TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) TL BRIGGS........................................................................ FORMER TRUSTEE	1.00 .......................	X		0	0
(2) JACQUE GOODMAN........................................................................ TRUSTEE	1.00 .......................	X		0	0
(3) SHARON GREER........................................................................ TRUSTEE	1.00 .......................	X		0	0
(4) CAROL HIBBS........................................................................ VICE CHAIRPERSON	3.00 .......................	X	X	0	0
(5) POLLY HINEMAN MD........................................................................ FORMER TRUSTEE/PHYSICIAN	40.00 .......................	X		170,047	9,774
(6) JOHN C HUGHES........................................................................ PRESIDENT & CHIEF EXECUTIVE OFFICER	40.00 .......................	X	X	276,507	32,445
(7) JIM LOWRANCE........................................................................ TREASURER	3.00 .......................	X	X	0	0
(8) SUE MARTIN........................................................................ TRUSTEE	1.00 .......................	X		0	0
(9) MIKE MASON........................................................................ CHAIRPERSON	3.00 .......................	X	X	0	0
(10) MIKE MCCARTY........................................................................ TRUSTEE	1.00 .......................	X		0	0
(11) JOSEPH POLLPETER........................................................................ TRUSTEE	1.00 .......................	X		0	0
(12) KIMBERLE SCHRYVER........................................................................ TRUSTEE	1.00 .......................	X		0	0
(13) KEVIN SWARTZ........................................................................ TRUSTEE	1.00 .......................	X		0	0
(14) STEPHEN VAN BUREN........................................................................ TRUSTEE	1.00 .......................	X		0	0
(15) BRUCE WIRIN........................................................................ SECRETARY	3.00 .......................	X	X	0	0
(16) TODD BURCH........................................................................ CHIEF FINANCIAL OFFICER	40.00 .......................		X	0	0
(17) HILARY DOLBEE........................................................................ FORMER V.P. OF FINANCE	40.00 .......................		X	152,991	15,169

(A) Name and business address	(B) Description of services	(C) Compensation
MACFARLAND CLINIC PC 1215 DUFF AVE AMES,IA50010	PHYSICIAN SERVICES	2,307,757
SQUARE WAVEFORM ANESTHESIOLOGY PO BOX 1192 MARSHALLTOWN,IA50158	ANESTHESIA SERVICES	1,933,500
ICE TECHNOLOGIES 411 SE 9TH ST PELLA,IA50219	IT SERVICES	1,438,473
ARAMARK CORPORATION 1225 E 60TH ST CHICAGO,IL60673	CLIN ENG/FACILITIES	1,428,524
IOWA ORTHO 1601 NW 114TH ST CLIVE,IA50325	PHYSICIAN SERVICES	1,320,144
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 23

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	24,647	24,647
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	995,818		995,818
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	27,495,841	22,103,044	5,392,797
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,102,681	879,826	222,855
9	Other employee benefits .......	4,240,868	3,383,776	857,092
10	Payroll taxes ...........	1,996,719	1,593,176	403,543
11	Fees for services (non-employees):
a	Management ......	3,968,090		3,968,090
b	Legal .........	466,834	19,195	447,639
c	Accounting ...........	58,573		58,573
d	Lobbying ...........	13,902		13,902
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	16,296,776	15,034,999	1,261,777
12	Advertising and promotion ....	268,881		268,881
13	Office expenses .......	496,665	355,396	141,269
14	Information technology ......	1,739,067		1,739,067
15	Royalties ..
16	Occupancy ...........	954,851	565,615	389,236
17	Travel ............	127,062	78,952	48,110
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	77,606	50,348	27,258
20	Interest ...........	1,243,997		1,243,997
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	4,131,888	1,570,004	2,561,884
23	Insurance ..............	524,942	76,223	448,719
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	8,150,940	8,150,940
b	ANCILLARY EXPENSES	2,351,478	2,351,478
c	ADMINISTRATIVE EXPENSES	1,210,760		1,210,760
d	NURSING EXPENSES	611,792	611,792
e	All other expenses	1,412,482	191,147	1,221,335
25	Total functional expenses. Add lines 1 through 24e	79,963,160	57,040,558	22,922,602	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	11,121	1	33,545
2	Savings and temporary cash investments .........	5,807,597	2	2,180,843
3	Pledges and grants receivable, net ...........	34,540	3	38,243
4	Accounts receivable, net .............	16,621,933	4	9,531,074
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............	58,874	7	166,774
8	Inventories for sale or use ..............	2,034,951	8	2,370,281
9	Prepaid expenses and deferred charges ..........	773,462	9	866,305
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	141,838,368
b	Less: accumulated depreciation .....	10b	64,492,878	38,288,768	10c	77,345,490
11	Investments—publicly traded securities ..........	180,119	11	0
12	Investments—other securities. See Part IV, line 11 .....	3,500,000	12	3,695,768
13	Investments—program-related. See Part IV, line 11 .....	1,249,849	13	2,003,395
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	2,561,891	15	4,462,453
16	Total assets. Add lines 1 through 15 (must equal line 34)......	71,123,105	16	102,694,171
	17	Accounts payable and accrued expenses .........	7,312,736	17	16,042,262
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	7,899,336	23	49,530,476
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................		25
26	Total liabilities. Add lines 17 through 25.........	15,212,072	26	65,572,738
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	54,422,234	27	35,579,968
28	Temporarily restricted net assets ...........	1,488,799	28	1,541,465
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	55,911,033	33	37,121,433
34	Total liabilities and net assets/fund balances ........	71,123,105	34	102,694,171

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization CENTRAL IOWA HEALTHCARE

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization CENTRAL IOWA HEALTHCARE

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

13,902

Total. Add lines 1c through 1i ...............................

