2016-11-14T11:14:53-06:00 2015-12-31 990 2015-01-01 421435199 IOWA HEALTH SYSTEM IOWA 5152416161 1776 WEST LAKES PARKWAY NO 400 WEST DES MOINES IA 50266 MARK A JOHNSON SVP/CFO 5152413315 2016-11-09 2015 2017-02-10 21:41:12Z UNITYPOINT HEALTH WILLIAM B LEAVER 1776 WEST LAKES PARKWAY NO 400 WEST DES MOINES IA 50266 402875946 0 X WWW.UNITYPOINT.ORG X 1994 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 21 14 1886 0 7322965 0 63447090 79622803 265290120 283634322 23335120 25169358 -6349896 13006183 345722434 401432666 63770091 79739656 0 0 91543376 120869119 0 0 0 186464999 206782950 341778466 407391725 3943968 -5959059 1082770586 1139719318 1105531207 1158197527 -22760621 -18478209 X TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 309992856 76807201 296640505 AFFILIATE SUPPORT SERVICESIHS ADMINISTRATION (CORP) IS ORGANIZED TO SUPPORT THE MISSIONS OF SEVERAL RELATED CHARITABLE, TAX-EXEMPT ORGANIZATIONS INCLUDING NINE SENIOR AFFILIATES, IOWA HEALTH DES MOINES (DES MOINES), TRINITY REGIONAL HEALTH SYSTEM (ROCK ISLAND), ST. LUKE'S HEALTHCARE (CEDAR RAPIDS), ALLEN HEALTH SYSTEMS (WATERLOO), TRINITY HEALTH SYSTEMS (FORT DODGE), ST. LUKE'S HEALTH SYSTEM (SIOUX CITY), FINLEY TRI-STATES HEALTH GROUP (DUBUQUE), METHODIST HEALTH SERVICES CORPORATION (PEORIA), MERITER HEALTH SERVICES, INC. (MADISON), AS WELL AS IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION (DBA UNITYPOINT CLINIC), UNITYPOINT AT HOME AND MULTIPLE RURAL AFFILIATES. THE SUPPORT SERVICES PROVIDED TO THESE ORGANIZATIONS ARE TO CONSTRUCT, OWN, LEASE, MANAGE, OPERATE, PROVIDE AND MAINTAIN ANY FACILITIES, PROGRAMS, SERVICES (MANAGEMENT OR OTHERWISE) AND RELATED ACTIVITIES IN FURTHERANCE OF HEALTH-CARE OR HEALTH EDUCATION. FACILITIES INCLUDE HOSPITALS, SELF-CARE FACILITIES, CLINICS, EDUCATIONAL FACILITIES, AND OTHER ESTABLISHMENTS CREATED TO CARRY THROUGH HEALTH-CARE AND EDUCATIONAL PROGRAMS. THE PRIMARY PURPOSE OF THE CORPORATION IS TO ENGAGE IN AND CONDUCT CHARITABLE, EDUCATIONAL, RELIGIOUS AND SCIENTIFIC ACTIVITIES IN ACCORDANCE WITH PREVIOUSLY STATED PURPOSES. 2932455 2932455 0 COMMUNITY BENEFITIOWA HEALTH SYSTEM 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; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. IOWA HEALTH SYSTEM COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. IOWA HEALTH SYSTEM HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $2,932,455. 312925311 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 1 0 1 X 2620 0 1 1886 1 1 1 0 0 0 0 0 0 0 0 0 X 21 14 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X X MARK A JOHNSON SVPCFO 5152413315 1776 WEST LAKES PARKWAY SUITE 400 WEST DES MOINES IA 50266 ANGELA ALDRICH MD BOARD MEMBER 1.00 1.00 X 13500 35 0 BILL ARNOLD FR 615 BOARD MEMBER 1.00 1.00 X 8000 0 0 DAVE BOYER BOARD MEMBER 1.00 1.00 X 15921 304 0 TERRI CHRISTOFFERSEN TO 1215 BOARD MEMBER 1.00 1.00 X 13742 0 0 BRENDA CLANCY BOARD MEMBER 1.00 0.00 X 5500 0 0 STANTON DANIELSON MD BOARD MEMBER 1.00 40.00 X 0 433046 63919 RANDY EASTON BOARD MEMBER 1.00 1.00 X 15427 878 0 SARAH HASKEN TO 615 BOARD MEMBER 1.00 0.00 X 8466 0 0 KENT HENNING BOARD MEMBER 1.00 1.00 X 14622 0 0 STEVE HERWIG DO BOARD MEMBER 1.00 1.00 X 9750 0 0 GEORGE KAMPERSHROER TO 1215 BOARD MEMBER 1.00 1.00 X 14272 6250 0 FRANCIS KANE MD BOARD MEMBER 1.00 0.00 X 11484 0 0 RONALD KLOSTERMAN TO 1215 BOARD MEMBER 1.00 0.00 X 14374 0 0 RICHARD MCCONNELL PHD BOARD TREASURER 1.00 1.00 X X 15755 0 0 PETER MCLAUGHLIN BOARD MEMBER 1.00 1.00 X 15006 226 0 LINDA NEWBORN BOARD SECRETARY 1.00 0.00 X X 14000 0 0 KURT PITTNER BOARD MEMBER 1.00 1.00 X 12705 2159 0 CATHERINE RANHEIM MD BOARD MEMBER 1.00 40.00 X 13972 286498 13187 BRUCE SHERMAN TO 1215 BOARD MEMBER 1.00 1.00 X 16053 0 0 MIKE STONE BOARD VICE CHAIR 1.00 1.00 X X 9500 0 0 DEVENDRA TRIVEDI MD BOARD MEMBER 1.00 1.00 X 14012 0 0 MIKE WILLIAMS BOARD CHAIR 1.00 1.00 X X 26785 50 0 MARK JOHNSON SVP/CFO 40.00 0.00 X 1069029 0 198116 WILLIAM LEAVER PRESIDENT/CEO 40.00 0.00 X 3959344 0 1024879 KEVIN VERMEER EVP/CSO & ACO CEO 40.00 1.00 X 1650897 0 323018 DAVID BRANDON PRESIDENT/CEO-DUB 1.00 40.00 X 0 486066 103839 TROY CARAWAY SVP INS DIV & CEO