2014-11-13T14:13:08-06:00 2013-12-31 990 2013-01-01 420680354 THE FINLEY HOSPITAL FINL 5635821881 350 NORTH GRANDVIEW AVE DUBUQUE IA 520016392 DAN L CARPENTER VP FINANCE/CFO 5635892414 2014-11-03 2013 2015-11-30 17:44:51Z DAVID R BRANDON 350 NORTH GRANDVIEW AVE DUBUQUE IA 520016392 149782347 0 X WWW.UNITYPOINT.ORG/DUBUQUE/ X 1941 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES OF THE TRI-STATE AREA. 16 11 939 304 457296 44141 653753 623318 95551988 100372754 7774582 7293038 997217 882126 104977540 109171236 34472 69523 0 0 46040387 47745963 0 0 0 48289101 48656563 94363960 96472049 10613580 12699187 145763800 157471506 22797568 20128476 122966232 137343030 X THE MISSION OF THE FINLEY HOSPITAL IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES OF THE TRI-STATE AREA. 0 0 75166466 48398 100427768 HEALTH-CARE SERVICESTHE FINLEY HOSPITAL IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE IOWA, ILLINOIS AND WISCONSIN TRI-STATE AREA COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH-CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. THE FINLEY HOSPITAL 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, 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 ENDED DECEMBER 31, 2013, THE FINLEY HOSPITAL ADMITTED 4,778 PATIENTS RESULTING IN A TOTAL OF 20,771 PATIENT DAYS. OUTPATIENT VISITS TOTALED 85,917 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 4,724. THERE WERE ALSO 22,962 EMERGENCY ROOM VISITS AND 670 BABIES DELIVERED. 7785996 21125 0 COMMUNITY BENEFITS, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: THE FINLEY HOSPITAL 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 COST OF $1,451,195 IN 2013. IT IS MORE COMMON FOR FINLEY HOSPITAL TO RECEIVE PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. THE FINLEY HOSPITAL PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. THE FINLEY HOSPITAL'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $2,797,241 FOR 2013. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $4,248,436.OTHER BENEFITS: THE FINLEY HOSPITAL 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. THE FINLEY HOSPITAL COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. THE FINLEY HOSPITAL HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $3,537,560. 82952462 1 1 0 0 0 0 0 0 0 1 1 0 1 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 1 1 0 0 1 125 0 1 939 1 1 1 0 0 0 0 0 0 0 0 0 X 16 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X X DAN CARPENTER VP FINANCECFO 5635892414 350 N GRANDVIEW AVE DUBUQUE IA 520016392 BILL ARNOLD BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 JESUS AVILES FR 0113 BOARD MEMBER 1.00 0.00 X 193 0 0 DAVID BRANDON BOARD MEMBER & PRESIDENT/CEO 40.00 1.00 X X 442269 0 138684 PAUL DELONG DMD BOARD MEMBER 1.00 0.00 X 537 0 0 MIKE DONOHUE BOARD MEMBER 1.00 0.00 X 182 0 0 NANCY DUNKEL BOARD MEMBER 1.00 0.00 X 0 0 0 FREDERICK HUNTER FUERSTE MD BOARD SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 BARB KEHL FR 0113 BOARD MEMBER 1.00 0.00 X 2097 0 0 PEG KERR BOARD MEMBER 1.00 0.00 X 0 0 0 TIMOTHY KUNKEL TO 413 BOARD MEMBER 1.00 0.00 X 950 0 0 CHAD LEITCH BOARD MEMBER 1.00 1.00 X 2188 0 0 KEVIN LYNCH BOARD CHAIR 1.00 1.00 X X 0 39 0 BRIAN NELSON MD BOARD MEMBER 1.00 0.00 X 1093 0 0 JAN POWERS BOARD MEMBER 1.00 0.00 X 1471 