2019-11-14T14:54:41-06:00 2018-12-31 990 2018-01-01 370692351 PEKIN MEMORIAL HOSPITAL PEKI 3093530700 600 SOUTH 13TH STREET PEKIN IL 61554 ROBERT A QUIN VP FINANCE/CFO 3096724893 2019-11-13 205.167.2.34 2019-11-13 11:12:01 CS P 8902F0315789D87F117F8AA9CDCEB0C04F949551 8902F0315789D87F117F8AA9CDCEB0C04F949551 2018 2020-03-31 21:24:44Z UNITYPOINT HEALTH-PEKIN ROBERT A QUIN 600 SOUTH 13TH STREET PEKIN IL 61554 62931745 0 X WWW.UNITYPOINT.ORG/PEORIA X 1913 IL IMPROVE HEALTH AND WELL-BEING OF COMMUNITY WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. 13 8 817 127 0 4108 205233 51006 60498800 57272617 1066518 734294 714836 996165 62485387 59054082 629769 95165 0 0 34842834 25523095 0 0 0 28770372 31758981 64242975 57377241 -1757588 1676841 48434799 63999249 35782407 50572430 12652392 13426819 X TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. 0 0 44375894 520 57996021 HEALTH-CARE SERVICESPEKIN MEMORIAL HOSPITAL IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE PEKIN, ILLINOIS AND SURROUNDING COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. PEKIN MEMORIAL 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, INTENSIVE CARE AND CRITICAL CARE AND EMERGENCY SERVICES. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2018, PEKIN MEMORIAL HOSPITAL ADMITTED 2,562 PATIENTS RESULTING IN A TOTAL OF 9,056 PATIENT DAYS. OUTPATIENT VISITS TOTALED 80,300 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 3,526. THERE WERE ALSO 35,329 EMERGENCY ROOM VISITS AND 326 BABIES DELIVERED. 3435753 94645 0 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: PEKIN MEMORIAL 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 VALUE OF $337,393 IN 2018. OFTENTIMES, PEKIN MEMORIAL HOSPITAL RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. PEKIN MEMORIAL HOSPITAL PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. PEKIN MEMORIAL HOSPITAL'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $2,855,000 FOR 2018. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $3,192,393.OTHER BENEFITS: PEKIN MEMORIAL HOSPITAL PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; SUBSIDIZED HEALTH SERVICES; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. PEKIN MEMORIAL HOSPITAL COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. PEKIN MEMORIAL HOSPITAL HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $243,360. 47811647 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 817 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X TONY MOORE 3096725914 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 RUSTY DUNN BOARD SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 DELORES EAGLESON BOARD VICE CHAIR (TO 7/18) 1.00 1.00 X X 0 0 0 CURTIS EETEN BOARD MEMBER 1.00 1.00 X 0 0 0 ROSS GOULD BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL HONAN MD BOARD MEMBER 1.00 40.00 X 0 699157 22738 MARIA HORNSTEIN BOARD MEMBER 1.00 1.00 X 0 0 0 RONALD MILLER BOARD CHAIR 1.00 40.00 X X 0 0 0 F NANI MOAZZAM MD BOARD MEMBER 1.00 1.00 X 0 414580 1535 JASON PROEHL BOARD MEMBER 1.00 1.00 X 0 0 0 DIRK ROECKER BOARD MEMBER 1.00 1.00 X 0 0 0 DEBORAH SIMON PRES & CEO MHSC/BOARD MEMBER 1.00 40.00 X X 0 834573 60584 JAIMIE STEVENSON BOARD MEMBER 1.00 1.00 X 0 0 0 KAREN STUMPE BOARD MEMBER 1.00 