13,902

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 22.8% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $4,995, AND 21% OF MEMBERSHIP DUES PAID TO THE IOWA HOSPITAL ASSOCIATION, OR $8,907.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	640,301	5,002,147		5,642,448
b	Buildings ................	19,328,772	69,471,591	38,018,390	50,781,973
c	Leasehold improvements ............
d	Equipment ................	16,261	44,884,745	25,253,432	19,647,574
e	Other .................	357,295	2,137,256	1,221,056	1,273,495
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					77,345,490

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes









Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	60,434,807
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	0
3	Subtract line 2e from line 1.....................			3	60,434,807
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	736,040
c	Add lines 4a and 4b.......................			4c	736,040
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	61,170,847

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	79,227,120
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	-736,040
e	Add lines 2a through 2d......................			2e	-736,040
3	Subtract line 2e from line 1.....................			3	79,963,160
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	79,963,160

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO ORGANIZATIONS SUCH AS THIS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE NATURE, THE CHARACTERIZATION AND THE TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. HOWEVER, AS OF OCTOBER 31, 2015 AND 2014, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY AS MANAGEMENT DOES NOT BELIEVE THE HOSPITAL HAS TAKEN ANY TAX POSITIONS THAT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES. FORMS 990 AND 990T FILED BY THE HOSPITAL ARE GENERALLY SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. THE HOSPITAL'S IRS FORMS 990 AND 990T ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED OCTOBER 31, 2012 AND PRIOR.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	COST OF GOODS SOLD -61,170. GAIN ON SALE OF FIXED ASSETS 77,952. JOINT VENTURE INCOME 707,236. RESTRICTED INCOME 12,022.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	COST OF GOODS SOLD 61,170. GAIN ON SALE OF FIXED ASSETS -77,952. JOINT VENTURE INCOME -707,236. RESTRICTED EXPENSES -12,022.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	24,647		24,647	0.030 %
b	Medicaid (from Worksheet 3, column a) ....	9,659,661	6,553,967	3,105,694	3.880 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	9,684,308	6,553,967	3,130,341	3.910 %
Other Benefits		436,754	33,143	403,611	0.500 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	436,754	33,143	403,611	0.500 %
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..	3,567,378	2,889,126	678,252	0.850 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	22,674		22,674	0.030 %
j	Total. Other Benefits ..	4,026,806	2,922,269	1,104,537	1.380 %
k	Total. Add lines 7d and 7j .	13,711,114	9,476,236	4,234,878	5.290 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	10,025	10,025	0.010 %
9	Other
10	Total	10,025	10,025	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

20,096,333

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

21,042,030

Enter Medicare allowable costs of care relating to payments on line 5.....

23,661,227

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-2,619,197

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	CENTRAL IOWA HEALTHCARE 3 SOUTH 4TH AVE MARSHALLTOWN,IA50158 WWW.CENTRALIOWAHEALTHCARE.COM 640007H	X	X	X

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CENTRAL IOWA HEALTHCARE
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.CENTRALIOWAHEALTHCARE.COM

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): WWW.CENTRALIOWAHEALTHCARE.COM

