2013-11-14T06:51:42-06:00 2012-12-31 990 2012-01-01 421435199 IOWA HEALTH SYSTEM IOWA 5152416161 1776 WEST LAKES PARKWAY NO 400 WEST DES MOINES IA 50266 MARK A JOHNSON 5152418215 2013-11-11 2012 2016-02-25 16:41:14Z WILLIAM B LEAVER 1776 WEST LAKES PARKWAY NO 400 WEST DES MOINES IA 50266 239856533 0 X WWW.UNITYPOINT.ORG X 1994 IA TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 22 15 860 15 1076339 0 12805722 30429565 140834457 180504353 18948720 17473449 239486 5623847 172828385 234031214 12598719 30311121 0 0 47563004 59637961 0 0 0 116924231 140332368 177085954 230281450 -4257569 3749764 704506413 726109495 774890482 790571301 -70384069 -64461806 X TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 208996646 28858828 186128200 AFFILIATE SUPPORT SERVICESIHS ADMINISTRATION (CORP) IS ORGANIZED TO SUPPORT THE MISSIONS OF SEVERAL RELATED CHARITABLE, TAX-EXEMPT ORGANIZATIONS INCLUDING EIGHT 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 IOWA HEALTH PHYSICIANS), INTRUST (DBA HEALTH HOME CARE), 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. 1452293 1452293 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: $1,452,293. 210448939 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 1 253 0 1 860 1 1 1 0 0 0 0 0 0 0 0 0 0 X 22 15 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 1.00 1.00 X 11338 0 0 GENE BLANC 1.00 0.00 X X 25993 0 0 TERRI CHRISTOFFERSEN 1.00 1.00 X 14500 0 0 STANTON DANIELSON MD FR 0212 1.00 40.00 X 0 372332 70835 KATHY ENO 1.00 1.00 X 15497 0 0 SARAH HASKEN 1.00 1.00 X 13669 0 0 KENT HENNING 1.00 1.00 X 11397 461 0 STEVE HERWIG DO 1.00 1.00 X X 11798 461 0 JIM HOFFMAN 1.00 1.00 X 13977 0 0 FRANCIS KANE MD 1.00 0.00 X 18676 0 0 RON KLOSTERMAN 1.00 0.00 X X 13922 0 0 LAWRENCE LIEBSCHER MD 1.00 0.00 X 11500 50 0 RICK MCCONNELL 1.00 1.00 X 14644 461 0 PETER MCLAUGHLIN 1.00 1.00 X 15294 0 0 LINDA NEWBORN 1.00 1.00 X 13000 0 0 KURT PITTNER 1.00 1.00 X 14569 1549 0 BILL PROWELL 1.00 1.00 X 12750 0 0 BRUCE SHERMAN 1.00 1.00 X X 15876 494 0 MICHAEL STONE 1.00 1.00 X 15000 0 0 KAREN STUMPE 1.00 1.00 X 13839 0 0 DEVENDRA TRIVEDI MD 1.00 1.00 X 14737 0 0 MIKE WILLIAMS 1.00 1.00 X 14838 418 0 WILLIAM LEAVER 40.00 0.00 X 1499801 0 560096 KEVIN VERMEER 40.00 1.00 X 808555 0 206217 DAVID BRANDON 0.00 40.00 X 0 465873 97459 ERIC CROWELL 1.00 40.00 X 0 784936 354442 DENNY DRAKE 40.00 0.00 X 567335 0 301975 KARA DUNHAM 40.00 0.00 X 241231 19605 48566 JOHN FROWNFELTER 40.00 0.00 X 332732 0 28361 JOY GROSSER 40.00 1.00 X 484877 0 90133 MARK JOHNSON 40.00 0.00 X 309535 84586 113677 ALAN KAPLAN MD 40.00 1.00 X 799880 0 202490 KATHERINE MARCHIK 40.00 0.00 X 300292 0 49685 MICHAEL MURPHY FR 0512 40.00 0.00 X 348365 0 112994 EMILY PORTER 40.00 1.00 X 320149 0 59297 RICHARD SEIDLER 1.00 40.00 X 0 628499 258250 DEBORAH SIMON 1.00 40.00 X 0 522675 188883 PHYLLIS STADTLANDER 1.00 40.00 X 0 242439 28446 SUSAN THOMPSON 1.00 40.00 X 0 431321 27664 PETER THOREEN 1.00 40.00 X 0 491055 213854 TOM TIBBITTS 40.00 1.00 X 907099 0 25149 THEODORE TOWNSEND 1.00 40.00 X 0 636489 250326 DAVID BURLAGE 40.00 