2026-02-03T11:50:32-06:00 2025-06-30 420794029 DENMAN CPA LLP 1601 22ND STREET SUITE 400 WEST DES MOINES IA 502661453 990 2024-07-01 421418132 LORING HOSPITAL LORI 7126627105 211 HIGHLAND AVE SAC CITY IA 50583 RUSS DAVIS CHAIR 7126627105 2026-02-03 1 0 STEVE BRUNER P01266887 5152258400 2024 2025-03-06 01:10:19Z RUSS DAVIS 211 HIGHLAND AVE SAC CITY IA 50583 25116678 0 X WWW.LORINGHOSPITAL.ORG X 1993 IA SEE FORM 990, PART III, LINE 1. 11 11 140 264 0 0 38121 1792031 20996053 21856437 435923 576351 289722 891859 21759819 25116678 0 0 0 0 8110179 8645409 0 0 0 10232327 10241507 18342506 18886916 3417313 6229762 33249963 56486477 7798765 24805517 25451198 31680960 X TO IMPROVE THE HEALTH OF THE CITIZENS OF OUR COMMUNITY THROUGH HEALING, CARING, AND EDUCATION, AND BY PROVIDING QUALITY HEALTH CARE WITH A PERSONAL TOUCH IN A COST EFFECTIVE MANNER. 0 0 12879227 16908245 LORING HOSPITAL IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE SAC COUNTY COMMUNITY RELIES ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTHCARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. THE 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, CRITICAL CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, 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 JUNE 30, 2025. THE HOSPITAL ADMITTED 105 PATIENTS RESULTING IN A TOTAL OF 354 PATIENT DAYS. OUTPATIENT REGISTRATIONS TOTALED 24,193. THERE WERE ALSO 2,267 EMERGENCY ROOM VISITS. 2132291 4948192 LORING 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 HEALTHCARE 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 PATIENTS AT A VALUE OF $99,833. OFTENTIMES, THE HOSPITAL RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. THE HOSPITAL PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTHCARE PROGRAMS. THE HOSPITAL'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $100,849. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE $200,682. THE 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, AND CASH AND IN KIND CONTRIBUTIONS TO COMMUNITY GROUPS. THE HOSPITAL COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE, AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. THE HOSPITAL HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. 15011518 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 1 140 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X MATT JOHNSON 7126627105 211 HIGHLAND AVENUE SAC CITY IA 50583 FRANK RICHARDSON CHAIR 1.00 X X 0 0 0 ANDY MEREDITH VICE-CHAIR 1.00 X X 0 0 0 SHELLY CRUMP TREASURER 1.00 X X 0 0 0 TANCY BECKER SECRETARY 1.00 X X 0 0 0 KAY BLESSINGTON DIRECTOR 1.00 X 0 0 0 RUSS DAVIS DIRECTOR 1.00 X 0 0 0 MIKE GREEN DIRECTOR 1.00 X 0 0 0 EVAN HECHT DIRECTOR 1.00 X 0 0 0 DR ZOLTON PEK DIRECTOR 1.00 X 0 0 0 KODI BROTHERSON DIRECTOR 1.00 X 0 0 0 WENDY HURD DIRECTOR 1.00 X 0 0 0 MATTHEW D JOHNSON CONTRACT CEO 40.00 X 0 260624 0 PEGGY MUNGER PHARMACIST 40.00 X 174445 0 26328 TREVOR TOFT CFO 40.00 X 158579 0 26066 LUISA CHING PHYSICAL THERAPIST 40.00 X 117057 0 24567 TINA ZIMMERMAN RN 40.00 X 111545 0 24615 MICHAEL ERAL IT DIRECTOR 40.00 X 116969 0 24766 678595 260624 126342 5 0 1 0 WAPITI MEDICAL GROUP 107 FLYNN DRIVE SUITE 600 MILLBANK SD 57252 EMERGENCY ROOM PHYSICIAN SERVICES 1543534 CDW 5908 HEADQUARTERS DRIVE STE 400 PLANO TX 75024 MEDICAL IT SOLUTIONS 1004072 UNITYPOINT HEALTH 1776 W LAKES PKWY STE 400 WEST DES MOINES IA 50266 MANAGEMENT SERVICES 946114 BUENA VISTA