Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
ST LUKE'S METHODIST HOSPITAL
 
 
Doing business as
ST LUKE'S HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
1026 A AVENUE NE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CEDAR RAPIDS, IA52402
D Employer identification number

42-0504780
E Telephone number

G Gross receipts $ 386,793,453
F Name and address of principal officer:
THEODORE E TOWNSEND JR
1026 A AVENUE NE
CEDAR RAPIDS,IA52402
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.UNITYPOINT.ORG/CEDARRAPIDS
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1903
M State of legal domicile: IA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO GIVE THE HEALTHCARE WE'D LIKE OUR LOVED ONES TO RECEIVE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 17
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 3,453
6 Total number of volunteers (estimate if necessary) ............. 6 953
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 420,511
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 94,174
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,467,847 4,937,901
9 Program service revenue (Part VIII, line 2g) ......... 355,624,988 357,078,950
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 8,589,640 7,990,488
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,870,850 3,120,500
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 369,553,325 373,127,839
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 19,863,319 24,259,763
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) 155,134,149 174,876,555
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 175,490,773 158,869,656
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 350,488,241 358,005,974
19 Revenue less expenses. Subtract line 18 from line 12....... 19,065,084 15,121,865
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 443,835,662 452,121,735
21 Total liabilities (Part X, line 26)............. 150,822,037 147,534,542
22 Net assets or fund balances. Subtract line 21 from line 20..... 293,013,625 304,587,193
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: THE MISSION OF ST. LUKE'S METHODIST HOSPITAL IS TO GIVE THE HEALTHCARE WE'D LIKE OUR LOVED ONES TO RECEIVE. OUR STRATEGIC FRAMEWORK IS BUILT UPON THESE PILLARS: 1. DEMONSTRABLY BETTER QUALITY IN OUR PATIENT CARE. WE STRIVE TO PROVIDE THE BEST POSSIBLE HEALTHCARE SERVICE TO OUR PATIENTS AND THEIR FAMILIES. OUR SERVICES ARE ACCESSIBLE TO ALL PERSONS REGARDLESS OF RACE, RELIGION, GENDER OR ABILITY TO PAY.2. ST. LUKE'S IS COMMITTED TO BEING THE WORKSHOP OF CHOICE FOR PHYSICIANS WHO PRACTICE IN OUR HOSPITAL.3. ST. LUKE'S IS COMMITTED TO PARTNERING WITH ALL PERSONNEL, WHO TOGETHER MAKE UP THE BOARD OF DIRECTORS, MEDICAL STAFF, VOLUNTEERS, EMPLOYEES AND STUDENTS WHICH RESULTS IN PERSONAL SATISFACTION, RECOGNITION, ACHIEVEMENT AND COMMITMENT.4. ST. LUKE'S IS COMMITTED TO STRENGTHENING OUR CORE SERVICES TO RENDER THE HIGHEST QUALITY OF HEALTHCARE.5. ST. LUKE'S IS COMMITTED TO BEING A REGIONAL RESOURCE FOR EASTERN IOWANS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 281,802,472 including grants of $ 17,562,326 ) (Revenue $ 358,154,086 )
HEALTH CARE SERVICES:ST. LUKE'S METHODIST HOSPITAL IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE CEDAR RAPIDS COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE, AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT.ST. LUKE'S METHODIST HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, HOME HEALTH, INTENSIVE CARE AND CRITICAL CARE, MENTAL HEALTH CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, SKILLED NURSING, BEHAVIORAL DISORDER PROGRAMS, MATERNAL/CHILD CARE, LABORATORY, PALLIATIVE CARE, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2015, ST. LUKE'S METHODIST HOSPITAL ADMITTED 18,367 PATIENTS RESULTING IN A TOTAL OF 82,594 PATIENT DAYS. OUTPATIENT VISITS TOTALED 567,254 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS, INCLUDING THE DIGESTIVE HEALTH CENTER, FOR THE SAME PERIOD WERE 17,897. THERE WERE ALSO 53,539 EMERGENCY ROOM VISITS AND 2,532 BABIES DELIVERED.
4b (Code:   ) (Expenses $ 28,211,692 including grants of $ 6,697,437 ) (Revenue $ 0 )
COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: ST. LUKE'S METHODIST HOSPITAL PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE TO PEOPLE AT A VALUE OF $1,459,119 IN 2015. OFTENTIMES, ST. LUKE'S METHODIST HOSPITAL RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. ST. LUKE'S METHODIST HOSPITAL PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. ST. LUKE'S METHODIST HOSPITAL'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $13,587,221 FOR 2015. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $15,046,340.OTHER BENEFITS: ST. LUKE'S METHODIST HOSPITAL PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. ST. LUKE'S METHODIST HOSPITAL COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. ST. LUKE'S METHODIST HOSPITAL HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. APPROXIMATELY 33,094 PERSONS WERE SERVED THROUGH THESE PROGRAMS. TOTAL OTHER BENEFITS REPORTED VALUE: $13,165,352.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet310,014,164
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,453
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
22
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
17
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletB LANNIE CHECKETTS SR VP FINCFO1026 A AVENUE NE   CEDAR RAPIDS,IA52402 (319) 369-7796
