2013-11-14T06:52:40-06:00 2012-12-31 990 2012-01-01 421009175 TRINITY REGIONAL MEDICAL CENTER TRIN 5155733101 802 KENYON RD FORT DODGE IA 50501 MIKE J DEWERFF 5155746608 2013-11-07 2012 2016-02-25 16:41:14Z SUSAN K THOMPSON 802 KENYON RD FORT DODGE IA 50501 170656622 0 X WWW.UNITYPOINT.ORG/FORTDODGE/DEFAULT.ASPX X 1973 IA TO IMPROVE THE HEALTH OF OUR COMMUNITY AND REGION THROUGH HEALING, CARING AND EDUCATION. 11 5 914 127 1298409 52652 1557035 3331057 92507322 92928485 3113714 5396781 2595687 2503346 99773758 104159669 20256 4808 0 0 49959039 46877559 0 0 0 50742754 50464883 100722049 97347250 -948291 6812419 138133571 142906433 36314723 34655325 101818848 108251108 X TO IMPROVE THE HEALTH OF THE CITIZENS OF OUR COMMUNITIES AND REGIONS BY PROVIDING QUALITY HEALTHCARE IN AN EFFICIENT AND COST-EFFECTIVE MANNER. 0 0 73538479 94658115 HEALTH-CARE SERVICESTRINITY REGIONAL MEDICAL CENTER IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE NORTH CENTRAL IOWA COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTHCARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. TRINITY REGIONAL MEDICAL CENTER PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO GENERAL ACUTE CARE, SURGERIES, INTENSIVE CARE, CRITICAL CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, MATERNAL/CHILD CARE, PEDIATRIC CARE, LABORATORY SERVICES, PHARMACEUTICAL DRUGS, RADIOLOGY AND MANY OTHER ROUTINE AND ANCILLARY SERVICES. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2012, TRINITY REGIONAL MEDICAL CENTER ADMITTED 4,689 PATIENTS RESULTING IN A TOTAL OF 15,071 PATIENT DAYS. OUTPATIENT REGISTRATIONS TOTALED 62,700 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 3,149. THERE WERE ALSO 21,692 EMERGENCY ROOM VISITS AND 532 BABIES DELIVERED. 8193536 4808 0 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: TRINITY REGIONAL MEDICAL CENTER PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE AT A VALUE OF $2,394,836 IN 2012. OFTENTIMES, TRINITY REGIONAL MEDICAL CENTER RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. TRINITY REGIONAL MEDICAL CENTER PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. TRINITY REGIONAL MEDICAL CENTER'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $2,143,155 FOR 2012 AND SERVED 11,097 PEOPLE. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $4,537,991.OTHER BENEFITS: TRINITY REGIONAL MEDICAL CENTER PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. TRINITY REGIONAL MEDICAL CENTER COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. TRINITY REGIONAL MEDICAL CENTER HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 12,107 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS REPORTED VALUE: $3,655,545. 81732015 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 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 1 0 1 126 0 1 914 1 1 1 0 0 0 0 0 0 0 0 0 X 11 5 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA X X MIKE J DEWERFF CFO 5155746608 802 KENYON ROAD FORT DODGE IA 50501 KENNETH ADAMS DO 1.00 40.00 X 0 844996 377328 JOHN BIRKETT MD 1.00 40.00 X 0 322576 36542 RHONDA CHAMBERS 1.00 1.00 X X 0 0 0 KAREN KAISER 1.00 1.00 X 0 0 0 JAMES MEYER DO 1.00 40.00 X 0 469349 176940 JOHN PERKINS 1.00 1.00 X 0 178 0 KURT PITTNER 1.00 1.00 X 0 16118 0 DENNIS PLAUTZ 1.00 1.00 X X 0 1219 0 TOM SCHNURR 1.00 1.00 X 0 0 0 JOHN TAETS 1.00 1.00 X X 0 0 0 SUSAN THOMPSON 1.00 40.00 