ANESTHESIA PO BOX 520 POPLAR BLUFF MO 63902 CRNA SERVICES 454020 DREES COMPANY 609 N CARROLL ST CARROLL IA 51401 REPAIR AND MAINTENANCE SERVICES 439300 5 1025187 766844 1792031 NET PATIENT REVENUE 900099 21856437 21856437 21856437 576351 576351 MISCELLANEOUS 900099 795027 795027 CAFETERIA 900099 71666 71666 LIFELINE 900099 24641 24641 525 525 891859 25116678 21856437 0 1468210 678595 403047 275548 6205116 5518346 686770 147512 126890 20622 1117706 961455 156251 496480 427074 69406 67095 67095 1450954 1450954 179195 179195 SUPPLIES AND EXPENSES 8544263 6123752 2420511 18886916 15011518 3875398 0 9454854 12084977 5222876 2732028 750000 1863967 1568296 319998 324881 657030 787618 60313489 23202412 13709506 37111077 2021732 1127600 33249963 56486477 1266310 1455498 3440000 2600000 3092455 20750019 7798765 24805517 X 25451198 31680960 25451198 31680960 33249963 56486477 6229762 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 91019 91019 39781863 6213612 33568251 20440607 16988800 3451807 37111077 FINANCING LEASE LIABILITIES 723191 OPERATING LEASE LIABILITIES 428829 CONSTRUCTION PAYABLES 4524920 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 725000 LINE OF CREDIT 14348079 20750019 X 25116678 0 25116678 0 25116678 18886916 0 18886916 0 18886916 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND DOES NOT PAY INCOME TAX ON EXEMPT-PURPOSE INCOME. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY (OR ASSET) FOR AN UNCERTAIN POSITION THAT MORE LIKELY THAN NO WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS EVALUATED THEIR MATERIAL TAX POSITIONS AND DETERMINED THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS POTENTIALLY SUBJECT TO ROUTINE AUDITS BY TAX AUTHORITIES; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO 2021. 1 1 X 1 X 1 X 1 1 0 1 1 26591 26591 0.00140 2031450 4948192 0 0.00000 2058041 4948192 26591 0.00140 6361 6361 0.00030 59689 59689 0.00320 8200 8200 0.00040 74250 74250 0.00390 2132291 4948192 100841 0.00530 2950 2950 0.00020 1866 1866 0.00010 325 325 0.00000 175 175 0.00000 5316 5316 0.00030 1 331799 10091958 9911478 180480 X 1 1 1 1 LORING HOSPITAL 211 HIGHLAND AVENUE SAC CITY IA 50583 X X X X LORING HOSPITAL 1 0 0 1 X X X X X X X X 22 1 0 0 1 X WWW.LORINGHOSPITAL.ORG X 1 22 1 WWW.LORINGHOSPITAL.ORG 0 1 X 150.000000000000 250.000000000000 X X X X X X X 1 1 X X X 1 X WWW.LORINGHOSPITAL.ORG X WWW.LORINGHOSPITAL.ORG X WWW.LORINGHOSPITAL.ORG X X X X X X X 1 X 0 X X X 1 X 0 0 LORING HOSPITAL PART V, SECTION B, LINE 5: LORING HOSPITAL TOOK INTO ACCOUNT INPUT FROM THE SAC COUNTY WELLNESS COALITION. THIS GROUP WAS FORMED IN 2012 TO ADDRESS THE WELLNESS NEED OF SAC COUNTY. MEMBERS INCLUDE APPROXIMATELY 20 REPRESENTATIVES ACROSS MANY DIFFERENT SECTORS OF THE COMMUNITY. LORING HOSPITAL PART V, SECTION B, LINE 11: THREE TOP PRIORITIES WERE IDENTIFIED. THESE INCLUDE MENTAL HEALTH, NUTRITION, OBESITY & WELLNESS, AND SUBSTANCE ABUSE. DUE TO CORRELATION OF THESE NEEDS OUR STRATEGY IS TO INCREASE AWARENESS, COORDINATE SERVICES TO IMPROVE ACCESS TO ASSISTANCE, AND EXPAND COMMUNITY WIDE INITIATIVES TO REDUCE THE DEPENDENCY WHILE INTRODUCING WAYS TO INCREASE MENTAL HEALTH MAINTENANCE. LORING HOSPITAL PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM AN APPROVED LIST OF PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSITANCE. THIRD PARTY AGENCIES ARE USED TO ASSIST WITH COLLECTIONS AND, IF THOSE AGENCIES PROVIDE A STATEMENT