UNITYPOINT AT HOME: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UNITYPOINT AT HOME (EIN 42-1477471)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-08
IRS object ID
201133129349302308
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-08T15:06:51-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421477471EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameSANDRA D DIELEMANName
TitleVP/CFOTitle
Phone5155573191Phone
Date Signed2011-10-18DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line111333 AURORA AVENUEAddressLine1
CityURBANDALECity
StateIAState
ZIP Code50322ZIPCode
FieldValueIRS element (for citing)
Gross Receipts75178424GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.IOWAHEALTHHOMECARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH HEALING, CARING AND TEACHING.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees794TotalNbrEmployees
Total Nbr Volunteers120TotalNbrVolunteers
Total Gross UBI247834TotalGrossUBI
Net Unrelated Business Txbl Income44892NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1050737ContributionsGrantsPriorYear
Contributions Grants Current Year466442ContributionsGrantsCurrentYear
Program Service Revenue Prior Year50880911ProgramServiceRevenuePriorYear
Program Service Revenue CY56665265ProgramServiceRevenueCY
Investment Income Prior Year632486InvestmentIncomePriorYear
Investment Income Current Year1594010InvestmentIncomeCurrentYear
Other Revenue Prior Year130210OtherRevenuePriorYear
Other Revenue Current Year132918OtherRevenueCurrentYear
Total Revenue Prior Year52694344TotalRevenuePriorYear
Total Revenue Current Year58858635TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year8226GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY8185GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year28929132SalariesEtcPriorYear
Salaries Etc Current Year33642619SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year15000TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY16500TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year65233TotalFundrsngExpCurrentYear
Other Expense Prior Year17771586OtherExpensePriorYear
Other Expenses Current Year20920876OtherExpensesCurrentYear
Total Expenses Prior Year46723944TotalExpensesPriorYear
Total Expenses Current Year54588180TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5970400RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4270455RevenuesLessExpensesCY
Total Assets BOY32727948TotalAssetsBOY
Total Assets EOY38222621TotalAssetsEOY
Total Liabilities BOY7056248TotalLiabilitiesBOY
Total Liabilities EOY7549159TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY25671700NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY30673462NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH HEALING, CARING AND TEACHING.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense45661994Expense
Grants0Grants
Revenue56798183Revenue
DescriptionHEALTH CARE SERVICESINTRUST PROVIDES HOME HEALTH SERVICES FOR PEOPLE IN NEED WITH THE PURPOSE TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. HIGHEST PRIORITY IS GIVEN TO LOW-INCOME INDIVIDUALS BUT SERVICES ARE AVAILABLE TO ALL RESIDENTS. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. HOME HEALTH CARE SERVICES PROVIDED AND PEOPLE SERVED MAY INCLUDE BUT ARE NOT LIMITED TO: CASE MANAGEMENT, CERTIFIED NURSING, PRIVATE DUTY NURSING, PALLIATIVE CARE, HOSPICE, INFUSION SERVICES, HOME MEDICAL EQUIPMENT, LIFELINE, MATERNAL HEALTH CLINICS, NURSING CARE, SUPPORT TO HIGH RISK NEW PARENTS AND NEWBORNS, PARENTING SUPPORT, CHILD HEALTH CLINICS, HEALTH MAINTENANCE VISITS AND SCREEENINGS, IMMUNIZATION CLINICS, SENIOR CITIZENS, DISABLED, ILL, HANDICAPPED AND TERMINALLY ILL. SERVICES MAY BE PROVIDED ON A ONE-TIME, INTERMITTENT, PART-TIME OR LONG-TERM BASIS. INTRUST MADE 117,355 HOME VISITS IN 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1661459Expense
Grants8185Grants
DescriptionCOMMUNITY BENEFITSINTRUST PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL OF IMPROVING THE COMMUNITY'S HEALTH AND ACCESS TO CARE. THIS INCLUDES PROVIDING HEALTH CARE SERVICES REGARDLESS OF A PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE TO 273 PATIENTS AT A VALUE OF $238,727 IN 2010. OFTENTIMES, INTRUST RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN ITS CHARGES FOR SERVICES. INTRUST PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. INTRUST'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COSTS IS $1,203,199 FOR 2010. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $1,441,926.OTHER BENEFITS: INTRUST PROVIDES SEVERAL ADDITIONAL HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS THAT SUPPORT ITS MISSION OF IMPROVING THE HEALTH OF ITS COMMUNITY THROUGH HEALING, CARING AND TEACHING. PROGRAMS INCLUDE BUT ARE NOT LIMITED TO: PREVENTION AND HEALTH SCREENINGS; SUBSIDIZED HEALTH SERVICES; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. INTRUST PARTNERS WITH HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND CHILDCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. APPROXIMATELY 1,771 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS PREPORTED VALUE: $219,533.Description
FieldValueIRS element (for citing)
Total Program Service Expense47323453TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096129NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees794NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