0 0 HILLARD SALAS MD BOARD MEMBER 1.00 1.00 X 0 0 0 LAURA WITTHOEFT MD BOARD MEMBER 1.00 0.00 X 812 0 0 DAN CARPENTER VP FINANCE & CFO 40.00 1.00 X 201507 0 51271 CHAD WOLBERS COO 40.00 0.00 X 246244 0 47747 DIANA BATCHELOR CHIEF NURSING OFFICER 40.00 1.00 X 166661 0 12716 RYAN CLOOS PHYSICIAN 40.00 0.00 X 355318 0 25741 PAMELA WESTERLING MEDICAL DIRECTOR 40.00 0.00 X 366299 0 27984 DAVID ARNOLD PHYSICIAN 40.00 0.00 X 313110 0 17896 ALEX HORCHAK PHYSICIAN 40.00 0.00 X 501227 0 32593 ANTHONY MARKHAM PHYSICIAN 40.00 0.00 X 358328 0 25086 BARRY WAACK PHYSICIAN 40.00 0.00 X 387341 0 16906 PHILIP ZIMMERMAN PHYSICIAN 40.00 0.00 X 363248 0 35124 JOHN KNOX TO 1010 FORMER BOARD MEMBER & PRES/CEO 0.00 0.00 X 0 164673 38845 3711075 164712 470593 36 1 1 0 UNITED CLINICAL LABORATORIES 205 BLUFF ST SUITE I DUBUQUE IA 52001 LABORATORY SERVICES 4420932 ARAMARK CTS INC 12483 COLLECTIONS CENTER CHICAGO IL 60693 MAINTENANCE SERVIES 1099122 INVISION ARCHITECTURE PO BOX 1800 WATERLOO IA 507041800 DESIGN SERVICES 598193 HORIZON MENTAL HEALTH MGMT PO BOX 840839 DALLAS TX 752840839 MANAGEMENT SERVICE 560679 ARAMARK MANAGEMENT SERVICES 24863 NETWORK PLACE CHICAGO IL 606731248 DIETARY, HOUSEKEEPING, LAUNDRY MANAGEMEN 527085 29 296948 76357 250013 623318 NET PATIENT REVENUE 900099 94995169 94995169 MISCELLANEOUS REVENUE 900099 2260793 2247718 13075 SUBS & JOINT VENTURES 900099 1381743 1371062 10681 MANAGEMENT, IT AND SUPPORT SERVIC 561000 591258 256733 334525 PHARMACY REVENUE 446110 478449 478449 665342 553252 112090 100372754 2516796 2516796 9600 17321 -7721 -7721 -7721 45364032 6000 40593528 262 4770504 5738 4776242 4776242 CAFETERIA/FOOD SVCS 722210 834833 834833 MISCELLANEOUS REVENUE 900099 55014 55014 889847 109171236 99478948 457296 8611674 X 55350 55350 14173 14173 2090871 2090871 41977 41977 38029432 34470951 3558481 1331559 1206007 125552 3678392 3335809 342583 2573732 2331056 242676 3966213 1875320 2090893 59403 59403 253266 4452 248814 11985895 10561965 1423930 758561 560524 198037 2946081 2724496 221585 6146424 4292083 1854341 1780574 1437084 343490 283925 179687 104238 13683 9304 4379 576311 217900 358411 6095162 6063631 31531 511363 511363 MEDICAL SUPPLIES 12479948 12461121 18827 MISCELLANEOUS EXPENSES 782268 640186 142082 INCOME TAXES 15200 15200 BAD DEBT EXPENSE 2286 2286 96472049 82952462 13519587 0 4813236 7226830 1204826 1496318 15438378 14158822 3599052 3392974 2257713 2520809 577994 462030 126658334 76654391 52461052 50003943 58363693 69940123 7023306 8256438 24550 13219 145763800 157471506 10931543 10463299 440218 -200439 11425807 9865616 22797568 20128476 X 118422741 131359517 2356257 3756473 2187234 2227040 122966232 137343030 145763800 157471506 X 12699187 1843879 -166268 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 46539711 2855498 7266345 84892 125579 56451083 35182029 5281540 6227066 65549 85375 46539711 33508847 1996760 202076 121502 35182029 28333902 6334676 1015141 144590 33508847 26824107 25000 1599223 114428 28333902 0.89400 0.03950 0.06650 0 1 1 949800 3701439 4651239 2873012 66078335 40827272 28124075 42779161 30749521 12029640 10276587 5077598 5198989 50003943 IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC 5000 C HEALTHNET CONNECT, LC 100 C DUBUQUE ENDOSCOPY CENTER, LC 184177 C FINLEY DEPARTMENT OF