X X 0 431321 27664 MIKE DEWERFF 1.00 40.00 X 0 233372 44701 TROY MARTENS 40.00 1.00 X 0 247161 45841 DEBRA SHRIVER 40.00 0.00 X 166124 0 31903 LINDA WHALEY 40.00 0.00 X 156536 0 16778 RICHARD BERGSTROM MD 40.00 0.00 X 354319 0 9129 COLIN BROWN 40.00 0.00 X 216952 0 34422 SUZANNE CLAPP 40.00 0.00 X 226057 0 30997 JEFFREY LUNA MD 40.00 0.00 X 634113 0 27713 KEVIN SCHMINKE 40.00 0.00 X 246805 0 30441 RALPH HEASLEY TO 1110 0.00 40.00 X 0 182502 27943 THOMAS TIBBITTS TO 1209 0.00 40.00 X 0 907099 25149 2000906 3655891 943491 30 1 1 0 WOODRUFF CONSTRUCTION 1890 KOUNTRY LANE FORT DODGE IA 50501 CONSTRUCTION SERVICES 2724476 EMERGENCY PRACTICE ASSOCIATES PO BOX 1260 WATERLOO IA 50704 ER COVERAGE 2427361 ARAMARK MANAGEMENT SERVICES 24863 NETWORK PLACE CHICAGO IL 606731248 HSKG,LAUNDRY, DIETARY,PLANT MANAGEMENT 1550186 ARAMARK CTS 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 BIOMEDICAL SERVICES 1390587 HEALOGICS WOUND CARE 3087 MOMENTUM PLACE CHICAGO IL 606895330 WOUND & HYPERBARIC SERVICE 665248 19 3309592 21465 3331057 NET PATIENT REVENUE 900099 88435171 88435171 RENTAL INCOME 531110 2613420 2613420 LABORATORY SERVICES 621510 1024441 1024441 MGMT & SUPPORT SVCS 561000 332487 332487 MISCELLANEOUS REVENUE 900099 220361 220361 302605 228772 62758 11075 92928485 741663 741663 71094746 57325 66496953 0 4597793 57325 4655118 4655118 MISCELLANEOUS REVENUE 900099 1983883 1931239 52644 CAFETERIA/FOOD SVCS 722210 721072 721072 MGMT & SUPPORT SVCS 561000 211210 211210 -412819 -412819 2503346 104159669 93128270 1298409 6401933 X 4808 4808 664343 664343 37253774 33718831 3534943 1437764 1301337 136427 5005725 4530741 474984 2515953 2277218 238735 3389829 137779 3252050 182476 2257 180219 132990 132990 11256638 9587841 1668797 293974 60852 233122 2530046 2400983 129063 9351219 5614948 3736271 1365453 1261652 103801 213443 152043 61400 72063 28287 43776 1160816 1160816 5197183 5005250 191933 -386705 12725 -399430 MEDICAL SUPPLIES 15606231 15575183 31048 MISCELLANEOUS EXPENSE 98715 59280 39435 INCOME TAXES 512 512 97347250 81732015 15615235 0 6491378 2085594 9684794 449304 13169506 12897080 2985662 8308978 2436152 2581845 419990 390915 170738943 106530035 56107070 64208908 29865312 33467984 16530187 17784759 443520 731066 138133571 142906433 7226199 8254790 5000000 240000 853722 366353 2028474 1152792 21206328 24641390 36314723 34655325 X 96072754 101754278 3866272 4652726 1879822 1844104 101818848 108251108 138133571 142906433 X 6812419 -1535789 1155630 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 33063211 3060682 5437843 1506851 70033 39984852 29807903 973133 3392627 1005240 105212 33063211 27332498 1210199 2606051 1217174 123671 29807903 24531627 277482 3094721 455696 115636 27332498 28819843 -4127098 84867 -270 76521 24531627 0.83750 0.04610 0.11640 0 1 1 331504 331504 86581759 41339161 45242598 1866826 677839 1188987 76035677 61506284 14529393 5923177 3006751 2916426 64208908 IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC 5000 C BENEFICIAL INTEREST IN TRINITY HEALTH FOUNDATION 16982694 F VARIOUS HEALTH ENTERPRISES OF IOWA PARTNERSHIP INTERESTS 522702 C HEALTHNET CONNECT LC 100 C TRINITY REGIONAL MEDICAL CENTER AUXILIARY 274263 C 17784759 ASBESTOS REMOVAL LIABILITY 78357 CONTINGENCY LIABILITY/SELF-INSURANCE RESERVE 1587105 IOWA HEALTH SYSTEM NOTE PAYABLE 21300000 HEALTH AND WELFARE BENEFITS RESERVE 1222957 DUE