2023-11-14T11:59:05-06:00 2022-12-31 990 2022-01-01 421525031 UNITY HEALTHCARE FOUNDATION UNIT 3097792200 1518 MULBERRY AVENUE MUSCATINE IA 52761 KATHERINE MARCHIK SR VP FINANCE/CFO 3097795790 2023-11-08 KATHERINE MARCHIK XXX-XX-XXXX 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TRINITY MUSCATINE FOUNDATION SHAWN MORROW 1518 MULBERRY AVENUE MUSCATINE IA 52761 424696 0 X WWW.UNITYPOINT.ORG (SEE SCH O) X 2001 IA PROVIDE FINANCIAL ASSISTANCE TO UNITY HEALTHCARE TO HELP ENABLE IT TO CARRY OUT ITS EXEMPT FUNCTION 9 8 0 8 0 0 16351 24931 0 0 283945 140014 0 0 300296 164945 49761 892311 0 0 22346 21884 0 0 26460 19103 18248 91210 932443 209086 -767498 3167786 2677116 1190 676657 3166596 2000459 X TO PROVIDE FINANCIAL ASSISTANCE TO UNITY HEALTHCARE TO HELP ENABLE IT TO CARRY OUT ITS EXEMPT FUNCTION OF PROVIDING HEALTH CARE TO THE COMMUNITY. 0 0 892311 892311 0 GRANTS, ALLOCATIONS AND PROGRAM SUPPORTUNITY HEALTHCARE FOUNDATION'S PURPOSE IS TO RAISE FUNDS TO MAINTAIN, DEVELOP, INCREASE AND EXTEND THE FACILITIES AND SERVICES OF UNITY HEALTHCARE IN MUSCATINE, 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 UNITY HEALTHCARE AND ITS SUBSIDIARIES BY RAISING FINANCIAL CONTRIBUTIONS AND INVESTING THE PROCEEDS.THE GRANTS, ALLOCATIONS AND PROGRAM SUPPORT SERVICES MAY INCLUDE:- CONTRIBUTIONS TO UNITY HEALTHCARE FOR EQUIPMENT PURCHASES, TO OFFSET OPERATING EXPENSES AND MISCELLANEOUS- SCHOLARSHIPS AND/OR LECTURESHIPS AWARDED TO INDIVIDUALS ASSOCIATED WITH UNITY HEALTHCARE- GRANTS TO LOCAL RURAL HEALTH COMMUNITIES ASSOCIATED WITH UNITY HEALTHCARE- MISCELLANEOUS GRANTS AND CONTRIBUTIONS TO ORGANIZATIONS AND/OR INDIVIDUALS ASSOCIATED WITH UNITY HEALTHCARE 892311 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X DANIEL LAGRANGE VP FINANCE & OPERATIONS 5152416289 1415 WOODLAND AVE SUITE E-200 DES MOINES IA 50309 JONI AXEL BOARD TREASURER 1.00 0.00 X X 0 0 0 JOHN BECKEY BOARD CHAIR 1.00 0.00 X X 0 0 0 TONI ELLER OD BOARD MEMBER 1.00 1.00 X 0 0 0 SUSAN EVERSMEYER BOARD MEMBER 1.00 0.00 X 0 0 0 BRADLEY HODAPP BOARD MEMBER 1.00 0.00 X 0 0 0 MIKE JOHANNSEN BOARD MEMBER 1.00 0.00 X 0 0 0 JAY LOGEL BOARD MEMBER 1.00 0.00 X 0 0 0 LINDSEY PHILLIPS BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT WEIS MD BOARD MEMBER 1.00 40.00 X 0 198561 18215 KATHERINE MARCHIK SR VP FINANCE/CFO 1.00 40.00 X 0 447615 96046 RACHEL POHL FR 222 EXEC DIRECTOR 1.00 40.00 X 0 134959 37988 0 781135 152249 0 0 1 0 0 24931 24931 51755 51755 348010 259751 88259 88259 88259 164945 0 0 140014 891311 891311 1000 1000 17615 4404 13211 764 191 573 2097 524 1573 1408 352 1056 8259 8201 58 MISCELLANEOUS EXPENSE 9989 9989 932443 892311 13672 26460 169108 83878 78719 63598 1161 6786 300 276 2918498 2522578 3167786 2677116 1190 676657 1190 676657 X 2268972 1761117 897624 239342 3166596 2000459 3167786 2677116 -767498 -398639 0 X 0 1 X 1 0 X 191927 193697 53005 16351 24931 479911 191927 193697 53005 16351 24931 479911 279090 200821 47844 59450 29687 55772 51755 244508 63 63 724482 0.27720 0.36700 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2018 AMOUNT: $ 63. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO AFFILIATES 676657 676657 X -255000 -398639 209 -398430 143430 8201 13314 21515 164945 33000 69 69 32931 8201 891311 899512 932443 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 209. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN NET ASSETS WITH DONOR RESTRICTIONS 13,314. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 69. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN NET ASSETS WITH DONOR RESTRICTIONS 671,597. EXPENSES IN NET ASSETS WITHOUT DONOR RESTRICTIONS 219,714. 