NORTHWEST IOWA HOSPITAL CORPORATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: NORTHWEST IOWA HOSPITAL CORPORATION (EIN 42-1019872)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-14
IRS object ID: 201213199349300736
Schema version: 2011v1.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R
Reasonable Cause Explanation

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-14T07:35:24-06:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	421019872	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	NORTHWEST IOWA HOSPITAL CORPORATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	NORT	NameControl
Phone	7122793500	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2720 STONE PARK BLVD	AddressLine1
City	SIOUX CITY	City
State	IA	State
ZIP Code	51104	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	JAMES L GOBELL	Name
Title	VP/CFO	Title
Phone	7122793201	Phone
Date Signed	2012-11-08	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	ST LUKE'S REGIONAL MEDICAL CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	PETER THOREEN	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	2720 STONE PARK BLVD	AddressLine1
City	SIOUX CITY	City
State	IA	State
ZIP Code	51104	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	152949734	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.STLUKES.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1974	YearFormation
State Legal Domicile	IA	StateLegalDomicile
Activity Or Mission Description	TO IMPROVE THE HEALTH OF THE PEOPLE OF SIOUXLAND.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	6	NbrIndependentVotingMembers
Total Nbr Employees	1546	TotalNbrEmployees
Total Nbr Volunteers	307	TotalNbrVolunteers
Total Gross UBI	43546	TotalGrossUBI
Net Unrelated Business Txbl Income	12430	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	758491	ContributionsGrantsPriorYear
Contributions Grants Current Year	903624	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	122941528	ProgramServiceRevenuePriorYear
Program Service Revenue CY	123251760	ProgramServiceRevenueCY
Investment Income Prior Year	3479577	InvestmentIncomePriorYear
Investment Income Current Year	2385996	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1617097	OtherRevenuePriorYear
Other Revenue Current Year	1969553	OtherRevenueCurrentYear
Total Revenue Prior Year	128796693	TotalRevenuePriorYear
Total Revenue Current Year	128510933	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1234456	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	1498715	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	59534825	SalariesEtcPriorYear
Salaries Etc Current Year	61938942	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	61431793	OtherExpensePriorYear
Other Expenses Current Year	56555061	OtherExpensesCurrentYear
Total Expenses Prior Year	122201074	TotalExpensesPriorYear
Total Expenses Current Year	119992718	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	6595619	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	8518215	RevenuesLessExpensesCY
Total Assets BOY	174653461	TotalAssetsBOY
Total Assets EOY	182750126	TotalAssetsEOY
Total Liabilities BOY	67884003	TotalLiabilitiesBOY
Total Liabilities EOY	69653773	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	106769458	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	113096353	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	THE MISSION OF NORTHWEST IOWA HOSPITAL CORPORATION, D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER, IS TO IMPROVE THE HEALTH OF THE PEOPLE OF SIOUXLAND.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	85847122	Expense
Grants	565884	Grants
Revenue	124136407	Revenue
Description	HEALTH-CARE SERVICESNORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER IS AN IMPORTANT ELEMENT OF THE HEALTH CARE DELIVERY SYSTEM THAT SIOUXLAND COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. NORTHWEST IOWA HOSPITAL CORPORATION PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, HOME HEALTH, INTENSIVE CARE AND CRITICAL CARE, MENTAL HEALTH CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, SKILLED NURSING, BEHAVIORAL DISORDER PROGRAMS, MATERNAL/CHILD CARE, LABORATORY, PALLIATIVE CARE, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDING DECEMBER 31, 2011, NORTHWEST IOWA HOSPITAL CORPORATION ADMITTED 11,218 PATIENTS. THE HOSPITAL HAD A TOTAL NUMBER OF 43,033 PATIENT DAYS. OUTPATIENT VISITS TOTALED 65,764 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 1,980. THERE WERE ALSO 30,435 EMERGENCY ROOM VISITS AND 2,079 BABIES DELIVERED.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	10550301	Expense
Grants	932831	Grants
Description	COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: NORTHWEST IOWA HOSPITAL CORPORATION PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE TO 2,256 PEOPLE AT A VALUE OF $3,492,046 IN 2011. OFTENTIMES, NORTHWEST IOWA HOSPITAL CORPORATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES OR SERVICES. NORTHWEST IOWA HOSPITAL CORPORATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT SPONSORED HEALTH-CARE PROGRAMS. NORTHWEST IOWA HOSPITAL CORPORATION'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $4,533,931 FOR 2011. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE WAS $8,025,977. OTHER BENEFITS: NORTHWEST IOWA HOSPITAL CORPORATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; SUBSIDIZED HEALTH SERVICES; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. NORTHWEST IOWA HOSPITAL CORPORATION COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. NORTHWEST IOWA HOSPITAL CORPORATION HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 14,213 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS REPORTED VALUE WAS $2,524,324.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	96397423	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	188	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	1546	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	7	NbrVotingGoverningBodyMembers
Number Independent Voting Members	6	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	1	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	IA	StatesWhereCopyOfReturnIsFiled
Own Website	X	OwnWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	JAMES L GOBELL VPCFO	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	7122793201	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2720 STONE PARK BLVD	AddressLine1
City	SIOUX CITY	City
State	IA	State
ZIP Code	51104	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
JAMES JENSEN
BOARD MEMBER	1.00	X	0	0	0
LEAH JOHNSON MD
BOARD MEMBER	1.00	X	12180	0	332
ELLEN KAPLAN
BOARD VICE CHAIR	1.00	X	0	0	0	X
KG SKIP PERLEY
BOARD SECRETARY	1.00	X	0	0	0	X
STEVE SHOOK MD FR 211
BOARD MEMBER	1.00	X	0	0	0
GARRETT SMITH FR 411
BOARD TREASURER	1.00	X	0	0	0	X
CHARESE YANNEY
BOARD CHAIR	1.00	X	0	0	0	X
RICHARD HILDEBRAND MD
VP MEDICAL AFFAIRS	40.00		349757	0	95648	X
MARK JOHNSON
VP/CFO	40.00		350027	0	52783	X
CHAD MARKHAM
VP CLINIC AND NETWORK DEV	1.00		134674	0	27486	X
PRISCILLA STOKES
VP/CNO	40.00		179405	0	19737	X
PETER THOREEN
PRESIDENT/CEO	40.00		461859	0	46020	X
SUSAN UNGER
VP FUNDRAISING DEVELOPMENT	1.00		142739	0	9251	X
LYNN WOLD
VP/COO	40.00		218152	0	55043	X
CRAIG BAINBRIDGE MD
PHYSICIAN	40.00		446446	0	24543		X
JITENDRAKUMAR GUPTA MD
PHYSICIAN	40.00		419077	0	32108		X
LUIS LEBREDO MD
PHYSICIAN	1.00		663865	0	29184		X
DOUGLAS MARTIN MD
PHYSICIAN	40.00		425983	0	33366		X
REBECCA ROSE MD
PHYSICIAN	1.00		483533	0	24937		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	4287697	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	450438	TotalOtherCompensation
Number Individuals GT100 K	56	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
WA KLINGER LLC
2015 E SEVENTH ST	SIOUX CITY	IA	511028800	CONSTRUCTION/RENOVATION	1361360
ARAMARK MANAGMENT SERVICES
25271 NETWORK PLACE	CHICAGO	IL	606731252	MANAGEMENT SERVICES/SUPPLIES	1021072
CASSLING
13808 F STREET	OMAHA	NE	681371102	MAINTENANCE SERVICES	521707
MAYO COLLABORATIVE SERVICES
PO BOX 9146	MINNEAPOLIS	MN	554809146	LAB SERVICES	515220
TRI-STATE SPECIALIST LLP
2800 PIERCE STREET 101	SIOUX CITY	IA	51104	CONTRACTED MEDICAL SERVICES	404772

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	31	NumberOfContractorsGT100K
Related Organizations	464764	RelatedOrganizations
All Other Contributions	438860	AllOtherContributions
Total Contributions	903624	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE	900099	118287352	118287352
EDUCATION & RESEARCH	900099	2302887	2302887
SUBS & JOINT VENTURES	900099	1378294	1378294
MISCELLANEOUS REVENUE	900099	919079	919079
RENTAL REVENUE	531110	202530	202530