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	CENTRAL IOWA HEALTHCARE
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000%
and FPG family income limit for eligibility for discounted care of 200.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	CENTRAL IOWA HEALTHCARE
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
CENTRAL IOWA HEALTHCARE	PART V, SECTION B, LINE 5: CENTRAL IOWA HEALTHCARE UTILIZED MANY METHODS IN ORDER TO ENSURE THAT INPUT WAS RECEIVED FROM THE ENTIRE COMMUNITY, INCLUDING REPRESENTATIVES OF THE COMMUNITY WITH PUBLIC HEALTH KNOWLEDGE, THOSE WITH SPECIALIZED HEALTH KNOWLEDGE, AS WELL AS THOSE SERVED BY THE HOSPITAL. THIS WAS DONE BY HOSTING THREE COMMUNITY MEETINGS, CONDUCTING A DIRECT MAIL SURVEY OF HOUSEHOLDS IN THE SERVICE AREA, AND FORMING FOCUS GROUPS ATTENDED BY BUSINESS LEADERS, CITY AND COUNTY LEADERS, HEALTH CARE PROFESSIONALS, RELIGIOUS LEADERS, NOT-FOR-PROFIT ORGANIZATIONS AND CONSUMERS.
CENTRAL IOWA HEALTHCARE	PART V, SECTION B, LINE 6B: THE MARSHALL COUNTY BOARD OF HEALTH AND THE PIONEERING HEALTHIER COMMUNITY COALITION
CENTRAL IOWA HEALTHCARE	PART V, SECTION B, LINE 11: CENTRAL IOWA HEALTHCARE WILL FOCUS ON PROVIDING MORE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN THE CENTRAL IOWA HEALTHCARE SERVICE AREA AND WILL WORK TOWARDS GREATER UTILIZATION OF THESE SPECIALTY SERVICES THAT ARE PREVIOUSLY EXISTING IN THE COMMUNITY. CENTRAL IOWA HEALTHCARE HAS MADE A NUMBER OF ADVANCEMENTS TOWARDS THE MENTAL HEALTH GOAL. IN FISCAL YEAR 2015, WE HIRED AN EXECUTIVE DIRECTOR OF BEHAVIOR HEALTH, WITH A FOCUS ON THE MOST CRITICAL AREA - BEHAVIORAL HEALTH PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT. IN ADDITION TO BRINGING THIS RESOURCE ON BOARD, WE REMODELED AN ED PATIENT ROOM FOR THE SAFETY OF THESE PATIENTS THAT INCLUDED REMOVING ITEMS THAT COULD BE USED TO SELF HARM OR HARM CAREGIVERS, ADDED VIDEO MONITORING TO ENSURE THAT THE PATIENT IN THE ROOM IS SAFE, GROWN AN ONSITE EMPLOYED SECURITY TEAM, PARTNERED MORE CLOSELY WITH THE COUNTY SHERIFF'S DEPARTMENT TO ENSURE THE SAFETY OF INDIVIDUALS UNDER THEIR CARE, AND MODIFIED POLICIES TO ENSURE ADEQUATE CARE IS PROVIDED. WE ALSO CONTRACTED WITH OTHER ORGANIZATIONS TO PROVIDE REMOTE EVALUATIONS WHEN THE PHYSICIANS REQUEST THE SERVICE.THERE WERE NEEDS IDENTIFIED THAT CENTRAL IOWA HEALTHCARE DOES NOT HAVE THE RESOURCES TO ADDRESS AT THIS TIME. THESE NEEDS WHILE IMPORTANT TO THE HEALTH SYSTEM AND THE COMMUNITY WERE NOT CHOSEN BASED ON THE ORGANIZATION'S PRIORITIZATION PROCESS, AVAILABLE STAFF RESOURCES AND OTHER PRIORITY PROJECTS. THIS PROCESS INCLUDED THE FOLLOWING QUESTIONS: 1) THE SEVERITY OF THE PROBLEM 2) THE HEALTH SYSTEM'S ABILITY TO IMPACT AND 3) THE EXTENT TO WHICH OTHER ORGANIZATIONS WERE MEETING THE NEED AS WELL AS 4) THE HEALTH SYSTEM'S CAPACITY AT THIS TIME.
CENTRAL IOWA HEALTHCARE	PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USES THE RATES PAID BY COMMERCIAL INSURANCE PAYORS TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO INDIVIDUALS ELIGIBLE UNDER THE HOSPITALS FINANCIAL ASSISTANCE POLICY.

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address		Type of Facility (describe)
1	CIH CLINIC - STATE CENTER 503 3RD AVENUE SW STATE CENTER,IA50247	PHYSICIAN CLINIC
2	CIH CLINIC - TAMATOLEDO 1307 SOUTH BROADWAY TOLEDO,IA52342	PHYSICIAN CLINIC
3	CIH CLINIC - CONRAD 105 NORTH CHURCH ST CONRAD,IA50621	PHYSICIAN CLINIC
4	CIH CLINIC - MARSHALLTOWN 405 EAST MAIN ST MARSHALLTOWN,IA50158	PHYSICIAN CLINIC
5	CIH - URGENT CARE 55 CENTRAL IOWA DRIVE SUITE 5 MARSHALLTOWN,IA50158	URGENT CARE CLINIC
6
7
8
9
10

