2023-03-13T16:16:00-05:00 2022-04-30 990 2022-01-01 237075505 GRINNELL REGIONAL MEDICAL CENTER AUXILIARY GRIN 6412367511 210 FOURTH AVENUE GRINNELL IA 50112 KYLE M WILCOX VP FINANCE 6412367511 2023-03-13 KYLE WILCOX XXX-XX-XXXX 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X JENNIFER HAVENS 210 FOURTH AVENUE GRINNELL IA 50112 0 0 X WWW.UNITYPOINT.ORG/GRINNELL/GRMC-AUXILIARY.ASPX X 1970 IA TO ASSIST GRINNELL REGIONAL MEDICAL CENTER IN PROMOTING THE HEALTH AND WELFARE OF THE COMMUNITY. X 20 18 0 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 128 6 128 -6 -128 6456 0 127795 0 -121339 0 TO ASSIST GRINNELL REGIONAL MEDICAL CENTER IN PROMOTING THE HEALTH AND WELFARE OF THE COMMUNITY. 0 0 128 0 0 THE GRINNELL REGIONAL MEDICAL CENTER AUXILIARY RAISES FUNDS TO SUPPORT THE GRINNELL REGIONAL MEDICAL CENTER. FUNDS ARE RAISED THROUGH: THE OPERATION OF A GIFT SHOP LOCATED WITHIN THE GRINNELL REGIONAL MEDICAL CENTER, VOLUNTEERS STAFF THE GRINNELL REGIONAL MEDICAL CENTER CAFETERIA DURING BREAKFAST HOURS EARNING HALF OF ALL PROCEEDS, AND THROUGH CONTRIBUTIONS FROM THE GENERAL PUBLIC. THE FUNDS RAISED ARE CONTRIBUTED TO GRINNELL REGIONAL MEDICAL CENTER FOR EQUIPMENT PURCHASES AND OTHER OPERATIONAL EXPENSES THAT AID IN THE CARE OF THE PATIENTS OF GRINNELL REGIONAL MEDICAL CENTER. THE AUXILIARY ALSO PROVIDES SCHOLARSHIPS TO STUDENTS WITH AN INTEREST IN THE MEDICAL FIELD. 128 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 20 18 0 0 0 0 1 1 1 1 1 0 0 1 0 1 1 1 1 0 X X KYLE M WILCOX VP FINANCEBUSINESS 6412367511 210 FOURTH AVENUE GRINNELL IA 50112 X JILL ALLEN BOARD MEMBER 1.00 0.00 X 0 0 0 ANDREA BARTLETT BOARD MEMBER 1.00 40.00 X 0 75800 15777 HEATHER COFFMAN BOARD MEMBER 1.00 0.00 X 0 0 0 CHRISTINE DAY BOARD MEMBER 1.00 0.00 X 0 0 0 CRYSTAL DENEVE BOARD MEMBER 1.00 0.00 X 0 0 0 VICKI DILLION BOARD MEMBER 1.00 0.00 X 0 0 0 DONNETTE ELLIS BOARD MEMBER 1.00 0.00 X 0 0 0 LIZ HANSEN BOARD MEMBER 1.00 0.00 X 0 0 0 MEG JONES-BAIR BOARD MEMBER 1.00 0.00 X 0 0 0 CAROL JORDAN BOARD CHAIR 1.00 0.00 X X 0 0 0 LINDA LOWE BOARD MEMBER 1.00 0.00 X 0 0 0 LEIGH ANN MEACHAM BOARD MEMBER 1.00 0.00 X 0 0 0 KATE MERRICK BOARD MEMBER 1.00 0.00 X 0 0 0 DODI REILLY BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 COLLEEN NICKYSLAYMAKER BOARD MEMBER 1.00 0.00 X 0 0 0 JANE TAYLOR BOARD MEMBER 1.00 0.00 X 0 0 0 KRISTIN VAN WYK BOARD VICE CHAIR 1.00 0.00 X X 0 0 0 EMILY VESELY BOARD MEMBER 1.00 40.00 X 0 59324 35405 ESTHER WARE BOARD MEMBER 1.00 0.00 X 0 0 0 KATY WELLS BOARD MEMBER 1.00 0.00 X 0 0 0 JENNIFER HAVENS CEO 1.00 40.00 X 0 293284 35489 KYLE WILCOX VP FINANCE 1.00 40.00 X 0 203252 18639 0 631660 105310 0 0 1 0 0 0 0 0 0 X 42 42 MISCELLANOUS EXPENSES 86 86 128 128 0 0 6456 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6456 0 127795 0 127795 0 X -121339 0 -121339 0 6456 0 X -128 121467 X 0 1 X 1 0 X X 1 GRINNELL REGIONAL MEDICAL CENTER 420933383 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 X 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 2018. 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. 