2011-11-08T15:07:32-06:00 2010-12-31 990 2010-01-01 362739299 TRINITY MEDICAL CENTER TRIN 3097795000 2701 17TH ST ROCK ISLAND IL 61201 GREG PAGLIUZZA JR 3097792218 2011-10-20 2010 2016-03-07 17:11:31Z RICHARD SEIDLER 2701 17TH ST ROCK ISLAND IL 61201 439754417 0 X WWW.TRINITYQC.COM X 1969 IL IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 20 8 2978 357 95086 3443 2537893 4557383 295145514 327767972 3737076 9729087 2279639 2704090 303700122 344758532 2214992 2856454 0 0 127849802 136467919 0 0 0 159856219 187923285 289921013 327247658 13779109 17510874 319060810 346938374 170351411 177254174 148709399 169684200 X THE MISSION OF TRINITY MEDICAL CENTER IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 243506667 2461013 328911826 HEALTH-CARE SERVICESTRINITY MEDICAL CENTER IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE QUAD CITY COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. TRINITY MEDICAL CENTER PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO GENERAL ACUTE CARE, SURGERIES, INTENSIVE CARE AND CRITICAL CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, SKILLED NURSING, MATERNAL/CHILD CARE, LABORATORY, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2010, TRINITY MEDICAL CENTER ADMITTED 18,994 PATIENTS RESULTING IN A TOTAL OF 80,447 PATIENT DAYS. TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 9,338. THERE WERE ALSO 77,732 EMERGENCY ROOM VISITS AND 1,926 BABIES DELIVERED. 19642438 395441 0 COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: TRINITY MEDICAL CENTER PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE TO 18,451 PEOPLE AT A VALUE OF $6,530,721 IN 2010. OFTENTIMES, TRINITY MEDICAL CENTER RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. TRINITY MEDICAL CENTER PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. TRINITY MEDICAL CENTER'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $8,555,090 FOR 2010. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $15,085,811OTHER BENEFITS: TRINITY MEDICAL CENTER PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. TRINITY MEDICAL CENTER COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. TRINITY MEDICAL CENTER HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 152,932 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS REPORTED VALUE: $4,556,627 263149105 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 269 0 1 2978 1 1 1 0 0 0 0 1 1 0 0 0 0 X 20 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL IA X X SUSAN M KAISER DIR OF FINANCE 3097792895 2701 17TH ST ROCK ISLAND IL 61201 STEPHANIE ACRI 1.00 X X 0 0 0 KIM ARMSTRONG 1.00 X 0 0 0 DUNCAN CAMERON 1.00 X 0 0 0 DR RAJENDRA DAHAL 1.00 X 0 0 0 DAVID DEOPERE 40.00 X X 296049 0 138677 JAMES HASS 1.00 X 0 0 0 KEN KOUPAL 1.00 X 0 0 0 DR FARAZ MANAZIR 1.00 X 0 0 0 KENNY MASSEY 1.00 X 0 0 0 PETER MCLAUGHLIN 1.00 X 0 13356 0 LINDA NEWBORN 1.00 X 0 11500 0 DR AHMED OKBA 1.00 X 0 0 0 DR ALEX PAREIGIS 1.00 X 0 0 0 KATHY PULLEY 1.00 X 0 0 0 MARK SCHWIEBERT 1.00 X 0 0 0 RICK SEIDLER FR 610 40.00 X X 295402 317602 