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	NOT APPLICABLE
PART I, LINE 6A:	A COMMUNITY BENEFIT REPORT IS PREPARED ANNUALLY IN A COLLABORATIVE EFFORT WITH THE IOWA HOSPITAL ASSOCIATION. THIS INFORMATION IS SHARED IN TOTAL FOR THE ENTIRE STATE THROUGH PRESS RELEASES AND FOR OUR INDIVIDUAL HOSPITAL BY INCLUDING THIS INFORMATION IN OUR ANNUAL CORPORATE REPORT, ON OUR WEBSITE AND A LOCAL PRESS RELEASE.
PART I, LINE 7:	AMOUNTS REPORTED IN THIS TABLE WERE CALCULATED BASED ON IRS WORKSHEETS 1-8, USING ENTITY SPECIFIC COST TO CHARGE RATIOS.
PART I, LINE 7G:	THE AMOUNT REPORTED ON THIS LINE INCLUDES SUBSIDIZED HEALTH SERVICES AT TWO PHYSICIAN CLINICS LOCATED IN RURAL COMMUNITIES IN OUR GEOGRAPHIC SERVICE AREA. THE PHYSICIAN CLINICS ARE PROVIDED IN THE RURAL AND MEDICALLY UNDERSERVED COMMUNITIES OF TAMA/TOLEDO, IOWA AND MARSHALLTOWN, IOWA TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY REDUCING GEOGRAPHIC AND FINANCIAL BARRIERS. COSTS OF $1,229,205 FOR TAMA/TOLEDO AND $2,338,173 WERE INCLUDED IN COMMUNITY BENEFIT EXPENSE, AS THESE COMMUNITIES WOULD BE MEDICALLY UNDERSERVED IF THESE SERVICES WERE NOT PROVIDED.
PART II, COMMUNITY BUILDING ACTIVITIES:	THE COMMUNITY BUILDING ACTIVITIES EXPENSE INCURRED BY CENTRAL IOWA HEALTHCARE ARE EXPENSES INCURRED TO RECRUIT PHYSICIANS WHO WOULD NOT OTHERWISE COME TO THIS MEDICALLY UNDERSERVED AREA AND TO RETAIN PHYSICIANS IN THIS MEDICALLY UNDERSERVED AREA.
PART III, LINE 2:	THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) IS DETERMINED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO.
PART III, LINE 4:	ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BY AN ALLOWANCE FOR AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	COSTS WERE DERIVED USING THE MEDICARE COST REPORT. THE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: 1) MANY MEDICARE RECIPIENTS ARE LOW-INCOME INDIVIDUALS AND IF NOT FOR MEDICARE, WOULD QUALIFY FOR CHARITY CARE OR OTHER MEANS TESTED GOVERNMENT PROGRAMS 2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS 3) IRS REV RULING 69-545 ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR HOSPITALS, WHICH INDICATES THAT IF A HOSPITAL SERVES PATIENTS COVERED BY GOVERNMENTAL HEALTH BENEFITS (INCLUDING MEDICARE), THEN THIS INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
PART III, LINE 9B:	AFTER A PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS EITHER PARTIALLY OR ENTIRELY WRITTEN-OFF. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY.
PART VI, LINE 2:	CENTRAL IOWA HEALTHCARE AND THE MARSHALL COUNTY BOARD OF HEALTH AND THE PIONEERING HEALTHIER COMMUNITY COALITION PARTNERED TO COMPLETE A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT IN CALENDAR YEAR 2013. THROUGH THESE EFFORTS, PRIORITIES AND STRATEGIES HAVE BEEN DEVELOPED. REPRESENTATIVES OF CENTRAL IOWA HEALTHCARE ARE INVOLVED IN THE ABOVE MENTIONED GROUPS AND THE LARGER COALITION. THE HEALTH NEEDS OF THE COMMUNITY ARE ASSESSED THROUGH A COMMUNITY NEEDS ASSESSMENT PROCESS EVERY THREE YEARS. A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY, AND TO ASSIST OUR COMMUNITY PARTNERS IN FOCUSING ON OUR COMMUNITIES FUTURE HEALTH NEEDS. THIS ASSESSMENT SERVES AS THE BASIS FOR MARSHALL COUNTY PUBLIC HEALTH, PIONEERING HEALTHIER COMMUNITIES, AND OUR OVERALL HEALTHCARE COMMUNITY TO DEVELOP ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES. THIS NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO - GAIN INSIGHT INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY - ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS - PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNING. CENTRAL IOWA HEALTHCARE ACTIVELY CONTRIBUTES TO THE COMMUNITY NEEDS ASSESSMENT AND ENGAGES IN THE PRIORITIES THAT MATCH ITS VISION AND MISSION. MEASUREMENT AND EVALUATION TOOLS ARE COLLECTED AND MONITORED BY THE LARGER COMMUNITY COALITION ENGAGED IN THE VARIOUS EFFORTS. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS, CENTRAL IOWA HEALTHCARE MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND RESOURCES AVAILABLE. INDIVIDUAL DEPARTMENTS ALSO WORK TO IDENTIFY COMMUNITY NEEDS AS RELATED TO THEIR SERVICES AND THE POPULATION SERVED.
