2016-11-14T11:14:53-06:00 2015-12-31 990 2015-01-01 420680452 CENTRAL IOWA HOSPITAL CORPORATION CENT 5152416212 1200 PLEASANT ST DES MOINES IA 503091453 JOSEPH F CORFITS SENIOR VP FINANCE/CFO 5152416396 2016-11-07 2015 2017-02-10 21:41:12Z UNITYPOINT HEALTH-DES MOINES ERIC T CROWELL 1200 PLEASANT ST DES MOINES IA 503091453 803705385 0 X WWW.UNITYPOINT.ORG/DES-MOINES X 1933 IA IMPROVING THE HEALTH OF THE COMMUNITY THROUGH HEALING, CARING AND TEACHING. 27 20 6509 8005 13800597 908783 7847144 7783053 692511004 713006203 28146071 28507263 6046926 6852722 734551145 756149241 27058932 31259457 0 0 342602667 382555457 0 0 0 312262040 291477251 681923639 705292165 52627506 50857076 975070197 961372028 268498019 231178868 706572178 730193160 X IMPROVING THE HEALTH OF THE COMMUNITY THROUGH HEALING, CARING AND TEACHING. 0 0 559822073 30255814 714213087 HEALTH-CARE SERVICESCENTRAL IOWA HOSPITAL CORPORATION IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE CENTRAL IOWA COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. CENTRAL IOWA HOSPITAL CORPORATION PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, HOME HEALTH, INTENSIVE CARE AND CRITICAL CARE, MENTAL HEALTH CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, SKILLED NURSING, BEHAVIORAL DISORDER PROGRAMS, MATERNAL/CHILD CARE, LABORATORY, PALLIATIVE CARE, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2015, CENTRAL IOWA HOSPITAL CORPORATION ADMITTED 38,046 PATIENTS RESULTING IN A TOTAL OF 170,465 PATIENT DAYS. OUTPATIENT VISITS TOTALED 335,440 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 22,153. THERE WERE ALSO 95,051 EMERGENCY ROOM VISITS AND 4,978 BABIES DELIVERED. 38667478 1003643 0 CHARITY CARE, MEANS-TESTED PROGRAMS AND OTHER COMMUNITY BENEFITSCHARITY CARE AND MEANS-TESTED PROGRAMS: CENTRAL IOWA HOSPITAL CORPORATION PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE AT A VALUE OF $4,242,934 IN 2015. OFTENTIMES, CENTRAL IOWA HOSPITAL CORPORATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. CENTRAL IOWA HOSPITAL CORPORATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. IOWA METHODIST MEDICAL CENTER, IOWA LUTHERAN HOSPITAL AND BLANK CHILDREN'S HOSPITALS' NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $17,752,400 FOR 2015. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $21,995,334.OTHER BENEFITS: CENTRAL IOWA HOSPITAL CORPORATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. CENTRAL IOWA HOSPITAL CORPORATION COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. CENTRAL IOWA HOSPITAL CORPORATION HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 232,084 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL NET OTHER BENEFITS REPORTED VALUE: $16,672,144. 598489551 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 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 1 0 1 X 0 0 6509 1 1 1 0 0 0 0 0 0 0 0 0 X 27 20 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X JOSEPH F CORFITS SENIOR VPCFO 5152416470 1200 PLEASANT ST DES MOINES IA 50309 KIRK ABRAHAMSON FR 22015 BOARD MEMBER 1.00 1.00 X 0 0 0 ERIC BARP DPM BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID BOARINI MD BOARD TREASURER 1.00 1.00 X X 0 0 0 BRAD BRODY BOARD CHAIR 1.00 1.00 X X 0 10225 0 MICHAEL BURK BOARD SECRETARY 1.00 1.00 X X 0 0 0 MARY CHAPMAN BOARD MEMBER 1.00 1.00 X 0 0 0 ERIC CROWELL BOARD MEMBER/CEO 1.00 40.00 X X 893753 0 265402 DIANA GORSCHE RN BSN CCM BOARD MEMBER 1.00 1.00 X 0 0 0 KENT HENNING BOARD MEMBER 1.00 1.00 X 0 14622 0 STEVE HERWIG DO BOARD MEMBER 1.00 1.00 X 0 9750 0 KAYLEEN HORNBROOK DO BOARD MEMBER 1.00 40.00 X 0 242331 31305 THOMAS HOUSER BOARD MEMBER 1.00 1.00 X 0 0 0 BURTON TOBY JOSEPH BOARD MEMBER 1.00 1.00 X 0 0 0 GARY KAHN FR 22015 BOARD MEMBER 1.00 1.00 X 0 0 0 JOSE LARACUENTE FR 42015 BOARD MEMBER 1.00 1.00 X 0 0 0 FRANK MARCOVIS TO 22015 BOARD MEMBER 1.00 1.00 X 0 0 0 RICHARD MCCONNELL PHD BOARD MEMBER 1.00 1.00 X 0 15755 0 PAT MCGOLDRICK BOARD MEMBER 1.00 1.00 X 0 0 0 JANETTE MILLER-STRAUB BOARD MEMBER 1.00 1.00 X 0 0 0 MARY O'KEEFE BOARD MEMBER 1.00 1.00 X 0 0 0 R LUCIA RIDDLE BOARD MEMBER 1.00 1.00 X 0 0 0 BRUCE SHERMAN BOARD MEMBER 1.00 1.00 X 0 16053 0 LYLE SIMPSON BOARD MEMBER 1.00 1.00 X 0 0 0 CHARLES SVENSSON MD BOARD MEMBER 1.00 40.00 X 0 313810 28906 CHARLIE TAYLOR BOARD MEMBER 1.00 1.00 X 0 0 0 TIFFANY TAUSCHECK FR 32015 BOARD MEMBER 1.00 1.00 X 0 0 0 JULIUS TRIMBLE BOARD MEMBER 1.00 1.00 X 0 0 0 MARTHA WILLITS BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 JOSEPH CORFITS SENIOR VP FINANCE/CFO 40.00 1.00 X 688162 0 139080 AMY BETHEL EXEC DIR SURGERY 40.00 0.00 X 154215 0 32639 CHRISTINE BLAIR MHA RN CHIEF ADMIN OFFICER 40.00 0.00 X 231424 0 43061 GAYLE CULBERTSON EXEC DIR LAB SVCS 40.00 0.00 X 161943 0 25867 DOUGLAS DORNER MD VP MEDICAL EDUCATION 40.00 0.00 X 538599 0 21936 CECELIA KIRVIN EXEC DIR/CCO BCH 40.00 0.00 X 187650 0 29492 TODD KRANPITZ EXEC DIR DIAGNOSTIC