252337 KARLA STEELE 1.00 X X 0 0 0 HEIDI STORL 1.00 X 0 0 0 KAI SWANSON 1.00 X 0 0 0 TOM TIBBITTS TO 610 40.00 X X 0 777414 17874 DR MATTHEW WILBER 1.00 X 0 0 0 TAMARA BYRAM FR 1110 40.00 X 144431 0 27884 MYKL GARRETT FR 1210 40.00 X 30269 0 0 DR PAUL MCLOONE 40.00 X 0 225617 47379 GREG PAGLIUZZA JR 40.00 X 289061 0 52277 JEFFREY STOLZE TO 1110 40.00 X 284763 0 77040 DR PAUL BOLGER 40.00 X 481424 0 45136 KATHLEEN CUNNINGHAM 40.00 X 257030 0 33548 PENNY DAVIS 40.00 X 164650 0 3049 JON HONSEY 40.00 X 266757 0 43890 MICHAEL PATTERSON 40.00 X 336285 0 25689 KATHERINE PEARSON 40.00 X 158714 0 35816 JAY WILLSHER TO 910 40.00 X 70826 143056 75623 DR GREGORY BOHN 40.00 X 496061 0 33103 DR MARK BUETTNER 40.00 X 500766 0 47537 DR CHARLES LEMON 40.00 X 473121 0 41674 DR WILLIAM OLSON 40.00 X 641229 0 43430 DR CHAD VANDERLINDEN 40.00 X 479349 0 40522 ANDREA COLEMAN TO 1109 0.00 X 451842 0 20966 WILLIAM LEAVER TO 1207 0.00 X 0 1280669 410066 KEVIN VERMEER TO 509 0.00 X 0 543405 198962 6118029 3312619 1712479 117 1 1 0 METROPOLITAN MEDICAL LAB P L C 1520 7TH STREET MOLINE IL 61265 LAB SERVICES 8352575 ARAMARK MANAGEMENT SERVICES 22506 NETWORK PLACE CHICAGO IL 606731225 FOOD SERVICES 999373 DIVERSIFIED CLINICAL SERVICES PO BOX 850001 ORLANDO FL 328850248 WOUND CARE SERVICES 987441 METRO MRI CENTER LIMITED PART 615 VALLEY VIEW DRIVE STE 202 MOLINE IL 61265 IMAGING SERVICES 804432 WESTERN IL ANESTHESIOLOGIST LLC PO BOX 309 MOLINE IL 61266 ANESTHESIA SERVICES 689145 17 12051 21515 4425388 59955 38474 4557383 NET PATIENT REVENUE 900099 320011868 320011868 EDUCATION & RESEARCH 900099 2783967 2783967 RENTAL REVENUE 531100 1948965 1948965 SUBS & JOINT VENTURES 900099 1405228 1405228 MGMT & SUPPORT SVCS 561000 892761 805636 87125 725183 717222 7961 327767972 2223152 2223152 102093653 10000 94546405 51313 7547248 -41313 7505935 7505935 51229 21515 9570 41659 41659 521041 388597 132444 132444 CAFETERIA/FOOD SVCS 722210 1386133 1386133 MISCELLANEOUS REVENUE 900099 1143854 1143854 2529987 344758532 328816740 95086 11289323 2844954 2844954 11500 11500 2757713 2757713 848092 375285 472807 104385437 90771996 13613441 4228206 3676784 551422 17686740 15380121 2306619 6561731 5705982 855749 12561787 1089166 11472621 569077 193984 375093 1600 1600 25000 25000 174411 174411 33036599 30655178 2381421 167901 39417 128484 68632964 67816191 816773 13357286 11933957 1423329 8283192 2733279 5549913 263681 168524 95157 74894 64467 10427 6323727 6323727 14728777 5292698 9436079 5236629 366379 4870250 PATIENT BAD DEBT 23814804 23814804 MISCELLANEOUS EXPENSES 670556 214439 456117 INCOME TAXES 400 400 327247658 263149105 64098553 0 14464 15304 15760945 34436245 36383249 38016303 13543050 12666600 7873428 8306448 1163007 1248670 295295751 162893751 138808709 132402000 95083986 109467727 8912555 8798316 1517417 1580761 319060810 346938374 19957857 25153133 -122421 385567 7870414 7139000 142645561 144576474 170351411 177254174 X 144781535 166128273 2632568 2229989 1295296 1325938 148709399 169684200 319060810 346938374 X 17510874 3463927 