PART VI, LINE 3:	SIGNS STATING THAT FINANCIAL ASSISTANCE AND FREE CARE ARE AVAILABLE AND ARE POSTED IN THE HOSPITAL REGISTRATION AND CASHIER AREAS. REGISTRATION STAFF HAVE EDUCATIONAL MATERIAL AND APPLICATION FORMS THAT ARE MADE AVAILABLE TO PATIENTS WANTING INFORMATION OR AN APPLICATION FOR OUR COMMUNITY ASSISTANCE PROGRAM. PATIENT FINANCIAL SERVICE REPS CONSULT AND ADVISE SELF PAY PATIENTS ON THEIR OPTIONS FOR GOVERNMENT SPONSORED FINANCIAL ASSITANCE AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ADDITIONALLY, AN OUTSIDE VENDOR CONTACTS ADMITTED SELF PAY PATIENTS AND DISCUSSES OPTIONS FOR GOVERNMENT SPONSORED FINANCIAL ASSISTANCE AND PROVIDES ASSISTANCE TO PATIENTS APPLYING FOR A SPECIFIC PROGRAM. OUR OUTSIDE VENDOR DIRECTS PATIENTS THAT DO NOT QUALITY FOR A GOVERNMENT SPONOSORED PROGRAM TO A HOSPITAL FINANCIAL SERVICE REPRESENTATIVE TO FOLLOW UP WITH AN APPLICATION FOR COMMUNITY ASSISTANCE. WE FURTHER USE AN "EARLY OUT" SELF PAY VENDOR THAT PROVIDES INFORMATION ON GOVERNMENT PROGRAMS AND THE HOSPITAL'S COMMUNITY ASSISTANCE PROGRAM. OUR SELF PAY VENDOR PROVIDES COMMUNITY ASSISTANCE APPLICATIONS TO PATIENTS WHEN AN APPLICATION IS REQUESTED AND MAKES REFERRALS FOR POSSIBLE APPLICATION TO GOVERNMENT SPONOSORED ASSISTANCE PROGRAMS. ALSO, A STATEMENT IS INCLUDED IN THE FIRST BILLING TO PATIENTS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE.
PART VI, LINE 4:	MARSHALL COUNTY, POPULATION 40,746, IS COMPRISED OF 13 INCORPORATED COMMUNITIES AND THEIR SURROUNDING AREAS. THE POPULATION IS SOMEWHAT CONCENTRATED IN THE CENTRAL CITY OF MARSHALLTOWN WHERE ABOUT 66% OF COUNTY RESIDENTS LIVE. THE COUNTY'S POPULATION HAS REMAINED STABLE OVER THE PAST 50 YEARS, HOWEVER, THE DEMOGRAPHICS OF THE POPULATION HAVE SHIFTED DRAMATICALLY IN THE PAST 15 YEARS. NEW IMMGRANTS RECRUITED TO THE COMMUNITY BY THE MEAT PACKING INDUSTRY HAVE DRIVEN THESE CHANGES. LARGE NUMBERS OF HISPANIC IMMIGRANTS HAVE LEFT THE SUB-MINIMUM WAGE EXISTENCE IN CENTRAL MEXICO TO TRAVEL TO THE AMERICAN MIDWEST FOR JOBS IN MEAT PACKING. THIS INDUSTRY IS THE LARGEST PRIVATE EMPLOYER IN MARSHALL COUNTY WITH PAY RANGING FROM $9 - $13 PER HOUR. THESE CHANGES HAVE RESULTED IN AN INCREASE IN THE NUMBER OF PEOPLE LIVING IN POVERTY AND AN UPSURGE IN THE NUMBER OF UNINSURED OR UNDERINSURED RESIDENTS. MARSHALL COUNTY IS DESIGNATED AS A HEALTH PROVIDER SHORTAGE AREA (HPSA). FURTHER, THE COUNTY HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVED COMMUNITY (MUC) AND THE IMMIGRANT POPULATION HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVED POPULATION (MUP) DUE TO LANGUAGE AND CULTURAL BARRIERS IN ACCESSSING HEALTH CARE SERVICES. ACCORDING TO THE 2015 US CENSUS DATA, 20.7% OF THE MARSHALL COUNTY'S POPULATION IS OF HISPANIC OR LATINO ORIGIN COMPARED TO 5.7% IN THE STATE OF IOWA; 18.8% OF MARSHALL COUNTY'S POLUATION (AGE 5+) SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME COMPARED TO 7.4% IN THE STATE OF IOWA; 84.7% OF MARSHALL COUNTY RESDIENTS ARE HIGH SCHOOL GRADUATES COMAPRED TO 91.3% IN IOWA; 20.1% OF MARSHALL COUNTY POPULATION HAD A BACHELOR'S DEGREE OR HIGHER COMPARED TO 26.4% IN IOWA (2000); THE MEDIAN HOUSEHOLD INCOME IN 2010-2014 IN MARSHALL COUNTY WAS 52,354 COMPARED TO 52,716 IN IOWA; PERSONS LIVING BELOW POVERTY IN MARSHALL COUNTY WAS 13% COMPARED TO 12.2% IN IOWA.
PART VI, LINE 5:	CENTRAL IOWA HEALTHCARE IS A SOLE COMMUNITY HOSPITAL AND A RURAL REFERRAL CENTER BY CMS'S DEFINITIONS. THE HOSPITAL IS LOCATED IN A RURAL, MEDICALLY UNDERSERVED AREA AND IS THE ONLY HOSPITAL WITHIN A 30 MILE RADIUS. THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES AND CONTINUALLY IMPROVING SERVICES TO RESPOND TO HEALTH CARE NEEDS. THE HOSPITAL PROVIDES A 24 HOUR EMERGENCY DEPARTMENT, INCLUDING AMBULANCE COVERAGE, AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES, NOR CONTRACTORS, NOR FAMILY MEMBERS THEREOF AND ARE A BROAD CROSS SECTION OF COMMUNITY LEADERS. THE ORGANIZATION PROVIDES AN OPEN MEDICAL STAFF TO ALL QUALIFIED PHYSICIANS, SUBJECT TO THE NORMAL, EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, EMERGENCY DEPARTMENT, AND HEART CATHETERIZATION LAB. THE EXCLUSIVE CONTRACTS ARE NECESSARY TO ASSURE THAT THESE MUCH NEEDED SERVICES ARE PROVIDED IN THIS RURAL MEDICALLY UNDERSERVED COMMUNITY. ALL SURPLUS FUNDS ARE USED TO MEET AND TO RESPOND TO THE HEALTHCARE NEEDS OF THE COMMUNITIES THIS ORGANIZATION SERVES.