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) KARL CASSELL......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(2) STEVEN CAVES......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(3) TERRI CHRISTOFFERSEN......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 13,742 0
(4) GREGORY CHURCHILL......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(5) LEE CLANCEY......................................................................
BOARD VICE CHAIR
1.00
.................
1.00
X   X       0 0 0
(6) RANDY EASTON......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 15,427 0
(7) SALLY GRAY......................................................................
BOARD CHAIR
1.00
.................
1.00
X   X       0 10,160 0
(8) ANNE GRUENEWALD......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(9) VICTOR HAMRE......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(10) JOHN HERRING MD......................................................................
BOARD SECRETARY
1.00
.................
1.00
X   X       0 0 0
(11) KATHLEEN MINETTE......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(12) ROBIN MIXDORF......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(13) DOUG OLSON......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(14) WILLIAM PROWELL......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(15) AMY REASNER......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(16) P JAMES RENZ MD......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
(17) MARCIA ROGERS......................................................................
BOARD MEMBER
1.00
.................
1.00
X           0 0 0
Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) BRIAN SCOTT........................................................................
BOARD MEMBER
1.00
.......................1.00
X           0 0 0
(19) CHRIS SKOGMAN........................................................................
BOARD MEMBER
1.00
.......................1.00
X           0 0 0
(20) MICK STARCEVICH........................................................................
BOARD MEMBER
1.00
.......................1.00
X           0 0 0
(21) THEODORE TOWNSEND JR........................................................................
BOARD MEMBER & PRESIDENT/CEO
40.00
.......................1.00
X   X       684,993 0 173,593
(22) STEVEN WAHLE MD........................................................................
BOARD MEMBER
1.00
.......................1.00
X           0 0 0
(23) MILTON AUNAN II TO 1115........................................................................
SENIOR VP FINANCE/CFO
40.00
.......................1.00
    X       493,023 19,487 24,530
(24) B LANNIE CHECKETTS FR 1215........................................................................
SENIOR VP FINANCE/CFO
40.00
.......................1.00
    X       14,575 0 1,668
(25) MICHELLE NIERMANN........................................................................
SENIOR VP/COO
40.00
.......................1.00
    X       442,406 0 79,114
(26) MARGARET M BRADKE........................................................................
VP POST-ACUTE SVCS
40.00
.......................0.00
      X     217,309 0 28,710
(27) MICHAEL EASLEY........................................................................
ADM DIR, FAC, PLNG & OPER
40.00
.......................0.00
      X     185,835 0 32,013
(28) CARMEN KLEINSMITH........................................................................
VP NURSING EXCELLENCE
40.00
.......................0.00
      X     217,593 0 33,465
(29) JOSEPH LINN........................................................................
VP OPERATIONS
40.00
.......................0.00
      X     205,270 0 31,718
(30) MARY ANN OSBORN........................................................................
SENIOR VP/CCO
40.00
.......................0.00
      X     422,616 0 109,496
(31) PEGGY PICKERING........................................................................
DIR SURGICAL SVCS
40.00
.......................0.00
      X     158,427 0 31,469
(32) RITU BANSAL BDS MS........................................................................
DIR DENTAL HEALTH CENTER
40.00
.......................0.00
        X   156,983 0 8,063
(33) SHERYL BREHM........................................................................
PHARMACIST
40.00
.......................0.00
        X   154,661 0 25,400
(34) THOMAS HANSEN MD........................................................................
PHYSICIAN-PSYCHOLOGY
40.00
.......................0.00
        X   174,050 0 8,592
(35) PATRICK THIES........................................................................
ADM DIR. MED. AFFAIRS/PHARM SVCS
40.00
.......................0.00
        X   186,131 0 30,646
(36) LORI WEIH........................................................................
DIR REG. OSC/CONTINUUM STRATEGY
40.00
.......................0.00
        X   167,806 0 30,654
(37) TODD LANGAGER MD TO 1213........................................................................
FORMER PRESIDENT (CLC)
0.00
.......................40.00
          X 0 473,076 41,501
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 3,881,678 531,892 690,632
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet97
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
MR ASSOCIATES