PPIC 40.00 0.00 X 570226 0 106662 ERIC CROWELL CEO-DSM 1.00 40.00 X 0 893753 265402 PAMELA DELAGARDELLE PRESIDENT/CEO-WAT 1.00 40.00 X 0 530644 105628 MIKE DEWERFF PRESIDENT/CEO-FD (FR 2/15) 1.00 40.00 X 0 537169 84504 DENNY DRAKE VP GENERAL COUNSEL/CORP CO 40.00 0.00 X 712570 0 183217 KARA DUNHAM VP FINANCE 40.00 0.00 X 424786 0 69567 JOY GROSSER VP & CIO (TO 10/15) 40.00 1.00 X 1005334 0 14849 BRIAN JONES VP PAYOR INNOVATION 40.00 0.00 X 451928 0 33634 ALAN KAPLAN MD EVPCCTO PRES/CEO IPCMF & UP@HOME 40.00 1.00 X 899181 0 186036 ART NIZZA PRESIDENT/CEO-WI (FR 2/15) 1.00 40.00 X 0 512068 77811 EMILY PORTER VP PEOPLE EXCELLENCE 40.00 0.00 X 539042 0 83837 SABRA ROSENER VP GOVERNMENT RELATIONS 40.00 0.00 X 421976 0 79875 RICHARD SEIDLER PRESIDENT/CEO-QC 1.00 40.00 X 0 726825 182435 ARIC SHARP VP/ACO 40.00 0.00 X 522121 0 31342 DEBORAH SIMON PRESIDENT/CEO-PM 1.00 40.00 X 0 727419 175621 SUSAN THOMPSON CEO-FD TO 215 SVP INT & OPT (FR 6/15) 40.00 1.00 X 200181 317381 163636 PETER THOREEN PRESCEO-SC TO 615 INTERIM CEO-WI (TO 2/15) 1.00 40.00 X 0 506110 239270 THEODORE TOWNSEND PRESIDENT/CEO-CR 1.00 40.00 X 0 684993 173593 LYNN WOLD PRESIDENT/CEO-SC (FR 06/15) 1.00 40.00 X 0 381162 94364 JOHN FROWNFELTER CHIEF MEDICAL INFO OFFICER 40.00 0.00 X 372685 0 19040 MATTHEW KIRSCHNER VP/TREASURY 40.00 0.00 X 450782 0 30608 KATHERINE MARCHIK VP/SUPPLY MANAGEMENT 40.00 0.00 X 401061 0 73660 WILLIAM O'BRIEN VP FINANCE INS DIV & CFO PPIC/HUHI 40.00 0.00 X 396249 0 62846 RENEE RASMUSSEN VP REVENUE CYCLE 40.00 0.00 X 360764 10518 96094 JAMES WOODWARD TO 0614 FORMER PRESIDENT/CEO-WI 0.00 0.00 X 0 708537 0 14691002 7752091 4360489 197 1 1 0 NORDIC CONSULTING PARTNERS INC 740 REGENT ST 400 MADISON WI 53715 CONSULTING FEES 5403433 HURON CONSULTING GROUP INC 550 W VAN BUREN ST CHICAGO IL 60607 CONSULTING FEES 3280434 OPTUM360 LLC 11000 OPTUM CIRC EDEN PRAIRIE MN 55344 CONSULTING FEES 3125886 SAGACIOUS CONSULTANTS LLC 8207 MELROSE DR 160 OVERLAND PARK KS 66214 CONSULTING FEES 3019802 H & R ACCOUNTS INC 7017 JOHN DEERE PKWY MOLINE IL 61265 MANAGEMENT FEES 3006705 178 79622803 79622803 MGMT & SUPPORT SVCS 561000 282285524 278764466 3521058 SUBS & JOINT VENTURES 900099 1348798 1348798 283634322 25071748 25071748 397715 1143175 307299 1135981 90416 7194 97610 97610 MISCELLANEOUS REVENUE 900099 9204276 9204276 MGMT & SUPPORT SVCS 561000 3801907 3801907 13006183 401432666 289317540 7322965 25169358 X 79739656 79739656 17784414 17784414 179560 179560 82521710 82521710 3803949 3803949 10365416 10365416 6214070 6214070 176578 176578 717124 717124 635274 635274 119634 6547 113087 90719522 66057352 24662170 3490597 5607 3484990 4071998 2297201 1774797 15386493 13792400 1594093 3588965 1541101 2047864 791733 437201 354532 31959732 31456008 503724 54281361 13937540 40343821 57170 47593 9577 MISCELLANEOUS EXPENSE 775159 66680 708479 SALES/USE TAXES 11610 6 11604 407391725 312925311 94466414 0 59677809 21930327 16489661 11017093 736630566 800500066 16840866 39002786 489263649 281400433 183771297 207863216 28707929 14325474 33417726 37084309 1336309 1474846 5898423 6521201 1082770586 1139719318 58040807 89454956 9627371 8183276 909359043 889639014 26900857 69004561 101603129 101915720 1105531207 1158197527 X -22808313 -18526349 47692 48140 -22760621 -18478209 1082770586 1139719318 X -5959059 1072843 9168628 X 0 1 X 1 0 X X 10 CENTRAL IOWA HOSPITAL CORPORATION 420680452 3 1 35466128 0 ST LUKE'S METHODIST HOSPITAL 420504780 3 1 24522458 0 ALLEN MEMORIAL HOSPITAL CORPORATION 420698265 3 1 9291490 0 NORTHWEST IOWA HOSPITAL CORPORATION 421019872 3 1 1054507 0 THE FINLEY HOSPITAL 420680354 3 1 698835 0 TRINITY REGIONAL MEDICAL CENTER 421009175 3 1 611592 0 TRINITY MEDICAL CENTER 362739299 3 1 23098977 0 UNITY HEALTHCARE 420680337 3 1 0 0 METHODIST MEDICAL CENTER OF ILLINOIS 370661223 3 1 848720 0 MERITER HOSPITAL INC 390806367 3 1 17937696 0 10 113530403 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 X 1 1 SECTION E, LINE 3A: IOWA HEALTH SYSTEM IS A FUNCTIONALLY-INTEGRATED SUPPORTING ORGANIZATION TO AFFILIATED NONPROFIT HOSPITALS. THE BOARD SHALL CONSIST OF UP TO TWENTY-FIVE PERSONS, WITH EACH HOSPITAL