1.00 X 0 0 0 ROBERT QUIN VP FINANCE/CFO, MHSC 1.00 40.00 X 0 463515 87647 JEANINE SPAIN VP, REGIONAL CNO/COO-PEKIN 20.00 20.00 X 0 422271 43245 ANGELIA DREHER PHARMACY MANAGER 40.00 0.00 X 143919 5245 24430 DURITA DRISKELL DIRECTOR PATIENT FIN SVCS 40.00 0.00 X 111824 0 2633 KAITLYN EDWARDS PHARMACIST 40.00 0.00 X 101257 111256 68 ASHOKKUMAR PATEL PHARMACIST 40.00 0.00 X 111816 8754 22495 APRIL WILLOBY PHARMACIST 40.00 0.00 X 103720 8414 14522 BOB HALEY FORMER CEO (TO 2017) 0.00 0.00 X 0 308994 1443 STEVE HALL FORMER CFO (TO 2017) 0.00 0.00 X 165087 0 8 737623 3276759 281348 6 1 1 0 RIVER CITY CONSTRUCTION LLC 101 HOFFER LN EAST PEORIA IL 61611 CONSTRUCTION 1242293 PROFESSIONAL THERAPY SERVICES 2810 FRANK SCOTT PARKWAY WEST BELLEVILLE IL 62223 REHAB SERVICES 663827 MIDWEST ANESTHESIA CONSULTANTS SC 4128 W STONEWATER DR PEORIA IL 61615 ANESTHESIA SERVICES 419437 SHEARWATER HEALTH INC 20 BURTON HILLS BLVD STE 400 NASHVILLE TN 37215 CONSULTING 269946 ARCHITECTURAL DESIGN GROUP INC 321 SW WATER ST STE 100 PEORIA IL 61602 CONSULTING 254406 20 51006 51006 NET PATIENT REVENUE 900099 30994958 30994958 PHARMACY REVENUE 900099 13802551 13802551 LABORATORY SERVICES 621500 12460530 12460530 RENTAL INCOME 531390 14553 14553 PUBLIC HEALTH PROGRAMS 900099 25 25 57272617 154284 55509 98775 4457673 3863133 14530 594540 -14530 580010 580010 80 0 80 80 DEFINED BENEFIT PENSION COST 900099 496710 496710 CAFETERIA/FOOD SVCS 722210 346708 18518 328190 MISCELLANEOUS 900099 152667 152667 996085 59054082 57996021 0 1007055 X 95165 95165 205655 205655 21174267 17713750 3460517 139871 117011 22860 2567124 2168117 399007 1436178 1201463 234715 7090000 3401736 3688264 68981 68981 25098 25098 87747 84469 3278 6932870 5624541 1308329 1204948 1106953 97995 1254203 1252748 1455 1568 960 608 4713 644 4069 395002 395002 3303390 3278672 24718 313870 313870 MEDICAL SUPPLIES 7828449 7812997 15452 MEDICAID PROVIDER ASSES 3236817 3236817 MISCELLANEOUS EXPENSE 12997 6732 6265 INCOME TAXES -1672 -1672 57377241 47811647 9565594 0 2011025 5138121 328561 2511106 12040130 11826895 6432217 20510824 1313032 1380044 1851067 338540 24523585 2756246 22009679 21767339 2449088 526380 48434799 63999249 5465201 3551746 857242 348328 2704008 4407450 26755956 42264906 35782407 50572430 X 12652392 13426819 12652392 13426819 48434799 63999249 X 1676841 -551028 -351386 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25098 25098 0 PART II-B, LINE 1: LOBBYING EXPENSES ARE ONLY INCURRED THROUGH MEMBERSHIP DUES (39% ATTRIBUTED TO LOBBYING) PAID TO THE ILLINOIS HOSPITAL ASSOCIATION. 2250000 2250000 7838055 197398 7640657 11897435 2498809 9398626 2538095 60039 2478056 21767339 MINIMUM PENSION LIABILITY 5974125 ESTIMATED SELF-INSURANCE COSTS 457360 DUE TO AFFILIATES 22696457 SELF-INSURANCE RESERVE 13136964 42264906 X 58505000 -551028 2924 -548104 59053104 978 978 59054082 57379000 2799 2799 57376201 978 62 1040 57377241 PART X, LINE 2: UNITYPOINT HEALTH 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 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 2015. THE 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, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES NETTED IN REVENUES 2,799. ROUNDING 125. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES NETTED IN REVENUES 2,799. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING 62. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 337393 337393 0.00590 14239000 11384000 2855000 0.04980 14576393 11384000 3192393 0.05570 105 105 0.00000 243255 243255 0.00420 243360 243360 0.00420 14819753 11384000 3435753 0.05990 0 1229872 0 15353246 15577025 -223779 X 1 1 1 1 PEKIN MEMORIAL HOSPITAL 600 SOUTH 13TH STREET PEKIN IL 61554 UNITYPOINT.ORG/PEORIA/DEFAULT.ASPX 001834 X X X PEKIN MEMORIAL HOSPITAL 0 0 1 X X X X X X X X X 16 1 1 1 1 X UNITYPOINT.ORG/PEORIA/DEFAULT.ASPX X 1 16 1 UNITYPOINT.ORG/PEORIA/DEFAULT.ASPX 0 1 X 200.000000000000 600.000000000000 X X X X X X X 1 1 X X X X 1 X UNITYPOINT.ORG/PEORIA/ADDITIONAL-FINANCIAL-ASSISTANCE-INFORMATION.ASPX X UNITYPOINT.ORG/PEORIA/ADDITIONAL-FINANCIAL-ASSISTANCE-INFORMATION.ASPX X UNITYPOINT.ORG/PEORIA/ADDITIONAL-FINANCIAL-ASSISTANCE-INFORMATION.ASPX X X X X X X 1 X 0 X X X X 1 X 0 0 PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS A COLLABORATIVE UNDERTAKING BY ORGANIZATIONS THAT REPRESENT THE INTERESTS OF THE POPULATION SERVED BY THE HOSPITAL. IN ADDITION TO HOSPITAL MEMBERS, THE COLLABORATIVE INCLUDED THE PEORIA CITY/COUNTY HEALTH DEPARTMENT, TAZEWELL COUNTY HEALTH DEPARTMENT, WOODFORD COUNTY HEALTH DEPARTMENT, HEART OF ILLINOIS UNITED WAY AND HEARTLAND COMMUNITY HEALTH CLINIC (A FEDERALLY QUALIFIED HEALTH CARE CENTER). EACH OF THESE ORGANIZATIONS SERVE/REPRESENT BOTH THE GENERAL AND AT-RISK POPULATION OF THE PRIMARY SERVICE AREA.IN ADDITION TO BROAD BASED REPRESENTATION ON THE COLLABORATIVE, THE CHNA INCLUDES A DETAILED ANALYSIS OF PRIMARY DATA COLLECTED FOR THE GENERAL POPULATION AND THE AT-RISK OR ECONOMICALLY DISADVANTAGED POPULATION. AREAS OF INVESTIGATION INCLUDED PERCEPTIONS OF THE COMMUNITY HEALTH ISSUES, UNHEALTHY BEHAVIORS, ISSUES WITH QUALITY OF LIFE, HEALTH BEHAVIORS AND ACCESS TO MEDICAL CARE, DENTAL CARE, PRESCRIPTION MEDICATIONS AND MENTAL HEALTH COUNSELING. ADDITIONALLY, DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS WERE UTILIZED TO PROVIDE INSIGHTS INTO WHY CERTAIN SEGMENTS OF THE POPULATION BEHAVED DIFFERENTLY. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: PEKIN MEMORIAL HOSPITAL CHNA WAS A COLLABORATIVE UNDERTAKING BY PROCTOR HOSPITAL, METHODIST MEDICAL CENTER OF ILLINOIS, KINDRED HOSPITAL, ADVOCATE EUREKA HOSPITAL, HOPEDALE MEDICAL CENTER, PEKIN HOSPITAL AND OSF SAINT FRANCIS MEDICAL CENTER TO HIGHLIGHT THE HEALTH NEEDS AND WELL-BEING OF RESIDENTS IN PEORIA, TAZEWELL, AND WOODFORD COUNTIES. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: PEORIA CITY/COUNTY HEALTH DEPARTMENT, TAZEWELL COUNTY HEALTH DEPARTMENT, WOODFORD COUNTY HEALTH DEPARTMENT, HEART OF ILLINOIS UNITED WAY, HEARTLAND COMMUNITY HEALTH CLINIC AND BRADLEY UNIVERSITY. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THREE MAJOR HEALTH NEEDS WERE IDENTIFIED IN THE PROGRESSIVE HEALTH SYSTEMS - PEKIN HOSPITAL 2016 CHNA: ACCESS TO CARE [UNINSURED/LIMITED INSURANCE; AND LACK OF PRIMARY CARE PHYSICIANS] AND HEALTHY BEHAVIORS & LIFESTYLE CHOICES. THESE NEEDS WERE IDENTIFIED AS PRIORITIES TO ADDRESS IN THE 2017 THROUGH 2019 PEKIN HOSPITAL CHNA IMPLEMENTATION PLAN. PEKIN HOSPITAL INTEGRATED INTO UNITYPOINT HEALTH BEGINNING IN JANUARY OF 2017.BELOW ARE EXAMPLES OF THE ACTIVITIES, MEASURES AND IMPACT FOR UNITYPOINT HEALTH PEKIN HOSPITAL DURING THE LAST THREE YEARS TO ADDRESS THESE NEEDS. 