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	161618	TotalRevenueColumn
Related Or Exempt Function Income	141904	RelatedOrExemptFunctionIncome
Exclusion	$19,714	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	123251760	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	1211493	TotalRevenueColumn
Exclusion	$1,211,493	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	25448430	Securities
Other	3300	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	24273155	Securities
Other	4072	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	1175275	Securities
Other	-772	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	1174503	TotalRevenueColumn
Exclusion	$1,174,503	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	307067	GrossSalesOfInventory
Cost Of Goods Sold	161574	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	145493	TotalRevenueColumn
Exclusion	$145,493	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount	Unrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA/FOOD SVCS	722210	1061205	121792	$939,413
MISCELLANEOUS REVENUE	900099	752619	711108		41511
PHARMACY REVENUE	446110	8201	8201

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	2035	TotalRevenueColumn
Unrelated Business Revenue	2035	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Other Revenue	1824060	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	128510933	TotalRevenueColumn
Related Or Exempt Function Income	124073147	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	43546	UnrelatedBusinessRevenue
Exclusion	$3,490,616	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	1488084	Total
Program Services	1488084	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	10631	Total
Program Services	10631	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1754417	Total
Management And General	1754417	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	47433304	Total
Program Services	39806123	ProgramServices
Management And General	7627181	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	2163982	Total
Program Services	1816018	ProgramServices
Management And General	347964	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	7263374	Total
Program Services	6095438	ProgramServices
Management And General	1167936	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	3323865	Total
Program Services	2789394	ProgramServices
Management And General	534471	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	2578821	Total
Program Services	12691	ProgramServices
Management And General	2566130	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	194251	Total
Program Services	37727	ProgramServices
Management And General	156524	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	8070	Total
Program Services	8070	ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	239532	Total
Program Services	9100	ProgramServices
Management And General	230432	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	10100606	Total
Program Services	8001448	ProgramServices
Management And General	2099158	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	780575	Total
Program Services	55035	ProgramServices
Management And General	725540	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	4595953	Total
Program Services	3964428	ProgramServices
Management And General	631525	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	7079378	Total
Program Services	4201484	ProgramServices
Management And General	2877894	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	2361277	Total
Program Services	2204957	ProgramServices
Management And General	156320	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	391212	Total
Program Services	180176	ProgramServices
Management And General	211036	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	266272	Total
Program Services	192123	ProgramServices
Management And General	74149	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	2600075	Total
Program Services	131116	ProgramServices
Management And General	2468959	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	5517081	Total
Program Services	5402312	ProgramServices
Management And General	114769	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	-178650	Total
Program Services	77741	ProgramServices
Management And General	-256391	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	19936402	19863057	73345
MISCELLANEOUS EXPENSE	81663	50270	31393
INCOME TAXES	2543		2543

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	119992718	Total
Program Services	96397423	ProgramServices
Management And General	23595295	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	2947095	BOY
EOY	5365800	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	8806025	BOY
EOY	12229132	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	16990063	BOY
EOY	17828902	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	39977117	BOY
EOY	44466833	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	2844642	BOY
EOY	2912489	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	1524030	BOY
EOY	610655	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	160711434	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	111702324	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	49885986	BOY
EOY	49009110	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	44844059	BOY
EOY	44292450	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	233382	BOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	6601062	BOY
EOY	6034755	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	174653461	BOY
EOY	182750126	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	8896556	BOY
EOY	10624302	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	101175	BOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	2402223	BOY
EOY	2589415	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	56484049	BOY
EOY	56440056	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	67884003	BOY
EOY	69653773	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	103018004	BOY
EOY	108937763	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2255199	BOY
EOY	2602509	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1496255	BOY
EOY	1556081	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	106769458	BOY
EOY	113096353	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	174653461	BOY
EOY	182750126	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	8518215	ReconcilationRevenueExpenses
Reconcilation Other Changes	-2191320	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	37780619	BeginningOfYearBalance
Contributions	0	Contributions
Investment Earnings Or Losses	209844	InvestmentEarningsOrLosses
Grants Or Scholarships	2060	GrantsOrScholarships
Administrative Expenses	115833	AdministrativeExpenses
End Of Year Balance	37872570	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	33351746	BeginningOfYearBalance
Contributions	715	Contributions
Investment Earnings Or Losses	4566553	InvestmentEarningsOrLosses
Grants Or Scholarships	417	GrantsOrScholarships
Administrative Expenses	137978	AdministrativeExpenses
End Of Year Balance	37780619	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	28560952	BeginningOfYearBalance
Contributions	150000	Contributions
Investment Earnings Or Losses	6779399	InvestmentEarningsOrLosses
Grants Or Scholarships	2006244	GrantsOrScholarships
Administrative Expenses	132361	AdministrativeExpenses
End Of Year Balance	33351746	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	38652656	BeginningOfYearBalance
Contributions	1802921	Contributions
Investment Earnings Or Losses	-9229015	InvestmentEarningsOrLosses
Grants Or Scholarships	2572634	GrantsOrScholarships
Administrative Expenses	92976	AdministrativeExpenses
End Of Year Balance	28560952	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.89020	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.04110	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.06870	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	1	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	5620346	OtherCostOrOtherBasis
Book Value	5620346	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	89240020	OtherCostOrOtherBasis
Depreciation	58259946	Depreciation
Book Value	30980074	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	5309930	OtherCostOrOtherBasis
Depreciation	3168252	Depreciation
Book Value	2141678	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	59725857	OtherCostOrOtherBasis
Depreciation	50274126	Depreciation
Book Value	9451731	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	815281	OtherCostOrOtherBasis
Book Value	815281	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	49009110	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescription	AmountAmount
DUE TO AFFILIATES	$4,152,452
ASBESTOS REMOVAL LIABILITY	$2,257,002
SELF-INSURANCE RESERVE	$4,495,158
LONG-TERM RETENTION INCENTIVES	$1,230,444
IOWA HEALTH SYSTEM NOTE PAYABLE	$44,305,000

