UNITYPOINT AT HOME: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
UNITYPOINT AT HOME (EIN 42-1477471)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201213199349300241
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T07:35:24-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421477471EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1INTRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlINTRNameControl
Phone5155573100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line111333 AURORA AVENUEAddressLine1
CityURBANDALECity
StateIAState
ZIP Code50322ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSANDRA D DIELEMANName
TitleVP/CFOTitle
Phone5155573191Phone
Date Signed2012-10-18DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1IOWA HEALTH HOME CAREBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonPHYLLIS STADTLANDERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line111333 AURORA AVENUEAddressLine1
CityURBANDALECity
StateIAState
ZIP Code50322ZIPCode
FieldValueIRS element (for citing)
Gross Receipts100269717GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.IOWAHEALTHHOMECARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH HEALING, CARING AND TEACHING.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees1360TotalNbrEmployees
Total Nbr Volunteers126TotalNbrVolunteers
Total Gross UBI262044TotalGrossUBI
Net Unrelated Business Txbl Income62653NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year466442ContributionsGrantsPriorYear
Contributions Grants Current Year1683428ContributionsGrantsCurrentYear
Program Service Revenue Prior Year56665265ProgramServiceRevenuePriorYear
Program Service Revenue CY87480501ProgramServiceRevenueCY
Investment Income Prior Year1594010InvestmentIncomePriorYear
Investment Income Current Year669710InvestmentIncomeCurrentYear
Other Revenue Prior Year132918OtherRevenuePriorYear
Other Revenue Current Year30197OtherRevenueCurrentYear
Total Revenue Prior Year58858635TotalRevenuePriorYear
Total Revenue Current Year89863836TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year8185GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY8104GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year33642619SalariesEtcPriorYear
Salaries Etc Current Year60525210SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year16500TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY32048TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year48671TotalFundrsngExpCurrentYear
Other Expense Prior Year20920876OtherExpensePriorYear
Other Expenses Current Year27821518OtherExpensesCurrentYear
Total Expenses Prior Year54588180TotalExpensesPriorYear
Total Expenses Current Year88386880TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4270455RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1476956RevenuesLessExpensesCY
Total Assets BOY38222621TotalAssetsBOY
Total Assets EOY43905187TotalAssetsEOY
Total Liabilities BOY7549159TotalLiabilitiesBOY
Total Liabilities EOY11832790TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY30673462NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY32072397NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH HEALING, CARING AND TEACHING.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense69380161Expense
Grants8104Grants
Revenue87510698Revenue
DescriptionHEALTH CARE SERVICESINTRUST PROVIDES HOME HEALTH SERVICES FOR PEOPLE IN NEED WITH THE PURPOSE TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. HIGHEST PRIORITY IS GIVEN TO LOW-INCOME INDIVIDUALS BUT SERVICES ARE AVAILABLE TO ALL RESIDENTS. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. HOME HEALTH CARE SERVICES PROVIDED AND PEOPLE SERVED MAY INCLUDE BUT ARE NOT LIMITED TO: CASE MANAGEMENT, CERTIFIED NURSING, PRIVATE DUTY NURSING, PALLIATIVE CARE, HOSPICE, INFUSION SERVICES, HOME MEDICAL EQUIPMENT, LIFELINE, MATERNAL HEALTH CLINICS, NURSING CARE, SUPPORT TO HIGH RISK NEW PARENTS AND NEWBORNS, PARENTING SUPPORT, CHILD HEALTH CLINICS, HEALTH MAINTENANCE VISITS AND SCREEENINGS, IMMUNIZATION CLINICS, SENIOR CITIZENS, DISABLED, ILL, HANDICAPPED AND TERMINALLY ILL. SERVICES MAY BE PROVIDED ON A ONE-TIME, INTERMITTENT, PART-TIME OR LONG-TERM BASIS. INTRUST MADE 200,420 HOME VISITS IN 2011.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense6290071Expense
DescriptionCOMMUNITY BENEFITSINTRUST PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL OF IMPROVING THE COMMUNITY'S HEALTH AND ACCESS TO CARE. THIS INCLUDES PROVIDING HEALTH CARE SERVICES REGARDLESS OF A 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 TO 400 PATIENTS AT A VALUE OF $385,055 IN 2011. OFTENTIMES, INTRUST RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN ITS CHARGES FOR SERVICES. INTRUST PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. INTRUST'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COSTS IS $5,400,653 FOR 2011. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $5,785,708.OTHER BENEFITS: INTRUST PROVIDES SEVERAL ADDITIONAL HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS THAT SUPPORT ITS MISSION OF IMPROVING THE HEALTH OF ITS COMMUNITY THROUGH HEALING, CARING AND TEACHING. PROGRAMS INCLUDE BUT ARE NOT LIMITED TO: PREVENTION AND HEALTH SCREENINGS; SUBSIDIZED HEALTH SERVICES; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. INTRUST PARTNERS WITH HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND CHILDCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. APPROXIMATELY 13,334 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS PREPORTED VALUE: $504,363.Description
FieldValueIRS element (for citing)
Total Program Service Expense75670232TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096216NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1360NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SANDRA D DIELEMAN VPCFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5155573100TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111333 AURORA AVENUEAddressLine1
CityURBANDALECity
StateIAState
ZIP Code50322ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
PASTOR STACIE FIDLAR
BOARD MEMBER1.00X000
PHIL GUNDERSON
BOARD SECRETARY1.00X000X
NORMA HAGENOW
BOARD VICE CHAIR1.00X000X
BERGEN PETERSON
BOARD MEMBER1.00X08388714287
MARIA ISABEL PINEIRO VAN DORN
BOARD MEMBER1.00X000
RAY PUGH TO 911
BOARD MEMBER1.00X000
MARK PURTLE MD
BOARD CHAIR1.00X0499847225741X
RICH WELLMAN
BOARD MEMBER1.00X000
GARY BARGSTADT
VP/COO40.00182967013417X
SANDRA DIELEMAN
VP/CFO/CAO40.00193477034915X
PHYLLIS STADTLANDER
PRESIDENT/CEO40.00212318024406X
ALAN KAPLAN
CHIEF MEDICAL OFFICER1.000717316135330X