1 & 2. ACCESS TO HEALTHCARE MEASUREMENT AND IMPACT- PEKIN PATIENT NAVIGATORS ENROLLED 209 PATIENTS INTO COMMERCIAL PLANS IN 2017 AND 2018 AND MADE OVER 800 PUBLIC AID ENROLLMENTS- PEKIN PROVIDED OVER $2.4M IN CHARITY CARE IN 2017 AND 201- PEKIN INCREASED THE NUMBER OF PRIMARY CARE AND PEDIATRIC VISITS OVER FY 2016 THE BASE YEAR = 33,764; 2017 = 33,215 PRIMARY AND PEDIATRIC VISITS; 2018 = 38,368 PRIMARY AND PEDIATRIC VISITS; *2019 PROJECTED (BASED ON MAY YTD) = 40,740 PRIMARY AND PEDIATRIC VISITS- OTHER INITIATIVES: * PEKIN HOSPITAL OPENED A MEDICAL OFFICE BUILDING [PEKIN EAST] IN JANUARY 2018 AND WITH UPH EXPANDED THE NUMBER OF PRIMARY CARE PROVIDERS IN THE MARKET. THE MEDICAL OFFICE BUILDING LOCATED AT THE CORNER OF VETERANS DRIVE AND GRIFFIN AVENUE IS 52,000-SQUARE-FOOT, THREE STORY FACILITY. THE BUILDING WAS DESIGNED FOR EASE OF ACCESS TO AMBULATORY CARE FOR THE COMMUNITY. EACH FLOOR HAS 26 EXAM ROOMS AND TWO PROCEDURE ROOMS. PEDIATRICS IS LOCATED ON THE FIRST FLOOR AND OFFERS EXTENDED HOURS TO CATER TO WORKING PARENTS. FAMILY MEDICINE PROVIDERS ARE LOCATED ON THE FIRST AND SECOND FLOOR. THE BUILDING ALSO CONTAINS LAB AND RADIOLOGY SERVICES FOR ONE STOP HEALTH CARE. THE FIRST FLOOR ALSO CONTAINS A FIRST CARE CLINIC WHICH ACCEPTS WALK-IN AND PRIMARY CARE PATIENTS AS PER FIRST CARE'S OPEN ACCESS MODEL. THE BUILDING ALSO HAS A COMMUNITY ROOM FOR HEALTH EDUCATION CLASSES AND PHYSICIAN PRESENTATIONS. * THE THIRD FLOOR IS RESERVED FOR SPECIALTY SERVICES TO BE STAFFED BY AFFILIATED SPECIALISTS WITH UNITYPOINT HEALTH IN ORDER TO PROVIDE GREATER ACCESS TO SPECIALISTS FOR THE PEKIN COMMUNITY.- PEKIN IN-SCHOOL HEALTH PROGRAM EXPANDED TO ADDITIONAL SITES.3, HEALTHY BEHAVIORS AND LIFESTYLE CHOICES MEASUREMENT AND IMPACT- COMMUNITY SCREENINGS: PEKIN HOSPITAL PROVIDED A VARIETY OF FREE COMMUNITY SCREENINGS WITHIN THE PEKIN AREA. THE FOLLOWING SCREENINGS WERE PROVIDED: SKIN SCREENING, BONE DENSITY, HEEL SCANS, BLOOD PRESSURE CHECKS, BODY COMPOSITION, SPIROMETRY TESTING, AND PHYSICAL THERAPY FITNESS. THE FOLLOWING SCREENINGS WERE OFFERED AT VARIETY OF COMPANIES INCLUDING: PARKSIDE ATHLETICS CLUB, MILLER CENTER, MACKINAW COMMUNITY CENTER, PEKIN PARK DISTRICT FOR HEART OF ILLINOIS 50+ GAMES, RIVERPLEX IN PEORIA FOR THE NEW MILLENNIUM INSTITUTE COMMUNITY HEALTH AND WELLNESS EXPO, CEFCU IN PEORIA, CITY /COUNTY OF PEKIN HEALTH FAIR, AND PEKIN INSURANCE.- HULT CENTER EDUCATION PROGRAMS: OVER 6,000 PEKIN STUDENTS WERE PROVIDED HEALTHY EATING ACTIVE LIVING EDUCATION IN 2017 AND 2018 AND OVER 1,000 PEKIN PRE-K STUDENTS WERE PROVIDED HEALTH AND FITNESS EDUCATION THROUGH THE HULT CENTER'S 'YOUR AMAZING BODY' PROGRAM.- IN THE LAST 12 MONTHS [AUG 2018 THRU JUN 2019] UPH PEKIN IN-SCHOOL HEALTH EXPANDED TO ELEVEN SCHOOL SITES WITH OVER 50,000 VISITS TO THE HEALTH CENTERS AND 6,000 VISITS RELATED TO DIABETES AND HEALTHY EATING/ACTIVE LIVING PROGRAMS. - 2018 AND 2019: OVER 250 PEKIN ADULT PARTICIPANTS REGISTERED IN THE HULT ENCORE PROGRAM.