PO BOX 2686
CEDAR RAPIDS,IA52406
MR SERVICES 2,006,497
ARAMARK MANAGEMENT SERVICES

24863 NETWORK PLACE
CHICAGO,IL60673
MANAGEMENT SERVICES 1,792,309
CLINICAL PATHOLOGY CONSULTANTS

1026 A AVE NE
CEDAR RAPIDS,IA52402
PATHOLOGY SERVICES 1,325,000
PHYSICIANS CLINIC OF IOWA

202 10TH STREET SE
CEDAR RAPIDS,IA52402
PHYSICIAN SERVICES 1,284,190
GRAHAM CONSTRUCTION CO INC

421 GRAND AVE
DES MOINES,IA50309
CONSTRUCTION SERVICES 1,115,906
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet80
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 1,286,521
e Government grants (contributions)1e 909,688
f All other contributions, gifts, grants, and similar amounts not included above1f 2,741,692
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 4,937,901
 Program Service RevenueAmt Business Code
2a NET PATIENT REVENUE 900099 259,784,030 259,784,030    
b PHARMACY REVENUE 446110 81,176,381 77,127,566   4,048,815
c RENTAL INCOME 531100 5,020,417 5,020,417    
d MGMT & SUPPORT SVCS 561000 4,853,787 4,742,078 111,709  
e SUBS & JOINT VENTURES 900099 4,415,779 4,337,795 77,984  
f All other program service revenue. 1,828,556 1,831,180 -2,624  
g Total.Add lines 2a–2f.....MediumBullet 357,078,950
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 4,399,376     4,399,376
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 577,526 16,013,941
b Less: cost or other basis and sales expenses 626,998 12,373,357
c Gain or (loss) -49,472 3,640,584
d Net gain or (loss).....MediumBullet 3,591,112     3,591,112
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a 128,991
b Less: direct expenses ...b 128,618
c Net income or (loss) from fundraising events..MediumBullet 373   373
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..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a 593,325
b Less: cost of goods sold ..b 536,641
c Net income or (loss) from sales of inventory..MediumBullet 56,684     56,684
Business Code Miscellaneous Revenue
11a CAFETERIA/FOOD SVCS 722210 1,988,307     1,988,307
b MISCELLANEOUS REVENUE 900099 1,075,136 841,694 233,442  
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 3,063,443
12 Total revenue. See Instructions......MediumBullet 373,127,839 353,684,760 420,511 14,084,667
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
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 24,174,892 24,174,892
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 84,871 84,871
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 3,563,643   3,563,643  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 288,737   288,737  
7 Other salaries and wages 138,456,230 118,465,120 19,991,110  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 7,478,379 6,402,356 1,076,023  
9 Other employee benefits ....... 16,046,781 13,750,051 2,296,730  
10 Payroll taxes ........... 9,042,785 7,718,957 1,323,828  
11 Fees for services (non-employees):        
a Management ...... 32,248,670 20,872,138 11,376,532  
b Legal ......... 956,725 60,984 895,741  
c Accounting ...........        
d Lobbying ........... 403   403  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 1,801,875 988,363 813,512  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 21,204,287 17,503,883 3,700,404  
12 Advertising and promotion .... 1,386,076 799,936 586,140  
13 Office expenses ....... 8,312,087 7,233,677 1,078,410  
14 Information technology ...... -1,444,235 -1,444,235    
15 Royalties ..        
16 Occupancy ........... 14,217,693 13,983,100 234,593  
17 Travel ............ 880,501 653,832 226,669  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 306,029 165,892 140,137  
20 Interest ........... 5,293,253 5,293,253    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 15,470,609 15,537,661 -67,052  
23 Insurance ... 823,816 823,816    
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 59,722,220 59,474,739 247,481  
b BAD DEBT EXPENSE 340,344 340,344    
c INCOME TAXES 8,433 2,841 5,592  
d MISCELLANEOUS EXPENSE -2,659,130 -2,872,307 213,177  
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 358,005,974 310,014,164 47,991,810 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 13,015,048 1 17,780,578
2 Savings and temporary cash investments ......... 5,409,700 2 7,158,469
3 Pledges and grants receivable, net ...... 177,533 3  
4 Accounts receivable, net ............. 50,820,328 4 49,621,336
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 .... 10,682,307 7 12,893,380
8 Inventories for sale or use ........ 6,554,074 8 7,534,601
9 Prepaid expenses and deferred charges ...... 1,750,067 9 1,744,809
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 334,428,736
b Less: accumulated depreciation 10b 189,327,523 144,902,727 10c 145,101,213
11 Investments—publicly traded securities . 164,430,497 11 164,306,262
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .. 46,093,381 13 45,385,416
14 Intangible assets ............... 0 14 595,671
15 Other assets. See Part IV, line 11 ...........   15  
16 Total assets. Add lines 1 through 15 (must equal line 34)... 443,835,662 16 452,121,735
Liabilities 17 Accounts payable and accrued expenses ..... 29,919,005 17 30,027,642
18 Grants payable ...   18  
19 Deferred revenue ......... 287,800 19 175,740
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 ..   23 581
24 Unsecured notes and loans payable to unrelated third parties .. 1,349,186 24 1,965,115
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 119,266,046 25 115,365,464
26 Total liabilities. Add lines 17 through 25.. 150,822,037 26 147,534,542
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 258,103,178 27 269,426,870
28 Temporarily restricted net assets ........... 15,983,118 28 16,382,662
29 Permanently restricted net assets 18,927,329 29 18,777,661
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 293,013,625 33 304,587,193
34 Total liabilities and net assets/fund balances ........ 443,835,662 34 452,121,735
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
373,127,839
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
358,005,974
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
15,121,865
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
293,013,625
5
Net unrealized gains (losses) on investments ...............
5
-7,465,340
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
3,917,043
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
304,587,193
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
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.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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.  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2015