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

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
PATRICK BURTON
BOARD CHAIR1.00XX000
KIM FOLTZ
BOARD MEMBER1.00X000
DAVID KECK
BOARD SECRETARY/TREASURER1.00XX000
MARK PURTLE MD
BOARD MEMBER1.00X0466859181233
GARY BARGSTADT
VP/COO40.00X688649616515244
SANDRA DIELEMAN
VP/CFO/CAO40.00X164422031059
PHYLLIS STADTLANDER
PRESIDENT/CEO40.00X178922024389
ALAN KAPLAN
CHIEF MEDICAL OFFICER40.000611284103820X
RUTH COADY
EXEC DIR STATEWIDE INFUSION40.00110961010924X
JAMES CUSHING
EXEC DIR PERFORMANCE IMPROVEMENT40.00111325012283X
TIMOTHY HACKBART
EXEC DIR SIOUX CITY40.00115298023347X
MONIQUE REESE
VP/CHIEF CLINICAL OFFICER40.0012161006801X
ELIZABETH SUTTER
EXEC DIR CERTIFIED40.00112005013273X
FieldValueIRS element (for citing)
Total Reportable Comp From Org983407TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1174308TotalReportableCompFrmRltdOrgs
Total Other Compensation422373TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MAXIM HEALTHCARE SERVICES
12558 COLLECTIONS CENTER DRIVECHICAGOIL60693STAFFING AGENCY528963
LIFELINE SYSTEMS INC
PO BOX 846071BOSTONMA022846071MONITORING SERVICE287361
VERIZON WIRELESS
151 COLLINS RD NECEDAR RAPIDSIA52402PHONE SERVICE192650
FRIENDSHIP HAVEN
420 KENYON RDFORT DODGEIA50501NURSING HOME- INPT SERVICES186327
AUTOMOTIVE RENTAL INC
PO BOX 8500-4375PHILADELPHIAPA191784375FLEET CARS173684
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Related Organizations388341RelatedOrganizations
Government Grants41625GovernmentGrants
All Other Contributions36476AllOtherContributions
Total Contributions466442TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
HOME HEALTH CARE SVCS6216105491293954730396182543
MGMT & SUPPORT SVCS56100016847311684731
SUBS & JOINT VENTURES90009967595230465291
FieldValueIRS element (for citing)
Total Program Service Revenue56665265TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column505399TotalRevenueColumn
Exclusion$505,399ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities17408400Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities16292286Securities
Other27503Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1116114Securities
Other-27503Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1088611TotalRevenueColumn
Exclusion$1,088,611ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column132918TotalRevenueColumn
Related Or Exempt Function Income132918RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue132918TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column58858635TotalRevenueColumn
Related Or Exempt Function Income56550349RelatedOrExemptFunctionIncome
Unrelated Business Revenue247834UnrelatedBusinessRevenue
Exclusion$1,594,010ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total8185Total
Program Services8185ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total474281Total
Management And General474281ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total25875259Total
Program Services22196548ProgramServices
Management And General3654155ManagementAndGeneral
Fundraising24556Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total944115Total
Program Services809707ProgramServices
Management And General133300ManagementAndGeneral
Fundraising1108Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4487342Total
Program Services3848617ProgramServices
Management And General633587ManagementAndGeneral
Fundraising5138Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1861622Total
Program Services1597021ProgramServices
Management And General262913ManagementAndGeneral
Fundraising1688Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total539809Total
Program Services110588ProgramServices
Management And General429221ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total643Total
Management And General643ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total16500Total
Fundraising16500Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total131572Total
Program Services1081ProgramServices
Management And General130491ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2864494Total
Program Services2790493ProgramServices
Management And General74001ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total144282Total
Program Services27629ProgramServices
Management And General111315ManagementAndGeneral
Fundraising5338Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total11372152Total
Program Services11120363ProgramServices
Management And General251181ManagementAndGeneral
Fundraising608Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1478660Total
Program Services956787ProgramServices
Management And General514592ManagementAndGeneral
Fundraising7281Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1207438Total
Program Services994130ProgramServices
Management And General212005ManagementAndGeneral
Fundraising1303Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total951705Total
Program Services914876ProgramServices
Management And General36344ManagementAndGeneral
Fundraising485Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total37368Total
Program Services20906ProgramServices
Management And General16462ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total60607Total
Management And General60607ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1507757Total
Program Services1323433ProgramServices
Management And General184324ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total-166622Total
Management And General-166622ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PATIENT BAD DEBT440460440460
MISCELLANEOUS EXPENSES3505511626291866941228