Field	Value	IRS element (for citing)
Total Of Amounts	56440056	TotalOfAmounts
Total Revenue	128510933	TotalRevenue
Total Expenses	119992718	TotalExpenses
Excess Or Deficit For Year	8518215	ExcessOrDeficitForYear
Net Unrealized GL On Investments	-2595736	NetUnrealizedGLOnInvestments
Other	$404,416	OtherAmount
Total Adjustments	-2191320	TotalAdjustments
Excess Or Deficit Per FS	6326895	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	131635000	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	-2595736	NetUnrealizedGainsInvestments
Other Revenues	6542522	OtherRevenues
Revenue Not Rptd F990	3946786	RevenueNotRptdF990
Revenue Subtotal	127688214	RevenueSubtotal
Investment Expenses Not Included	96525	InvestmentExpensesNotIncluded
Other Revenues Not Included	726194	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	822719	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	128510933	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	123617000	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	5484764	OtherExpensesIncluded
Expenses Not Rptd F990	5484764	ExpensesNotRptdF990
Expenses Subtotal	118132236	ExpensesSubtotal
Investment Expenses Not Included2	96525	InvestmentExpensesNotIncluded2
Other Expenses Not Included	1763957	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	1860482	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	119992718	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
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:	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 2008. 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 8 - OTHER ADJUSTMENTS:		CHANGE IN BENEFICIAL INTEREST OF ST. LUKE'S HEALTH FOUNDATION 404,416.
PART XII, LINE 2D - OTHER ADJUSTMENTS:		SUBSIDIARY ELMININATING ENTRIES 6,380,941. COST OF GOODS SOLD 161,574. ROUNDING 7.
PART XII, LINE 4B - OTHER ADJUSTMENTS:		REVENUES IN UNRESTRICTED FUND BALANCE 178,883. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 4,780. IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATE 464,764. REVENUES NETTED IN EXPENSES 77,767.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:		SUBSIDIARY ELMININATING ENTRIES 5,322,887. COST OF GOODS SOLD 161,574. ROUNDING 303.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:		EXPENSES IN UNRESTRICTED FUND BALANCE 1,219,366. EXPENSES IN TEMPORARILY RESTRICTED FUND BALANCE 2,060. IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATE 464,764. REVENUES NETTED IN EXPENSES 77,767.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	2256	PersonsServed
Total Community Benefit Expense	3492046	TotalCommunityBenefitExpense
Net Community Benefit Expense	3492046	NetCommunityBenefitExpense
Percent Of Total Expense	0.02910	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	23969	PersonsServed
Total Community Benefit Expense	22412879	TotalCommunityBenefitExpense
Direct Offsetting Revenue	17878948	DirectOffsettingRevenue
Net Community Benefit Expense	4533931	NetCommunityBenefitExpense
Percent Of Total Expense	0.03780	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Persons Served	26225	PersonsServed
Total Community Benefit Expense	25904925	TotalCommunityBenefitExpense
Direct Offsetting Revenue	17878948	DirectOffsettingRevenue
Net Community Benefit Expense	8025977	NetCommunityBenefitExpense
Percent Of Total Expense	0.06690	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	22	NumberOfActivitiesOrPrograms
Persons Served	11305	PersonsServed
Total Community Benefit Expense	27636	TotalCommunityBenefitExpense
Direct Offsetting Revenue	420	DirectOffsettingRevenue
Net Community Benefit Expense	27216	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	2891521	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2270374	DirectOffsettingRevenue
Net Community Benefit Expense	621147	NetCommunityBenefitExpense
Percent Of Total Expense	0.00520	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Persons Served	1359	PersonsServed
Total Community Benefit Expense	4683154	TotalCommunityBenefitExpense
Direct Offsetting Revenue	3820698	DirectOffsettingRevenue
Net Community Benefit Expense	862456	NetCommunityBenefitExpense
Percent Of Total Expense	0.00720	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	11	NumberOfActivitiesOrPrograms
Persons Served	1549	PersonsServed
Total Community Benefit Expense	1577328	TotalCommunityBenefitExpense
Direct Offsetting Revenue	563823	DirectOffsettingRevenue
Net Community Benefit Expense	1013505	NetCommunityBenefitExpense
Percent Of Total Expense	0.00840	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	41	NumberOfActivitiesOrPrograms
Persons Served	14213	PersonsServed
Total Community Benefit Expense	9179639	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6655315	DirectOffsettingRevenue
Net Community Benefit Expense	2524324	NetCommunityBenefitExpense
Percent Of Total Expense	0.02100	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	41	NumberOfActivitiesOrPrograms
Persons Served	40438	PersonsServed
Total Community Benefit Expense	35084564	TotalCommunityBenefitExpense
Direct Offsetting Revenue	24534263	DirectOffsettingRevenue
Net Community Benefit Expense	10550301	NetCommunityBenefitExpense
Percent Of Total Expense	0.08790	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Total Community Building Expense	2399	TotalCommunityBuildingExpense
Net Community Building Expense	2399	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Building Expense	1067	TotalCommunityBuildingExpense
Net Community Building Expense	1067	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Total Community Building Expense	3466	TotalCommunityBuildingExpense
Net Community Building Expense	3466	NetCommunityBuildingExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$3,392,931	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	31731118	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	29567927	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	2163191	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	1 PIERCE STREET SAME DAY SURGERY LC	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	AMBULATORY SURGERY CENTER	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.50000	OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership	0.05500	OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership	0.44500	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ST LUKE'S REGIONAL MEDICAL CENTER	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	2720 STONEPARK BLVD	AddressLine1
City	SIOUX CITY	City
State	IA	State
ZIP Code	51104	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Teaching Hospital	X	TeachingHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ST LUKE'S REGIONAL MEDICAL CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	0	CHNAConducted
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	200.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	1	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Permit Lawsuit	X	PermitLawsuit
Permit Lien On Residence	X	PermitLienOnResidence
Permit Other Actions	X	PermitOtherActions
Collection Activities	1	CollectionActivities
Report To Credit Agency	X	ReportToCreditAgency
Lawsuit	X	Lawsuit
Lien On Residence	X	LienOnResidence
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	1	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	1	NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	PIERCE STREET SAME DAY SURGERY	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	2730 PIERCE STREET	AddressLine1
City	SIOUX CITY	City
State	IA	State
ZIP Code	51104	ZIPCode

