2011-11-08T15:04:37-06:00 2010-12-31 990 2010-01-01 420680452 CENTRAL IOWA HOSPITAL CORPORATION CENT 5152416212 1200 PLEASANT ST DES MOINES IA 503091453 JOSEPH F CORFITS 5152416396 2011-10-21 2010 2016-03-07 17:11:31Z ERIC T CROWELL 1200 PLEASANT ST DES MOINES IA 503091453 1067112616 0 X WWW.IOWAHEALTH.ORG X 1933 IA IMPROVING THE HEALTH OF THE COMMUNITY THROUGH HEALING, CARING AND TEACHING. 21 15 6253 3858 12606364 2890895 7283762 5648151 604692444 640855688 14855128 32927906 6522554 5981267 633353888 685413012 4497494 2887518 0 0 318088402 339582270 0 0 0 266186444 303862963 588772340 646332751 44581548 39080261 763247804 801088699 293381707 279149752 469866097 521938947 X IMPROVING THE HEALTH OF THE COMMUNITY THROUGH HEALING, CARING AND TEACHING. 0 0 537059872 1087321 641162001 HEALTH-CARE SERVICESCENTRAL IOWA HOSPITAL CORPORATION IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE CENTRAL IOWA COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. CENTRAL 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 ENDED DECEMBER 31, 2010, CENTRAL IOWA HOSPITAL CORPORATION ADMITTED 34,723 PATIENTS RESULTING IN A TOTAL OF 168,679 PATIENT DAYS. OUTPATIENT VISITS TOTALED 633,097 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 10,864. THERE WERE ALSO 80,267 EMERGENCY ROOM VISITS AND 3,995 BABIES DELIVERED. 49278611 1800197 0 COMMUNITY BENEFITS, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: CENTRAL 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 7,179 PEOPLE AT A VALUE OF $7,574,467 IN 2010. OFTENTIMES, CENTRAL IOWA HOSPITAL CORPORATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. CENTRAL IOWA HOSPITAL CORPORATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. IOWA METHODIST MEDICAL CENTER, IOWA LUTHERAN HOSPITAL, METHODIST WEST HOSPITAL AND BLANK CHILDREN'S HOSPITALS' NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $21,161,010 FOR 2010. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $28,735,477.OTHER BENEFITS: CENTRAL IOWA HOSPITAL CORPORATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. CENTRAL 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. CENTRAL IOWA HOSPITAL CORPORATION HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 88,627 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL NET OTHER BENEFITS REPORTED VALUE: $20,543,134. 586338483 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 0 1 459 0 1 6253 1 1 1 0 0 0 0 0 0 0 0 0 X 21 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA X X JOSEPH F CORFITS SENIOR VPCFO 5152416470 1200 PLEASANT ST DES MOINES IA 50309 PEG ARMSTRONG-GUSTAFSON 1.00 X 300 11863 0 LARRY BAKER DO 1.00 X 275 0 0 BRAD BRODY 1.00 X X 225 0 0 BISHOP MICHAEL BURK 1.00 X X 50 0 0 CHARLES COLBY 1.00 X 435 209 0 ERIC CROWELL 40.00 X X 771234 0 313754 KATRINA GUEST MD 1.00 X 0 0 0 JOHN HEFFERNAN MD 40.00 X 392426 0 60434 KENT HENNING 1.00 X X 135 0 0 STEVE HERWIG DO 1.00 X 50 13163 0 JAMES HUBBELL III 1.00 X 135 0 0 BURTON 'TOBY' JOSEPH 1.00 X X 275 0 0 RICHARD MCCONNELL 1.00 X 140 0 0 JAMES PATTEN MD 1.00 X 225 0 0 CARLINE PHILLIPS 1.00 X 410 0 0 DON ROSS 1.00 X 441 16037 0 BRUCE SHERMAN 1.00 X 225 15838 0 DAVID STUBBS MD 40.00 X 0 19267 1174 JULIUS TRIMBLE 1.00 X 140 0 0 RICHARD WILLIS 1.00 X 135 0 0 BRAD WINTERBOTTOM 1.00 X 50 0 0 WILLIAM YOST MD 40.00 X 0 219196 61841 JOSEPH CORFITS 40.00 X 412550 0 124641 SUSAN ALLYN 40.00 X 311236 0 127135 AMY BETHEL 40.00 X 154224 0 49087 CHRISTINE BLAIR 40.00 X 204615 0 67146 DOUGLAS DORNER MD 40.00 X 630889 0 46855 CECELIA KIRVIN 40.00 X 170580 0 29355 ERIC LOTHE 40.00 X 350404 0 64465 JOYCE MCDANEL 40.00 X 173622 0 21337 MARK PURTLE MD 40.00 X 466859 0 181233 SIDNEY RAMSEY 40.00 X 333242 0 99960 JEANETTE SHELTON 40.00 X 186377 0 49639 DAVID STARK 40.00 X 407939 0 57553 STEPHEN STEPHENSON MD 40.00 X 516530 0 183089 TIMOTHY HART MD 40.00 X 1095931 0 40712 AMAR NATH MD 40.00 X 1097464 0 38428 PRASAD PALAKURTHY MD 40.00 X 794299 0 31704 JOHN PARGULSKI DO 40.00 X 760698 0 37357 CRAIG STEVENS MD 40.00 X 820730 0 39778 10055495 295573 1726677 250 0 1 0 ARAMARK FACILITIES SERVICES 22506 NETWORK PLACE CHICAGO IL 60673 LAUNDRY, CLEANING & FOOD SERVICES 7860741 WEITZ COMPANY INC 5901 THORNTON AVE DES MOINES IA 50321 CONSTRUCTION 7400507 FLYNN WRIGHT INC 501 SW 7TH STREET DES MOINES IA 50309 ADVERTISING & PROMOTION 1063818 AJ ALLEN MECHANICAL CONTRACTORS INC PO BOX 931 DES MOINES IA 503040931 REPAIR & MAINTENANCE 574810 GRAHAM CONSTRUCTION CO 421 GRAND DES MOINES IA 50309 CONSTRUCTION 523809 24 4588668 569675 489808 5648151 NET PATIENT REVENUE 900099 612414482 612414482 LABORATORY SERVICES 