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total54588180Total
Program Services47323453ProgramServices
Management And General7199494ManagementAndGeneral
Fundraising65233Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1578948BOY
EOY691277EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4633551BOY
EOY3766303EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6890460BOY
EOY6788006EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY117073BOY
EOY188254EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY732825BOY
EOY936019EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY16289BOY
EOY15440EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis13836474LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7560037LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6495738BOY
EOY6276437EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY11624954BOY
EOY19201183EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY638110BOY
EOY359702EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY32727948BOY
EOY38222621EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3952995BOY
EOY5325005EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY698612BOY
EOY43372EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2404641BOY
EOY2180782EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7056248BOY
EOY7549159EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY25600275BOY
EOY30613040EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY71425BOY
EOY60422EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY25671700BOY
EOY30673462EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY32727948BOY
EOY38222621EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4270455ReconcilationRevenueExpenses
Reconcilation Other Changes731307ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years943587CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years161878CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5212CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1050737CurrentTaxYearMinus1Year
Current Tax Year466442CurrentTaxYear
Total2627856Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years37939553CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years43052317CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years45754426CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year50880911CurrentTaxYearMinus1Year
Current Tax Year56665265CurrentTaxYear
Total234292472Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years28399CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year130210CurrentTaxYearMinus1Year
Current Tax Year132918CurrentTaxYear
Total291527Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years38883140CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years43214195CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years45788037CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52061858CurrentTaxYearMinus1Year
Current Tax Year57264625CurrentTaxYear
Total237211855Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509237211855PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years130549CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years333750CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years345228CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year472417CurrentTaxYearMinus1Year
Current Tax Year505399CurrentTaxYear
Total1787343Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years130549CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years333750CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years345228CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year472417CurrentTaxYearMinus1Year
Current Tax Year505399CurrentTaxYear
Total1787343Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years90125CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years115961CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years96793CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year126127CurrentTaxYearMinus1Year
Current Tax Year247834CurrentTaxYear
Total676840Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years39103814CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years43663906CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years46230058CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52660402CurrentTaxYearMinus1Year
Current Tax Year58017858CurrentTaxYear
Total239676038Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98970PublicSupportPercentage509
Prior Year Support Percentage0.99110PriorYearSupportPercentage
Investment Income Percentage0.00750InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00670PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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

