2015-11-12T13:43:44-06:00 2014-12-31 990 2014-01-01 421411630 IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION IOWA 5154719200 8101 BIRCHWOOD COURT NO N JOHNSTON IA 50131 KEITH G SEASHORE EXECUTIVE VP/CFO 5154719305 2015-11-09 2014 2016-02-25 16:41:14Z UNITYPOINT CLINIC ALAN KAPLAN MD 8101 BIRCHWOOD COURT NO N JOHNSTON IA 50131 376377308 0 X WWW.UNITYPOINT.ORG/CLINICS X 1993 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 11 6 3298 1 1271574 99488 34169189 63556827 259036685 301350776 2226580 1812974 8698798 9583336 304131252 376303913 16018 22005 0 0 220919335 266149767 0 0 0 84743505 116356031 305678858 382527803 -1547606 -6223890 124535960 136214503 78134392 88774146 46401568 47440357 X TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 332474825 0 310731180 HEALTH-CARE SERVICESIOWA PHYSICIANS CLINIC MEDICAL FOUNDATION IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE IOWA AND WESTERN ILLINOIS COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, INTENSIVE CARE AND CRITICAL CARE, MENTAL HEALTH CARE, REHABILITATION, SKILLED NURSING, MATERNAL/CHILD CARE, LABORATORY, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2014, IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION HAD 1,963,135 PATIENT ENCOUNTERS. 18676944 22005 0 COMMUNITY BENEFITSCHARITY CARE AND MEANS-TESTED PROGRAMS: IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE TO 3,080 PEOPLE AT A VALUE OF $1,459,444 IN 2014. OFTENTIMES, IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $14,976,560 FOR 2014. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $16,436,004OTHER BENEFITS: IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONAL'S EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION COLLABORATES WITH OTHER HEALTH-CARE PROVIDERS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. APPROXIMATELY 18,927 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS REPORTED VALUE: $2,240,940 351151769 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 260 0 1 3298 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X KEITH G SEASHORE EXEC VPCFO 5154719305 8101 BIRCHWOOD COURT N JOHNSTON IA 50131 KENNETH ANDERSON MD BOARD SECRETARY 40.00 1.00 X X 317276 0 49467 ANDRIA BARR DO BOARD MEMBER 40.00 1.00 X 380339 0 38288 KYLE CHRISTIASON MD BOARD CHAIR 40.00 1.00 X X 291093 13903 90729 ERIC CROWELL BOARD MEMBER & CIHS CEO 1.00 40.00 X X 242 840219 395786 STAN DANIELSON MD BOARD TREASURER 40.00 1.00 X X 380261 0 39733 RANDY EASTON BOARD MEMBER 1.00 1.00 X 258 14003 0 VENESSA MACRO BOARD MEMBER 1.00 1.00 X 285 0 0 KURT PITTNER BOARD MEMBER 1.00 1.00 X 591 19602 0 JAMES STEVENSON BOARD MEMBER 1.00 1.00 X 882 0 0 RICH WELLMAN BOARD MEMBER 1.00 1.00 X 687 0 0 MIKE WILLIAMS BOARD MEMBER 1.00 1.00 X 89 11942 0 KEITH SEASHORE EXEC VP & CFO 40.00 0.00 X 349240 0 76424 ALAN KAPLAN MD CEO 1.00 40.00 X 0 904150 244448 RUSSELL ADAMS MD PHYSICIAN 40.00 0.00 X 386012 0 37733 HIMABINDU ALLA MD PHYSICIAN 40.00 0.00 X 191549 0 25024 DANIEL ALLEN MD REGIONAL VP MEDICAL DIRECTOR - CI 40.00 0.00 X 316282 0 