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
CENTRAL IOWA HEALTHCARE

Employer identification number
42-0948420

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) MARSHALL COUNTY EMERGENCY MEDICAL SERVICES 1 E MAIN STREET MARSHALLTOWN,IA50158	42-6004936	MARSHALL COUNTY	5,609	GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2014

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	THE ORGANIZATION ISSUES FUNDS DIRECTLY TO THE RECIPIENT ORGANIZATION FOR USE AT ITS DISCRETION.

Schedule I (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1POLLY HINEMAN MDFORMER TRUSTEE/PHYSICIAN	(i) (ii)	168,997 ............................... 0	0 ............................... 0	1,050 ............................... 0	8,450 ............................... 0	1,324 ............................... 0	179,821 ............................... 0	0 ............................... 0
2JOHN C HUGHESPRESIDENT & CHIEF EXECUTIVE OFFICER	(i) (ii)	267,823 ............................... 0	0 ............................... 0	8,684 ............................... 0	13,601 ............................... 0	18,844 ............................... 0	308,952 ............................... 0	0 ............................... 0
3HILARY DOLBEEFORMER V.P. OF FINANCE	(i) (ii)	152,796 ............................... 0	0 ............................... 0	195 ............................... 0	7,681 ............................... 0	7,488 ............................... 0	168,160 ............................... 0	0 ............................... 0
4LIZ ZUERCHERFORMER V.P. OF ADMINISTRATION	(i) (ii)	154,900 ............................... 0	0 ............................... 0	486 ............................... 0	7,944 ............................... 0	19,200 ............................... 0	182,530 ............................... 0	0 ............................... 0
5SADIA ASHRAF-BENSON DOPHYSICIAN	(i) (ii)	234,342 ............................... 0	0 ............................... 0	25,363 ............................... 0	12,967 ............................... 0	1,692 ............................... 0	274,364 ............................... 0	0 ............................... 0
6BONTE GBEMUDU MDPHYSICIAN	(i) (ii)	218,908 ............................... 0	0 ............................... 0	240 ............................... 0	11,185 ............................... 0	15,995 ............................... 0	246,328 ............................... 0	0 ............................... 0
7JOHN MCCUNE MDPHYSICIAN	(i) (ii)	309,589 ............................... 0	11,314 ............................... 0	3,346 ............................... 0	16,316 ............................... 0	21,573 ............................... 0	362,138 ............................... 0	0 ............................... 0
8RONALD TERRILL MDPHYSICIAN	(i) (ii)	229,560 ............................... 0	0 ............................... 0	4,724 ............................... 0	11,718 ............................... 0	16,034 ............................... 0	262,036 ............................... 0	0 ............................... 0
9YARED VAZQUEZ MDPHYSICIAN	(i) (ii)	204,592 ............................... 0	0 ............................... 0	286 ............................... 0	10,501 ............................... 0	20,973 ............................... 0	236,352 ............................... 0	0 ............................... 0
10ROBERT L DOWNEYFORMER CHIEF FINANCIAL OFF	(i) (ii)	0 ............................... 0	0 ............................... 0	201,246 ............................... 0	0 ............................... 0	12,501 ............................... 0	213,747 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 4A	THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT OR CHANGE OF CONTROL PAYMENT IN TAX YEAR 2014: ROBERT L. DOWNEY - $197,431. THIS AMOUNT IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS IN THIS ENTITY SHALL BE BONA FIDE CITIZENS OF THE AREA SERVED BY THIS HOSPITAL WHO ARE AT LEAST 18 YEARS OF AGE AND WHO HAVE PAID THEIR ANNUAL DUES.