Land Land

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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3520092OtherCostOrOtherBasis
Depreciation1452732Depreciation
Book Value2067360BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10156382OtherCostOrOtherBasis
Depreciation6107305Depreciation
Book Value4049077BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6276437TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$470,740
SELF-INSURANCE RESERVE$287,864
HEALTH AND WELFARE BENEFITS RESERVE$407,178
IOWA HEALTH SYSTEM NOTE PAYABLE$1,015,000
FieldValueIRS element (for citing)
Total Of Amounts2180782TotalOfAmounts
Total Revenue58858635TotalRevenue
Total Expenses54588180TotalExpenses
Excess Or Deficit For Year4270455ExcessOrDeficitForYear
Net Unrealized GL On Investments731307NetUnrealizedGLOnInvestments
Total Adjustments731307TotalAdjustments
Excess Or Deficit Per FS5001762ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt59529000TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments731307NetUnrealizedGainsInvestments
Other Revenues13512OtherRevenues
Revenue Not Rptd F990744819RevenueNotRptdF990
Revenue Subtotal58784181RevenueSubtotal
Investment Expenses Not Included62566InvestmentExpensesNotIncluded
Other Revenues Not Included11888OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt74454RevenueNotRptdOnFinStmt
Total Revenue Per Form99058858635TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt54835000TotExpensesEtcAuditedFinclStmt
Other Expenses Included309731OtherExpensesIncluded
Expenses Not Rptd F990309731ExpensesNotRptdF990
Expenses Subtotal54525269ExpensesSubtotal
Investment Expenses Not Included262566InvestmentExpensesNotIncluded2
Other Expenses Not Included345OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt62911ExpensesNotRptdOnFinStmt
Total Expenses Per Form99054588180TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ORGANIZATION RETAINS FUNDS FOR INTENDED FUTURE USES, INCLUDING PURCHASE OF EQUIPMENT, INDIGENT CARE, FUNDING OF MISSION RELATED OPERATIONS, AND HEALTH EDUCATION. IN ADDITION, SOME FUNDS ARE HELD FOR INVESTMENT IN PERPETUITY.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:IOWA HEALTH SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) AND 501(C)(2) OF THE INTERNAL REVENUE CODE (THE CODE). TAX-EXEMPT ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME AS DESCRIBED UNDER PROVISIONS OF SECTION 511 OF THE CODE. THE HEALTH SYSTEM FILES FORM 990 FOR SUBSTANTIALLY ALL OF ITS OPERATING ENTITIES IN THE U.S. FEDERAL JURISDICTION AND IS NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES FOR THE YEARS BEFORE 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 XII, LINE 2D - OTHER ADJUSTMENTS:REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 11,003. EXPENSES NETTED IN REVENUES 2,509.
PART XII, LINE 4B - OTHER ADJUSTMENTS:REVENUES IN UNRESTRICTED FUND BALANCE 11,793. ROUNDING 95.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:EXPENSES IN UNRESTRICTED FUND BALANCE 307,222. EXPENSES NETTED IN REVENUES 2,509.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:ROUNDING 345.

Schedule G IRS990ScheduleG

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

Fundraiser Activity Information FundraiserActivityInformation

Name Of Organization NameOfOrganization

FieldValueIRS element (for citing)
Business Name Line1IOWA HEALTH FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11440 INGERSOLL AVEAddressLine1
CityDES MOINESCity
StateIAState
ZIP Code50309ZIPCode
FieldValueIRS element (for citing)
ActivityRECEIPTING OF MEMORIALS/MAILINGSActivity
Fundraiser Control Of Funds1FundraiserControlOfFunds
Gross Receipts245006GrossReceipts
Amount Retained By Contractor16500AmountRetainedByContractor
Net To Organization228506NetToOrganization
FieldValueIRS element (for citing)
Total Gross Receipts245006TotalGrossReceipts
Total Retained By Contractors16500TotalRetainedByContractors
Total Net To Organization228506TotalNetToOrganization
Licensed StatesIALicensedStates

Form990 Schedule G Part IV Form990ScheduleGPartIV

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

Schedule I IRS990ScheduleI

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

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK PURTLE MD
03400080984260284250162414018819064809200
GARY BARGSTADT
64941683230200543923778829265325369732967548710478600
SANDRA DIELEMAN
13863701643309352080130230460195481000
PHYLLIS STADTLANDER
147973017103013846072870171020203311000
ALAN KAPLAN
0483390087679040215084859018961071510400

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationTHE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: ALAN KAPLAN $72,609, MARK PURTLE $150,164.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (11 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
WEST LAKES MEDICAL EQUIPMENT LLC
COMMON BOARD MEMBER/OFFICER595516INVESTMENT, PERFORMANCE OF SERVICES, MANAGEMENT FEES, ETC.0
(no name)
00
(no name)
00
(no name)
00
(no name)
00
(no name)
00
(no name)
00
(no name)
00
(no name)
00
(no name)
00
(no name)
00

