2023-11-14T11:43:13-06:00 2022-12-31 990 2022-01-01 420933383 GRINNELL REGIONAL MEDICAL CENTER GRIN 6412367511 210 FOURTH AVENUE GRINNELL IA 50112 KYLE M WILCOX INTERIM CEO/VP FIN & OPS 6412367511 2023-11-10 KYLE WILCOX XXX-XX-XXXX 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JENNIFER HAVENS 210 FOURTH AVENUE GRINNELL IA 50112 62553816 0 X WWW.UNITYPOINT.ORG (SEE SCH O) X 1967 IA TO TREAT, HEAL AND CARE FOR THE SICK AND DISABLED. 15 10 407 10 314403 0 867471 2811418 58318627 58649990 68123 -90060 825585 1055539 60079806 62426887 191996 511830 0 0 35235734 39528823 0 0 0 22347731 23116735 57775461 63157388 2304345 -730501 29904442 29996972 17830741 18787847 12073701 11209125 X GRINNELL REGIONAL MEDICAL CENTER'S MISSION IS DEDICATION TO HEALTH CARE FOR LIFE THROUGH GENUINE CARE AND COMPASSION FOR THE HEALTH AND WELL-BEING OF PATIENTS, FAMILIES AND THE COMMUNITIES GRINNELL REGIONAL MEDICAL CENTER IS PRIVILEGED TO SERVE, RESPONSIVENESS TO BALANCING COMMUNITY NEEDS WITH AVAILABLE RESOURCES, MARVELOUS PEOPLE MAKING A DIFFERENCE THROUGH QUALITY CARE AND SERVICE EXCELLENCE EVERY DAY AND COMMITMENT TO PROMOTING WELLNESS, RESTORING HEALTH AND ENHANCING THE QUALITY OF LIFE WE SERVE. 0 0 52127775 506135 59705529 THE ORGANIZATION IS A PROSPECTIVE PAYMENT SYSTEM HOSPITAL WITH 49 ACUTE BEDS. THE ORGANIZATION PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN INPATIENT AND OUTPATIENT SETTINGS. IN ADDITION, THE ORGANIZATION OPERATES SEVERAL PHYSICIANS' CLINICS. DURING 2022, THE ORGANIZATION PROVIDED 4,131 DAYS OF ACUTE CARE, 561 DAYS OF SKILLED NURSING CARE AND 380 NURSERY DAYS. 3826391 5695 0 CHARITY CARE, MEANS-TESTED PROGRAMS AND OTHER COMMUNITY BENEFITSCHARITY CARE AND MEANS-TESTED PROGRAMS: GRINNELL REGIONAL 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 AT A VALUE OF $133,895 IN 2022. OFTENTIMES, GRINNELL REGIONAL MEDICAL CENTER RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. GRINNELL REGIONAL MEDICAL CENTER PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $3,686,801 FOR 2022. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $3,820,696.OTHER BENEFITS: GRINNELL REGIONAL 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; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. GRINNELL REGIONAL MEDICAL CENTER COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. GRINNELL REGIONAL MEDICAL CENTER HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL NET OTHER BENEFITS REPORTED VALUE: $5,695. 55954166 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 407 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X KYLE M WILCOX VP FINANCEBUSINESS 6412367511 210 FOURTH AVENUE GRINNELL IA 50112 RYAN ALBRIGHT MD BOARD MEMBER 1.00 0.00 X 0 0 0 PEGGY BROWN BOARD MEMBER 1.00 0.00 X 0 0 0 JACOB BOYER PC-A BOARD MEMBER 40.00 0.00 X 226820 0 10971 DARWIN COPEMEN BOARD TREASURER 1.00 0.00 X X 0 0 0 JENNIFER HAVENS BOARD MEMBER/CEO 40.00 1.00 X X 0 268250 38115 RACHEL KINNICK BOARD SECRETARY 1.00 0.00 X X 0 0 0 SALLY LANG BOARD CHAIR 1.00 0.00 X X 0 130 0 ALY MALY BOARD