0.00 X 219683 0 24547 KATHLEEN CUNNINGHAM 40.00 0.00 X 307439 0 31034 ANTHONY LANGENSTEIN 40.00 0.00 X 205969 0 31923 SABRA ROSENER 40.00 0.00 X 325496 0 51473 GERALD SCHMIDT 40.00 0.00 X 201587 0 25537 JOHN KNOX TO 1111 0.00 0.00 X 0 578376 26789 8486839 5262080 3480102 87 1 1 1 EPIC LLC PO BOX 88314 MILWAUKEE WI 532880314 IT CONSULTING 10101681 MARSH USA INC PO BOX 1450 NW 1810 MINNEAPOLIS MN 554851810 RENT 6755273 MCKESSON TECHNOLOGIES INC PO BOX 98347 CHICAGO IL 606938347 IT CONSULTING 5312026 VITALIZE CONSULTING SOLUTION 248 MAIN STREET SUITE 101 READING MA 01867 IT CONSULTING 3615765 VITAL SUPPORT SYSTEMS 11191 AURORA AVENUE URBANDALE IA 50322 IT CONSULTING 3067260 168 29836922 558993 33650 30429565 MGMT & SUPPORT SVCS 561000 180337072 179287876 1049196 SUBS & JOINT VENTURES 900099 167281 167281 180504353 17538742 17538742 5732476 27550 5361749 463570 370727 -436020 -65293 -65293 MISCELLANEOUS REVENUE 900099 3355001 3327858 27143 LOSS ON REFINANCE 900099 2268846 2268846 5623847 234031214 185051861 1076339 17473449 X 30311121 30311121 9023717 9023717 41873140 41873140 1481166 1481166 3883382 3883382 3376556 3376556 935569 564706 370863 699076 699076 743969 743969 42957 37502 5455 56792160 51589192 5202968 163997 159332 4665 15727721 13920316 1807405 489621 134776 354845 2006640 1631654 374986 2426389 1355065 1071324 720187 421573 298614 27544847 27543446 1401 31323250 31290274 32976 71667 65155 6512 MISCELLANEOUS EXPENSE 646301 66614 579687 INCOME TAXES -1983 -1983 230281450 210448939 19832511 0 6596057 5775314 29964756 6305342 395923 2453143 524320288 514140494 14116167 13673310 337465426 190705187 113426071 146760239 6617600 9874261 3000 3000 3448926 22283072 5043817 4606196 573808 235124 704506413 726109495 38431526 31956235 6826505 8134695 624120000 560290000 2055362 81347630 103457089 108842741 774890482 790571301 X -70487046 -64520453 102977 58647 -70384069 -64461806 704506413 726109495 X 3749764 4907818 -2735319 X 0 1 X 1 0 X X X 0 0 0 CENTRAL IOWA HOSPITAL CORPORATION 420680452 3 1 1 1 17102418 ST LUKE'S METHODIST HOSPITAL 420504780 3 1 1 1 1587286 ALLEN MEMORIAL HOSPITAL CORPORATION 420698265 3 1 1 1 4696841 NORTHWEST IOWA HOSPITAL CORPORATION 421019872 3 1 1 1 0 THE FINLEY HOSPITAL 420680354 3 1 1 1 0 TRINITY REGIONAL MEDICAL CENTER 421009175 3 1 1 1 0 TRINITY MEDICAL CENTER 362739299 3 1 1 1 6450376 UNITY HEALTHCARE 420680337 3 1 1 1 0 METHODIST MEDICAL CENTER OF ILLINOIS 370661223 3 1 1 1 0 9 29836921 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 743969 893042 743969 893042 209704970 2657990668 210448939 2658883710 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 939868 927928 809126 893042 3569964 250000 250000 250000 250000 1000000 1500000 102976 81667 1807 127803 58647 46770 150535 1400 95729 102976 41860 41430 1815 38335 46770 40498 51133 1508 51279 41860 37616 54000 2736 53854 40498 0.00000 0.00000 1.00000 0 0 4306 4306 0 18261614 17200763 1060851 302204142 173500118 128704024 16995364 16995364 146760239 SELF-INSURANCE RESERVE 1043278 SWAP LIABILITY 95291176 LONG-TERM RETENTION