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO NOMINATE AND APPOINT BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE SOLE MEMBER, IOWA HEALTH SYSTEM, HAS THE POWER TO APPROVE CHANGES IN ARTICLES AND BYLAWS, DISSOLUTIONS OR MERGERS, AND APPOINT BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
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 12C
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: ALAN KAPLAN AND MARK PURTLE, MD. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY A COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION.FORM 990, PART VI, SECTION B, LINE 15
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 VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 731,307.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (41 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
ALLEN COLLEGE
1825 LOGAN AVENUEWATERLOOIA50703421351526EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALSIA501(C)(3)170(B)(1) (A)(II)ALLEN HEALTH SYSTEMS INC1
ALLEN HEALTH SYSTEMS INC
1825 LOGAN AVENUEWATERLOOIA50703421201924SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
ALLEN MEMORIAL HOSPITAL CORPORATION
1825 LOGAN AVENUEWATERLOOIA50703420698265HOSPITALIA501(C)(3)170(B)(1) (A)(III)ALLEN HEALTH SYSTEMS INC1
ANAMOSA AREA AMBULANCE SERVICE
101 GRANT WOOD DRIVEANAMOSAIA52205421466284PROVIDE AMBULANCE SERVICESIA501(C)(3)509(A)(2)ST LUKE'SJONES REGIONAL MEDICAL CENTER1
CENTRAL IOWA HEALTH PROPERTIES CORPORATION
1200 PLEASANT STREETDES MOINESIA50309421233759PROPERTY HOLDING COMPANYIA501(C)(2)CENTRAL IOWA HEALTH SYSTEM1
CENTRAL IOWA HEALTH SYSTEM
1200 PLEASANT STREETDES MOINESIA50309421189791SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
CENTRAL IOWA HOSPITAL CORPORATION
1200 PLEASANT STREETDES MOINESIA50309420680452HOSPITALIA501(C)(3)170(B)(1) (A)(III)CENTRAL IOWA HEALTH SYSTEM1
FINLEY HEALTH FOUNDATION INC
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001421286953CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)THE FINLEY HOSPITAL AND THE DUBUQUE VISITING NURSE ASSOCIATION1
FINLEY TRI-STATES HEALTH GROUP INC
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001421307495SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
HNC SERVICES
1200 PLEASANT STREETDES MOINESIA50309270987243SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(2)IOWA HEALTH SYSTEM1
INTRUST
11333 AURORA AVENUEURBANDALEIA50322421477471HOME HEALTH CAREIA501(C)(3)509(A)(2)IOWA HEALTH SYSTEM1
IOWA HEALTH FOUNDATION
1440 INGERSOLL AVENUEDES MOINESIA50309421467682CHARITABLE FUNDRAISINGIA501(C)(3)509(A)(3), TYPE IIICENTRAL IOWA HEALTH SYSTEM1
IOWA HEALTH SYSTEM
1200 PLEASANT STREETDES MOINESIA50309421435199SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE III1
IOWA LUTHERAN HOSPITAL AUXILIARY
1440 INGERSOLL AVENUEDES MOINESIA50309426059539SUPPORT IOWA LUTHERAN HOSPITAL MISSION TO IMPROVE HEALTHCAREIA501(C)(3)509(A)(3), TYPE III1
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
8101 BIRCHWOOD COURTJOHNSTONIA50131421411630PRIMARY HEALTH CARE SERVICESIA501(C)(3)170(B)(1) (A)(III)IOWA HEALTH SYSTEM1
JONES REGIONAL MEDICAL CENTER FOUNDATION
104 BROADWAY PLACEANAMOSAIA52205421429225CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)ST LUKE'SJONES REGIONAL MEDICAL CENTER1
MEMORIAL FOUNDATION OF ALLEN HOSPITAL
1825 LOGAN AVENUEWATERLOOIA50703421201138CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)ALLEN HEALTH SYSTEMS INC1
NELLIE R SHERWOOD TRUST
1026 A AVENUE NECEDAR RAPIDSIA52402426061621PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAYIA501(C)(3)509(A)(3), TYPE IST LUKE'S METHODIST HOSPITAL1
NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED
720 KENYON DRIVEFORT DODGEIA50501420937390MENTAL HEALTH CAREIA501(C)(3)170(B)(1) (A)(III)TRINITY HEALTH SYSTEMS INC1
NORTHWEST IOWA HOSPITAL CORPORATION
2720 STONE PARK BLVDSIOUX CITYIA51104421019872HOSPITALIA501(C)(3)170(B)(1) (A)(III)IOWA HEALTH SYSTEM1
ST LUKE'S HEALTH CARE FOUNDATION
855 A AVENUE NE STE 105CEDAR RAPIDSIA52402421106819CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)ST LUKE'S METHODIST HOSPITAL (50 BENEFICIAL INTEREST)1
ST LUKE'S HEALTH FOUNDATION OF SIOUX CITY IOWA
2720 STONE PARK BLVDSIOUX CITYIA51104421301885CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)NORTHWEST IOWA HOSPITAL CORPORATION (50 BENEFICIAL INTEREST)1
ST LUKE'S HEALTH RESOURCES
2720 STONE PARK BLVDSIOUX CITYIA51104421059182OUTPATIENT CLINICS AND HEALTHCARE SERVICESIA501(C)(3)509(A)(2)ST LUKE'S HEALTH SYSTEM INC1
ST LUKE'S HEALTH SYSTEM INC
2720 STONE PARK BLVDSIOUX CITYIA51104421294091SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIIOWA HEALTH SYSTEM1
ST LUKE'S HEALTHCARE
1026 A AVENUE NECEDAR RAPIDSIA52402421487968SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
ST LUKE'S METHODIST HOSPITAL
1026 A AVENUE NECEDAR RAPIDSIA52402420504780HOSPITALIA501(C)(3)170(B)(1) (A)(III)ST LUKE'S HEALTHCARE1
ST LUKE'SJONES REGIONAL MEDICAL CENTER
1795 HIGHWAY 64 EASTANAMOSAIA52205421487967HOSPITALIA501(C)(3)170(B)(1) (A)(III)ST LUKE'S HEALTHCARE1
STL CARE COMPANY
1026 A AVENUE NECEDAR RAPIDSIA52402421276632IMPROVE PUBLIC HEALTH SERVICESIA501(C)(3)509(A)(2)ST LUKE'S HEALTHCARE1
THE DUBUQUE VISITING NURSE ASSOCIATION
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001420680410PUBLIC HEALTH SERVICES/HOME CAREIA501(C)(3)509(A)(2)FINLEY TRI-STATES HEALTH GROUP INC1
THE FINLEY HOSPITAL
350 NORTH GRANDVIEW AVENUEDUBUQUEIA52001420680354HOSPITALIA501(C)(3)170(B)(1) (A)(III)FINLEY TRI-STATES HEALTH GROUP INC1
THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
2701 17TH STREETROCK ISLANDIL61201363678909MENTAL HEALTH CAREIL501(C)(3)170(B)(1) (A)(VI)TRINITY REGIONAL HEALTH SYSTEM1
TRINITY BUILDING CORPORATION
802 KENYON ROADFORT DODGEIA50501421376187PROPERTY HOLDING COMPANYIA501(C)(2)TRINITY HEALTH SYSTEMS INC1
TRINITY HEALTH FOUNDATION
802 KENYON ROADFORT DODGEIA50501421222381CHARITABLE FUNDRAISINGIA501(C)(3)170(B)(1) (A)(VI)TRINITY HEALTH SYSTEMS INC1
TRINITY HEALTH FOUNDATION
2701 17TH STREETROCK ISLANDIL61201363321751CHARITABLE FUNDRAISINGIL501(C)(3)170(B)(1) (A)(VI)TRINITY REGIONAL HEALTH SYSTEM1
TRINITY HEALTH SYSTEMS INC
802 KENYON ROADFORT DODGEIA50501421222877SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIA501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
TRINITY MEDICAL CENTER
2701 17TH STREETROCK ISLANDIL61201362739299HOSPITALIL501(C)(3)170(B)(1) (A)(III)TRINITY REGIONAL HEALTH SYSTEM1
TRINITY REGIONAL HEALTH SYSTEM
2701 17TH STREETROCK ISLANDIL61201363351952SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CAREIL501(C)(3)509(A)(3), TYPE IIIOWA HEALTH SYSTEM1
TRINITY REGIONAL HOSPITAL AUXILIARY
802 KENYON ROADFORT DODGEIA50501426081474CHARITABLE FUNDRAISING AND VOLUNTEER SERVICESIA501(C)(3)509(A)(2)TRINITY REGIONAL MEDICAL CENTER1
TRINITY REGIONAL MEDICAL CENTER
802 KENYON ROADFORT DODGEIA50501421009175HOSPITALIA501(C)(3)170(B)(1) (A)(III)TRINITY HEALTH SYSTEMS INC1
TRINITY VISITING NURSE & HOMECARE ASSOCIATION
2701 17TH STREETROCK ISLANDIL61201363052939HOME HEALTH CAREIL501(C)(3)509(A)(2)TRINITY REGIONAL HEALTH SYSTEM1
UNITY HEALTHCARE
1518 MULBERRY AVENUEMUSCATINEIA52761420680337HOSPITALIA501(C)(3)170(B)(1) (A)(III)TRINITY REGIONAL HEALTH SYSTEM1