MONIQUE REESE
VP/CHIEF CLINICAL OFFICER40.0016702007150X
JOHN WILLIAMS TO 1111
VP/CORPORATE COMMUNICATIONS/BUSINESS DVLPMT40.0015243804791X
RUTH COADY
EXEC DIR STATEWIDE INFUSION40.0011265107465X
JAMES CUSHING
EXEC DIR PERFORMANCE IMPROVEMENT40.00131514012135X
TIMOTHY HACKBART
EXEC DIR SIOUX CITY40.00116478025747X
ELIZABETH LANE
EXEC DIR CERTIFIED40.00113998019717X
TODD RICHARD
EXEC DIR TVNHA40.00118891025436X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1501752TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1301050TotalReportableCompFrmRltdOrgs
Total Other Compensation550537TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LIFELINE SYSTEMS INC
PO BOX 846071BOSTONMA022846071MONITORING SERVICE705836
A-1 CAREERS INC
PO BOX 25830SHAWNEE MISSIONKS66225STAFFING AGENCY515675
MAXIM HEALTHCARE SERVICES
12558 COLLECTIONS CENTER DRCHICAGOIL60693STAFFING AGENCY415642
VERIZON WIRELESS
151 COLLINS RD NECEDAR RAPIDSIA52402PHONE SERVICE404328
MARIAN HOME
2400 6TH AVENUE NORTHFORT DODGEIA50501NURSING HOME- INPT SERVICES228159
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Government Grants123461GovernmentGrants
All Other Contributions1559967AllOtherContributions
Total Contributions1683428TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
HOME HEALTH CARE SVCS6216108551376885311494202274
MGMT & SUPPORT SVCS56100016926961692696
IHS CONTRACTING SVCS900099170452170452
SUBS & JOINT VENTURES9000991035854381559770
FieldValueIRS element (for citing)
Total Program Service Revenue87480501TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column372215TotalRevenueColumn
Exclusion$372,215ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities10703376Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities10234611Securities
Other171270Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities468765Securities
Other-171270Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column297495TotalRevenueColumn
Exclusion$297,495ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column30197TotalRevenueColumn
Related Or Exempt Function Income30197RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue30197TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column89863836TotalRevenueColumn
Related Or Exempt Function Income87248654RelatedOrExemptFunctionIncome
Unrelated Business Revenue262044UnrelatedBusinessRevenue
Exclusion$669,710ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total8104Total
Program Services8104ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total661500Total
Management And General661500ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total46711359Total
Program Services40377116ProgramServices
Management And General6321262ManagementAndGeneral
Fundraising12981Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1739498Total
Program Services1484824ProgramServices
Management And General254108ManagementAndGeneral
Fundraising566Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8160388Total
Program Services6966890ProgramServices
Management And General1192293ManagementAndGeneral
Fundraising1205Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3252465Total
Program Services2798963ProgramServices
Management And General452623ManagementAndGeneral
Fundraising879Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total791966Total
Management And General791966ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total67458Total
Program Services680ProgramServices
Management And General66778ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total280Total
Management And General280ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total32048Total
Fundraising32048Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total156443Total
Management And General156443ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3288885Total
Program Services3052883ProgramServices
Management And General236002ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total251978Total
Program Services100238ProgramServices
Management And General151740ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total14536885Total
Program Services14148199ProgramServices
Management And General388413ManagementAndGeneral
Fundraising273Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2824472Total
Program Services2059025ProgramServices
Management And General765447ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1657509Total
Program Services1166319ProgramServices
Management And General491190ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1797545Total
Program Services1681985ProgramServices
Management And General115560ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total44641Total
Program Services26133ProgramServices
Management And General18508ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total87256Total
Management And General87256ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1892565Total
Program Services1586031ProgramServices
Management And General306534ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total50109Total
Program Services-11746ProgramServices
Management And General61855ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MISCELLANEOUS EXPENSE327826224588102519719
INCOME TAXES4570045700

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total88386880Total
Program Services75670232ProgramServices
Management And General12667977ManagementAndGeneral
Fundraising48671Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY691277BOY
EOY297386EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3766303BOY
EOY2081916EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6788006BOY
EOY15573009EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY188254BOY
EOY1836364EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY936019BOY
EOY1031231EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY15440BOY
EOY38658EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16311878LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10004612LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6276437BOY
EOY6307266EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY19201183BOY
EOY16183091EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY359702BOY
EOY556266EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY38222621BOY
EOY43905187EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5325005BOY
EOY7993949EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY43372BOY
EOY751840EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2180782BOY
EOY3087001EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7549159BOY