SVCS 40.00 0.00 X 206973 0 23021 ERIC LOTHE VP OPERATIONS/CAO-ILH 40.00 0.00 X 447558 0 91993 JOYCE MCDANEL VP HUMAN RESOURCES 40.00 0.00 X 370978 0 87665 DEBRA MOYER BSN MPA RN CHIEF NURSING EXEC 40.00 0.00 X 425479 0 62314 THOMAS MULROONEY VP SURGICAL & CARDIOVASCULAR 40.00 0.00 X 260369 0 32778 MARK PURTLE MD VP MEDICAL AFFAIRS 40.00 0.00 X 599513 0 94323 SIDNEY RAMSEY VP STRATEGIC BUSINESS DEV- 40.00 0.00 X 444783 0 49177 DAVID STARK PRESIDENT/COO BCH & EVP IH 40.00 0.00 X 614836 0 99452 STEPHEN STEPHENSON MD EXEC VP/COO-IHDM 40.00 0.00 X 781983 0 37358 THARWAT STEWART BOULIS MD PHYSICIAN-PERINATOLOGY 40.00 0.00 X 619027 0 33223 ROBERT ISAAK MD PHYSICIAN-RADATION ONCOLOGY 40.00 0.00 X 1424963 0 38060 ALAN SACKS MD PHYSICIAN-NEONATAL-PERINATAL 40.00 0.00 X 557420 0 12248 JOHN TRIANTAFYLLOS MD PHYSICIAN-RADATION ONCOLOGY 40.00 0.00 X 1293897 0 33604 ONYEBUCHI UKABIALA MD PHYSICIAN-PEDIATRIC SURGERY 40.00 0.00 X 759912 0 74321 LESLIE SMIAROWSKI EXEC DR-FAC SVCS FORMER KE 40.00 0.00 X 176244 0 23875 11839681 622546 1411100 338 1 1 0 THE IOWA CLINIC 5950 UNIVERSITY AVE WEST DES MOINES IA 50266 HEALTHCARE SERVICES 3618821 ARAMARK FACILITIES 22506 NETWORK PLACE CHICAGO IL 60673 LAUNDRY, CLEANING AND FOOD SERVICES 1924977 ASSOCIATED ANESTHESIOLOGISTS PC 1215 PLEASANT ST SUITE 400 DES MOINES IA 50309 ANESTHESIOLOGY SERVICES 1801969 MAYO MEDICAL LABORATORIES 3050 SUPERIOR DR NW ROCHESTER MN 55905 LABORATORY SERVICES 1524907 GRAPETREE MEDICAL STAFFING 1003 23RD STREET MILFORD IA 51351 MEDICAL STAFFING 1007647 61 7213138 141371 428544 7783053 NET PATIENT REVENUE 900099 670474572 670474572 LABORATORY SERVICES 621500 16115903 2702526 13413377 MGMT & SUPPORT SVCS 561000 12405174 12403265 1909 SUBS & JOINT VENTURES 900099 12115705 12115705 MISCELLANEOUS REVENUE 900099 1105211 1105211 789638 789638 713006203 13833137 10637 13822500 61037680 1192590 46368336 1187808 14669344 4782 14674126 14674126 CAFETERIA/FOOD SVCS 722210 4295066 81284 4213782 CHILDCARE SERVICES 624410 1442693 1442693 MISCELLANEOUS REVENUE 900099 694054 694054 420909 116882 304027 6852722 756149241 700412490 13800597 34153101 31259457 31259457 8143774 8143774 703210 703210 309481321 265195652 44285669 9522530 8159890 1362640 35386187 30327692 5058495 19318435 16554036 2764399 53802769 33550951 20251818 1090511 3998 1086513 99 99 6000 6000 2635358 682411 1952947 40492382 27473015 13019367 2021050 1069445 951605 12210490 10851819 1358671 -3181040 -3181040 15965249 15040202 925047 896649 576241 320408 554767 185136 369631 7976826 7944575 32251 28711956 27726818 985138 1724014 18103 1705911 MEDICAL SUPPLIES 125288514 124447281 841233 MISCELLANEOUS EXPENSES 1244635 594001 650634 INCOME TAXES 37022 9769 27253 705292165 598489551 106802614 0 4629445 5289869 2596525 2332948 101354258 95566610 16257543 16475588 13728297 15145479 2840346 2932347 748831466 506158345 232950508 242673121 545394144 522678145 41178843 42992421 327486 313382 13812802 14972118 975070197 961372028 59823259 46221961 1801999 1807240 23000000 3321819 3092432 5320340 7568738 175230602 172488497 268498019 231178868 X 674713150 694317229 13215695 18731243 18643333 17144688 706572178 730193160 975070197 961372028 X 50857076 -25741245 -1494849 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 6000 6000 0 PART II-B, LINE 1: PAID TO CONSULTING FIRM FOR LOBBYING ACTIVITIES ON BEHALF OF HEALTH CARE. 541715046 624976 7687415 23000000 1227405 525800032 504003468 179713 38451558 179556 740137 541715046 409386470 40087047 59414890 3820990 1063949 504003468 402694127 10820990 44751469 48054272 825844 409386470 393764418 14837391 -4633215 1274466 402694128 0.92830 0.03260 0.03910 0 1 1 11282819 11282819 248946559 168129646 80816913 11932517 8868164 3064353 442009118 321647479 120361639 34660453 7513056 27147397 242673121 ASBESTOS REMOVAL LIABILITY 2524719 DUE TO AFFILIATES 140976964 SELF-INSURANCE RESERVE 11856831 LONG-TERM RETENTION INCENTIVES 14093344 HEALTH & WELFARE BENEFITS RESERVE 2841639 MISCELLANEOUS LIABILITY 195000 172488497 X 726368000 -25994351 2152949 -23841402 750209402 1232854 4706985 5939839 756149241 670192000 0 670192000 1232854 33867311 35100165 705292165 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 2D - OTHER ADJUSTMENTS: REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 2,152,949. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 2,545,990. IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATES 2,160,835. ROUNDING 160. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 31,706,066. IOWA HEALTH SYSTEM CONTRACTING SERVICES PURCHASE REBATES 2,160,835. ROUNDING 410. 