Form990 Schedule R Part III Form990ScheduleRPartIII (25 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnershipBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Code VCodeVAmount
1776 WESTLAKES PARKWAY LC
4949 WESTOWN PARKWAY SUITE 200WEST DES MOINESIA50266205031651OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BUILDINGSIAN/AUNRELATED17782212340369010.33330
CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC
1200 PLEASANT STREETDES MOINESIA50309273625869CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICESIAN/ARELATED8055166239010.20000
DES MOINES PARKING ASSOCIATES
1200 PLEASANT STREETDES MOINESIA50309382622972PARKING DECK OPERATIONSIARELATED2674863933296011.00000CENTRAL IOWA HEALTH PROPERTIES CORPORATION
DUBUQUE ENDOSCOPY CENTER LC
1515 DELHI STREET SUITE 500DUBUQUEIA52001201597161AMBULATORY SURGERY CENTERIARELATED671118126090010.51000THE FINLEY HOSPITAL
FINLEYHARTIG HOMECARE LLC
703 MAIN STDUBUQUEIA52001421487138SALE/RENTAL OF MEDICAL EQUIPMENTIAN/ARELATED172294783074010.50000
HEALTH CARE AFFILIATES OF THE TRI-STATES LLC
350 N GRANDVIEW AVEDUBUQUEIA52001421428503PROVIDE ACCESS TO LICENSED SOFTWAREIAN/ARELATED14037010.50000
HEALTH ENTERPRISES VENTURES LC
4250 GLASS ROAD NECEDAR RAPIDSIA52402391894290INVESTMENT VEHICLE OWNING PARTS OF EACH OF THE CLINICAL JOINT VENTURESIAN/AUNRELATED-15790775135000.55660$59,802
HY-VEEIOWA HEALTH LC
5820 WESTOWN PARKWAYWEST DES MOINESIA50266263293530PRIMARY CARE CLINICIAN/ARELATED-17253931249010.00000
IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC
1200 PLEASANT STREETDES MOINESIA50309030482623OUTPATIENT DIAGNOSTIC IMAGINGIAN/ARELATED17462213109901010.50000
IOWA HEALTH SYSTEM CONTRACTING SERVICES LC
1200 PLEASANT STREETDES MOINESIA50309421511142GROUP PURCHASINGIAN/ARELATED57550398927942111.00000
LAKEVIEW SURGERY CENTER LC
1200 PLEASANT STREETDES MOINESIA50309421516120SURGERY CENTERIAN/ARELATED32924595440740010.50000
MEDICAL LABORATORIES OF EASTERN IOWA LC
1026 A AVE NECEDAR RAPIDSIA52402421359640MEDICAL LABORATORY SERVICESIAN/ARELATED420861977532010.50000
METRO MRI CENTER LIMITED PARTNERSHIP
615 VALLEY VIEW DRIVE SUITE 102MOLINEIL61265363710164PROVIDE MRI AND OTHER MEDICAL SERVICESILN/ARELATED7012491694638010.33970
MR ASSOCIATES LLP
1455 SHERMAN ROADHIAWATHAIA52233421260463OWN AND OPERATE MR UNITIAN/ARELATED28235012022295010.33330
NORTHEAST IOWA PHYSICAL THERAPY AND SPORTS MEDICINE LLC
1825 LOGAN AVENUEWATERLOOIA50703202124978ATHLETIC TRAINING AND SPORTS MEDICINEIAN/ARELATED-9147428104010.50000
ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC
1200 PLEASANT STREETDES MOINESIA50309421508092AMBULATORY SURGERY CENTERIAN/ARELATED25784543587597010.50000