TO AFFILIATES 428991 MISCELLANEOUS LIABILITY 23980 24641390 X 99330000 -1535789 -1535789 100865789 70044 3223836 3293880 104159669 94836000 190 190 94835810 70044 2441396 2511440 97347250 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IOWA HEALTH SYSTEM 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 HEALTH 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 2009. THE HEALTH 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 HEALTH SYSTEM BELIEVES REALIZATION OF THESE BENEFITS IS UNLIKELY. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 1,399,554. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 1,553,831. IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC REBATES 270,375. ROUNDING 76. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 190. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 2,171,021. IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC REBATES 270,375. 1 1 X 1 X 1 X 1 1 0 1 1 2394836 2394836 0.02460 11097 9359990 7216835 2143155 0.02200 11097 11754826 7216835 4537991 0.04660 11520 535737 62831 472906 0.00490 587 1666570 1666570 0.01710 5 3810101 2314652 1495449 0.01540 21120 500 20620 0.00020 5 12107 6033528 2377983 3655545 0.03760 5 23204 17788354 9594818 8193536 0.08420 3 1 9687 1650 8037 0.00010 1 2961 2961 0.00000 1 2 8138 8138 0.00010 2 37 382132 382132 0.00390 7 40 402918 1650 401268 0.00410 0 1813538 0 30764663 36163376 -5398713 X 1 1 1 1 TRINITY REGIONAL MEDICAL CENTER

802 KENYON ROAD FORT DODGE IA 50501

X X X TRINITY REGIONAL MEDICAL CENTER 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 PART I, LINE 6A: TRINITY REGIONAL MEDICAL CENTER'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. PART II: COMMUNITY BUILDING ACTIVITIES 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 FREE CLINICS OR AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. TRINITY REGIONAL MEDICAL CENTER (TRMC) CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. 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. OTHER DONATIONS SUCH AS FOOD OR OTHER DURABLE GOODS PROVIDE AREA SHELTERS AND OTHER ORGANIZATIONS IN THE AREA. THIS ALLOWS THESE ORGANIZATIONS TO MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. TRMC EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, TRMC EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COMMUNITY COLLABORATIVE COLLECTIVELY WORKING TO ADDRESS COMPLEX HEALTH ISSUES. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT TRMC HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A VERY WELL 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 TRINITY REGIONAL MEDICAL CENTER. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 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 HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL REPORTED ON LINE 7 ABOVE 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, HAVE LIMITED INCOME 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: TRINITY REGIONAL MEDICAL CENTER (TRMC) CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN CENTRAL IOWA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, TRMC IS A SPONSORING PARTNER OF SEVERAL HEALTH SCREENINGS AND FAIRS WHICH ARE A COMMUNITY COLLABORATIVE CONVENED BY PARTNERS SUCH AS IOWA CENTRAL COMMUNITY COLLEGE AND SURROUNDING NURSING HOMES TO ASSESS, ADDRESS AND MONITOR THE HEALTH NEEDS OF WEBSTER COUNTY AND SURROUNDING AREAS. A