621510 11288340 11288340 SUBS & JOINT VENTURES 900099 7459958 7272924 187034 MGMT & SUPPORT SVCS 561000 6246560 2853315 392411 3000834 OTHER HEALTHCARE SVCS 900099 971711 535088 436623 2474637 2218745 27990 227902 640855688 6780510 6780510 407745497 94407 381604552 87956 26140945 6451 26147396 26147396 9417 7096 2321 2321 CAFETERIA/FOOD SVCS 722210 4556570 175501 4381069 CHILDCARE SERVICES 624410 1195395 1195395 MISCELLANEOUS REVENUE 900099 226981 130812 96169 5978946 685413012 624890278 12606364 42268219 2887518 2887518 8098544 8098544 390539 390539 266698375 248157071 18541304 10351393 9631747 719646 37272031 34680819 2591212 16771388 15605414 1165974 35893153 35893153 1306928 86802 1220126 24000 24000 1941172 1941172 41026690 31770032 9256658 1936251 208860 1727391 132495580 130822644 1672936 3909143 3865516 43627 16890289 15766865 1123424 1076590 873976 202614 221411 179281 42130 8175736 8175736 32215550 31893831 321719 892521 899216 -6695 PATIENT BAD DEBT 20910718 20910718 MISCELLANEOUS EXPENSES 3493231 1814481 1678750 INCOME TAXES 1454000 1454000 646332751 586338483 59994268 0 35945 35649 15824014 19857649 79256659 83025267 1283055 661730 5547472 8669125 10388122 10472938 9969808 8572592 682246197 434514237 260840400 247731960 343957909 391365556 34085792 30228353 1956745 384245 101883 83635 763247804 801088699 59462155 61264550 97215 418924 478794 23000000 23000000 594633 563298 200000 100000 209608780 193743110 293381707 279149752 X 440336205 495594082 16479262 11884147 13050630 14460718 469866097 521938947 763247804 801088699 X 39080261 12992589 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24000 24000 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PAID TO CONSULTING FIRM FOR LOBBYING ACTIVITIES ON BEHALF OF HEALTH CARE. 345461149 7133406 46487853 3862243 1455747 393764418 247692356 25092385 77357269 3399333 1281528 345461149 310035426 5000000 -52884188 13612295 846587 247692356 0.93730 0.03670 0.02600 0 1 1 9922760 9922760 237767288 143200560 94566728 18541705 13641025 4900680 407689747 277672652 130017095 8324697 8324697 247731960 ASBESTOS REMOVAL LIABILITY 3103168 CAPITAL LEASE PAYABLE 1502863 DUE TO AFFILIATES 11467916 SELF-INSURANCE RESERVE 11789581 LONG-TERM RETENTION INCENTIVES 9717189 IOWA HEALTH SYSTEM NOTE PAYABLE 149562000 HEALTH AND WELFARE BENEFITS RESERVE 5223559 MISCELLANEOUS LIABILITY 1376834 193743110 685413012 646332751 39080261 14655497 -1662908 12992589 52072850 696691000 14977610 4018370 18995980 677695020 1543902 6174090 7717992 685413012 637876000 7096 7096 637868904 1543902 6919945 8463847 646332751 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 IOWA HEALTH FOUNDATION 834,397. CHANGES IN PENSION LIABILITY -2,497,305. PART XII, LINE 2D - OTHER ADJUSTMENTS: SALES OF INVENTORY 7,096. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 4,011,274. PART XII, LINE 4B - OTHER ADJUSTMENTS: IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATES 2,712,629. REVENUES IN UNRESTRICTED FUND BALANCE 3,460,902. ROUNDING 559. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SALES OF INVENTORY 7,096. PART XIII, LINE 4B - OTHER ADJUSTMENTS: IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATES 2,712,629. EXPENSES IN TEMPORARILY RESTRICTED FUND BALANCE 8,150. EXPENSES IN UNRESTRICTED FUND BALANCE 4,198,442. ROUNDING 724. 1 1 X 1 X 1 X 1000.000000000000 1 1 1 0 1 1 7179 7574467 0 7574467 0.01210 23235 68631557 47470547 21161010 0.03380 30414 76206024 47470547 28735477 0.04590 27 80256 5355976 1253525 4102451 0.00660 16 2608 13086396 5852433 7233963 0.01160 1 3679 37114941 30741220 6373721 0.01020 1 587746 587746 0.00090 8 2084 2245253 2245253 0.00360 53 88627 58390312 37847178 20543134 0.03290 53 119041 134596336 85317725 49278611 0.07880 4 584 1115 1115 0.00000 1 0 543531 543531 0.00090 5 584 544646 544646 0.00090 1 7843400 139324957 136728523 2596434 X 1 1 1 1776 WESTLAKES PARKWAY LC OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BLDGS 0.33330 0.66670 0.00000 2 CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT COMPANY MANAGEMENT OF CARDIAC SERVICE LINE 0.20000 0.24350 3 IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC OUTPATIENT DIAGNOSTIC IMAGING 0.50000 0.50000 4 LAKEVIEW SURGERY CENTER LC SURGERY CENTER 0.50000 0.50000 5 ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC AMBULATORY SURGERY CENTER 0.50000 0.50000 6 WEST HOSPITAL ORTHOPAEDIC CO-MANAGEMENT COMPANY MANAGEMENT OF METHODIST WEST ORTHO SERVICE LINE 0.20000 0.80000 7 WEST LAKES SLEEP CENTER LLC TREATMENT OF CHRONIC SLEEP DISORDERS 0.50000 0.50000 3 1 IOWA METHODIST MEDICAL CENTER

