2014-11-13T14:37:18-06:00 2013-12-31 990 2013-01-01 421435199 IOWA HEALTH SYSTEM IOWA 5152416161 1776 WEST LAKES PARKWAY NO 400 WEST DES MOINES IA 50266 MARK A JOHNSON SVP/CFO 5152413315 2014-11-13 2013 2015-11-30 17:44:51Z UNITYPOINT HEALTH WILLIAM B LEAVER 1776 WEST LAKES PARKWAY NO 400 WEST DES MOINES IA 50266 274015636 0 X WWW.UNITYPOINT.ORG X 1994 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 21 17 1011 0 244212 0 30429565 35800157 180504353 206245342 17473449 17520105 5623847 11366989 234031214 270932593 30311121 34346953 0 0 59637961 71278308 0 0 0 140332368 142810147 230281450 248435408 3749764 22497185 726109495 831977745 790571301 830386300 -64461806 1591445 X TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 218053400 32908572 217612331 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), NORTHWEST IOWA HOSPITAL CORPORATION (SIOUX CITY), FINLEY TRI-STATES HEALTH GROUP (DUBUQUE), METHODIST HEALTH SERVICES CORPORATION (PEORIA), IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION (DBA UNITYPOINT CLINIC), UNITYPOINT AT HOME, AS WELL AS 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. 1438381 1438381 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: $1,438,381. 219491781 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 0 1 0 0 0 0 1 1 1 1 1 0 1 260 0 1 1011 1 1 1 0 0 0 0 0 0 0 0 0 0 X 21 17 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 BOARD MEMBER 1.00 1.00 X 11913 4040 0 GENE BLANC BOARD MEMBER 1.00 0.00 X 13289 0 0 TERRI CHRISTOFFERSEN BOARD MEMBER 1.00 1.00 X 13039 0 0 STANTON DANIELSON MD BOARD MEMBER 1.00 40.00 X 0 366154 87878 RANDY EASTON BOARD MEMBER 1.00 1.00 X 14347 0 0 KATHY ENO BOARD MEMBER 1.00 1.00 X 15380 0 0 SARAH HASKEN BOARD MEMBER 1.00 0.00 X 14123 0 0 KENT HENNING BOARD MEMBER 1.00 1.00 X 13789 499 0 STEVE HERWIG DO BOARD SECRETARY 1.00 1.00 X X 13855 499 0 FRANCIS KANE MD BOARD MEMBER 1.00 0.00 X 14039 0 0 RON KLOSTERMAN BOARD CHAIR 1.00 0.00 X X 27257 0 0 LAWRENCE LIEBSCHER MD BOARD MEMBER 1.00 0.00 X 11289 0 0 RICK MCCONNELL BOARD MEMBER 1.00 1.00 X 16148 499 0 PETER MCLAUGHLIN BOARD MEMBER 1.00 1.00 X 15115 0 0 LINDA NEWBORN BOARD MEMBER 1.00 1.00 X 14539 0 0 KURT PITTNER BOARD MEMBER 1.00 1.00 X 12081 5085 0 BRUCE SHERMAN BOARD MEMBER 1.00 1.00 X 15697 499 0 MICHAEL STONE BOARD TREASURER 1.00 1.00 X X 13579 0 0 KAREN STUMPE BOARD MEMBER 1.00 1.00 X 11740 0 0 DR TRIVEDI DEVENDRA BOARD MEMBER 1.00 1.00 X 13955 0 0 MIKE WILLIAMS BOARD VICE CHAIR 1.00 1.00 X X 15489 92 0 MARK JOHNSON SVP/CFO 40.00 0.00 X 393710 0 136467 WILLIAM LEAVER PRESIDENT/CEO 40.00 0.00 X 1365042 0 927949 KEVIN VERMEER EVP/CSO & ACO CEO 40.00 1.00 X 823232 0 287543 DAVID BRANDON PRESIDENT/CEO - DUB 1.00 40.00 X 0 442269 138684 ERIC CROWELL CEO - DSM 1.00 40.00 X 0 675781 529904 PAMELA DELAGARDELLE PRESIDENT/CEO - WAT 1.00 40.00 X 0 358678 87032 DENNY DRAKE VP GENERAL COUNSEL/CORP CO 40.00 0.00 X 556199 0 306284 KARA DUNHAM VP FINANCE 40.00 0.00 X 266660 0 55989 JOHN FROWNFELTER CHIEF MEDICAL INFO OFFICER 40.00 0.00 X 345634 0 26005 JOY GROSSER VP & CIO 40.00 1.00 X 460321 0 130454 ALAN KAPLAN MD VP/CMO & PRES/CEO IPCMF 40.00 1.00 X 755427 0 258250 KATHERINE MARCHIK VP/SUPPLY MANAGEMENT 40.00 