1 1 X 1 X 1 X 1 1 0 1 1 4242934 4242934 0.00600 113537616 95785216 17752400 0.02520 117780550 95785216 21995334 0.03120 229865 2463076 470556 1992520 0.00280 2219 13652697 7118226 6534471 0.00930 23171511 16706677 6464834 0.00920 676676 676676 0.00100 1003643 1003643 0.00140 232084 40967603 24295459 16672144 0.02370 232084 158748153 120080675 38667478 0.05490 57741 57741 0.00010 73333 73333 0.00010 131074 131074 0.00020 0 6630094 0 177491689 172450027 5041662 X 1 1 1 CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT COMPANY LLC MANAGEMENT OF CARDIAC SERVICE LINE 0.20000 0.80000 2 CENTRAL IOWA ONCOLOGY CO-MANAGEMENT COMPANY MANAGEMENT OF ONCOLOGY SERVICE LINE 0.20000 0.80000 3 CENTRAL IOWA SURGICAL SERVICES CO-MANAGEMENT COMPANY LLC MANAGEMENT OF SURGERY SERVICE LINE 0.20000 0.80000 4 IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC OUTPATIENT DIAGNOSTIC IMAGING 0.50000 0.50000 5 LAKEVIEW SURGERY CENTER LC SURGERY CENTER 0.50000 0.50000 6 ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC AMBULATORY SURGERY CENTER 0.50000 0.50000 7 WEST HOSPITAL ORTHOPAEDIC CO-MANAGEMENT COMPANY MANAGEMENT OF METHODIST WEST ORTHO SERVICE LINE 0.20000 0.80000 8 WEST LAKES SLEEP CENTER LLC TREATMENT OF CHRONIC SLEEP DISORDERS 0.50000 0.50000 3 1 IOWA METHODIST MEDICAL CENTER 1200 PLEASANT STREET DES MOINES IA 50309 WWW.UNITYPOINT.ORG/DESMOINES 770079H X X X X X X X A 2 IOWA LUTHERAN HOSPITAL 700 EAST UNIVERSITY AVENUE DES MOINES IA 50316 WWW.UNITYPOINT.ORG/DESMOINES 770078H X X X A 3 METHODIST WEST HOSPITAL 1660 60TH STREET WEST DES MOINES IA 50266 WWW.UNITYPOINT.ORG/DESMOINES 250080H X X X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X X 15 1 1 1 1 X WWW.UNITYPOINT.ORG/DESMOINES X 1 15 1 WWW.UNITYPOINT.ORG/DESMOINES 1 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X WWW.UNITYPOINT.ORG/DESMOINES/FINANCIALASSISTANCE.ASPX X WWW.UNITYPOINT.ORG/DESMOINES/FINANCIALASSISTANCE.ASPX X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: IOWA METHODIST MEDICAL CENTER, - FACILITY 2: IOWA LUTHERAN HOSPITAL, - FACILITY 3: METHODIST WEST HOSPITAL GROUP A-FACILITY 1 -- IOWA METHODIST MEDICAL CENTER PART V, SECTION B, LINE 3J: IT IS ENVISIONED THAT THE CAPITAL CROSSROADS AND GREATER DES MOINES PARTNERSHIP STAFF IN COLLABORATION WITH THE WELLNESS CAPITAL COMMITTEE WILL CONTINUE FACILITATION WITH THE CHNA STEERING COMMITTEE TO ENSURE PROGRESS IN IMPLEMENTING THE PRIORITIES LAID OUT IN THE CHNA. GROUP A-FACILITY 1 -- IOWA METHODIST MEDICAL CENTER PART V, SECTION B, LINE 5: IN ALIGNMENT WITH THE CAPITAL CROSSROADS REGIONAL VISION PLAN, THE GREATER DES MOINES PARTNERSHIP FACILITATED THE DEVELOPMENT OF THIS CHNA ALONG WITH A STEERING COMMITTEE COMPRISED OF REPRESENTATIVES FROM HOSPITALS, HEALTH DEPARTMENTS, PHILANTHROPIC ORGANIZATIONS, SERVICE PROVIDERS, ACADEMIC INSTITUTIONS AND THE PRIVATE SECTOR. THE GROUP IDENTIFIED FIVE AREAS TO ADDRESS IN THE CHNA: ACCESS TO CARE, YOUTH, PHYSICAL ENVIRONMENT, WORKFORCE, AND MENTAL HEALTH. WORK GROUPS WERE CREATED TO ASSESS EACH FOCUS AREA AND TO IDENTIFY CURRENT CONDITIONS, TARGETS, CHALLENGES, NEEDED RESOURCES, AND PRIORITY AREAS. UPON COMPLETION OF THIS WORK, THE STEERING COMMITTEE RECONVENED TO CAPTURE THE OVERALL VISION FOR A HEALTHY COMMUNITY ENVIRONMENT THAT SUPPORTS AND ENABLES ALL CENTRAL IOWANS TO LIVE HEALTHY LIVES AND ENCOURAGES EVERYONE TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH. GROUP A-FACILITY 1 -- IOWA METHODIST MEDICAL CENTER PART V, SECTION B, LINE 6A: MERCY MEDICAL CENTER, BROADLAWNS MEDICAL CENTER GROUP A-FACILITY 1 -- IOWA METHODIST MEDICAL CENTER PART V, SECTION B, LINE 6B: UNITED WAY OF CENTRAL IOWA, WARREN COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, DALLAS COUNTY HEALTH DEPARTMENT, GREATER DES MOINES PARTNERSHIP, HCI CARE SERVICES AND VNS OF IOWA, YMCA OF GREATER DES MOINES, DES MOINES UNIVERSITY, PRIMARY HEALTH CARE INC., WELLMARK BLUE CROSS AND BLUE SHIELD, MID-IOWA HEALTH FOUNDATION GROUP A-FACILITY 1 -- IOWA METHODIST MEDICAL CENTER PART V, SECTION B, LINE 11: THE 2016 CENTRAL IOWA COMMUNITY HEALTH NEEDS ASSESSMENT IS A COLLABORATION OF HOSPITAL AND HEALTH DEPARTMENT REPRESENTATIVES ALONG WITH OTHER COMMUNITY STAKEHOLDERS. A STEERING COMMITTEE IDENTIFIED FIVE AREAS TO ADDRESS, INCLUDING ACCESS TO CARE, MENTAL HEALTH, PHYSICAL ENVIRONMENT, WORKFORCE, AND YOUTH. THE FINAL REPORT ADDRESSES SIX PRIORITIES, BASED ON THE POTENTIAL FOR IMPLEMENTATION AND DEPTH OF IMPACT. THOSE PRIORITIES INCLUDE:A. INCREASE OPPORTUNITIES FOR EXPANDED AND ALTERNATIVE MEANS OF HEALTHCARE DELIVERY TO ADDRESS ISSUES LIMITING ACCESS TO CAREB. ESTABLISH MORE VIBRANT COMMUNITIES AND NEIGHBORHOODS CHARACTERIZED BY MIXED- AND JOINT-USE SPACES AND FACILITIES THAT ARE ACCESSIBLE AND AVAILABLE TO EVERYONE, INCLUDING PUBLIC GATHERING PLACES FOR DIVERSE AND INTEGRATED ENGAGEMENT, AND DESIGNS THAT PROMOTE HEALTHY LIFESTYLESC. EXPAND STATEWIDE TRAINING EFFORTS FOR ALL PROFESSIONALS WORKING WITH CHILDREN ACROSS THE VARIOUS HEALTH AND CHILD-SERVING SYSTEMS IN TRAUMA INFORMED CARE, CULTURAL COMPETENCY, AND MENTAL HEALTH FIRST AIDD. IDENTIFY ADDITIONAL SOURCES OF FUNDING TO CREATE NEW AND EXPAND EXISTING TRAINING PROGRAMS IN PSYCHIATRY AND PSYCHOLOGY AND