IOWA HEALTH FOUNDATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- IOWA HEALTH FOUNDATION (EIN 42-1467682)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201213199349300631
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T07:35:24-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421467682 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IOWA HEALTH FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | IOWA | NameControl |
| Phone | 5152416304 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 WOODLAND AVENUE NO E-200 | AddressLine1 |
| City | DES MOINES | City |
| State | IA | State |
| ZIP Code | 50309 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL M LAGRANGE | Name |
| Title | VP FINANCE & OPERATIONS | Title |
| Phone | 5152416289 | Phone |
| Date Signed | 2012-10-10 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | DENNIS W LINDERBAUM | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 WOODLAND AVENUE NO E-200 | AddressLine1 |
| City | DES MOINES | City |
| State | IA | State |
| ZIP Code | 50309 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 72462675 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.IOWAHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | IMPROVING THE HEALTH OF OUR COMMUNITIES THROUGH PHILANTHROPY, SERVICE AND VOLUNTEERISM. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 21 | TotalNbrEmployees |
| Total Nbr Volunteers | 500 | TotalNbrVolunteers |
| Total Gross UBI | 16566 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 13366 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 7423931 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 5965794 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 44310 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 55966 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 13409399 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4876630 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 48778 | OtherRevenuePriorYear |
| Other Revenue Current Year | 175517 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 20926418 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11073907 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 6126705 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 6123452 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1345965 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1394399 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 124558 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 124239 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1066221 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 834053 | OtherExpensePriorYear |
| Other Expenses Current Year | 830695 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8431281 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8472785 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 12495137 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2601122 | RevenuesLessExpensesCY |
| Total Assets BOY | 107254511 | TotalAssetsBOY |
| Total Assets EOY | 102522709 | TotalAssetsEOY |
| Total Liabilities BOY | 1405576 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1304266 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 105848935 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 101218443 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | IMPROVING THE HEALTH OF OUR COMMUNITIES THROUGH PHILANTHROPY, SERVICE AND VOLUNTEERISM. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6123452 | Expense |
| Grants | 6123452 | Grants |
| Revenue | 72532 | Revenue |
| Description | GRANTS, ALLOCATIONS AND PROGRAM SUPPORTIOWA HEALTH FOUNDATION'S PURPOSE IS TO RAISE FUNDS TO MAINTAIN, DEVELOP, INCREASE AND EXTEND THE FACILITIES AND SERVICES OF CENTRAL IOWA HOSPITAL CORPORATION, IOWA HEALTH HOME CARE AND IOWA HEALTH SYSTEM IN DES MOINES, IA, AND TO PROVIDE BROADER HOSPITAL, MEDICAL AND EDUCATIONAL SERVICE OPPORTUNITIES TO ITS PATIENTS AND THEIR FAMILIES, STAFF, AND RESIDENTS OF THE GEOGRAPHICAL AREA IT SERVES. IT SUPPORTS THE MISSIONS OF THESE ENTITIES BY RAISING FINANCIAL CONTRIBUTIONS AND INVESTING THE PROCEEDS.THE GRANT ALLOCATIONS AND PROGRAM SUPPORT SERVICES INCLUDE:- CONTRIBUTIONS TO CENTRAL IOWA HOSPITAL CORPORATION, IOWA HEALTH HOME CARE AND IOWA HEALTH SYSTEM FOR CAPITAL AND EQUIPMENT PURCHASES, RESEARCH, PATIENT ASSISTANCE, EDUCATION, AND PROGRAM AND GENERAL OPERATING EXPENSES.- SCHOLARSHIPS AWARDED TO INDIVIDUALS PURSUING NURSING AND OTHER MEDICAL EDUCATION.- GRANTS AWARDED TO EMPLOYEES IN CRISIS ASSOCIATED WITH CENTRAL IOWA HOSPITAL CORPORATION.- GRANTS TO LOCAL HEALTH COMMUNITIES ASSOCIATED WITH CENTRAL IOWA HOSPITAL CORPORATION. | Description |
| Total Program Service Expense | 6123452 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 3 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 21 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANIEL M LAGRANGE VP FIN & OPERATIONS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5152416289 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 WOODLAND AVE SUITE E-200 | AddressLine1 |
| City | DES MOINES | City |
| State | IA | State |
| ZIP Code | 50309 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| LARRY BAKER DO | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 208763 | 19024 | ||