EOY11832790EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY30613040BOY
EOY31720571EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY60422BOY
EOY351826EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY30673462BOY
EOY32072397EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY38222621BOY
EOY43905187EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1476956ReconcilationRevenueExpenses
Reconcilation Other Changes-78021ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years161878CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5212CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1050737CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year466442CurrentTaxYearMinus1Year
Current Tax Year1683428CurrentTaxYear
Total3367697Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43052317CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years45754426CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years50880911CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year56665265CurrentTaxYearMinus1Year
Current Tax Year87139597CurrentTaxYear
Total283492516Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years28399CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years130210CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year132918CurrentTaxYearMinus1Year
Current Tax Year30197CurrentTaxYear
Total321724Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43214195CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years45788037CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years52061858CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year57264625CurrentTaxYearMinus1Year
Current Tax Year88853222CurrentTaxYear
Total287181937Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509287181937PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years333750CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years345228CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years472417CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year505399CurrentTaxYearMinus1Year
Current Tax Year372215CurrentTaxYear
Total2029009Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years333750CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years345228CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years472417CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year505399CurrentTaxYearMinus1Year
Current Tax Year372215CurrentTaxYear
Total2029009Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years115961CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years96793CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years126127CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year247834CurrentTaxYearMinus1Year
Current Tax Year262044CurrentTaxYear
Total848759Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43663906CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years46230058CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years52660402CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year58017858CurrentTaxYearMinus1Year
Current Tax Year89487481CurrentTaxYear
Total290059705Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99010PublicSupportPercentage509
Prior Year Support Percentage0.98970PriorYearSupportPercentage
Investment Income Percentage0.00700InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00750PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance60422BeginningOfYearBalance
Contributions875890Contributions
Other Expenditures584486OtherExpenditures
End Of Year Balance351826EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance71425BeginningOfYearBalance
Contributions245006Contributions
Other Expenditures256009OtherExpenditures
End Of Year Balance60422EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2007900BeginningOfYearBalance
Contributions199654Contributions
Grants Or Scholarships1965738GrantsOrScholarships
Other Expenditures169379OtherExpenditures
Administrative Expenses1012AdministrativeExpenses
End Of Year Balance71425EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance67543BeginningOfYearBalance
Contributions2298975Contributions
Investment Earnings Or Losses-133563InvestmentEarningsOrLosses
Other Expenditures224220OtherExpenditures
Administrative Expenses835AdministrativeExpenses
End Of Year Balance2007900EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis160000OtherCostOrOtherBasis
Book Value160000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2287895OtherCostOrOtherBasis
Depreciation765435Depreciation
Book Value1522460BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1246296OtherCostOrOtherBasis
Depreciation985188Depreciation
Book Value261108BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12617687OtherCostOrOtherBasis
Depreciation8253989Depreciation
Book Value4363698BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6307266TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$786,256
SELF-INSURANCE RESERVE$1,183,034
HEALTH AND WELFARE BENEFITS RESERVE$492,711
IOWA HEALTH SYSTEM NOTE PAYABLE$625,000
FieldValueIRS element (for citing)
Total Of Amounts3087001TotalOfAmounts
Total Revenue89863836TotalRevenue
Total Expenses88386880TotalExpenses
Excess Or Deficit For Year1476956ExcessOrDeficitForYear
Net Unrealized GL On Investments-888702NetUnrealizedGLOnInvestments
Other$810,681OtherAmount
Total Adjustments-78021TotalAdjustments
Excess Or Deficit Per FS1398935ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt88862000TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-888702NetUnrealizedGainsInvestments
Other Revenues415564OtherRevenues
Revenue Not Rptd F990-473138RevenueNotRptdF990
Revenue Subtotal89335138RevenueSubtotal
Investment Expenses Not Included65220InvestmentExpensesNotIncluded
Other Revenues Not Included463478OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt528698RevenueNotRptdOnFinStmt
Total Revenue Per Form99089863836TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt88819000TotExpensesEtcAuditedFinclStmt
Other Expenses Included667792OtherExpensesIncluded
Expenses Not Rptd F990667792ExpensesNotRptdF990
Expenses Subtotal88151208ExpensesSubtotal
Investment Expenses Not Included265220InvestmentExpensesNotIncluded2
Other Expenses Not Included170452OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt235672ExpensesNotRptdOnFinStmt
Total Expenses Per Form99088386880TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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: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 2008. 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 8 - OTHER ADJUSTMENTS:MISCELLANEOUS OTHER ADJUSTMENTS 810,681.