INCENTIVES 5352116 DUE TO AFFILIATES 1000 MISCELLANEOUS LONG-TERM LIABILITIES 7155171 108842741 X 180111000 3843291 44329 3887620 176223380 5455 57802379 57807834 234031214 200363000 0 200363000 5455 29912995 29918450 230281450 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IOWA HEALTH SYSTEM 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 HEALTH 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 2009. THE HEALTH 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 HEALTH SYSTEM BELIEVES REALIZATION OF THESE BENEFITS IS UNLIKELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 44,329. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 57,726,494. ROUNDING 266. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 75,619. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 29,836,921. IOWA HEALTH SYSTEM CONTRACTING SERVICES REBATES 75,619. ROUNDING 455. 1 ALS ASSOCIATION OF IOWA CHAPTER 9051 SWANSON BLVD CLIVE IA 50325 421320908 501C(3) 5000 PROGRAM SUPPORT CENTRAL IOWA HOSPITAL CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 420680452 501C(3) 15000 PROGRAM SUPPORT CHARACTER COUNTS 1213 25TH ST DES MOINES IA 50311 391896160 501C(3) 25000 PROGRAM SUPPORT GIRL SCOUTS OF GREATER IOWA 10715 HICKMAN ROAD DES MOINES IA 50322 420698218 501C(3) 5000 PROGRAM SUPPORT IOWA HEALTHCARE COLLABORATIVE 100 EAST GRAND SUITE 360 DES MOINES IA 50309 203869767 501C(3) 50000 PROGRAM SUPPORT IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 8101 BIRCHWOOD CT JOHNSTON IA 50131 421411630 501C(3) 29836921 PROGRAM SUPPORT IOWA SPORTS FOUNDATIONS 1421 S BELL AVE 104 AMES IA 50010 421278326 501C(3) 60000 PROGRAM SUPPORT IOWA STATEWIDE POISON CONTROL 2910 HAMILTON BLVD SIOUX CITY IA 51104 421509042 501C(3) 159000 PROGRAM SUPPORT JUNIOR ACHIEVEMENT OF CENTRAL IOWA 6100 GRAND AVENUE DES MOINES IA 50312 420759070 501C(3) 5000 PROGRAM SUPPORT MAKE A WISH FOUNDATION 3024 104TH ST URBANDALE IA 50322 421310530 501C(3) 15000 PROGRAM SUPPORT PE4LIFE 127 W 10TH STREET SUITE 101 KANSAS CITY MO 64106 320044523 501C(3) 45000 PROGRAM SUPPORT UNIVERSITY OF IOWA 2346 MORMAN TREK BLVD IOWA CITY IA 52246 426004813 GOVERNMENT 66850 PROGRAM SUPPORT 12 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 1 1 X X X X X 1 1 0 0 0 0 0 0 0 STANTON DANIELSON MD FR 0212 0 356343 0 6805 0 9184 0 51994 0 18841 0 443167 0 0 WILLIAM LEAVER 1030010 0 400000 0 69791 0 506261 0 53835 0 2059897 0 0 0 KEVIN VERMEER 561610 0 194800 0 52145 0 180795 0 25422 0 1014772 0 0 0 DAVID BRANDON 0 301579 0 110229 0 54065 0 78129 0 19330 0 563332 0 0 ERIC CROWELL 0 544607 0 174400 0 65929 0 332224 0 22218 0 1139378 0 0 DENNY DRAKE 427735 0 89308 0 50292 0 277836 0 24139 0 869310 0 0 0 KARA DUNHAM 199892 0 5678 19605 35661 0 23288 980 24298 0 288817 20585 0 0 JOHN FROWNFELTER 279318 0 20260 0 33154 0 8056 0 20305 0 361093 0 0 0 JOY GROSSER 358977 0 82734 0 43166 0 88716 0 1417 0 575010 0 0 0 MARK JOHNSON 244459 8579 0 75600 65076 407 93581 556 19495 45 422611 85187 0 0 ALAN KAPLAN MD 536285 0 204000 0 59595 0 177238 0 25252 0 1002370 0 0 0 KATHERINE