IMPROVE THE MENTAL HEALTH AND DISABILITIES TRAINING OF PRIMARY CARE DOCTORS AND OTHER PRIMARY CARE PROVIDERSE. ENSURE ACCESS TO HIGH-QUALITY PRE-K AND K-12 EDUCATION FOR CENTRAL IOWA CHILDRENF. ENSURE ACCESS TO HEALTH CARE SERVICES AND EDUCATION FOR CENTRAL IOWA'S NEWCOMER POPULATION GROUP A-FACILITY 1 -- IOWA METHODIST MEDICAL CENTER 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, FAMILY INVESTMENT PROGRAM, BARNABAS UPLIFT, MISSION HEALTH, AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. GROUP A-FACILITY 2 -- IOWA LUTHERAN HOSPITAL PART V, SECTION B, LINE 3J: IT IS ENVISIONED THAT THE CAPITAL CROSSROADS AND GREATER DES MOINES PARTNERSHIP STAFF IN COLLABORATION WITH THE WELLNESS CAPITAL COMMITTEE WILL CONTINUE FACILITATION WITH THE CHNA STEERING COMMITTEE TO ENSURE PROGRESS IN IMPLEMENTING THE PRIORITIES LAID OUT IN THE CHNA. GROUP A-FACILITY 2 -- IOWA LUTHERAN HOSPITAL PART V, SECTION B, LINE 5: IN ALIGNMENT WITH THE CAPITAL CROSSROADS REGIONAL VISION PLAN, THE GREATER DES MOINES PARTNERSHIP FACILITATED THE DEVELOPMENT OF THIS CHNA ALONG WITH A STEERING COMMITTEE COMPRISED OF REPRESENTATIVES FROM HOSPITALS, HEALTH DEPARTMENTS, PHILANTHROPIC ORGANIZATIONS, SERVICE PROVIDERS, ACADEMIC INSTITUTIONS AND THE PRIVATE SECTOR. THE GROUP IDENTIFIED FIVE AREAS TO ADDRESS IN THE CHNA: ACCESS TO CARE, YOUTH, PHYSICAL ENVIRONMENT, WORKFORCE, AND MENTAL HEALTH. WORK GROUPS WERE CREATED TO ASSESS EACH FOCUS AREA AND TO IDENTIFY CURRENT CONDITIONS, TARGETS, CHALLENGES, NEEDED RESOURCES, AND PRIORITY AREAS. UPON COMPLETION OF THIS WORK, THE STEERING COMMITTEE RECONVENED TO CAPTURE THE OVERALL VISION FOR A HEALTHY COMMUNITY ENVIRONMENT THAT SUPPORTS AND ENABLES ALL CENTRAL IOWANS TO LIVE HEALTHY LIVES AND ENCOURAGES EVERYONE TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH. GROUP A-FACILITY 2 -- IOWA LUTHERAN HOSPITAL PART V, SECTION B, LINE 6A: MERCY MEDICAL CENTER, BROADLAWNS MEDICAL CENTER GROUP A-FACILITY 2 -- IOWA LUTHERAN HOSPITAL PART V, SECTION B, LINE 6B: UNITED WAY OF CENTRAL IOWA, WARREN COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, DALLAS COUNTY HEALTH DEPARTMENT, GREATER DES MOINES PARTNERSHIP, HCI CARE SERVICES AND VNS OF IOWA, YMCA OF GREATER DES MOINES, DES MOINES UNIVERSITY, PRIMARY HEALTH CARE INC., WELLMARK BLUE CROSS AND BLUE SHIELD, MID-IOWA HEALTH FOUNDATION GROUP A-FACILITY 2 -- IOWA LUTHERAN HOSPITAL PART V, SECTION B, LINE 11: THE 2016 CENTRAL IOWA COMMUNITY HEALTH NEEDS ASSESSMENT IS A COLLABORATION OF HOSPITAL AND HEALTH DEPARTMENT REPRESENTATIVES ALONG WITH OTHER COMMUNITY STAKEHOLDERS. A STEERING COMMITTEE IDENTIFIED FIVE AREAS TO ADDRESS, INCLUDING ACCESS TO CARE, MENTAL HEALTH, PHYSICAL ENVIRONMENT, WORKFORCE, AND YOUTH. THE FINAL REPORT ADDRESSES SIX PRIORITIES, BASED ON THE POTENTIAL FOR IMPLEMENTATION AND DEPTH OF IMPACT. THOSE PRIORITIES INCLUDE:A. INCREASE OPPORTUNITIES FOR EXPANDED AND ALTERNATIVE MEANS OF HEALTHCARE DELIVERY TO ADDRESS ISSUES LIMITING ACCESS TO CAREB. ESTABLISH MORE VIBRANT COMMUNITIES AND NEIGHBORHOODS CHARACTERIZED BY MIXED- AND JOINT-USE SPACES AND FACILITIES THAT ARE ACCESSIBLE AND AVAILABLE TO EVERYONE, INCLUDING PUBLIC GATHERING PLACES FOR DIVERSE AND INTEGRATED ENGAGEMENT, AND DESIGNS THAT PROMOTE HEALTHY LIFESTYLESC. EXPAND STATEWIDE TRAINING EFFORTS FOR ALL PROFESSIONALS WORKING WITH CHILDREN ACROSS THE VARIOUS HEALTH AND CHILD-SERVING SYSTEMS IN TRAUMA INFORMED CARE, CULTURAL COMPETENCY, AND MENTAL HEALTH FIRST AIDD. IDENTIFY ADDITIONAL SOURCES OF FUNDING TO CREATE NEW AND EXPAND EXISTING TRAINING PROGRAMS IN PSYCHIATRY AND PSYCHOLOGY AND IMPROVE THE MENTAL HEALTH AND DISABILITIES TRAINING OF PRIMARY CARE DOCTORS AND OTHER PRIMARY CARE PROVIDERSE. ENSURE ACCESS TO HIGH-QUALITY PRE-K AND K-12 EDUCATION FOR CENTRAL IOWA CHILDRENF. ENSURE ACCESS TO HEALTH CARE SERVICES AND EDUCATION FOR CENTRAL IOWA'S NEWCOMER POPULATION GROUP A-FACILITY 2 -- IOWA LUTHERAN 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, FAMILY INVESTMENT PROGRAM, BARNABAS UPLIFT, MISSION HEALTH, AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. GROUP A-FACILITY 3 -- METHODIST WEST HOSPITAL PART V, SECTION B, LINE 3J: IT IS ENVISIONED THAT THE CAPITAL CROSSROADS AND GREATER DES MOINES PARTNERSHIP STAFF IN COLLABORATION WITH THE WELLNESS CAPITAL COMMITTEE WILL CONTINUE FACILITATION WITH THE CHNA STEERING COMMITTEE TO ENSURE PROGRESS IN IMPLEMENTING THE PRIORITIES LAID OUT IN THE CHNA. GROUP A-FACILITY 3 -- METHODIST WEST HOSPITAL PART V, SECTION B, LINE 5: IN ALIGNMENT WITH THE CAPITAL CROSSROADS REGIONAL VISION PLAN, THE GREATER DES MOINES PARTNERSHIP FACILITATED THE DEVELOPMENT OF THIS CHNA ALONG WITH A STEERING COMMITTEE COMPRISED OF REPRESENTATIVES FROM HOSPITALS, HEALTH DEPARTMENTS, PHILANTHROPIC ORGANIZATIONS, SERVICE PROVIDERS, ACADEMIC INSTITUTIONS AND THE PRIVATE SECTOR. THE GROUP IDENTIFIED FIVE AREAS TO ADDRESS IN THE CHNA: ACCESS TO