0 0 0 0 0 0 0 0 0 JENNIFER HAVENS CEO 0 226468 0 66558 0 258 0 12336 0 23153 0 328773 0 0 KYLE WILCOX VP FINANCE 0 176252 0 26846 0 154 0 10351 0 8288 0 221891 0 0 CASH 2022-04-30 6328 FMV 421454737 GRINNELL REGIONAL MEDICAL CENTER FOUNDATION 210 FOURTH AVENUE GRINNELL IA 50112 501(C)(3) 0 0 0 0 1 1 1 1 0 FORM 990, PART VI, SECTION A, LINE 6 GRINNELL REGIONAL MEDICAL CENTER, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, GRINNEL REGIONAL MEDICAL CENTER, SHALL HAVE THE AUTHORITY TO APPOINT ALL DIRECTORS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, GRINNELL REGIONAL MEDICAL CENTER, HAS THE FINAL AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE BOARD OF DIRECTORS, AS SET OUT IN THE GOVERNING DOCUMENTS. 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 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 2021 FOR THE FOLLOWING INDIVIDUALS: JENNIFER HAVENS 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 VII EXECUTIVE COMPENSATION AMOUNTS ARE BASED OFF OF YEAR END 12/31/2021, THESE AMOUNTS WERE REPORTED ON THE PRIOR YEAR FORM 990. FORM 990, PART IX, LINE 11G BANK FEES: PROGRAM SERVICE EXPENSES 42. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42. FORM 990, PART XI, LINE 9: BALANCE TRANSFER TO GRINNELL REGIONAL MEDICAL CENTER FOUNDATION -6,328. TRANFERS TO GRINNELL REGIONAL MEDICAL CENTER 123,772. TRANFERS TO CENTRAL IOWA HOSPITAL CORPORATION 4,023. 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 CHATHAM OAKS 740 N 15TH AVE NO A HIAWATHA IA 52233 421302928 MENTAL HEALTH AND/OR DISABILITY RESIDENTIAL TREATMENT SERVICES IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 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 AUXILIARY 210 FOURTH AVENUE GRINNELL IA 50112 237075505 CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES IA 501(C)(3) 509(A)(3), TYPE I GRINNELL REGIONAL MEDICAL CENTER 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 PENN CENTER INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421421803 RESIDENTIAL TREATMENT SERVICES FOR INDEPENDENT LIVING IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 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 - UNITYPLACE 0 THE DUBUQUE VISITING NURSE ASSOCIATION 350 NORTH GRANDVIEW AVENUE DUBUQUE IA 52001 420680410 PUBLIC HEALTH SERVICES/HOME CARE IA 501(C)(3) 509(A)(2) FINLEY TRI-STATES HEALTH GROUP INC 0 THE FINLEY HOSPITAL 350 NORTH GRANDVIEW AVENUE DUBUQUE IA 52001 420680354 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) FINLEY TRI-STATES HEALTH GROUP INC 0 THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH 2701 17TH STREET ROCK ISLAND IL 61201 363678909 MENTAL HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(VI) TRINITY REGIONAL HEALTH SYSTEM 0 TRIMARK PHYSICIANS GROUP 802 KENYON ROAD FORT DODGE IA 50501 453791448 SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC 0 TRINITY COLLEGE OF NURSING & HEALTH SCIENCES 2122 25TH AVE ROCK ISLAND IL 61201 810994377 EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS IL 501(C)(3) 170(B)(1) (A)(II) TRINITY MEDICAL CENTER 0 TRINITY HEALTH FOUNDATION 802 KENYON ROAD FORT DODGE IA 50501 421222381 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) TRINITY HEALTH SYSTEMS INC 0 TRINITY HEALTH FOUNDATION 2701 17TH STREET ROCK ISLAND IL 61201 363321751 CHARITABLE FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) TRINITY REGIONAL HEALTH SYSTEM 0 TRINITY HEALTH SYSTEMS INC 802 KENYON ROAD FORT DODGE IA 50501 421222877 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 TRINITY MEDICAL CENTER 