PART XII, LINE 2D - OTHER ADJUSTMENTS:EXPENSES NETTED IN REVENUES 415,564.
PART XII, LINE 4B - OTHER ADJUSTMENTS:REVENUES IN UNRESTRICTED FUND BALANCE 1,550. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 291,404. ROUNDING 72. IHS CONTRACTING SERVICES PURCHASE REBATE 170,452.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:EXPENSES IN UNRESTRICTED FUND BALANCE 252,178. ROUNDING 50. EXPENSES NETTED IN REVENUES 415,564.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:IHS CONTRACTING SERVICES PURCHASE REBATE 170,452.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Phone SolicitationsXPhoneSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref Fundraising1AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeActivityActivityFundraiser Control Of FundsFundraiserControlOfFundsGross ReceiptsGrossReceiptsAmount Retained By ContractorAmountRetainedByContractorNet To OrganizationNetToOrganization
TRINITY HEALTH FOUNDATION
802 KENYON RDFORT DODGEIA50501RECEIPTING OF MEMORIALS/MAILINGS168742515548671877
IOWA HEALTH FOUNDATION
2700 GRAND AVE NO 109DES MOINESIA50312RECEIPTING OF MEMORIALS/MAILINGS118846516500171965
FieldValueIRS element (for citing)
Total Gross Receipts875890TotalGrossReceipts
Total Retained By Contractors32048TotalRetainedByContractors
Total Net To Organization843842TotalNetToOrganization
Licensed StatesIALicensedStates

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF FUNDRAISING PAYMENTSIdentifier
Return ReferenceSCHEDULE G, PART I, LINE 2B, COLUMN (V)ReturnReference
ExplanationWE WORK COLLABORATIVELY WITH FUNDRAISERS ON PROJECTS AND METHODS TO RAISE FUNDS. WE HAVE THE ULTIMATE DECISION AS TO METHODS, PROJECTS AND EVENTS THAT ARE DONE. ALL RECEIPTING AND IRS RELATED ISSUES ARE HANDLED BY FOUNDATION STAFF.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK PURTLE MD
035808501103540314080207858017883072558800
GARY BARGSTADT
1402190342480850005510079070196384000
SANDRA DIELEMAN
146183035840011454095130254020228392000
PHYLLIS STADTLANDER
164636031745015937083640160420236724000
ALAN KAPLAN
050352301576210561720113172022158085264600
MONIQUE REESE
1374260295940005027021230174170000
JOHN WILLIAMS TO 1111
1127920179050217410391608750157229000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINES 4A-BReturnReference
ExplanationSEVERANCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT DURING THE YEAR THAT WAS INCLUDED IN THEIR TAXABLE INCOME: JAMES CUSHING $11,155 AND JOHN WILLIAMS $14,222. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: ALAN KAPLAN $100,922 AND MARK PURTLE $195,608Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (11 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
WEST LAKES MEDICAL EQUIPMENT LLC
COMMON BOARD MEMBER/OFFICER205000INVESTMENT0
FRIENDSHIP HAVEN
COMMON BOARD MEMBER/OFFICER144171SENIOR LIVING NURSING HOME0
(no name)
0
(no name)
0
(no name)
0
(no name)
0
(no name)
0
(no name)
0
(no name)
0
(no name)
0
(no name)
0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NEW PROGRAM SERVICESFORM 990, PART III, LINE 2ON 1/1/2011 ADDED ALLEN HOMECARE & TRINITY VNHA. ALLEN HOME HEALTH CARE SERVICE LINES INCLUDE HOME HEALTH, HOSPICE, HME, AND LIFELINE. TRINITY SERVICE LINES INCLUDE HOME HEALTH & HOSPICE.