PIERCE STREET SAME DAY SURGERY LC
2730 PIERCE STREETSIOUX CITYIA51104205895205AMBULATORY SURGERY CENTERIAN/ARELATED13576043410402010.50000
QUAD CITY AMBULATORY SURGERY CENTER LLC
520 VALLEY VIEW DRIVE SUITE 300MOLINEIL61265364471903AMBULATORY SURGERY CENTER.ILN/ARELATED3235273373129010.50000
TEAM DES MOINES PARTNERS LLC
1205 TECHNOLOGY PARKWAYCEDAR FALLSIA50613262753371COMPUTER SUPPORTIAN/AUNRELATED010.00000
THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC
1075 FIRST AVENUE SECEDAR RAPIDSIA52403721550812AMBULATORY SURGERY CENTER.IAN/ARELATED33747107172047010.50000
TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
4500 UTICA RIDGE RDBETTENDORFIA52722272562753ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICESIAN/ARELATED20893128254010.50000
TRI-WEBSTER LC
1610 COLLINS STWEBSTER CITYIA50595010740062MEDICAL BUILDING AND SURROUNDING PROPERTYIAN/ARELATED1130481782267010.50000
WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC
1660 60TH STREETWEST DES MOINESIA50266271414600ORTHOPEDIC SERVICE LINES MANAGEMENTIAN/ARELATED2040404258010.20000
WEST LAKES MEDICAL EQUIPMENT LLC
5950 UNIVERSITY AVENUE SUITE 321WEST DES MOINESIA50266263300536MEDICAL EQUIPMENT SALES AND RENTALIAN/AUNRELATED67986198717010.50000$65,291
WEST LAKES SLEEP CENTER LLC
5950 UNIVERSITY AVENUE SUITE 2WEST DES MOINESIA50266263193923SLEEP DISORDER CENTER AS INDEPENDENT DIAGNOSTIC TESTING FACILITYIAN/ARELATED23024355798010.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomePercentage OwnershipPercentageOwnershipShare Of EOY AssetsShareOfEOYAssets
BROADBAND INC
1200 PLEASANT STDES MOINESIA50309273819741INFORMATION TECHNOLOGY MGMT.IAIHSC629201.00000
MEDIMORE INC
1200 PLEASANT STDES MOINESIA50309421414390MANAGED CAREIAIHSC1558261.00000
PRECEDENCE INC
4622 PROGRESS DRIVE STE ADAVENPORTIA52807371288604MANAGED MENTAL CAREIARYCC5350681.00000395659
RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC
700 E UNIVERSITY AVEDES MOINESIA50316261271143SPECIALTY PHYSICIANS MEDICAL CAREIACIHCC4068680.57100164732
ST LUKE'S DEVELOPMENT COMPANY
1026 A AVE NECEDAR RAPIDSIA52402421353658LESSOR NONRESIDENTIAL REAL ESTATEIASLHCFC1.00000
STL HEALTH RESOURCES CO
1026 A AVE NECEDAR RAPIDSIA52402421193499PHYSICIAN OFFICE RENTALIASLMHC10758461.000006293579
TRIMARK PHYSICIANS GROUP INC
802 KENYON ROADFORT DODGEIA50501421335554MEDICAL CLINICSIATHSC434335251.0000017778844
TRINITY HEALTH ENTERPRISES INC
2701 17TH STROCK ISLANDIL61201363320141RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACYILTRHSC35543761.000003394181
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

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

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