HAVNG THE POWER TO APPOINT BOARD OF DIRECTOR MEMBERS, INCLUDING UP TO SIX AT-LARGE MEMBERS AS DETERMINED BY THE BOARD OF DIRECTORS AND SUBJECT TO THE ARTICLES OF INCORPORATION. THE BOARD SHALL ELECT AND APPOINT A COMPETENT PRESIDENT WHO SHALL BE ITS DIRECT EXECUTIVE REPRESENTATIVE IN THE MANAGEMENT OF THE CORPORATION. THE PRESIDENT SHALL BE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION, AND, SUBJECT TO THE DIRECTION AND UNDER THE SUPERVISION OF THE BOARD OF DIRECTORS, SHALL HAVE GENERAL CHARGE OF THE BUSINESS AFFAIRS AND PROPERTY OF THE CORPORATION. SECTION E, LINE 3B: IOWA HEALTH SYSTEM IS A FUNCTIONALLY-INTEGRATED SUPPORTING ORGANIZATION TO AFFILIATED NONPROFIT HOSPITALS. THE BOARD OF DIRECTORS OF IOWA HEALTH SYSTEM HAS FINAL AUTHORITY WITH RESPECT TO: THE APPROVAL OF STRATEGIC PLANS; ADOPTION OF BUSINESS PLANS; INCURRENCE OF LONG-TERM INDEBTEDNESS; SELECTION (AFTER CONSULTATION WITH THE AFFECTED CORPORATION'S BOARD) OF ANY NEW OR REMOVAL OF ANY EXISTING CORPORATE OFFICER; PURSUANT TO THE AFFILIATION AGREEMENT, TRANSFER, SALE OR CLOSURE OF ANY FACILITY, DEPARTMENT OR FUNCTION AT THE CORPORATION; AMEND ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; MANAGED CARE STRATEGY AND EXECUTITION OF MANAGED CARE CONTRACTS; AND PAYMENTS OR TRANSFER OF ASSETS BETWEEN CORPORATE AFFILIATES ANY OF THE ORGANIZATIONS WHOSE SOLE CORPORATE MEMBER RELATIONSHIP TO IOWA HEALTH SYSTEM IS SUBSTANTIALLY SIMILAR TO RELATIONSHIPS DESCRIBED IN THE AFFILIATION AGREEMENTS WITH IOWA HEALTH SYSTEM. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 635274 733618 635274 733618 312290037 3461434032 312925311 3462167650 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 893042 947884 770005 733618 3344549 250000 250000 250000 250000 1000000 1500000 47692 447 48139 73276 504 26088 47692 58647 25281 494 11146 73276 102976 81667 1807 127803 58647 46770 150535 1400 95729 102976 0.00000 0.00000 1.00000 0 0 180263 21468 158795 5552845 3447126 2105719 471063962 277931839 193132123 12466579 12466579 207863216 SELF-INSURANCE RESERVE 832600 SWAP LIABILITY 78850957 LONG-TERM RETENTION INCENTIVES 9973827 DUE TO AFFILIATES 12183083 MISCELLANEOUS LT LIABILITIES 75253 101915720 X 293185000 -262777 -262777 293447777 10162 107974727 107984889 401432666 323511000 0 323511000 10162 83870563 83880725 407391725 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. 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 2012. 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 4B - OTHER ADJUSTMENTS: SUBSIDIARY ELIMINATING ENTRY 3,234,000. REVENUES IN UNRESTRICTED FUND BALANCE 104,344,817. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 447. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 395,417. ROUNDING 46. PART XII, LINE 4B - OTHER ADJUSTMENTS: SUBSIDIARY ELIMINATING ENTRY 4,018,000. EXPENSES IN UNRESTRICTED FUND BALANCE 79,456,989. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 395,417. ROUNDING 157. 1 BRANSTAD-REYNOLDS SCHOLARSHIP FUND 1601 22ND STREET STE 400 WEST DES MOINES IA 50266 273956456 501(C)(3) 15000 PROGRAM SUPPORT DES MOINES UNIVERSITY OSTEOPATHIC MEDICAL CENTER 3200 GRAND AVE DES MOINES IA 503124198 420730347 501(C)(3) 5000 PROGRAM SUPPORT DRAKE UNIVERSITY 2507 UNIVERSITY AVE DES MOINES IA 503114516 420680460 501(C)(3) 100000 PROGRAM SUPPORT GREAT IOWA NURSES 2400 86TH STREET URBANDALE IA 50322 420636682 501(C)(6) 5000 EVENT SPONSOR IOWA HEALTH CARE COLLABORATIVE 100 E GRAND AVE SUITE 360 DES MOINES IA 50309 203869767 501(C)(3) 25000 PROGRAM SUPPORT IOWA HOSPITAL ASSOCIATION 100 E GRAND AVE SUITE 100 DES MOINES IA 50309 420706508 501(C)(6) 5000 PROGRAM SUPPORT IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 8101 BIRCHWOOD CT JOHNSTON IA 50131 421411630 501(C)(3) 79456989 PROGRAM SUPPORT IOWA SPORTS FOUNDATION 1421 S BELL AVE STE 104 AMES IA 50010 421278326 501(C)(3) 30000 PROGRAM SUPPORT JUNIOR ACHIEVEMENT OF CENTRAL IOWA 6100 GRAND AVENUE DES MOINES IA 50312 420759070 501(C)(3) 7500 PROGRAM SUPPORT PRINCIPAL CHARITY CLASSIC 2771 104TH ST STE 1 URBANDALE IA 50322 426139033 501(C)(3) 15000 EVENT SPONSOR UNIVERSITY OF IOWA FOUNDATION PO BOX 4550 IOWA