| TIM BILLERBECK | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| TOM BUROKER MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| TOM CARLSTROM MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| CHARLES COLBY III | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | X | |
| ERIC CROWELL | |||||||
| BOARD MEMBER/CIHC CEO | 1.00 | X | 0 | 785263 | 243606 | ||
| JOHN GHRIST | |||||||
| BOARD SECRETARY | 1.00 | X | 0 | 43 | 0 | ||
| DEVON GOETZ | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| LINDA GRANDQUIST | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| DEREK HILL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| THOMAS HOUSER | |||||||
| BOARD VICE CHAIR | 1.00 | X | 0 | 43 | 0 | X | |
| BURTON TOBY JOSEPH | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 1702 | 0 | ||
| MARILYN KOLLMORGEN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| JOANNE MAHAFFEY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| PAT MCGOLDRICK | |||||||
| BOARD CHAIR | 1.00 | X | 0 | 1970 | 0 | X | |
| JAMIE MYERS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| BEN RENZO | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| JEFF ROSE | |||||||
| BOARD TREASURER | 1.00 | X | 0 | 43 | 0 | X | |
| LYLE SIMPSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 1033 | 0 | ||
| ROGER STETSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| ROD WARREN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 43 | 0 | ||
| SANDRA DONOHOE | |||||||
| VP FINANCE & OPERATIONS | 40.00 | 120111 | 0 | 25365 | X | ||
| DENNIS LINDERBAUM | |||||||
| PRESIDENT | 40.00 | 0 | 323139 | 47314 | X | ||
| DONALD IRELAND-SCHUNICHT | |||||||
| EXECUTIVE VP | 40.00 | 161545 | 0 | 76077 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 281656 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1322558 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 411386 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 809701 | FundraisingEvents |
| Related Organizations | 5000 | RelatedOrganizations |
| Government Grants | 382993 | GovernmentGrants |
| All Other Contributions | 4768100 | AllOtherContributions |
| Noncash Contributions | 1743048 | NoncashContributions |
| Total Contributions | 5965794 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 55966 | TotalRevenueColumn |
| Related Or Exempt Function Income | 55966 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 55966 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1831024 | TotalRevenueColumn |
| Exclusion | $1,831,024 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 30408 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 30408 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30408 | TotalRevenueColumn |
| Unrelated Business Revenue | 16566 | UnrelatedBusinessRevenue |
| Exclusion | $13,842 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 63321573 | Securities |
| Other | 456155 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 60548290 | Securities |
| Other | 183832 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2773283 | Securities |
| Other | 272323 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3045606 | TotalRevenueColumn |
| Exclusion | $3,045,606 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 146783 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 809701 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 199657 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -52874 | TotalRevenueColumn |
| Exclusion | -$52,874 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 6257 | GrossIncomeGaming |
| Gaming Direct Expenses | 690 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5567 | TotalRevenueColumn |
| Exclusion | $5,567 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 648715 | GrossSalesOfInventory |
| Cost Of Goods Sold | 456299 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192416 | TotalRevenueColumn |
| Exclusion | $192,416 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11073907 | TotalRevenueColumn |
| Related Or Exempt Function Income | 55966 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 16566 | UnrelatedBusinessRevenue |
| Exclusion | $5,035,581 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6096754 | Total |
| Program Services | 6096754 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26698 | Total |
| Program Services | 26698 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 753551 | Total |
| Management And General | 753551 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 508299 | Total |
| Fundraising | 508299 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12837 | Total |
| Fundraising | 12837 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51095 | Total |
| Fundraising | 51095 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68617 | Total |
| Fundraising | 68617 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 124239 | Total |
| Fundraising | 124239 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 351832 | Total |
| Management And General | 351832 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98344 | Total |
| Fundraising | 98344 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49261 | Total |
| Management And General | 20843 | ManagementAndGeneral |
| Fundraising | 28418 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47380 | Total |
| Management And General | 47380 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20017 | Total |
| Fundraising | 20017 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9303 | Total |