MEMBER 1.00 0.00 X 0 0 0 AMY MILLER BOARD MEMBER 1.00 0.00 X 0 0 0 HENRY MORISADA RIETZ PHD BOARD MEMBER 1.00 0.00 X 0 0 0 SID RAMSEY BOARD MEMBERVP MARKETING & BUSINESS DEV-CIHC 1.00 40.00 X 0 407236 37576 SARAH SMITH BOARD MEMBER 1.00 0.00 X 0 0 0 TRACI SMITH BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID STARK BOARD MEMBER/CEO-CIHC 1.00 40.00 X 0 1646674 128464 DOUGLAS VAN DAELE MD BOARD MEMBER 1.00 0.00 X 0 0 0 KYLE WILCOX VP FINANCE 40.00 1.00 X 193922 0 18486 LAURA JUEL VP NURSING & CLINICAL SERVICES 40.00 0.00 X 182406 0 45656 MICHAEL LINE MD CHIEF MEDICAL OFFICER 40.00 1.00 X 0 296449 45437 SCOTT DOYLE CRNA ARNP ANESTHESIOLOGY 40.00 0.00 X 270806 0 34111 STEPHEN ELLESTAD DO PHYSICIAN 40.00 0.00 X 306661 0 16067 SUMIN LI MD PHYSICIAN 40.00 0.00 X 285683 0 42644 KATHRYN OGBURN CRNA ANESTHESIOLOGY 40.00 0.00 X 257626 0 23227 KRISTIN PHELPS PA-C FAMILY MEDICINE 40.00 0.00 X 229034 0 30849 1952958 2618739 471603 43 0 1 0 AMN HEALTHCARE 8840 CYPRESS WATERS BLVD SUITE 300 DALLAS TX 75019 MEDICAL STAFFING 2265929 WHITMAN ENT PLC 202 4TH AVE GRINNELL IA 50112 MEDICAL SERVICES 763285 PHILLIP BILDERBACK MD PC 122 4TH AVE GRINNELL IA 50112 MEDICAL SERVICES 690772 MAHMOD F EL-TAYASH 122 4TH AVE GRINNELL IA 50112 MEDICAL SERVICES 643866 DES MOINES ORTHOPAEDIC SURGEON 6001 WESTOWN PARKWAY WEST DES MOINES IA 60266 MEDICAL SERVICES 625443 24 167459 2581083 62876 2811418 NET PATIENT REVENUE 900099 58350168 58350168 RENTAL INCOME 531390 187694 187694 MGMT & SUPPORT SVCS 561000 112128 112128 58649990 21869 21869 15000 14546 112383 -14546 -97383 -111929 -111929 MISCELLANEOUS 900099 789882 475479 314403 SHARED SAVINGS REVENUE 900099 145910 145910 CAFETERIA/FOOD SVCS 722210 119747 119747 1055539 62426887 59391126 314403 -90060 511830 511830 792086 237791 554295 32136415 27555937 4580478 957032 807795 149237 4054415 3422182 632233 1588875 1341111 247764 4285464 4285464 124580 9750 114830 100790 47774 53016 3542134 3289183 252951 108737 1544 107193 820004 637035 182969 1219772 1152798 66974 77396 64306 13090 28415 21796 6619 85413 85413 1834205 1714812 119393 534156 534156 MEDICAL SUPPLIES 10292872 10196380 96492 MISCELLANEOUS EXPENSE 65412 39724 25688 INCOME TAXES 85 85 BAD DEBT EXPENSE -2700 -2700 63157388 55954166 7203222 0 1884473 1451675 26323 515161 7615450 7798659 4850126 3813757 1610593 1453436 216669 219591 58204990 45344179 11547030 12860811 2153683 1883787 95 95 29904442 29996972 4146349 5414738 3004505 1039822 360260 261832 1534909 1582081 8784718 10489374 17830741 18787847 X 12027173 11162597 46528 46528 12073701 11209125 29904442 29996972 X -730501 -10305 -123770 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 428497 428497 289742 289742 29808316 21119044 8689272 1402098 1327416 74682 26244112 22748729 3495383 460722 148990 311732 12860811 LONG-TERM RETENSION INCENTIVES 1836252 DUE TO AFFILIATES 8213836 HEALTH AND WELFARE BENEFITS RESERVE 319326 OPERATING LEASE LIABILITY -109552 SELF INSURANCE RESERVE 229512 10489374 X 62277000 -10305 281 -10024 62287024 669 139194 139863 62426887 62994000 63 63 62993937 669 162782 163451 63157388 PART X, LINE 2: UNITYPOINT HEALTH 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 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 2019. THE 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, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 281. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN NET ASSETS WITHOUT DONOR RESTRICTIONS 139,194. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 63. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN NET ASSETS WITHOUT DONOR RESTRICTIONS 162,782. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 133895 133895 0.00210 11961403 8274602 3686801 0.05840 12095298 8274602 3820696 0.06050 5695 5695 0.00010 5695 5695 0.00010 12100993 8274602 3826391 0.06060 130615 130615 0.00210 130615 130615 0.00210 0 804144 0 11364121 13029836 -1665715 X 1 1 1 1 GRINNELL REGIONAL MEDICAL CENTER 210 FOURTH AVENUE GRINNELL IA 50112 WWW.UNITYPOINT.ORG/GRINNELL 790016H X X X GRINNELL REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, PAGE 8 X 1 22 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 600.000000000000 X X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 GRINNELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: THIS ASSESSMENT WAS CONDUCTED ON BEHALF OF UNITYPOINT HEALTH - GRINNELL REGIONAL MEDICAL CENTER (UPH-GRMC) BY PRC, A NATIONALLY RECOGNIZED HEALTH CARE CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENTS IN HUNDREDS OF COMMUNITIES ACROSS THE UNITED STATES SINCE 1994. THIS ASSESSMENT INCORPORATES DATA FROM MULTIPLE SOURCES, INCLUDING PRIMARY RESEARCH (THROUGH THE PRC COMMUNITY HEALTH SURVEY AND PRC ONLINE KEY INFORMANT SURVEY), AS WELL AS SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA). IT ALSO ALLOWS FOR COMPARISON TO BENCHMARK DATA AT THE STATE AND NATIONAL LEVELS. THE SURVEY INSTRUMENT USED FOR THIS STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. THE FINAL SURVEY INSTRUMENT WAS DEVELOPED BY UPH-GRMC AND PRC. A PRECISE AND CAREFULLY EXECUTED METHODOLOGY IS CRITICAL IN ASSERTING THE VALIDITY OF THE RESULTS GATHERED IN THE PRC COMMUNITY HEALTH SURVEY. THUS, TO ENSURE THE BEST REPRESENTATION OF THE POPULATION SURVEYED, A MIXED-MODE METHODOLOGY WAS IMPLEMENTED. THIS INCLUDED TARGETED SURVEYS CONDUCTED BY PRC VIA TELEPHONE (CELL PHONE AND LANDLINE), AS WELL AS A COMMUNITY OUTREACH COMPONENT PROMOTED BY THE STUDY SPONSORS THROUGH SOCIAL MEDIA POSTING AND OTHER COMMUNICATIONS. FOR THE TARGETED ADMINISTRATION, PRC ADMINISTERED 200 SURVEYS AT RANDOM THROUGHOUT THE COUNTY. PRC ALSO CREATED A LINK TO AN ONLINE VERSION OF THE SURVEY, AND UPH-GRMC PROMOTED THIS LINK THROUGHOUT THE VARIOUS COMMUNITIES TO DRIVE ADDITIONAL PARTICIPATION AND BOLSTER OVERALL SAMPLES. THIS YIELDED AN ADDITIONAL 138 SURVEYS TO THE OVERALL SAMPLE. IN ALL, 338 SURVEYS WERE COMPLETED THROUGH THESE MECHANISMS. ONCE THE INTERVIEWS WERE COMPLETED, THESE WERE WEIGHTED IN PROPORTION TO THE ACTUAL POPULATION DISTRIBUTION TO APPROPRIATELY REPRESENT POWESHIEK