FORM 990, PART VI, SECTION A, LINE 6IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO NOMINATE AND APPOINT BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO APPROVE CHANGES IN ARTICLES AND BYLAWS, DISSOLUTIONS OR MERGERS, AND APPOINT BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15THE 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 2011 FOR THE FOLLOWING INDIVIDUALS: ALAN KAPLAN AND MARK PURTLE, MD. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY A 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 19IOWA 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.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -888,702. MISCELLANEOUS OTHER ADJUSTMENTS 810,681. TOTAL TO FORM 990, PART XI, LINE 5: -78,021.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (43 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
ALLEN COLLEGE
1825 LOGAN AVENUEWATERLOOIA50703421351526EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALSIA501(C)(3)170(B)(1) (A)(II)ALLEN HEALTH SYSTEMS INC1
ALLEN HEALTH SYSTEMS INC
1825 LOGAN AVENUEWATERLOOIA50703421201924SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
ALLEN MEMORIAL HOSPITAL CORPORATION
1825 LOGAN AVENUEWATERLOOIA50703420698265HOSPITALIA501(C)(3)170(B)(1) (A)(III)ALLEN HEALTH SYSTEMS INC1
ANAMOSA AREA AMBULANCE SERVICE
101 GRANT WOOD DRIVEANAMOSAIA52205421466284PROVIDE AMBULANCE SERVICESIA501(C)(3)509(A)(2)ST LUKE'SJONES REGIONAL MEDICAL CENTER1
CENTRAL IOWA HEALTH PROPERTIES CORPORATION
1200 PLEASANT STREETDES MOINESIA50309421233759PROPERTY HOLDING COMPANYIA501(C)(2)CENTRAL IOWA HEALTH SYSTEM1
CENTRAL IOWA HEALTH SYSTEM
1200 PLEASANT STREETDES MOINESIA50309421189791SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
CENTRAL IOWA HOSPITAL CORPORATION
1200 PLEASANT STREETDES MOINESIA50309420680452HOSPITALIA501(C)(3)170(B)(1) (A)(III)CENTRAL IOWA HEALTH SYSTEM1
FINLEY TRI-STATES HEALTH GROUP INC
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001421307495SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
HNC SERVICES
1200 PLEASANT STREETDES MOINESIA50309270987243SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(2)IOWA HEALTH SYSTEM1
INTEGRATED CARE ORGANIZATION
1200 PLEASANT STREETDES MOINESIA50309274665007PROMOTE, SUPPPORT THE INTERESTS AND PURPOSES OF AFFILIATES' HOSPITALSIA501(C)(3)509(A)(2)IOWA HEALTH SYSTEM1
INTRUST
11333 AURORA AVENUEURBANDALEIA50322421477471HOME HEALTH CAREIA501(C)(3)509(A)(2)IOWA HEALTH SYSTEM1
IOWA HEALTH FOUNDATION
2700 GRAND AVE SUITE 109DES MOINESIA50312421467682CHARITABLE FUNDRAISINGIA501(C)(3)509(A)(3), TYPE IIICENTRAL IOWA HEALTH SYSTEM1
IOWA HEALTH SYSTEM
1200 PLEASANT STREETDES MOINESIA50309421435199SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE III1
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
8101 BIRCHWOOD COURTJOHNSTONIA50131421411630PRIMARY HEALTH CARE SERVICESIA501(C)(3)170(B)(1) (A)(III)IOWA HEALTH SYSTEM1
MEMORIAL FOUNDATION OF ALLEN HOSPITAL
1825 LOGAN AVENUEWATERLOOIA50703421201138CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)ALLEN HEALTH SYSTEMS INC1
METHODIST HEALTH SERVICES CORPORATION
221 NORTHEAST GLEN OAK AVENUEPEORIAIL61636371111135HEALTHCAREIL501(C)(3)509(A)(3), TYPE IIIIOWA HEALTH SYSTEM1
METHODIST MEDICAL CENTER FOUNDATION
221 NORTHEAST GLEN OAK AVENUEPEORIAIL61636510186460FUNDRAISINGIL501(C)(3)170(B)(1) (A)(VI)METHODIST HEALTH SERVICES CORPORATION1
METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUEPEORIAIL61636370661223HEALTHCAREIL501(C)(3)170(B)(1) (A)(III)METHODIST HEALTH SERVICES CORPORATION1
METHODIST SERVICES INC