2701 17TH STREET ROCK ISLAND IL 61201 362739299 HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) TRINITY REGIONAL HEALTH SYSTEM 0 TRINITY REGIONAL HEALTH SYSTEM 2701 17TH STREET ROCK ISLAND IL 61201 363351952 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 TRINITY REGIONAL HOSPITAL AUXILIARY 802 KENYON ROAD FORT DODGE IA 50501 426081474 CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES IA 501(C)(3) 509(A)(2) TRINITY REGIONAL MEDICAL CENTER 0 TRINITY REGIONAL MEDICAL CENTER 802 KENYON ROAD FORT DODGE IA 50501 421009175 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC 0 UNITY HEALTHCARE 1518 MULBERRY AVENUE MUSCATINE IA 52761 420680337 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) TRINITY REGIONAL HEALTH SYSTEM 0 UNITY HEALTHCARE FOUNDATION 1518 MULBERRY AVENUE MUSCATINE IA 52761 421525031 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE I UNITY HEALTHCARE 0 UNITYPOINT HEALTH - MARSHALLTOWN 1825 LOGAN AVENUE WATERLOO IA 50703 815034179 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ALLEN HEALTH SYSTEMS INC 0 UNITYPOINT HEALTH - MARSHALLTOWN FOUNDATION 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 421388518 CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC 0 UNITYPOINT HEALTH - UNITYPLACE 221 NORTHEAST GLEN OAK AVENUE PEORIA IL 61636 834051901 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE II METHODIST HEALTH SERVICES CORPORATION 0 UNITYPOINT AT HOME 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421477471 HOME HEALTH CARE IA 501(C)(3) 509(A)(2) IOWA HEALTH SYSTEM 0 UNITYPOINT HEALTH AT WORK 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 810872241 EMPLOYER ONSITE MEDICAL SERVICES AND OCCUPATIONAL MEDICINE IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM 0 WISCONSIN DIALYSIS INC 3034 FISH HATCHERY ROAD MADISON WI 53713 300072647 OUTPATIENT KIDNEY DIALYSIS WI 501(C)(3) 509(A)(3), TYPE III 0 ADVANCED IMAGING CENTER LLC 615 VALLEY VIEW DRIVE MOLINE IL 61265 364356301 DIAGNOSTIC RADIOLOGY CENTER IA N/A 0 1 ANKENY MEDICAL PARK SURGERY CENTER LC 3625 NORTH ANKENY BLVD STE J ANKENY IA 50021 831281114 AMBULATORY SURGERY CENTER IA N/A 0 1 CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC 1200 PLEASANT ST DES MOINES IA 50309 273625869 CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A 0 1 CENTRAL IOWA ONCOLOGY CO-MANAGEMENT COMPANY 1200 PLEASANT STREET DES MOINES IA 50309 453017991 ONCOLOGY MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A 0 1 CENTRAL IOWA PHYSIO LLC 4714 GETTYSBURG ROAD MECHANICSBURG PA 17055 364799633 PHYSICAL THERAPY SERVICES IA N/A 0 1 CENTRAL IOWA SURGICAL SERVICES CO-MANAGEMENT CO LLC 1200 PLEASANT ST DES MOINES IA 50309 471608704 SURGICAL MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A 0 1 DUBUQUE ENDOSCOPY CENTER LC 1515 DELHI STREET SUITE 500 DUBUQUE IA 52001 201597161 AMBULATORY SURGERY CENTER IA N/A 0 1 EASTERN IOWA SLEEP SUPPLY LLC 275 10TH STREET SE STE 1130-B CEDAR RAPIDS IA 52403 851990451 MEDICAL EQUIPMENT RETAIL SALES IA N/A 0 1 HEALTH CARE AFFILIATES OF THE TRI-STATES LLC 350 N GRANDVIEW AVE DUBUQUE IA 52001 421428503 PROVIDE ACCESS TO LICENSED SOFTWARE IA N/A 0 1 IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC 1200 PLEASANT STREET DES MOINES IA 50309 030482623 OUTPATIENT DIAGNOSTIC IMAGING IA N/A 0 1 