- PROVIDED YEAR-LONG EVIDENCE BASED NATIONAL DIABETES PREVENTION PROGRAM IN 2018 TO NEARLY 20 PEKIN AREA HIGH-RISK PRE-DIABETIC ADULTS TO IMPLEMENT HEALTHY LIFESTYLE CHANGES FOR THE PREVENTION OF TYPE 2 DIABETES. TO DATE, THIS COHORT HAS LOST A TOTAL OF NEARLY 200 POUNDS TO REDUCE THEIR RISK FOR TYPE 2 DIABETES BY UP TO 71%.- AS PART OF NATIONAL MAMMOGRAPHY DAY, PEKIN HOSPITAL PARTNERED WITH TAZEWELL COUNTY HEALTH DEPARTMENT TO OFFER FREE MAMMOGRAMS TO TAZEWELL COUNTY WOMEN AGES 40 AND OVER WHO ARE UNINSURED. THERE WERE 17 FREE MAMMOGRAMS PROVIDED, WITH 13 NORMAL AND 4 ABNORMAL RESULTS. THIS WAS THE 15TH YEAR FOR THE ANNUAL EVENT.- HEALTH FAIRS: PEKIN HOSPITAL PARTICIPATED BY PROVIDING SCREENINGS AT A NUMBER OF LOCAL HEALTH FAIRS. * NEW MILLENNIUM INSTITUTE COMMUNITY HEALTH AND WELLNESS EXPO HELD IN PEORIA: 7 WERE SCREENED FOR BONE DENSITY, 13 FOR SPIROMETRY SCREENING AND 7 FOR FITNESS TESTING.* CEFCU EMPLOYEE HEALTH FAIR: 38 SCREENED FOR BONE DENSITY, 36 SCREENED FOR SPIROMETRY.* CITY OF PEKIN/TAZEWELL COUNTY HEALTH FAIR: 23 RECEIVED BONE DENSITY SCREENINGS, 27 HAD SKIN SCREENINGS, 7 SPIROMETRY SCREENINGS AND 35 HAD PHYSICAL THERAPY FITNESS SCREENINGS.* MILLER CENTER SENIOR FITNESS EVENT* DIABETES WORKSHOPS: ELEVEN (THREE-HOUR) COMMUNITY DIABETES CLASSES WERE OFFERED TO INCLUDE A TOTAL OF 80 PARTICIPANTS.* MEDICATION RECONCILIATION: TO RAISE COMMUNITY AWARENESS ON THIS TOPIC, WALLET CARDS THAT ASSIST PATIENTS IN KEEPING ACCURATE LISTS OF MEDICATIONS WERE PLACED IN ALL INPATIENT FOLDERS. THE WALLET CARDS WERE ALSO PROVIDED AT OUR RETAIL PHARMACY, SENIOR EXPO EVENTS, AND OTHER COMMUNITY EVENTS. * OVER 600 STUDENTS EDUCATED ON HEALTH AND WELLNESS THROUGH HULT DURING THE PEKIN HIGH SCHOOL HEALTH FAIR - APRIL 2019.- PUBLIC LECTURES AND PROGRAMS: * PEKIN HEAD START SCHOOL: SPOKE TO 120 PRESCHOOL CHILDREN AND THEIR TEACHERS ABOUT HEART HEALTH.* PHN LEAP INTO WELLNESS PROGRAM: OFFERED A FREE NINE WEEK WEIGHT LOSS PROGRAM TO 7 LOCAL BUSINESSES IN THE PHN NETWORK.* PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: PEKIN HOSPITAL REGISTERED DIETICIAN SPOKE TO 22 PARTICIPANTS ON MY PLATE GUIDELINES AND HOW TO READ FOOD LABELS.* PEKIN INSURANCE RETIREMENT GROUP SPEAKING ENGAGEMENT: DR. JOHN LINDELL SPOKE TO 38 RETIREES ABOUT HEALTHY EATING AND THE IMPORTANCE OF EXERCISE.* PEKIN HEAD START SCHOOL: SPOKE TO 120 PRESCHOOLERS ABOUT THE IMPORTANCE OF HEALTHY EATING AND THE MY PLATE GUIDELINES.* PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: DR. JOHN LINDELL SPOKE TO 14 PROGRAM PARTICIPANTS ABOUT FAST AND SLOW OXIDIZERS.* PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: FINANCIAL ADVISOR FROM UNLAND COMPANIES SPOKE TO PARTICIPANTS ABOUT FINANCIAL WELLNESS.* YWCA OF PEKIN: SPOKE TO 10 PARTICIPANTS ABOUT VOLUNTEERING IN THE LOCAL COMMUNITY.* PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: PROFESSIONAL THERAPY SERVICES SPOKE TO 10 PROGRAM PARTICIPANTS ABOUT ERGONOMICS IN THE WORKPLACE.* PHN LEAP INTO WELLNESS PROGRAM LUNCH AND LEARN: FINANCIAL ADVISOR FROM UNLAND COMPANIES SPOKE TO 5 PROGRAM PARTICIPANTS ABOUT FINANCIAL WELLNESS.* PEKIN PAIN MANAGEMENT/MIDWEST ORTHOPAEDIC COMMUNITY PRESENTATION: HIP AND JOINT AWARENESS 25 PARTICIPANTS.