2023-11-14T12:01:58-06:00 2022-12-31 990 2022-01-01 421301885 ST LUKE'S HEALTH FOUNDATION OF SIOUX CITY IOWA STLU 7122793500 2720 STONE PARK BLVD SIOUX CITY IA 51104 LEAH KNAPP INTERIM VP OF FIN 7122793824 2023-11-03 LEAH KNAPP 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z LEAH GLASGO 2720 STONE PARK BLVD SIOUX CITY IA 51104 9930114 0 X WWW.UNITYPOINT.ORG (SEE SCH O) X 1987 IA ENHANCE THE QUALITY OF LIFE FOR THE PEOPLE OF SIOUXLAND BY OBTAINING FUNDS TO SUPPORT HEALTH-CARE. 13 13 0 33 0 0 1329560 1839791 0 0 122065 401001 74876 129104 1526501 2369896 645836 1678136 0 0 418421 506090 65000 60615 534032 126231 110257 1255488 2355098 271013 14798 4909154 4501551 84085 613659 4825069 3887892 X TO ENHANCE THE QUALITY OF LIFE FOR THE PEOPLE OF THE SIOUXLAND REGION BY OBTAINING FUNDS IN SUPPORT OF THE HEALTH-CARE MISSION OF ST. LUKE'S HEALTH SYSTEM. 0 0 1678136 1678136 3716 GRANTS, ALLOCATIONS AND PROGRAM SUPPORTST. LUKE'S HEALTH FOUNDATION'S PURPOSE IS TO RAISE FUNDS TO MAINTAIN, DEVELOP, INCREASE AND EXTEND THE FACILITIES AND SERVICES OF ST. LUKE'S REGIONAL MEDICAL CENTER IN SIOUX CITY, IOWA AND TO PROVIDE BROADER HOSPITAL, MEDICAL AND EDUCATIONAL SERVICE OPPORTUNITIES TO ITS PATIENTS, STUDENTS, STAFF, FACULTY AND RESIDENTS OF THE GEOGRAPHICAL AREA IT SERVES. IT SUPPORTS THE MISSIONS OF ST. LUKE'S HEALTH SYSTEM AND ITS SUBSIDIARIES BY RAISING FINANCIAL CONTRIBUTIONS AND INVESTING THE PROCEEDS.THE GRANTS, ALLOCATIONS AND PROGRAM SUPPORT SERVICES MAY INCLUDE: CONTRIBUTIONS TO ST. LUKE'S REGIONAL MEDICAL CENTER FOR EQUIPMENT PURCHASES, TO OFFSET OPERATING EXPENSES AND MISCELLANEOUS SCHOLARSHIPS AND/OR LECTURESHIPS AWARDED TO INDIVIDUALS ASSOCIATED WITH ST. LUKE'S REGIONAL MEDICAL CENTER, GRANTS TO LOCAL RURAL HEALTH COMMUNITIES ASSOCIATED WITH ST. LUKE'S REGIONAL MEDICAL CENTER, AND MISCELLANEOUS GRANTS AND CONTRIBUTIONS TO ORGANIZATIONS AND/OR INDIVIDUALS ASSOCIATED WITH ST. LUKE'S REGIONAL MEDICAL CENTER. 1678136 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X LEAH KNAPP INTERIM VP OF FIN 7122793824 802 KENYON ROAD FORT DODGE IA 50501 AL AYMAR BOARD MEMBER 1.00 0.00 X 0 0 0 TASHA BARKER BOARD CHAIR 1.00 0.00 X X 0 0 0 KRIS CRAIGHEAD BOARD MEMBER 1.00 0.00 X 0 0 0 MIKE CRONE BOARD MEMBER 1.00 0.00 X 0 0 0 TIFFANY HUNT BOARD MEMBER 1.00 0.00 X 0 0 0 KYLE KELLY BOARD MEMBER 1.00 0.00 X 0 0 0 KATIE KRUSE BOARD MEMBER 1.00 0.00 X 0 0 0 JEN LETCH BOARD TREASURER 1.00 0.00 X X 0 0 0 JULIANA MAYNE BOARD MEMBER 1.00 0.00 X 0 0 0 EMILY MILLS BOARD VICE CHAIR 1.00 0.00 X X 0 0 0 JOSH SHERER BOARD MEMBER 1.00 0.00 X 0 0 0 JEFFREY STANLEY BOARD SECRETARY 1.00 0.00 X X 0 0 0 MATT THOMPSON BOARD MEMBER 1.00 0.00 X 0 0 0 KARI WINKLEPLECK PRESIDENT - FOUNDATION 40.00 0.00 X 149845 0 28021 JAMES GOBELL TO 0722 VP/CFO - NIHC 1.00 0.00 X 805630 0 83553 SARAH MARSH INTERIM CFO (FR 08/22) 1.00 0.00 X 218564 0 38381 LORENZO SUTER TO 0722 PRESIDENT/CEO - NIHC 1.00 