SURGERY CO-MANAGEMENT COMPANY, LLC 117000 C UNITED CLINICAL LABORATORIES, INC. 984739 C FINLEY/HARTIG HOMECARE, LLC 956757 C HEALTH ENTERPRISES OF IOWA & RELATED PARTNERSHIPS 154767 C BENEFICIAL INTEREST IN THE FINLEY HEALTH FOUNDATION, INC. 5853898 F 8256438 ASBESTOS REMOVAL LIABILITY 433239 SELF-INSURANCE RESERVE 1597254 LONG-TERM RETENTION INCENTIVES 399237 IOWA HEALTH SYSTEM NOTE PAYABLE 6753000 DUE TO AFFILIATES 333580 MISCELLANEOUS LIABILITY 349306 9865616 X 108571000 1843879 1843879 106727121 184991 2259124 2444115 109171236 93803000 500 500 93802500 184991 2484558 2669549 96472049 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 2010. 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 DURING THE CARRYFORWARD PERIOD. NO INCOME TAX BENEFIT HAS BEEN RECOGNIZED FOR THE NET OPERATING LOSS CARRYFORWARDS OR OTHER POTENTIAL DEFERRED TAX ASSETS IN THE CONSOLIDATED FINANCIAL STATEMENTS BECAUSE THE SYSTEM BELIEVES REALIZATION OF THESE BENEFITS IS UNLIKELY. PART XI, LINE 4B - OTHER ADJUSTMENTS: FORGIVENESS OF AMOUNTS OWNED FROM FINLEY HEALTH FOUNDATION INC 1,476,674. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 296,948. REVENUE RECORDED AS OFFSET TO EXPENSE ON BOOKS 332,356. REVENUES IN UNRESTRICTED FUND BALANCE 22,953. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 129,615. ROUNDING 578. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 500. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 1,855,254. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 296,948. REVENUE RECORDED AS OFFSET TO EXPENSE ON BOOKS 332,356. 1 1 X 1 X 1 X 1 1 1 0 1 1 1383 1451195 1451195 0.01500 13385 8849354 6052113 2797241 0.02900 14768 10300549 6052113 4248436 0.04400 32 7566 200879 16183 184696 0.00190 4 556 451480 250 451230 0.00470 4 14532 19271815 17179900 2091915 0.02170 14 42425 809719 809719 0.00840 54 65079 20733893 17196333 3537560 0.03670 54 79847 31034442 23248446 7785996 0.08070 8 4171 148513 148513 0.00150 2 1300 2891 2891 0.00000 1 0 154 154 0.00000 11 5471 151558 151558 0.00150 0 1409955 0 33507692 37660612 -4152920 X 1 1 1 DUBUQUE ENDOSCOPY CENTER LC AMBULATORY SURGERY CENTER 0.51000 0.49000 2 UNITED CLINICAL LABORATORIES INC MERCY HEALTH CENTER AND PATHOLOGY ASSOC. 0.33330 0.33330 3 FINLEY DEPARTMENT OF SURGERY CO MANAGEMENT COMPANY LLC SURGERY SERVICE LINES 0.50000 0.50000 1 1 THE FINLEY HOSPITAL 350 NORTH GRANDVIEW AVE DUBUQUE IA 52001 WWW.UNITYPOINT.ORG/DUBUQUE 310020H X X X THE FINLEY HOSPITAL 1 1 X X X X X X X X 13 1 1 1 X WWW.UNITYPOINT.ORG/DUBUQUE X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 THE FINLEY HOSPITAL PART V, SECTION B, LINE 3: AS PART OF FINLEY AND PUBLIC HEALTH, THE VNA DIRECTOR PROVIDED LEADERSHIP FOR THE COUNTY CHNA-HIP THAT INVOLVED A WIDE ARRAY OF COMMUNITY PARTNERS. DURING THAT PROCESS, DIRECTORS OF SEVERAL DEPARTMENTS FROM FINLEY HOSPITAL PARTICIPATED IN THE MEETINGS AND PLANNING PROCESS. THAT COUNTY NEEDS ASSESSMENT AND PLAN WAS A BASIS FOR FINLEY'S EXPANDED ASSESSMENT AND PLAN WHICH INCLUDED A SUBCOMMITTEE UNDER THE DIRECTION OF THE CHIEF OPERATING OFFICER. THE FINLEY HOSPITAL PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER DUBUQUE 7 DBA FINLEY HOME HEALTH CARE 1333 DELHI ST DUBUQUE IA 52001 LICENSED TO OPERATE HOME HEALTH AGENCY IN WISCONSIN & ILLINOIS DBA WENDT CANCER