- 5K DASH AT DUSK * 465 PARTICIPANTS IN THE 2017 AND 2018 DASH TO DUSK- NUMBER OF PARTICIPANTS IN THE WEIGHT LOSS PROGRAM* 860 PARTICIPANTS IN THE 2017 AND 2018 WEIGHT LOSS PROGRAMS WITH OVER 2,130 LBS LOST- NUMBER OF PARTICIPANTS IN WELLNESS COACHING:* 2017: 598* 2018: 602ADDITIONAL PEKIN MARKET MEASUREMENT AND IMPACT- CANCER: 2019 OPENING OF A NEW UPH HIGH-RISK BREAST CLINIC IN PEKIN: JUNE 5, 2019 AT PEKIN EAST LOCATION. - SUBSTANCE ABUSE: LIMITING OPIOID SCRIPTS WITH PROGRESSIVE HEALTH PEKIN EMPLOYED PHYSICIANS.- ACCESS TO CARE: ADDITION OF UPH SPECIALISTS TO THE PEKIN MARKET TO PROVIDE GREATER ACCESS TO CARE. PEKIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM THE FOLLOWING PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSISTANCE: THE U.S. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE FOOD STAMP PROGRAM; WOMEN, INFANTS & CHILDREN (WIC); AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. THIRD PARTY AGENCIES ARE USED TO ASSIST WITH COLLECTIONS AND, IF THOSE AGENCIES PROVIDE A STATEMENT REGARDING A PATIENT'S LIKELY INCOME LEVEL, THAT INFORMATION IS USED IN DETERMINING THE ELIGIBILITY STATUS AND THE LEVEL OF DISCOUNT AVAILABLE. 2 1 - PEKIN HOSPITAL MRI BUILDING 1300 PARK AVENUE PEKIN IL 61554 DIAGNOSTIC CENTER 2 - PEKIN HOSPITAL PAIN MANAGEMENT LLC 600 SOUTH 13TH STREET PEKIN IL 61554 PAIN CLINIC PART I, LINE 6A: PEKIN MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE UNITYPOINT HEALTH COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. PART 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' 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 SHORTFALL 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 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: PEKIN HOSPITAL CONTRACTED WITH BKD, TO ASSIST WITH THE CREATION OF ITS STRATEGIC PLAN. THE COMMUNITY ASSESSMENT WAS PERFORMED THROUGH A SERIES OF FOCUS GROUPS, COMMUNITY SURVEYS, INTERNAL STATISTICAL DATA, AND COUNTY AND SERVICE AREA DEMOGRAPHICS. PART VI, LINE 3: THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE TO ALL PATIENTS AND WITHIN THE COMMUNITY. COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. THE CENTRAL BILLING OFFICE IS AVAILABLE BY PHONE TO ANSWER QUESTIONS ABOUT THE POLICY, OR PATIENTS SHOULD GO TO THE CASHIER'S OFFICE AT THE HOSPITAL TO OBTAIN THIS INFORMATION. THE PLAIN LANGUAGE SUMMARY IS OFFERED AS PART OF THE PATIENT INTAKE AND/OR DISCHARGE PROCESS AND INCLUDED WHEN A PATIENT IS SENT WRITTEN NOTICE THAT EXTRAORDINARY COLLECTION ACTIONS MAY BE TAKEN AGAINST HIM/HER. THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND ALL FINANCIAL ASSISTANCE FORMS ARE AVAILABLE IN ENGLISH AND IN ANY OTHER LANGUAGE IN WHICH LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS CONSTITUTE THE LESSER OF 1,000 PERSONS OR MORE THAN 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. THESE TRANSLATED DOCUMENTS WILL BE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. PART VI, LINE 4: PEKIN HOSPITAL PRIMARILY SERVES TAZEWELL, MASON AND PEORIA COUNTIES IN THE STATE OF ILLINOIS. IT IS ONE OF THE LARGEST EMPLOYERS IN THE CITY OF PEKIN AND IN TAZEWELL COUNTY. THE SERVICE AREA SITS TO THE SOUTH AND EAST OF THE GREATER PEORIA AREA, WHERE CATERPILLAR IS A MAJOR INDUSTRIAL EMPLOYER. ITS PRIMARY SERVICE AREA HAS A POPULATION OF 34,000 WITH A SECONDARY SERVICE AREA OF APPROXIMATELY 78,000. THE MEDIAN AGE OF ITS SERVICE AREA IS 41 YEARS, WHILE THE