1200 PLEASANT STREET DES MOINES IA 50309

X X X X X X X 2 IOWA LUTHERAN HOSPITAL

700 EAST UNIVERSITY AVENUE DES MOINES IA 50316

X X X 3 METHODIST WEST HOSPITAL

1660 60TH STREET WEST DES MOINES IA 50266

X X X N A 1 38 LAKEVIEW SURGERY CENTER LC

1750 60TH ST WEST DES MOINES IA 50266

SURGERY CENTER IOWA DIAGNOSTIC IMAGING AND PROCEDURE CE

6000 UNIVERSITY AVE SUITE 150 WEST DES MOINES IA 50266

OUTPATIENT DIAGNOSTIC IMAGING CHILDREN'S HEALTH CENTER

MOB I STE 300 DES MOINES IA 50309

PHYSICIAN CLINIC ORTHOPAEDIC OUTPATIENT SURGERY CENTER L

1600 60TH ST WEST DES MOINES IA 50266

AMBULATORY SURGERY CENTER IOWA HEALTH CARDIOLOGY

1301 PENN AVENUE SUITE 100 DES MOINES IA 50316

PHYSICIAN CLINIC 1776 WESTLAKES PARKWAY LC

1776 WESTLAKES PARKWAY WEST DES MOINES IA 50266

OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BLDGS URBANDALE FAMILY PHYSICIANS AND SPORTS M

2901 86TH STREET URBANDALE IA 50322

PHYSICIAN CLINIC & THERAPY WEST DES MOINES FAMILY PHYSICIANS

6010 MILLS CIVIC PARKWAY SUITE 200 WEST DES MOINES IA 50266

PHYSICIAN CLINIC NORWALK FAMILY PHYSICIANS

800 COLONIAL CIRCLE SUITE 200 NORWALK IA 50211

PHYSICIAN CLINIC ALTOONA FAMILY CARE CENTER

2720 8TH STREET SW ALTOONA IA 50009

PHYSICIAN CLINIC PENN AVENUE INTERNAL MEDICINE

1201 PENN AVENUE DES MOINES IA 50316

PHYSICIAN CLINIC NORTHWEST FAMILY PHYSICIANS

5700 HICKMAN ROAD DES MOINES IA 50310

PHYSICIAN CLINIC JOHN STODDARD CANCER CENTER - RADIATION

1221 PLEASANT STREET DES MOINES IA 50309

PHYSICIAN CLINIC EAST DES MOINES FAMILY CARE CENTER

840 EAST UNIVERSITY AVENUE DES MOINES IA 50316

PHYSICIAN CLINIC HIGHLAND PARK FAMILY PHYSICIANS

1530 E EUCLID AVENUE DES MOINES IA 50313

PHYSICIAN CLINIC INGERSOLL FAMILY PHYSICIANS

2103 INGERSOLL AVENUE DES MOINES IA 50312

PHYSICIAN CLINIC GRIMES FAMILY PHYSICIANS

1551 SE 3RD STREET GRIMES IA 50111

PHYSICIAN CLINIC HUXLEY FAMILY PHYSICIANS

305 SO HWY 69 HUXLEY IA 50124

PHYSICIAN CLINIC OCC MED

6000 UNIVERSITY AVE SUITE 124 WEST DES MOINES IA 50266

OCCUPATIONAL MEDICINE TRANSPLANT CENTER AND CENTER FOR LIVER D

1215 PLEASANT STREET SUITE 506 DES MOINES IA 50309

PHYSICIAN CLINIC IOWA HEALTH CARDIOLOGY WEST

6000 WEST UNIVERSITY AVENUE A20 WEST DES MOINES IA 50266

PHYSICIAN CLINIC JOHNSTON FAMILY PHYSICIANS

PHYSICIAN CLINIC JOHNSTON IA 50131

PHYSICIAN CLINIC PERINATAL

PHYSICIAN CLINIC DES MOINES IA 50309

PHYSICIAN CLINIC IOWA HEALTH DES MOINES BARIATRIC SERVICE

PHYSICIAN CLINIC WEST DES MOINES IA 50266

PHYSICIAN CLINIC COUNSELING CENTER

PHYSICIAN CLINIC WEST DES MOINES IA 50266

PHYSICIAN CLINIC WEST HOSPITAL ORTHOPAEDIC CO-MANAGEMENT

MANAGEMENT OF METHODIST WEST ORTHO SERVI WEST DES MOINES IA 50266

MANAGEMENT OF METHODIST WEST ORTHO SERVICE LINE IOWA HEALTH PSYCHIATRY SERVICES

PHYSICIAN CLINIC DES MOINES IA 50309

PHYSICIAN CLINIC SOUTHWEST FAMILY PHYSICIANS

PHYSICIAN CLINIC DES MOINES IA 50315

PHYSICIAN CLINIC PENN AVENUE OBGYN

PHYSICIAN CLINIC DES MOINES IA 50316

PHYSICIAN CLINIC MIDWIVES

PHYSICIAN CLINIC DES MOINES IA 50309

PHYSICIAN CLINIC PENN INTERNAL MEDICINE METHODIST

PHYSICIAN CLINIC DES MOINES IA 50309

PHYSICIAN CLINIC WEST LAKES SLEEP CENTER LLC

TREATMENT OF CHRONIC SLEEP DISORDERS WEST DES MOINES IA 50266

TREATMENT OF CHRONIC SLEEP DISORDERS PIH OP THERAPY EAST

THERAPY ALTOONA IA 50009

THERAPY CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMEN

MANAGEMENT OF CARDIAC SERVICE LINE DES MOINES IA 50309

MANAGEMENT OF CARDIAC SERVICE LINE CARDIO THORACIC

PHYSICIAN CLINIC DES MOINES IA 50309