Schedule A (Form 990 or 990-EZ) 2015
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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
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
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
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.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) 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.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
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
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
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
 
 
Section B. Type I Supporting Organizations
Yes
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
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 2015 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-2015
(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2016. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
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) 2015


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......... 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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number
42-0504780
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


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2015)

Additional Data


Software ID:  
Software Version:  
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 BulletInformation about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
If the organization answered "Yes" on 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" on 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" on 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
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ......................................................................................................................SchCMd Bullet
$  
3
Volunteer hours .............................................................................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

Schedule C (Form 990 or 990-EZ) 2015
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(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? ..............................................................................................................

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) 2012 (b) 2013 (c) 2014 (d) 2015 (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) 2015


Schedule C (Form 990 or 990-EZ) 2015
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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
403
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
 
No
 
j
Total. Add lines 1c through 1i ....................................................................................................
403
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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: FEES PAID FOR LOBBYING FOR HOSPITAL-RELATED ISSUES.
Schedule C (Form 990 or 990EZ) 2015


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on 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
2015
Open to Public Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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 ....    
5
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? ...........
6
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? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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" on Form 990, Part IV, line 8.
1a
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.
b
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 on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
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" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 6,477,403 6,044,744 5,562,297 4,994,969 4,843,994
b Contributions ...          
c Net investment earnings, gains, and losses 24,063 448,736 497,592 584,096 182,201
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
17,525 15,199 14,398 16,115 30,735
f Administrative expenses .... 689 878 747 653 491
g End of year balance ...... 6,483,252 6,477,403 6,044,744 5,562,297 4,994,969
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet93.280 %
b
Permanent endowment SchDMd Bullet1.150 %
c
Temporarily restricted endowment SchDMd Bullet5.570 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
No
(ii) related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
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' on 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 ...   17,957,673 17,957,673
b Buildings   129,474,863 71,062,391 58,412,472
c Leasehold improvements        
d Equipment ...   179,978,580 116,574,680 63,403,900
e Other ...   7,017,620 1,690,452 5,327,168
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 145,101,213
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on 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    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on 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
(1)AFFORDABLE HOUSE NETWORK-BOND ENDENTURE 83,333 C
(2)BENEFICIAL INTEREST IN ST. LUKE'S HEALTH CARE FOUNDATION 34,085,793 F
(3)EASTERN IOWA SLEEP CENTER, LLC 407,075 C
(4)HEALTHNET CONNECT, LC 100 C
(5)HONEYMAN DIALYSIS, LLC 91,653 C
(6)IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC 5,000 C
(7)MR ASSOCIATES, LLP 418,884 C
(8)PCI LENDER, LLC 342,469 C
(9)PCI REGIONAL MEDICAL MALL, LLC 575,670 C
(10)ST. LUKE'S-COE STEAM, INC. 333,135 C
(11)STL HEALTH RESOURCES CO 5,077,020 C
(12)THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC 3,920,284 C
(13)UNITYPOINT AT WORK 45,000 C
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 45,385,416
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
DUE TO AFFILIATES 15,872,103
ASBESTOS REMOVAL LIABILITY 1,076,681
LONG-TERM RETENTION INCENTIVES 3,268,370
IOWA HEALTH SYSTEM NOTE PAYABLE 73,438,989
SELF-INSURANCE RESERVE 7,408,400
DEFINED BENEFIT RETIREMENT PLAN L 13,638,041
CONTINGENCY LIABILITY 662,880
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 115,365,464
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) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 362,978,000
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a -7,458,062
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 767,000
e Add lines 2a through 2d ..................... 2e -6,691,062
3 Subtract line 2e from line 1.................. 3 369,669,062
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 400,378
b Other (Describe in Part XIII.) ........... 4b 3,058,399
c Add lines 4a and 4b.................... 4c 3,458,777
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 373,127,839
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 333,627,000
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 536,641
e Add lines 2a through 2d.................... 2e 536,641
3 Subtract line 2e from line 1................... 3 333,090,359
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 400,378
b Other (Describe in Part XIII.) ............ 4b 24,515,237
c Add lines 4a and 4b..................... 4c 24,915,615
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 358,005,974

