2022-06-29T09:18:31-05:00 2021-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 421058745 Northeast Iowa Medical Education Foundation Inc NORT 3192722525 2055 Kimball Avenue 101 Waterloo IA 50702 Anthony A Day MD Executive Director 3192722525 2022-06-28 1 Anthony Day MD 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-06-28 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X Anthony A Day MD 2055 Kimball Avenue 101 Waterloo IA 50702 0 0 X www.familypracticeresidency.org X 1975 IA Develop excellent Family Medicine physicians. X 12 12 0 12 0 0 4592643 0 3931460 0 -8035 0 0 0 8516068 0 0 0 0 0 4737797 13418 0 0 0 2494834 871980 7232631 885398 1283437 -885398 3029033 0 247636 0 2781397 0 X Developing excellent Family Medicine physicians by modeling and teaching compassionate and comprehensive patient care delivered with the highest quality. 0 1 821339 The Northeast Iowa Medical Education Foundation was founded in 1975 to develop a Family Medicine training program. The Organization administratively dissolved on September 7, 2021. 821339 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Julie Smith 3192722112 2055 Kimball Avenue Ste 101 Waterloo IA 50702 X Anthony A Day MD Executive Director 5.00 X X 0 0 0 Russel Adams MD President 0.10 X X 0 0 0 Matthew Sojka MD Vice President 0.10 X X 0 0 0 Jack Dusenbery Secretary 0.10 X X 0 0 0 Pamela Delagardelle Treasurer 0.10 X X 0 0 0 Eric Neverman DO Director 0.10 X 0 0 0 Vinko Bogdanic MD Director 0.10 X 0 0 0 Adriane Argenio MD Director 0.10 X 0 0 0 Julie Sandell DO Director 0.10 X 0 0 0 Greg Nelson Director 0.10 X 0 0 0 Attiq-UR Rehman MD Director 0.10 X 0 0 0 Dan Glascock MD Director 0.10 X 0 0 0 Julie Smith Clinical Operations Manager 10.00 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2351 2351 8507 8507 2560 2560 1927 1927 25381 25381 172667 172667 96037 96037 36751 36751 52030 52030 478221 478221 Patient refunds 8966 8966 885398 821339 64059 0 1000 0 495447 0 49160 0 308555 0 0 0 0 0 182026 0 0 455808 0 141784 0 0 0 0 1395253 0 3029033 0 174523 73113 247636 0 X 2781397 0 2781397 0 3029033 0 X -885398 -1895999 X 0 0 0 X 3745630 3464023 3582952 4592643 15385248 3787265 4117044 3952616 3931460 15788385 7532895 7581067 7535568 8524103 31173633 0 0 0 31173633 3389 4241 4242 5478 17350 3389 4241 4242 5478 17350 7536284 7585308 7539810 8529581 31190983 0.99940 0.99940 0.00060 0.00060 X Schedule A, Part III, Section A, column (e): No revenue is shown as the Organization is preparing a short year, final Form 990 and did not have any activity that generated revenue. Cash 2021-07-01 800000 Book value 420698265 UnityPoint Health - Allen Hospital 1825 Logan Ave Waterloo IA 50703 501(c)(3) Cash 2021-07-01 580000 Book value 421264647 Covenant Medical Center - MercyOne Waterloo Medical Center 3421 W 9th St Waterloo IA 50702 501(c)(3) Leasehold Improvement 2021-07-01 328530 Book value 421264647 Covenant Medical Center - MercyOne Waterloo Medical Center 3421 W 9th St Waterloo IA 50702 501(c)(3) Grant and research contracts 2021-07-01 63327 Book value 421264647 Covenant Medical Center - MercyOne Waterloo Medical Center 3421 W 9th St Waterloo IA 50702 501(c)(3) Cash 2022-03-31 124142 Book value 421264647 Covenant Medical Center - MercyOne Waterloo Medical Center 3421 W 9th St Waterloo IA 50702 501(c)(3) 1 1 0 0 1 1 1 1 0 Part I, Line 2e: Explanation of Involvement: Russell Adams, MD, board President, is CMO of UnityPoint Health Allen Hospital.Matthew Sojka, MD, board Vice President, is VP of Medical Affairs and Trustee Director of Covenant Medical Center MercyOne Waterloo Medical Center.Jack Dusenbery, board Secretary, is President and CEO Covenant Medical Center MercyOne Waterloo Medical Center.Pamela Delagardell, board Treasurer, is CEO of UnityPoint Health Allen Hospital.Dan Glascock, MD, board Director, is Physician Director of UnityPoint Health Allen Hospital.Vinko Bogdanic, MD, board Director, is Physician Director of UnityPoint Health Allen Hospital.Julie Sandell, DO, board Director, is Physician Director of Covenant Medical Center MercyOne Waterloo Medical Center.Adriane Argenio, MD, board Director, is Physician Director of Covenant Medical Center MercyOne Waterloo Medical Center.Eric Neverman, DO, board Director, is Physician Director of UnityPoint Health Allen Hospital.Attiq-UR Rehman, MD, board Director, is Physician Director of Covenant Medical Center MercyOne Waterloo Medical Center.The individuals held the positions with the transferee organizations before and after the dissolution. Form 990, Part III, line 3 Northeast Iowa Medical Education Foundation administratively dissolved effective September 7, 2021. Form 990, Part VI, Section A, line 1a The Executive Committee is composed of the officers elected by the Board of Directors. The Executive Committee has authority to transact all regular business of the organization during the period between the meetings of the Board of Directors subject to any prior limitation imposed by the Board of Directors. Form 990, Part VI, Section A, line 4 MercyOne and Allen were the members of Northeast Iowa Medical Education Foundation, Inc., an Iowa nonprofit corporation. The Members effectively dissolved the corporation on July 1, 2021. The Organization administratively dissolved with the State of Iowa effective September 7, 2021. Form 990, Part VI, Section A, line 6 The members of Northeast Iowa Medical Education Foundation are Unity Point Health - Allen and MercyOne Waterloo Medical Center. New members may be admitted only with the unanimous consent of the present members. Form 990, Part VI, Section A, line 7a The two members, Unity Point Health - Allen and MercyOne Waterloo Medical Center, appoint the Board of Directors of Northeast Iowa Medical Education Foundation Inc. The President/Chief Executive Officer of each of the Members are automatically, by virtue of their office, Directors of this corporation. The Executive Director of the Northeast Iowa Medical Education Foundation, Inc. serves on the Board. A representative of the University of Iowa College of Medicine serves on the Board as appointed by the Dean of the College. Each Member appoints to the Board of Directors two persons who are members of the medical staff of the appointing Member, and two persons who are also directors of the appointing Member, or an affiliated organization of such appointing Member. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the governing body. The Executive Director and Administrator review the 990 before it is filed. Form 990, Part VI, Section B, line 12c Board members and officers are required to sign a conflict of interest statement annually. The statements are reviewed by the Administrator of the organization. Any potential conflict is brought to the Board's attention for discussion. In the event of a potential conflict, the Member will disclose the potential conflict and either abstain from involvement or discussion of the issue leading to the conflict or resign. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon written request. Form 990, Part IX, line 11g Purchased services: Program service expenses 172,667. Management and general expenses 0. Fundraising expenses 0. Total expenses 172,667. Form 990, Part XI, line 9: Asset transfers due to dissolution -1,895,999.