2011-11-08T15:05:08-06:00 2010-12-31 990 2010-01-01 420680354 THE FINLEY HOSPITAL FINL 5635821881 350 NORTH GRANDVIEW AVE DUBUQUE IA 520016392 DAVID R BRANDON 5635892414 2011-10-18 2010 2016-03-07 17:11:31Z DAVID R BRANDON 350 NORTH GRANDVIEW AVE DUBUQUE IA 520016392 136923367 0 X WWW.FINLEYHOSPITAL.ORG X 1941 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES OF THE TRI-STATE AREA. 16 10 898 300 404678 0 731575 917391 90328947 92817939 1091978 4051160 695819 830099 92848319 98616589 56960 32506 0 0 43154184 43886807 0 0 0 42658373 46152864 85869517 90072177 6978802 8544412 124135052 135117150 27204542 25152635 96930510 109964515 X THE MISSION OF THE FINLEY HOSPITAL IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES OF THE TRI-STATE AREA. 0 0 64998114 11538 92841829 HEALTH-CARE SERVICESTHE FINLEY HOSPITAL IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE IOWA, ILLINOIS AND WISCONSIN TRI-STATE AREA COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH-CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. THE FINLEY HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, HOME HEALTH, INTENSIVE CARE AND CRITICAL CARE, MENTAL HEALTH CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, BEHAVIORAL DISORDER PROGRAMS, MATERNAL/CHILD CARE, LABORATORY, PALLIATIVE CARE, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2010, THE FINLEY HOSPITAL ADMITTED 4,616 PATIENTS RESULTING IN A TOTAL OF 19,590 PATIENT DAYS. OUTPATIENT VISITS TOTALED 65,029 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 5,392. THERE WERE ALSO 22,974 EMERGENCY ROOM VISITS AND 729 BABIES DELIVERED. 5307951 20968 0 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: THE FINLEY HOSPITAL PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE AT A COST OF $1,592,790 IN 2010. OFTENTIMES THE FINLEY HOSPITAL RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. THE FINLEY HOSPITAL PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. THE FINLEY HOSPITAL'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $960,013 FOR 2010. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $2,552,803.OTHER BENEFITS: THE FINLEY HOSPITAL PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. THE FINLEY HOSPITAL COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. THE FINLEY HOSPITAL HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $2,755,148. 70306065 1 1 0 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 111 0 1 898 1 1 1 0 0 0 0 0 0 0 0 0 X 16 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA IL X X KIM M DUWE CONTROLLER 5635892639 350 N GRANDVIEW AVE DUBUQUE IA 520016392 BILL ARNOLD 1.00 X 753 0 0 RONALD CAVANAGH 1.00 X X 1023 0 0 PAUL DELONG DMD 1.00 X 0 0 0 SARAH HASKEN 1.00 X 790 0 0 PEG KERR 1.00 X 567 0 0 JOHN KNOX TO 1010 40.00 X X 407186 77295 199709 TIMOTHY KUNKEL 1.00 X 1004 0 0 CHAD LEITCH 1.00 X X 602 357 0 KEVIN LYNCH 1.00 X X 816 0 0 JEFFREY MOZENA 1.00 X 0 0 0 DAVID OPPERT MD 1.00 X 0 0 0 JAN POWERS 1.00 X 790 0 0 DALE REPASS 1.00 X 816 0 0 HILLARD SALAS MD 1.00 X 753 0 0 NANCY WILSON 1.00 X 0 0 0 LAURA WITTHOEFT MD 1.00 X 0 0 0 CHAD WOLBERS FR 1110 40.00 X X 194827 0 39881 KATHLEEN ABBA 40.00 X 230171 0 125120 THEODORE GIFFORD 40.00 X 251133 0 19258 SANJEEV GUPTA 40.00 X 525244 0 16564 KEVIN KURTH 40.00 X 487989 0 27600 ANTHONY MARKHAM 40.00 X 258237 0 29239 PHILIP ZIMMERMAN 40.00 X 263669 0 32673 PAUL BRANDT TO 1206 0.00 X 0 15396 0 RONALD KLOSTERMAN TO 1205 0.00 X 0 14533 0 2626370 107581 490044 31 1 1 0 UNITED CLINICAL LABORATORIES 205 BLUFF STREET DUBUQUE IA 52001 LABORATORY SERVICES 4008113 CONLON CONSTRUCTION PO BOX 3400 DUBUQUE IA 520043400 CONSTRUCTION 2149639 ARAMARK MANAGEMENT SERVICES 22506 NETWORK PLACE CHICAGO IL 606731225 FOOD, HOUSKEEPING & LAUNDRY 1423403 HORIZON MENTAL HEALTH MGMT PO BOX 840839 DALLAS TX 752840839 MANAGEMENT SERVICES 562605 MISSISSIPPI VALLEY