1 UNITY HEALTHCARE 1518 MULBERRY AVENUE MUSCATINE IA 52761 420680337 501(C)(3) 891311 0 PROGRAM SUPPORT 1 0 PART I, LINE 2: UNITY HEALTHCARE FOUNDATION REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PART II & III (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINES A SERIES OF ELIGIBLITY STANDARDS THAT ARE REQUIRED TO BE MET. THE ORGANIZATION THEN REVIEWS THESE APPLICATIONS, AND BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS. 0 1 0 0 0 0 0 0 0 KATHERINE MARCHIK SR VP FINANCE/CFO 0 356893 0 86084 0 4638 0 66238 0 29808 0 543661 0 0 ROBERT WEIS MD BOARD MEMBER 0 192884 0 0 0 5677 0 9785 0 8430 0 216776 0 0 RACHEL POHL FR 222 EXEC DIRECTOR 0 122117 0 12798 0 44 0 7209 0 30779 0 172947 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: KATHRINE MARCHIK $50,988. FORM 990, PART V, LINES 1A & 1B CASH DISBURSEMENTS ARE CENTRALIZED THROUGH THE PARENT ORGANIZATION, IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THE PARENT MAKES THE PAYMENTS AND FILES THE RELATED FORMS 1099 AND 1096 ON BEHALF OF ALL UNITYPOINT HEALTH SYSTEM RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 6 UNITY HEALTHCARE, A TAX-EXEMPT IOWA NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A UNITY HEALTHCARE APPOINTS AND APPROVES ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B UNITY HEALTHCARE, AS SOLE MEMBER, APPROVES AMENDMENTS TO ARTICLES, BYLAWS AND MISSION, MAY REMOVE ANY TRUSTEE WITH OR WITHOUT CAUSE, APPOINTS CEO AND PRESIDENT, APPROVES MERGERS, DISSOLUTIONS, CREATION OF SUBSIDIARY OR AFFILIATE ORGANIZATIONS, AND APPROVES BUDGETS AND LONG-RANGE STRATEGY. 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. 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: KATHERINE MARCHIK 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, LINE J, WEBSITE: WWW.UNITYPOINT.ORG/GIVING/TRINITY-MUSCATINE-FOUNDATION 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 0 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 - UNITYPLACE 0 IOWA HEALTH FOUNDATION 1415 WOODLAND AVE SUITE E-200 DES MOINES IA 50309 421467682 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) CENTRAL IOWA HEALTH SYSTEM 0 IOWA HEALTH SYSTEM 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421435199 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III 0 IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421411630 PRIMARY HEALTH CARE SERVICES IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM 0 MEMORIAL FOUNDATION OF ALLEN HOSPITAL 1825 LOGAN AVENUE WATERLOO IA 50703 421201138 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 0 MERITER FOUNDATION INC 202 SOUTH PARK STREET MADISON WI 53715 237098688 CHARITABLE FUNDRAISING WI 501(C)(3) 170(B)(1) (A)(VI) MERITER HEALTH SERVICES INC 0 MERITER HEALTH SERVICES INC 202 SOUTH PARK STREET MADISON WI 53715 391412318 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE WI 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM 0 MERITER HOSPITAL INC 202 SOUTH PARK STREET MADISON WI 53715 390806367 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) MERITER HEALTH SERVICES INC 0 METHODIST HEALTH SERVICES CORPORATION 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 371111135 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM 0 METHODIST MEDICAL CENTER FOUNDATION 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 510186460 CHARITABLE FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) METHODIST HEALTH SERVICES CORPORATION 0 METHODIST MEDICAL CENTER OF ILLINOIS 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 370661223 HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION 0 METHODIST SERVICES INC 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 371111134 OFFICE RENTAL IL 501(C)(3) 509(A)(2) METHODIST HEALTH SERVICES CORPORATION 0 NELLIE R SHERWOOD TRUST 1026 A AVENUE NE CEDAR RAPIDS IA 52402 426061621 PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY IA 501(C)(3) 509(A)(3), TYPE I ST LUKE'S METHODIST HOSPITAL 0 NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED 720 KENYON DRIVE FORT DODGE IA 50501 420937390 MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC 0 NORTHWEST IOWA HOSPITAL CORPORATION 2720 STONE PARK BLVD SIOUX CITY IA 51104 421019872 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTH SYSTEM INC 0 PARK COURT LIMITED 600 SOUTH 13TH STREET PEKIN IL 61554 371178386 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE II METHODIST HEALTH SERVICES CORPORATION 0 PEKIN MEMORIAL HOSPITAL 600 SOUTH 13TH STREET PEKIN IL 61554 370692351 HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION 0 PRAIRIE VIEW VILLAS NO 1 1900 SPRING ROAD STE 300 OAK BROOK IL 60523 261755679 MENTAL HEALTH AND/OR DISABILITY RESIDENTIAL TREATMENT SERVICES IL 501(C)(3) 170(B)(1) (A)(VI) TAZWOOD MENTAL HEALTH CENTER INC 0 PROCTOR HEALTH SYSTEMS 5409 N KNOXVILLE AVE PEORIA IL 61614 364147437 PRIMARY HEALTH CARE SERVICES IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION 0 PROCTOR HOSPITAL 5409 N KNOXVILLE AVE PEORIA IL 61614 370681540 HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION 0 SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 376181831 FUND SELF-INSURANCE PLAN IL 501(C)(3) 509(A)(3), TYPE I METHODIST MEDICAL CENTER OF ILLINOIS 0 SIOUXLAND PACE INC 1200 TRI VIEW AVE SIOUX CITY IA 51103 261120134 ALL-INCLUSIVE CARE FOR THE ELDERLY IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTH SYSTEM INC 0 ST LUKE'S HEALTH RESOURCES 2720 STONE PARK BLVD SIOUX CITY IA 51104 421059182 OUTPATIENT CLINICS AND HEALTHCARE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'S HEALTH SYSTEM INC 0 ST LUKE'S HEALTH SYSTEM INC 2720 STONE PARK BLVD SIOUX CITY IA 51104 421294091 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM 0 ST LUKE'S HEALTHCARE 1026 A AVENUE NE CEDAR RAPIDS IA 52402 421487968 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 ST LUKE'S METHODIST HOSPITAL 1026 A AVENUE NE CEDAR RAPIDS IA 52402 420504780 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTHCARE 0 ST LUKE'SJONES REGIONAL MEDICAL CENTER 1795 HIGHWAY 64 EAST ANAMOSA IA 52205 421487967 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTHCARE 0 STL CARE COMPANY 1026 A AVENUE NE CEDAR RAPIDS IA 52402 421276632 IMPROVE PUBLIC HEALTH SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'S HEALTHCARE 0 TAZWOOD MENTAL HEALTH CENTER INC 3248 VANDEVER AVE PEKIN IL 61554 371278969 MENTAL HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(VI) UNITYPOINT HEALTH - 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IA N/A C 0 DELHI POINT CONDO ASSOCIATION 350 N GRANDVIEW DUBUQUE IA 52001 421467002 REAL ESTATE MANAGEMENT IA N/A C 0 HCP CORPORATION 202 SOUTH PARK STREET MADISON WI 53715 391177562 REAL ESTATE RENTAL WI N/A C 0 HANSEN CHARITABLE REMAINDER ANNUITY TRUST 210 FOURTH AVENUE GRINNELL IA 50112 396770806 INVESTMENT IA N/A T 0 HANSEN CHARITABLE REMAINDER UNITRUST 210 FOURTH AVENUE GRINNELL IA 50112 396770807 INVESTMENT IA N/A T 0 HEALTH ADVANTAGE PLUS INC 210 4TH AVENUE GRINNELL IA 50112 421436490 PHYSICAL THERAPY IA N/A C 0 HEALTH PLUS INC 5409 N KNOXVILLE AVE PEORIA IL 61614 371295532 MANAGED CARE ADMINISTRATION IL N/A C 0 HNC SERVICES 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 270987243 FIBER OPTIC NETWORK SERVICES IA N/A C 0 MEDIMORE INC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421414390 MANAGED CARE IA N/A C 0 MERITER HEALTH ENTERPRISES INC 202 SOUTH PARK STREET MADISON WI 53715 391293620 MANAGEMENT SERVICES WI N/A C 0 MERITER MANAGEMENT SERVICES INC 202 SOUTH PARK STREET MADISON WI 53715 391458235 ADMINISTRATIVE SERVICES WI N/A C 0 METHODIST HEALTH VENTURES INC & SUB PO BOX 87 PEORIA IL 61650 371140939 PHARMACY/OFFICE STAFFING IL N/A C 0 OPTIMUM HEALTH SOLUTIONS INC 221 NORTHEAST GLEN OAK AVE PEORIA IL 61636 205430137 HEALTH & WELLNESS CONSULTING IA N/A C 0 PEKIN PROHEALTH INC 600 SOUTH 13TH STREET PEKIN IL 61554 371117052 CLINIC IL N/A C 0 PRECEDENCE INC 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 371288604 MANAGED MENTAL CARE IA N/A C 0 PRECEDENCE PLUS INC 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 364140096 MANAGED MENTAL CARE IA N/A C 0 PROVIDER RESOURCE MANAGEMENT INC PO BOX 87 PEORIA IL 61650 371223550 RESOURCE MANAGEMENT IL N/A C 0 STL HEALTH RESOURCES CO 1026 A AVE NE CEDAR RAPIDS IA 52402 421193499 PHYSICIAN OFFICE RENTAL IA N/A C 0 TRINITY HEALTH ENTERPRISES INC 2701 17TH ST ROCK ISLAND IL 61201 363320141 RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY IL N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 SCHEDULE R, PARTS I - IV: IOWA HEALTH SYSTEM AND SUBSIDIARIES (D/B/A UNITYPOINT HEALTH) 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.