| Fundraising | 9303 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26131 | Total |
| Management And General | 26131 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|
| MISCELLANEOUS EXPENSES | 150018 | 76375 | 73643 |
| WRITTEN PLANNED GIFT EX | 71409 | 71409 | |
| INCOME TAXES | 7000 | 7000 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8472785 | Total |
| Program Services | 6123452 | ProgramServices |
| Management And General | 1283112 | ManagementAndGeneral |
| Fundraising | 1066221 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 825 | BOY |
| EOY | 625 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 628640 | BOY |
| EOY | 746813 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6285994 | BOY |
| EOY | 3103608 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8906 | BOY |
| EOY | 13877 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 105745 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32769 | BOY |
| EOY | 37657 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 122601 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 110015 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 210521 | BOY |
| EOY | 12586 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 96173626 | BOY |
| EOY | 94376219 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 452463 | BOY |
| EOY | 443340 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3460767 | BOY |
| EOY | 3682239 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107254511 | BOY |
| EOY | 102522709 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 384917 | BOY |
| EOY | 361948 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1020659 | BOY |
| EOY | 942318 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1405576 | BOY |
| EOY | 1304266 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78834838 | BOY |
| EOY | 77680206 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12179241 | BOY |
| EOY | 8782445 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14834856 | BOY |
| EOY | 14755792 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105848935 | BOY |
| EOY | 101218443 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107254511 | BOY |
| EOY | 102522709 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2601122 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -7231614 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 1 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL IOWA HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420680452 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $5,862,741 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 5862741 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 75763173 | BeginningOfYearBalance |
| Contributions | 1434190 | Contributions |
| Investment Earnings Or Losses | -3398599 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 234520 | GrantsOrScholarships |
| End Of Year Balance | 73564244 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 64415005 | BeginningOfYearBalance |
| Contributions | 5459165 | Contributions |
| Investment Earnings Or Losses | 8689940 | InvestmentEarningsOrLosses |
| Other Expenditures | 2106920 | OtherExpenditures |
| Administrative Expenses | 694017 | AdministrativeExpenses |
| End Of Year Balance | 75763173 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 50500762 | BeginningOfYearBalance |
| Contributions | 436024 | Contributions |
| Investment Earnings Or Losses | 14067443 | InvestmentEarningsOrLosses |
| Other Expenditures | 40011 | OtherExpenditures |
| Administrative Expenses | 549213 | AdministrativeExpenses |
| End Of Year Balance | 64415005 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 72271988 | BeginningOfYearBalance |
| Contributions | 1497992 | Contributions |
| Investment Earnings Or Losses | -22561815 | InvestmentEarningsOrLosses |
| Other Expenditures | 81910 | OtherExpenditures |
| Administrative Expenses | 625493 | AdministrativeExpenses |
| End Of Year Balance | 50500762 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.83710 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.15050 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.01240 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12029 | OtherCostOrOtherBasis |
| Depreciation | 2004 | Depreciation |
| Book Value | 10025 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 110572 | OtherCostOrOtherBasis |
| Depreciation | 108011 | Depreciation |
| Book Value | 2561 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 12586 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ANNUITIES PAYABLE | $737,705 |
| LONG-TERM RETENTION INCENTIVES | $204,613 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 942318 | TotalOfAmounts |
| Total Revenue | 11073907 | TotalRevenue |
| Total Expenses | 8472785 | TotalExpenses |
| Excess Or Deficit For Year | 2601122 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -7234609 | NetUnrealizedGLOnInvestments |
| Other | $2,995 | OtherAmount |
| Total Adjustments | -7231614 | TotalAdjustments |
| Excess Or Deficit Per FS | -4630492 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1614000 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -6300702 | NetUnrealizedGainsInvestments |
| Other Revenues | 123 | OtherRevenues |
| Revenue Not Rptd F990 | -6300579 | RevenueNotRptdF990 |
| Revenue Subtotal | 7914579 | RevenueSubtotal |