40601 ENRIQUE BEDIA MD PHYSICIAN 40.00 0.00 X 581999 0 47650 MATTHEW BEHRENS VP PRACTICE OPERATIONS 40.00 1.00 X 197760 0 21947 MICHAEL BERSTLER MD PHYSICIAN 40.00 0.00 X 287069 0 39589 JASON COGDILL MD PHYSICIAN 40.00 0.00 X 223057 0 41112 DOUGLAS DAWSON MD PHYSICIAN 40.00 1.00 X 465029 0 16098 DANIEL GLASCOCK MD REGIONAL VP MEDICAL DIRECTOR - WL 40.00 1.00 X 301811 54 41826 JAN HAHN VP REGIONAL OPERATIONS 40.00 0.00 X 160302 0 23199 ERICK LAINE EXEC VP/COO 40.00 0.00 X 475602 0 80688 TODD LANGAGER MD PHYSICIAN 40.00 0.00 X 510444 22287 38019 TIMOTHY MAYFIELD MD PHYSICIAN 40.00 0.00 X 312434 0 40296 JESSICA MEISNER VP HR & EDUCATION 40.00 0.00 X 163233 0 25181 MICHELLE NIERMANN SVP/COO VP CLINIC OPERATIONS 1.00 40.00 X 0 407508 81770 KIRK PETERSON MD PHYSICIAN 40.00 0.00 X 328023 0 46662 MARK REINERTSON MD PHYSICIAN 40.00 0.00 X 314014 0 43883 JOHN ROOF MD REGIONAL VP MEDICAL DIRECTOR - CR 40.00 0.00 X 361805 0 35968 MATT SOJKA MD REGIONAL VP MEDICAL DIRECTOR - QC 40.00 1.00 X 376680 0 21924 NATHAN FIERCE MD PHYSICIAN 40.00 0.00 X 1111571 0 32644 TIMOTHY HART MD PHYSICIAN 40.00 0.00 X 708012 0 35612 MARY HLAVIN MD PHYSICIAN 40.00 0.00 X 733822 0 34689 TAUSEEF KHAN MD PHYSICIAN 40.00 0.00 X 797844 0 35093 CRAIG STARK MD PHYSICIAN 40.00 0.00 X 742650 0 40211 MARK BARNHILL DO TO 1211 FORMER CHIEF MEDICAL OFFICER 0.00 40.00 X 8834 256230 27214 JEANETTE SHELTON TO 713 FORMER VP PRACTICE OPERATIONS 0.00 0.00 X 124639 0 7750 11901720 2489898 1897258 533 1 1 0 NUANCE COMMUNICATIONS INC P O BOX 2561 CAROL STREAM IL 601322561 TRANSCRIPTION 1169999 MAIL SERVICES LLC 4100 121ST STREET DES MOINES IA 503232334 MAILING SERVICE 1168248 HAYES LOCUMS LLC 6700 N ANDREWS AVE STE 600 FORT LAUDERDALE FL 33309 PHYSICIAN SERVICES 564751 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 490050 HAUGE ASSOCIATES INC PO BOX 88610 SIOUX FALLS SD 57105 COLLECTION SERVICES 463428 20 63462541 94286 63556827 NET PATIENT REVENUE 900099 277148846 277148846 MANAGEMENT, IT AND SUPPORT SERVIC 561000 18509864 17788383 721481 MISCELLANEOUS REVENUE 900099 2390132 2390132 EDUCATION & RESEARCH 900099 2276937 2276937 RENTAL REVENUE 531100 994367 994367 30630 30630 301350776 1810458 1810458 57716 18195 56700 16695 1016 1500 2516 2516 OTHER HEALTHCARE SVCS 900099 7412325 7128365 283960 MISCELLANEOUS REVENUE 900099 2152711 1701946 247833 202932 EDUCATION & RESEARCH 900099 18300 18300 9583336 376303913 309459606 1271574 2015906 22005 22005 8830160 8830160 199791 199791 218530340 210775711 7754629 8092988 7805805 287183 18624646 17963744 660902 11871842 11450565 421277 5559171 43680 5515491 274775 169410 105365 668889 77 668812 13006012 10056548 2949464 680922 266145 414777 5980029 5442259 537770 27581865 27581865 24391592 22923092 1468500 925411 511637 413774 1892524 1819711 72813 460864 460864 6060354 5657480 402874 6182839 6042832 140007 MEDICAL SUPPLIES 22103105 22102925 180 MISCELLANEOUS EXPENSE 523089 55414 467675 INCOME TAXES 64590 64590 382527803 351151769 31376034 0 3621870 218943 1278223 734319 22529239 26772968 25307065 