HEALTH AGENDA WAS DEVELOPED BY IDENTIFYING SPECIFIC HEALTH PRIORITIES THAT ARE RELEVANT TO THE COMMUNITY THROUGH THESE VARIOUS HEALTH SCREENS.TRMC WORKS CLOSELY WITH OTHER COMMUNITY GROUPS TO ASSESS THE AREA NEED. THEY WORK CLOSELY WITH THE UNITED WAY AND THE CHARACTER COUNTS PROGRAM. TRMC AND THE UNITED WAY ARE SPONSORING PARTNERS, ALONG WITH THE CITY OF FORT DODGE FOR THIS WORTHY PROGRAM. PART VI, LINE 3: TRINITY REGIONAL MEDICAL CENTER PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR BROCHURES IN APPROPRIATE AREAS OF THE PROVIDER (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING 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: TRINITY REGIONAL MEDICAL CENTER (TRMC) IS A 200-BED PRIVATE, NON-PROFIT HOSPITAL THAT SERVES FORT DODGE, WHICH IS LOACTED IN WEBSTER COUNTY, AND SURROUNDING COMMUNITIES. TRMC IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.AS A DESIGNATED REGIONAL REFERRAL CENTER, TRMC SERVES AN EIGHT COUNTY AREA WITH A POPULATION OF APPROXIMATELY 100,000. ROUGHLY 25 PERCENT OF TRMC MARKET RESIDENTS LIVE WITHIN THE CITY LIMITS OF FORT DODGE. THE REMAINING MARKET SHARE LIVES IN THE RURAL AREAS OR SMALL TOWNS SURROUNDING FORT DODGE. IN 2012 TRMC ADMITTED 4,689 INPATIENTS AND SAW APPROXIMATELY 21,692 PATIENTS IN THE EMERGENCY ROOMMEDIAN HOUSEHOLD INCOMES FOR TRMC'S PATIENT POPULATION RANGE FROM $33,286 TO $41,155, AND THE AVERAGE POVERTY RATE IS 7 PERCENT. WEBSTER COUNTY, THE ONLY COUNTY IN THE SERVICE AREA WITH SIGNIFICANT MINORITY POPULATION, IS 92.3 PERCENT CAUCASIAN, 3.4 PERCENT AFRICAN-AMERICAN AND 3.8 PERCENT HISPANIC. PART VI, LINE 5: THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE. PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM. INITIALLY FORMED IN 1995, IOWA HEALTH SYSTEM IS THE STATE'S FIRST AND LARGEST INTEGRATED HEALTH SYSTEM, SERVING NEARLY ONE OF EVERY THREE PATIENTS IN IOWA. THROUGH RELATIONSHIPS WITH 29 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND 280 PHYSICIAN CLINICS, IOWA HEALTH SYSTEM PROVIDES CARE THROUGHOUT IOWA AND ILLINOIS.IOWA HEALTH SYSTEM ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH MORE THAN 24,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 4 MILLION PATIENT VISITS, IOWA HEALTH SYSTEM HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $2.7 BILLION, IOWA HEALTH SYSTEM 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. IOWA HEALTH SYSTEM 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 2012, IOWA HEALTH SYSTEM AND ITS AFFILIATES PROVIDED $421 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY IOWA HEALTH SYSTEM AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. REPORTS FILED WITH STATES PART VI, LINE 7 IA X X X X X 0 1 0 0 0 0 0 0 0 KENNETH ADAMS DO 0 626119 0 0 0 218877 0 359977 0 17351 0 1222324 0 0 JOHN BIRKETT MD 0 180723 0 6716 0 135137 0 25000 0 11542 0 359118 0 0 JAMES MEYER DO 0 350056 0 0 0 119293 0 159400 0 17540 0 646289 0 0 SUSAN THOMPSON 0 316042 0 58480 0 56799 0 9088 0 18576 0 458985 0 0 MIKE DEWERFF 0 185439 0 28623 0 19310 0 23785 0 20916 0 278073 0 0 TROY MARTENS 0 194209 0 32321 0 20631 0 22885 0 22956 0 293002 0 0 DEBRA SHRIVER 161679 0 0 0 4445 0 8795 0 23108 0 198027 0 0 0 LINDA WHALEY 155643 0 0 0 893 0 7966 0 8812 0 173314 0 0 0 RICHARD BERGSTROM MD 317308 0 0 0 37011 0 8481 0 648 0 363448 0 0 0 COLIN BROWN 179727 0 0 0 37225 0 11321 0 23101 0 251374 0 0 0 SUZANNE CLAPP 