REGIONAL PO BOX 3655 DAVENPORT IA 52808 BLOOD SERVICES 468196 24 827874 89248 269 917391 NET PATIENT REVENUE 900099 88986142 88986142 MGMT & SUPPORT SVCS 561000 1243947 964603 239020 40324 SUBS & JOINT VENTURES 900099 882300 866957 15343 PHARMACY REVENUE 446110 729561 729561 RENTAL REVENUE 531100 473017 473017 502972 329790 150315 22867 92817939 1298385 1298385 17242 4124 13118 13118 13118 40925430 129999 38295475 7179 2629955 122820 2752775 2752775 CAFETERIA/FOOD SVCS 722210 793091 793091 MISCELLANEOUS REVENUE 900099 23890 23890 816981 98616589 91644399 404678 5650121 32506 32506 1025089 1025089 39724 39724 34433373 28991341 5442032 1238877 1043078 195799 4718238 3972543 745695 2431506 2047218 384288 2305493 1287900 1017593 14983 14983 408 408 187952 187952 10351830 8234183 2117647 377292 56470 320822 17186632 16145500 1041132 4251279 2976022 1275257 1320331 32654 1287677 284672 197407 87265 680652 680652 5676703 2630114 3046589 688918 688918 PATIENT BAD DEBT 2640368 2640368 MISCELLANEOUS EXPENSES 184951 18761 166190 INCOME TAXES 400 400 90072177 70306065 19766112 0 1880 1675 9660421 12364519 180 11264410 11391754 1207196 1426898 2140147 2058294 789018 791258 118065019 66212725 51982531 51852294 41149594 47846598 90000 90000 5849675 7293860 124135052 135117150 8471561 9185460 850 0 1394000 888306 17338131 15078869 27204542 25152635 X 93149902 104766263 1978374 3396018 1802234 1802234 96930510 109964515 124135052 135117150 X 8544412 4489593 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28333902 6334676 1015141 144590 33508847 26824107 25000 1599223 114428 28333902 31069223 -4116708 40305 88103 26824107 0.84490 0.05380 0.10130 0 1 1 949800 3531743 4481543 2755702 63559048 33264335 33050415 6207191 4594529 1612662 40756898 28267071 12489827 304637 86790 217847 51852294 IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC 5000 C HEALTHNET CONNECT, LC 100 C DUBUQUE ENDOSCOPY CENTER, LC 245988 C UNITED CLINICAL LABORATORIES, INC. 906879 C FINLEY/HARTIG HOMECARE, LLC 786334 C HEALTH ENTERPRISES OF IOWA & RELATED PARTNERSHIPS 151307 C BENEFICIAL INTEREST IN THE FINLEY HEALTH FOUNDATION 5198252 F 7293860 MISCELLANEOUS LIABILITY 452963 SELF-INSURANCE RESERVE 624852 LONG-TERM RETENTION INCENTIVES 359988 IOWA HEALTH SYSTEM NOTE PAYABLE 10672000 DUE TO AFFILIATES 160588 ANNUITIES LIABILITY 2808478 15078869 98616589 90072177 8544412 2056808 2432785 4489593 13034005 98577000 2056808 1015141 3071949 95505051 187952 2923586 3111538 98616589 87744000 0 87744000 187952 2140225 2328177 90072177 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 2007. 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 FINLEY HEALTH FOUNDATION 2,432,785. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 1,015,141. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 1,371,067. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 356,025. REVENUE RECORDED AS OFFSET TO EXPENSE ON BOOKS 1,196,067. ROUNDING 427. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 588,017. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 356,025. REVENUE RECORDED AS OFFSET TO EXPENSE ON BOOKS 1,196,067. ROUNDING 116. 1 1 X 1 X 1 X 1000.000000000000 1 1 0 1 1 1592790 1592790 0.01820 6415 6343485 5383472 960013 0.01100 6415 7936275 5383472 2552803 0.02920 48 11318 279850 16859 262991 0.00300 23 335 575656 575656 0.00660 3 644 3103612 1639345 1464267 0.01670 26 13317 693463 241229 452234 0.00520 100 25614 4652581 1897433 2755148 0.03150 100 32029 12588856 7280905 5307951 0.06070 7956 149856 1200 148656 0.00170 8805 8805 0.00010 873 10335 10335 0.00010 378 3851 3851 0.00000 9207 172847 1200 171647 0.00190 1 1075507 0 27658177 29733680 -2075503 X 1 1 1 DUBUQUE ENDOSCOPY CENTER LC AMBULATORY SURGERY CENTER 0.51000 0.49000 2 UNITED CLINICAL LABORATORIES INC MEDICAL LABORATORY SERVICES 0.33330 0.33330 1 1 THE FINLEY HOSPITAL