TREATMENT CENTER 350 N GRANDVIEW AVE DUBUQUE IA 52001 OUTPATIENT RADIATION ONCOLOGY SERVICES DBA KEHL DIABETES CENTER 1550 UNIVERSITY AVE DUBUQUE IA 52001 OUTPATIENT DIABETES CLINIC DBA FINLEY OUTPATIENT REHAB -GRANDVIEW 444 N GRANDVIEW AVE DUBUQUE IA 52001 OUTPATIENT REHAB CLINIC DBA FINLEY OUTPATIENT REHAB -WESTMARK 1665 EMBASSY WEST DR STE 250 DUBUQUE IA 52002 OUTPATIENT DIABETES CLINIC DUBUQUE ENDOSCOPY CENTER LC 1515 DELHI STREET DUBUQUE IA 52001 OUTPATIENT CLINIC FINLEYHARTIG HOMECARE LLC 703 MAIN ST DUBUQUE IA 52001 OUTPATIENT CLINIC PART I, LINE 6A: THE FINLEY HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. PART I, LINE 7G: THE NET COMMUNITY BENEFIT COST OF SUBSIDIZED HEALTH SERVICES OF $2,091,915 IS ATTRIBUTED TO A PHYSICIAN CLINIC. 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 $ 2,286. 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. THE FINLEY HOSPITAL CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. I.E. FINLEY SPONSORS A MEAL SERVED AT THE LOCAL MISSION WITH STAFF SERVING AND FINLEY SUPPLYING THE FOOD ON A MONTHLY BASIS, SPACE IS PROVIDED FOR THE SHIIP PROGRAM (SENIOR HEALTH INSURANCE INFORMATION PROGRAM), ANNUALLY A HOLIDAY MEAL WITH SANTA, PRESENTS, AND A MEAL PROVIDED TO LOCAL FAMILIES IN NEED. THESE DONATIONS ALLOW OTHER NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH STATUS IN WAYS THAT MAY DIFFER FROM THE DIRECT SERVICES OF THE HOSPITAL ORGANIZATION AND MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. THE HOSPITAL EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, THE HOSPITAL EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COLLABORATE TO ADDRESS COMPLEX HEALTH ISSUES. 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 THE FINLEY HOSPITAL. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 8: AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. THE ORGANIZATIONS COST ACCOUNTING SYSTEM CALCULATES A MEDICARE SHORTFALL OF $12,449,109. IN ADDITION TO THESE ITEMS THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM DO NOT INCLUDE MEDICARE PHYSICIAN FEE SCHEDULE EXPENSE OF $1,506,268 AND REVENUE OF $1,412,037. AFTER TAKING THESE ITEMS INTO ACCOUNT WE CALCULATE AN ACTUAL MEDICARE SHORTFALL OF $12,543,340.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 HOSPITALS 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: THE FINLEY HOSPITAL CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN CENTRAL IOWA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, THE FINLEY HOSPITAL IS A SPONSORING PARTNER OF THE DUBUQUE VISITING NURSE ASSOCIATION'S (VNA) WORK ON THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT & HEALTH IMPROVEMENT PLAN (CHNA/HIP) THE CHNA/HIP IS A COMMUNITY COLLABORATIVE MANDATED BY IOWA CODE REQUIRING ALL IOWA COUNTIES' BOARDS OF HEALTH TO COMPLETE EVERY FIVE YEARS. THE VNA PROVIDES LEADERSHIP AND ASSISTANCE TO THE BOARD OF HEALTH TO COMPLETE THE CHNA/HIP AND IMPLEMENT ACTION PLANS DEVELOPED DURING THE PROCESS. THE CHNA/HIP ASSESSES COMMUNITY HEALTH NEEDS BASED ON DATA ON SPECIFIC INDICATORS, PRIORITIZES AND ADDRESSES NEEDS IN THE HEALTH IMPROVEMENT PLAN, AND THEN ASSISTS THE BOARD OF HEALTH TO IMPLEMENT WITH COMMUNITY PARTNERS. THROUGHOUT THE CHNA/HIP PROCESS THE VNA ASSISTS THE COMMUNITY AND BOARD OF HEALTH TO DEVELOP A HEALTH