| Investment Expenses Not Included | 327211 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 2832117 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 3159328 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 11073907 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1987000 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 508 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 508 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1986492 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 327211 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 6159082 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 6486293 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 8472785 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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: | CHANGE IN PLEDGE VALUE 5,077. CHANGE IN PRESENT VALUE OF ANNUITY CONTRACTS -2,082. TOTAL TO SCHEDULE D, PART XI, LINE 8: 2,995. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | ROUNDING 123. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 1,980,270. REVEMIES IN PERMANENTLY RESTRICTED FUND BALANCE 851,847. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | ROUNDING 508. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES IN UNRESTRICTED FUND BALANCE 782,016. EXPENSES IN TEMPORARILY RESTRICTED FUND BALANCE 5,377,066. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Email Solicitations | X | EmailSolicitations |
| Phone Solicitations | X | PhoneSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Solicitation Of Govt Grants | X | SolicitationOfGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | ActivityActivity | Fundraiser Control Of FundsFundraiserControlOfFunds | Gross ReceiptsGrossReceipts | Amount Retained By ContractorAmountRetainedByContractor | Net To OrganizationNetToOrganization |
|---|---|---|---|---|---|---|---|---|
| GONSER GERBER TINKER STUHR | ||||||||
| 400 E DIEHL ROAD 380 | NAPERVILLE | IL | 60563 | GENERAL FUNDRAISING CONSULTING | 0 | 0 | 64239 | 0 |
| THOMPSON & ASSOCIATES OF IOWA INC | ||||||||
| 229 WARD CIRCLE SUITE A-23 | BRENTWOOD | TN | 37027 | PLANNED GIVING CONSULTING | 0 | 0 | 60000 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | 124239 | TotalRetainedByContractors |
| Licensed States | IA | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | FESTIVAL OF TREES & LIGHTS | NameOfEvent1 |
| Gross Receipts Event1 | 487439 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 372183 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 115256 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 27881 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 4271 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 63054 | OtherDirectExpensesEvent1 |
| Name Of Event2 | RALLY AGAINST CANCER | NameOfEvent2 |
| Gross Receipts Event2 | 333441 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 300622 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 32819 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 370 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 11495 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 34177 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 39877 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 2 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 135604 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 136896 | CharitableContribOtherEvents |
| Gross Revenue Other Events | -1292 | GrossRevenueOtherEvents |
| Food And Beverage Other Events | 11288 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 7244 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 956484 | GrossReceiptsTotal |
| Charitable Contributions Total | 809701 | CharitableContributionsTotal |
| Gross Revenue Total Events | 146783 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 370 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 39376 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 49736 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 110175 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 199657 | DirectExpenseSummaryEvents |
| Net Income Summary | -52874 | NetIncomeSummary |
Form990 Schedule G Part IV Form990ScheduleGPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF FUNDRAISING PAYMENTS | Identifier |
| Return Reference | SCHEDULE G, PART I, LINE 2B, COLUMN (V) | ReturnReference |
| Explanation | GONSER GERBER TINKER STUHR - DOUG MASON IS OUR CONSULTANT - CONTRACT PROVIDES FOR A PER VISIT FEE ($64,238 FOR THE YEAR) PLUS REIMBURSEMENT OF TRAVEL & LODGING EXPENSES WHICH TOTALED $5,527 IN 2011. THOMPSON & ASSOCIATES OF IOWA, INC. - EDDIE THOMPSON IS OUR CONSULTANT - CONTRACT PROVIDES FOR A MONTHLY FEE OF $5,000.00 ($60,000.00 FOR THE YEAR) PLUS REIMBURSEMENT OF TRAVEL & LODGING EXPENSES WHICH TOTALED $0 IN 2011. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| CENTRAL IOWA HOSPITAL CORPORATION | |||||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | 420680452 | 501(C)(3) | 5862741 | PROGRAM SUPPORT |
| INTRUST (DBA IOWA HEALTH HOME CARE-INTRUST) | |||||||
| 11333 AURORA AVENUE | URBANDALE | IA | 50322 | 421477471 | 501(C)(3) | 180484 | PROGRAM SUPPORT |
| IOWA HEALTH SYSTEM | |||||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | 421435199 | 501(C)(3) | 52589 | PROGRAM SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | EMPLOYEE ASSISTANCE PROGRAM | TypeOfGrant |
| Number Of Recipients | 19 | NumberOfRecipients |
