPPORT SUNRISE RETIREMENT COMMUNITY 5501 GORDAN DRIVE SIOUX CITY IA 51106 461142187 501(C)(3) 25250 PROGRAM SUPPORT THE WARMING SHELTER INC 601 PIERCE STREET SIOUX CITY IA 51101 471257560 501(C)(3) 5000 PROGRAM SUPPORT UNITED WAY OF SIOUXLAND 701 STEUBEN ST SIOUX CITY IA 51101 420680395 501(C)(3) 15300 PROGRAM SUPPORT PROGRAM SUPPORT 18 1 PART I, LINE 2: NORTHWEST IOWA HOSPITAL CORPORATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART II (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINE A SERIES OF ELIGIBILITY STANDARDS THAT ARE REQUIRED TO BE MET. NORTHWEST IOWA HOSPITAL CORPORATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED & ELIGIBILITY, MANAGEMENT MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. NORTHWEST IOWA HOSPITAL CORPORATION MINIMIZES THE THREAT OF DIVERSION FOR INTENDED PURPOSE BY SENDING THE FUNDS DIRECTLY TO THE ORGANIZATION, WHERE POSSIBLE, ETC. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 LEAH GLASGO VP/CLINICAL OPERATIONS 242440 0 27427 0 16144 0 43361 0 23093 0 352465 0 0 0 JAMES GOBELL VP/CFO 246120 0 27368 0 17128 0 68241 0 22189 0 381046 0 0 0 CHAD MARKHAM VP/CLINIC & NETWORK DEVELOPMENT 228086 0 24284 0 15907 0 41081 0 22658 0 332016 0 0 0 PRISCILLA STOKES VP/ATOEMT CARE 186995 0 21204 0 15546 0 14868 0 13766 0 252379 0 0 0 SUSAN UNGER VP FUNDRAISING DEVELOPMENT 172352 0 26478 0 7907 0 14089 0 7902 0 228728 0 0 0 LYNN WOLD PRESIDENT/CEO 369296 0 54543 0 50877 0 80275 0 22617 0 577608 0 0 0 RICK COLWELL MD PHYSICIAN 312011 0 124038 0 2248 0 35088 0 30624 0 504009 0 0 0 ALFRED FLEMING MD PHYSICIAN 500308 0 43750 0 3218 0 13250 0 21837 0 582363 0 0 0 FADY JABRE MD PHYSICIAN 447126 0 127239 0 1154 0 17066 0 21837 0 614422 0 0 0 DOUGLAS MARTIN MD PHYSICIAN 317878 0 238146 0 1100 0 18550 0 26562 0 602236 0 0 0 JEFFREY O'TOOL MD PHYSICIAN 477675 0 119990 0 500 0 16915 0 22703 0 637783 0 0 0 RICHARD HILDEBRAND MD TO 1215 FORMER VP/MEDICAL AFFAIRS 152879 0 0 0 2385 0 7757 0 3003 0 166024 0 0 0 MARK JOHNSON TO 1211 FORMER VP/CFO 0 734552 0 170759 0 47278 0 182703 0 22670 0 1157962 0 0 PETER THOREEN TO 615 FORMER PRESIDENT/CEO 5700 0 0 0 890259 0 71674 0 0 0 967633 0 888754 0 PART I, LINE 1A FIRST-CLASS OR CHARTER TRAVEL: CEO AND BOARD MEMBERS USE PRIVATE CHARTER FOR BUSINESS TRAVEL BETWEEN AFFILIATE CITIES AND 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 INDIVIDUAL(S) PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS:LEAH GLASGO $24,877; JAMES GOBELL $47,625; MARK JOHNSON $159,009; CHAD MARKHAM $22,861; PETER THOREEN $68,433; LYNN WOLD $67,025. NONQUALIFIED RETIREMENT PLAN DISTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED PLAN: PETER THOREEN $888,754. PAYOUTS ARE MADE WITH VESTED FUNDS, AS ESTABLISHED BY PLAN DOCUMENTS. ANGELA PEACOCK FAMILY MEMBER OF BOARD MEMBER JON PEACOCK, MD 15170 EMPLOYMENT 0 BETH SITZMANN FAMILY MEMBER OF OFFICER LYNN WOLD 24749 EMPLOYMENT 0 KASSANDRA SMITH FAMILY MEMBER OF BOARD MEMBER GARRETT SMITH 52243 EMPLOYMENT 0 PIERCE STREET SAME DAY SURGERY CENTER LC COMMON BOARD MEMBER/OFFICER 3188410 INVESTMENT 0 RONDA HILDEBRAND FAMILY MEMBER OF OFFICER RICHARD HILDEBRAND 37887 EMPLOYMENT 0 TAFFY ZOELLE FAMILY MEMBER OF KEY EMPLOYEE JEFFERY ZOELLE 109259 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 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 HEALTH SYSTEM, INC., A TAX-EXEMPT IOWA NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B ST. LUKE'S HEALTH SYSTEM, INC., AS SOLE MEMBER, APPROVES AMENDMENTS TO ARTICLES AND BYLAWS, APPOINTS AND REMOVES CEO, APPROVES LIQUIDATION OR DISSOLUTION, AND APPROVES INDEBTEDNESS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY FUNCTIONAL AREA WITH RESPONSIBILITY 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 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 2016 FOR THE FOLLOWING INDIVIDUALS: MARK JOHNSON AND LYNN WOLD. 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 OF ST. LUKE'S HEALTH FOUNDATION OF SC, IA 176,037. 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 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 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 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IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM 33 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).