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 25000 0 0 25000 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: DENNY JACOBS AND ASSOCIATES ACTS ON TMC'S BEHALF TO PROMOTE AND EDUCATE LEGISLATORS AND STATE GOVERNMENT ABOUT TMC'S POSITION RELATING TO LAWS, BILLS, POLICIES, PROCEDURES AND ETC. 98763528 368566 13589944 1113651 111608387 73344833 6436324 19425565 443195 98763528 98982185 582339 -26903952 446486 -1130747 73344833 0.96810 0.01190 0.02000 0 1 1 6322281 6322281 195680139 99761612 95918527 83395226 58832659 24562567 9898105 4299480 5598625 132402000 DUE TO AFFILIATES 1100271 ASBESTOS REMOVAL LIABILITY 1041023 MISCELLANEOUS LIABILITY 154013 SELF-INSURANCE RESERVE 14145083 LONG-TERM RETENTION INCENTIVES 1288916 HEALTH AND WELFARE BENEFITS RESERVE 1747168 IOWA HEALTH SYSTEM NOTE PAYABLE 125100000 144576474 344758532 327247658 17510874 4080355 -616428 3463927 20974801 363713000 4080355 15959255 20039610 343673390 1085142 1085142 344758532 337100000 15958906 15958906 321141094 6106564 6106564 327247658 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 2007. 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 BENEFICIAL INTEREST IN TRINITY HEALTH FOUNDATION -352,854. CHANGES IN PENSION LIABILITY -263,574. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1,137. SPECIAL EVENT EXPENSES 9,570. SUBSIDIARY ELIMINATING ENTRIES (PRECEDENCE) 438,605. SUBSIDIARY ELIMINATING ENTRIES (RYC) 15,121,346. COST OF GOODS SOLD 388,597. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 103,377. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 244. IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC PURCHASE REBATES 981,521. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARY ELIMINATING ENTRIES (PRECEDENCE) 438,605. ROUNDING 788. SPECIAL EVENT EXPENSES 9,570. SUBSIDIARY ELIMINATING ENTRIES (RYC) 15,121,346. COST OF GOODS SOLD 388,597. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 5,125,043. IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC PURCHASE REBATES 981,521. STYLE SHOW 41927 20960 20967 6085 450 1807 GARDEN PARTY 2941 555 2386 490 738 9 27876 27876 72744 21515 51229 6085 490 450 2545 9570 41659 1 1 X 1 X 1 X 1000.000000000000 1 1 0 1 1 18451 6530721 6530721 0.02150 26383 14638347 6083257 8555090 0.02820 44834 21169068 6083257 15085811 0.04970 146442 1340049 7884 1332165 0.00440 480 48612 48612 0.00020 2355 2115617 2115617 0.00700 508 480076 70366 409710 0.00140 3147 1065783 415260 650523 0.00210 152932 5050137 493510 4556627 0.01510 197766 26219205 6576767 19642438 0.06480 24414 160568 12975 147593 0.00050 24414 160568 12975 147593 0.00050 1 8810919 0 100361071 102760421 -2399350 X 1 1 1 QUAD CITY AMBULATORY SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.50000 0.50000 2 TRINITY PHYSICIAN HOSPITAL ORGANIZATION LTD LICENSED PPO PROVIDING HEALTH MGMT SERVICES TO PEOPLE IN IL & IA 0.49900 0.42600 3 TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC ADMINISTRATION OF ORTHOPEDIC SERVICE LINES 0.50000 0.50000 3 1 TRINITY MEDICAL CENTER - ROCK ISLAND