350 NORTH GRANDVIEW AVE DUBUQUE IA 52001

X X X THE FINLEY HOSPITAL 1 7 DBA FINLEY HOME HEALTH CARE

1333 DELHI ST DUBUQUE IA 52001

LICENSED TO OPERATE HOME HEALTH AGENCY IN WISCONSIN & ILLINOIS DBA WENDT CANCER TREATMENT CENTER

350 N GRANDVIEW AVE DUBUQUE IA 52001

OUTPATIENT RADIATION ONCOLOGY SERVICES DBA KEHL DIABETES CENTER

1550 UNIVERSITY AVE DUBUQUE IA 52001

OUTPATIENT DIABETES CLINIC DBA FINLEY OUTPATIENT REHAB-GRANDVIEW

444 N GRANDVIEW AVE DUBUQUE IA 52001

OUTPATIENT REHAB CLINIC DBA FINLEY OUTPATIENT REHAB-WESTMARK

1665 EMBASSY WEST DR STE 250 DUBUQUE IA 52002

OUTPATIENT REHAB CLINIC DUBUQUE ENDOSCOPY CENTER LC

1515 DELHI STREET SUITE 500 DUBUQUE IA 52001

OUTPATIENT CLINIC FINLEYHARTIG HOMECARE LLC

703 MAIN ST DUBUQUE IA 52001

OUTPATIENT CLINIC PART I, LINE 6A: THE FINLEY HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.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, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2640368. PART II: COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO FREE CLINICS OR AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. THE FINLEY HOSPITAL CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH STATUS IN WAYS THAT MAY DIFFER FROM THE DIRECT SERVICES OF THE HOSPITAL ORGANIZATION. OTHER DONATIONS SUCH AS FOOD OR OTHER DURABLE GOODS PROVIDE AREA SHELTERS AND OTHER ORGANIZATIONS IN THE AREA. THIS ALLOWS THESE ORGANIZATIONS TO MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. THE FINLEY HOSPITAL EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, FINLEY HOSPITAL EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COMMUNITY COLLABORATIVE COLLECTIVELY WORKING TO ADDRESS COMPLEX HEALTH ISSUES. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT FINLEY HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A VERY WELL COMPREHENSIVE AND INTENTIONAL APPROACH.FINLEY HAS A PARTNERSHIP WITH THE DUBUQUE COMMUNITY Y PROVIDING A CHILDCARE LOCATION FOR OUR COMMUNITY. THE FINLEY HEALTHY KIDS PLAY ZONE, ENTIRELY SPONSORED BY THE FINLEY HOSPITAL AT THE KENNEDY MALL, FURTHER SUPPORTS THIS YOUTH FOCUS. THIS PLAY ZONE PROMOTES GOOD NUTRITION AND EXERCISE IN A SAFE ENVIRONMENT.FINLEY ALSO SUPPORTS OUR COMMUNITY BY PROVIDING FINLEY SAFETY PERSONNEL AT CONCERTS, HOCKEY GAMES, AND COMMUNITY GATHERINGS, AS WELL AS SAFETY SUPPORT AT THE ANNUAL IOWA WINTER GAMES HELPING OUR LOCAL AND BROADER COMMUNITY.A PARTNERSHIP BETWEEN FINLEY AND THE SCENIC VALLEY AREA AGENCY ON AGING PROVIDES OUR COMMUNITY WITH A MOBILE MEALS FOOD DELIVERY SERVICE FOR SHUT IN'S OVER THE AGE OF 60 YEARS OF AGE. THE HOURS TO PLAN, PREPARE AND PACKAGE NUTRITIOUS MEALS FOR THIS AT RISK DEMOGRAPHIC SUPPORTS THE QUALITY OF LIFE TO THIS FRAGILE SEGMENT OF OUR COMMUNITY.THE FINLEY SERVING OTHERS OUTREACH INITIATIVE IS A PROGRAM THAT DIRECTLY SUPPORTS THE DUBUQUE RESCUE MISSION. FINLEY PROVIDES AND FINLEY EMPLOYEES SERVE A MONTHLY MEAL AT THE MISSION, AND PROVIDE MEDICAL ATTENTION TO COMMUNITY MEMBERS THAT OTHERWISE WOULD NOT HAVE THIS OPPORTUNITY. FINLEY PROVIDES THE HEALTH EDUCATION AND WELLNESS OPPORTUNITY FOR OUR COMMUNITY IN THE FREE USE OF MEETING ROOMS DURING THE ENTIRE YEAR FOR SUPPORT GROUPS EDUCATIONAL SEMINARS AND SCREENINGS.THE FINLEY HOSPITAL/VISITING NURSE ASSOCIATION IS THE KEY FAMILY AND YOUTH HEALTH AND SOCIAL DEVELOPMENT CENTER FOR THE COMMUNITY COORDINATING THOUSANDS OF SCREENINGS, SHOTS AND GUIDANCE APPOINTMENTS FOR LOW INCOME AND ALL INDIVIDUALS IN NEED OF ASSISTANCE IN OUR COMMUNITY.THESE TYPES OF ACTIVITIES ARE ONLY REPRESENTATIVE OF THE BREADTH AND CAPACITY THAT THE FINLEY HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A VERY WELL COMPREHENSIVE AND INTENTIONAL APPROACH. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR FINLEY HOSPITAL THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 8: THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL REPORTED ON LINE 7 ABOVE SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITALS CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS.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. PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. PART VI, LINE 2: THE FINLEY HOSPITAL CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN CENTRAL IOWA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, THE FINLEY HOSPITAL IS A SPONSORING PARTNER OF THE DUBUQUE VISITING NURSE ASSOCIATION'S (VNA) WORK ON THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT & HEALTH IMPROVEMENT PLAN (CHNA/HIP) THE CHNA/HIP IS A COMMUNITY COLLABORATIVE MANDATED BY IOWA CODE REQUIRING ALL IOWA COUNTIES' BOARDS OF HEALTH TO COMPLETE EVERY FIVE YEARS. THE VNA PROVIDES LEADERSHIP AND ASSISTANCE TO THE BOARD OF HEALTH TO COMPLETE THE CHNA/HIP AND IMPLEMENT ACTION PLANS DEVELOPED DURING THE PROCESS. THE CHNA/HIP ASSESSES COMMUNITY HEALTH NEEDS BASED ON DATA ON SPECIFIC INDICATORS, PRIORITIZES AND ADDRESSES NEEDS IN THE HEALTH IMPROVEMENT PLAN, AND THEN ASSISTS THE BOARD OF HEALTH TO IMPLEMENT WITH COMMUNITY PARTNERS. THROUGHOUT THE CHNA/HIP PROCESS THE VNA ASSISTS THE COMMUNITY AND BOARD OF HEALTH TO DEVELOP A HEALTH FIVE-YEAR AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES THAT ARE RELEVANT TO THE COMMUNITY. THE DUBUQUE VISITING NURSE ASSOCIATION WORKS COLLECTIVELY WITH THE BOARD OF HEALTH AND THE COMMUNITY TO ADDRESS THE PRIORITIES THROUGH LEVERAGING THE RESOURCES OF THE COMMUNITY. THE FINLEY HOSPITAL, AS THE SPONSORING AGENCY OF THE VNA, ACTIVELY CONTRIBUTES TO THIS PROCESS AND ENGAGES IN THE IDENTIFIED PRIORITIES THAT MATCH ITS MISSION AND CAPACITY. EFFORTS ARE MONITORED IN PART BY OTHER PARTNER AGENCIES SUCH AS THE FAMILY AND CHILD POLICY CENTER WHICH MONITORS AND REPORTS SPECIFIC INDICATORS TO ASSESS EFFECTIVENESS AND AID IN THE DEVELOPMENT OF NEW PLANS OR REFINING EXISTING ONES. FURTHER, THE DUBUQUE VISITING NURSE ASSOCIATION WILL CONTINUE TO ASSIST THE BOARD OF HEALTH TO DEVELOP A MEASUREMENT PROCESS TO EVALUATE EFFECTIVENESS OF THE HEALTH IMPROVEMENT PLAN AND ADDITIONAL COMMUNITY NEEDS PERIODICALLY OVER THE NEXT FIVE YEARS. THE DUBUQUE VISITING NURSE ASSOCIATION ASSISTS THE BOARD OF HEALTH TO CONVENE TWO HEALTH ACCESS SUBCOMMITTEE MEETINGS ANNUALLY TO SEEK PROVIDER INPUT ON PROGRESS IN HEALTH INITIATIVES. FINLEY HOSPITAL ASSISTS THE COMMUNITY BY MONITORING EFFECTIVENESS OF COMMUNITY HEALTH AND WELLNESS. AN EXAMPLE OF COMMUNITY COLLABORATION IS THE FINLEY SUITE BEGINNINGS PROGRAM, WHICH PROVIDES PRE-NATAL EDUCATION AND POSTPARTUM HOME VISITS TO ALL NEWBORNS. BY IMPROVING PRENATAL EDUCATION, THIS PROGRAM HELPS IMPROVE NEONATAL OUTCOMES. THE DUBUQUE VNA ATTENDS ALL