Field	Value	IRS element (for citing)
Facility Type	FREESTANDING OUTPATIENT SURGERY CENTER (JOINT VENTURE)	FacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
PART I, LINE 6A: NORTHWEST IOWA HOSPITAL CORPORATION'S D/B/A/ ST. LUKE'S REGIONAL MEDICAL CENTER'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.IHS.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 FOR HEALTHCARE ORGANIZATIONS LIKE NORTHWEST IOWA HOSPITAL CORPORATION D/B/A/ ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) BECAUSE THEY HELP ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. AS SUCH, ST. LUKE'S REGIONAL MEDICAL CENTER SUPPORTS AND CONTRIBUTES TO COMMUNITY ORGANIZATIONS, EVENTS, AND PROGRAMS SUCH AS THE LOCAL CHAMBER, SIOUX CITY GROWTH ORGANIZATION, AND OTHER ECONOMIC DEVELOPMENT ACTIVITIES. ST. LUKE'S ALSO CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF SIOUXLAND ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER LOCAL, NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL-BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH. ACCESS TO HEALTHY FOOD IS CRITICAL FOR GOOD HEALTH. ST. LUKE'S WORKS WITH SIOUXLAND LLC, A NONPROFIT ORGANIZATION, TO HELP FUND A LOCAL FARMER'S MARKET. THE MARKET OFFERS FARM-FRESH FOOD TO THE COMMUNITY, INCLUDING EBT PARTICIPANTS.WORKING THROUGHOUT THE COMMUNITY IS ALSO IMPORTANT IN DELIVERING COMMUNITY HEALTH. ST. LUKE'S REGIONAL MEDICAL CENTER, SIOUXLAND COMMUNITY HEALTH CENTER, COMMUNITY MENTAL HEALTH CENTER, AND OTHER INTERESTED PARTIES MEET MONTHLY TO ASSESS AND PLAN FOR IMPROVED ACCESS AND SERVICES FOR PATIENTS WITH MENTAL ILLNESS; MOST OF WHOM ARE UNDERSERVED. HEALTHY SIOUXLAND INITIATIVE IS ANOTHER COLLABORATIVE GROUP ST. LUKE'S PARTICIPATES IN WITH OTHER HEALTH PROVIDERS AND SOCIAL SERVICE ORGANIZATIONS TO HELP MEET THE COMMUNITY'S HEALTH NEEDS. WITH THE GOALS OF INCREASED AWARENESS AND INCREASED NUMBER OF PARTICIPANTS THROUGHOUT THE TRI-STATE AREA, ST. LUKE'S WORKS WITH OTHER HEALTH ORGANIZATIONS TO PROMOTE COLORECTAL CANCER SCREENING.ST. LUKE'S ENCOURAGES ITS LEADERSHIP STAFF TO SUPPORT AND PROVIDE LEADERSHIP TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE AREA. ST. LUKE'S IS ACTIVELY INVOLVED WITH SIOUXLAND COMMUNITY HEALTH CENTER, AN ORGANIZATION FOUNDED TO RESPOND TO THE UNMET HEALTH CARE NEEDS AMONG THE UNDERSERVED IN THE COMMUNITY. ST. LUKE'S EMPLOYEES ARE ALSO VERY ACTIVE IN VOLUNTEERISM FOR NON-PROFIT ORGANIZATIONS, FROM SUPPORT TO LEADERSHIP ROLES. THIS ALLOWS EMPLOYEES TO USE THEIR HEALTHCARE EDUCATION AND EXPERTISE TO IMPACT THE COMMUNITY'S OVERALL HEALTH STATUS. ST. LUKE'S EMPLOYEES ARE PROACTIVE IN EDUCATING THE PEOPLE WE SERVE ABOUT PERTINENT HEALTH INFORMATION THROUGH PUBLIC HEALTH CLASSES, PROFESSIONAL HEALTH EDUCATION PROGRAMS AND PARTICIPATION IN HEALTH FAIRS ACROSS THE TRI-STATE AREA. THE HOSPITAL'S WEBSITE AT WWW.STLUKES.ORG ALSO CONTAINS AN UP-TO-DATE LISTING OF PROGRAMS AND SCREENS AS WELL AS PERTINENT HEALTH INFORMATION TO EDUCATE CONSUMERS ABOUT SYMPTOMS, TREATMENT AND HEALTHCARE OPTIONS THEY HAVE IN SIOUXLAND. BY SUPPORTING THE COMMUNITY AND OTHER NON-PROFIT ORGANIZATIONS, ST. LUKE'S IS ABLE TO MOVE ONE STEP CLOSER TO FULFILLING ITS MISSION TO IMPROVE THE HEALTH OF THE PEOPLE OF SIOUXLAND.
PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR NIHC. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2.
PART III, LINE 8: AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. THE ORGANIZATION'S COST ACCOUNTING SYSTEM CALCULATES A MEDICARE SHORTFALL OF $1,984,285. IN ADDITION TO THESE ITEMS THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM DO NOT INCLUDE MEDICARE PHYSICIAN FEE SCHEDULE EXPENSE OF $1,147,879 AND REVENUE OF $996,419. AFTER TAKING THESE ITEMS INTO ACCOUNT WE CALCULATE AN ACTUAL MEDICARE SHORTFALL OF $2,135,745.NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKES REGIONAL MEDICAL CENTER BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY.
PART V, SECTION B, LINE 15E: GUARANTORS RECEIVE A CYCLE BILL EVERY 30 DAYS FOR THE LIFE OF THE ACCOUNT ON A/R. ON DAY 41, 11 DAYS AFTER THE SECOND BILLING CYCLE, A FIRST COLLECTION ATTEMPT IS MADE FROM THE TELEVOX DIALER. THE SECOND COLLECTION ATTEMPT IS MADE BY THE DIALER ON DAY 71, 11 DAYS AFTER THE THIRD AND FINAL BILLING CYCLE. THE THIRD COLLECTION ATTEMPT IS MADE BY THE DIALER ON DAY 87, E DAYS BEFORE THE ACCOUNT IS REVIEWED FOR COLLECTIONS. ACCOUNTS WITH SATISFACTORY PAYMENTS OR PREARRANGED PAYMENT ARRANGEMENTS THAT ARE CURRENT ARE NOT SENT TO THE DIALER. ACCOUNTS WITH A MENTAL HEALTH DIAGNOSIS, WORKERS COMPENSATION ACCOUNTS, ACCOUNTS WITH SKILLED NURSING FACILITIES, AND ACCOUNTS WITH NO PHONE NUMBER ARE ALSO NOT SENT TO THE DIALER. THESE ACCOUNTS ARE ON A MANUAL LIST WHICH THE COLLECTION TEAM REVIEWS AND MAKES CALLS MANUALLY AS DEEMED APPROPRIATE. WHEN THE ACCOUNTS ARE GREATER THAN OR EQUAL TO $5,000, THE COLLECTION TEAM WILL SEND A FINANCIAL ASSISTANCE APPLICATION IF THEY CANNOT MAKE CONTACT WITH THE GUARANTOR AND 10 BUSINESS DAYS LATER, A PAST LETTER. THEY WILL ALSO CHECK FOR MEDICAID ELIGIBILITY FOR THEIR STATE OF RESIDENCE.	ST. LUKE'S REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 19D: IF THE INDIVIDUAL APPLIES AND QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE SERVICES AT THE HOSPITAL FACILITY TO DETERMINE THE AMOUNTS BILLED FOR ALL SERVICES, INCLUDING EMERGENCY OR MEDICALLY NECESSARY CARE. THIS OCCURS REGARDLESS WHETHER THE INDIVIDUAL HAS INSURANCE COVERAGE. ALSO, IF THE INDIVIDUAL HAS INSURANCE COVERAGE AND DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE INSURER'S NEGOTIATED RATE FOR THOSE SERVICES AT THE HOSPITAL FACILITY. HOWEVER, IF THE INDIVIDUAL DOES NOT HAVE INSURANCE COVERAGE AND EITHER DOES NOT APPLY OR DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE GROSS RATES FOR THOSE SERVICES TO DETERMINE THE AMOUNTS BILLED. IF THE UNINSURED INDIVIDUAL AGREES TO PAY THE BILL IN FULL, THE HOSPITAL FACILITY WILL PROVIDE A 20%-30% DISCOUNT FROM THE GROSS RATES FOR THOSE INDIVIDUALS.	ST. LUKE'S REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 21: AS DESCRIBED IN SCHEDULE H, PART V, LINE 19, IF THE PATIENT DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE AND ALSO IS UNINSURED OR RECEIVES NO BENEFIT FROM THEIR INSURANCE ON A SERVICE PROVIDED BY THE HOSPITAL FACILITY, THEY WOULD BE CHARGED AMOUNTS EQUAL TO GROSS CHARGES FOR THE SERVICES PROVIDED TO THE PATIENT. HOWEVER, IF THE PATIENT AGREES TO PAY IN FULL, THEY WILL RECEIVE A 20%-30% DISCOUNT FROM THE GROSS CHARGES.	ST. LUKE'S REGIONAL MEDICAL CENTER
PART VI, LINE 2: NORHTWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) CONTINUALLY WORKS WITH COMMUNITY PARTNERS TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SIOUXLAND DISTRICT HEALTH, LOCATED IN SIOUX CITY, ASSESSES THE COMMUNITY'S HEALTHCARE NEEDS AT LEAST EVERY FIVE YEARS. THROUGH A PLANNED AND ORGANIZED EFFORT, SIOUXLAND DISTRICT HEALTH DEVELOPS A HEALTH AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES AND SHARES THAT INFORMATION THROUGH A COMPREHENSIVE REPORT TO THE COMMUNITY. IN COLLABORATION WITH THIS AGENCY, ST. LUKE'S UTILIZES THIS INFORMATION TO MONITOR LOCAL HEALTH, ENSURING THE HOSPITAL'S PROGRAMS, SERVICES AND HEALTH EDUCATION SUPPORT HEALTH INFORMATION COLLECTED BY SIOUXLAND DISTRICT HEALTH. ST. LUKE'S ALSO PARTICIPATES IN HEALTHY SIOUXLAND INITIATIVE, A COLLECTION OF PUBLIC HEALTH PARTNERS THAT CONVENES MONTHLY, AND OTHER COMMUNITY HEALTH COLLABORATIONS, DESIGNED TO BUILD PARTNERSHIPS AMONG COMMUNITY HEALTHCARE ORGANIZATIONS TO BUILD A HEALTHY AND SAFE COMMUNITY. IN ADDITION TO THESE EFFORTS, ST. LUKE'S CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS ALSO WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATIONS THEY IMPACT.
PART VI, LINE 3: NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) CARES FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. TO ACCOMPLISH THIS, ST. LUKE'S PROVIDES EFFECTIVE COMMUNICATIONS FOR PATIENTS REGARDING THEIR HOSPITAL BILLS, MAKES EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS AND OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS.ST. LUKE'S COMMUNICATES THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS BY PLACING SIGNAGE AND EDUCATIONAL INFORMATION IN HIGH TRAFFIC AREAS OF THE HOSPITAL AND ITS CAMPUS INCLUDING ADMITTING, EMERGENCY AND OUTPATIENT AREAS AND PROVIDER OFFICES. IN ADDITION, DETAILED INFORMATION ABOUT ST. LUKE'S FINANCIAL ASSISTANCE PROGRAMS INCLUDING CHARITY CARE AND HOW TO OBTAIN MORE INFORMATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE AT WWW.STLUKES.ORG. ST. LUKE'S ALSO PROVIDES INFORMATION ABOUT FINANCIAL ASSISTANCE AT REGISTRATION, AND AGAIN, ON THE PATIENT'S HEALTHCARE BILLING STATEMENT. STAFF HAS BEEN EDUCATED TO DIRECT INPATIENTS TO APPROPRIATE CONTACTS UPON ADMISSION IF FINANCIAL ASSISTANCE IS NEEDED. DESIGNATED INDIVIDUALS ARE AVAILABLE TO ANSWER QUESTIONS REGARDING ST. LUKE'S CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS. TRANSLATION SERVICES ARE AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK TO ENSURE CLARITY OF ASSISTANCE.ST. LUKE'S ALSO WORKS WITH THE MISSION HEALTH PROGRAM, A COLLABORATION BETWEEN THE SIOUXLAND COMMUNITY HEALTH CENTER, MERCY MEDICAL CENTER - SIOUX CITY AND ST. LUKE'S. INFORMATION IN THIS PROGRAM IS ALSO AVAILABLE IN SPANISH. THIS COMMUNITY OUTREACH PROGRAM PRE-QUALIFIES PARTICIPANTS FOR FINANCIAL ASSISTANCE AT BOTH LOCAL HOSPITALS, AND PARTICIPANTS ARE INVITED TO SELECT A MEDICAL HOME. OVER 1400 PATIENTS ARE ENROLLED.EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, FINANCIAL SUPPORT DETERMINATION MAY BE MADE DURING ANY STAGE OF A PATIENTS STAY AFTER STABILIZATION OR COLLECTION CYCLE.
PART VI, LINE 4: NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) IS AN URBAN, ACUTE-CARE COMMUNITY HOSPITAL LICENSED FOR 346 BEDS AND STAFFED FOR 154 BEDS SERVING THE SIOUXLAND AREA. THE SIOUXLAND AREA IS A TRI-STATE AREA CONSISTING OF NORTHWEST IOWA, NORTHEAST NEBRASKA, AND SOUTHEAST SOUTH DAKOTA. ST. LUKE'S IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE. ST. LUKE'S DISCHARGES JUST OVER 11,000 INPATIENTS AND CARES FOR JUST UNDER 66,000 OUTPATIENTS PER YEAR INCLUDING EMERGENCY PATIENTS. WITHIN THE SIOUXLAND AREA, ST. LUKE'S SERVES A PRIMARY AND SECONDARY MARKET DEFINED BY COUNTIES. THE PRIMARY MARKETS ARE PLYMOUTH AND WOODBURY COUNTIES IN IOWA, DAKOTA COUNTY IN NEBRASKA AND UNION COUNTY IN SOUTH DAKOTA. THE PRIMARY COUNTY ACCOUNTS FOR 86% OF ST. LUKE'S INPATIENT DISCHARGES. WITHIN THE PRIMARY MARKET, TWO COMMUNITY HOSPITALS ARE LOCATED IN WOODBURY COUNTY, IOWA, AND ONE SURGICAL SPECIALTY HOSPITAL THAT IS PHYSICIAN-OWNED IS LOCATED IN UNION COUNTY, SOUTH DAKOTA. WOODBURY COUNTY IS THE LARGEST COUNTY IN THE SIOUXLAND AREA WITH APPROXIMATELY 102,000 RESIDENTS. SIOUX CITY IS THE LARGEST CITY IN THE AREA WITH A 2010 POPULATION OF 82,600. APPROXIMATELY 65% OF ST. LUKE'S DISCHARGES COME FROM WOODBURY COUNTY.THE SECONDARY MARKETS ARE CHEROKEE, MONONA AND SIOUX COUNTIES IN IOWA AND THURSTON COUNTY IN NEBRASKA. THESE COUNTIES WITH THE EXCEPTION OF THURSTON HOUSE THEIR CRITICAL ACCESS HOSPITALS.FOCUSING ON THE PRIMARY MARKET, THE HISPANIC POPULATION REPRESENTS 33% OF DAKOTA COUNTY'S POPULATION AND 12.7% IN WOODBURY COUNTY. WHEN LOOKING AT SIOUX CITY INDEPENDENTLY, 16.4% OF THE POPULATION IS HISPANIC. ONE-THIRD OF THE PRIMARY MARKET IS CATEGORIZED AS "POVERTY, SINGLE WITH KIDS." 10% OF THE FOUR-COUNTY MARKET REPRESENTS CHILDREN IN POVERTY WITH MOST OF THE CHILDREN LIVING IN THE SIOUX CITY.THE LARGEST SEGMENT OF THE PRIMARY MARKET POPULATION (52.8%) FALLS INTO TWO CATEGORIES: THE UNDER 18 AGE CATEGORY AT 26.9% AND THE 44 TO 64 AGE GROUP AT 25.9%IN WOODBURY COUNTY, 86.4% OF RESIDENTS HAVE INSURANCE. OF THOSE THAT HAVE INSURANCE, 9.3% (8,067) ARE ON MEDICARE AND 10.8 % (9,404) ARE ON MEDICAID. OF THE MEDICARE POPULATION, 88% IS 65 AND OLDER, WHILE 46% OF THE MEDICAID POPULATION IS UNDER 18.
PART VI, LINE 5: NORTHWEST IOWA HOSPITAL CORPORATION D/B/A ST. LUKE'S REGIONAL MEDICAL CENTER (ST. LUKE'S) IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. ST. LUKE'S SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. ST. LUKE'S HAS EARNED ITS GOLD CERTIFICATION IN STROKE, IS THE REGION'S ONLY IOWA LEVEL II REGIONAL OBSTETRICAL TRANSPORT CENTER FOR HIGH RISK OBSTETRICS AND HAS AN IOWA LEVEL II NEONATOLOGY CENTER.ST. LUKE'S IS ALSO INVOLVED IN THE NW IOWA'S AMERICAN HEART TASK FORCE, TRI-STATE DISASTER COMMITTEE, IOWA'S DISASTER MEDICAL ASSISTANCE TEAM AND EMERGENCY CONFERENCE COMMITTEE. ST. LUKE'S SUPPORTS THE SIOUXLAND MEDICAL EDUCATION FOUNDATION, A FAMILY PRACTICE RESIDENCY AS WELL AS ST. LUKE'S COLLEGE, WHICH IS THE REGION'S ONLY MEDICAL CENTER BASED HEALTH SCIENCES COLLEGE. THE COLLEGE OFFERS ASSOCIATE OF SCIENCE DEGREES IN NURSING, RADIOLOGY, AND RESPIRATORY CARE AS WELL AS CERTIFICATES IN MEDICAL LABORATORY SCIENCES AND PHLEBOTOMY.THE BOARD OF DIRECTORS OF ST. LUKE'S IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE.
PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM. 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 27 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 200 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 3.1 MILLION PATIENT VISITS, IOWA HEALTH SYSTEM HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $2.8 BILLION, IOWA HEALTH SYSTEM IS THE FIFTH 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 2011, IOWA HEALTH SYSTEM AND ITS AFFILIATES PROVIDED MORE THAN $387 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.
IA	REPORTS FILED WITH STATES	PART VI, LINE 7