REGARDING A PATIENT'S INCOME LEVEL, THAT INFORMATION IS USED IN DETERMINING THE ELIGIBILITY STATUS AND THE LEVEL OF DISCOUNT AVAILABLE. PART I, LINE 6A: THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: CHARITY CARE WAS CALCULATED BASED ON AN OVERALL COST TO CHARGE RATIO. MEDICAID WAS CALCULATED BASED ON THE MEDICAID COST REPORT. OTHER BENEFITS WERE CALCULATED USING ACTUAL EXPENSES PLUS AN ALLOCATION OF INDIRECT EXPENSES. THE HOSPITAL USED THE WORKSHEETS PROVIDED ON THE IRS INSTRUCTIONS FOR SCHEDULE H IN ADDITION TO THE INTERNAL COST ACCOUNTING SYSTEM. PART II, COMMUNITY BUILDING ACTIVITIES: OFTEN THE MOST EFFECTIVE WAYS 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 NONPROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO FREE CLINICS OR AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. THE HOSPITAL AND EMPLOYEES CONTRIBUTE IN VARIOUS WAYS TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THIS ALLOWS OTHER 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. PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING AN OVERALL COST TO CHARGE RATIO, FROM THE FACILITY COST REPORT. THIS RATIO WAS APPLIED TO THE BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS TO ARRIVE AT THE BAD DEBTS EXPENSE AT COST REPORTED IN LINE 2. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY IS CHARITY CARE AS A PERCENTAGE OF TOTAL REVENUES APPLIED TO BAD DEBT. PART III, LINE 4: THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DISCUSSING BAD DEBT. THE HOSPITAL 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 HOSPITAL 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. PRIOR TO ANY ACCOUNT BEING CLASSIFIED AS BAD DEBT, ALL DISCOUNTS ARE TAKEN, ALL PAYMENTS ARE APPLIED, AND EVERY EFFORT IS MADE WITH THE PATIENT IN AN ATTEMPT TO COLLECT THE OUTSTANDING BALANCE. PATIENTS ARE ENCOURAGED TO COMPLETE FINANCIAL ASSISTANCE FORMS AND PAYMENT PLANS ARE PRESENTED AS OPTIONS. THE HOSPITAL WORKS WITH PATIENTS TO ESTABLISH PAYMENT PLANS THAT ARE TAILORED TO THEIR ABILITY TO PAY. PART III, LINE 8: THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. 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 HOSPITAL COLLABORATES WITH THE COUNTY HEALTH DEPARTMENT IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. USAGE DATA FROM THE IOWA HOSPITAL ASSOCIATION IS REVIEWED ON THE PRIMARY MEDICAL DIAGNOSIS IN OUR COMMUNITIES. PART VI, LINE 3: THE HOSPITAL'S BUSINESS OFFICE PERSONNEL WORK WITH PATIENTS UPON ADMISSION, AT DISCHARGE, AND AFTER DISCHARGE DISCUSSING THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR OTHER FEDERAL OR STATE PROGRAMS, AND ALSO ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS WHERE APPLICABLE. PATIENTS ARE ALSO INFORMED OF THE HOSPITAL FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION. STAFF WHO INTERACT WITH PATIENTS ARE INSTRUCTED TO DIRECT THEM TO BUSINESS OFFICE PERSONNEL. PATIENTS ARE ENCOURAGED TO COMPLETE FINANCIAL ASSISTANCE FORMS AND PAYMENT PLANS ARE PRESENTED AS OPTIONS. PART VI, LINE 4: THE HOSPITAL IS A LICENSED 25 BED PRIVATE, NONPROFIT HOSPITAL THAT IS LOCATED IN SAC CITY, SAC COUNTY, IOWA. THE HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE. IN 2020, THE POPULATION FOR SAC COUNTY WAS 9,814 PEOPLE. THE HOSPITAL'S SERVICE AREA IS A 20 MILE RADIUS SURROUNDING OUR COMMUNITY. THIS AREA CONSISTS OF MANY SMALL, RURAL COMMUNITIES THAT ARE AGRICULTURAL BASED. IN 2025, THE HOSPITAL ADMITTED 