0.00 X 308859 0 51367 MICHAEL MURPHY TO 0913 VP SR/CEO ACCOUNTABLE CARE 40.00 0.00 X 696645 0 46702 EMILY PORTER VP PEOPLE EXCELLENCE 40.00 1.00 X 361666 0 67845 SABRA ROSENER VP GOVERNMENT RELATIONS 40.00 0.00 X 302357 0 58475 RICHARD SEIDLER PRESIDENT/CEO - QC 1.00 40.00 X 0 622225 316659 ARIC SHARP FR 0513 VP/ACO 40.00 1.00 X 364483 0 23139 DEBORAH SIMON PRESIDENT/CEO - PM 1.00 40.00 X 0 618876 141555 PHYLLIS STADTLANDER CEO - HOME 1.00 40.00 X 0 244112 60762 SUSAN THOMPSON CEO - FD 1.00 40.00 X 0 482565 190438 PETER THOREEN PRESIDENT/CEO - SC 1.00 40.00 X 0 445160 227887 TOM TIBBITTS VP SYS DEV-IHS 40.00 1.00 X 658337 0 5529 THEODORE TOWNSEND PRESIDENT/CEO - CR 1.00 40.00 X 0 535642 342113 DAVID BURLAGE ASSOC COUNSEL 40.00 0.00 X 224154 0 23541 KATHLEEN CUNNINGHAM EXEC DIR ACCT CARE STRATEG 40.00 0.00 X 225686 0 30709 MATTHEW KIRSCHNER FR 0613 VP/TREASURY 40.00 0.00 X 264665 0 15417 ANTHONY LANGENSTEIN TO 0913 DIR TECHNOLOGY 40.00 0.00 X 231217 0 29000 DEBORAH MURO EXEC DIR CLINICAL & BUS APPL 40.00 0.00 X 204626 0 23227 JOHN KNOX TO 1111 FORMER PRESIDENT/CEO - WAT 0.00 0.00 X 0 164673 38845 9099583 4967348 4665649 104 1 1 0 EPIC LLC PO BOX 88314 MILWAUKEE WI 532880314 IT CONSULTING 7838402 MCKESSON TECHNOLOGIES INC PO BOX 98347 CHICAGO IL 606938347 IT CONSULTING 4740790 IBM CORPORATION PO BOX 676673 DALLAS TX 752676673 IT CONSULTING 4574020 PRICEWATERHOUSECOOPERSLLP PO BOX 75647 CHICAGO IL 606755647 CONSULTING 4519351 ZLR IGNITION 303 WATSON POWELL JR WAY DES MOINES IA 50309 CONSULTING 4069484 138 35774877 25280 35800157 MGMT & SUPPORT SVCS 561000 205931863 205908283 23580 SUBS & JOINT VENTURES 900099 313479 313479 206245342 18245660 18245660 2357488 2558117 524926 -200629 -524926 -725555 -725555 HEALTHCARE QUAL/PYMT REFORM 900099 6612227 6612227 MISCELLANEOUS REVENUE 900099 4998285 4777653 220632 LOSS ON REFINANCE 900099 -243523 -243523 11366989 270932593 217368119 244212 17520105 X 34346953 34346953 10611310 10611310 50641320 50641320 1206355 1206355 5096058 5096058 3723265 3723265 1139022 55253 1083769 543760 543760 820035 820035 95199 38119 57080 52071898 46226086 5845812 4712633 102399 4610234 12821726 10533884 2287842 1447348 953085 494263 3977687 3444695 532992 1995402 824915 1170487 473646 248940 224706 26865160 26832756 32404 34555055 34173368 381687 166793 160001 6792 MISCELLANEOUS EXPENSE 1124768 64294 1060474 INCOME TAXES 15 15 248435408 219491781 28943627 0 5775314 50794667 6305342 24451078 2453143 6850104 514140494 511542794 13673310 15267711 332421468 184901288 146760239 147520180 9874261 48283646 3000 3000 22283072 21617530 4606196 6016186 235124 -369151 726109495 831977745 31956235 42038451 8134695 8676832 558591920 696131006 83045710 21069492 108842741 62470519 790571301 830386300 X -64520453 1518169 58647 73276 -64461806 1591445 726109495 831977745 X 22497185 44446934 -890868 X 0 1 X 1 1 1 X X X 0 0 0 CENTRAL IOWA HOSPITAL CORPORATION 420680452 3 1 1 1 73958250 ST LUKE'S METHODIST HOSPITAL 420504780 3 1 1 1 34525904 ALLEN MEMORIAL HOSPITAL CORPORATION 420698265 3 1 1 1 22271659 NORTHWEST IOWA HOSPITAL CORPORATION 421019872 3 1 1 1 13584748 THE FINLEY HOSPITAL 420680354 3 1 1 1 8555976 TRINITY REGIONAL MEDICAL CENTER 