2701 17TH ST ROCK ISLAND IL 61201

X X X 2 TRINITY MEDICAL CENTER - MOLINE

500 JOHN DEERE RD MOLINE IL 61265

X X X 3 TRINITY MEDICAL CENTER - BETTENDORF

4500 UTICA RIDGE RD BETTENDORF IA 52722

X X X TRINITY MEDICAL CENTER 1 20 TRINITY CENTER FOR WOUND CARE

4480 UTICA RIDGE ROAD SUITE 110 BETTENDORF IA 52722

OUTPATIENT ONLY TRINITY AMBULANCE SERVICE

4469 48TH AVE CRT ROCK ISLAND IL 61201

AMBULANCE SERVICES TRINITY OUTPATIENT REHABILITATION SERVIC

4112 BLACKHAWK ROAD ROCK ISLAND IL 61201

REHAB CLINIC TRINITY COLLEGE OF NURSING & HEALTH SCIE

2122 - 25TH AVENUE ROCK ISLAND IL 61201

COLLEGE TRINITY OBGYN

4480 UTICA RIDGE ROAD SUITE 1140 BETTENDORF IA 52722

OB/GYN CLINIC TRINITY SURGICAL PARTNERS - BOHN

4480 UTICA RIDGE ROAD SUITE 108 BETTENDORF IA 52722

SURGERY CLINIC 7TH STREET INTERNAL MEDICINE

600 JOHN DEERE ROAD SUITE 404 MOLINE IL 61265

INTERNAL MEDICINE CLINIC TRINITY OUTPATIENT REHABILITATION SERVIC

4480 UTICA RIDGE ROAD SUITE 102 BETTENDORF IA 52722

OUTPATIENT ONLY TRINITY EXPRESS CARE CLINIC

465 AVE OF THE CITIES SUITE 100 EM IL EAST MOLINE IL 61244

CLINIC TRINITY EXPRESS CARE CLINIC

106 -19TH AVENUE SUITE 103 MOLINE IL 61265

CLINIC TRINITY PULMONARY MEDICINE

2570 - 24TH STREET SUITE 127 ROCK ISLAND IL 61201

CLINIC TRINITY SURGICAL PARTERS

600 JOHN DEERE ROAD SUITE 308 MOLINE IL 61265

SURGERY CLINIC TRINITY COAL VALLEY CLINIC

104 W 18TH AVENUE COAL VALLEY IL 61240

CLINIC TRINITY OUTPATIENT REHABILITATION

465 AVE OF THE CITIES SUITE 145 EM IL EAST MOLINE IL 61244

REHAB CLINIC TRINITY TP FAMILY PRACTICE CLINIC

4480 UTICA RIDGE ROAD SUITE 160 BETTENDORF IA 52722

FAMILY PRACTICE CLINIC TRINITY FAMILY CARE

5359 EASTERN DAVENPORT IA 52804

FAMILY PRACTICE CLINIC PHYSIATRIST REHAB

2570 - 24TH STREET SUITE 125 ROCK ISLAND IL 61201

REHAB CLINIC TRINITY BETTENDORF INTERNAL MEDICINE

4626 PROGRESS DR STE A DAVENPORT IA 52804

INTERNAL MEDICINE CLINIC TRINITY FAMILY PRACTICE - RF

4350 7TH STREET MOLINE IL 61265

FAMILY PRACTICE CLINIC QUAD CITY AMBULATORY SURGERY CENTER

520 VALLEY VIEW DRIVE SUITE 300 MOLINE IL 61265

AMBULATORY SURGERY CENTER PART I, LINE 6A: TRINITY MEDICAL CENTER'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM CONSOLIDATED COMMUNITY BENEFIT REPORT WHICH IS POSTED ON ITS WEBSITE AT WWW.IHS.ORG.IN ADDITION, THE HOSPITAL AND ITS REGIONAL AFFILIATES PUBLISHES AN ANNUAL COMMUNITY BENEFIT REPORT. THIS REPORT IS POSTED ON ITS WEBSITE AT WWW.TRINITYQC.COM. PART I, LINE 7G: THE NET COMMUNITY BENEFIT COST OF SUBSIDIZED HEALTH SERVICES OF $2,115,617 IS ATTRIBUTED TO TRINITY AMBULANCE SERVICE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 23814804. PART II: COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO FREE CLINICS OR AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. TRINITY MEDICAL CENTER CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH STATUS IN WAYS THAT MAY DIFFER FROM THE DIRECT SERVICES OF THE HOSPITAL ORGANIZATION AND MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. TRINITY MEDICAL CENTER EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, TRINITY MEDICAL CENTER EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COLLABORATE TO ADDRESS COMPLEX HEALTH ISSUES. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT TRINITY MEDICAL CENTER HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR TRINITY MEDICAL CENTER. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 8: THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL REPORTED ON LINE 7 ABOVE SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS.AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE. PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. PART VI, LINE 2: TRINITY MEDICAL CENTER CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN THE QUAD CITY AREA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, TRINITY MEDICAL CENTER IS A SPONSORING PARTNER OF QUAD CITY HEALTH INITIATIVE WHICH IS A COMMUNITY COLLABORATIVE CONVENED BY GENESIS HEALTH SYSTEM AND TRINITY REGIONAL HEALTH SYSTEM TO ASSESS, ADDRESS AND MONITOR THE HEALTH NEEDS OF THE QUAD CITY AREA. THROUGH A PLANNED AND ORGANIZED EFFORT, QUAD CITY HEALTH INITIATIVE DEVELOPS A HEALTH AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES THAT ARE RELEVANT TO THE COMMUNITY. QUAD CITY HEALTH INITIATIVE WORKS COLLECTIVELY TO ADDRESS THE PRIORITIES THROUGH LEVERAGING THE RESOURCES OF THE COMMUNITY. TRINITY MEDICAL CENTER, AS A SPONSORING AGENCY, ACTIVELY CONTRIBUTES TO THIS PROCESS AND ENGAGES IN THE IDENTIFIED PRIORITIES THAT MATCH ITS MISSION AND CAPACITY. TRINITY MEDICAL CENTER ALSO PARTICIPATES AS PART OF THE UNITED WAY OF THE QUAD CITIES IOWA'S COMMUNITY IMPACT COMMITTEE. THIS GROUP ACTIVELY ADDRESSES NEED AND STRATEGIES ASSOCIATED WITH HEALTH. MORE SPECIFICALLY, THIS GROUP OFTEN FOCUSES ON THE SOCIAL DETERMINANTS OF HEALTH AND HOW TO IMPACT THEM IN THE EFFORT TO RAISE THE COMMUNITY HEALTH STATUS. THIS WIDE BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR TRINITY MEDICAL CENTER TO ENGAGE IN VARIOUS AREAS OF SERVICE TO THE COMMUNITY THAT MAY BE OUTSIDE OF ITS TYPICAL EXPERTISE BUT WITHIN ITS EXISTING RESOURCES. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS, TRINITY MEDICAL CENTER CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS OFTEN WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT. PART VI, LINE 3: TRINITY MEDICAL CENTER PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR BROCHURES IN APPROPRIATE AREAS OF THE PROVIDER (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THAT THE PROVIDER/PHYSICIAN PRACTICE OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE. PART VI, LINE 4: TRINITY MEDICAL CENTER IS A 515-BED COMMUNITY HOSPITAL IN EASTERN IOWA AND WESTERN ILLINOIS. TRINITY MEDICAL CENTER IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE. EIGHTY PERCENT OF TRINITY MEDICAL CENTER'S INPATIENT MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF CLINTON, MUSCATINE AND SCOTT, AND ILLINOIS COUNTIES OF HENRY, MERCER AND ROCK ISLAND. TRINITY MEDICAL CENTER ADMITS APPROXIMATELY 18,994 INPATIENTS AND CARES FOR 77,732 EMERGENCY PATIENTS PER YEAR. THERE ARE SEVEN OTHER HOSPITALS WITHIN THE SIX-COUNTY SERVICE AREA. FOR THESE COUNTIES, THE