105 INPATIENTS AND SAW 2,267 PATIENTS IN THE EMERGENCY ROOM. MEDIAN HOUSEHOLD INCOMES FOR THE HOSPITAL'S PATIENT POPULATION IS $57,446, AND THE AVERAGE POVERTY RATE IS 10.5%. SAC COUNTY, IOWA, IS 94.9% CAUCASIAN AND 3.0% HISPANIC. THE PATIENT BASE CONSISTS OF A LARGE MEDICARE POPULATION. FOR THE FISCAL YEAR ENDING JUNE 30, 2025, THE MEDICARE PAYOR MIX WAS 46%. PART VI, LINE 5: THE HOSPITAL IS ORGANIZED AND OPERATES EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE BOARD MEMBERS ALL RESIDE IN THE PRIMARY COMMUNITIES OF OUR SERVICE AREA. BOARD MEMBERS ARE NOT EMPLOYED BY LORING AND NONE ARE FAMILY MEMBERS. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY EXCEPT FOR PHYSICIANS WITH PENDING QUALITY ISSUES. THE HOSPITAL APPLIES SURPLUS FUNDS TO FURTHER OUR CHARITABLE PURPOSE TO IMPROVE PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH THROUGH THE NORMAL BUDGET AND CAPITAL BUDGET PROCESSES. THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY OPERATING AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY, PARTICIPATING IN GOVERNMENT-SPONSORED HEALTH PROGRAMS, AND VOLUNTEERING IN THE COMMUNITY. PART VI, LINE 6: THE HOSPITAL IS MANAGED BY TRINITY HEALTH SYSTEM, WHICH IS A PART OF IOWA HEALTH SYSTEM(D/B/A UNITYPOINT HEALTH). UNITYPOINT HEALTH ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH MORE THAN 28,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. UNITYPOINT HEALTH 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. 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 0 0 0 0 0 0 0 0 0 MATTHEW D JOHNSON CONTRACT CEO 0 260624 0 0 0 0 0 0 0 0 0 260624 0 0 PEGGY MUNGER PHARMACIST 174445 0 0 0 0 0 5047 0 21281 0 200773 0 0 0 TREVOR TOFT CFO 158579 0 0 0 0 0 4757 0 21309 0 184645 0 0 0 A CITY OF SAC CITY IOWA 426005178 78571KCL2 2021-10-07 5080000 REFUND PRIOR ISSUE (10/14/14) 0 0 0 A 840000 5080000 142242 4937758 2009 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF SAC CITY, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2021 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF DIRECTORS HAVE ENTERED INTO A CONTRACT WITH TRINITY HEALTH SYSTEMS, INC., FORT DODGE, IOWA, TO PROVIDE CERTAIN MANAGEMENT SERVICES, INCLUDING CEO AND OTHER SERVICES, TO THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED USING INFORMATION OBTAINED FROM THE HOSPITAL'S CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER GATHERS INFORMATION INTERNALLY FROM VARIOUS FUNCTIONAL AREAS OF THE HOSPITAL. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE CHIEF EXECUTIVE OFFICER AND BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICIES AND QUESTIONNAIRES ARE UPDATED AND REVIEWED ANNUALLY FOR EACH BOARD MEMBER AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEWS AND APPROVES COMPENSATION OF THE CHIEF EXECUTIVE OFFICER ON AN ANNUAL BASIS. DATA FROM MOST RECENT IOWA HOSPITAL ASSOCIATION SALARY SURVEY IS USED FOR COMPARISON. FORM 990, PART VI, SECTION C, LINE 18 FINANCIAL RECORDS AND OTHER OFFICIAL DOCUMENTS ARE AVAILABLE FOR INSPECTION UPON REQUEST AT THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL RECORDS AND OTHER OFFICIAL DOCUMENTS ARE AVAILABLE FOR INSPECTION UPON REQUEST AT THE HOSPITAL. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE LORING TRUST 211 HIGHLAND AVENUE SAC CITY IA 50583 420819819 SUPPORT & MAINTENANCE OF LORING HOSPITAL IA 501 (C) (3) LINE 11A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0