421009175 3 1 1 1 12582200 TRINITY MEDICAL CENTER 362739299 3 1 1 1 47008992 UNITY HEALTHCARE 420680337 3 1 1 1 98593 METHODIST MEDICAL CENTER OF ILLINOIS 370661223 3 1 1 1 7935789 9 220522111 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 820035 947884 820035 947884 219491781 2823313945 220311816 2824261829 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 927928 809126 893042 947884 3577980 250000 250000 250000 250000 1000000 1500000 58647 25281 494 11146 73276 102976 81667 1807 127803 58647 46770 150535 1400 95729 102976 41860 41430 1815 38335 46770 40498 51133 1508 51279 41860 0.00000 0.00000 1.00000 0 0 4306 4306 0 20262070 17943435 2318635 285573488 166953547 118619941 26581604 26581604 147520180 SELF-INSURANCE RESERVE 574266 SWAP LIABILITY 50911263 LONG-TERM RETENTION INCENTIVES 6794028 DUE TO AFFILIATES 1374347 MISCELLANEOUS LONG-TERM LIABILITIES 2816615 62470519 X 215769000 26834379 99739 26934118 188834882 11414 82086297 82097711 270932593 214280000 99739 99739 214180261 11414 34243733 34255147 248435408 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 2010. 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 DURING THE CARRYFORWARD PERIOD. NO INCOME TAX BENEFIT HAS BEEN RECOGNIZED FOR THE NET OPERATING LOSS CARRYFORWARDS OR OTHER POTENTIAL DEFERRED TAX ASSETS IN THE CONSOLIDATED FINANCIAL STATEMENTS BECAUSE THE SYSTEM BELIEVES REALIZATION OF THESE BENEFITS IS UNLIKELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARY ELIMINATING ENTRY 99,739. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 81,879,908. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 14,629. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 190,737. ROUNDING 1,023. PART XII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARY ELIMINATING ENTRY 99,739. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 34,051,927. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 190,737. ROUNDING 1,069. 1 100 GREAT IOWA NURSES 2400 86TH STREET URBANDALE IA 50322 420636682 501(C)(6) 5000 EVENT SPONSOR CHARACTER COUNTS IN IOWA 1213 25TH ST DES MOINES IA 50311 391896160 501(C)(3) 25000 PROGRAM SUPPORT GIRL SCOUTS OF GREATER IOWA 10715 HICKMAN ROAD DES MOINES IA 50322 420698218 501(C)(3) 20000 PROGRAM SUPPORT IOWA HEALTH CARE COLLABORATIVE 100 E GRAND AVE SUITE 360 DES MOINES IA 50309 203869767 501(C)(3) 25000 PROGRAM SUPPORT IOWA HEALTHIEST STATE PO BOX 678 CHARITON IA 500490678 454570642 501(C)(3) 10000 PROGRAM SUPPORT IOWA HOSPITAL ASSOCIATION 100 E GRAND AVE SUITE 100 DES MOINES IA 50309 420706508 501(C)(6) 15000 PROGRAM SUPPORT IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 8101 BIRCHWOOD CT JOHNSTON IA 50131 421411630 501(C)(3) 34051927 PROGRAM SUPPORT IOWA POISON CONTROL CENTER 2910 HAMILTON BLVD SIOUX CITY IA 51104 421509042 501(C)(3) 89776 PROGRAM SUPPORT IOWA WOMEN'S LEADERSHIP CONFERENCE 305 2ND ST SE CEDAR RAPIDS IA 52401 452932668 501(C)(3) 10000 PROGRAM SUPPORT JUNIOR ACHIEVEMENT OF CENTRAL IOWA 6100 GRAND AVENUE DES MOINES IA 50312 420759070 501(C)(3) 5000 PROGRAM SUPPORT MAKE-A-WISH FOUNDATION OF IOWA 3024 104TH ST URBANDALE IA 50322 421310530 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) 62500 PROGRAM SUPPORT 