IOWA HEALTH SYSTEM CONTRACTING SERVICES LC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421511142 GROUP PURCHASING IA N/A 1 1 LAKEVIEW SURGERY CENTER LC 1200 PLEASANT STREET DES MOINES IA 50309 421516120 SURGERY CENTER IA N/A 0 1 MIDWEST ORTHOPAEDIC HOSPITAL AT UNITYPOINT HEALTH-PROCTOR LLC 5409 N KNOXVILLE AVE PEORIA IL 61614 843733879 OUTPATIENT ORTHOPEDIC SERVICE LINE MANAGEMENT IL N/A 0 1 MR ASSOCIATES LLP 1956 1ST AVENUE NE CEDAR RAPIDS IA 52402 421260463 OWN AND OPERATE MR UNIT IA N/A 0 1 ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC 1200 PLEASANT STREET DES MOINES IA 50309 421508092 AMBULATORY SURGERY CENTER IA N/A 0 1 REHABILITATION THERAPY SERVICES LLC 416 ST MARKS CT 110 PEORIA IL 61603 810584193 REHABILATION THERAPY IL N/A 0 1 THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC 1075 FIRST AVENUE SE CEDAR RAPIDS IA 52403 721550812 AMBULATORY SURGERY CENTER. IA N/A 0 1 UNITED MEDICAL PARK ASC LLC DBA THE SURGERY CENTER AT UNITED MEDICAL PARK 1825 LOGAN AVE WATERLOO IA 50703 420698265 AMBULATORY SURGERY CENTER IA N/A 0 1 UPHT-SCA HOLDINGS LLC 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM AL 35209 473564984 AMBULATORY SURGERY CENTER INVESTMENT DE N/A 0 0 WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC 1660 60TH STREET WEST DES MOINES IA 50266 271414600 ORTHOPEDIC SERVICE LINES MANAGEMENT IA N/A 0 1 WEST LAKES SLEEP CENTER LLC 5950 UNIVERSITY AVENUE SUITE 2 WEST DES MOINES IA 50266 263193923 SLEEP DISORDER DIAGNOSTIC TESTING FACILITY IA N/A 0 1 ABBE MANAGEMENT CORPORATION 740 N 15TH AVE NO A HIAWATHA IA 52233 421361755 MANAGEMENT SERVICES IA N/A C 0 BELCREST SERVICES LTD 5409 N KNOXVILLE AVE PEORIA IL 61614 371196307 MEDICAL SERVICES IL N/A C 0 BROADBAND INC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 273819741 INFORMATION TECHNOLOGY MGMT. 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 HOME HEALTH PLUS SERVICES INC PO BOX 87 PEORIA IL 61650 364053068 HOME HEALTH SERVICES IL N/A C 0 MARIGOLD CITY LAND TRUST NO ONE 2956 COURT STREET PEKIN IL 61554 272750273 PROPERTY MANAGEMENT IL N/A T 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 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 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). AS THE NATION'S 13TH LARGEST NONPROFIT HEALTH SYSTEM, UNITYPOINT HEALTH PROVIDES PROGRESSIVE AND HIGH QUALITY SERVICES ACROSS ITS 9 REGIONS WHICH SPAN IOWA, WESTERN ILLINOIS AND SOUTHERN WISCONSIN. THIS REGIONAL CARE MODEL HAS BEEN SUCCESSFUL IN ACHIEVING STANDARDIZED LEVELS OF PERFORMANCE AND KEEPING CARE LOCAL. WITH $4.9B IN TOTAL OPERATING REVENUE, UNITYPOINT HEALTH EMPLOYS APPROXIMATELY 33,000 TEAM MEMBERS AND OPERATES 20 REGIONAL HOSPITALS, 19 COMMUNITY NETWORK HOSPITALS AND OVER 435 CLINICS. AS A KEY COMPONENT OF UNITYPOINT HEALTH, UNITYPOINT CLINIC IS A 1,180 PROVIDER MULTISPECIALTY GROUP THAT IS BUILT ON THE FOUNDATION OF CARE DELIVERY, INNOVATION AND EXPERIENCE. REPRESENTED BY OVER 40 SPECIALTIES, UPC IS A FORWARD-THINKING DELIVERY PROVIDER AND IS ON THE LEADING EDGE OF CARE DELIVERY WITH ITS TELEHEALTH, AMBULATORY AND URGENT CARE PROGRAMS. THE DIVERSIFIED HEALTH SYSTEM ALSO INCLUDES UNITYPOINT ACCOUNTABLE CARE, UNITYPOINT HEALTH COLLEGES, UNITYPOINT AT HOME AND EXTENDS HEALTH COVERAGE THROUGH THE HEALTHPARTNERS UNITYPOINT INSURANCE PLAN.