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (8 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
AMERICAN HEART ASSOCIATION
32468 K42	HINTON	IA	51024	135613797	501(C)(3)	7500	PROGRAM SUPPORT
IOWA HEALTH SYSTEM
1200 PLEASANT STREET	DES MOINES	IA	50309	421435199	501(C)(3)	12548	EVENT SPONSOR
MAPLETON TORNADO RELIEF FUND
PO BOX 178	MAPLETON	IA	51034	426004921	501(C)(3)	5000	PROGRAM SUPPORT
SIOUX CITY SYMPHONY ORCHESTRA
375 ORPHEUM ELECTRIC BUILDING	SIOUX CITY	IA	51102	426006580	501(C)(3)	10000	EVENT SPONSOR
SIOUXLAND INITIATIVE
101 PIERCE STREET	SIOUX CITY	IA	51101	421328697	501(C)(6)	20000	PROGRAM SUPPORT
SIOUXLAND MEDICAL EDUCATION FOUNDATION
2501 PIERCE STREET	SIOUX CITY	IA	51104	421036971	501(C)(3)	1139000	PROGRAM SUPPORT
ST LUKE'S HEALTH FOUNDATION
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421301885	501(C)(3)	228053	PROGRAM SUPPORT
UNITED WAY OF SIOUXLAND
701 STEUBEN STREET	SIOUX CITY	IA	51101	420680395	501(C)(3)	22000	PROGRAM SUPPORT

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	7	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	1	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	SCHOLARSHIPS	TypeOfGrant
Number Of Recipients	53	NumberOfRecipients
Amount Of Cash Grant	10631	AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	Identifier
Return Reference	PART I, LINE 2:	ReturnReference
Explanation	SCHEDULE I, PART I, LINE 2: NORTHWEST IOWA HOSPITAL CORPORATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART II (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINE A SERIES OF ELIGIBILITY STANDARDS THAT ARE REQUIRED TO BE MET. NORTHWEST IOWA HOSPITAL CORPORATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED & ELIGIBILITY, MANAGEMENT MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. NORTHWEST IOWA HOSPITAL CORPORATION MINIMIZES THE THREAT OF DIVERSION FOR INTENDED PURPOSE BY SENDING THE FUNDS DIRECTLY TO THE ORGANIZATION, WHERE POSSIBLE, ETC.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
First Class Or Charter Travel	X	FirstClassOrCharterTravel
Travel For Companions	X	TravelForCompanions
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RICHARD HILDEBRAND MD
255530	0	65916	0	28311	0	71048	0	24600	0	445405	0	0	0
MARK JOHNSON
217890	0	121531	0	10606	0	28849	0	23934	0	402810	0	0	0
CHAD MARKHAM
103149	0	23019	0	8506	0	6713	0	20773	0	162160	0	0	0
PRISCILLA STOKES
140004	0	30871	0	8530	0	8730	0	11007	0	199142	0	0	0
PETER THOREEN
313786	0	88917	0	59156	0	31043	0	14977	0	507879	0	0	0
SUSAN UNGER
108374	0	26823	0	7542	0	6866	0	2385	0	151990	0	0	0
LYNN WOLD
167239	0	38399	0	12514	0	33523	0	21520	0	273195	0	0	0
CRAIG BAINBRIDGE MD
443316	0	0	0	3130	0	12250	0	12293	0	470989	0	0	0
JITENDRAKUMAR GUPTA MD
414562	0	0	0	4515	0	12250	0	19858	0	451185	0	0	0
LUIS LEBREDO MD
630605	0	0	0	33260	0	16345	0	12839	0	693049	0	0	0
DOUGLAS MARTIN MD
424273	0	0	0	1710	0	12250	0	21116	0	459349	0	0	0
REBECCA ROSE MD
452123	0	0	0	31410	0	12250	0	12687	0	508470	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference

ExplanationExplanation

PART I, LINE 1A

FIRST-CLASS OR CHARTER TRAVEL: CEO AND BOARD MEMBERS USE PRIVATE CHARTER FOR BUSINESS TRAVEL BETWEEN AFFILIATE CITIES AND FOR BOARD OF DIRECTOR MEETINGS. THIS TRAVEL IS FOR BUSINESS PURPOSES ONLY. NO FIRST CLASS COMMERCIAL TRAVEL IS REIMBURSED. TRAVEL FOR COMPANIONS: SPOUSES SOMETIMES ACCOMPANY BOARD MEMBERS AND/OR OFFICERS ON ORGANIZATIONAL ACTIVITIES, INCLUDING BOARD RELATED TRAVEL. THE ADDITIONAL COST ATTRIBUTABLE TO THE SPOUSE IS TREATED AS TAXABLE COMPENSATION TO THE BOARD MEMBER OR OFFICER AND REPORTED AS APPROPRIATE TO THE IRS.

PART I, LINE 4B

THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: RICHARD HILDEBRAND $58,798, MARK JOHNSON $15,217, PETER THOREEN $18,690, AND LYNN WOLD $22,801.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
PIERCE STREET SAME DAY SURGERY CENTER LC
COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE	3776198	LEASE STAFF, RENT SPACE AND EQUIPMENT, AND DIVIDENDS	0
RHONDA HILDEBRAND
FAMILY MEMBER OF OFFICER RICHARD HILDEBRAND, M.D.	14952	EMPLOYMENT	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6	IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	IOWA HEALTH SYSTEM, AS SOLE MEMBER, APPROVES AMENDMENTS TO ARTICLES AND BYLAWS, APPOINTS AND REMOVES CEO, APPROVES LIQUIDATION OR DISSOLUTION, AND APPROVES INDEBTEDNESS.
FORM 990, PART VI, SECTION B, LINE 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 NOVEMBER 2011 FOR THE FOLLOWING INDIVIDUALS: RICHARD HILDEBRAND, MD, MARK JOHNSON, PETER THOREEN, AND LYNN WOLD. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19	IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, HAS VOLUNTARILY ADOPTED MANY OF OUR INDUSTRY'S GOVERNANCE "BEST PRACTICES." IOWA HEALTH SYSTEM HAS 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 SYSTEM BOARD OF DIRECTORS VOLUNTARILY ADOPTED OVER 40 CHANGES TO ITS GOVERNANCE STRUCTURE TO BETTER COMPLY WITH GOVERNANCE BEST PRACTICES AND THE INTENT AND APPLICABLE REQUIREMENTS OF THE SARBANES-OXLEY ACT OF 2003. IN ADDITION, GOVERNANCE POLICIES AND RELATED INFORMATION HAS BEEN ADDED TO THE IOWA HEALTH SYSTEM WEBSITE, WWW.IHS.ORG, INCLUDING BUT NOT LIMITED TO: OVER 130 CORPORATE COMPLIANCE POLICIES, INCLUDING CHARITY CARE AND CONFLICTS OF INTEREST POLICIES; GOVERNANCE BEST PRACTICE POLICIES; THE IDENTIFICATION OF BOARD MEMBERS AND BOARD COMMITTEES; COMPENSATION FOR HOSPITAL CEO'S; AND FINANCIAL INFORMATION FOR THE PAST SEVEN YEARS.
FORM 990, PART XI, LINE 5:	NET UNREALIZED LOSSES ON INVESTMENTS: -2,595,736. CHANGE IN BENEFICIAL INTEREST OF ST. LUKE'S HEALTH FOUNDATION 404,416. TOTAL TO FORM 990, PART XI, LINE 5: -2,191,320.	CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (43 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
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	1
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	1
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	1
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	1
CENTRAL IOWA HEALTH PROPERTIES CORPORATION
1200 PLEASANT STREET	DES MOINES	IA	50309	421233759	PROPERTY HOLDING COMPANY	IA	501(C)(2)		CENTRAL IOWA HEALTH SYSTEM	1
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	1
CENTRAL IOWA HOSPITAL CORPORATION
1200 PLEASANT STREET	DES MOINES	IA	50309	420680452	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	CENTRAL IOWA HEALTH SYSTEM	1
FINLEY TRI-STATES HEALTH GROUP INC
350 NORTH GRANDVIEW AVENUE	DUBUQUE	IA	52001	421307495	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	1
HNC SERVICES
1200 PLEASANT STREET	DES MOINES	IA	50309	270987243	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(2)	IOWA HEALTH SYSTEM	1
INTEGRATED CARE ORGANIZATION
1200 PLEASANT STREET	DES MOINES	IA	50309	274665007	PROMOTE, SUPPPORT THE INTERESTS AND PURPOSES OF AFFILIATES' HOSPITALS	IA	501(C)(3)	509(A)(2)	IOWA HEALTH SYSTEM	1
INTRUST
11333 AURORA AVENUE	URBANDALE	IA	50322	421477471	HOME HEALTH CARE	IA	501(C)(3)	509(A)(2)	IOWA HEALTH SYSTEM	1
IOWA HEALTH FOUNDATION
2700 GRAND AVE SUITE 109	DES MOINES	IA	50312	421467682	CHARITABLE FUNDRAISING	IA	501(C)(3)	509(A)(3), TYPE III	CENTRAL IOWA HEALTH SYSTEM	1
IOWA HEALTH SYSTEM
1200 PLEASANT STREET	DES MOINES	IA	50309	421435199	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE III		1
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
8101 BIRCHWOOD COURT	JOHNSTON	IA	50131	421411630	PRIMARY HEALTH CARE SERVICES	IA	501(C)(3)	170(B)(1) (A)(III)	IOWA HEALTH SYSTEM	1
MEMORIAL FOUNDATION OF ALLEN HOSPITAL
1825 LOGAN AVENUE	WATERLOO	IA	50703	421201138	CHARITABLE FUNDRAISING	IA	501(C)(3)	170(B)(1) (A)(VI)	ALLEN HEALTH SYSTEMS INC	1
METHODIST HEALTH SERVICES CORPORATION
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	371111135	HEALTHCARE	IL	501(C)(3)	509(A)(3), TYPE III	IOWA HEALTH SYSTEM	1
METHODIST MEDICAL CENTER FOUNDATION
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	510186460	FUNDRAISING	IL	501(C)(3)	170(B)(1) (A)(VI)	METHODIST HEALTH SERVICES CORPORATION	1
METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	370661223	HEALTHCARE	IL	501(C)(3)	170(B)(1) (A)(III)	METHODIST HEALTH SERVICES CORPORATION	1
METHODIST SERVICES INC
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	371111134	OFFICE RENTAL	IL	501(C)(3)	509(A)(2)	METHODIST HEALTH SERVICES CORPORATION	1
NELLIE R SHERWOOD TRUST
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	426061621	PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY	IA	501(C)(3)	509(A)(3), TYPE I	ST LUKE'S METHODIST HOSPITAL	1
NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED
720 KENYON DRIVE	FORT DODGE	IA	50501	420937390	MENTAL HEALTH CARE	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY HEALTH SYSTEMS INC	1
NORTHWEST IOWA HOSPITAL CORPORATION
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421019872	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	IOWA HEALTH SYSTEM	1
SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUE	PEORIA	IL	61636	376181831	FUND SELF-INSURANCE PLAN	IL	501(C)(3)	509(A)(3), TYPE III	METHODIST MEDICAL CENER OF ILLINOIS	1
SIOUXLAND PACE INC
313 COOK STREET	SIOUX CITY	IA	51103	261120134	ALL-INCLUSIVE CARE FOR THE ELDERLY	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTH SYSTEM INC	1
ST LUKE'S HEALTH RESOURCES
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421059182	OUTPATIENT CLINICS AND HEALTHCARE SERVICES	IA	501(C)(3)	509(A)(2)	ST LUKE'S HEALTH SYSTEM INC	1
ST LUKE'S HEALTH SYSTEM INC
2720 STONE PARK BLVD	SIOUX CITY	IA	51104	421294091	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE III	IOWA HEALTH SYSTEM	1
ST LUKE'S HEALTHCARE
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	421487968	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	1
ST LUKE'S METHODIST HOSPITAL
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	420504780	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTHCARE	1
ST LUKE'SJONES REGIONAL MEDICAL CENTER
1795 HIGHWAY 64 EAST	ANAMOSA	IA	52205	421487967	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	ST LUKE'S HEALTHCARE	1
STL CARE COMPANY
1026 A AVENUE NE	CEDAR RAPIDS	IA	52402	421276632	IMPROVE PUBLIC HEALTH SERVICES	IA	501(C)(3)	509(A)(2)	ST LUKE'S HEALTHCARE	1
THE DUBUQUE VISITING NURSE ASSOCIATION
350 NORTH GRANDVIEW AVENUE	DUBUQUE	IA	52001	420680410	PUBLIC HEALTH SERVICES/HOME CARE	IA	501(C)(3)	509(A)(2)	FINLEY TRI-STATES HEALTH GROUP INC	1
THE FINLEY HOSPITAL
350 NORTH GRANDVIEW AVENUE	DUBUQUE	IA	52001	420680354	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	FINLEY TRI-STATES HEALTH GROUP INC	1
THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
2701 17TH STREET	ROCK ISLAND	IL	61201	363678909	MENTAL HEALTH CARE	IL	501(C)(3)	170(B)(1) (A)(VI)	TRINITY REGIONAL HEALTH SYSTEM	1
TPG HEALTH
802 KENYON ROAD	FORT DODGE	IA	50501	453791448	SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY HEALTH SYSTEMS INC	1
TRINITY BUILDING CORPORATION
802 KENYON ROAD	FORT DODGE	IA	50501	421376187	PROPERTY HOLDING COMPANY	IA	501(C)(2)		TRINITY HEALTH SYSTEMS INC	1
TRINITY HEALTH FOUNDATION
802 KENYON ROAD	FORT DODGE	IA	50501	421222381	CHARITABLE FUNDRAISING	IA	501(C)(3)	170(B)(1) (A)(VI)	TRINITY HEALTH SYSTEMS INC	1
TRINITY HEALTH FOUNDATION
2701 17TH STREET	ROCK ISLAND	IL	61201	363321751	CHARITABLE FUNDRAISING	IL	501(C)(3)	170(B)(1) (A)(VI)	TRINITY REGIONAL HEALTH SYSTEM	1
TRINITY HEALTH SYSTEMS INC
802 KENYON ROAD	FORT DODGE	IA	50501	421222877	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IA	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	1
TRINITY MEDICAL CENTER
2701 17TH STREET	ROCK ISLAND	IL	61201	362739299	HOSPITAL	IL	501(C)(3)	170(B)(1) (A)(III)	TRINITY REGIONAL HEALTH SYSTEM	1
TRINITY REGIONAL HEALTH SYSTEM
2701 17TH STREET	ROCK ISLAND	IL	61201	363351952	SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE	IL	501(C)(3)	509(A)(3), TYPE II	IOWA HEALTH SYSTEM	1
TRINITY REGIONAL HOSPITAL AUXILIARY
802 KENYON ROAD	FORT DODGE	IA	50501	426081474	CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES	IA	501(C)(3)	509(A)(2)	TRINITY REGIONAL MEDICAL CENTER	1
TRINITY REGIONAL MEDICAL CENTER
802 KENYON ROAD	FORT DODGE	IA	50501	421009175	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY HEALTH SYSTEMS INC	1
UNITY HEALTHCARE
1518 MULBERRY AVENUE	MUSCATINE	IA	52761	420680337	HOSPITAL	IA	501(C)(3)	170(B)(1) (A)(III)	TRINITY REGIONAL HEALTH SYSTEM	1