11 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 332504 0 29882 0 3768 0 70529 0 17349 0 454032 0 0 MARK JOHNSON SVP/CFO 268417 0 30875 0 94418 0 117616 0 18851 0 530177 0 0 0 WILLIAM LEAVER PRESIDENT/CEO 1088523 0 209751 0 66768 0 885177 0 42772 0 2292991 0 0 0 KEVIN VERMEER EVP/CSO & ACO CEO 623473 0 137500 0 62259 0 264798 0 22745 0 1110775 0 0 0 DAVID BRANDON PRESIDENT/CEO - DUB 0 307858 0 79336 0 55075 0 121528 0 17156 0 580953 0 0 ERIC CROWELL CEO - DSM 0 554590 0 54532 0 66659 0 504278 0 25626 0 1205685 0 0 PAMELA DELAGARDELLE PRESIDENT/CEO - WAT 0 293627 0 10000 0 55051 0 60750 0 26282 0 445710 0 0 DENNY DRAKE VP GENERAL COUNSEL/CORP CO 449074 0 52844 0 54281 0 289692 0 16592 0 862483 0 0 0 KARA DUNHAM VP FINANCE 205234 0 24938 0 36488 0 34064 0 21925 0 322649 0 0 0 JOHN FROWNFELTER CHIEF MEDICAL INFO OFFICER 280634 0 34000 0 31000 0 8294 0 17711 0 371639 0 0 0 JOY GROSSER VP & CIO 373481 0 43311 0 43529 0 129127 0 1327 0 590775 0 0 0 ALAN KAPLAN MD VP/CMO & PRES/CEO IPCMF 562291 0 137500 0 55636 0 236335 0 21915 0 1013677 0 0 0 KATHERINE MARCHIK VP/SUPPLY MANAGEMENT 235669 0 27016 0 46174 0 33962 0 17405 0 360226 0 0 0 MICHAEL MURPHY TO 0913 VP SR/CEO ACCOUNTABLE CARE 358253 0 152500 0 185892 0 23487 0 23215 0 743347 0 0 0 EMILY PORTER VP PEOPLE EXCELLENCE 297960 0 28500 0 35206 0 41320 0 26525 0 429511 0 0 0 SABRA ROSENER VP GOVERNMENT RELATIONS 236274 0 29213 0 36870 0 30835 0 27640 0 360832 0 0 0 RICHARD SEIDLER PRESIDENT/CEO - QC 0 507258 0 53537 0 61430 0 303105 0 13554 0 938884 0 0 ARIC SHARP FR 0513 VP/ACO 195497 0 20000 0 148986 0 9334 0 13805 0 387622 0 0 0 DEBORAH SIMON PRESIDENT/CEO - PM 0 368577 0 81803 0 168496 0 116938 0 24617 0 760431 0 0 PHYLLIS STADTLANDER CEO - HOME 0 197771 0 31191 0 15150 0 51509 0 9253 0 304874 0 0 SUSAN THOMPSON CEO - FD 0 325066 0 89606 0 67893 0 176032 0 14406 0 673003 0 0 PETER THOREEN PRESIDENT/CEO - SC 0 325914 0 60314 0 58932 0 203699 0 24188 0 673047 0 0 TOM TIBBITTS VP SYS DEV-IHS 27553 0 81724 0 549060 0 5465 0 64 0 663866 0 547071 0 THEODORE TOWNSEND PRESIDENT/CEO - CR 0 438640 0 27663 0 69339 0 323469 0 18644 0 877755 0 0 DAVID BURLAGE ASSOC COUNSEL 197878 0 26276 0 0 0 11367 0 12174 0 247695 0 0 0 KATHLEEN CUNNINGHAM EXEC DIR ACCT CARE STRATEG 190831 0 16026 0 18829 0 12589 0 18120 0 256395 0 0 0 MATTHEW KIRSCHNER FR 0613 VP/TREASURY 159345 0 50000 0 55320 0 6692 0 8725 0 280082 0 0 0 ANTHONY LANGENSTEIN TO 0913 DIR TECHNOLOGY 133100 0 19045 0 79072 0 9341 0 19659 0 260217 0 0 0 DEBORAH MURO EXEC DIR CLINICAL & BUS APPL 180647 0 15479 0 8500 0 9969 0 13258 0 227853 0 0 0 JOHN KNOX TO 1111 FORMER PRESIDENT/CEO - WAT 0 0 0 0 0 164673 0 37209 0 1636 0 203518 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: ANTHONY LANGENSTEIN $44,816; MICHAEL MURPHY $96,577; JOHN KNOX $164,981. THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: DAVID BRANDON $96,979; ERIC CROWELL $469,270; PAMELA DELAGARDELLE $48,000; DENNIS DRAKE $276,942; KARA DUNHAM $22,116; JOY GROSSER $111,519; MARK JOHNSON $102,316; ALAN KAPLAN $223,585; WILLIAM LEAVER $855,679; KATHERINE MARCHIK $21,327; EMILY PORTER $28,570; SABRA ROSENER $25,735; RICHARD SEIDLER $275,238; DEBORAH SIMON $79,922; PHYLLIS