MEDIAN HOUSEHOLD INCOMES RANGE FROM $43,719 TO $51,200, AND THE AVERAGE POVERTY RATE IS 8.4 PERCENT. MUSCATINE, ROCK ISLAND AND SCOTT COUNTIES ARE THE ONLY COUNTIES IN THE SERVICE AREA WITH SIGNIFICANT MINORITY POPULATION. MUSCATINE COUNTY IS 92.8 PERCENT CAUCASIAN. ROCK ISLAND COUNTY IS 83.4 PERCENT CAUCASIAN AND 7.9 PERCENT AFRICAN AMERICAN. SCOTT COUNTY IS 87.0 PERCENT CAUCASIAN AND 6.4 PERCENT AFRICAN-AMERICAN. APPROXIMATELY 59 PERCENT OF TRINITY MEDICAL CENTER PATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. PART VI, LINE 6: TRINITY MEDICAL CENTER IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE. PART VI, LINE 7: TRINITY MEDICAL CENTER IS PART OF IOWA HEALTH SYSTEM. INITIALLY FORMED IN 1995, IOWA HEALTH SYSTEM IS THE STATE'S FIRST AND LARGEST INTEGRATED HEALTH SYSTEM, SERVING NEARLY ONE OF EVERY THREE PATIENTS IN IOWA. THROUGH RELATIONSHIPS WITH 25 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 140 PHYSICIAN CLINICS, IOWA HEALTH SYSTEM PROVIDES CARE THROUGHOUT IOWA AND WESTERN ILLINOIS. IOWA HEALTH SYSTEM ENTITIES EMPLOY THE STATE'S LARGEST NON-PROFIT WORKFORCE, WITH NEARLY 20,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 2.5 MILLION PATIENT VISITS, IOWA HEALTH SYSTEM HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $2.3 BILLION, IOWA HEALTH SYSTEM IS THE SIXTH LARGEST NONDENOMINATIONAL HEALTH SYSTEM IN AMERICA AND PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES TO IMPROVE THE HEALTH OF PEOPLE IN ITS COMMUNITIES.IOWA HEALTH SYSTEM AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES THROUGHOUT IOWA, AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THE STATE. IN 2010, IOWA HEALTH SYSTEM AND ITS AFFILIATES PROVIDED MORE THAN $152 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY IOWA HEALTH SYSTEM AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. REPORTS FILED WITH STATES PART VI, LINE 7 IL,IA 1 ILLINOIS HOSPITAL ASSOCIATION 37092 EAGLE WAY CHICAGO IL 60679 362352486 501(C)(3) 111132 PROGRAM SUPPORT IOWA HEALTH SYSTEM 1200 PLEASANT ST DES MOINES IA 50309 421435199 501(C)(3) 2729721 PROGRAM SUPPORT 2 0 SCHOLARSHIPS 13 11500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TRINITY MEDICAL CENTER AUXILIARY REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART III TO APPLY FOR THE GRANT THROUGH A STRUCTURED PROCESS AND OUTLINES A SERIES OF ELIGIBILITY STANDARDS THAT ARE REQUIRED TO BE MET. THE AUXILIARY SCHOLARSHIP COMMITTEE THEN REVIEWS THESE APPLICATIONS FOR COMPLETENESS AND COMPLIANCE. AFTER ELIGIBILITY FOR GRANT REVIEW IS ESTABLISHED THE APPLICATION IS FORWARDED TO THE AUXILIARY BOARD FOR REVIEW. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 DAVID DEOPERE 187096 0 71077 0 37876 0 119690 0 18987 0 434726 0 0 0 RICK SEIDLER FR 610 221612 170601 35000 104871 38790 42130 211047 28204 7734 5352 514183 351158 0 0 TOM TIBBITTS TO 610 0 307940 0 86452 0 383022 0 6125 0 11749 0 795288 0 319047 TAMARA BYRAM FR 1110 126239 0 3750 0 14442 0 5311 0 22573 0 172315 0 0 0 DR PAUL MCLOONE 0 225207 0 385 0 25 0 29538 0 17841 0 272996 0 0 GREG PAGLIUZZA JR 261290 0 0 0 27771 0 36424 