| Amount Of Cash Grant | 26698 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: ALL GRANTS ARE MADE TO IOWA HEALTH SYSTEM AND CENTRAL IOWA HOSPITAL CORPORATION AND THEIR SUBSIDIARIES. GRANTS ARE ALL APPROVED ADMINISTRATIVELY BY APPROPRIATE DEPARTMENT HEADS, CFO & CEO OF THE ORGANIZATION. WE WORK CLOSELY WITH THE FINANCE DEPARTMENTS OF THE RECIPIENT ORGANIZATIONS TO MAKE SURE FUNDS ARE SPENT ACCORDING TO DONOR RESTRICTIONS. THE ONLY EXCEPTION TO THE ABOVE IS THE EMPLOYEE ASSISTANCE PROGRAM WHERE FUNDS ARE GRANTED DIRECTLY TO EMPLOYEES EXPERIENCING TRAGEDY IN THEIR LIVES. THE EMPLOYEE ASSISTANCE CENTRE WORKS WITH EMPLOYEES TO DOCUMENT THEIR SITUATION, DETERMINE IF OTHER SOURCES OF FUNDS ARE AVAILABLE, AND MAKE SURE THEIR SITUATION MEETS THE CRITERIA FOR THE FUNDS. IF THE COMMITTEE APPROVES THE REQUEST, EMPLOYEES ARE REQUIRED TO PROVIDE RECEIPTS OF EXPENDITURES TO PROVE THE FUNDS WERE USED AS APPROVED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LARRY BAKER DO | |||||||||||||
| 0 | 168471 | 0 | 0 | 0 | 40292 | 0 | 9818 | 0 | 9206 | 0 | 227787 | 0 | 0 |
| ERIC CROWELL | |||||||||||||
| 0 | 527761 | 0 | 189984 | 0 | 67518 | 0 | 221399 | 0 | 22207 | 0 | 1028869 | 0 | 0 |
| DENNIS LINDERBAUM | |||||||||||||
| 0 | 210404 | 0 | 64973 | 0 | 47762 | 0 | 28507 | 0 | 18807 | 0 | 370453 | 0 | 0 |
| DONALD IRELAND-SCHUNICHT | |||||||||||||
| 143846 | 0 | 12139 | 0 | 5560 | 0 | 48620 | 0 | 27457 | 0 | 237622 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: IF AN INDIVIDUAL IS PROVIDED SOMETHING FROM THE EMPLOYER OF VALUE, SUCH AS A PAID BENEFIT, GIFT CARD OR GIFT, WHICH IS CONSIDERED TAXABLE INCOME, THEN THE EMPLOYER WILL ADD AS "NONCASH COMP" (IMPUTED MISCELLANEOUS) TO PAYCHECK IN ORDER TO TAX APPROPRIATELY. |
| PART I, LINE 1B | TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: IF AN INDIVIDUAL IS PROVIDED SOMETHING FROM THE EMPLOYER OF VALUE, SUCH AS A PAID BENEFIT, GIFT CARD OR GIFT, WHICH IS CONSIDERED TAXABLE INCOME, THEN THE EMPLOYER WILL ADD AS "NONCASH COMP" (IMPUTED MISCELLANEOUS) TO PAYCHECK IN ORDER TO TAX APPROPRIATELY. |
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: ERIC CROWELL $198,085, DENNIS LINDERBAUM $16,257. |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 2 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 34369 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenues |
Real Estate Other RealEstateOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 1708679 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 1 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CENTRAL IOWA HEALTH SYSTEM, INC., A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER. | |
| FORM 990, PART VI, SECTION A, LINE 7A | CENTRAL IOWA HEALTH SYSTEM, INC., AS SOLE MEMBER, HAS THE POWER TO APPOINT AND REMOVE ANY BOARD MEMBER. | |
| FORM 990, PART VI, SECTION A, LINE 7B | CENTRAL IOWA HEALTH SYSTEM, INC., AS SOLE MEMBER, HAS THE POWER TO APPROVE AMENDMENTS TO THE ARTICLES AND BYLAWS, APPROVE MERGERS AND DISSOLUTIONS, AND APPOINT AND REMOVE 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 2011 FOR THE FOLLOWING INDIVIDUALS: ERIC CROWELL AND DENNIS LINDERBAUM. 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. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -7,234,609. CHANGE IN PLEDGE VALUE 5,077. CHANGE IN PRESENT VALUE OF ANNUITY CONTRACTS -2,082. TOTAL TO FORM 990, PART XI, LINE 5: -7,231,614. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (43 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| ALLEN COLLEGE | ||||||||||
| 1825 LOGAN AVENUE | WATERLOO | IA | 50703 | 421351526 | EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS | IA | 501(C)(3) | 170(B)(1) (A)(II) | ALLEN HEALTH SYSTEMS INC | 1 |
| ALLEN HEALTH SYSTEMS INC | ||||||||||
| 1825 LOGAN AVENUE | WATERLOO | IA | 50703 | 421201924 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE II | IOWA HEALTH SYSTEM | 1 |
| ALLEN MEMORIAL HOSPITAL CORPORATION | ||||||||||
| 1825 LOGAN AVENUE | WATERLOO | IA | 50703 | 420698265 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | ALLEN HEALTH SYSTEMS INC | 1 |
| ANAMOSA AREA AMBULANCE SERVICE | ||||||||||
| 101 GRANT WOOD DRIVE | ANAMOSA | IA | 52205 | 421466284 | PROVIDE AMBULANCE SERVICES | IA | 501(C)(3) | 509(A)(2) | ST LUKE'SJONES REGIONAL MEDICAL CENTER | 1 |
| CENTRAL IOWA HEALTH PROPERTIES CORPORATION | ||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 421233759 | PROPERTY HOLDING COMPANY | IA | 501(C)(2) | CENTRAL IOWA HEALTH SYSTEM | 1 | |
| CENTRAL IOWA HEALTH SYSTEM | ||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 421189791 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE II | IOWA HEALTH SYSTEM | 1 |
| CENTRAL IOWA HOSPITAL CORPORATION | ||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 420680452 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | CENTRAL IOWA HEALTH SYSTEM | 1 |
| FINLEY TRI-STATES HEALTH GROUP INC | ||||||||||
| 350 NORTH GRANDVIEW AVENUE | DUBUQUE | IA | 52001 | 421307495 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE II | IOWA HEALTH SYSTEM | 1 |
| HNC SERVICES | ||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 270987243 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(2) | IOWA HEALTH SYSTEM | 1 |
| INTEGRATED CARE ORGANIZATION | ||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 274665007 | PROMOTE, SUPPPORT THE INTERESTS AND PURPOSES OF AFFILIATES' HOSPITALS | IA | 501(C)(3) | 509(A)(2) | IOWA HEALTH SYSTEM | 1 |
| INTRUST | ||||||||||