0.00 X 519612 0 31675 LEAH GLASGO FR 0722 PRESIDENT/CEO (SC & FD) 1.00 0.00 X 1067658 0 100798 2761309 0 282428 0 0 1 1 0 834719 1005072 91608 1839791 90133 90133 7817234 7506366 310868 310868 310868 171795 53852 117943 117943 7445 0 7445 7445 MISCELLANEOUS 900099 3716 3716 3716 2369896 3716 0 526389 1678086 1678086 50 50 217619 50609 167010 237467 49993 187474 10572 2226 8346 24392 5135 19257 16040 3377 12663 10500 10500 60615 60615 35740 30455 5285 16343 16343 16442 16442 4912 4912 8885 8885 93 93 3782 3782 MISCELLANEOUS EXPENSE 12425 12425 INCOME TAXES 1135 1135 2355098 1678136 142930 534032 672098 835380 725605 451279 9450 3475468 3170685 35983 34757 4909154 4501551 24408 70276 59677 543383 84085 613659 X -531808 -830412 5356877 4718304 4825069 3887892 4909154 4501551 X 14798 -766932 -185043 X 0 1 X 1 0 X 1319972 1269554 1726630 1329560 1839791 7485507 1319972 1269554 1726630 1329560 1839791 7485507 854157 6631350 252152 86997 84729 119248 90133 633259 3716 3716 8122482 785723 0.81640 0.78740 X SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: MISCELLANEOUS INCOME 2022 AMOUNT: $ 3,716. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2837841 213008 -746468 81999 2222382 2820839 36000 31247 50245 2837841 2255362 5000 730362 169885 2820839 2163055 10000 82307 2255362 1981187 5000 176868 2163055 0.00000 0.87409 0.12591 0 0 0 DUE TO AFFILIATES 543383 543383 X 1387465 -766932 -766932 2154397 30455 185044 215499 2369896 2324641 0 2324641 30455 2 30457 2355098 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. PART X, LINE 2: THE FOUNDATION HAS BEEN GRANTED TAX-EXEMPT STATUS UNDER SECTION 501(C)(3) OFTHE INTERNAL REVENUE CODE. IT HAS NOT BEEN CLASSIFIED AS A PRIVATE FOUNDATION UNDER SECTION 509(A)(3) OF THE INTERNAL REVENUE CODE. THE STATE OF IOWA HAS DETERMINED UNDER IOWA CODE SECTION 422.34 THAT THE FOUNDATION IS EXEMPT FROM IOWA CORPORATION INCOME TAX. AS SUCH, INCOME EARNED IN THE PERFORMANCE OF ITS EXEMPT PURPOSE IS NOT SUBJECT TO INCOME TAX AND ACCORDINGLY, THE FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION FOR INCOME TAXES. MANAGEMENT HAS CONCLUDED THAT ANY UNCERTAIN TAX POSITIONS WOULD BE IMMATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT INCLUDE ANY PROVISION FOR UNCERTAIN TAX POSITIONS, AND NO RELATED INTEREST OR PENALTIES HAVE BEEN RECORDED IN THE OPERATING STATEMENT OR ACCRUED IN THE BALANCE SHEET. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTERESTS IN TRUSTS 185,043. ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING 2. X X X X X 1 THOMPSON ASSOCIATES 112 WESTWOOD PLACE SUITE 250 BRENTWOOD TN 37027 CONSULTING/PLANNED GIVING 0 0 60615 0 60615 IA GOLF INVITATIONAL 72560 72560 7436 8900 2136 CROSS CHECK CANCER 99235 99235 27731 7649 171795 171795 7436 36631 9785 53852 117943 SCHEDULE G, PART I, LINE 2B, COLUMN (V) THOMPSON & ASSOCIATES PROVIDES CONSULTING TO FOUNDATION; CONDUCTS SEMINARS/PRESENTATIONS ON PLANNED GIVING. 