STADTLANDER $36,107; SUSAN THOMPSON $163,282; PETER THOREEN, $186,878; THEODORE TOWNSEND $276,421; KEVIN VERMEER $241,254. THE FOLLOWING INDIVIDUAL(S) RECEIVED PAYMENT FROM A NON-QUALIFIED RETIREMENT PLAN: THOMAS TIBBITTS $547,071. A IOWA FINANCE AUTHORITY 521699886 462466CF8 2009-03-04 244270000 SEE PART V 1 0 0 B IOWA FINANCE AUTHORITY 521699886 462466DS9 2009-08-06 402440333 SEE PART V 0 0 0 C IOWA FINANCE AUTHORITY 521699886 462466ER0 2013-09-19 101172373 SEE PART V 0 0 0 D IOWA FINANCE AUTHORITY 521699886 462466ET6 2013-10-03 79120000 SEE PART V 0 0 0 A 28620000 244271037 201270000 43001037 2011 1 0 1 1 B 402440333 351270000 1064433 50127894 2010 1 0 1 1 C 101172373 1172373 100000000 2014 1 0 0 1 D 79120000 28620000 500000 50000000 2014 0 0 0 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(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 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. BKD LLP COMMON BOARD MEMBER/OFFICER 662801 AUDIT AND ACCOUNTING FEES 0 MEDIMORE INC COMMON BOARD MEMBER/OFFICER 300951 EXPENSE REIMBURSEMENT 0 TRUVEN HEALTH ANALYTICS COMMON BOARD MEMBER/OFFICER 794601 SALE OF MEDICAL EQUIPMENT 0 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 2013 FOR THE FOLLOWING INDIVIDUALS: DAVID BRANDON, ERIC CROWELL, PAMELA DELAGARDELLE, DENNY DRAKE, KARA DUNHAM, JOY GROSSER, MARK JOHNSON, ALAN KAPLAN, MATTHEW KIRSCHNER, WILLIAM LEAVER, KATHERINE MARCHIK, EMILY PORTER, SABRA ROSENER, RICHARD SEIDLER, ARIC SHARP, DEBORAH SIMON, PHYLLIS STADTLANDER, SUSAN THOMPSON, PETER THOREEN, 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 MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 13,106,316. MANAGEMENT AND GENERAL EXPENSES 5,829,812. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,936,128. SERVICE MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 33,118,299. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,118,299. HEALTH-CARE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,216. MANAGEMENT AND GENERAL EXPENSES 16,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,216. PURCHASED HOUSEKEEPING AND LAUNDRY: PROGRAM SERVICE EXPENSES 255. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 255. FORM 990, PART XI, LINE 9: SUBSIDIARY ELIMINATING ENTRY -63,148. FUND BALANCE TRANSFERS -827,720. BHC LC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 273820391 INFORMATION TECHNOLOGY MGMT. IA 6 2047 IOWA HEALTH SYSTEM DISEASE MANAGEMENT STRATEGIES LLC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 113649153 DISEASE CASE MANAGEMENT SERVICES IA 0 0 IOWA HEALTH SYSTEM IOWA HEALTH ACCOUNTABLE CARE LC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 454550692 ACCOUNTABLE CARE IA 7891493 8581406 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)(III) 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 CENTRAL IOWA 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REHABILATION THERAPY IL N/A SLRMC CARDIOVASCULAR CO-MANAGEMENT COMPANY LLC 2720 STONE PARK BLVD SIOUX CITY IA 51104 455322324 CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC 1075 FIRST AVENUE SE CEDAR RAPIDS IA 52403 721550812 AMBULATORY SURGERY CENTER. IA N/A TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC 4500 UTICA RIDGE RD BETTENDORF IA 52722 272562753 ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICES IA N/A WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC 1660 60TH STREET WEST DES MOINES IA 50266 271414600 ORTHOPEDIC SERVICE LINES MANAGEMENT IA N/A ASSOCIATED CHIROPRACTIC PROVIDERS INC 5409 N KNOXVILLE AVE PEORIA IL 61614 371304745 CHIROPRACTIC SERVICES IL N/A C 1 BELCREST SERVICES LTD 5409 N KNOXVILLE AVE PEORIA IL 61614 371196307 MEDICAL SERVICES IL N/A C 1 BROADBAND INC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 273819741 INFORMATION TECHNOLOGY MGMT. IA IOWA HEALTH SYSTEM C 952487 23269123 1.00000 1 DELHI POINT CONDO ASSOCIATION 350 N GRANDVIEW DUBUQUE IA 52001 421467002 REAL ESTATE MANAGEMENT IA 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 353212 125562 1.00000 1 MEDIMORE INC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421414390 MANAGED CARE IA IOWA HEALTH SYSTEM C 260923 1.00000 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 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 0 0 0 0 0 0 1 0 1 1 1 0 0 1 1 1 ALLEN MEMORIAL HOSPITAL CORPORATION A 3151522 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION C 3193389 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION J 1624499 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION L 15792892 BASED ON GAAP, CASH, AND/OR FMV. ALLEN MEMORIAL HOSPITAL CORPORATION S 1633254 BASED ON GAAP, CASH, AND/OR FMV. BROADBAND INC J 76018 BASED ON GAAP, CASH, AND/OR FMV. BROADBAND INC M 100015 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HEALTH PROPERTIES CORPORATION A 43488 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HEALTH PROPERTIES CORPORATION S 21001 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION A 6615234 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION C 18096469 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION J 4903082 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION L 46805686 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION N 81916 BASED ON GAAP, CASH, AND/OR FMV. CENTRAL IOWA HOSPITAL CORPORATION S 4071098 BASED ON GAAP, CASH, AND/OR FMV. HNC SERVICES Q 839321 BASED ON GAAP, CASH, AND/OR FMV. IOWA HEALTH SYSTEM CONTRACTING SERVICES LC Q 3957367 BASED ON GAAP, CASH, AND/OR FMV. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION B 34051927 BASED ON GAAP, CASH, AND/OR FMV. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION J 827867 BASED ON GAAP, CASH, AND/OR FMV. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION L 12724825 BASED ON GAAP, CASH, AND/OR FMV. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION R 651976 BASED ON GAAP, CASH, AND/OR FMV. IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION S 159794 BASED ON GAAP, CASH, AND/OR FMV. MEDIMORE INC B 260922 BASED ON GAAP, CASH, AND/OR FMV. METHODIST HEALTH SERVICES CORPORATION J 855072 BASED ON GAAP, CASH, AND/OR FMV. METHODIST HEALTH SERVICES CORPORATION L 6282431 BASED ON GAAP, CASH, AND/OR FMV. METHODIST HEALTH SERVICES CORPORATION S 798286 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S HEALTH SYSTEM INC A 3346933 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S