COUNTY AS A WHOLE. ALL ADMINISTRATION OF THE SURVEYS, DATA COLLECTION, AND DATA ANALYSIS WAS CONDUCTED BY PRC.TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY ALSO WAS IMPLEMENTED AS PART OF THIS PROCESS. A LIST OF RECOMMENDED PARTICIPANTS WAS PROVIDED BY UPH-GRMC; THIS LIST INCLUDED NAMES AND CONTACT INFORMATION FOR PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. KEY INFORMANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE; REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. IN ALL, 65 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. THROUGH THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW INCOME, MINORITY, OR OTHER MEDICALLY UNDERSERVED POPULATIONS. GRINNELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: UPH-GRMC CONDUCTED ITS LAST CHNA IN 2019 AND REVIEWED THE HEALTH PRIORITIES IDENTIFIED THROUGH THAT ASSESSMENT. CONSIDERING THE TOP-IDENTIFIED NEEDS AS WELL AS HOSPITAL RESOURCES AND OVERALL ALIGNMENT WITH THE HOSPITAL'S MISSION, GOALS AND STRATEGIC PRIORITIES IT WAS DETERMINED AT THAT TIME THAT UPH-GRMC WOULD FOCUS ON DEVELOPING AND/OR SUPPORTING STRATEGIES AND INITIATIVES TO IMPROVE: ACCESS TO HEALTH CARE SERVICESO RECRUITED PRIMARY CARE PROVIDERS ADDICTIONO PROVIDED EDUCATIONAL ITEMS TO PHYSICIANS REGARDING QUITLINE AND MY LIFE MY QUIT FOR TEENAGERSO WORKED WITH ISTEPS IN SCHOOL DISTRICTS TO EDUCATE ON HARMS OF NICOTINE USE MENTAL HEALTHO INCREASED AVAILABILITY OF MENTAL HEALTH TELEHEALTH SERVICESO PARTNERED WITH UPH-DES MOINES ON PSYCHIATRY PROGRAMO PARTNERED WITH AREA EMPLOYERS TO INCREASE MENTAL HEALTH SERVICES TRANSPORTATIONO DEVELOPMENT OF TRANSPORTATION COMMITTEE NUTRITION, PHYSICAL ACTIVITY, AND WEIGHTO REGISTERED AS 5210 HEALTH CHOICE WORKPLACEO PRE-DIABETES SCREENINGS AND NUTRITIONAL CLASS OFFERINGSTRATEGIES FOR ADDRESSING THESE NEEDS WERE OUTLINED IN UNITYPOINT HEALTH-GRINNELL REGIONAL MEDICAL CENTER'S IMPLEMENTATION STRATEGY. PURSUANT TO IRS REQUIREMENTS, THE FOLLOWING SECTIONS PROVIDE AN EVALUATION OF THE IMPACT OF THE ACTIONS TAKEN BY UPH-GRMC TO ADDRESS THESE SIGNIFICANT HEALTH NEEDS IN OUR COMMUNITY. GRINNELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM THE FOLLOWING PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSISTANCE: THE US. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE FOOD STAMP PROGRAM; WOMEN, INFANTS & CHILDREN (WIC); AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. THIRD PARTY AGENCIES ARE USED TO ASSIST WITH COLLECTIONS AND, IF THOSE AGENCIES PROVIDE A STATEMENT REGARDING A PATIENT'S LIKELY INCOME LEVEL, THAT INFORMATION IS USED IN DETERMINING THE ELIGIBILITY STATUS AND THE LEVEL OF DISCOUNT AVAILABLE. STATE LAW REQUIREMENTS THAT OFFER ADDITIONAL AND/OR MORE STRINGENT ELIGIBILITY REQUIREMENTS WILL BE FOLLOWED FOR THOSE STATES. PART V, LINE 7A, CHNA REPORT: THE CHNA REPORT WAS WIDELY AVAILABLE ON A WEBSITE (LIST URL):WWW.UNITYPOINT.ORG/ABOUT-UNITYPOINT-HEALTH/COMMUNITY-BENEFITS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS PART V, LINE 10A, IMPLEMENTATION STRATEGY: THE CHNA REPORT WAS WIDELY AVAILABLE ON A WEBSITE (LIST URL):WWW.UNITYPOINT.ORG/ABOUT-UNITYPOINT-HEALTH/COMMUNITY-BENEFITS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS PART V, LINE 16A, FAP WEBSITE: THE FAP WAS WIDELY AVAILABLE ON A WEBSITE (LIST URL): WWW.UNITYPOINT.