CITY IA 52244 420796760 501(C)(3) 63500 PROGRAM SUPPORT 9 2 PART I, LINE 2: IOWA HEALTH SYSTEM 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. IOWA HEALTH SYSTEM THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. X X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 STANTON DANIELSON MD BOARD MEMBER 0 400761 0 24406 0 7879 0 54895 0 9024 0 496965 0 0 CATHERINE RANHEIM MD BOARD MEMBER 13972 253630 0 8154 0 24714 0 10600 0 2587 13972 299685 0 0 MARK JOHNSON SVP/CFO 607066 0 212100 0 249863 0 178022 0 20094 0 1267145 0 202961 0 WILLIAM LEAVER PRESIDENT/CEO 1391570 0 448600 0 2119174 0 1005200 0 19679 0 4984223 0 2056472 0 KEVIN VERMEER EVP/CSO & ACO CEO 967581 0 273750 0 409566 0 299778 0 23240 0 1973915 0 357447 0 DAVID BRANDON PRESIDENT/CEO-DUB 0 338746 0 94427 0 52893 0 82806 0 21033 0 589905 0 0 TROY CARAWAY SVP INS DIV & CEO PPIC 444900 0 80087 0 45239 0 88778 0 17884 0 676888 0 0 0 ERIC CROWELL CEO-DSM 0 620009 0 195829 0 77915 0 244932 0 20470 0 1159155 0 0 PAMELA DELAGARDELLE PRESIDENT/CEO-WAT 0 383807 0 101028 0 45809 0 87277 0 18351 0 636272 0 0 MIKE DEWERFF PRESIDENT/CEO-FD (FR 2/15) 0 294060 0 101657 0 141452 0 63208 0 21296 0 621673 0 0 DENNY DRAKE VP GENERAL COUNSEL/CORP CO 510724 0 150309 0 51537 0 162313 0 20904 0 895787 0 0 0 KARA DUNHAM VP FINANCE 255776 0 72669 0 96341 0 46239 0 23328 0 494353 0 56267 0 JOY GROSSER VP & CIO (TO 10/15) 371749 0 118496 0 515089 0 13828 0 1021 0 1020183 0 347204 0 BRIAN JONES VP PAYOR INNOVATION 339059 0 79713 0 33156 0 13250 0 20384 0 485562 0 0 0 ALAN KAPLAN MD EVPCCTO PRES/CEO IPCMF & UP@HOME 632225 0 212240 0 54716 0 162744 0 23292 0 1085217 0 0 0 ART NIZZA PRESIDENT/CEO-WI (FR 2/15) 0 375811 0 100000 0 36257 0 60260 0 17551 0 589879 0 0 EMILY PORTER VP PEOPLE EXCELLENCE 401678 0 101481 0 35883 0 62669 0 21168 0 622879 0 0 0 SABRA ROSENER VP GOVERNMENT RELATIONS 299596 0 84379 0 38001 0 54416 0 25459 0 501851 0 0 0 RICHARD SEIDLER PRESIDENT/CEO-QC 0 554851 0 114259 0 57715 0 167543 0 14892 0 909260 0 0 ARIC SHARP VP/ACO 382970 0 106003 0 33148 0 13250 0 18092 0 553463 0 0 0 DEBORAH SIMON PRESIDENT/CEO-PM 0 466402 0 117392 0 143625 0 159196 0 16425 0 903040 0 0 SUSAN THOMPSON CEO-FD TO 215 SVP INT & OPT (FR 6/15) 173979 200504 0 87255 26202 29622 143696 14112 2854 2974 346731 334467 0 0 PETER THOREEN PRESCEO-SC TO 615 INTERIM CEO-WI (TO 2/15) 0 364349 0 97797 0 43964 0 220026 0 19244 0 745380 0 0 THEODORE TOWNSEND PRESIDENT/CEO-CR 0 479095 0 142764 0 63134 0 152346 0 21247 0 858586 0 0 LYNN WOLD PRESIDENT/CEO-SC (FR 06/15) 0 284826 0 58341 0 37995 0 74271 0 20093 0 475526 0 0 JOHN FROWNFELTER CHIEF MEDICAL INFO OFFICER 52280 0 45604 0 274801 0 3223 0 15817 0 391725 0 0 0 MATTHEW KIRSCHNER VP/TREASURY 322254 0 89568 0 38960 0 12833 0 17775 0 481390 0 0 0 KATHERINE MARCHIK VP/SUPPLY MANAGEMENT 278241 0 79713 0 43107 0 55516 0 18144 0 474721 0 0 0 WILLIAM O'BRIEN VP FINANCE INS DIV & CFO PPIC/HUHI 357722 0 0 0 38527 0 47621 0 15225 0 459095 0 0 0 RENEE RASMUSSEN VP REVENUE CYCLE 265171 8796 63309 0 32284 1722 71399 455 22440 1800 454603 12773 0 0 JAMES WOODWARD TO 0614 FORMER PRESIDENT/CEO-WI 0 0 0 85889 0 622648 0 0 0 0 0 708537 0 0 PART I, LINE 1A TRAVEL: CEO AND BOARD MEMBERS USE PRIVATE CHARTER FOR BUSINESS TRAVEL BETWEEN AFFILIATE CITIES AND FOR BOARD OF DIRECTOR MEETINGS. THIS TRAVEL IS FOR BUSINESS PURPOSES ONLY. NO FIRST CLASS COMMERCIAL TRAVEL IS REIMBURSED. TRAVEL FOR COMPANIONS: SPOUSES SOMETIMES ACCOMPANY BOARD MEMBERS AND/OR OFFICERS ON ORGANIZATIONAL ACTIVITIES, INCLUDING BOARD RETREATS. 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. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: IF AN INDIVIDUAL IS PROVIDED SOMETHING FROM THE EMPLOYER OF VALUE, SUCH AS A PAID BENEFIT, GIFT CARD OR GIFT, WHICH IS CONSIDERED TAXABLE INCOME, THEN THE EMPLOYER WILL ADD IMPUTED AMOUNTS TO PAYCHECK IN ORDER TO TAX APPROPRIATELY. PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL(S) RECEIVED A SEVERANCE PAYMENT DURING THE YEAR THAT WAS INCLUDED IN THEIR TAXABLE INCOME: JOHN FROWNFELTER $269,536; JOY GROSSER $69,454; JAMES WOODWARD $622,648. NONQUALIFIED RETIREMENT PLAN EARNINGS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: DAVID BRANDON $69,506; TROY CARAWAY $78,179; ERIC CROWELL $198,474; STANTON DANIELSON $11,756; PAMELA DELAGARDELLE $74,027; MIKE DEWERFF $50,953; DENNY DRAKE $118,117; KARA DUNHAM $32,989; JOY GROSSER $2,830; MARK JOHNSON $162,122; ALAN KAPLAN $149,494; WILLIAM LEAVER $990,154; KATHERINE MARCHIK $42,266; ART NIZZA $60,260; WILLIAM O'BRIEN $35,152; EMILY PORTER $49,419; RENEE RASMUSSEN $58,575; SABRA ROSENER $49,116; RICHARD SEIDLER $146,008; DEBORAH SIMON $90,485; SUSAN THOMPSON $144,558; PETER THOREEN $205,920; THEODORE TOWNSEND $136,423; KEVIN VERMEER $285,009; LYNN WOLD $61,368. NONQUALIFIED RETIREMENT PLAN DISTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED PLAN: KARA DUNHAM $56,267; JOY GROSSER $347,204; MARK JOHNSON $202,961; WILLIAM LEAVER $2,056,472; DEBORAH SIMON $90,832; KEVIN VERMEER $357,447. PAYOUTS ARE MADE WITH VESTED FUNDS, AS ESTABLISHED BY PLAN DOCUMENTS. A IOWA FINANCE AUTHORITY 521699886 462466CF8 2009-03-04 244270000 SEE PART VI 1 0 0 B IOWA FINANCE AUTHORITY 521699886 462466DS9 2009-08-06 402440333 SEE PART VI 0 0 0 C IOWA FINANCE AUTHORITY 521699886 462466ER0 2013-09-19 101172373 SEE PART VI 0 0 0 D IOWA FINANCE AUTHORITY 521699886 462466ET6 2013-10-03 79120000 SEE PART VI 0 0 0 A 33956037 28620000 244271037 201270000 43001037 2011 1 0 1 1 B 161835333 402440333 351270000 1170333 50000000 2010 1 0 1 1 C 101172373 1172373 100000000 2014 1 0 1 1 D 1735000 79120000 28620000 500000 50000000 2014 0 0 1 1 A 1 1 1 1 0 0.00000 0.00010 0.00010 0 0 1 B 1 1 1 1 0 0.00000 0.00010 0.00010 0 0 1 C 1 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 1 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 SEE PART V 26.000000000000 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 PART I, LINE A(ENTITY 2) - CUSIP # MULTIPLE IOWA FINANCE AUTHORITY CUSIPS ISSUED TO THIS BOND - #97670FBE0; #97712DEA0; #97712DEB8; AND #462466EW9. PART I, LINE A(F) - BOND ISSUES (I) REFUND A PORTION OF THE IOWA FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS, (IOWA HEALTH SYSTEM), SERIES 2005B ISSUED ON 7/27/05; (II) CONSTRUCT AND EQUIP HOSPITAL FACILITIES OF THE ORGANIZATION AND AFFILIATES LOCATED IN CEDAR RAPIDS, DES MOINES, DUBUQUE, FORT DODGE, SIOUX CITY, AND WATERLOO, IOWA. PART I, LINE B(F) - BOND ISSUES (I) REFUND A PORTION OF THE IOWA FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS, (IOWA HEALTH SYSTEM), SERIES 2005A ISSUED ON 7/27/05; (II) REFUND A PORTION OF THE IOWA FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS (IOWA HEALTH SYSTEM), SERIES 2008A ISSUED ON 5/20/08; (III) CONSTRUCT AND EQUIP HOSPITAL FACILITIES OF THE ORGANIZATION AND AFFILIATES LOCATED IN DES MOINES, DUBUQUE, SIOUX CITY, AND WATERLOO, IOWA. PART I, LINE C(F) - BOND ISSUES (I) CONSTRUCT AND EQUIP HOSPITAL FACILITIES OF THE ORGANIZATION AND AFFILIATES LOCATED IN CEDAR RAPIDS, DUBUQUE, MUSCATINE, SIOUX CITY, AND WATERLOO, IOWA. PART I, LINE D(F) - BOND ISSUES (I) REFUND A PORTION OF THE IOWA FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS (IOWA HEALTH SYSTEM), SERIES 2009A-E ISSUED ON 3/4/09; (II) REFUND A PORTION OF THE IOWA FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS (IOWA HEALTH SYSTEM), SERIES 2009F ISSUED ON 8/6/09. PART I, LINE E(F) - BOND ISSUES (I) REFUND A PORTION OF THE IOWA FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS (IOWA HEALTH SYSTEM), SERIES 2005A ISSUED ON 3/4/09. PART I, LINE F(F) - BOND ISSUES (I) MERITER HOSPITAL REFUNDING OF BONDS ISSUED 5/21/2008 BY WISC HEALTH & EDUCATIONAL FACILITIES; MERITER BECAME AFFILIATED WITH UNITYPOINT HEALTH ON 1/1/2014; DURING 2014 MERITER HOSPITAL BONDS WERE MOVED TO THE BOOKS OF UNITYPOINT HEALTH AND PARTIALLY REFUNDED WITH A 2014 BOND DRAW BY UNITYPOINT HEALTH. PART I, LINE G(F) - BOND ISSUES (I) MERITER HOSPITAL ISSUANCE THROUGH WISC HEALTH & EDUCATIONAL FACILITIES TO CONSTRUCT AND EQUIP HOSPITAL FACILITIES; MERITER BECAME AFFILIATED WITH UNITYPOINT HEALTH ON 1/1/2014; DURING 2014 MERITER HOSPITAL BONDS WERE MOVED TO THE BOOKS OF UNITYPOINT HEALTH AND PARTIALLY REFUNDED WITH A 2014 BOND DRAW BY UNITYPOINT HEALTH. PART II, LINE 