Form990 Schedule R Part III Form990ScheduleRPartIII (29 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Code VCodeVAmount
1776 WESTLAKES PARKWAY LC
4949 WESTOWN PARKWAY SUITE 200	WEST DES MOINES	IA	50266	205031651	OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BUILDINGS	IA	N/A	UNRELATED	229642	12309952	0	1	0.33330
ALLEN MEMORIAL HOSPITAL ORTHOPEDIC CO-MANAGEMENT CO LLC
1825 LOGAN AVE	WATERLOO	IA	50703	453237125	ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES	IA	N/A	RELATED	22920	39683	0	0	0.20000
CENTRAL ILLINOIS CANCER CARE CENTER LLC
7309 N KNOXVILLE	PEORIA	IL	61614	261128108	RADIATION THERAPY	IL	N/A	RELATED	1031613	1886570	0	1	0.50000
CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC
1200 PLEASANT ST	DES MOINES	IA	50309	273625869	CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES	IA	N/A	RELATED	281022	87957	0	0	0.20000
DES MOINES PARKING ASSOCIATES
1200 PLEASANT ST	DES MOINES	IA	50309	382622972	PARKING DECK OPERATIONS	IA		RELATED	540801	3772221	0	1	1.00000	CENTRAL IA HEALTH PROP CORP
DUBUQUE ENDOSCOPY CENTER LC
1515 DELHI STREET SUITE 500	DUBUQUE	IA	52001	201597161	AMBULATORY SURGERY CENTER	IA		RELATED	660133	210769	0	1	0.51000	THE FINLEY HOSPITAL
ENSEVA - HIAWATHA LLC
524 PARK ROAD	WATERLOO	IA	50704	453437363	COLLOCATION FACILITY	IA		RELATED	2624	2203353	0	0	0.52000	IOWA HEALTH SYSTEM
FINLEY DEPT OF SURGERY CO-MGMT CO LLC
350 N GRANDVIEW AVE	DUBUQUE	IA	52001	422808785	SURGERY DEPARTMENT MANAGEMENT SERVICES	IA	N/A	RELATED	101716	208966	0	0	0.50000
FINLEYHARTIG HOMECARE LLC
703 MAIN ST	DUBUQUE	IA	52001	421487138	SALE/RENTAL OF MEDICAL EQUIPMENT	IA	N/A	RELATED	132479	842404	0	1	0.50000
HEALTH CARE AFFILIATES OF THE TRI-STATES LLC
350 N GRANDVIEW AVE	DUBUQUE	IA	52001	421428503	PROVIDE ACCESS TO LICENSED SOFTWARE	IA	N/A	RELATED		14037	0	1	0.50000
HEALTH ENTERPRISES VENTURES LC
4250 GLASS ROAD NE	CEDAR RAPIDS	IA	52402	391894290	INVESTMENT VEHICLE OWNING CLINICAL JVS	IA	N/A	UNRELATED	89797	817011	0	0	0.55670		$57,299
HY-VEEIOWA HEALTH LC
5820 WESTOWN PARKWAY	WEST DES MOINES	IA	50266	263293530	PRIMARY CARE CLINIC	IA	N/A	RELATED	-175705	44300	0	1	0.50000
IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC
1200 PLEASANT STREET	DES MOINES	IA	50309	030482623	OUTPATIENT DIAGNOSTIC IMAGING	IA	N/A	RELATED	1323429	2917182	0	1	0.50000
IOWA HEALTH SYSTEM CONTRACTING SERVICES LC
1200 PLEASANT STREET	DES MOINES	IA	50309	421511142	GROUP PURCHASING	IA	N/A	RELATED	4775894	15888961	0	1	1.00000
LAKEVIEW SURGERY CENTER LC
1200 PLEASANT STREET	DES MOINES	IA	50309	421516120	SURGERY CENTER	IA	N/A	RELATED	3443692	4825696	0	1	0.50000
MEDICAL LABORATORIES OF EASTERN IOWA LC
1026 A AVE NE	CEDAR RAPIDS	IA	52402	421359640	MEDICAL LABORATORY SERVICES	IA	N/A	RELATED	664320	870817	0	1	0.50000
METRO MRI CENTER LIMITED PARTNERSHIP
615 VALLEY VIEW DRIVE SUITE 102	MOLINE	IL	61265	363710164	PROVIDE MRI AND OTHER MEDICAL SERVICES	IL	N/A	RELATED	600876	1499952	0	1	0.33970
MR ASSOCIATES LLP
1455 SHERMAN ROAD	HIAWATHA	IA	52233	421260463	OWN AND OPERATE MR UNIT	IA	N/A	RELATED	2540143	1416839	0	1	0.33330
NE IA PHYSICAL THERAPY AND SPORTS MEDICINE LLC
1825 LOGAN AVE	WATERLOO	IA	50703	202124978	ATHLETIC TRAINING AND SPORTS MEDICINE	IA	N/A	RELATED	-41070		0	1
ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC
1200 PLEASANT STREET	DES MOINES	IA	50309	421508092	AMBULATORY SURGERY CENTER	IA	N/A	RELATED	3314858	3461181	0	1	0.50000
PIERCE STREET SAME DAY SURGERY LC
2730 PIERCE STREET	SIOUX CITY	IA	51104	205895205	AMBULATORY SURGERY CENTER	IA	N/A	RELATED	931816	3357708	0	1	0.50000
QUAD CITY AMBULATORY SURGERY CENTER LLC
520 VALLEY VIEW DRIVE SUITE 300	MOLINE	IL	61265	364471903	AMBULATORY SURGERY CENTER.	IL	N/A	RELATED	255765	3500259	0	1	0.50000
REHABILITATION THERAPY SERVICES LLC
416 ST MARKS CT 110	PEORIA	IL	61603	810584193	REHABILATION THERAPY	IL		RELATED	448732	1397476	0	1	0.60030	METHODIST MEDICAL CENTER OF ILLINOIS
THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC
1075 FIRST AVENUE SE	CEDAR RAPIDS	IA	52403	721550812	AMBULATORY SURGERY CENTER.	IA	N/A	RELATED	3310383	7115889	0	1	0.50000
TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
4500 UTICA RIDGE RD	BETTENDORF	IA	52722	272562753	ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICES	IA	N/A	RELATED	175377	118891	0	1	0.50000
TRI-WEBSTER LC
1610 COLLINS ST	WEBSTER CITY	IA	50595	010740062	MEDICAL BUILDING AND SURROUNDING PROPERTY	IA	N/A	RELATED	110738	1715230	0	1	0.50000
WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
1660 60TH STREET	WEST DES MOINES	IA	50266	271414600	ORTHOPEDIC SERVICE LINES MANAGEMENT	IA	N/A	RELATED	244306	26600	0	1	0.20000
WEST LAKES MEDICAL EQUIPMENT LLC
5950 UNIVERSITY AVENUE SUITE 321	WEST DES MOINES	IA	50266	263300536	MEDICAL EQUIPMENT SALES AND RENTAL	IA	N/A	UNRELATED	59770	171967	0	1	0.50000		$59,770
WEST LAKES SLEEP CENTER LLC
5950 UNIVERSITY AVENUE SUITE 2	WEST DES MOINES	IA	50266	263193923	SLEEP DISORDER DIAGNOSTIC TESTING FACILITY	IA	N/A	RELATED	92541	318508	0	1	0.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV (15 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership
BROADBAND INC
1200 PLEASANT ST	DES MOINES	IA	50309	273819741	INFORMATION TECHNOLOGY MGMT.	IA	IHS	C	338870	13238641	1.00000
CHARITABLE REMAINDER UNITRUST #1
					INVESTMENT	IA	SLHCF	T
CHARITABLE REMAINDER UNITRUST #2
					INVESTMENT	IA	SLHCF	T
CHARITABLE REMAINDER UNITRUST #3
					INVESTMENT	IA	SLHCF	T
CHARITABLE REMAINDER UNITRUST #6
					INVESTMENT	IA	SLHCF	T
IOWA HEALTH SYSTEM 457 DEF COMP PLAN
1415 WOODLAND AVE 2ND FL	DES MOINES	IA	50309	421435199	INVESTMENT	IA	IHS	T	266087	4546270	1.00000
METHODIST HEALTH VENTURES INC
PO BOX 87	PEORIA	IL	61650	371140939	PHARMACY/OFFICE STAFFING	IL	MHSC	C	868566	2437393	1.00000
MEDIMORE INC
1200 PLEASANT ST	DES MOINES	IA	50309	421414390	MANAGED CARE	IA	IHS	C	210170		1.00000
METHODIST PHYSICIAN SERVICES INC
PO BOX 87	PEORIA	IL	61650	363858550	MEDICAL SERVICES	IL	MHVI	C	11908671	1305915	1.00000
PRECEDENCE INC
4622 PROGRESS DRIVE STE A	DAVENPORT	IA	52807	371288604	MANAGED MENTAL CARE	IA	RYC	C	506534	435657	1.00000
PROVIDER RESOURCE MANAGEMENT INC
PO BOX 87	PEORIA	IL	61650	371223550	RESOURCE MANAGEMENT	IL	MHSC	C		57427	1.00000
RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC
700 E UNIVERSITY AVE	DES MOINES	IA	50316	261271143	SPECIALTY PHYSICIANS MEDICAL CARE	IA	CIHC	C	481860	198055	0.57000
STL HEALTH RESOURCES CO
1026 A AVE NE	CEDAR RAPIDS	IA	52402	421193499	PHYSICIAN OFFICE RENTAL	IA	SLMH	C	322129	5577505	1.00000
TRIMARK PHYSICIANS GROUP INC
802 KENYON ROAD	FORT DODGE	IA	50501	421335554	MEDICAL CLINICS	IA	THS	C	44216247		1.00000
TRINITY HEALTH ENTERPRISES INC
2701 17TH ST	ROCK ISLAND	IL	61201	363320141	RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY	IL	TRHS	C	3295832	2957465	1.00000