| 11333 AURORA AVENUE | URBANDALE | IA | 50322 | 421477471 | HOME HEALTH CARE | IA | 501(C)(3) | 509(A)(2) | IOWA HEALTH SYSTEM | 1 |
| IOWA HEALTH FOUNDATION | ||||||||||
| 2700 GRAND AVE SUITE 109 | DES MOINES | IA | 50312 | 421467682 | CHARITABLE FUNDRAISING | IA | 501(C)(3) | 509(A)(3), TYPE III | CENTRAL IOWA HEALTH SYSTEM | 1 |
| IOWA HEALTH SYSTEM | ||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 421435199 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE III | 1 | |
| IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION | ||||||||||
| 8101 BIRCHWOOD COURT | JOHNSTON | IA | 50131 | 421411630 | PRIMARY HEALTH CARE SERVICES | IA | 501(C)(3) | 170(B)(1) (A)(III) | IOWA HEALTH SYSTEM | 1 |
| MEMORIAL FOUNDATION OF ALLEN HOSPITAL | ||||||||||
| 1825 LOGAN AVENUE | WATERLOO | IA | 50703 | 421201138 | CHARITABLE FUNDRAISING | IA | 501(C)(3) | 170(B)(1) (A)(VI) | ALLEN HEALTH SYSTEMS INC | 1 |
| METHODIST HEALTH SERVICES CORPORATION | ||||||||||
| 221 NORTHEAST GLEN OAK AVENUE | PEORIA | IL | 61636 | 371111135 | HEALTHCARE | IL | 501(C)(3) | 509(A)(3), TYPE III | IOWA HEALTH SYSTEM | 1 |
| METHODIST MEDICAL CENTER FOUNDATION | ||||||||||
| 221 NORTHEAST GLEN OAK AVENUE | PEORIA | IL | 61636 | 510186460 | FUNDRAISING | IL | 501(C)(3) | 170(B)(1) (A)(VI) | METHODIST HEALTH SERVICES CORPORATION | 1 |
| METHODIST MEDICAL CENTER OF ILLINOIS | ||||||||||
| 221 NORTHEAST GLEN OAK AVENUE | PEORIA | IL | 61636 | 370661223 | HEALTHCARE | IL | 501(C)(3) | 170(B)(1) (A)(III) | METHODIST HEALTH SERVICES CORPORATION | 1 |
| METHODIST SERVICES INC | ||||||||||
| 221 NORTHEAST GLEN OAK AVENUE | PEORIA | IL | 61636 | 371111134 | OFFICE RENTAL | IL | 501(C)(3) | 509(A)(2) | METHODIST HEALTH SERVICES CORPORATION | 1 |
| NELLIE R SHERWOOD TRUST | ||||||||||
| 1026 A AVENUE NE | CEDAR RAPIDS | IA | 52402 | 426061621 | PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY | IA | 501(C)(3) | 509(A)(3), TYPE I | ST LUKE'S METHODIST HOSPITAL | 1 |
| NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED | ||||||||||
| 720 KENYON DRIVE | FORT DODGE | IA | 50501 | 420937390 | MENTAL HEALTH CARE | IA | 501(C)(3) | 170(B)(1) (A)(III) | TRINITY HEALTH SYSTEMS INC | 1 |
| NORTHWEST IOWA HOSPITAL CORPORATION | ||||||||||
| 2720 STONE PARK BLVD | SIOUX CITY | IA | 51104 | 421019872 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | IOWA HEALTH SYSTEM | 1 |
| SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS | ||||||||||
| 221 NORTHEAST GLEN OAK AVENUE | PEORIA | IL | 61636 | 376181831 | FUND SELF-INSURANCE PLAN | IL | 501(C)(3) | 509(A)(3), TYPE III | METHODIST MEDICAL CENER OF ILLINOIS | 1 |
| SIOUXLAND PACE INC | ||||||||||
| 313 COOK STREET | SIOUX CITY | IA | 51103 | 261120134 | ALL-INCLUSIVE CARE FOR THE ELDERLY | IA | 501(C)(3) | 170(B)(1) (A)(III) | ST LUKE'S HEALTH SYSTEM INC | 1 |
| ST LUKE'S HEALTH RESOURCES | ||||||||||
| 2720 STONE PARK BLVD | SIOUX CITY | IA | 51104 | 421059182 | OUTPATIENT CLINICS AND HEALTHCARE SERVICES | IA | 501(C)(3) | 509(A)(2) | ST LUKE'S HEALTH SYSTEM INC | 1 |
| ST LUKE'S HEALTH SYSTEM INC | ||||||||||
| 2720 STONE PARK BLVD | SIOUX CITY | IA | 51104 | 421294091 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE III | IOWA HEALTH SYSTEM | 1 |
| ST LUKE'S HEALTHCARE | ||||||||||
| 1026 A AVENUE NE | CEDAR RAPIDS | IA | 52402 | 421487968 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE II | IOWA HEALTH SYSTEM | 1 |
| ST LUKE'S METHODIST HOSPITAL | ||||||||||
| 1026 A AVENUE NE | CEDAR RAPIDS | IA | 52402 | 420504780 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | ST LUKE'S HEALTHCARE | 1 |
| ST LUKE'SJONES REGIONAL MEDICAL CENTER | ||||||||||
| 1795 HIGHWAY 64 EAST | ANAMOSA | IA | 52205 | 421487967 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | ST LUKE'S HEALTHCARE | 1 |
| STL CARE COMPANY | ||||||||||
| 1026 A AVENUE NE | CEDAR RAPIDS | IA | 52402 | 421276632 | IMPROVE PUBLIC HEALTH SERVICES | IA | 501(C)(3) | 509(A)(2) | ST LUKE'S HEALTHCARE | 1 |
| THE DUBUQUE VISITING NURSE ASSOCIATION | ||||||||||
| 350 NORTH GRANDVIEW AVENUE | DUBUQUE | IA | 52001 | 420680410 | PUBLIC HEALTH SERVICES/HOME CARE | IA | 501(C)(3) | 509(A)(2) | FINLEY TRI-STATES HEALTH GROUP INC | 1 |
| THE FINLEY HOSPITAL | ||||||||||
| 350 NORTH GRANDVIEW AVENUE | DUBUQUE | IA | 52001 | 420680354 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | FINLEY TRI-STATES HEALTH GROUP INC | 1 |
| THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH | ||||||||||
| 2701 17TH STREET | ROCK ISLAND | IL | 61201 | 363678909 | MENTAL HEALTH CARE | IL | 501(C)(3) | 170(B)(1) (A)(VI) | TRINITY REGIONAL HEALTH SYSTEM | 1 |
| TPG HEALTH | ||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 453791448 | SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES | IA | 501(C)(3) | 170(B)(1) (A)(III) | TRINITY HEALTH SYSTEMS INC | 1 |
| TRINITY BUILDING CORPORATION | ||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 421376187 | PROPERTY HOLDING COMPANY | IA | 501(C)(2) | TRINITY HEALTH SYSTEMS INC | 1 | |
| TRINITY HEALTH FOUNDATION | ||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 421222381 | CHARITABLE FUNDRAISING | IA | 501(C)(3) | 170(B)(1) (A)(VI) | TRINITY HEALTH SYSTEMS INC | 1 |
| TRINITY HEALTH FOUNDATION | ||||||||||
| 2701 17TH STREET | ROCK ISLAND | IL | 61201 | 363321751 | CHARITABLE FUNDRAISING | IL | 501(C)(3) | 170(B)(1) (A)(VI) | TRINITY REGIONAL HEALTH SYSTEM | 1 |