FIVE-YEAR AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES THAT ARE RELEVANT TO THE COMMUNITY. THE DUBUQUE VISITING NURSE ASSOCIATION WORKS COLLECTIVELY WITH THE BOARD OF HEALTH AND THE COMMUNITY TO ADDRESS THE PRIORITIES THROUGH LEVERAGING THE RESOURCES OF THE COMMUNITY. THE FINLEY HOSPITAL, AS THE SPONSORING AGENCY OF THE VNA, ACTIVELY CONTRIBUTES TO THIS PROCESS AND ENGAGES IN THE IDENTIFIED PRIORITIES THAT MATCH ITS MISSION AND CAPACITY. EFFORTS ARE MONITORED IN PART BY OTHER PARTNER AGENCIES SUCH AS THE FAMILY AND CHILD POLICY CENTER WHICH MONITORS AND REPORTS SPECIFIC INDICATORS TO ASSESS EFFECTIVENESS AND AID IN THE DEVELOPMENT OF NEW PLANS OR REFINING EXISTING ONES. FURTHER, THE DUBUQUE VISITING NURSE ASSOCIATION WILL CONTINUE TO ASSIST THE BOARD OF HEALTH TO DEVELOP A MEASUREMENT PROCESS TO EVALUATE EFFECTIVENESS OF THE HEALTH IMPROVEMENT PLAN AND ADDITIONAL COMMUNITY NEEDS PERIODICALLY OVER THE NEXT FIVE YEARS. THE DUBUQUE VISITING NURSE ASSOCIATION ASSISTS THE BOARD OF HEALTH TO CONVENE TWO HEALTH ACCESS SUBCOMMITTEE MEETINGS ANNUALLY TO SEEK PROVIDER INPUT ON PROGRESS IN HEALTH INITIATIVES. FINLEY HOSPITAL ASSISTS THE COMMUNITY BY MONITORING EFFECTIVENESS OF COMMUNITY HEALTH AND WELLNESS. AN EXAMPLE OF COMMUNITY COLLABORATION IS THE FINLEY SUITE BEGINNINGS PROGRAM, WHICH PROVIDES PRE-NATAL EDUCATION AND POSTPARTUM HOME VISITS TO ALL NEWBORNS. BY IMPROVING PRENATAL EDUCATION, THIS PROGRAM HELPS IMPROVE NEONATAL OUTCOMES. THE DUBUQUE VNA ATTENDS ALL DUBUQUE COUNTY BOARD OF HEALTH MEETINGS REPORTING TO THE BOARD ON EACH MONTH'S PUBLIC HEALTH ACTIVITIES. FINLEY HOSPITAL IS ALSO A SPONSORING PARTNER FOR THE CRESCENT COMMUNITY HEALTH CENTER WHICH ENABLES COMMUNITY RESIDENTS TO MORE EASILY ACCESS HEALTH AND DENTAL CARE. THE FINLEY SERVING OTHERS OUTREACH INITIATIVE IS A PROGRAM THAT DIRECTLY SUPPORTS THE DUBUQUE RESCUE MISSION. FINLEY PROVIDES AND FINLEY EMPLOYEES SERVE A MONTHLY MEAL AT THE MISSION, AND PROVIDE MEDICAL ATTENTION TO COMMUNITY MEMBERS THAT OTHERWISE WOULD NOT HAVE THIS OPPORTUNITY. FINLEY HOSPITAL ALSO PARTICIPATES ACTIVELY IN THE ANNUAL UNITED WAY CAMPAIGN TO HELP FUND THE UNITED WAY PROGRAMS. FINLEY HOSPITAL HAS BEEN A LEADER IN LIVE HEALTHY IOWA FOR SEVERAL YEARS LEADING TO VERY SUCCESSFUL CAMPAIGNS IN DUBUQUE TO IMPROVE RESIDENT'S HEALTH. BOTH FINLEY HOSPITAL AND THE VNA HAVE PROVIDED LEADERSHIP IN THE SUCCESSFUL 2009 HARKIN WELLNESS GRANT APPLICATIONS RESULTING IN THE HEALTHY MEALS IN A HURRY PROGRAM IN COLLABORATION WITH HY-VEE AND THE BOARD OF HEALTH. THE PROGRAM FOCUSES ON CLASSES TO ENCOURAGE FAMILIES TO COOK HEALTHY MEALS AT HOME AND FOCUSES ON THE BENEFITS ON EATING MEALS AS A FAMILY. THE VNA AND THE BOARD OF HEALTH IMPLEMENTED A PERMANENT BOARD SUBCOMMITTEE ON FOOD, FITNESS, AND WELLNESS. THIS GROUP ACTIVELY HAS BEEN MEETING MONTHLY AND ADDRESSES NEEDS/STRATEGIES ASSOCIATED WITH HEALTH THAT CAN PRODUCE BEHAVIOR CHANGE. THIS WIDE BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR THE FINLEY HOSPITAL 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 ORGANIZED COMMUNITY EFFORTS, FINLEY HOSPITAL CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO IT'S SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS OFTEN WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT. PART VI, LINE 