0 15853 0 341338 0 0 0 JEFFREY STOLZE TO 1110 191722 0 75509 0 17532 0 50982 0 26058 0 361803 0 0 0 DR PAUL BOLGER 417491 0 18301 0 45632 0 18846 0 26290 0 526560 0 0 0 KATHLEEN CUNNINGHAM 170473 0 59115 0 27442 0 18574 0 14974 0 290578 0 0 0 PENNY DAVIS 85012 0 18560 0 61078 0 0 0 3049 0 167699 0 0 0 JON HONSEY 182052 0 65585 0 19120 0 18846 0 25044 0 310647 0 0 0 MICHAEL PATTERSON 238366 0 58800 0 39119 0 18846 0 6843 0 361974 0 0 0 KATHERINE PEARSON 137126 0 6396 0 15192 0 10547 0 25269 0 194530 0 0 0 JAY WILLSHER TO 910 58301 80690 0 32127 12525 30239 45641 5235 6645 18102 123112 166393 0 0 DR GREGORY BOHN 473618 0 0 0 22443 0 11496 0 21607 0 529164 0 0 0 DR MARK BUETTNER 468443 0 0 0 32323 0 18846 0 28691 0 548303 0 0 0 DR CHARLES LEMON 449162 0 0 0 23959 0 18846 0 22828 0 514795 0 0 0 DR WILLIAM OLSON 578485 0 0 0 62744 0 19524 0 23906 0 684659 0 0 0 DR CHAD VANDERLINDEN 436359 0 0 0 42990 0 18846 0 21676 0 519871 0 0 0 ANDREA COLEMAN TO 1109 60402 0 92904 0 298536 0 14084 0 6882 0 472808 0 40073 0 WILLIAM LEAVER TO 1207 0 843095 0 375540 0 62034 0 388573 0 21493 0 1690735 0 0 KEVIN VERMEER TO 509 0 410986 0 84714 0 47705 0 182223 0 16739 0 742367 0 0 PART I, LINE 1A HOUSING ALLOWANCE: A HOUSING ALLOWANCE WAS PROVIDED TEMPORARILY FOR A NEW EXECUTIVE WHILE TRANSITIONING THEIR RESIDENCE. THIS ALLOWANCE WAS INCLUDED IN COMPENSATION, TAXED, AND REPORTED ON FORM W-2. PART I, LINES 4A-B SEVERANCE PAYMENT: THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING THE YEAR THAT WAS INCLUDED IN THEIR TAXABLE INCOME: ANDREA COLEMAN $258,139. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: ANDREA COLEMAN $14,084, DAVID DEOPERE $100,844, WILLIAM LEAVER $376,323, WILLIAM OLSON $678, GREG PAGLIUZZA, JR. $26,182, RICHARD SEIDLER $199,241, JEFFREY STOLZE $32,136, KEVIN VERMEER $169,973, AND JAY WILLSHER $41,995. AMANDA CROWELL FAMILY MEMBER OF BOARD MEMBER DUNCAN CAMERON 105775 EMPLOYMENT 0 BOBETTE PATTERSON FAMILY MEMBER OF KEY EMPLOYEE MICHAEL PATTERSON 177026 EMPLOYMENT 0 CARDIOVASCULAR MEDICINE PC COMMON BOARD MEMBER/OFFICER 153643 MEDICAL SERVICES 0 MARSHA ROMAN FAMILY MEMBER OF KEY EMPLOYEE MICHAEL PATTERSON 92485 EMPLOYMENT 0 MEDICAL ARTS ASSOCIATES LTD PC COMMON BOARD MEMBER/OFFICER 762000 RENT AND MEDICAL SERVICES 0 METRO MRI CENTER LIMITED PARTNERSHIP COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 1908000 INVESTMENT AND PATIENT SERVICE REVENUE 0 QUAD CITY AMBULATORY SURGERY CENTER LLC COMMON BOARD MEMBER/OFFICER 3337000 INVESTMENT 0 SNYDER PARK NELSON & SCHWIEBERT PC COMMON BOARD MEMBER/OFFICER 182382 ATTORNEY FEES 0 TRINITY HEALTH ENTERPRISES INC COMMON BOARD MEMBER/OFFICER 106048 RENT, SHARING OF EMPLOYEES AND EXPENSE REIMBURSEMENT 0 TRINITY PHYSICIAN HOSPITAL ORGANIZATION LTD COMMON BOARD MEMBER/OFFICER 519000 INVESTMENT, RENT, ADMINISTRATIVE FEES, SALARIES/BENEFITS, CREDENTIALING FEES, OTHER PROFESSIONAL FEES 0 US BANK COMMON BOARD MEMBER/OFFICER 613211 FINANCIAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 ALEX PAREIGIS, MD; AHMED OKBA, MD; BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 TRINITY REGIONAL HEALTH