FORM 990, PART VI, SECTION A, LINE 7A	AN ANNUAL MEETING IS HELD IN WHICH THE AGENDA INCLUDES ELECTION OF TRUSTEES. PROXY VOTES MAY BE CAST BY ELIGIBLE MEMBERS WHO ARE UNABLE TO ATTEND THE MEETING. THE BOARD MEMBERSHIP SHALL INCLUDE MEMBERS FROM THE COMMUNITIES THAT ARE SERVED BY CENTRAL IOWA HEALTHCARE.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 AND ALL RELATED SCHEDULES AND SUPPLEMENTAL INFORMATION ARE EMAILED TO THE BOARD FOR A REVIEW PERIOD AND ALL QUESTIONS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE CONFLICT OF INTEREST POLICY REQUIRES ANNUAL CERTIFICATION THAT EACH TRUSTEE HAS THE CONFLICT OF INTEREST POLICY, THAT THEY HAVE A COPY OF THE SECTION OF THE ORGANIZATIONAL BY-LAWS THAT DISCUSSES CONFLICTS OF INTEREST, AND THAT THEY AGREE TO COMPLY WITH THE POLICY. THE EXECUTIVE ASSISTANT TO THE PRESIDENT IS ASSIGNED TO ENSURE THAT ALL RECIPIENTS ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY. THE DIRECTOR OF ACCOUNTING/FINANCE REVIEWS THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE IF A CONFLICT DOES EXIST. IF A POTENTIAL CONFLICT IS DISCLOSED, THE INDIVIDUAL IS ALLOWED TO MAKE A PRESENTATION CONCERNING THE PROPOSED TRANSACTION BUT IS THEN ASKED TO LEAVE THE ROOM WHILE FURTHER DISCUSSION TAKES PLACE AND THE REST OF THE BOARD DETERMINES WHETHER OR NOT TO ENTER THE TRANSACTION.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT BOARD MEMBERS WHO MEET MULTIPLE TIMES PER YEAR TO REVIEW THE IOWA HOSPITAL ASSOCIATION'S WAGE SURVEY DATA. THE COMMITTEE RECOMMENDS CHANGES BASED ON SURVEY COMPARISONS AND ANNUAL PERFORMANCE EVALUATIONS. THE RECOMMENDATIONS ARE PRESENTED TO THE FULL BOARD. NO INCREASES WERE GIVEN IN THE CURRENT YEAR.
FORM 990, PART VI, SECTION C, LINE 19	NO DOCUMENTS MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11G	ER FEES: PROGRAM SERVICE EXPENSES 2,141,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,141,316. ANESTHESIA FEES: PROGRAM SERVICE EXPENSES 2,280,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,280,000. CARDIOLOGY FEES: PROGRAM SERVICE EXPENSES 220,620. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 220,620. HOSPITALIST FEES: PROGRAM SERVICE EXPENSES 1,561,696. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,561,696. ENT FEES: PROGRAM SERVICE EXPENSES 75,568. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,568. ORTHO FEES: PROGRAM SERVICE EXPENSES 1,125,241. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,125,241. PEDIATRIC CALL FEES: PROGRAM SERVICE EXPENSES 175,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,200. SURGICAL CALL FEES: PROGRAM SERVICE EXPENSES 194,025. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 194,025. ORTHO CALL FEES: PROGRAM SERVICE EXPENSES 225,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 225,000. PATHOLOGY FEES: PROGRAM SERVICE EXPENSES 150,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,000. OTHER PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 154,225. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,225. CLINICAL ENGINEERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 240,561. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 240,561. UTILIZATION REVIEW SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 189,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189,967. PURCHASED SERVICE FEES: PROGRAM SERVICE EXPENSES 1,092,962. MANAGEMENT AND GENERAL EXPENSES 147,255. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,240,217. DIAG IMAGING SERVICE FEES: PROGRAM SERVICE EXPENSES 909,899. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 909,899. CATH LAB SERVICE FEES: PROGRAM SERVICE EXPENSES 80,841. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,841. LAB SERVICE FEES: PROGRAM SERVICE EXPENSES 88,249. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 88,249. BILLING SERVICE AND COLLECTION FEES: PROGRAM SERVICE EXPENSES 311,704. MANAGEMENT AND GENERAL EXPENSES 632,841. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 944,545. STAFFING SERVICE FEES: PROGRAM SERVICE EXPENSES 4,248,453. MANAGEMENT AND GENERAL EXPENSES 51,153. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,299,606.
FORM 990, PART XI, LINE 9:	CHANGE IN INTEREST IN NET ASSETS OF CENTRAL IOWA HEALTHCARE FOUNDATION -2,615.
FORM 990, PART XII, LINE 2C:	THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR.
FORM 990, PART VI, SECTION B, LINE 16B	WHILE CENTRAL IOWA HEALTHCARE DID NOT HAVE A WRITTEN POLICY OR PROCEDURE IN PLACE TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS IN THE FISCAL YEAR-ENDED OCTOBER 31, 2015, THE ORGANIZATION IS CURRENTLY DEVELOPING SUCH POLICIES AND PROCEDURES AND PLANS TO HAVE THEM IN PLACE PRIOR TO THE YEAR-ENDING OCTOBER 31, 2016.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CENTRAL IOWA HEALTHCARE

Employer identification number

42-0948420

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CENTRAL IOWA PHYSIO LLC 4714 GETTYSBURG ROAD MECHANICSBURG,PA17055 36-4799633	PHYSICAL THERAPY REHABILITATION	IA	CENTRAL IOWA HEALTHCARE	RELATED	58,136	583,136		No			No	50.000 %
(2) MARSHALLTOWN MOB 1 MANAGING MEMBER LLC 4706 BROADWAY SUITE 240 KANSAS CITY,MO64112 46-4821701	REAL ESTATE	DE	CENTRAL IOWA HEALTHCARE	RELATED	195,768	3,695,768		No			No	63.390 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CENTRAL IOWA PHYSIO LLC	B	525,000	FAIR MARKET VALUE
(2) CENTRAL IOWA PHYSIO LLC	S	400,000	FAIR MARKET VALUE