3(A) - PROCEEDS THERE IS A DIFFERENCE BETWEEN THE BOND ISSUE PRICE AND THE TOTAL PROCEEDS OF BOND ISSUE DUE TO INVESTMENT EARNINGS OF $1,037. PART IV - ARBITRAGE CITIBANK, N.A.; JPMORGAN CHASE BANK, N.A.; MORGAN STANLEY CAPITAL SERVICES, INC. A IOWA FINANCE AUTHORITY (SEE PART V) 521699886 97670FBE0 2014-05-21 259106530 SEE PART VI 0 0 0 B WISC HEALTH & EDUCATIONAL FACILITIES 391337855 2012-08-09 45200000 SEE PART VI 0 0 0 C WISC HEALTH & EDUCATIONAL FACILITIES 391337855 2012-08-09 20000000 SEE PART VI 0 0 0 A 7515000 243525000 71310750 2593568 185202212 2015 1 0 1 1 B 31250000 45200000 45200000 2012 1 0 1 1 C 1223683 20023683 20023683 2014 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 1 PIPER JAFFREY 9.900000000000 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 BKD LLP COMMON BOARD MEMBER/OFFICER 871304 AUDIT AND ACCOUNTING FEES 0 MEDIMORE INC COMMON BOARD MEMBER/OFFICER 470732 EXPENSE REIMBURSEMENT 0 MICHAEL CLANCY FAMILY MEMBER OF BOARD MEMBER BRENDA CLANCY 46053 EMPLOYMENT 0 NATHAN THOMPSON FAMILY MEMBER OF KEY EMPLOYEE SUSAN THOMPSON 133507 EMPLOYMENT 0 FORM 990, PART V, LINES 1A & 1B CASH DISBURSEMENTS ARE CENTRALIZED THROUGH THE PARENT ORGANIZATION, IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THE PARENT MAKES THE PAYMENTS AND FILES THE RELATED FORMS 1099 AND 1096 ON BEHALF OF ALL UNITYPOINT HEALTH SYSTEM RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 7A IOWA HEALTH SYSTEM IS A SUPPORTING ORGANIZATION TO AFFILIATED NONPROFIT HOSPITALS. EACH HOSPITAL HAS THE POWER TO APPOINT DIRECTORS TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B IOWA HEALTH SYSTEM IS A SUPPORTING ORGANIZATION TO AFFILIATED NONPROFIT HOSPITALS. EACH HOSPITAL HAS THE POWER TO APPOINT BOARD OF DIRECTORS. 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 2014 FOR THE FOLLOWING INDIVIDUALS: JOY GROSSER, WILLIAM LEAVER. THE ANNUAL REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2015 FOR THE FOLLOWING INDIVIDUALS: DAVID BRANDON, TROY CARAWAY, ERIC CROWELL, PAMELA DELAGARDELLE, MIKE DEWERFF, DENNY DRAKE, KARA DUNHAM, MARK JOHNSON, ALAN KAPLAN M.D., KATHERINE MARCHIK, ART NIZZA, WILLIAM O'BRIEN, EMILY PORTER, RENEE RASMUSSEN, SABRA ROSENER, RICHARD SEIDLER, ARIC SHARP, DEBORAH SIMON, SUSAN THOMPSON, THEODORE TOWNSEND, KEVIN VERMEER. 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 7,440. MANAGEMENT AND GENERAL EXPENSES 28,803. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,243. PURCHASED HOUSEKEEPING AND LAUNDRY: PROGRAM SERVICE EXPENSES 138. MANAGEMENT AND GENERAL EXPENSES 759. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 897. MISC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 66,049,774. MANAGEMENT AND GENERAL EXPENSES 24,632,608. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,682,382. FORM 990, PART XI, LINE 9: EQUITY EARNINGS IN JOINT VENTURES 1,000. FUND BALANCE TRANSFERS 9,167,628. BHC LC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 273820391 INFORMATION TECHNOLOGY MGMT. IA 1 1551 IOWA HEALTH SYSTEM IOWA HEALTH ACCOUNTABLE CARE LC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 454550692 ACCOUNTABLE CARE IA 3234507 3857423 IOWA HEALTH SYSTEM ALLEN COLLEGE 1825 LOGAN AVENUE WATERLOO IA 50703 421351526 EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS IA 501(C)(3) 170(B)(1) (A)(II) ALLEN HEALTH SYSTEMS INC 1 ALLEN HEALTH SYSTEMS INC 1825 LOGAN AVENUE WATERLOO IA 50703 421201924 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 1 ALLEN MEMORIAL HOSPITAL CORPORATION 1825 LOGAN AVENUE WATERLOO IA 50703 420698265 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ALLEN HEALTH SYSTEMS INC 1 ANAMOSA AREA AMBULANCE SERVICE 101 GRANT WOOD DRIVE ANAMOSA IA 52205 421466284 PROVIDE AMBULANCE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'SJONES REGIONAL MEDICAL CENTER 1 BLACK HAWK-GRUNDY MENTAL HEALTH CENTER INC 3251 WEST NINTH STREET WATERLOO IA 50702 420733463 MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 1 CENTRAL IOWA HEALTH PROPERTIES CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 421233759 PROPERTY HOLDING COMPANY IA 501(C)(2) CENTRAL IOWA HEALTH SYSTEM 1 CENTRAL IOWA