PHYSICIAN CLINIC LA CLINICA

PHYSICIAN CLINIC DES MOINES IA 50317

PHYSICIAN CLINIC IOWA KIDNEY STONE CENTER

REMOVAL OF KIDNEY STONES DES MOINES IA 50309

REMOVAL OF KIDNEY STONES IOWA HEALTH PAIN MANAGEMENT CLINIC

PHYSICIAN CLINIC DES MOINES IA 50309

PHYSICIAN CLINIC PART I, LINE 6A: CENTRAL IOWA HOSPTITAL CORPORATION D/B/A IOWA HEALTH DES MOINES' COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM CONSOLIDATED COMMUNITY BENEFIT REPORT WHICH IS POSTED ON ITS WEBSITE AT WWW.IHS.ORG.IN ADDITION, THE HOSPITAL AND ITS REGIONAL AFFILIATES PUBLISHES AN ANNUAL COMMUNITY BENEFIT REPORT. THIS REPORT IS POSTED ON ITS WEBSITE AT WWW.IOWAHEALTH.ORG. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. PART I, LINE 7G: THE NET COMMUNITY BENEFIT COST OF SUBSIDIZED HEALTH SERVICES OF $666,823 IS ATTRIBUTED TO A PHYSICIAN CLINIC. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 20910718. 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 CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES 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. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES 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 THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR CENTRAL IOWA HOSPITAL CORPORATION. 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 $13,715,801. IN ADDITION TO THESE ITEMS THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM DO NOT INCLUDE MEDICARE PHYSICIAN FEE SCHEDULE EXPENSE OF $20,289,490 AND REVENUE OF $9,920,669. AFTER TAKING THESE ITEMS INTO ACCOUNT WE CALCULATE AN ACTUAL MEDICARE SHORTFALL OF $24,084,622.THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. 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: CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN CENTRAL IOWA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES IS A SPONSORING PARTNER OF HEALTHY POLK WHICH IS A COMMUNITY COLLABORATIVE CONVENED BY POLK COUNTY HEALTH DEPARTMENT TO ASSESS, ADDRESS AND MONITOR THE HEALTH NEEDS OF POLK COUNTY. THROUGH A PLANNED AND ORGANIZED EFFORT, HEALTHY POLK DEVELOPS A HEALTH AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES THAT ARE RELEVANT TO THE COMMUNITY. HEALTHY POLK WORKS COLLECTIVELY TO ADDRESS THE PRIORITIES THROUGH LEVERAGING THE RESOURCES OF THE COMMUNITY. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES, AS A SPONSORING AGENCY, 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, HEALTHY POLK 2020 HAS DEVELOPED A MEASUREMENT PROCESS TO EVALUATE EFFECTIVENESS AS WELL AS NEED. HEALTHY POLK CONVENES TWO TOWN HALL MEETINGS ANNUALLY TO SEEK PUBLIC INPUT ON HEALTH INITIATIVES. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES IS ALSO A SPONSORING PARTNER IN DALLAS COUNTY PARTNERSHIP FOR HEALTH. THIS COLLABORATIVE ALSO COMPLETES A COMMUNITY HEALTH ASSESSMENT. FROM THIS, PRIORITIES AND STRATEGIES HAVE BEEN IDENTIFIED. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES HAS ACTIVELY ENGAGED IN ADDRESSING AND MONITORING HEALTH ISSUES AND NEEDS AS A RESULT OF THIS PROCESS.CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES ALSO PARTICIPATES AS PART OF THE UNITED WAY COMMUNITY IMPACT COMMITTEE. THIS GROUP ACTIVELY ADDRESSES NEED AND STRATEGIES ASSOCIATED WITH HEALTH. MORE SPECIFICALLY, THIS GROUP OFTEN FOCUSES ON THE SOCIAL DETERMINANTS OF HEALTH AND HOW TO IMPACT THEM IN THE EFFORT TO RAISE THE COMMUNITY HEALTH STATUS. THIS WIDE-BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES 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, CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO ITS 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: CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR BROCHURES IN APPROPRIATE AREAS OF THE PROVIDER (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THE PROVIDER/PHYSICIAN PRACTICE OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE. PART VI, LINE 4: CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES IS A 779-BED COMMUNITY HOSPITAL SYSTEM SERVING CENTRAL IOWA. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF DALLAS, GUTHRIE, JASPER, MADISON, MARION, POLK, STORY, AND WARREN. CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES ADMITS 31,184 INPATIENTS AND CARES FOR 80,267 EMERGENCY PATIENTS PER YEAR. THERE ARE 34 OTHER HOSPITALS WITHIN THE 30-COUNTY SERVICE AREA. MEDIAN HOUSEHOLD INCOMES RANGE FROM $45,594.00 TO $67,146.00 AND THE AVERAGE POVERTY RATE IS 9.81%. 51% OF CENTRAL IOWA HOSPITAL CORPORATION D/B/A IOWA HEALTH DES MOINES PATIENTS ARE ELIGIBLE FOR MEDICARE (40%) OR MEDICAID (11%). DALLAS, POLK AND STORY COUNTIES ARE THE ONLY COUNTIES IN THE SERVICE AREA WITH SIGNIFICANT MINORITY POPULATIONS. DALLAS COUNTY IS 6% HISPANIC, POLK COUNTY IS 5% AFRICAN AMERICAN, POLK COUNTY IS 6% HISPANIC, AND STORY COUNTY IS 6% ASIAN. PART VI, LINE 6: THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE. PART VI, LINE 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 1 AMERICAN HEART ASSOCIATION 1111 NINTH STREET SUITE 280 DES MOINES IA 50314 135613797 501(C)3 12500 EVENT SPONSOR ARTHRITIS FOUNDATION 2600 72ND ST STE D DES MOINES IA 503224724 264629290 501(C)3 9002 EVENT SPONSOR BRAS FOR THE CAUSE - IOWA FOUNDATION INC 650 S PRAIRIE VIEW DR SUITE 125 WEST DES MOINES IA 50266 230446913 501(C)3 75000 EVENT SPONSOR BRAVO GREATER DES MOINES 1915 GRAND AVE DES MOINES IA 50309 203598346 501(C)3 10000 EVENT SPONSOR BROADLAWNS MEDICAL CENTER 1801 HICKMAN RD DES MOINES IA 50314 421527407 501(C)3 1400000 CAPITAL BUILDING CAMPAIGN CENTRAL IOWA HEALTH SYSTEM 1200 PLEASANT STREET DES MOINES IA 50309 421189791 501(C)3 123784 PROGRAM SUPPORT CITY OF DES MOINES 400 ROBERT D RAY DRIVE DES MOINES IA 50309 426004514 GOVERNMENT 179716 PAYMENT IN LIEU OF TAXES CIVIC CENTER OF GREATER DES MOINES 221 WALNUT ST DES MOINES IA 50309 510138181 501(C)3 10000 CAPITAL BUILDING CAMPAIGN DES MOINES AREA COMMUNITY COLLEGE FOUNDATION 2006 S ANKNEY BLVD ANKENY IA 500233993 237229486 501(C)3 50525 EVENT SPONSOR DES MOINES UNIVERSITY 3200 GRAND AVE DES MOINES IA 50312 420730347 501(C)3 20000 CAPITAL BUILDING CAMPAIGN GREATER DES MOINES COMMUNITY FOUNDATION 1915 GRAND AVE DES MOINES IA 50309 426139033 501(C)3 58300 PROGRAM SUPPORT IOWA CAREGIVERS 1211 VINE ST STE 1000 WEST DES MOINES IA 502654478 421457592 501(C)3 10000 PROGRAM SUPPORT IOWA CLINIC HEALTHCARE FOUNDATION 1215 PLEASANT ST SUITE 618 DES MOINES IA 50309 810599749 501(C)3 10000 EVENT SPONSOR IOWA HEALTH SYSTEM 1200 PLEASANT STREET DES MOINES IA 50309 421435199 501(C)3 365446 PROGRAM SUPPORT JUVENILE DIABETES RESEARCH FOUNDATION 5444 NW 96TH ST SUITE A JOHNSTON IA 50131 421907729 501(C)3 71500 EVENT SPONSOR MARCH OF DIMES 111 9TH STE 270 DES MOINES IA 50314 131846366 501(C)3 22500 EVENT SPONSOR MEALS FROM THE HEARTLAND PO BOX 71606 CLIVE IA 50325 263443290 501(C)3 10000 EVENT SPONSOR OPERATION DOWNTOWN 700 LOCUST STREET SUITE 100 DES MOINES IA 50309 861058466 501(C)6 35000 PROGRAM SUPPORT PRINCIPAL CHARITY CLASSIC 2771 104TH ST STE 1 URBANDALE IA 50322 426139033 501(C)3 85000 EVENT SPONSOR PUBLIC