MEDIAN HOUSEHOLD INCOME IS $53,000. PART VI, LINE 5: PEKIN HOSPITAL PROVIDES MANY FREE HEALTH SCREENINGS THROUGHOUT THE YEAR TO PROMOTE EARLY DETECTION AND PREVENTION. THIS INCLUDES BUT IS NOT LIMITED TO MAMMOGRAPHY, BONE DENSITY, BLOOD PRESSURE, COLON, OBESITY AND SPIROMETRY. PEKIN HOSPITAL HAS ENGAGED ITS PHYSICIANS TO SPEAK AT DIFFERENT COMMUNITY ORGANIZATIONS, TO SHARE INFORMATION ON HEALTH AND WELL-BEING. IT HAS ALSO SENT REPRESENTATIVES OUT TO DISCUSS HEALTHCARE REFORM. PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THROUGH RELATIONSHIPS WITH 36 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 280 PHYSICIAN CLINICS, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERN ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY A LARGE NONPROFIT WORKFORCE, WITH MORE THAN 30,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 6.5 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $4.4 BILLION, UNITYPOINT HEALTH IS THE FIFTH LARGEST NONDENOMINATIONAL HEALTH SYSTEM IN AMERICA AND PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES TO IMPROVE THE HEALTH OF PEOPLE IN ITS COMMUNITIES. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES THROUGHOUT IOWA, AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THE STATE. IN 2018, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $559 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY UNITYPOINT HEALTH AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 PEKIN MEMORIAL HOSPITAL FOUNDATION 600 S 13TH STREET PEKIN IL 61554 371200267 501(C)(3) 95165 PROGRAM SUPPORT 1 0 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. 1 X X 1 1 0 0 0 0 0 0 0 MICHAEL HONAN MD BOARD MEMBER 0 453114 0 244421 0 1622 0 -5 0 22743 0 721895 0 0 F NANI MOAZZAM MD BOARD MEMBER 0 406514 0 7500 0 566 0 0 0 1535 0 416115 0 0 DEBORAH SIMON PRES & CEO MHSC/BOARD MEMBER 0 574808 0 89920 0 169845 0 44565 0 16019 0 895157 0 0 ROBERT QUIN VP FINANCE/CFO, MHSC 0 333207 0 59897 0 70411 0 74721 0 12926 0 551162 0 66031 JEANINE SPAIN VP, REGIONAL CNO/COO-PEKIN 0 309157 0 54032 0 59082 0 27535 0 15710 0 465516 0 0 ANGELIA DREHER PHARMACY MANAGER 139516 5245 0 0 4403 0 0 0 23505 925 167424 6170 0 0 KAITLYN EDWARDS PHARMACIST 101226 111225 0 0 31 31 0 0 32 36 101289 111292 0 0 BOB HALEY FORMER CEO (TO 2017) 0 6462 0 22400 0 280132 0 1443 0 0 0 310437 0 0 STEVE HALL FORMER CFO (TO 2017) 0 0 0 0 165087 0 0 0 8 0 165095 0 0 0 PART I, LINES 4A-B SEVERANCE PAYMENTS: THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS DURING THE YEAR THAT WERE INCLUDED IN THEIR TAXABLE INCOME: BOB HALEY $280,000; STEVE HALL $164,752. NONQUALIFIED RETIREMENT PLAN EARNINGS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: ROBERT QUIN $56,921, DEBORAH SIMON $106,400, JEANINE SPAIN $49,030. JACOB MILLER FAMILY MEMBER OF BOARD MEMBER RONALD MILLER 22938 EMPLOYMENT 0 MEGAN GOULD FAMILY MEMBER OF BOARD MEMBER ROSS GOULD 17622 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 PROGRESSIVE HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, PROGRESSIVE HEALTH SYSTEMS, HAS THE POWER TO ELECT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, PROGRESSIVE HEALTH SYSTEMS, HAS THE RIGHT TO APPROVE THE FOLLOWING DECISIONS BY THE GOVERNING BODY: A) ESTABLISHMENT OR MODIFICATION