221 NORTHEAST GLEN OAK AVENUEPEORIAIL61636371111134OFFICE RENTALIL501(C)(3)509(A)(2)METHODIST HEALTH SERVICES CORPORATION1
NELLIE R SHERWOOD TRUST
1026 A AVENUE NECEDAR RAPIDSIA52402426061621PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAYIA501(C)(3)509(A)(3), TYPE IST LUKE'S METHODIST HOSPITAL1
NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED
720 KENYON DRIVEFORT DODGEIA50501420937390MENTAL HEALTH CAREIA501(C)(3)170(B)(1) (A)(III)TRINITY HEALTH SYSTEMS INC1
NORTHWEST IOWA HOSPITAL CORPORATION
2720 STONE PARK BLVDSIOUX CITYIA51104421019872HOSPITALIA501(C)(3)170(B)(1) (A)(III)IOWA HEALTH SYSTEM1
SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUEPEORIAIL61636376181831FUND SELF-INSURANCE PLANIL501(C)(3)509(A)(3), TYPE IIIMETHODIST MEDICAL CENER OF ILLINOIS1
SIOUXLAND PACE INC
313 COOK STREETSIOUX CITYIA51103261120134ALL-INCLUSIVE CARE FOR THE ELDERLYIA501(C)(3)170(B)(1) (A)(III)ST LUKE'S HEALTH SYSTEM INC1
ST LUKE'S HEALTH RESOURCES
2720 STONE PARK BLVDSIOUX CITYIA51104421059182OUTPATIENT CLINICS AND HEALTHCARE SERVICESIA501(C)(3)509(A)(2)ST LUKE'S HEALTH SYSTEM INC1
ST LUKE'S HEALTH SYSTEM INC
2720 STONE PARK BLVDSIOUX CITYIA51104421294091SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIIOWA HEALTH SYSTEM1
ST LUKE'S HEALTHCARE
1026 A AVENUE NECEDAR RAPIDSIA52402421487968SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
ST LUKE'S METHODIST HOSPITAL
1026 A AVENUE NECEDAR RAPIDSIA52402420504780HOSPITALIA501(C)(3)170(B)(1) (A)(III)ST LUKE'S HEALTHCARE1
ST LUKE'SJONES REGIONAL MEDICAL CENTER
1795 HIGHWAY 64 EASTANAMOSAIA52205421487967HOSPITALIA501(C)(3)170(B)(1) (A)(III)ST LUKE'S HEALTHCARE1
STL CARE COMPANY
1026 A AVENUE NECEDAR RAPIDSIA52402421276632IMPROVE PUBLIC HEALTH SERVICESIA501(C)(3)509(A)(2)ST LUKE'S HEALTHCARE1
THE DUBUQUE VISITING NURSE ASSOCIATION
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001420680410PUBLIC HEALTH SERVICES/HOME CAREIA501(C)(3)509(A)(2)FINLEY TRI-STATES HEALTH GROUP INC1
THE FINLEY HOSPITAL
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001420680354HOSPITALIA501(C)(3)170(B)(1) (A)(III)FINLEY TRI-STATES HEALTH GROUP INC1
THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
2701 17TH STREETROCK ISLANDIL61201363678909MENTAL HEALTH CAREIL501(C)(3)170(B)(1) (A)(VI)TRINITY REGIONAL HEALTH SYSTEM1
TPG HEALTH
802 KENYON ROADFORT DODGEIA50501453791448SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICESIA501(C)(3)170(B)(1) (A)(III)TRINITY HEALTH SYSTEMS INC1
TRINITY BUILDING CORPORATION
802 KENYON ROADFORT DODGEIA50501421376187PROPERTY HOLDING COMPANYIA501(C)(2)TRINITY HEALTH SYSTEMS INC1
TRINITY HEALTH FOUNDATION
802 KENYON ROADFORT DODGEIA50501421222381CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)TRINITY HEALTH SYSTEMS INC1
TRINITY HEALTH FOUNDATION
2701 17TH STREETROCK ISLANDIL61201363321751CHARITABLE FUNDRAISINGIL501(C)(3)170(B)(1) (A)(VI)TRINITY REGIONAL HEALTH SYSTEM1
TRINITY HEALTH SYSTEMS INC
802 KENYON ROADFORT DODGEIA50501421222877SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
TRINITY MEDICAL CENTER
2701 17TH STREETROCK ISLANDIL61201362739299HOSPITALIL501(C)(3)170(B)(1) (A)(III)TRINITY REGIONAL HEALTH SYSTEM1
TRINITY REGIONAL HEALTH SYSTEM
2701 17TH STREETROCK ISLANDIL61201363351952SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIL501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
TRINITY REGIONAL HOSPITAL AUXILIARY
802 KENYON ROADFORT DODGEIA50501426081474CHARITABLE FUNDRAISING AND VOLUNTEER SERVICESIA501(C)(3)509(A)(2)TRINITY REGIONAL MEDICAL CENTER1
TRINITY REGIONAL MEDICAL CENTER
802 KENYON ROADFORT DODGEIA50501421009175HOSPITALIA501(C)(3)170(B)(1) (A)(III)TRINITY HEALTH SYSTEMS INC1