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE PART V, LINE 16B, FAP WEBSITE: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE ON A WEBSITE (LIST URL):WWW.UNITYPOINT.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE PART V, LINE 16C, FAP WEBSITE: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE ON A WEBSITE (LIST URL):WWW.UNITYPOINT.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE 14 1 - GRINNELL REGIONAL MEDICAL CENTER 210 FOURTH AVENUE GRINNELL IA 50112 CLINIC 2 - COMMUNITY CARE CLINIC 306 FOURTH AVENUE GRINNELL IA 50112 CLINIC 3 - FAMILY PRACTICERHC 202 4TH AVE SUITE 300 GRINNELL IA 50112 CLINIC 4 - PAIN CLINIC RHC 202 4TH AVE SUITE 200 GRINNELL IA 50112 CLINIC 5 - POSTELS COMMUNITY HEALTH PARK 807 BROAD STREET GRINNELL IA 50112 CLINIC 6 - MONTEZUMARHC 101 WEST WASHINGTON ST SUITE 100 MONTEZUMA IA 50171 CLINIC 7 - VICTOR HEALTH CENTER 709 SECOND STREET VICTOR IA 52347 CLINIC 8 - INTERNAL MEDICINERHC 202 4TH AVE SUITE 200 GRINNELL IA 50112 CLINIC 9 - GRINNELL ORTHOPEDIC CLINIC 202 4TH AVE GRINNELL IA 50112 CLINIC 10 - URGENT CARERHC 202 4TH AVE SUITE 100 GRINNELL IA 50112 CLINIC 11 - OBGYNRHC 202 4TH AVE SUITE 300 GRINNELL IA 50112 CLINIC 12 - ENT 202 4TH AVENUE GRINNELL IA 50112 CLINIC 13 - GENERAL SURGERY 122 4TH AVENUE GRINNELL IA 50112 CLINIC 14 - PAIN CLINIC 210 4TH AVENUE GRINNELL IA 50112 CLINIC PART I, LINE 6A: GRINNELL REGIONAL MEDICAL CENTERS' COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE UNITYPOINT HEALTH COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. 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 $ -2,700. PART II, COMMUNITY BUILDING ACTIVITIES: 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 CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. 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' 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 CENTRAL IOWA HOSPITAL CORPORATION. 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: 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.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL 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. 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: POWESHIEK COUNTY RESIDENTS RECENTLY PARTICIPATED IN AN EXTENSIVE COMMUNITY HEALTH NEEDS ASESSMENT. THIS SURVEY PROVIDED DIRECTION FOR GRINNELL REGIONAL MEDICAL CENTER (GRMC) AND GRINNELL REGIONAL PUBLIC HEALTH TO DEVELOP A HEALTH IMPROVEMENT PLAN OVER THE NEXT FIVE YEARS AND DETERMINE WHAT IS IMPORTANT FOR THE HEALTH OF THE COUNTY. GRMC HAS RECENTLY SURVEYED ITS COMMUNITY HEALTHCARE PROVIDERS TO IDENTIFY WHAT THEY FEEL ARE THE MOST URGENT NEEDS. GRMC ALSO REVIEWS STATEWIDE DATABASES (I.E., TEEN PREGNANCY, CANCER RATES) TO IDENTIFY AREAS IN WHICH TO CONCENTRATE EFFORTS. PART VI, LINE 3: THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE TO ALL PATIENTS AND WITHIN THE COMMUNITY. COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. THE CENTRAL BILLING OFFICE IS AVAILABLE BY PHONE TO ANSWER QUESTIONS ABOUT THE POLICY, OR PATIENTS SHOULD GO TO THE CASHIER'S OFFICE AT THE HOSPITAL TO OBTAIN THIS INFORMATION. THE PLAIN LANGUAGE SUMMARY IS OFFERED AS PART OF THE PATIENT INTAKE AND/OR DISCHARGE PROCESS AND INCLUDED WHEN A PATIENT IS SENT WRITTEN NOTICE THAT EXTRAORDINARY COLLECTION ACTIONS MAY BE TAKEN AGAINST HIM/HER. THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND ALL FINANCIAL ASSISTANCE FORMS ARE AVAILABLE IN ENGLISH AND IN ANY OTHER LANGUAGE IN WHICH LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS CONSTITUTE THE LESSER OF 1,000 PERSONS OR MORE THAN 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. THESE TRANSLATED DOCUMENTS WILL BE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. PART VI, LINE 4: GRINNELL REGIONAL MEDICAL CENTER (GRMC) IS A PRIVATE, NON-PROFIT AND NON-TAX-SUPPORTED MEDICAL CENTER LOCATED ON THE WESTERN EDGE OF POWESHIEK COUNTY, SERVING MORE THAN 49,000 RESIDENTS IN A SIX-COUNTY RURAL AREA OF EAST CENTRAL IOWA. GRINNELL IS 50 MILES EAST OF DES MOINES, IOWA AND 60 MILES WEST OF IOWA CITY, IOWA. DES MOINES AND IOWA CITY ARE THE CLOSEST CITIES WITH TERTIARY HOSPITALS FOR OUR SERVICE AREA. MEDIAN HOUSEHOLD INCOME FOR POWESHIEK IS ESTIMATED AT $56,080 ACCORDING TO AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES. IN TERMS OF AGE, 21.7% OF RESIDENTS IN POWESHIEK COUNTY ARE 65 YEARS OF AGE OR OLDER WHILE ACROSS THAT STATE 17.9% ARE 65 YEARS OF AGE OR OLDER. PART VI, LINE 5: THE HOSPITAL 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 6: THIS ENTITY IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH), THE NATION'S FIFTH LARGEST NON-DENOMINATIONAL HEALTH SYSTEM WITH $4.3B IN OPERATING REVENUE AND 27,000 TEAM MEMBERS. AS AN INTEGRATED HEALTH SYSTEM, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERN ILLINOIS AND SOUTHERN WISCONSIN IN NOT-FOR-PROFIT HOSPITALS, CLINICS AND OTHER HEALTHCARE FACILITIES. UNITYPOINT HEALTH OPERATES: 17 REGIONAL HOSPITALS; OVER 370 CLINICS; 19 COMMUNITY NETWORK HOSPITALS; 13 HOME CARE AREAS OF SERVICE; FIVE AFFILIATED COMMUNITY MENTAL HEALTH CENTERS; AN ACCOUNTABLE CARE ORGANIZATION; AND HAS INSURANCE PRESENCE ACROSS ALL OF ITS MARKETS. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THEIR REGIONS. IN 2022, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $742 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY UNITYPOINT HEALTH AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. PART VI, LINE 7, REPORTS FILED WITH STATES IA 1 GRINNELL REGIONAL MEDICAL CENTER FOUNDATION 210 FOURTH AVENUE GRINNELL IA 50112 421454737 501(C)(3) 162782 0 PROGRAM SERVICE 1 0 PART I, LINE 2: GRINNELL REGIONAL MEDICAL CENTER MONITORS THE USE OF GRANT FUNDS ACCORDING TO THE STANDARD FINANCIAL POLICIES OF THE ORGANIZATION AND AS REQUIRED BY THE GRANT OR GRANTOR. THE POLICIES AND PROTOCOLS OF