HEALTH SYSTEM INC J 1139592 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S HEALTH SYSTEM INC L 11274526 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S HEALTH SYSTEM INC S 1149945 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S METHODIST HOSPITAL A 3984086 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S METHODIST HOSPITAL C 2305947 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S METHODIST HOSPITAL J 2769970 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S METHODIST HOSPITAL L 26680869 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S METHODIST HOSPITAL R 119149 BASED ON GAAP, CASH, AND/OR FMV. ST LUKE'S METHODIST HOSPITAL S 2487893 BASED ON GAAP, CASH, AND/OR FMV. THE FINLEY HOSPITAL A 358380 BASED ON GAAP, CASH, AND/OR FMV. THE FINLEY HOSPITAL J 740952 BASED ON GAAP, CASH, AND/OR FMV. THE FINLEY HOSPITAL L 7250402 BASED ON GAAP, CASH, AND/OR FMV. THE FINLEY HOSPITAL S 551998 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER A 7119286 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER C 12179072 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER J 2986775 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER L 27845316 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER N 50292 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER S 4046130 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER A 1028979 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER J 1124394 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER L 10543195 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER S 822328 BASED ON GAAP, CASH, AND/OR FMV. UNITYPOINT AT HOME J 359370 BASED ON GAAP, CASH, AND/OR FMV. UNITYPOINT AT HOME L 5054075 BASED ON GAAP, CASH, AND/OR FMV. UNITYPOINT AT HOME S 91123 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 SIXTEEN HOSPITAL FACILITIES AND VARIOUS AMBULATORY SERVICE AND CLINIC LOCATIONS IN IOWA AND ILLINOIS. PRIMARY, SECONDARY AND TERTIARY CARE SERVICES ARE PROVIDED TO RESIDENTS OF IOWA, ILLINOIS 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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A AVENUE NE CEDAR RAPIDS IA 52402 426061621 0 0 0 16238 16238 3248 812 0 0 0 NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC 720 KENYON ROAD FORT DODGE IA 50501 420937390 0 0 0 1921422 1921422 246071 61518 0 0 0 NORTHWEST IOWA HOSPITAL CORPORATION 2720 STONE PARK BLVD SIOUX CITY IA 51104 421019872 0 0 0 115514362 115514362 1000000 250000 0 0 0 PROCTOR HEALTH CARE INCORPORATED 5409 N KNOXVILLE AVE PEORIA IL 61614 371133412 0 0 0 225318 225318 45064 11266 0 0 0 PROCTOR HEALTH SYSTEMS 5409 N KNOXVILLE AVE PEORIA IL 61614 364147437 0 0 0 4626375 4626375 381319 95330 0 0 0 PROCTOR HOSPITAL 5409 N KNOXVILLE AVE PEORIA IL 61614 370681540 0 0 0 86642530 86642530 1000000 250000 0 0 0 SELF INSURANCE TRUST AGREEMENT EST BY MMCI 221 NE GLEN OAK AVENUE PEORIA IL 61636 376181831 0 0 0 0 0 0 0 0 0 0 SIOUXLAND PACE INC 309 COOK STREET SIOUX CITY IA 51103 261120134 0 0 0 8495004 8495004 574750 143688 0 0 0 ST LUKE'S HEALTH RESOURCES 2720 STONE PARK BLVD SIOUX CITY IA 51104 421059182 0 0 0 15715301 15715301 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