| TRINITY HEALTH SYSTEMS INC | ||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 421222877 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IA | 501(C)(3) | 509(A)(3), TYPE II | IOWA HEALTH SYSTEM | 1 |
| TRINITY MEDICAL CENTER | ||||||||||
| 2701 17TH STREET | ROCK ISLAND | IL | 61201 | 362739299 | HOSPITAL | IL | 501(C)(3) | 170(B)(1) (A)(III) | TRINITY REGIONAL HEALTH SYSTEM | 1 |
| TRINITY REGIONAL HEALTH SYSTEM | ||||||||||
| 2701 17TH STREET | ROCK ISLAND | IL | 61201 | 363351952 | SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE | IL | 501(C)(3) | 509(A)(3), TYPE II | IOWA HEALTH SYSTEM | 1 |
| TRINITY REGIONAL HOSPITAL AUXILIARY | ||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 426081474 | CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES | IA | 501(C)(3) | 509(A)(2) | TRINITY REGIONAL MEDICAL CENTER | 1 |
| TRINITY REGIONAL MEDICAL CENTER | ||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 421009175 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | TRINITY HEALTH SYSTEMS INC | 1 |
| UNITY HEALTHCARE | ||||||||||
| 1518 MULBERRY AVENUE | MUSCATINE | IA | 52761 | 420680337 | HOSPITAL | IA | 501(C)(3) | 170(B)(1) (A)(III) | TRINITY REGIONAL HEALTH SYSTEM | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (29 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Code VCodeVAmount |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1776 WESTLAKES PARKWAY LC | |||||||||||||||
| 4949 WESTOWN PARKWAY SUITE 200 | WEST DES MOINES | IA | 50266 | 205031651 | OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BUILDINGS | IA | N/A | UNRELATED | 229642 | 12309952 | 0 | 1 | 0.33330 | ||
| ALLEN MEMORIAL HOSPITAL ORTHOPEDIC CO-MANAGEMENT CO LLC | |||||||||||||||
| 1825 LOGAN AVE | WATERLOO | IA | 50703 | 453237125 | ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES | IA | N/A | RELATED | 22920 | 39683 | 0 | 0 | 0.20000 | ||
| CENTRAL ILLINOIS CANCER CARE CENTER LLC | |||||||||||||||
| 7309 N KNOXVILLE | PEORIA | IL | 61614 | 261128108 | RADIATION THERAPY | IL | N/A | RELATED | 1031613 | 1886570 | 0 | 1 | 0.50000 | ||
| CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC | |||||||||||||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | 273625869 | CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES | IA | N/A | RELATED | 281022 | 87957 | 0 | 0 | 0.20000 | ||
| DES MOINES PARKING ASSOCIATES | |||||||||||||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | 382622972 | PARKING DECK OPERATIONS | IA | RELATED | 540801 | 3772221 | 0 | 1 | 1.00000 | CENTRAL IA HEALTH PROP CORP | ||
| DUBUQUE ENDOSCOPY CENTER LC | |||||||||||||||
| 1515 DELHI STREET SUITE 500 | DUBUQUE | IA | 52001 | 201597161 | AMBULATORY SURGERY CENTER | IA | RELATED | 660133 | 210769 | 0 | 1 | 0.51000 | THE FINLEY HOSPITAL | ||
| ENSEVA - HIAWATHA LLC | |||||||||||||||
| 524 PARK ROAD | WATERLOO | IA | 50704 | 453437363 | COLLOCATION FACILITY | IA | RELATED | 2624 | 2203353 | 0 | 0 | 0.52000 | IOWA HEALTH SYSTEM | ||
| FINLEY DEPT OF SURGERY CO-MGMT CO LLC | |||||||||||||||
| 350 N GRANDVIEW AVE | DUBUQUE | IA | 52001 | 422808785 | SURGERY DEPARTMENT MANAGEMENT SERVICES | IA | N/A | RELATED | 101716 | 208966 | 0 | 0 | 0.50000 | ||
| FINLEYHARTIG HOMECARE LLC | |||||||||||||||
| 703 MAIN ST | DUBUQUE | IA | 52001 | 421487138 | SALE/RENTAL OF MEDICAL EQUIPMENT | IA | N/A | RELATED | 132479 | 842404 | 0 | 1 | 0.50000 | ||
| HEALTH CARE AFFILIATES OF THE TRI-STATES LLC | |||||||||||||||
| 350 N GRANDVIEW AVE | DUBUQUE | IA | 52001 | 421428503 | PROVIDE ACCESS TO LICENSED SOFTWARE | IA | N/A | RELATED | 14037 | 0 | 1 | 0.50000 | |||
| HEALTH ENTERPRISES VENTURES LC | |||||||||||||||
| 4250 GLASS ROAD NE | CEDAR RAPIDS | IA | 52402 | 391894290 | INVESTMENT VEHICLE OWNING CLINICAL JVS | IA | N/A | UNRELATED | 89797 | 817011 | 0 | 0 | 0.55670 | $57,299 | |
| HY-VEEIOWA HEALTH LC | |||||||||||||||
| 5820 WESTOWN PARKWAY | WEST DES MOINES | IA | 50266 | 263293530 | PRIMARY CARE CLINIC | IA | N/A | RELATED | -175705 | 44300 | 0 | 1 | 0.50000 | ||
| IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC | |||||||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 030482623 | OUTPATIENT DIAGNOSTIC IMAGING | IA | N/A | RELATED | 1323429 | 2917182 | 0 | 1 | 0.50000 | ||
| IOWA HEALTH SYSTEM CONTRACTING SERVICES LC | |||||||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 421511142 | GROUP PURCHASING | IA | N/A | RELATED | 4775894 | 15888961 | 0 | 1 | 1.00000 | ||
| LAKEVIEW SURGERY CENTER LC | |||||||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 421516120 | SURGERY CENTER | IA | N/A | RELATED | 3443692 | 4825696 | 0 | 1 | 0.50000 | ||
| MEDICAL LABORATORIES OF EASTERN IOWA LC | |||||||||||||||
| 1026 A AVE NE | CEDAR RAPIDS | IA | 52402 | 421359640 | MEDICAL LABORATORY SERVICES | IA | N/A | RELATED | 664320 | 870817 | 0 | 1 | 0.50000 | ||
| METRO MRI CENTER LIMITED PARTNERSHIP | |||||||||||||||
| 615 VALLEY VIEW DRIVE SUITE 102 | MOLINE | IL | 61265 | 363710164 | PROVIDE MRI AND OTHER MEDICAL SERVICES | IL | N/A | RELATED | 600876 | 1499952 | 0 | 1 | 0.33970 | ||
| MR ASSOCIATES LLP | |||||||||||||||
| 1455 SHERMAN ROAD | HIAWATHA | IA | 52233 | 421260463 | OWN AND OPERATE MR UNIT | IA | N/A | RELATED | 2540143 | 1416839 | 0 | 1 | 0.33330 | ||
| NE IA PHYSICAL THERAPY AND SPORTS MEDICINE LLC | |||||||||||||||
| 1825 LOGAN AVE | WATERLOO | IA | 50703 | 202124978 | ATHLETIC TRAINING AND SPORTS MEDICINE | IA | N/A | RELATED | -41070 | 0 | 1 | ||||
| ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC | |||||||||||||||