CARE, YOUTH, PHYSICAL ENVIRONMENT, WORKFORCE, AND MENTAL HEALTH. WORK GROUPS WERE CREATED TO ASSESS EACH FOCUS AREA AND TO IDENTIFY CURRENT CONDITIONS, TARGETS, CHALLENGES, NEEDED RESOURCES, AND PRIORITY AREAS. UPON COMPLETION OF THIS WORK, THE STEERING COMMITTEE RECONVENED TO CAPTURE THE OVERALL VISION FOR A HEALTHY COMMUNITY ENVIRONMENT THAT SUPPORTS AND ENABLES ALL CENTRAL IOWANS TO LIVE HEALTHY LIVES AND ENCOURAGES EVERYONE TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH. GROUP A-FACILITY 3 -- METHODIST WEST HOSPITAL PART V, SECTION B, LINE 6A: MERCY MEDICAL CENTER, BROADLAWNS MEDICAL CENTER GROUP A-FACILITY 3 -- METHODIST WEST HOSPITAL PART V, SECTION B, LINE 6B: UNITED WAY OF CENTRAL IOWA, WARREN COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, DALLAS COUNTY HEALTH DEPARTMENT, GREATER DES MOINES PARTNERSHIP, HCI CARE SERVICES AND VNS OF IOWA, YMCA OF GREATER DES MOINES, DES MOINES UNIVERSITY, PRIMARY HEALTH CARE INC., WELLMARK BLUE CROSS AND BLUE SHIELD, MID-IOWA HEALTH FOUNDATION GROUP A-FACILITY 3 -- METHODIST WEST HOSPITAL PART V, SECTION B, LINE 11: THE 2016 CENTRAL IOWA COMMUNITY HEALTH NEEDS ASSESSMENT IS A COLLABORATION OF HOSPITAL AND HEALTH DEPARTMENT REPRESENTATIVES ALONG WITH OTHER COMMUNITY STAKEHOLDERS. A STEERING COMMITTEE IDENTIFIED FIVE AREAS TO ADDRESS, INCLUDING ACCESS TO CARE, MENTAL HEALTH, PHYSICAL ENVIRONMENT, WORKFORCE, AND YOUTH. THE FINAL REPORT ADDRESSES SIX PRIORITIES, BASED ON THE POTENTIAL FOR IMPLEMENTATION AND DEPTH OF IMPACT. THOSE PRIORITIES INCLUDE:A. INCREASE OPPORTUNITIES FOR EXPANDED AND ALTERNATIVE MEANS OF HEALTHCARE DELIVERY TO ADDRESS ISSUES LIMITING ACCESS TO CAREB. ESTABLISH MORE VIBRANT COMMUNITIES AND NEIGHBORHOODS CHARACTERIZED BY MIXED- AND JOINT-USE SPACES AND FACILITIES THAT ARE ACCESSIBLE AND AVAILABLE TO EVERYONE, INCLUDING PUBLIC GATHERING PLACES FOR DIVERSE AND INTEGRATED ENGAGEMENT, AND DESIGNS THAT PROMOTE HEALTHY LIFESTYLESC. EXPAND STATEWIDE TRAINING EFFORTS FOR ALL PROFESSIONALS WORKING WITH CHILDREN ACROSS THE VARIOUS HEALTH AND CHILD-SERVING SYSTEMS IN TRAUMA INFORMED CARE, CULTURAL COMPETENCY, AND MENTAL HEALTH FIRST AIDD. IDENTIFY ADDITIONAL SOURCES OF FUNDING TO CREATE NEW AND EXPAND EXISTING TRAINING PROGRAMS IN PSYCHIATRY AND PSYCHOLOGY AND IMPROVE THE MENTAL HEALTH AND DISABILITIES TRAINING OF PRIMARY CARE DOCTORS AND OTHER PRIMARY CARE PROVIDERSE. ENSURE ACCESS TO HIGH-QUALITY PRE-K AND K-12 EDUCATION FOR CENTRAL IOWA CHILDRENF. ENSURE ACCESS TO HEALTH CARE SERVICES AND EDUCATION FOR CENTRAL IOWA'S NEWCOMER POPULATION GROUP A-FACILITY 3 -- METHODIST WEST 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, FAMILY INVESTMENT PROGRAM, BARNABAS UPLIFT, MISSION HEALTH, AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. 16 1 - LAKEVIEW SURGERY CENTER LC 1750 60TH ST WEST DES MOINES IA 50266 SURGERY CENTER 2 - IOWA DIAGNOSTIC IMAGING & PROCEDURE CTR 6000 UNIVERSITY AVE SUITE 150 WEST DES MOINES IA 50266 OUTPATIENT DIAGNOSTIC IMAGING 3 - ORTHOPAEDIC OUTPATIENT SURGERY CENTER L 1600 60TH ST WEST DES MOINES IA 50266 AMBULATORY SURGERY CENTER 4 - CHILDREN'S HEALTH CENTER MOB I STE 300 DES MOINES IA 50309 PHYSICIAN CLINIC 5 - CARDIO THORACIC 1200 PLEASANT ST DES MOINES IA 50309 PHYSICIAN CLINIC 6 - COUNSELING CENTER 6000 UNIVERSITY AVE SUITE 200 WEST DES MOINES IA 50266 PHYSICIAN CLINIC 7 - TRANSPLANT CTR & CENTER FOR LIVER DISORD 1215 PLEASANT STREET SUITE 506 DES MOINES IA 50309 PHYSICIAN CLINIC 8 - PERINATAL MOB II STE 116 DES MOINES IA 50309 PHYSICIAN CLINIC 9 - OCC MED 6000 UNIVERSITY AVE SUITE 124 WEST DES MOINES IA 50266 OCCUPATIONAL MEDICINE 10 - MIDWIVES 1440 PLEASANT ST STE1 DES MOINES IA 50309 PHYSICIAN CLINIC 11 - WEST LAKES SLEEP CENTER LLC 5950 UNIVERSITY AVE WEST DES MOINES IA 50266 TREATMENT OF CHRONIC SLEEP DISORDERS 12 - 1776 WESTLAKES PARKWAY LC 1776 WESTLAKES PARKWAY WEST DES MOINES IA 50266 OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BLDGS 13 - CENTRAL IOWA CARDIOVASCULAR CO-MGMT 1200 PLEASANT ST DES MOINES IA 50309 MANAGEMENT OF CARDIAC SERVICE LINE 14 - WEST HOSPITAL ORTHOPAEDIC CO-MGMT 1660 60TH ST WEST DES MOINES IA 50266 MANAGEMENT OF METHODIST WEST ORTHO SERVICE LINE 15 - CENTRAL IOWA ONCOLOGY CO-MANAGEMENT 1200 PLEASANT ST DES MOINES IA 50309 MANAGEMENT OF ONCOLOGY SERVICE LINE 16 - CENTRAL IOWA SURGICAL SERVICES CO-MGMT 1200 PLEASANT ST DES MOINES IA 50309 MANAGEMENT OF SURGICAL SERVICES LINE PART I, LINE 6A: CENTRAL IOWA HOSPITAL CORPORATION'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM 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 II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH-DES MOINES CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH STATUS IN WAYS THAT MAY DIFFER FROM THE DIRECT SERVICES OF THE HOSPITAL ORGANIZATION. OTHER DONATIONS SUCH AS FOOD OR OTHER DURABLE GOODS PROVIDE AREA SHELTERS AND OTHER ORGANIZATIONS IN THE AREA. THIS ALLOWS THESE ORGANIZATIONS TO MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH-DES MOINES EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH-DES MOINES EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COMMUNITY COLLABORATIVE COLLECTIVELY WORKING TO ADDRESS COMPLEX HEALTH. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT' LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR CENTRAL IOWA HOSPITAL CORPORATION. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 8: AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. PART VI, LINE 2: CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH-DES MOINES PARTICIPATES IN A TRI-COUNTY PROCESS TO CONDUCT A COMMUNITY NEEDS ASSESSMENT (CHNA). THIS INCLUDED POLK, WARREN AND DALLAS COUNTIES. THESE COUNTIES ARE IDENTIFIED AS THE HOSPITAL'S "SERVICE AREA." THE CHNA IS CONDUCTED IN PARTNERSHIP WITH MERCY AND BROADLAWNS MEDICAL CENTERS AS WELL AS THE HEALTH DEPARTMENTS OF EACH COUNTY. NUMEROUS OTHER COMMUNITY PARTNERS AND STAKEHOLDERS SUCH AS THE UNITED WAY ARE INCLUDED IN THIS PROCESS AS WELL AS COMMUNITY MEMBERS.THE IMPACT ON THE NEEDS WILL BE MEASURED AND ASSESSED WITH THE ESTABLISHED PARTNERSHIP. CONTINUAL COLLABORATION WITH THE LOCAL HEALTH DEPARTMENTS WILL ASSURE THAT EFFORTS ARE COORDINATED ACROSS THE COMMUNITY. THIS WILL ALSO LAY GROUNDWORK FOR THE NEXT CHNA PROCESS SCHEDULED FOR 2015. PART VI, LINE 3: CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH-DES MOINES PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR BROCHURES IN APPROPRIATE AREAS OF THE PROVIDER (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THE PROVIDER/PHYSICIAN PRACTICE OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE. PART VI, LINE 4: CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH DES MOINES IS A 779-BED COMMUNITY HOSPITAL SYSTEM SERVING CENTAL IOWA. CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH DES MOINES IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH DES MOINES' MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF DALLAS, GUTHRIE, JASPER, MADISON, MARION, POLK, STORY, AND WARREN. CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH DES MOINES ADMITS 38,046 INPATIENTS AND CARES FOR 95,051 EMERGENCY PATIENTS PER YEAR. THERE ARE 34 OTHER HOSPITALS WITHIN THE 30-COUNTY SERVICE AREA. MEDIAN HOUSEHOLD INCOMES RANGE FROM $50,238 TO $74,876 AND THE AVERAGE POVERTY RATE IS 11.08%. 56% OF CENTRAL IOWA HOSPITAL CORPORATION D/B/A UNITYPOINT HEALTH DES MOINES PATIENTS ARE ELIGIBLE FOR MEDICARE (41%) OR MEDICAID (15%). DALLAS, POLK AND STORY COUNTIES ARE THE ONLY COUNTIES IN THE SERVICE AREA WITH SIGNIFICANT MINORITY POPULATIONS. DALLAS COUNTY IS 6.2 PERCENT HISPANIC, POLK COUNTY IS 6.2 PERCENT AFRICAN AMERICAN AND 7.8 PERCENT HISPANIC, AND STORY COUNTY IS 6.2 PERCENT ASIAN. PART VI, LINE 5: THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE. PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). INITIALLY FORMED IN 1994, UNITYPOINT HEALTH IS THE STATE'S FIRST AND LARGEST INTEGRATED HEALTH SYSTEM, SERVING NEARLY ONE OF EVERY THREE PATIENTS IN IOWA. THROUGH RELATIONSHIPS WITH 32 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 280 PHYSICIAN CLINICS, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY THE STATE'S LARGEST 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 4.5 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $3.9 BILLION, UNITYPOINT HEALTH IS THE FOURTH 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 2015, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $507 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 IA 1 AMERICAN CANCER SOCIETY 8364 HICKMAN RD STE D DES MOINES IA 50325 131788491 501(C)(3) 6500 EVENT SPONSOR AMERICAN HEART ASSOCIATION 1111 NINTH ST STE 280 DES MOINES IA 50314 135613797 501(C)(3) 19500 EVENT SPONSOR AMERICAN RED CROSS 2116 GRAND AVEUE DES MOINES IA 50312 530196605 501(C)(3) 5000 EVENT SPONSOR ANKENY COMMUNITY FOUNDATION 410 WEST FIRST ST ANKENY IA 50023 203850596 501(C)(3) 8333 CAPITAL BUILDING CAMPAIGN CITY OF DES MOINES 400 ROBERT D RAY DRIVE DES MOINES IA 50309 426004514 GOVERNMENT 82057 OTHER CITY OF WEST DES MOINES 4200 MILLS CIVIC PKY WEST DES MOINES IA 50265 426005359 GOVERNMENT 5000 OTHER CLARKE COUNTY HOSPITAL 800 SOUTH FILLMORE OSCEOLA IA 50213 426037982 501(C)(3) 10000 EVENT SPONSOR COURAGE LEAGUE SPORTS PO BOX 790 WAUKEE IA 50263 461443733 501(C)(3) 5000 EVENT SPONSOR DES MOINES AREA COMMUNITY COLLEGE FOUNDATION 2006 S ANKNEY BLVD ANKENY IA 500233993 237229486 501(C)(3) 5000 EVENT SPONSOR DES MOINES COMMUNITY PLAYHOUSE 831 42ND ST DES MOINES IA 50312 420710259 501(C)(3) 10000 CAPITAL BUILDING CAMPAIGN DES MOINES SYMPHONY 221 WALNUT STREET DES MOINES IA 50309 426058830 501(C)(3) 15000 EVENT SPONSOR DES MOINES UNIVERSITY 3200 GRAND AVE DES MOINES IA 50312 420730347 501(C)(3) 7500 CAPITAL BUILDING CAMPAIGN DOWNTOWN PARTNERSHIP INC DBA DOWNTOWN COMMUNITY ALLIANCE 700 