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	61,646	61,942
9	Program service revenue (Part VIII, line 2g) .........	67,966,624	57,707,153
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	61,618	92,434
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,312,419	3,309,318
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	70,402,307	61,170,847
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	24,647
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	37,375,001	35,831,927
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	34,790,295	44,106,586
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	72,165,296	79,963,160
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,762,989	-18,792,313
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	71,123,105	102,694,171
21	Total liabilities (Part X, line 26).............	15,212,072	65,572,738
22	Net assets or fund balances. Subtract line 21 from line 20.....	55,911,033	37,121,433

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 57,040,558 including grants of $ 24,647 ) (Revenue $ 58,414,389 )
	TO PROVIDE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY AND SURROUNDING COMMUNITIES REGARDLESS OF ABILITY TO PAY. CARE INCLUDES PREVENTION, DIAGNOSIS, TREATMENT, REHABILITATION AND OTHER SERVICES. CENTRAL IOWA HEALTHCARE EXPERIENCED APPROXIMATELY 196,102 OUTPATIENT VISITS; 2,717 ADMISSIONS; 480 BIRTHS; 8,388 PATIENT DAYS; 4,131 SURGICAL PROCEDURES AND 20,671 EMERGENCY ROOM VISITS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses57,040,558

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) LIZ ZUERCHER........................................................................ FORMER V.P. OF ADMINISTRATION	40.00 .......................	X			155,386	0	27,144
(19) SADIA ASHRAF-BENSON DO........................................................................ PHYSICIAN	40.00 .......................		X		259,705	0	14,659
(20) BONTE GBEMUDU MD........................................................................ PHYSICIAN	40.00 .......................		X		219,148	0	27,180
(21) JOHN MCCUNE MD........................................................................ PHYSICIAN	40.00 .......................		X		324,249	0	37,889
(22) RONALD TERRILL MD........................................................................ PHYSICIAN	40.00 .......................		X		234,284	0	27,752
(23) YARED VAZQUEZ MD........................................................................ PHYSICIAN	40.00 .......................		X		204,878	0	31,474
(24) ROBERT L DOWNEY........................................................................ FORMER CHIEF FINANCIAL OFF	40.00 .......................			X	201,246	0	12,501

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,198,441	0	235,987

1	Briefly describe the organization’s mission or most significant activities: TO CREATE AND CONTINUALLY IMPROVE SERVICES THAT RESPOND TO HEALTHCARE NEEDS IN OUR COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	704
6	Total number of volunteers (estimate if necessary) .............	6	250
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b		13,550
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		48,392

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			61,942
			Business Code
2a	NET PATIENT SERVICE REVENUE		621400	57,707,153	57,707,153
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			57,707,153
3	Investment income (including dividends, interest, and other similar amounts).......			14,482			14,482
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	1,907,026
b	Less: rental expenses	1,042,759
c	Rental income or (loss)	864,267
d	Net rental income or (loss).......			864,267			864,267
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		575,660
b	Less: cost or other basis and sales expenses		497,708
c	Gain or (loss)		77,952
d	Net gain or (loss)..........			77,952			77,952
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		119,969
b	Less: cost of goods sold ..b		61,170
c	Net income or (loss) from sales of inventory..			58,799			58,799
Miscellaneous Revenue			Business Code
11a	JOINT VENTURE INCOME		900099	707,236	707,236
b	CAFETERIA INCOME		722514	487,528			487,528
c	ELECTRONIC HEALTH RECORD REVENUE		900099	227,158			227,158
d	All other revenue ....			964,330			964,330
e	Total. Add lines 11a–11d ......			2,386,252
12	Total revenue. See Instructions......			61,170,847	58,414,389	0	2,694,516


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			11,121	1	33,545
2	Savings and temporary cash investments .........			5,807,597	2	2,180,843
3	Pledges and grants receivable, net ...........			34,540	3	38,243
4	Accounts receivable, net .............			16,621,933	4	9,531,074
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............			58,874	7	166,774
8	Inventories for sale or use ..............			2,034,951	8	2,370,281
9	Prepaid expenses and deferred charges ..........			773,462	9	866,305
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	141,838,368
b	Less: accumulated depreciation .....	10b	64,492,878	38,288,768	10c	77,345,490
11	Investments—publicly traded securities ..........			180,119	11	0
12	Investments—other securities. See Part IV, line 11 .....			3,500,000	12	3,695,768
13	Investments—program-related. See Part IV, line 11 .....			1,249,849	13	2,003,395
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			2,561,891	15	4,462,453
16	Total assets. Add lines 1 through 15 (must equal line 34)......			71,123,105	16	102,694,171
17	Accounts payable and accrued expenses .........			7,312,736	17	16,042,262
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			7,899,336	23	49,530,476
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................				25
26	Total liabilities. Add lines 17 through 25.........			15,212,072	26	65,572,738
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			54,422,234	27	35,579,968
28	Temporarily restricted net assets ...........			1,488,799	28	1,541,465
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			55,911,033	33	37,121,433
34	Total liabilities and net assets/fund balances ........			71,123,105	34	102,694,171