1 NORTHWEST IOWA HOSPITAL CORPORATION 2720 STONE PARK BLVD SIOUX CITY IA 51104 421019872 501(C)(3) 1666910 0 PROGRAM SUPPORT SIOUXLAND PACE 2720 STONE PARK BLVD SIOUX CITY IA 51104 261120134 501(C)(3) 5770 0 PROGRAM SUPPORT 2 0 PART I, LINE 2: RECIPIENTS OF APPROVED GRANTS MUST SUBMIT INVOICES AND CHECK REQUESTS TO THE FOUNDATION WITH THEIR GRANT PAYMENT AUTHORIZATION FORM FOR FINAL APPROVAL BY FOUNDATION STAFF TO ASSURE THE GRANT IS BEING USED FOR THE INTENDED PURPOSE. PAPERWORK IS THEN SENT TO FISCAL SERVICES FOR PAYMENT. 1 1 0 0 0 0 0 0 0 LEAH GLASGO FR 0722 PRESIDENT/CEO (SC & FD) 459262 0 153147 0 455249 0 69078 0 31720 0 1168456 0 399489 0 JAMES GOBELL TO 0722 VP/CFO - NIHC 236905 0 57218 0 511507 0 60223 0 23330 0 889183 0 458758 0 LORENZO SUTER TO 0722 PRESIDENT/CEO - NIHC 266375 0 60010 0 193227 0 6100 0 25575 0 551287 0 0 0 SARAH MARSH INTERIM CFO (FR 08/22) 187578 0 28893 0 2093 0 11417 0 26964 0 256945 0 0 0 KARI WINKLEPLECK PRESIDENT - FOUNDATION 148550 0 0 0 1295 0 7775 0 20246 0 177866 0 0 0 PART I, LINES 4A-B SEVERANCE PAYMENTS: THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS DURING THE YEAR THAT WERE INCLUDED IN THEIR TAXABLE INCOME: LORENZO SUTER $187,131. NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED CONTRIBUTIONS IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: LEAH GLASGO $53,828 AND JAMES GOBELL $33,830. NONQUALIFIED RETIREMENT PLAN DISTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED PLAN: LEAH GLASGO $449,085 AND JAMES GOBELL $504,209. PAYOUTS ARE MADE WITH VESTED FUNDS, AS ESTABLISHED BY PLAN DOCUMENTS. FORM 990, SECTION VII, LINE 5 NORTHWEST IOWA HOSPITAL CORPORATION PAYS COMPENSATION TO LEAH GLASGO, IN THE AMOUNTS OF: BASE PAY $459,262, BONUS & INCENTIVE COMPENSATION $153,147, OTHER COMPENSATION $455,249, DEFERRED COMPENSATION $69,078, NONTAXABLE BENEFITS $31,720. ST. LUKE'S HEALTH FOUNDATION OF SIOUX CITY, IOWA REIMBURSES NORTHWEST IOWA HOSPITAL CORPORATION FOR PART OF THE COMPENSATION PAID TO LEAH GLASGO. NORTHWEST IOWA HOSPITAL CORPORATION PAYS COMPENSATION TO LORENZO SUTER, IN THE AMOUNTS OF: BASE PAY $266,375, BONUS & INCENTIVE COMPENSATION $60,010, OTHER COMPENSATION $193,227, DEFERRED COMPENSATION $6,100, NONTAXABLE BENEFITS $25,575. ST. LUKE'S HEALTH FOUNDATION OF SIOUX CITY, IOWA REIMBURSES NORTHWEST IOWA HOSPITAL CORPORATION FOR PART OF THE COMPENSATION PAID TO LORENZO SUTER. NORTHWEST IOWA HOSPITAL CORPORATION PAYS COMPENSATION TO JAMES GOBELL, IN THE AMOUNTS OF: BASE PAY $236,905, BONUS & INCENTIVE COMPENSATION $57,218, OTHER COMPENSATION $511,507, DEFERRED COMPENSATION $60,223, NONTAXABLE BENEFITS $23,330. ST. LUKE'S HEALTH FOUNDATION OF SIOUX CITY, IOWA REIMBURSES NORTHWEST IOWA HOSPITAL CORPORATION FOR PART OF THE COMPENSATION PAID TO JAMES GOBELL. NORTHWEST IOWA HOSPITAL CORPORATION PAYS COMPENSATION TO KARI WINKLEPLECK, IN THE AMOUNTS OF: BASE PAY $148,550, BONUS & INCENTIVE COMPENSATION $0, OTHER COMPENSATION $1,295, DEFERRED COMPENSATION $7,775, NONTAXABLE BENEFITS $20,246. ST. LUKE'S HEALTH FOUNDATION OF SIOUX CITY, IOWA REIMBURSES NORTHWEST IOWA HOSPITAL CORPORATION FOR PART OF THE COMPENSATION PAID TO KARI WINKLEPLECK. NORTHWEST IOWA HOSPITAL CORPORATION PAYS COMPENSATION TO SARAH MARSH, IN THE AMOUNTS OF: BASE PAY $187,578, BONUS & INCENTIVE COMPENSATION $28,893, OTHER COMPENSATION $2,093, DEFERRED COMPENSATION $11,417, NONTAXABLE BENEFITS $26,964. ST. LUKE'S HEALTH FOUNDATION OF SIOUX CITY, IOWA REIMBURSES NORTHWEST IOWA HOSPITAL CORPORATION FOR PART OF THE COMPENSATION PAID TO SARAH MARSH. X 977 91608 AVERAGE MARKET VALUE 0 1 0 PART I, COLUMN (B): LINE 9, COLUMN (B) - REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, LINE J, WEBSITE: HTTPS://WWW.UNITYPOINT.ORG/GIVING/ST-LUKES-FOUNDATION-SIOUX-CITY FORM 990, PART VI, SECTION A, LINE 7B PRESIDENT SHALL BE CEO OF ST. LUKE'S HEALTH SYSTEM. PRESIDENT AND EXECUTIVE VICE PRESIDENT MAY ONLY BE REMOVED WITH APPROVAL OF ST. LUKE'S HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE IOWA HEALTH SYSTEM TAX SERVICES DEPARTMENT USING INFORMATION GATHERED FROM THE FINANCIAL SERVICES AND ADMINISTRATIVE OFFICES OF THE ORGANIZATION. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE EXECUTIVE DIRECTOR FOR REVIEW. ONCE REVIEWED 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 A DESIGNATED PERSON WITHIN THE ORGANIZATION AND OTHER RELATED ORGANIZATIONS SUBJECT TO THIS POLICY SHALL SEND DISCLOSURE QUESTIONNAIRES TO ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND HIGHLY COMPENSATED EMPLOYEES. PERSONS REQUIRED TO REPORT WHO HAVE NOT RETURNED QUESTIONNAIRES WILL BE CONTACTED AND FOLLOW-UP WILL CONTINUE ON A REGULAR BASIS IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE INFORMATION DISCLOSED WILL BE USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICARE QUESTIONNAIRES. THE DUTY TO IDENTIFY AND DISCLOSE POTENTIAL CONFLICTS OF INTEREST IS A DUTY THAT IS ONGOING. ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND HIGHLY COMPENSATED EMPLOYEES SHALL IMMEDIATELY DISCLOSE SUCH POTENTIAL CONFLICT OR DUALITY OF INTEREST AS SOON AS THE INTEREST OCCURS. DISCLOSURE SHOULD BE MADE TO THE COVERED PERSON'S SUPERVISOR, THE CHIEF EXECUTIVE OFFICER OF THE COMPANY, OR THE BOARD CHAIR OF THE COMPANY, AS APPLICABLE. 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: LEAH GLASGO, SARAH MARSH, AND LORENZO SUTER. 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 ST. LUKE'S HEALTH FOUNDATION MAKES AVAILABLE TO THE PUBLIC THE ORGANIZATION'S BOARD OF DIRECTORS LIST ON ITS WEBSITE. FORM 990 TAX INFORMATION, CONFLICT OF INTEREST POLICY, AND WHISTLEBLOWER POLICY ARE AVAILABLE TO THE PUBLIC THROUGH LINKS AT ST. LUKE'S HEALTH SYSTEM'S WEBSITE (WWW.UNITYPOINT.ORG/SIOUXCITY). FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUSTS -185,043.