SYSTEM, A TAX-EXEMPT ILLINOIS NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A TRINITY REGIONAL HEALTH SYSTEM'S MAY APPOINT ONE BOARD MEMBER AND APPROVES ALL OTHERS. FORM 990, PART VI, SECTION A, LINE 7B TRINITY REGIONAL HEALTH SYSTEM, AS SOLE MEMBER, APPROVES AMENDMENTS TO ARTICLES, BYLAWS AND MISSION, MAY REMOVE ANY TRUSTEE WITH OR WITHOUT CAUSE, APPOINTS CEO AND VICE PRESIDENT, APPROVES MERGERS, CREATION OF SUBSIDIARY OR AFFILIATE ORGANIZATIONS, AND APPROVES BUDGETS AND LONG-RANGE STRATEGY. TRINITY REGIONAL HEALTH SYSTEM AND IOWA HEALTH SYSTEM MUST APPROVE DISSOLUTION. 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 2010 FOR THE FOLLOWING INDIVIDUALS: DAVID DEOPERE, WILLIAM LEAVER, GREG PAGLIUZZA, RICHARD SEIDLER, JEFFREY STOLZE, AND THOMAS TIBBITTS. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,080,355. CHANGE IN BENEFICIAL INTEREST IN TRINITY HEALTH FOUNDATION -352,854. CHANGES IN PENSION LIABILITY -263,574. TOTAL TO FORM 990, PART XI, LINE 5: 3,463,927. 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 HEALTH FOUNDATION INC 350 NORTH GRANDVIEW AVENUE DUBUQUE IA 52001 421286953 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) THE FINLEY HOSPITAL AND THE DUBUQUE VISITING NURSE ASSOCIATION 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 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 1440 INGERSOLL AVENUE DES MOINES IA 50309 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 LUTHERAN HOSPITAL AUXILIARY 1440 INGERSOLL AVENUE DES MOINES IA 50309 426059539 SUPPORT IOWA LUTHERAN HOSPITAL MISSION TO IMPROVE HEALTHCARE 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 JONES REGIONAL MEDICAL CENTER FOUNDATION 104 BROADWAY PLACE ANAMOSA IA 52205 421429225 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ST LUKE'SJONES REGIONAL MEDICAL CENTER 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 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 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IA IHS C 62920 1.00000 MEDIMORE INC 1200 PLEASANT ST DES MOINES IA 50309 421414390 MANAGED CARE IA IHS C 155826 1.00000 PRECEDENCE INC 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 371288604 MANAGED MENTAL CARE IA RYC C 535068 395659 1.00000 RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC 700 E UNIVERSITY AVE DES MOINES IA 50316 261271143 SPECIALTY PHYSICIANS MEDICAL CARE IA CIHC C 406868 164732 0.57100 ST LUKE'S DEVELOPMENT COMPANY 1026 A AVE NE CEDAR RAPIDS IA 52402 421353658 LESSOR NONRESIDENTIAL REAL ESTATE IA SLHCF C 1.00000 STL HEALTH RESOURCES CO 1026 A AVE NE CEDAR RAPIDS IA 52402 421193499 PHYSICIAN OFFICE RENTAL IA SLMH C 1075846 6293579 1.00000 TRIMARK PHYSICIANS GROUP INC 802 KENYON ROAD FORT DODGE IA 50501 421335554 MEDICAL CLINICS IA THS C 43433525 17778844 1.00000 TRINITY HEALTH ENTERPRISES INC 2701 17TH ST ROCK ISLAND IL 61201 363320141 RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY IL TRHS C 3554376 3394181 1.00000 0 1 1 1 0 0 0 1 1 0 1 1 0 1 1 1 0 0 SECTION 512(B)(13) CONTROLLED ENTITY SCHEDULE R, PART II, COLUMN (G) 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.