| 1200 PLEASANT STREET | DES MOINES | IA | 50309 | 421508092 | AMBULATORY SURGERY CENTER | IA | N/A | RELATED | 3314858 | 3461181 | 0 | 1 | 0.50000 | ||
| PIERCE STREET SAME DAY SURGERY LC | |||||||||||||||
| 2730 PIERCE STREET | SIOUX CITY | IA | 51104 | 205895205 | AMBULATORY SURGERY CENTER | IA | N/A | RELATED | 931816 | 3357708 | 0 | 1 | 0.50000 | ||
| QUAD CITY AMBULATORY SURGERY CENTER LLC | |||||||||||||||
| 520 VALLEY VIEW DRIVE SUITE 300 | MOLINE | IL | 61265 | 364471903 | AMBULATORY SURGERY CENTER. | IL | N/A | RELATED | 255765 | 3500259 | 0 | 1 | 0.50000 | ||
| REHABILITATION THERAPY SERVICES LLC | |||||||||||||||
| 416 ST MARKS CT 110 | PEORIA | IL | 61603 | 810584193 | REHABILATION THERAPY | IL | RELATED | 448732 | 1397476 | 0 | 1 | 0.60030 | METHODIST MEDICAL CENTER OF ILLINOIS | ||
| THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC | |||||||||||||||
| 1075 FIRST AVENUE SE | CEDAR RAPIDS | IA | 52403 | 721550812 | AMBULATORY SURGERY CENTER. | IA | N/A | RELATED | 3310383 | 7115889 | 0 | 1 | 0.50000 | ||
| TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC | |||||||||||||||
| 4500 UTICA RIDGE RD | BETTENDORF | IA | 52722 | 272562753 | ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICES | IA | N/A | RELATED | 175377 | 118891 | 0 | 1 | 0.50000 | ||
| TRI-WEBSTER LC | |||||||||||||||
| 1610 COLLINS ST | WEBSTER CITY | IA | 50595 | 010740062 | MEDICAL BUILDING AND SURROUNDING PROPERTY | IA | N/A | RELATED | 110738 | 1715230 | 0 | 1 | 0.50000 | ||
| WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC | |||||||||||||||
| 1660 60TH STREET | WEST DES MOINES | IA | 50266 | 271414600 | ORTHOPEDIC SERVICE LINES MANAGEMENT | IA | N/A | RELATED | 244306 | 26600 | 0 | 1 | 0.20000 | ||
| WEST LAKES MEDICAL EQUIPMENT LLC | |||||||||||||||
| 5950 UNIVERSITY AVENUE SUITE 321 | WEST DES MOINES | IA | 50266 | 263300536 | MEDICAL EQUIPMENT SALES AND RENTAL | IA | N/A | UNRELATED | 59770 | 171967 | 0 | 1 | 0.50000 | $59,770 | |
| WEST LAKES SLEEP CENTER LLC | |||||||||||||||
| 5950 UNIVERSITY AVENUE SUITE 2 | WEST DES MOINES | IA | 50266 | 263193923 | SLEEP DISORDER DIAGNOSTIC TESTING FACILITY | IA | N/A | RELATED | 92541 | 318508 | 0 | 1 | 0.50000 | ||
Form990 Schedule R Part IV Form990ScheduleRPartIV (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BROADBAND INC | |||||||||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | 273819741 | INFORMATION TECHNOLOGY MGMT. | IA | IHS | C | 338870 | 13238641 | 1.00000 |
| CHARITABLE REMAINDER UNITRUST #1 | |||||||||||
| INVESTMENT | IA | SLHCF | T | ||||||||
| CHARITABLE REMAINDER UNITRUST #2 | |||||||||||
| INVESTMENT | IA | SLHCF | T | ||||||||
| CHARITABLE REMAINDER UNITRUST #3 | |||||||||||
| INVESTMENT | IA | SLHCF | T | ||||||||
| CHARITABLE REMAINDER UNITRUST #6 | |||||||||||
| INVESTMENT | IA | SLHCF | T | ||||||||
| IOWA HEALTH SYSTEM 457 DEF COMP PLAN | |||||||||||
| 1415 WOODLAND AVE 2ND FL | DES MOINES | IA | 50309 | 421435199 | INVESTMENT | IA | IHS | T | 266087 | 4546270 | 1.00000 |
| METHODIST HEALTH VENTURES INC | |||||||||||
| PO BOX 87 | PEORIA | IL | 61650 | 371140939 | PHARMACY/OFFICE STAFFING | IL | MHSC | C | 868566 | 2437393 | 1.00000 |
| MEDIMORE INC | |||||||||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | 421414390 | MANAGED CARE | IA | IHS | C | 210170 | 1.00000 | |
| METHODIST PHYSICIAN SERVICES INC | |||||||||||
| PO BOX 87 | PEORIA | IL | 61650 | 363858550 | MEDICAL SERVICES | IL | MHVI | C | 11908671 | 1305915 | 1.00000 |
| PRECEDENCE INC | |||||||||||
| 4622 PROGRESS DRIVE STE A | DAVENPORT | IA | 52807 | 371288604 | MANAGED MENTAL CARE | IA | RYC | C | 506534 | 435657 | 1.00000 |
| PROVIDER RESOURCE MANAGEMENT INC | |||||||||||
| PO BOX 87 | PEORIA | IL | 61650 | 371223550 | RESOURCE MANAGEMENT | IL | MHSC | C | 57427 | 1.00000 | |
| RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC | |||||||||||
| 700 E UNIVERSITY AVE | DES MOINES | IA | 50316 | 261271143 | SPECIALTY PHYSICIANS MEDICAL CARE | IA | CIHC | C | 481860 | 198055 | 0.57000 |
| STL HEALTH RESOURCES CO | |||||||||||
| 1026 A AVE NE | CEDAR RAPIDS | IA | 52402 | 421193499 | PHYSICIAN OFFICE RENTAL | IA | SLMH | C | 322129 | 5577505 | 1.00000 |
| TRIMARK PHYSICIANS GROUP INC | |||||||||||
| 802 KENYON ROAD | FORT DODGE | IA | 50501 | 421335554 | MEDICAL CLINICS | IA | THS | C | 44216247 | 1.00000 | |
| TRINITY HEALTH ENTERPRISES INC | |||||||||||
| 2701 17TH ST | ROCK ISLAND | IL | 61201 | 363320141 | RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY | IL | TRHS | C | 3295832 | 2957465 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SECTION 512(B)(13) CONTROLLED ENTITY | Identifier |
| Return Reference | SCHEDULE R, PART II, COLUMN (G) | ReturnReference |
| Explanation | THE 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 |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | THE ORGANIZATION E-FILED A REQUEST FOR AN ADDITIONAL EXTENSION OF TIME TO FILE TO NOVEMBER 15, 2012, ON PART II OF FORM 8868. THE E-FILED EXTENSION WAS ACCEPTED BY THE IRS ON JULY 31, 2012; HOWEVER, THE IRS ISSUED NOTICE CP211A, DATED AUGUST 27, 2012, WITH AN INCORRECT DATE FOR PART II OF AUGUST 15, 2012 INSTEAD OF NOVEMBER 15, 2012. AS SUCH, THE ORGANIZATION RESPECTUFLLY REQUESTS THE ORGANIZATION'S RECORDS BE UPDATED ACCORDINGLY TO SHOW THIS FORM 990 AS BEING EXTENDED TO NOVEMBER 15, 2012, AND TIMELY FILED. | Explanation |
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