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	1	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	SECTION 512(B)(13) CONTROLLED ENTITY	Identifier
Return Reference	SCHEDULE R, PART II, COLUMN (G)	ReturnReference
Explanation	THE ORGANIZATION IS A MEMBER OF A CONSOLIDATED HEALTH SYSTEM AND HAS A COMMON PARENT ORGANIZATION, "IOWA HEALTH SYSTEM." FOR ENTITIES THAT ARE PART OF THE CONSOLIDATED HEALTH SYSTEM (WITH COMMON CONTROL) THE ATTRIBUTION RULES OF IRC SECTION 318 APPLY; MEANING THAT ALL ORGANIZATIONS ARE DEEMED TO HAVE CONTROL OF THE ORGANIZATIONS OWNED BY THE CONTROLLING ORGANIZATION. AS SUCH, WE ARE REPORTING ALL RELATED ORGANIZATIONS OF THE HEALTH SYSTEM IN PARTS II, III & IV. FOR PART V REPORTING, THE TRANSACTIONS DISCLOSED ARE THOSE BETWEEN THE DIRECTLY CONTROLLED PARENT-SUBSIDIARY ONLY.	Explanation

Reasonable Cause Explanation ReasonableCauseExplanation

Field	Value	IRS element (for citing)
Explanation	THE ORGANIZATION E-FILED A REQUEST FOR AN ADDITIONAL EXTENSION OF TIME TO FILE TO NOVEMBER 15, 2012, ON PART II OF FORM 8868. THE E-FILED EXTENSION WAS ACCEPTED BY THE IRS ON JULY 31, 2012; HOWEVER, THE IRS ISSUED NOTICE CP211A, DATED AUGUST 27, 2012, WITH AN INCORRECT DATE FOR PART II OF AUGUST 15, 2012 INSTEAD OF NOVEMBER 15, 2012. AS SUCH, THE ORGANIZATION RESPECTUFLLY REQUESTS THE ORGANIZATION'S RECORDS BE UPDATED ACCORDINGLY TO SHOW THIS FORM 990 AS BEING EXTENDED TO NOVEMBER 15, 2012, AND TIMELY FILED.	Explanation