OF COMPENSATION AND BENEFIT POLICIES; AND B) DEVELOPMENT OR MODIFICATION OF CORPORATE COMPLIANCE PROGRAMS, INCLUDING PROGRAMS DESIGNED TO DETECT OR PREVENT HEALTH CARE FRAUD OR IMPROPER THIRD PARTY BILLING, ACTIVITIES REGARDING LEGAL AND REGULATORY COMPLIANCE RELATING TO THE CODE, ENVIRONMENTAL ISSUES, OCCUPATIONAL SAFETY AND HEALTH, ANTITRUST, FEDERAL ELECTION LAWS, AND ALL OTHER LAWS APPLICABLE TO THE CORPORATION. VARIOUS OTHER POWERS ARE RESERVED EXCLUSIVELY TO THE SOLE MEMBER, AS OUTLINED IN THE BYLAWS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B 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 REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS 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 THE CEO FORUM GROUP AND SVP POSITIONS FOR 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 REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2018 FOR THE FOLLOWING INDIVIDUALS: DEBBIE SIMON. 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 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, LEGAL DEPARTMENT. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE ON THE IOWA HEALTH SYSTEM WEBSITE, WWW.UNITYPOINT.ORG. FORM 990, PART IX, LINE 11G HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 1,599,832. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,599,832. PURCHASED HOUSEKEEPING AND LAUNDRY: PROGRAM SERVICE EXPENSES 142,845. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 142,845. MISC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,881,864. MANAGEMENT AND GENERAL EXPENSES 1,308,329. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,190,193. FORM 990, PART XI, LINE 9: CHANGES IN PENSION LIABILITY -351,386. ABBE CENTER FOR COMMUNITY MENTAL HEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421045257 MENTAL HEALTH CARE IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 0 ABBEHEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421373123 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III ST LUKE'S HEALTHCARE 0 AGING SERVICES INC 740 N 15TH AVE NO A HIAWATHA IA 52233 237085316 SENIOR SERVICES IA 501(C)(3) 170(B)(1) (A)(VI) ABBEHEALTH INC 0 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 0 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 0 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 0 ANAMOSA AREA AMBULANCE SERVICE 101 GRANT WOOD DRIVE ANAMOSA 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IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM 36 HOSPITAL FACILITIES AND OVER 400 OUTPATIENT SITES IN IOWA, ILLINOIS AND WISCONSIN. PRIMARY, SECONDARY AND TERTIARY CARE SERVICES ARE PROVIDED TO RESIDENTS OF IOWA, ILLINOIS, WISCONSIN AND ADJACENT STATES. ON APRIL 16, 2013, IOWA HEALTH SYSTEM BEGAN BEING PUBLICLY KNOWN AS UNITYPOINT HEALTH (THE SYSTEM). THIS NAME CHANGE REFLECTS THE TRANSFORMATION OF CLINICAL PROCESSES UNDERWAY WITHIN THE SYSTEM AND THE ADAPTATION TO BETTER ADDRESS THE HEALTH CARE NEEDS OF COMMUNITIES, INCLUDING BUILDING A MODEL OF DELIVERING HEALTH CARE THAT COORDINATES CARE AROUND THE PATIENT WHILE FOCUSING ON IMPROVING THE QUALITY OF CARE AND REDUCING COSTS. THE LEGAL NAME OF THE PARENT REMAINS IOWA HEALTH SYSTEM, WITH THE UNITYPOINT HEALTH NAME REFLECTING A DOING BUSINESS AS (D/B/A).