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 V, LINE 4: THE ORGANIZATION RETAINS FUNDS FOR INTENDED FUTURE USES, INCLUDING PURCHASE OF EQUIPMENT, INDIGENT CARE, FUNDING OF MISSION RELATED OPERATIONS, AND HEALTH EDUCATION. IN ADDITION, SOME FUNDS ARE HELD FOR INVESTMENT IN PERPETUITY.
PART X, LINE 2: UNITYPOINT HEALTH AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) AND 501(C)(2) OF THE INTERNAL REVENUE CODE (THE CODE). TAX-EXEMPT ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME AS DESCRIBED UNDER PROVISIONS OF SECTION 511 OF THE CODE. THE SYSTEM FILES FORM 990 FOR SUBSTANTIALLY ALL OF ITS OPERATING ENTITIES IN THE U.S. FEDERAL JURISDICTION AND IS NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES FOR THE YEARS BEFORE 2012. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL.
PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 536,641. ROUNDING 8. SUBSIDIARY ELIMINATING ENTRIES (MEDLABS OF EASTERN IOWA, LC) 222,811. SUBSIDIARY ELIMINATING ENTRIES (CARDIOLOGISTS, LC) 7,540.
PART XI, LINE 4B - OTHER ADJUSTMENTS: IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC PURCHASE REBATES 1,286,521. REVENUES IN UNRESTRICTED FUND BALANCE 1,514,724. REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 257,154.
PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 536,641.
PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 23,211,685. IOWA HEALTH SYSTEM CONTRACTING SERVICES, LC PURCHASE REBATES 1,286,521. ROUNDING 364. FORGIVENESS OF AMOUNTS OWED FROM AFFORDABLE HOUSING NETWORK 16,667.
Schedule D (Form 990) 2015


Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Part I
Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser)
(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2015
Schedule G (Form 990 or 990-EZ) 2015
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.




VerticalRevenue
(a) Event #1

BOOK SALE
(event type)
(b) Event #2

FOLLIES SALE
(event type)
(c) Other events

5
(total number)
(d) Total events
(add col. (a) through col. (c))

1

Gross receipts . . . . .

28,603

65,554

34,834

128,991

2

Less: Contributions . . . .

0

0

0

 
3 Gross income (line 1 minus
line 2) . . . . . .

28,603

65,554

34,834

128,991



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . .        
6 Rent/facility costs . . . .        
7 Food and beverages . . .        
8 Entertainment . . . .        
9 Other direct expenses . . . 31,055 74,035 23,528 128,618
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 128,618
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow 373
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo
(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1

Gross revenue . . . . .

 

 

 

 
VerticalDirectExpenses

2

Cash prizes . . . . .

 

 

 

 

3

Noncash prizes . . . .

 

 

 

 

4

Rent/facility costs . . . .

 

 

 

 

5

Other direct expenses . . .

31,055

74,035

23,528

128,618


6


Volunteer labor . . . .
%
%
%


7

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

 

8

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2015
Schedule G (Form 990 or 990-EZ) 2015
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2015
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on 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
2015
Open to Public Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . .
    1,459,119 0 1,459,119 0.410 %
b Medicaid (from Worksheet 3, column a) . . . . .   17,709 58,969,376 45,382,155 13,587,221 3.800 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0    
d Total Financial Assistance and Means-Tested Government Programs . . . . .   17,709 60,428,495 45,382,155 15,046,340 4.210 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   30,064 849,261 36,719 812,542 0.230 %
f Health professions education (from Worksheet 5) . . .   677 3,394,921 359,922 3,034,999 0.850 %
g Subsidized health services (from Worksheet 6) . . . .     13,105,184 10,675,329 2,429,855 0.680 %
h Research (from Worksheet 7) .     1,372 0 1,372 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .   2,353 14,101,019 7,214,435 6,886,584 1.930 %
j Total. Other Benefits . .   33,094 31,451,757 18,286,405 13,165,352 3.690 %
k Total. Add lines 7d and 7j .   50,803 91,880,252 63,668,560 28,211,692 7.900 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(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            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,711,048
3
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. ......
3
0
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
78,656,747
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
98,398,315
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-19,741,568
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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 %
11 MEDLABS OF EASTERN IOWA LC
 