UNITY HEALTHCARE
1518 MULBERRY AVENUEMUSCATINEIA52761420680337HOSPITALIA501(C)(3)170(B)(1) (A)(III)TRINITY REGIONAL HEALTH SYSTEM1

Form990 Schedule R Part III Form990ScheduleRPartIII (29 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnershipBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Code VCodeVAmount
1776 WESTLAKES PARKWAY LC
4949 WESTOWN PARKWAY SUITE 200WEST DES MOINESIA50266205031651OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BUILDINGSIAN/AUNRELATED22964212309952010.33330
ALLEN MEMORIAL HOSPITAL ORTHOPEDIC CO-MANAGEMENT CO LLC
1825 LOGAN AVEWATERLOOIA50703453237125ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICESIAN/ARELATED2292039683000.20000
CENTRAL ILLINOIS CANCER CARE CENTER LLC
7309 N KNOXVILLEPEORIAIL61614261128108RADIATION THERAPYILN/ARELATED10316131886570010.50000
CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC
1200 PLEASANT STDES MOINESIA50309273625869CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICESIAN/ARELATED28102287957000.20000
DES MOINES PARKING ASSOCIATES
1200 PLEASANT STDES MOINESIA50309382622972PARKING DECK OPERATIONSIARELATED5408013772221011.00000CENTRAL IA HEALTH PROP CORP
DUBUQUE ENDOSCOPY CENTER LC
1515 DELHI STREET SUITE 500DUBUQUEIA52001201597161AMBULATORY SURGERY CENTERIARELATED660133210769010.51000THE FINLEY HOSPITAL
ENSEVA - HIAWATHA LLC
524 PARK ROADWATERLOOIA50704453437363COLLOCATION FACILITYIARELATED26242203353000.52000IOWA HEALTH SYSTEM
FINLEY DEPT OF SURGERY CO-MGMT CO LLC
350 N GRANDVIEW AVEDUBUQUEIA52001422808785SURGERY DEPARTMENT MANAGEMENT SERVICESIAN/ARELATED101716208966000.50000
FINLEYHARTIG HOMECARE LLC
703 MAIN STDUBUQUEIA52001421487138SALE/RENTAL OF MEDICAL EQUIPMENTIAN/ARELATED132479842404010.50000
HEALTH CARE AFFILIATES OF THE TRI-STATES LLC
350 N GRANDVIEW AVEDUBUQUEIA52001421428503PROVIDE ACCESS TO LICENSED SOFTWAREIAN/ARELATED14037010.50000
HEALTH ENTERPRISES VENTURES LC
4250 GLASS ROAD NECEDAR RAPIDSIA52402391894290INVESTMENT VEHICLE OWNING CLINICAL JVSIAN/AUNRELATED89797817011000.55670$57,299
HY-VEEIOWA HEALTH LC
5820 WESTOWN PARKWAYWEST DES MOINESIA50266263293530PRIMARY CARE CLINICIAN/ARELATED-17570544300010.50000
IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC
1200 PLEASANT STREETDES MOINESIA50309030482623OUTPATIENT DIAGNOSTIC IMAGINGIAN/ARELATED13234292917182010.50000
IOWA HEALTH SYSTEM CONTRACTING SERVICES LC
1200 PLEASANT STREETDES MOINESIA50309421511142GROUP PURCHASINGIAN/ARELATED477589415888961011.00000
LAKEVIEW SURGERY CENTER LC
1200 PLEASANT STREETDES MOINESIA50309421516120SURGERY CENTERIAN/ARELATED34436924825696010.50000
MEDICAL LABORATORIES OF EASTERN IOWA LC
1026 A AVE NECEDAR RAPIDSIA52402421359640MEDICAL LABORATORY SERVICESIAN/ARELATED664320870817010.50000
METRO MRI CENTER LIMITED PARTNERSHIP
615 VALLEY VIEW DRIVE SUITE 102MOLINEIL61265363710164PROVIDE MRI AND OTHER MEDICAL SERVICESILN/ARELATED6008761499952010.33970
MR ASSOCIATES LLP
1455 SHERMAN ROADHIAWATHAIA52233421260463OWN AND OPERATE MR UNITIAN/ARELATED25401431416839010.33330
NE IA PHYSICAL THERAPY AND SPORTS MEDICINE LLC
1825 LOGAN AVEWATERLOOIA50703202124978ATHLETIC TRAINING AND SPORTS MEDICINEIAN/ARELATED-4107001
ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC
1200 PLEASANT STREETDES MOINESIA50309421508092AMBULATORY SURGERY CENTERIAN/ARELATED33148583461181010.50000
PIERCE STREET SAME DAY SURGERY LC
2730 PIERCE STREETSIOUX CITYIA51104205895205AMBULATORY SURGERY CENTERIAN/ARELATED9318163357708010.50000
QUAD CITY AMBULATORY SURGERY CENTER LLC
520 VALLEY VIEW DRIVE SUITE 300MOLINEIL61265364471903AMBULATORY SURGERY CENTER.ILN/ARELATED2557653500259010.50000