LOCUST STREET SUITE 100 DES MOINES IA 50309 421174898 501(C)(6) 50000 EVENT SPONSOR GLOBAL SPECTRUM (WELLS FARGO ARENA) 730 3RD ST DES MOINES IA 50309 593599248 OTHER 11350 EVENT SPONSOR GRANDVIEW UNIVERSITY 1200 GRANDVIEW AVE DES MOINES IA 50316 420681049 501(C)(3) 100000 PROGRAM SUPPORT GREAT OUTDOORS FOUNDATION PO BOX 8071 DES MOINES IA 50301 421441098 501(C)(3) 5900 EVENT SPONSOR GREATER DES MOINES BASEBALL CO PRINCIPAL PARK ONE LINE DRIVE DES MOINES IA 50309 421173488 OTHER 26000 EVENT SPONSOR GREATER DES MOINES COMMUNITY FOUNDATION 1915 GRAND AVE DES MOINES IA 50309 426139033 501(C)(3) 26850 PROGRAM SUPPORT HOYT SHERMAN PLACE 1501 WOODLAND AVE DES MOINES IA 50309 421433940 501(C)(3) 6250 EVENT SPONSOR IOWA CLINIC HEALTHCARE FOUNDATION 1215 PLEASANT ST SUITE 618 DES MOINES IA 50309 810599749 501(C)(3) 15000 EVENT SPONSOR IOWA FOUNDATION INC (BRAS FOR THE CAUSE) 1913 LANCASTER DR ANKENY IA 50021 260446913 501(C)(3) 10000 PROGRAM SUPPORT IOWA HEALTH SYSTEM 1200 PLEASANT STREET DES MOINES IA 50309 421435199 501(C)(3) 30232694 PROGRAM SUPPORT IOWA WOMEN LEAD CHANGE 200 1ST ST SE SUITE 2100 CEDAR RAPIDS IA 52401 452932668 501(C)(3) 7500 EVENT SPONSOR JUVENILE DIABETES RESEARCH FOUNDATION 5444 NW 96TH ST SUITE A JOHNSTON IA 50131 421907729 501(C)(3) 20000 EVENT SPONSOR KEEP IOWA BEAUTIFUL 300 E LOCUST STREET SUITE 100 DES MOINES IA 50309 421497912 501(C)(3) 5000 EVENT SPONSOR LADIES PROFESIONAL GOLF ASSOCIATION 100 INTERNATIONAL GOLF DR DAYTONA BEACH FL 32124 271317091 501(C)(3) 67000 EVENT SPONSOR MAKE A WISH FOUNDATION OF IOWA 3024 104TH ST URBANDALE IA 50322 421310530 501(C)(3) 21000 EVENT SPONSOR OPERATION DOWNTOWN 700 LOCUST STREET SUITE 100 DES MOINES IA 50309 861058466 501(C)(6) 21000 PROGRAM SUPPORT POLK COUNTY HOUSING TRUST FUND 108 THIRD ST STE 350 DES MOINES IA 50309 421510879 GOVERNMENT 30000 EVENT SPONSOR PREMIER EVENT MANAGEMENT 509 S AL DAVIS RD STE B HARAHAN LA 70123 721241861 OTHER 10000 EVENT SPONSOR PRINCIPAL CHARITY CLASSIC 2771 104TH ST STE 1 URBANDALE IA 50322 426139033 501(C)(3) 85000 EVENT SPONSOR SCIENCE CENTER OF IOWA 401 WEST MARTIN LUTHER KING DES MOINES IA 50309 426097912 501(C)(3) 30000 EVENT SPONSOR STRANDS OF STRENGTH 520 S 18TH ST WEST DES MOINES IA 50265 454145232 501(C)(3) 25000 PROGRAM SUPPORT THE ALS ASSOCIATION IOWA CHAPTER 3636 WESTOWN PARKWAY SUITE 204 WEST DES MOINES IA 50266 300051272 501(C)(3) 5000 EVENT SPONSOR THE GREATER DES MOINES PARTNERSHIP 700 LOCUST STREET SUITE 100 DES MOINES IA 50309 421489668 501(C)(6) 100000 CAPITAL BUILDING CAMPAIGN UNITED WAY OF CENTRAL IOWA 1111 NINTH ST STE 100 DES MOINES IA 50314 420680425 501(C)(3) 15000 EVENT SPONSOR WESLEY LIFE (MEALS ON WHEELS) 5508 NW 88TH ST JOHNSTON IA 50131 420680440 501(C)(3) 25000 PROGRAM SUPPORT YMCA OF GREATER DES MOINES 101 LOCUST ST DES MOINES IA 50309 420680438 501(C)(3) 47950 EVENT SPONSOR YOUTH EMERGENCY SERVICES AND SHELTER 918 SE 11TH ST DES MOINES IA 50309 237442304 501(C)(3) 5000 CAPITAL BUILDING CAMPAIGN 33 6 PART I, LINE 2: CENTRAL IOWA HOSPITAL CORPORATION REQUIRES EACH RECIPIENT OF THE GRANTS (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINE A SERIES OF ELIGIBLITY STANDARDS THAT ARE REQUIRED TO BE MET. ORGANIZATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 ERIC CROWELL BOARD MEMBER/CEO 620009 0 195829 0 77915 0 244932 0 20470 0 1159155 0 0 0 KAYLEEN HORNBROOK DO BOARD MEMBER 0 223516 0 17899 0 916 0 13573 0 17732 0 273636 0 0 CHARLES SVENSSON MD BOARD MEMBER 0 299197 0 11948 0 2665 0 8463 0 20443 0 342716 0 0 JOSEPH CORFITS SENIOR VP FINANCE/CFO 398757 0 113546 0 175859 0 118613 0 20467 0 827242 0 129048 0 AMY BETHEL EXEC DIR SURGERY 147083 0 6021 0 1111 0 18900 0 13739 0 186854 0 0 0 CHRISTINE BLAIR MHA RN CHIEF ADMIN OFFICER 161906 0 49355 0 20163 0 28210 0 14851 0 274485 0 0 0 GAYLE CULBERTSON EXEC DIR LAB SVCS 141218 0 19589 0 1136 0 19443 0 6424 0 187810 0 0 0 DOUGLAS DORNER MD VP MEDICAL EDUCATION 294710 0 118602 0 125287 0 10801 0 11135 0 560535 0 0 0 CECELIA KIRVIN EXEC DIR/CCO BCH 164528 0 22036 0 1086 0 22516 0 6976 0 217142 0 0 0 TODD KRANPITZ EXEC DIR DIAGNOSTIC SVCS 147284 0 41412 0 18277 0 10318 0 12703 0 229994 0 0 0 ERIC LOTHE VP OPERATIONS/CAO-ILH 316657 0 91531 0 39370 0 71610 0 20383 0 539551 0 0 0 JOYCE MCDANEL VP HUMAN RESOURCES 273123 0 75678 0 22177 0 67115 0 20550 0 458643 0 0 0 DEBRA MOYER BSN MPA RN CHIEF NURSING EXEC 293265 0 79925 0 52289 0 56115 0 6199 0 487793 0 0 0 THOMAS MULROONEY VP SURGICAL & CARDIOVASCULAR 191257 0 53842 0 15270 0 12536 0 20242 0 293147 0 0 0 MARK PURTLE MD VP MEDICAL AFFAIRS 448508 0 121324 0 29681 0 73940 0 20383 0 693836 0 0 0 SIDNEY RAMSEY VP STRATEGIC BUSINESS DEV- 315669 0 83814 0 45300 0 43303 0 5874 0 493960 0 0 0 DAVID STARK PRESIDENT/COO BCH & EVP IH 362593 0 100894 0 151349 0 75867 0 23585 0 714288 0 113779 0 STEPHEN STEPHENSON MD EXEC VP/COO-IHDM 434009 0 125721 0 222253 0 16360 0 20998 0 819341 0 167539 0 THARWAT