3: THE FINLEY HOSPITAL PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR PATIENT FINANCIAL POLICY BROCHURES IN APPROPRIATE AREAS OF THE HOSPITAL (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THAT THE PROVIDER/PHYSICIAN PRACTICE OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE. PART VI, LINE 4: THE FINLEY HOSPITAL IS A 126 BED COMMUNITY HOSPITAL SERVING THE MIDWEST REGION. THE FINLEY HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF THE FINLEY HOSPITAL MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF CLAYTON, DELAWARE, DUBUQUE, JACKSON AND GRANT. THE FINLEY HOSPITAL ADMITS APPROXIMATELY 4,800,INPATIENTS AND CARES FOR 23,000 EMERGENCY PATIENTS PER YEAR. THERE ARE 9 OTHER HOSPITALS WITHIN THE 5-COUNTY SERVICE AREA. MEDIAN HOUSEHOLD INCOME IS $50,885 AND THE AVERAGE POVERTY RATE IS 10.0%.63.4% OF FINLEY HOSPITAL'S INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. PART VI, LINE 5: THE FINLEY 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). INITIALLY FORMED IN 1994, UNITYPOINT HEALTH IS THE STATE'S FIRST AND LARGEST INTEGRATED HEALTH SYSTEM, SERVING NEARLY ONE OF EVERY THREE PATIENTS IN IOWA. THROUGH RELATIONSHIPS WITH 31 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 280 PHYSICIAN CLINICS, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA AND ILLINOIS.UNITYPOINT HEALTH ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH MORE THAN 25,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 4 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $2.8 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 2013, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $373 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,IL 1 AMERICAN CANCER SOCIETY 2774 UNIVERSITY AVE STE D DUBUQUE IA 520015669 410724036 501(C)(3) 7600 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION PO BOX 4002902 DES MOINES IA 503402902 135613797 501(C)(3) 15000 PROGRAM SUPPORT DUBUQUE AREA CHAMBER OF COMMERCE 300 MAIN ST SUITE 200 DUBUQUE IA 52001 420223700 501(C)(6) 20000 PROGRAM SUPPORT GREATER DUBUQUE DEVELOPMENT 900 JACKSON STM SUITE 120 DUBUQUE IA 52001 421263173 501(C)(6) 5000 PROGRAM SUPPORT 2 2 SCHOLARSHIPS 18 10250 MEDICAL, DENTAL AND HOSPITAL EXPENSES 1 2000 FOOD, CLOTHING AND SHELTER FOR INDIGENTS 1 1923 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 1 1 X X X X X 1 1 0 0 0 0 0 0 0 DAVID BRANDON BOARD MEMBER & PRESIDENT/CEO 307858 0 79336 0 55075 0 121528 0 17156 0 580953 0 0 0 DAN CARPENTER VP FINANCE & CFO 154952 0 37200 0 9355 0 28465 0 22806 0 252778 0 0 0 CHAD WOLBERS COO 190542 0 43594 0 12108 0 29919 0 17828 0 293991 0 0 0 DIANA BATCHELOR CHIEF NURSING OFFICER 142597 0 21292 0 2772 0 7602 0 5114 0 179377 0 0 0 RYAN CLOOS PHYSICIAN 320677 0 0 0 34641 0 12750 0 12991 0 381059 0 0 0 PAMELA WESTERLING MEDICAL DIRECTOR 355325 0 0 0 10974 0 12750 0 15234 0 394283 0 0 0 DAVID ARNOLD PHYSICIAN 310062 0 0 0 3048 0 8241 0 9655 0 331006 0 0 0 ALEX HORCHAK PHYSICIAN 482265 0 0 0 18962 0 13576 0 19017 0 533820 0 0 0 ANTHONY MARKHAM PHYSICIAN 344884 0 0 0 13444 0 12750 0 12336 0 383414 0 0 0 BARRY WAACK PHYSICIAN 318637 0 60000 0 8704 0 8355 0 8551 0 404247 0 0 0 PHILIP ZIMMERMAN PHYSICIAN 348989 0 0 0 14259 0 12750 0 22374 0 398372 0 0 0 JOHN KNOX TO 1010 FORMER BOARD MEMBER & PRES/CEO 0 0 0 