LABORATORY SERVICES 100.000 %   0 %
22 THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC
 
AMBULATORY SURGERY CENTER 50.000 %   50.000 %
33 MR ASSOCIATES LLP
 
PURCHASE, OWN & OPERATE MOBILE & FIXED-BASED MRI UNITS 33.330 %   33.330 %
44 EASTERN IOWA SLEEP CENTER LLC
 
PROVIDE SLEEP STUDIES 33.330 %   33.330 %
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 ST LUKE'S METHODIST HOSPITAL
1026 A AVENUE NE
CEDAR RAPIDS,IA524023026
WWW.UNITYPOINT.ORG/CEDARRAPIDS
570066H
X X   X     X      
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 4
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)
ST LUKE'S METHODIST HOSPITAL
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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 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 ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2015
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
ST LUKE'S METHODIST HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
UNITYPOINT.ORG/CEDARRAPIDS/FINANCIAL-ASSISTANCE
b
UNITYPOINT.ORG/CEDARRAPIDS/FINANCIAL-ASSISTANCE
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

ST LUKE'S METHODIST HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 7
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
ST. LUKE'S METHODIST HOSPITAL PART V, SECTION B, LINE 5: THE TARGET AREA FOR THE ASSESSMENT INCLUDED AN EIGHT COUNTY REGION OF LINN COUNTY AND SEVEN OF ITS CONTIGUOUS COUNTIES (BUCHANAN, DELAWARE, BENTON, JONES, IOWA, JOHNSON AND CEDAR). PUBLIC HEALTH AND HOSPITAL REPRESENTATIVES FROM EACH COUNTY WERE INVITED TO SERVE ON A STEERING COMMITTEE TO HELP GUIDE THE CHNA PROCESS FROM START TO FINISH. SPECIAL ATTENTION WAS PAID TO RECRUITING DIVERSE SUBSETS OF THE POPULATION TO HELP ACCURATELY IDENTIFY THE MOST CRITICAL ISSUES IN THE AREA. A LIST OF ALL THE CONTRIBUTORS FOR EACH STEP IN THE PROCESS IS AVAILABLE BY REQUEST.
ST. LUKE'S METHODIST HOSPITAL PART V, SECTION B, LINE 6A: IN ADDITION TO ST. LUKE'S HOSPITAL, ST. LUKE'S CARE COMPANY (CONTINUING CARE HOSPITAL) AND JONES REGIONAL MEDICAL CENTER, THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITALS: MERCY MEDICAL CENTER, VIRGINIA GAY HOSPITAL, AND REGIONAL MEDICAL CENTER.PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH STEERING COMMITTEE MEMBERS FROM THE FOLLOWING ORGANIZATIONS: CEDAR COUNTY, BENTON COUNTY PUBLIC HEALTH, COMMUNITY HEALTH FREE CLINIC, HACAP, HIS HANDS FREE CLINIC, JOHNSON COUNTY PUBLIC HEALTH, JONES REGIONAL MEDICAL CENTER, LINN COMMUNITY CARE, LINN COUNTY PUBLIC HEALTH, MERCY MEDICAL CENTER, REGIONAL MEDICAL CENTER, ST. LUKE'S HOSPITAL, UNITED WAY OF EAST CENTRAL IOWA, AND VIRGINIA GAY HOSPITAL.