DUBUQUE COUNTY BOARD OF HEALTH MEETINGS REPORTING TO THE BOARD ON EACH MONTH'S PUBLIC HEALTH ACTIVITIES. FINLEY HOSPITAL IS ALSO A SPONSORING PARTNER FOR THE CRESCENT COMMUNITY HEALTH CENTER WHICH ENABLES COMMUNITY RESIDENTS TO MORE EASILY ACCESS HEALTH AND DENTAL CARE. THE "FINLEY SERVING OTHERS" OUTREACH INITIATIVE IS A PROGRAM THAT DIRECTLY SUPPORTS THE DUBUQUE RESCUE MISSION. FINLEY PROVIDES AND FINLEY EMPLOYEES SERVE A MONTHLY MEAL AT THE MISSION, AND PROVIDE MEDICAL ATTENTION TO COMMUNITY MEMBERS THAT OTHERWISE WOULD NOT HAVE THIS OPPORTUNITY. FINLEY HOSPITAL ALSO PARTICIPATES ACTIVELY IN THE ANNUAL UNITED WAY CAMPAIGN TO HELP FUND THE UNITED WAY PROGRAMS. FINLEY HOSPITAL HAS BEEN A LEADER IN LIVE HEALTHY IOWA FOR SEVERAL YEARS LEADING TO VERY SUCCESSFUL CAMPAIGNS IN DUBUQUE TO IMPROVE RESIDENT'S HEALTH. BOTH FINLEY HOSPITAL AND THE VNA HAVE PROVIDED LEADERSHIP IN THE SUCCESSFUL 2009 HARKIN WELLNESS GRANT APPLICATIONS RESULTING IN THE "HEALTHY MEALS IN A HURRY" PROGRAM IN COLLABORATION WITH HY-VEE AND THE BOARD OF HEALTH. THE PROGRAM FOCUSES ON CLASSES TO ENCOURAGE FAMILIES TO COOK HEALTHY MEALS AT HOME AND FOCUSES ON THE BENEFITS ON EATING MEALS AS A FAMILY. THE VNA AND THE BOARD OF HEALTH IMPLEMENTED A PERMANENT BOARD SUBCOMMITTEE ON FOOD, FITNESS, AND WELLNESS. THIS GROUP ACTIVELY HAS BEEN MEETING MONTHLY AND ADDRESSES NEEDS/STRATEGIES ASSOCIATED WITH HEALTH THAT CAN PRODUCE BEHAVIOR CHANGE. THIS WIDE BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR THE FINLEY HOSPITAL TO ENGAGE IN VARIOUS AREAS OF SERVICE TO THE COMMUNITY THAT MAY BE OUTSIDE OF ITS TYPICAL EXPERTISE BUT WITHIN ITS EXISTING RESOURCES. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS, FINLEY HOSPITAL CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO IT'S SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS OFTEN WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT. PART VI, LINE 3: THE FINLEY HOSPITAL PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR PATIENT FINANCIAL POLICY BROCHURES IN APPROPRIATE AREAS OF THE HOSPITAL (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THAT THE PROVIDER/PHYSICIAN PRACTICE OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE. PART VI, LINE 4: THE FINLEY HOSPITAL IS A 126 BED COMMUNITY HOSPITAL SERVING THE MIDWEST REGION. THE FINLEY HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF THE FINLEY HOSPITAL MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF CLAYTON, DELAWARE, DUBUQUE, JACKSON AND GRANT. THE FINLEY HOSPITAL ADMITS APPROXIMATELY 4,500 INPATIENTS AND CARES FOR 23,000 EMERGENCY PATIENTS PER YEAR. THERE ARE 9 OTHER HOSPITALS WITHIN THE 5-COUNTY SERVICE AREA. MEDIAN HOUSEHOLD INCOMES RANGE FROM $43,111 THRU $48,152 AND THE AVERAGE POVERTY RATE IS 7%.56.8% OF FINLEY HOSPITAL'S INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. PART VI, LINE 6: THE FINLEY HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. FINLEY HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF FINLEY HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE. PART VI, LINE 7: 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 25 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 140 PHYSICIAN CLINICS, IOWA HEALTH SYSTEM PROVIDES CARE THROUGHOUT IOWA AND WESTERN ILLINOIS.IOWA HEALTH SYSTEM ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH NEARLY 20,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 2.5 MILLION PATIENT VISITS, IOWA HEALTH SYSTEM HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $2.3 BILLION, IOWA HEALTH SYSTEM IS THE SIXTH 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 2010, IOWA HEALTH SYSTEM AND ITS AFFILIATES PROVIDED MORE THAN $152 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY IOWA HEALTH SYSTEM AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. REPORTS FILED WITH STATES PART VI, LINE 7 IA,IL 1 FINLEY TRI-STATES HEALTH GROUP INC 350 NORTH GRANDVIEW AVE DUBUQUE IA 52001 421307495 501(C)(3) 21406 PROGRAM SUPPORT GUTTENBERG MUNICIPAL HOSPITAL 200 MAIN ST GUTTENBERG IA 52052 426038728 CITY OF GUTTENBERG 10000 CAPITAL BUILDING CAMPAIGN 1 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART II & III (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINES A SERIES OF ELIGIBLITY STANDARDS THAT ARE REQUIRED TO BE MET. THE ORGANIZATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 JOHN KNOX TO 1010 232509 50351 102586 0 72091 26944 12250 169933 7740 9786 427176 257014 0 0 CHAD WOLBERS FR 1110 156496 0 17825 0 20506 0 18187 0 21694 0 234708 0 0 0 KATHLEEN ABBA 172634 0 45502 0 12035 0 104830 0 20290 0 355291 0 0 0 THEODORE GIFFORD 245708 0 0 0 5425 0 11496 0 7762 0 270391 0 0 0 SANJEEV GUPTA 482802 0 0 0 42442 0 12250 0 4314 0 541808 0 0 0 KEVIN KURTH 334182 0 0 0 153807 0 12250 0 15350 0 515589 0 0 0 ANTHONY MARKHAM 254992 0 0 0 3245 0 11496 0 17743 0 287476 0 0 0 PHILIP ZIMMERMAN 258717 0 0 0 4952 0 11496 0 21177 0 296342 0 0 0 PAUL BRANDT TO 1206 0 15396 0 0 0 0 0 0 0 0 0 15396 0 0 RONALD KLOSTERMAN TO 1205 0 14533 0 0 0 0 0 0 0 0 0 14533 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS: SPOUSES SOMETIMES ACCOMPANY BOARD MEMBERS AND/OR OFFICERS ON ORGANIZATIONAL ACTIVITIES, INCLUDING BOARD RELATED TRAVEL. THE ADDITIONAL COST ATTRIBUTABLE TO THE SPOUSE IS TREATED AS TAXABLE COMPENSATION TO THE BOARD MEMBER OR OFFICER AND REPORTED AS APPROPRIATE TO THE IRS. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: KATHLEEN ABBA $94,215, JOHN KNOX $169,933, CHAD WOLBERS $9,178. DUBUQUE ENDOSCOPY CENTER LC COMMON BOARD MEMBER/OFFICER 246000 INVESTMENT 0 DUBUQUE SURGERY COMMON BOARD MEMBER/OFFICER 183000 TRAUMA CALL, PHONE SERVICES AND PHARMACY 0 FINLEYHARTIG HOMECARE LLC COMMON BOARD MEMBER/OFFICER 787000 INVESTMENT 0 KEN-MO FARMS INC COMMON BOARD MEMBER/OFFICER 142776 RENT 0 TRI-STATE IPA COMMON BOARD MEMBER/OFFICER 274000 ADMINISTRATOR PAY, DUES, OCCUPATIONAL HEALTH, ETC. 0 UNITED CLINICAL LABORATORIES INC COMMON BOARD MEMBER/OFFICER 5268000 INVESTMENT, LAB SERVICES, AND LAB RENTS 0 VICKI ARNOLD FAMILY MEMBER OF BOARD MEMBER BILL ARNOLD 39724 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 JEFF MOZENA; DALE REPASS; BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 FINLEY TRI-STATES HEALTH GROUP, INC., A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A FINLEY TRI-STATES HEALTH GROUP, INC., AS SOLE MEMBER, APPOINTS ONE BOARD MEMBER AND APPROVES OTHERS. IOWA HEALTH SYSTEM, AS SOLE MEMBER OF FINLEY TRI-STATES HEALTH GROUP, APPOINTS ONE BOARD MEMBER AND APPROVES OTHERS. FORM 990, PART VI, SECTION A, LINE 7B FINLEY TRI-STATES HEALTH GROUP, INC., AS SOLE MEMBER, APPOINTS AND REMOVES BOARD OF DIRECTORS, APPROVES AMENDMENTS TO ARTICLES AND BYLAWS, APPROVES INDEBTEDNESS, AND APPOINTS PRESIDENT. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND REPORTING PHYSICIANS ARE REQUESTED TO COMPLETE A QUESTIONNAIRE TO REPORT POTENTIAL CONFLICTS OF INTEREST. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE ANNUAL QUESTIONNAIRES INCLUDE AN ACKNOWLEDGEMENT THAT THE OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN: 1) HAS ACCESS TO A COPY OF THE CONFLICT OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. SENIOR ADMINISTRATIVE STAFF AT ALL RELATED ORGANIZATIONS PROVIDE INFORMATION TO A CENTRAL COORDINATOR RELATED TO THE IDENTIFICATION OF WHICH INDIVIDUALS SHOULD RECEIVE THE QUESTIONNAIRE FOR COMPLETION. THE RESULTS ARE COMPILED CENTRALLY AND REVIEWED BY THE IOWA HEALTH SYSTEM COMPLIANCE OFFICER AND DIRECTOR OF INTERNAL AUDIT. THE DETAIL RESULTS ARE REPORTED TO A COMMITTEE OF THE SYSTEM BOARD. THE RESULTS RELATED TO SPECIFIC REGIONAL PARENT COMPANIES, THEIR HOSPITALS AND RELATED ORGANIZATIONS, ARE DISTRIBUTED IN DETAIL TO THE CHAIRPERSON OF THE REGIONAL PARENT ORGANIZATION, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND COMPLIANCE MANAGER. THESE INDIVIDUALS ARE ALSO REMINDED OF THE APPROPRIATE PROCESS TO BE FOLLOWED DURING THE YEAR TO ADDRESS POTENTIAL CONFLICTS OF INTEREST THAT RELATE TO MATTERS THAT ARE BROUGHT TO THE BOARD OF DIRECTORS FOR ACTION. THE INFORMATION DISCLOSED IS USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICAID QUESTIONNAIRES. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN TOGETHER WITH ALL MATERIAL FACTS, SHOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST OCCURS OR BECOMES A MATTER OF BOARD ACTION. ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN HAVING A CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT BE PRESENT DURING GENERAL DISCUSSION NOR VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM FOR PURPOSES OF THE MATTER OR ITEM AS TO WHICH A CONFLICT EXISTS. THE BOARD SHOULD EXCLUDE THE INDIVIDUAL FROM ANY DISCUSSION OR VOTE IN WHICH THE BOARD DECIDES WHETHER OR NOT A CONFLICT OF INTEREST EXISTS. IN CASES IN WHICH AN OFFICER, DIRECTOR, KEY EMPLOYEE, REPORTING PHYSICIAN OR THE INDIVIDUAL'S HOUSEHOLD MEMBER HAS A CONFLICT OF INTEREST IN AN ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN AT THE DIRECTION OF THE BOARD OF DIRECTORS: 1) AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL 1) DECIDE IF A CONFLICT OF INTEREST EXISTS, 2) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION; 3) IN ORDER TO APPROVE THE ARRANGEMENT OR TRANSACTION, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED MEMBERS, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED MEMBERS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS SHALL CONTAIN: 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; 2) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH; IN ORDER TO PROTECT THE ORGANIZATION'S BEST INTERESTS, APPROPRIATE DISCIPLINARY ACTION MAY BE TAKEN WITH RESPECT TO AN OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN WHO VIOLATES THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS (COMMITTEE) CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATIONS OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE CEO). THIS ANNUAL REVIEW COMPARES THE TOTAL COMPENSATION AND VALUE OF BENEFITS PROVIDED TO EACH EXECUTIVE, ON A POSITION BY POSITION BASIS, TO THAT PROVIDED TO FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED ORGANIZATIONS. THIS REVIEW IS CONDUCTED BY THE COMMITTEE WITH THE ASSISTANCE OF A NATIONAL, INDEPENDENT COMPENSATION CONSULTANT REPORTING DIRECTLY TO THE COMMITTEE. THE COMMITTEE HAS BEEN DELEGATED THE RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION AND IS MADE UP ENTIRELY OF INDEPENDENT DIRECTORS WITHIN THE MEANING OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX INTERMEDIATE SANCTIONS RULES. THE COMPENSATION CONSULTANT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT, PERFORMS THESE VALUATIONS ON A REGULAR BASIS, IS QUALIFIED TO MAKE THE VALUATIONS OF THE SERVICES INVOLVED, AND HAS SO INDICATED IN A WRITTEN CERTIFICATION TO THE COMMITTEE. BASED UPON THE ADVICE OF THE COMPENSATION CONSULTANT, AND APPLYING THE BOARD'S COMPENSATION PHILOSOPHY, THE COMMITTEE ESTABLISHES THE OVERALL ADJUSTMENT IN COMPENSATION AND BENEFITS FOR APPROXIMATELY THE TOP FIFTY EXECUTIVES IN THE ENTIRE HEALTH SYSTEM (SEVERAL OF WHICH ARE EMPLOYEES OF THE FILING ORGANIZATION) AND DELEGATES TO THE CEO THE AUTHORITY TO MAKE ADJUSTMENTS, CONSISTENT WITH THE COMMITTEE'S DIRECTION, FOR THE OTHER EXECUTIVES. THE COMMITTEE DETERMINES ALL ASPECTS OF THE COMPENSATION AND BENEFITS OF THE CEO. THE COMMITTEE INTENTIONALLY TAKES ALL THE STEPS NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES, INCLUDING CONTEMPORANEOUS SUBSTANTIATION OF ALL COMMITTEE MEETINGS AND ACTIONS. THE ORGANIZATION BELIEVES IT IS IN FULL COMPLIANCE WITH SECTION 4958 OF THE IRC, PROVIDES NO MORE THAN REASONABLE AND FAIR MARKET VALUE COMPENSATION AND BENEFITS FOR ITS EMPLOYEES AND DOES NOT PROVIDE ANY EXCESS COMPENSATION OR BENEFITS AS PROHIBITED BY SECTION 4958. THE ANNUAL REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2010 FOR THE FOLLOWING INDIVIDUALS: KATHLEEN ABBA AND CHAD WOLBERS THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,056,808. CHANGE IN BENEFICIAL INTEREST OF FINLEY HEALTH FOUNDATION 2,432,785. TOTAL TO FORM 990, PART XI, LINE 5: 4,489,593. 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 HEALTH FOUNDATION INC 350 NORTH GRANDVIEW AVENUE DUBUQUE IA 52001 421286953 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) THE FINLEY HOSPITAL AND THE DUBUQUE VISITING NURSE ASSOCIATION 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 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 1440 INGERSOLL AVENUE DES MOINES IA 50309 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 LUTHERAN HOSPITAL AUXILIARY 1440 INGERSOLL AVENUE DES MOINES IA 50309 426059539 SUPPORT IOWA LUTHERAN HOSPITAL MISSION TO IMPROVE HEALTHCARE 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 JONES REGIONAL MEDICAL CENTER FOUNDATION 104 BROADWAY PLACE ANAMOSA IA 52205 421429225 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ST LUKE'SJONES REGIONAL MEDICAL CENTER 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 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 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SECTION 512(B)(13) CONTROLLED ENTITY SCHEDULE R, PART II, COLUMN (G) 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.