STEWART BOULIS MD PHYSICIAN-PERINATOLOGY 618279 0 0 0 748 0 13250 0 19973 0 652250 0 0 0 ROBERT ISAAK MD PHYSICIAN-RADATION ONCOLOGY 530011 0 894454 0 498 0 13250 0 24810 0 1463023 0 0 0 ALAN SACKS MD PHYSICIAN-NEONATAL-PERINATAL 554496 0 0 0 2924 0 10614 0 1634 0 569668 0 0 0 JOHN TRIANTAFYLLOS MD PHYSICIAN-RADATION ONCOLOGY 521781 0 770970 0 1146 0 13250 0 20354 0 1327501 0 0 0 ONYEBUCHI UKABIALA MD PHYSICIAN-PEDIATRIC SURGERY 756622 0 0 0 3290 0 53525 0 20796 0 834233 0 0 0 LESLIE SMIAROWSKI EXEC DR-FAC SVCS FORMER KE 150530 0 24625 0 1089 0 8928 0 14947 0 200119 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS: SPOUSES SOMETIMES ACCOMPANY BOARD MEMBERS AND/OR OFFICERS ON ORGANIZATIONAL ACTIVITIES, INCLUDING BOARD RELATED TRAVEL. THE ADDITIONAL COST ATTRIBUTABLE TO THE SPOUSE IS TREATED AS TAXABLE COMPENSATION TO THE BOARD MEMBER OR OFFICER AND REPORTED AS APPROPRIATE TO THE IRS. 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 AS "NONCASH COMP" (IMPUTED MISCELLANEOUS) TO PAYCHECK IN ORDER TO TAX APPROPRIATELY. PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN EARNINGS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: JOSEPH CORFITS $82,131, ERIC CROWELL $198,474, ERIC LOTHE $58,360, JOYCE MCDANEL $53,709, DEBRA MOYER $42,917, MARK PURTLE $60,690, DAVID STARK $62,579, STEPHEN STEPHENSON $10,185. NONQUALIFIED RETIREMENT PLAN DISTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED PLAN: JOSEPH CORFITS $129,048, DAVID STARK $113,779, STEPHEN STEPHENSON $167,539. PAYOUTS ARE MADE WITH VESTED FUNDS, AS ESTABLISHED BY PLAN DOCUMENTS. 1776 WESTLAKES PARKWAY LC COMMON BOARD MEMBER/OFFICER 788000 INVESTMENT 0 CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 1620000 INVESTMENT, MANAGEMENT FEE AND FINANCIAL SERVICES 0 CENTRAL IOWA ONCOLOGY CO-MANAGEMENT COMPANY LLC COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 1271000 INVESTMENT, MANAGEMENT FEE AND FINANCIAL SERVICES 0 CENTRAL IOWA SURGICAL SERVICES CO-MANAGEMENT COMPANY LLC COMMON BOARD MEMBER/OFFICER 2525000 INVESTMENT 0 GREATER DES MOINES PARTNERSHIP COMMON BOARD MEMBER/OFFICER 101000 MEMBERSHIP/SUPPORT 0 IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 1457000 INVESTMENT AND IMAGING SERVICES 0 IOWA HEALTH SYSTEM CONTRACTING SERVICES LC COMMON BOARD MEMBER/KEY EMPLOYEE 3243384 PERFORMANCE OF SERVICES 0 IOWA RADIOLOGY PC COMMON BOARD MEMBER/OFFICER 226000 PROFESSIONAL SERVICES 0 LAKEVIEW SURGERY CENTER LC COMMON BOARD MEMBER/OFFICER 1904000 INVESTMENT, SUPPLIES, OTHER 0 NORTH ANKENY MEDICAL PARK LLC COMMON BOARD MEMBER/OFFICER 760000 INVESTMENT 0 ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC COMMON BOARD MEMBER/OFFICER 1885000 INVESTMENT, LAUNDRY 0 THE IOWA CLINIC COMMON BOARD MEMBER/OWNERSHIP INTEREST 9310000 PROFESSIONAL SERVICES 0 STEPHEN HOUSE FAMILY MEMBER OF KEY EMPLOYEE AMY BETHEL 159396 EMPLOYMENT 0 TRACY EKHARDT MD FAMILY MEMBER OF KEY EMPLOYEE STEPHEN STEPHENSON, MD 503091 EMPLOYMENT 0 WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 1495000 INVESTMENT, MANAGEMENT FEE AND FINANCIAL SERVICES 0 WEST LAKES SLEEP CENTER LLC COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 181000 INVESTMENT 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 2 ERIC LOTHE; SIDNEY RAMSEY; BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 CENTRAL IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A CENTRAL IOWA HEALTH SYSTEM ELECTS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CENTRAL IOWA HEALTH SYSTEM ELECTS AND CAN REMOVE BOARD OF DIRECTORS, AND APPROVE DISSOLUTIONS OR MERGER. IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION CAN AMEND THE ARTICLES AND BYLAWS AFTER CONSULTATION WITH CENTRAL IOWA HEALTH SYSTEM. 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 2015 FOR THE FOLLOWING INDIVIDUALS: JOSEPH CORFITS, ERIC CROWELL, DOUGLAS DORNER, ERIC LOTHE, JOYCE MCDANEL, DEBORA MOYER, MARK PURTLE, SIDNEY RAMSEY, DAVID STARK, STEPHEN STEPHENSON. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY, STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS AND WRITTEN EMPLOYMENT CONTRACT. 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 XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF IOWA HEALTH FOUNDATION 6,162,799. CHANGES IN PENSION LIABILITY -7,664,700. CHANGE IN PLEDGE VALUE 7,052. 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 IA 52205 421466284 PROVIDE AMBULANCE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'SJONES REGIONAL MEDICAL CENTER 0 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 0 CENTRAL IOWA HEALTH PROPERTIES CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 421233759 PROPERTY HOLDING COMPANY IA 501(C)(2) CENTRAL IOWA HEALTH SYSTEM 0 CENTRAL 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CENTRAL IOWA HEALTH PROPERTIES CORPORATION P 95529 BASED ON GAAP, CASH, AND/OR FMV. 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).