25071053 3150314 3677258 645332 783480 61491295 31636174 23338148 29855121 44285253 48964597 27002 380516 109762 124535960 136214503 33578554 41273703 680 9442453 8946705 35112705 38553738 78134392 88774146 X 46401568 47440357 46401568 47440357 124535960 136214503 X -6223890 7262679 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 33845666 14669583 19176083 27645629 16966591 10679038 29855121 SELF-INSURANCE RESERVE 13167430 LONG-TERM RETENTION INCENTIVES 22509725 DUE TO AFFILIATES 1117819 HEALTH AND WELFARE BENEFITS RESERVE 1758764 38553738 X 313288000 481183 28 481211 312806789 50034 63447090 63497124 376303913 371208000 393 393 371207607 50034 11270162 11320196 382527803 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 2011. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 28. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 63,447,090. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 393. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 11,270,162. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 KENNETH ANDERSON MD BOARD SECRETARY 283304 0 27432 0 6540 0 33261 0 16206 0 366743 0 0 0 ANDRIA BARR DO BOARD MEMBER 379307 0 0 0 1032 0 14990 0 23298 0 418627 0 0 0 KYLE CHRISTIASON MD BOARD CHAIR 266906 13903 21413 0 2774 0 65516 0 25213 0 381822 13903 0 0 ERIC CROWELL BOARD MEMBER & CIHS CEO 242 596908 0 173399 0 69912 0 375225 0 20561 242 1236005 0 0 STAN DANIELSON MD BOARD TREASURER 349973 0 22240 0 8048 0 31300 0 8433 0 419994 0 0 0 KEITH SEASHORE EXEC VP & CFO 257642 0 70616 0 20982 0 51250 0 25174 0 425664 0 0 0 ALAN KAPLAN MD CEO 0 595351 0 253497 0 55302 0 220824 0 23624 0 1148598 0 0 RUSSELL ADAMS MD PHYSICIAN 352745 0 32666 0 601 0 25225 0 12508 0 423745 0 0 0 HIMABINDU ALLA MD PHYSICIAN 173044 0 11297 0 7208 0 7105 0 17919 0 216573 0 0 0 DANIEL ALLEN MD REGIONAL VP MEDICAL DIRECTOR - CI 267804 0 45900 0 2578 0 19531 0 21070 0 356883 0 0 0 ENRIQUE BEDIA MD PHYSICIAN 560145 0 20000 0 1854 0 20482 0 27168 0 629649 0 0 0 MATTHEW BEHRENS VP PRACTICE OPERATIONS 171737 0 25913 0 110 0 10019 0 11928 0 219707 0 0 0 MICHAEL BERSTLER MD PHYSICIAN 265990 0 17474 0 3605 0 24012 0 15577 0 326658 0 0 0 JASON COGDILL MD PHYSICIAN 175255 0 19956 0 27846 0 11396 0 29716 0 264169 0 0 0 DOUGLAS DAWSON MD PHYSICIAN 455184 0 6077 0 3768 0 12006 0 4092 0 481127 0 0 0 DANIEL GLASCOCK MD REGIONAL VP MEDICAL DIRECTOR - WL 263657 54 36743 0 1411 0 18233 0 23593 0 343637 54 0 0 JAN HAHN VP REGIONAL OPERATIONS 129904 0 30145 0 253 0 8227 0 14972 0 183501 0 0 0 ERICK LAINE EXEC VP/COO 345947 0 92807 0 36848 0 57569 0 23119 0 556290 0 0 0 TODD LANGAGER MD PHYSICIAN 505508 22287 1040 0 3896 0 12123 877 25019 0 547586 23164 0 0 TIMOTHY MAYFIELD MD PHYSICIAN 301552 0 9781 0 1101 0 13000 0 27296 0 352730 0 0 0 JESSICA MEISNER VP HR & EDUCATION 149824 0 13253 0 156 0 8651 0 16530 0 188414 0 0 0 MICHELLE NIERMANN SVP/COO VP CLINIC OPERATIONS 0 289636 0 85054 0 32818 0 60789 0 20981 0 489278 0 0 KIRK PETERSON MD PHYSICIAN 300811 0 25677 0 1535 0 26893 0 19769 0 374685 0 0 0 MARK REINERTSON MD