REHABILITATION THERAPY SERVICES LLC
416 ST MARKS CT 110PEORIAIL61603810584193REHABILATION THERAPYILRELATED4487321397476010.60030METHODIST MEDICAL CENTER OF ILLINOIS
THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC
1075 FIRST AVENUE SECEDAR RAPIDSIA52403721550812AMBULATORY SURGERY CENTER.IAN/ARELATED33103837115889010.50000
TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
4500 UTICA RIDGE RDBETTENDORFIA52722272562753ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICESIAN/ARELATED175377118891010.50000
TRI-WEBSTER LC
1610 COLLINS STWEBSTER CITYIA50595010740062MEDICAL BUILDING AND SURROUNDING PROPERTYIAN/ARELATED1107381715230010.50000
WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
1660 60TH STREETWEST DES MOINESIA50266271414600ORTHOPEDIC SERVICE LINES MANAGEMENTIAN/ARELATED24430626600010.20000
WEST LAKES MEDICAL EQUIPMENT LLC
5950 UNIVERSITY AVENUE SUITE 321WEST DES MOINESIA50266263300536MEDICAL EQUIPMENT SALES AND RENTALIAN/AUNRELATED59770171967010.50000$59,770
WEST LAKES SLEEP CENTER LLC
5950 UNIVERSITY AVENUE SUITE 2WEST DES MOINESIA50266263193923SLEEP DISORDER DIAGNOSTIC TESTING FACILITYIAN/ARELATED92541318508010.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV (15 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
BROADBAND INC
1200 PLEASANT STDES MOINESIA50309273819741INFORMATION TECHNOLOGY MGMT.IAIHSC338870132386411.00000
CHARITABLE REMAINDER UNITRUST #1
INVESTMENTIASLHCFT
CHARITABLE REMAINDER UNITRUST #2
INVESTMENTIASLHCFT
CHARITABLE REMAINDER UNITRUST #3
INVESTMENTIASLHCFT
CHARITABLE REMAINDER UNITRUST #6
INVESTMENTIASLHCFT
IOWA HEALTH SYSTEM 457 DEF COMP PLAN
1415 WOODLAND AVE 2ND FLDES MOINESIA50309421435199INVESTMENTIAIHST26608745462701.00000
METHODIST HEALTH VENTURES INC
PO BOX 87PEORIAIL61650371140939PHARMACY/OFFICE STAFFINGILMHSCC86856624373931.00000
MEDIMORE INC
1200 PLEASANT STDES MOINESIA50309421414390MANAGED CAREIAIHSC2101701.00000
METHODIST PHYSICIAN SERVICES INC
PO BOX 87PEORIAIL61650363858550MEDICAL SERVICESILMHVIC1190867113059151.00000
PRECEDENCE INC
4622 PROGRESS DRIVE STE ADAVENPORTIA52807371288604MANAGED MENTAL CAREIARYCC5065344356571.00000
PROVIDER RESOURCE MANAGEMENT INC
PO BOX 87PEORIAIL61650371223550RESOURCE MANAGEMENTILMHSCC574271.00000
RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC
700 E UNIVERSITY AVEDES MOINESIA50316261271143SPECIALTY PHYSICIANS MEDICAL CAREIACIHCC4818601980550.57000
STL HEALTH RESOURCES CO
1026 A AVE NECEDAR RAPIDSIA52402421193499PHYSICIAN OFFICE RENTALIASLMHC32212955775051.00000
TRIMARK PHYSICIANS GROUP INC
802 KENYON ROADFORT DODGEIA50501421335554MEDICAL CLINICSIATHSC442162471.00000
TRINITY HEALTH ENTERPRISES INC
2701 17TH STROCK ISLANDIL61201363320141RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACYILTRHSC329583229574651.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierSECTION 512(B)(13) CONTROLLED ENTITYIdentifier
Return ReferenceSCHEDULE R, PART II, COLUMN (G)ReturnReference
ExplanationTHE ORGANIZATION IS A MEMBER OF A CONSOLIDATED HEALTH SYSTEM AND HAS A COMMON PARENT ORGANIZATION, "IOWA HEALTH SYSTEM." FOR ENTITIES THAT ARE PART OF THE CONSOLIDATED HEALTH SYSTEM (WITH COMMON CONTROL) THE ATTRIBUTION RULES OF IRC SECTION 318 APPLY; MEANING THAT ALL ORGANIZATIONS ARE DEEMED TO HAVE CONTROL OF THE ORGANIZATIONS OWNED BY THE CONTROLLING ORGANIZATION. AS SUCH, WE ARE REPORTING ALL RELATED ORGANIZATIONS OF THE HEALTH SYSTEM IN PARTS II, III & IV. FOR PART V REPORTING, THE TRANSACTIONS DISCLOSED ARE THOSE BETWEEN THE DIRECTLY CONTROLLED PARENT-SUBSIDIARY ONLY.Explanation

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