MARCHIK 190031 0 48668 0 61593 0 25791 0 23894 0 349977 0 0 0 MICHAEL MURPHY FR 0512 280575 0 0 0 67790 0 97898 0 15096 0 461359 0 0 0 EMILY PORTER 235507 0 49616 0 35026 0 30850 0 28447 0 379446 0 0 0 RICHARD SEIDLER 0 480524 0 87666 0 60309 0 245587 0 12663 0 886749 0 0 DEBORAH SIMON 0 361217 0 0 0 161458 0 165303 0 23580 0 711558 0 0 PHYLLIS STADTLANDER 0 200426 0 27013 0 15000 0 11666 0 16780 0 270885 0 0 SUSAN THOMPSON 0 316042 0 58480 0 56799 0 9088 0 18576 0 458985 0 0 PETER THOREEN 0 320456 0 112281 0 58318 0 192446 0 21408 0 704909 0 0 TOM TIBBITTS 352970 0 49612 0 504517 0 12500 0 12649 0 932248 0 449963 0 THEODORE TOWNSEND 0 417844 0 152085 0 66560 0 226754 0 23572 0 886815 0 0 DAVID BURLAGE 192395 0 27288 0 0 0 11133 0 13414 0 244230 0 0 0 KATHLEEN CUNNINGHAM 185250 0 84102 0 38087 0 12504 0 18530 0 338473 0 0 0 ANTHONY LANGENSTEIN 171926 0 25543 0 8500 0 10209 0 21714 0 237892 0 0 0 SABRA ROSENER 230276 0 58298 0 36922 0 21932 0 29541 0 376969 0 0 0 GERALD SCHMIDT 175460 0 26127 0 0 0 10328 0 15209 0 227124 0 0 0 JOHN KNOX TO 1111 0 0 0 114414 0 463962 0 16549 0 10240 0 605165 0 298980 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. PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL(S) RECEIVED A SEVERANCE PAYMENT DURING THE YEAR THAT WAS INCLUDED IN THEIR TAXABLE INCOME: JOHN KNOX $164,981. THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: DAVID BRANDON $63,483; ERIC CROWELL $305,816; DENNIS DRAKE $214,960; KARA DUNHAM $12,585; JOY GROSSER $83,350; MARK JOHNSON $79,901; JOHN KNOX $298,980, ALAN KAPLAN $164,738; WILLIAM LEAVER $484,530; KATHERINE MARCHIK $14,021; MICHAEL MURPHY $87,081; EMILY PORTER $18,405; SABRA ROSENER $16,932; RICHARD SEIDLER $223,629; DEBORAH SIMON $76,755; SUSAN THOMPSON $-3,412; PETER THOREEN, $178,218; THEODORE TOWNSEND $191,690; KEVIN VERMEER $164,063. THE FOLLOWING INDIVIDUAL(S) RECEIVED PAYMENT FROM A NON-QUALIFIED RETIREMENT PLAN: THOMAS TIBBITTS $449,963. SUPPLEMENTAL INFORMATION PART III COMPENSATION FROM UNRELATED ORGANIZATION IOWA HEALTH SYSTEM PAYS BOARD FEES TO SHUTTLEWORTH & INGERSOLL, PLC IN THE AMOUNT OF: BASE PAY $12,750. WILLIAM PROWELL, DIRECTOR, IS AN OFFICER OF SHUTTLEWORTH & INGERSOLL, PLC. A IOWA FINANCE AUTHORITY 521699886 462466CF8 2009-03-04 244270000 SEE PART V 0 0 0 B IOWA FINANCE AUTHORITY 521699886 462466DS9 2009-08-06 402440333 SEE PART V 0 0 0 A 244271037 201270000 43001037 2011 1 0 1 1 B 402440333 351270000 1064433 50127894 2010 1 0 1 1 A 1 1 1 1 0 0.00120 0.00120 0 0 1 B 1 1 1 1 0 0.00100 0.00100 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 A 1 PART I, LINE A(F) - BOND ISSUES DESCRIPTION OF PURPOSE (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 DESCRIPTION OF PURPOSE (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 IV - ARBITRAGE NAME OF PROVIDER CITIBANK, N.A.; JPMORGAN CHASE BANK, N.A.; MORGAN STANLEY CAPITAL SERVICES, INC. PART II, LINE 3(A) - PROCEEDS TOTAL PROCEEDS AT ISSUE THERE IS A DIFFERENCE BETWEEN THE BOND ISSUE PRICE AND THE TOTAL PROCEEDS OF BOND ISSUE DUE TO INVESTMENT EARNINGS OF $1,037. BKD