190442 0 0 0 35615 0 11598 0 19399 0 257054 0 0 0 JEFFREY LUNA MD 618488 0 15000 0 625 0 9327 0 18386 0 661826 0 0 0 KEVIN SCHMINKE 220300 0 24000 0 2505 0 12500 0 17941 0 277246 0 0 0 RALPH HEASLEY TO 1110 0 169974 0 0 0 12528 0 8701 0 19242 0 210445 0 0 THOMAS TIBBITTS TO 1209 0 352970 0 49612 0 504517 0 12500 0 12649 0 932248 0 449963 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: MIKE DEWERFF $12,772, TROY MARTENS $11,146 AND SUSAN THOMPSON $-3,412. A IOWA FINANCE AUTHORITY 521699886 46246NHS8 2008-12-30 5000000 CONSTRUCTION OF FACILITIES 0 0 0 A 5000095 5000095 2008 0 0 1 1 A 0 0 1 1 0 0.00260 0.00260 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 SCHEDULE K, PART II, LINE 3, COLUMN (A) THERE IS A DIFFERENCE BETWEEN THE BOND ISSUE PRICE AND THE TOTAL PROCEEDS OF BOND ISSUE DUE TO INVESTMENT EARNINGS OF $95. CATHERINE LENSCH FAMILY MEMBER OF BOARD MEMBER RHONDA CHAMBERS 67334 EMPLOYMENT 0 IOWA HEALTH SYSTEM CONTRACTING SERVICES LC COMMON BOARD MEMBER/OFFICER 132022 PERFORMANCE OF SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 TRINITY HEALTH SYSTEMS, INC., A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B TRINITY HEALTH SYSTEMS, INC., AS SOLE MEMBER, AND IOWA HEALTH SYSTEM, AS SOLE MEMBER OF TRINITY HEALTH SYSTEMS, APPROVE BOARD OF DIRECTORS, BUDGETS, APPOINT PRESIDENT, APPROVE ESTABLISHING SUBSIDIARIES, AFFILIATES AND JOINT VENTURES, APPROVE MERGERS, CONSOLIDATIONS OR DISSOLUTIONS, APPROVE CHANGES IN PURPOSE, AND APPROVE PURCHASE, SALE, LEASE TRANSFER OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY. FORM 990, PART VI, SECTION B, LINE 11 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 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 2012 FOR THE FOLLOWING INDIVIDUALS: MIKE DEWERFF, TROY MARTENS, AND SUSAN THOMPSON. 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 IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, HAS VOLUNTARILY ADOPTED MANY OF OUR INDUSTRY'S GOVERNANCE "BEST PRACTICES." WE'VE DONE SO TO FURTHER ASSURE OUR STAKEHOLDERS THAT OUR GOVERNANCE AND MANAGEMENT IS CONDUCTED RESPONSIBLY AND WARRANTS THE TRUST YOU PLACE IN US. IN SEPTEMBER 2003, THE IOWA HEALTH BOARD OF DIRECTORS VOLUNTARILY ADOPTED OVER 40 CHANGES TO ITS GOVERNANCE STRUCTURE TO BETTER COMPLY WITH GOVERNANCE BEST PRACTICES. IN ADDITION, MANY GOVERNANCE POLICIES AND CORPORATE INFORMATION HAS BEEN ADDED TO THE IOWA HEALTH SYSTEM WEBSITE, WWW.UNITYPOINT.ORG, INCLUDING BUT NOT LIMITED TO: OVER 130 CORPORATE COMPLIANCE POLICIES, INCLUDING CHARITY CARE AND CONFLICT OF INTEREST; GOVERNANCE BEST PRACTICE POLICIES; BOARD MEMBERS AND COMMITTEES; COMPENSATION FOR EACH SENIOR AFFILIATE TOP EXECUTIVE; AND FINANCIAL INFORMATION FOR PAST SEVEN YEARS. OTHER FEES FORM 990, PART IX, LINE 11G HEALTH-CARE PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 3,727,981. MANAGEMENT AND GENERAL EXPENSES 11,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,739,296. PURCHASED HOUSEKEEPING AND LAUNDRY : PROGRAM SERVICE EXPENSES 759,026. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 759,026. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 5,100,834. MANAGEMENT AND GENERAL EXPENSES 1,657,482. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,758,316. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF TRINITY HEALTH FOUNDATION 1,155,630. 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