HEALTH SYSTEM 1200 PLEASANT STREET DES MOINES IA 50309 421189791 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 1 CENTRAL IOWA HOSPITAL CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 420680452 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) CENTRAL IOWA HEALTH SYSTEM 1 DES MOINES AREA MEDICAL EDUCATION CONSORTIUM INC 1415 WOODLAND AVE SUITE 130 DES MOINES IA 50309 421412497 COORDINATION OF MEDICAL EDUCATION PROGRAMS IA 501(C)(3) 509(A)(3), TYPE III 1 FINLEY TRI-STATES HEALTH GROUP INC 350 NORTH GRANDVIEW AVENUE DUBUQUE IA 52001 421307495 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 1 FRIENDS OF THE BLACK HAWK-GRUNDY MENTAL HEALTH CENTER 3820 HILLSIDE DRIVE CEDAR FALLS IA 50613 421372380 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 1 HULT CENTER FOR HEALTHY LIVING INC 5409 N KNOXVILLE AVE PEORIA IL 61614 363510390 HEALTH EDUCATION TO THE COMMUNITY IL 501(C)(3) 170(B)(1) (A)(VI) PROCTOR HOSPITAL 1 IOWA HEALTH FOUNDATION 1415 WOODLAND AVE SUITE E-200 DES MOINES IA 50309 421467682 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) CENTRAL IOWA HEALTH SYSTEM 1 IOWA HEALTH SYSTEM 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421435199 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III 1 IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 8101 BIRCHWOOD COURT JOHNSTON IA 50131 421411630 PRIMARY HEALTH CARE SERVICES IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM 1 MEMORIAL FOUNDATION OF ALLEN HOSPITAL 1825 LOGAN AVENUE WATERLOO IA 50703 421201138 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 1 MERITER FOUNDATION INC 202 SOUTH PARK STREET MADISON WI 53715 237098688 CHARITABLE FUNDRAISING WI 501(C)(3) 170(B)(1) (A)(VI) MERITER HEALTH SERVICES INC 1 MERITER HEALTH SERVICES INC 202 SOUTH PARK STREET MADISON WI 53715 391412318 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE WI 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 1 MERITER HOSPITAL INC 202 SOUTH PARK STREET MADISON WI 53715 390806367 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) MERITER HEALTH SERVICES INC 1 MERITER MEDICAL GROUP INC 202 SOUTH PARK STREET MADISON WI 53715 050545222 SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES WI 501(C)(3) 509(A)(3), TYPE II MERITER HOSPITAL INC 1 METHODIST HEALTH SERVICES CORPORATION 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 371111135 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM 1 METHODIST MEDICAL CENTER FOUNDATION 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 510186460 CHARITABLE FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) METHODIST HEALTH SERVICES CORPORATION 1 METHODIST MEDICAL CENTER OF ILLINOIS 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 370661223 HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION 1 METHODIST SERVICES INC 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 371111134 OFFICE RENTAL IL 501(C)(3) 509(A)(2) METHODIST HEALTH SERVICES CORPORATION 1 NELLIE R SHERWOOD TRUST 1026 A AVENUE NE CEDAR RAPIDS IA 52402 426061621 PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY IA 501(C)(3) 509(A)(3), TYPE I ST LUKE'S METHODIST HOSPITAL 1 NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED 720 KENYON DRIVE FORT DODGE IA 50501 420937390 MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC 1 NORTHWEST IOWA HOSPITAL CORPORATION 2720 STONE PARK BLVD SIOUX CITY IA 51104 421019872 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTH SYSTEM INC 1 PROCTOR HEALTH CARE INCORPORATED 5409 N KNOXVILLE AVE PEORIA IL 61614 371133412 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH 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IA IOWA HEALTH SYSTEM C 1799291 19020472 1.00000 1 DELHI POINT CONDO ASSOCIATION 350 N GRANDVIEW DUBUQUE IA 52001 421467002 REAL ESTATE MANAGEMENT IA N/A C 1 HCP CORPORATION 202 SOUTH PARK STREET MADISON WI 53715 391177562 REAL ESTATE RENTAL WI N/A C 1 HEALTH PLUS INC 5409 N KNOXVILLE AVE PEORIA IL 61614 371295532 MANAGED CARE ADMINISTRATION IL N/A C 1 HNC SERVICES 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 270987243 FIBER OPTIC NETWORK SERVICES IA IOWA HEALTH