ST. LUKE'S METHODIST HOSPITAL PART V, SECTION B, LINE 11: ST. LUKE'S METHODIST HOSPITAL, ST. LUKE'S CARE COMPANY (CONTINUING CARE HOSPITAL) AND JONES REGIONAL MEDICAL CENTER ARE ADDRESSING THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT BY CONTINUING TO MAKE PROGRESS ON AND MEETING THE OBJECTIVES IDENTIFIED IN THEIR RESPECTIVE PLANS. MANY OBJECTIVES THAT WE IDENTIFIED AND ARE IMPLEMENTING GET SPREAD ACROSS OUR REGION THAT INCLUDES ALL THREE ENTITIES, HOWEVER, WE WOULD LIKE TO HIGHLIGHT A FEW SPECIFIC TO THE SITES.OBESITY: ST. LUKE'S METHODIST HOSPITAL AND CONTINUING CARE HOSPITAL HELD HEALTHY EATING PROMOTION PROGRAMS INCLUDING COOKING WITH THE CARDIOLOGIST. WE ARE A BLUE ZONE WORKSITE. IN ADDITION, UNITYPOINT CLINICS HAVE BEEN ROLLING OUT PATIENT CENTERED MEDICAL HOMES WHICH HELP PATIENTS WITH HEALTHY EATING. THE MAJORITY OF CLINICS WILL HAVE MOVED TO THIS MODEL AND HAVE RECEIVED DESIGNATION AS SUCH. THESE CLINICS ALSO ARE IN THE JONES COUNTY AREA. STAFF ACROSS THE CONTINUUM WERE ALSO TRAINED IN CHRONIC DISEASE MANAGEMENT IN 2014 AND 2015 TO SUPPORT OUR PATIENTS ON IDENTIFYING THEIR GOALS, MOTIVATIONAL INTERVIEWING AND SIGNS AND SYMPTOMS IF THEY HAVE A CONDITION. THIS IS NOW AN ONGOING PART OF ORIENTATION FOR APPLICABLE TEAM MEMBERS.CANCER: ST. LUKE'S METHODIST HOSPITAL AND CONTINUING CARE HOSPITAL HAVE OFFERED FOUR COMMUNITY CANCER PREVENTION PROGRAMS IN THE AREAS OF LUNG CANCER SCREENING/PREVENTION, SKIN CANCER PREVENTION, ORAL/HEAD AND NECK SCREENING. WE HAVE INCREASED THE NUMBER OF INDIVIDUALS RECEIVING A LUNG CHECK TO SCREEN FOR LUNG CANCER AND ASSOCIATED RISK FACTORS FROM 120 IN 2015 COMPARED TO 13 IN 2014. WE HAVE COLLABORATED WITH AREA HIGH SCHOOLS TO DEVELOP AND IMPLEMENT A VERY SUCCESSFUL SKIN CANCER PREVENTION SOCIAL MARKETING CAMPAIGN. WE HAD A 2015 FREE MAMMOGRAPHY AND PAP EVENT IN COLLABORATION WITH COMMUNITY PARTNERS WHERE WE PROVIDED FOR WOMEN AGE 40-64 WITH NO MEDICAL INSURANCE QUALIFY INCOME GUIDELINES DO APPLY. ALL PATIENTS WERE SIGNED UP FOR THE CARE FOR YOURSELF AND ESPECIALLY FOR YOU PROGRAMS WITH LINN COUNTY PUBLIC HEALTH, RECEIVED INFORMATION REGARDING INSURANCE SIGN UP AND ACCESS TO OTHER SERVICES BY EASTERN IOWA HEALTH CENTER. NINETEEN TOTAL INDIVIDUALS WERE SEEN WITH 19 CBE AND MAMMOGRAMS PERFORMED WITH 9 PAP TESTS PERFORMED.SUBSTANCE ABUSE: ST. LUKE'S METHODIST HOSPITAL AND CONTINUING CARE HOSPITAL THROUGH THE ST. LUKE'S PHARMACY DEPARTMENT HAS SUPPORTED THE NATIONAL PRESCRIPTION DRUG TAKE-BACK DAYS BY PROVIDING SIGNAGE IN THE HALLWAYS, COMMUNICATION WITH OUR ASSOCIATES, AND ADDITIONAL BROCHURES ON LOCATIONS TO TAKE-BACK MEDICATIONS. WE HAVE REPRESENTATION ON THE LINN COUNTY COALITION FOR SAFE AND HEALTHY COMMUNITIES, A COALITION THAT MEETS MONTHLY TO SUPPORT DRUG FREE COMMUNITIES. TO SUPPORT TOBACCO CESSATION, OUR HEALTH PROMOTIONS TEAM CONTACTED AND FOLLOWED 117 PATIENTS. OF THESE 117 PATIENTS, 53 WERE ENROLLED IN QUITLINE IOWA. IN ADDITION, OUR PATIENT CENTERED MEDICAL HOMES REFERRED AND CONTINUE TO REFER PEOPLE TO QUITLINE IOWA. AT THIS TIME, WE DON'T HAVE THE TOTAL NUMBER REFERRED FROM THE PATIENT CENTERED MEDICAL HOME, DUE TO A RECENT ELECTRONIC HEALTH RECORD CONVERSION, BUT BELIEVE WE