PHYSICIAN 282218 0 24689 0 7107 0 28415 0 15468 0 357897 0 0 0 JOHN ROOF MD REGIONAL VP MEDICAL DIRECTOR - CR 322703 0 36438 0 2664 0 19143 0 16825 0 397773 0 0 0 MATT SOJKA MD REGIONAL VP MEDICAL DIRECTOR - QC 337160 0 36706 0 2814 0 12058 0 9866 0 398604 0 0 0 NATHAN FIERCE MD PHYSICIAN 1110539 0 0 0 1032 0 13000 0 19644 0 1144215 0 0 0 TIMOTHY HART MD PHYSICIAN 704244 0 0 0 3768 0 13000 0 22612 0 743624 0 0 0 MARY HLAVIN MD PHYSICIAN 731376 0 784 0 1662 0 18095 0 16594 0 768511 0 0 0 TAUSEEF KHAN MD PHYSICIAN 795804 0 978 0 1062 0 13000 0 22093 0 832937 0 0 0 CRAIG STARK MD PHYSICIAN 613736 0 0 0 128914 0 15974 0 24237 0 782861 0 0 0 MARK BARNHILL DO TO 1211 FORMER CHIEF MEDICAL OFFICER 8496 217849 0 33637 338 4744 433 12401 562 13818 9829 282449 0 0 JEANETTE SHELTON TO 713 FORMER VP PRACTICE OPERATIONS 320 0 26274 0 98045 0 1445 0 6305 0 132389 0 0 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. PART I, LINES 4A-B SEVERANCE PAYMENT: THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING THE YEAR THAT WAS INCLUDED IN THEIR TAXABLE INCOME: JEANETTE SHELTON $100,037. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: RUSSELL ADAMS, MD $12,225; DANIEL ALLEN, MD $6,531; KENNETH ANDERSON, MD $15,744; KYLE CHRISTIASON, MD $52,516; ERIC CROWELL $341,885; STAN DANIELSON, MD $18,300; DANIEL GLASCOCK, MD $5,233; ALAN KAPLAN $207,824; ERICK LAINE $44,505; MICHELLE NIERMANN $47,789; KIRK PETERSON, MD $13,893; MARK REINERTSON, MD $15,415; JOHN ROOF, MD $6,143; AND KEITH SEASHORE $35,625. GRAHAM CONSTRUCTION - METHODIST PLAZA III COMMON BOARD MEMBER/OWNER 1836000 RENT 0 KAREN REINERTSON FAMILY MEMBER OF KEY EMPLOYEE MARK REINERTSON, MD 25173 EMPLOYMENT 0 MARY ADAMS FAMILY MEMBER OF KEY EMPLOYEE RUSSELL ADAMS, MD 32402 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO NOMINATE AND APPOINT BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO APPROVE CHANGES IN ARTICLES AND BYLAWS, STRATEGIC PLANNING, BUSINESS PLANS, OPERATING AND/OR CAPITAL BUDGETS, SELECTION AND REMOVAL OF THE CEO, INCURRING INDEBTEDNESS, MANAGED CARE STRATEGY, TRANSFER OF ASSETS, TRANSFER, SALE OR CLOSURE OF ANY FACILITY OR DEPARTMENT, AND DIRECT THE TRANSFER OR SALE OF ASSETS. FORM 990, PART VI, SECTION B, LINE 11 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 ANNUAL REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS ANNUAL 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 APPROXIMATELY THE TOP FIFTY 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 ANNUAL REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2014 FOR THE FOLLOWING INDIVIDUALS: ERIC CROWELL, ALAN KAPLAN, ERICK LAINE, MICHELLE NIERMANN, AND KEITH SEASHORE. 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: NET ASSET TRANSFER FROM AFFILIATES 6,781,496. UNREALIZED GAINS/LOSSES 481,183. 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IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM SEVENTEEN HOSPITAL FACILITIES AND VARIOUS AMBULATORY SERVICE AND CLINIC LOCATIONS 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).