0 0 164673 0 37209 0 1636 0 203518 0 0 PART I, LINE 1A 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 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: IF AN INDIVIDUAL IS PROVIDED SOMETHING FROM THE EMPLOYER OF VALUE, SUCH AS A PAID BENEFIT, GIFT CARD OR GIFT, WHICH IS CONSIDERED TAXABLE INCOME, THEN THE EMPLOYER WILL ADD IMPUTED AMOUNTS TO PAYCHECK IN ORDER TO TAX APPROPRIATELY. PART I, LINES 4A-B THE FOLLOWING INDIVUDAL RECEIVED SEVERANCE PAYMENTS DURING THE YEAR THAT WERE INCLUDED IN TAXABLE INCOME: JOHN KNOX $164,981. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: DAVID BRANDON $96,979, DAN CARPENTER $19,337 AND CHAD WOLBERS $19,133. DUBUQUE ENDOSCOPY CENTER LC COMMON BOARD MEMBER/OFFICER 184000 INVESTMENT 0 DUBUQUE INTERNAL MEDICINE COMMON BOARD MEMBER/OFFICER 322000 LEASE, DIALYSIS, PARKING, PHARMACY, MAINTENANCE, ETC 0 FINLEY DEPARTMENT OF SURGERY CO-MANAGEMENT COMPANY LLC COMMON BOARD MEMBER/OFFICER 117000 INVESTMENT 0 FINLEYHARTIG HOMECARE LLC COMMON BOARD MEMBER/OFFICER 957000 INVESTMENT 0 IOWA HEALTH SYSTEM CONTRACTING SERVICES LC COMMON BOARD MEMBER/OFFICER 153362 PERFORMANCE OF SERVICES 0 UNITED CLINICAL LABORATORIES INC COMMON BOARD MEMBER/OFFICER 5287000 INVESTMENT, LAB SERVICES, AND LAB RENTS 0 VICKI ARNOLD FAMILY MEMBER OF BOARD MEMBER BILL ARNOLD 41978 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 FINLEY TRI-STATES HEALTH GROUP, INC., A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A FINLEY TRI-STATES HEALTH GROUP, INC., AS SOLE MEMBER, APPOINTS ONE BOARD MEMBER AND APPROVES OTHERS. IOWA HEALTH SYSTEM, AS SOLE MEMBER OF FINLEY TRI-STATES HEALTH GROUP, APPOINTS ONE BOARD MEMBER AND APPROVES OTHERS. FORM 990, PART VI, SECTION A, LINE 7B FINLEY TRI-STATES HEALTH GROUP, INC., AS SOLE MEMBER, APPOINTS AND REMOVES BOARD OF DIRECTORS, APPROVES AMENDMENTS TO ARTICLES AND BYLAWS, APPROVES INDEBTEDNESS, AND APPOINTS PRESIDENT. 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 2013 FOR THE FOLLOWING INDIVIDUALS: DAVID BRANDON, DAN CARPENTER, AND CHAD WOLBERS 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 IX, LINE 11G HEALTH-CARE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,746,033. MANAGEMENT AND GENERAL EXPENSES 69,586. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,815,619. PURCHASED HOUSEKEEPING AND LAUNDRY: PROGRAM SERVICE EXPENSES 373,085. MANAGEMENT AND GENERAL EXPENSES 5,236. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 378,321. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,442,847. MANAGEMENT AND GENERAL EXPENSES 1,349,108. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,791,955. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF FINLEY HEALTH FOUNDATION, INC. 1,310,406. FORGIVENESS OF AMOUNTS OWNED FROM FINLEY HEALTH FOUNDATION, INC. -1,476,674. 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 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 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DUBUQUE ENDOSCOPY CENTER LC F 803000 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 SIXTEEN HOSPITAL FACILITIES AND VARIOUS AMBULATORY SERVICE AND CLINIC LOCATIONS IN IOWA AND ILLINOIS. PRIMARY, SECONDARY AND TERTIARY CARE SERVICES ARE PROVIDED TO RESIDENTS OF IOWA, ILLINOIS 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).