LIBRARY OF DES MOINES FOUNDATION PO BOX 93243 400 LOCUST ST STE 350 DES MOINES IA 50393 421484890 501(C)3 20000 CAPITAL BUILDING CAMPAIGN STAGEWEST THEATER COMPANY PO BOX 12127 DES MOINES IA 50312 311636048 501(C)3 7500 EVENT SPONSOR TCOYD 1110 CAMINO DEL MAR STE B DEL MAR CA 92014 330794608 501(C)3 5000 EVENT SPONSOR THE GREATER DES MOINES PARTNERSHIP 700 LOCUST STREET SUITE 100 DES MOINES IA 50309 421489668 501(C)6 205000 CAPITAL BUILDING CAMPAIGN WAUKEE AREA ARTS COUNCIL PO BOX 790 WAUKEE IA 50263 562472267 501(C)3 5000 EVENT SPONSOR 21 3 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CENTRAL IOWA HOSPITAL CORPORATION REQUIRES EACH RECIPIENT OF THE GRANTS (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINE A SERIES OF ELIGIBLITY STANDARDS THAT ARE REQUIRED TO BE MET. 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 ERIC CROWELL 512213 0 196475 0 62546 0 294805 0 18949 0 1084988 0 0 0 JOHN HEFFERNAN MD 376503 0 9707 0 6216 0 44290 0 16144 0 452860 0 0 0 WILLIAM YOST MD 0 219096 0 0 0 100 0 42032 0 19809 0 281037 0 0 JOSEPH CORFITS 280997 0 86516 0 45037 0 104522 0 20119 0 537191 0 0 0 SUSAN ALLYN 197445 0 58870 0 54921 0 125797 0 1338 0 438371 0 27541 0 AMY BETHEL 129942 0 21272 0 3010 0 32380 0 16707 0 203311 0 0 0 CHRISTINE BLAIR 142518 0 46331 0 15766 0 45535 0 21611 0 271761 0 0 0 DOUGLAS DORNER MD 351496 0 109745 0 169648 0 29263 0 17592 0 677744 0 140313 0 CECELIA KIRVIN 127224 0 39874 0 3482 0 18040 0 11315 0 199935 0 0 0 ERIC LOTHE 263987 0 50039 0 36378 0 38172 0 26293 0 414869 0 0 0 JOYCE MCDANEL 142396 0 28822 0 2404 0 8671 0 12666 0 194959 0 0 0 MARK PURTLE MD 340008 0 98426 0 28425 0 162414 0 18819 0 648092 0 0 0 SIDNEY RAMSEY 221472 0 67726 0 44044 0 94941 0 5019 0 433202 0 0 0 JEANETTE SHELTON 147255 0 20582 0 18540 0 33253 0 16386 0 236016 0 0 0 DAVID STARK 302273 0 35046 0 70620 0 42149 0 15404 0 465492 0 0 0 STEPHEN STEPHENSON MD 355252 0 109070 0 52208 0 170774 0 12315 0 699619 0 0 0 TIMOTHY HART MD 964087 0 50000 0 81844 0 12250 0 28462 0 1136643 0 0 0 AMAR NATH MD 970341 0 50000 0 77123 0 12250 0 26178 0 1135892 0 0 0 PRASAD PALAKURTHY MD 736891 0 0 0 57408 0 12250 0 19454 0 826003 0 0 0 JOHN PARGULSKI DO 705334 0 0 0 55364 0 12000 0 25357 0 798055 0 0 0 CRAIG STEVENS MD 714139 0 50000 0 56591 0 12250 0 27528 0 860508 0 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: JOSEPH CORFITS $29,711, ERIC CROWELL $270,012, DOUG DORNER $7,119, JOHN HEFFERNAN $4,771, ERIC LOTHE $25,922, MARK PURTLE $150,164, SIDNEY RAMSEY $24,960, DAVID STARK $17,612, STEPHEN STEPHENSON $158,524, WILLIAM YOST $12,746. TIMOTHY HART RECRUITMENT INDUCEMENT X 229863 122594 0 1 1 AMAR NATH RECRUITMENT INDUCEMENT X 229863 122594 0 1 1 PRASAD PALAKURTHY RECRUITMENT INDUCEMENT X 229863 122594 0 1 1 JOHN PARGULSKI RECRUITMENT INDUCEMENT X 229863 122594 0 1 1 CRAIG STEVENS RECRUITMENT INDUCEMENT X 229863 122594 0 1 1 DAVID STARK RECRUITMENT INDUCEMENT X 60000 48760 0 1 1 661730 1776 WESTLAKES PARKWAY LC COMMON BOARD MEMBER/OFFICER 730000 INVESTMENT 0 CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC COMMON BOARD MEMBER/OFFICER 82000 INVESTMENT AND FINANCIAL SERVICES 0 IOWA HEALTH SYSTEM CONTRACTING SERVICES LC COMMON BOARD MEMBER/KEY EMPLOYEE 756123 PERFORMANCE OF SERVICES 0 HEALTH SYSTEM EMERGENCY PHYSICIANS COMMON BOARD MEMBER/OFFICER 800000 RENTAL INCOME AND PURCHASED SERVICES 0 HUBBELL REALTY COMPANY COMMON BOARD MEMBER/OFFICER 1591000 RENT 0 IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC COMMON BOARD MEMBER/OFFICER 1995000 