THE FUNDING SOURCE ARE ENFORCED AND MONITORED BY THE ORGANIZATION AND REPORTED AS REQUIRED. X X X 0 1 0 0 0 0 0 0 0 DAVID STARK BOARD MEMBER/CEO-CIHC 0 573849 0 172266 0 900559 0 102789 0 25675 0 1775138 0 817368 SID RAMSEY BOARD MEMBERVP MARKETING & BUSINESS DEV-CIHC 0 326230 0 51697 0 29309 0 27450 0 10126 0 444812 0 0 MICHAEL LINE MD CHIEF MEDICAL OFFICER 0 295530 0 0 0 919 0 13725 0 31712 0 341886 0 0 SUMIN LI MD PHYSICIAN 270663 0 0 0 15020 0 13860 0 28784 0 328327 0 0 0 STEPHEN ELLESTAD DO PHYSICIAN 300992 0 0 0 5669 0 15050 0 1017 0 322728 0 0 0 JENNIFER HAVENS BOARD MEMBER/CEO 0 230030 0 37962 0 258 0 12531 0 25584 0 306365 0 0 SCOTT DOYLE CRNA ARNP ANESTHESIOLOGY 256808 0 13500 0 498 0 13139 0 20972 0 304917 0 0 0 KATHRYN OGBURN CRNA ANESTHESIOLOGY 246990 0 10000 0 636 0 12814 0 10413 0 280853 0 0 0 KRISTIN PHELPS PA-C FAMILY MEDICINE 172480 0 56494 0 60 0 11667 0 19182 0 259883 0 0 0 JACOB BOYER PC-A BOARD MEMBER 162396 0 64234 0 190 0 10756 0 215 0 237791 0 0 0 LAURA JUEL VP NURSING & CLINICAL SERVICES 151374 0 30962 0 70 0 9831 0 35825 0 228062 0 0 0 KYLE WILCOX VP FINANCE 179496 0 14372 0 54 0 9547 0 8939 0 212408 0 0 0 PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED CONTRIBUTIONS IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: DAVID STARK $87,539. NONQUALIFIED RETIREMENT PLAN DISTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED PLAN: DAVID STARK $ 883,999. PAYOUTS ARE MADE WITH VESTED FUNDS, AS ESTABLISHED BY PLAN DOCUMENTS. LEAH VAN REES FAMILY MEMBER OF BOARD MEMBER RACHAEL KINNICK 59041 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 CENTRAL IOWA HEALTH SYSTEM, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, CENTRAL IOWA HEALTH SYSTEM, SHALL HAVE THE AUTHORITY TO DIRECTLY APPOINT AND ELECT UP TO THREE DIRECTORS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, CENTRAL IOWA HEALTH SYSTEM, HAS THE FINAL AUTHORITY TO APPROVE MERGERS, CONSOLIDATIONS OR CORPORATE RE-STRUCTURE AND SELECTION OR REMOVAL OF ANY EXISTING CEO AS WELL AS THE ADMINISTRATIVE REPORTING RELATIONSHIP OF THE CEO. FORM 990, PART VI, SECTION B, LINE 11B 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 REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS 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 THE TOP 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 REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2022 FOR THE FOLLOWING INDIVIDUALS: JENNIFER HAVENS, SIDNEY RAMSEY, & DAVID STARK. 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 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, LEGAL DEPARTMENT. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE ON THE IOWA HEALTH SYSTEM WEBSITE, WWW.UNITYPOINT.ORG. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE- GRMC AUXILIARY -123,770. FORM 990, LINE J, WEBSITE: WWW.UNITYPOINT.ORG/LOCATIONS/UNITYPOINT-HEALTH---GRINNELL-REGIONAL-MEDIC AL-CENTER ABBE CENTER FOR COMMUNITY MENTAL HEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421045257 MENTAL HEALTH CARE IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 0 ABBEHEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421373123 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III ST LUKE'S HEALTHCARE 0 AGING SERVICES INC 740 N 15TH AVE NO A HIAWATHA IA 52233 237085316 SENIOR SERVICES IA 501(C)(3) 170(B)(1) (A)(VI) ABBEHEALTH INC 0 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 0 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 0 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 0 ANAMOSA AREA AMBULANCE SERVICE 101 GRANT WOOD DRIVE ANAMOSA IA 52205 421466284 PROVIDE AMBULANCE SERVICES IA 501(C)(3) 509(A)(3), TYPE III ST LUKE'SJONES REGIONAL MEDICAL CENTER 0 BLACK HAWK-GRUNDY MENTAL HEALTH CENTER INC 3251 WEST NINTH STREET WATERLOO IA 50702 420733463 MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 0 CENTER FOR ALCOHOL AND DRUG SERVICES INC 4869 FOREST GROVE DRIVE BETTENDORF IA 52722 421134273 SUBSTANCE ABUSE SERVICES IA 501(C)(3) 170(B)(1) (A)(VI) THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH 0 CENTRAL IOWA HEALTH PROPERTIES CORPORATION 1200 PLEASANT STREET DES MOINES IA 50309 421233759 PROPERTY HOLDING COMPANY IA 501(C)(2) CENTRAL IOWA HEALTH SYSTEM 0 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 0 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 0 DES MOINES AREA MEDICAL EDUCATION CONSORTIUM INC 1415 WOODLAND AVE SUITE 130 DES MOINES IA 50309 421412497 COORDINATION OF MEDICAL EDUCATION PROGRAMS IA 501(C)(3) 509(A)(3), TYPE III 0 EYERLY-BALL COMMUNITY MENTAL HEALTH SERVICES 945 19TH STREET DES MOINES IA 50314 420942273 MENTAL HEALTH CARE IA 501(C)(3) 509(A)(2) CENTRAL IOWA HEALTH SYSTEM 0 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 0 FRIENDS OF THE BLACK HAWK-GRUNDY MENTAL HEALTH CENTER 3820 HILLSIDE DRIVE CEDAR FALLS IA 50613 421372380 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 0 GRINNELL REGIONAL MEDICAL CENTER 210 FOURTH AVENUE GRINNELL IA 50112 420933383 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) CENTRAL IOWA HEALTH SYSTEM 0 GRINNELL REGIONAL MEDICAL CENTER FOUNDATION 210 FOURTH AVENUE GRINNELL IA 50112 421454737 CHARITABLE FUNDRAISING IA 501(C)(3) 509(A)(3), TYPE I GRINNELL REGIONAL MEDICAL CENTER 1 HULT CENTER FOR HEALTHY LIVING INC 5409 N KNOXVILLE AVE PEORIA IL 61614 363510390 HEALTH EDUCATION TO THE COMMUNITY IL 501(C)(3) 170(B)(1) (A)(VI) PROCTOR HOSPITAL 0 HUMAN SERVICE CENTER 600 FAYETTE PO BOX 1346 PEORIA IL 61654 371004882 MENTAL HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(VI) UNITYPOINT HEALTH - 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AS AN INTEGRATED HEALTH SYSTEM, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERN ILLINOIS AND SOUTHERN WISCONSIN IN NOT-FOR-PROFIT HOSPITALS, CLINICS AND OTHER HEALTHCARE FACILITIES. UNITYPOINT HEALTH OPERATES: 17 REGIONAL HOSPITALS; OVER 370 CLINICS; 19 COMMUNITY NETWORK HOSPITALS; 13 HOME CARE AREAS OF SERVICE; FIVE AFFILIATED COMMUNITY MENTAL HEALTH CENTERS; AN ACCOUNTABLE CARE ORGANIZATION; AND HAS INSURANCE PRESENCE ACROSS ALL OF ITS MARKETS.