SYSTEM C 666919 592451 1.00000 1 MEDIMORE INC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421414390 MANAGED CARE IA IOWA HEALTH SYSTEM C 289365 1.00000 1 MERITER HEALTH ENTERPRISES INC 202 SOUTH PARK STREET MADISON WI 53715 391293620 MANAGEMENT SERVICES WI N/A C 1 MERITER MANAGEMENT SERVICES INC 202 SOUTH PARK STREET MADISON WI 53715 391458235 ADMINISTRATIVE SERVICES WI N/A C 1 METHODIST HEALTH VENTURES INC PO BOX 87 PEORIA IL 61650 371140939 PHARMACY/OFFICE STAFFING IL N/A C 1 METHODIST PHYSICIAN SERVICES INC PO BOX 87 PEORIA IL 61650 363858550 MEDICAL SERVICES IL N/A C 1 PRECEDENCE INC 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 371288604 MANAGED MENTAL CARE IA N/A C 1 PROVIDER RESOURCE MANAGEMENT INC PO BOX 87 PEORIA IL 61650 371223550 RESOURCE MANAGEMENT IL N/A C 1 PHYSICIANS PLUS INSURANCE CORPORATION 2650 NOVATION PARKWAY SUITE 400 MADISON WI 53713 391565691 FEDERALLY QUALIFIED HMO WI IOWA HEALTH SYSTEM C 251647521 64581388 1.00000 1 RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC 700 E UNIVERSITY AVE DES MOINES IA 50316 261271143 SPECIALTY PHYSICIANS MEDICAL CARE IA N/A C 1 STL HEALTH RESOURCES CO 1026 A AVE NE CEDAR RAPIDS IA 52402 421193499 PHYSICIAN OFFICE RENTAL IA N/A C 1 TRINITY HEALTH ENTERPRISES INC 2701 17TH ST ROCK ISLAND IL 61201 363320141 RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY IL N/A C 1 TRINITY PHYSICIAN HOSPITAL ORGANIZATION LTD 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 363924720 MANAGED HEALTH CARE IA N/A C 1 1 1 1 1 0 0 0 0 0 1 0 1 1 1 0 0 1 1 1 ALLEN MEMORIAL HOSPITAL CORPORATION A 2890067 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION C 7553524 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION J 1377793 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION L 323596 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION S 1997203 BASED ON GAAP, CASH, AND/OR FMV. BROADBAND INC J 226385 BASED ON GAAP, CASH, AND/OR FMV. BROADBAND INC M 114882 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HEALTH PROPERTIES CORPORATION A 17862 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION A 5865201 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION C 30232694 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION J 4105138 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION L 1021527 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION N 106769 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION S 4445869 BASED ON GAAP, CASH, AND/OR FMV. 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SCHEDULE R, PARTS I - IV: IOWA HEALTH SYSTEM AND SUBSIDIARIES (D/B/A UNITYPOINT HEALTH) IOWA HEALTH SYSTEM IS AN IOWA NONPROFIT CORPORATION FORMED IN DECEMBER 1994. IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM 32 HOSPITAL FACILITIES AND VARIOUS AMBULATORY SERVICE AND CLINIC LOCATIONS 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). 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20786 0 0 0 TRINITY HEALTH FOUNDATION 2701 17TH STREET ROCK ISLAND IL 61201 363321751 0 0 0 843927 843927 151589 37897 0 0 0 TRINITY HEALTH SYSTEMS INC 802 KENYON ROAD FORT DODGE IA 50501 421222877 0 0 0 3617693 3617693 330885 82721 0 0 0 TRINITY MEDICAL CENTER 2701 17TH STREET ROCK ISLAND IL 61201 362739299 0 12500 12500 342415192 342427692 1000000 250000 0 0 0 TRINITY REGIONAL HEALTH SYSTEM 2701 17TH STREET ROCK ISLAND IL 61201 363351952 0 0 0 617925 617925 117689 29422 0 0 0 TRINITY REGIONAL HOSPITAL AUXILIARY 802 KENYON ROAD FORT DODGE IA 50501 426081474 0 0 0 131553 131553 26311 6578 0 0 0 TRINITY REGIONAL MEDICAL CENTER 802 KENYON ROAD FORT DODGE IA 50501 421009175 0 0 0 87697129 87697129 1000000 250000 0 0 0 UNITY HEALTHCARE 1518 MULBERRY AVENUE MUSCATINE IA 52761 420680337 0 0 0 41951632 41951632 1000000 250000 0 0 0 UNITY HEALTHCARE FOUNDATION 1518 MULBERRY AVENUE MUSCATINE IA 52761 421525031 0 0 0 605338 605338 115801 28950 0 0 0 UNITYPOINT AT HOME 11333 AURORA AVENUE URBANDALE IA 50322 421477471 0 0 0 83611330 83611330 1000000 250000 0 0 0 UNITYPOINT HEALTH AT WORK 1776 WEST LAKES PKWY STE 400 WEST DES MOINES IA 50266 810872241 0 0 0 0 0 0 0 0 0 0