LLP COMMON BOARD MEMBER/OFFICER 690936 AUDIT AND ACCOUNTING FEES 0 MEDIMORE INC COMMON BOARD MEMBER/OFFICER 190536 EXPENSE REIMBURSEMENT 0 TRUVEN HEALTHCARE COMMON BOARD MEMBER/OFFICER 390778 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, 2012 FOR THE FOLLOWING INDIVIDUALS: DAVID BRANDON, ERIC CROWELL, DENNY DRAKE, KARA DUNHAM, JOHN FROWNFELTER, JOY GROSSER, MARK JOHNSON, ALAN KAPLAN, WILLIAM LEAVER, KATHERINE MARCHIK, MICHAEL MURPHY, EMILY PORTER, SABRA ROSENER, RICHARD SEIDLER, DEBORAH SIMON, 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 IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, HAS VOLUNTARILY ADOPTED MANY OF OUR INDUSTRY'S GOVERNANCE "BEST PRACTICES." IOWA HEALTH SYSTEM HAS DONE SO TO FURTHER ASSURE OUR STAKEHOLDERS THAT OUR GOVERNANCE AND MANAGEMENT IS CONDUCTED RESPONSIBLY AND WARRANTS THE TRUST YOU PLACE IN US. IN SEPTEMBER 2003, THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS VOLUNTARILY ADOPTED OVER 40 CHANGES TO ITS GOVERNANCE STRUCTURE TO BETTER COMPLY WITH GOVERNANCE BEST PRACTICES AND THE INTENT AND APPLICABLE REQUIREMENTS OF THE SARBANES-OXLEY ACT OF 2003. IN ADDITION, GOVERNANCE POLICIES AND RELATED INFORMATION HAS BEEN ADDED TO THE IOWA HEALTH SYSTEM WEBSITE, WWW.IHS.ORG, INCLUDING BUT NOT LIMITED TO: OVER 130 CORPORATE COMPLIANCE POLICIES, INCLUDING CHARITY CARE AND CONFLICTS OF INTEREST POLICIES; GOVERNANCE BEST PRACTICE POLICIES; THE IDENTIFICATION OF BOARD MEMBERS AND BOARD COMMITTEES; COMPENSATION FOR HOSPITAL CEO'S; AND FINANCIAL INFORMATION FOR THE PAST SEVEN YEARS. OTHER FEES FORM 990, PART IX, LINE 11G MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 14,008,177. MANAGEMENT AND GENERAL EXPENSES 5,186,668. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,194,845. SERVICE MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 37,581,015. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,581,015. HEALTH-CARE PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 16,300. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,300. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER TO BROADBAND, INC. -2,483,807. SUBSIDIARY ELIMINATING ENTRY -17. RETIREMENT PLAN NET ASSET TRANSFER -251,495. BHC LC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 273820391 INFORMATION TECHNOLOGY MGMT. 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THE FINLEY HOSPITAL A 401344 BASED ON GAAP, CASH, AND/OR FMV. THE FINLEY HOSPITAL J 1363224 BASED ON GAAP, CASH, AND/OR FMV. THE FINLEY HOSPITAL L 6566506 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER A 7080920 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER C 6450377 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER J 5420699 BASED ON GAAP, CASH, AND/OR FMV. TRINITY MEDICAL CENTER L 24384129 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER A 833716 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER J 2157982 BASED ON GAAP, CASH, AND/OR FMV. TRINITY REGIONAL MEDICAL CENTER L 10375145 BASED ON GAAP, CASH, AND/OR FMV. 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