INVESTMENT AND LAUNDRY 0 IOWA KIDNEY STONE CENTER COMMON BOARD MEMBER/OFFICER 458000 INVESTMENT 0 LAKEVIEW SURGERY CENTER LC COMMON BOARD MEMBER/OFFICER 1219000 INVESTMENT, SUPPLIES, FINANCIAL SERVICES, MAINTENANCE, TRANSCRIPTION, PHARMACISTS, BIO-TECH 0 RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC COMMON BOARD MEMBER/KEY EMPLOYEE 175611 EXPENSE REIMBURSMENT 0 ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC COMMON BOARD MEMBER/OFFICER 961000 INVESTMENT, SUPPLIES, LAUNDRY, MAINTENANCE, BIO-TECH, ETC. 0 TRACY EKHARDT MD FAMILY MEMBER OF KEY EMPLOYEE STEPHEN STEPHENSON, MD 352452 EMPLOYMENT 0 WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC COMMON BOARD MEMBER/OFFICER 40000 INVESTMENT AND FINANCIAL SERVICES 0 WEST LAKES SLEEP CENTER LLC COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 130000 INVESTMENT 0 WINIFRED HALL FAMILY MEMBER OF KEY EMPLOYEE JEANETTE SHELTON 42535 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 BISHOP MICHAEL BURK; KENT HENNING; BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 2 KENT HENNING; ERIC CROWELL; BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 2 BISHOP MICHAEL BURK; ERIC CROWELL; BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 CENTRAL IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A CENTRAL IOWA HEALTH SYSTEM ELECTS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CENTRAL IOWA HEALTH SYSTEM ELECTS AND CAN REMOVE BOARD OF DIRECTORS, APPROVE AMENDMENTS TO ARTICLES AND BYLAWS, AND APPROVE DISSOLUTIONS OR MERGER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND REPORTING PHYSICIANS ARE REQUESTED TO COMPLETE A QUESTIONNAIRE TO REPORT POTENTIAL CONFLICTS OF INTEREST. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE ANNUAL QUESTIONNAIRES INCLUDE AN ACKNOWLEDGEMENT THAT THE OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN: 1) HAS ACCESS TO A COPY OF THE CONFLICT OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. SENIOR ADMINISTRATIVE STAFF AT ALL RELATED ORGANIZATIONS PROVIDE INFORMATION TO A CENTRAL COORDINATOR RELATED TO THE IDENTIFICATION OF WHICH INDIVIDUALS SHOULD RECEIVE THE QUESTIONNAIRE FOR COMPLETION. THE RESULTS ARE COMPILED CENTRALLY AND REVIEWED BY THE IOWA HEALTH SYSTEM COMPLIANCE OFFICER AND DIRECTOR OF INTERNAL AUDIT. THE DETAIL RESULTS ARE REPORTED TO A COMMITTEE OF THE SYSTEM BOARD. THE RESULTS RELATED TO SPECIFIC REGIONAL PARENT COMPANIES, THEIR HOSPITALS AND RELATED ORGANIZATIONS, ARE DISTRIBUTED IN DETAIL TO THE CHAIRPERSON OF THE REGIONAL PARENT ORGANIZATION, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND COMPLIANCE MANAGER. THESE INDIVIDUALS ARE ALSO REMINDED OF THE APPROPRIATE PROCESS TO BE FOLLOWED DURING THE YEAR TO ADDRESS POTENTIAL CONFLICTS OF INTEREST THAT RELATE TO MATTERS THAT ARE BROUGHT TO THE BOARD OF DIRECTORS FOR ACTION. THE INFORMATION DISCLOSED IS USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICAID QUESTIONNAIRES. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN TOGETHER WITH ALL MATERIAL FACTS, SHOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST OCCURS OR BECOMES A MATTER OF BOARD ACTION. ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN HAVING A CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT BE PRESENT DURING GENERAL DISCUSSION NOR VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM FOR PURPOSES OF THE MATTER OR ITEM AS TO WHICH A CONFLICT EXISTS. THE BOARD SHOULD EXCLUDE THE INDIVIDUAL FROM ANY DISCUSSION OR VOTE IN WHICH THE BOARD DECIDES WHETHER OR NOT A CONFLICT OF INTEREST EXISTS. IN CASES IN WHICH AN OFFICER, DIRECTOR, KEY EMPLOYEE, REPORTING PHYSICIAN OR THE INDIVIDUAL'S HOUSEHOLD MEMBER HAS A CONFLICT OF INTEREST IN AN ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN AT THE DIRECTION OF THE BOARD OF DIRECTORS: 1) AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL 1) DECIDE IF A CONFLICT OF INTEREST EXISTS, 2) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION; 3) IN ORDER TO APPROVE THE ARRANGEMENT OR TRANSACTION, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED MEMBERS, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED MEMBERS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS SHALL CONTAIN: 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; 2) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH; IN ORDER TO PROTECT THE ORGANIZATION'S BEST INTERESTS, APPROPRIATE DISCIPLINARY ACTION MAY BE TAKEN WITH RESPECT TO AN OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN WHO VIOLATES THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS ("COMMITTEE") CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS ANNUAL REVIEW COMPARES THE TOTAL COMPENSATION AND VALUE OF BENEFITS PROVIDED TO EACH EXECUTIVE, ON A POSITION BY POSITION BASIS, TO THAT PROVIDED TO FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED ORGANIZATIONS. THIS REVIEW IS CONDUCTED BY THE COMMITTEE WITH THE ASSISTANCE OF A NATIONAL, INDEPENDENT COMPENSATION CONSULTANT REPORTING DIRECTLY TO THE COMMITTEE. THE COMMITTEE HAS BEEN DELEGATED THE RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION AND IS MADE UP ENTIRELY OF INDEPENDENT DIRECTORS WITHIN THE MEANING OF THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE FEDERAL INCOME TAX INTERMEDIATE SANCTIONS RULES. THE COMPENSATION CONSULTANT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT, PERFORMS THESE VALUATIONS ON A REGULAR BASIS, IS QUALIFIED TO MAKE THE VALUATIONS OF THE SERVICES INVOLVED, AND HAS SO INDICATED IN A WRITTEN CERTIFICATION TO THE COMMITTEE. BASED UPON THE ADVICE OF THE COMPENSATION CONSULTANT, AND APPLYING THE BOARD'S COMPENSATION PHILOSOPHY, THE COMMITTEE ESTABLISHES THE OVERALL ADJUSTMENT IN COMPENSATION AND BENEFITS FOR APPROXIMATELY THE TOP FIFTY EXECUTIVES IN THE ENTIRE HEALTH SYSTEM (SEVERAL OF WHICH ARE EMPLOYEES OF THE FILING ORGANIZATION) AND DELEGATES TO THE CEO THE AUTHORITY TO MAKE ADJUSTMENTS, CONSISTENT WITH THE COMMITTEE'S DIRECTION, FOR THE OTHER EXECUTIVES. THE COMMITTEE DETERMINES ALL ASPECTS OF THE COMPENSATION AND BENEFITS OF THE CEO. THE COMMITTEE INTENTIONALLY TAKES ALL THE STEPS NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES, INCLUDING CONTEMPORANEOUS SUBSTANTIATION OF ALL COMMITTEE MEETINGS AND ACTIONS. THE ORGANIZATION BELIEVES IT IS IN FULL COMPLIANCE WITH SECTION 4958 OF THE IRC, PROVIDES NO MORE THAN REASONABLE AND FAIR MARKET VALUE COMPENSATION AND BENEFITS FOR ITS EMPLOYEES AND DOES NOT PROVIDE ANY EXCESS COMPENSATION OR BENEFITS AS PROHIBITED BY SECTION 4958. THE ANNUAL REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2010 FOR THE FOLLOWING INDIVIDUALS: SUSAN ALLYN, JOSEPH CORFITS, ERIC CROWELL, DOUGLAS DORNER, ERIC LOTHE, JOYCE MCDANEL, MARK PURTLE, SIDNEY RAMSEY, DAVID STARK, STEPHEN STEPHENSON. 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: 14,655,497. CHANGE IN BENEFICIAL INTEREST OF IOWA HEALTH FOUNDATION 834,397. CHANGES IN PENSION LIABILITY -2,497,305. TOTAL TO FORM 990, PART XI, LINE 5: 12,992,589. 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