HAVE SURPASSED THE GOAL OF 200. WE ARE CURRENTLY WORKING ON AUTOMATIC REFERRAL SYSTEM.MENTAL HEALTH: ST. LUKE'S METHODIST HOSPITAL AND CONTINUING CARE HOSPITAL HAVE BEEN FURTHERING OUR OBJECTIVES TO SUPPORT MENTAL HEALTH NEEDS. IN THE CONTINUING CARE HOSPITAL, WE HAVE PROVIDED EDUCATION TO ALL CLINICAL STAFF AT THE ANNUAL SKILLS FAIR IN OCTOBER 2015. A 2 QUESTIONS DEPRESSION SCREEN HAS BEGUN TO BE COMPLETED ON ADMISSION FOR EACH PATIENT IN THE CONTINUING CARE HOSPITAL AS WELL AS IN ALL UNITYPOINT CLINICS. WE ARE PLANNING TO ROLE THIS OUT IN THE HOSPITAL AS WELL. AN OBJECTIVE OF THE CONTINUING CARE HOSPITAL OFFERS SUPPORT TO PATIENTS AND FAMILIES THROUGH SPIRITUAL CARE DEPARTMENT. A CHAPLAIN TO PROVIDE INITIAL PATIENT VISIT WITHIN 48 BUSINESS HOURS OF ADMISSION AND FOLLOW-UP VISITS ON A WEEKLY BASIS OR AS NEEDED. WHILE MEETING PATIENTS SPIRITUAL CARE NEEDS DOES NOT NECESSARILY MEAN THAT THEIR MENTAL HEALTH NEEDS ARE BEING ADDRESSED, THIS IS AN INDICATOR OF SUPPORT BEING OFFERED TO CCH PATIENTS. BETWEEN SEPT. 2104 AND SEPT. 2015, 80% OF CCH'S GAVE A TOP BOX RATING OF HIGHLY SATISFIED WHEN ASKED IF THEIR SPIRITUAL CARE NEEDS WERE MET DURING THEIR HOSPITAL STAY. WE ENSURE MENTAL HEALTH IS PART OF PATIENT CARE TEAM CONFERENCE DISCUSSIONS AND CARE PLANS FOR ALL PATIENTS FROM JANUARY 2014 TO DECEMBER 2015. THIS IS PART OF THE WEEKLY DISCUSSION AT OUR PATIENT CARE TEAM MEETINGS. RECOMMENDATIONS IN REGARDS TO MENTAL HEALTH TREATMENTS ARE BROUGHT TO THE PROVIDER BY CASE MANAGEMENT FOLLOWING THE MEETING. IN ADDITION, WE HAVE INCLUDED A BEHAVIORAL HEALTH REPRESENTATIVE IN OUR ST. LUKE'S MEETINGS TO ADDRESS HIGH RISK PATIENT NEEDS, AND HAVE STARTED TO INTEGRATE BEHAVIORAL HEALTH INTO THE PATIENT CENTERED MEDICAL HOMES. OBJECTIVES WE ARE CONTINUING TO WORK ON ARE RELATED TO OUR ADOLESCENT LIFE PROGRAM WITH IMPLEMENTING YOUTH SUICIDE SCREENING. ONE OF THE LARGE HIGH SCHOOLS HAS IMPLEMENTED A GOOD SCREENING, BUT THERE IS ADDITIONAL OPPORTUNITY IN OTHER SCHOOLS. IN ADDITION, WE ARE CONSISTENTLY MAKING SURE MOST OF OUR KIDS SEE A THERAPIST (FAMILY OR INDIVIDUAL). HOWEVER WE DO NOT HAVE A THERAPIST WHO COMES TO WORK WITH THE FAMILIES. ACCESS TO CARE: ST. LUKE'S METHODIST HOSPITAL AND JONES REGIONAL MEDICAL CENTER SUPPORTED INDIVIDUALS IN OUR COMMUNITY WHO DIDN'T HAVE INSURANCE WITH SIGNING UP FOR THE IOWA HEALTH AND WELLNESS PROGRAM. WE TRAINED INDIVIDUALS IN THE HOSPITAL ON HOW TO BE DESIGNATED COUNSELORS TO ASSIST AND MAINTAINED SCHEDULED HOURS IN THE HOSPITAL AND VOLUNTEERED IN COMMUNITY SITES TO ASSIST. WE ARE AN ACTIVE MEMBER IN THE LINN COUNTY COMMUNITY COALITION, A COLLECTIVE EFFORT IN THE COMMUNITY TO PROMOTE, SUPPORT AND OFFER INSURANCE SIGN UP ASSISTANCE. OUR COMMUNITY COALITION EFFORTS WERE RECOGNIZED BY IOWA REPRESENTATIVES IN CONGRESS AS WELL AS MEMBERS IN STATE LEADERSHIP. TO REDUCE THE USE OF THE EMERGENCY ROOM FOR NON-EMERGENT CARE BY PROVIDING A PLAN OF CARE IN CONJUNCTION WITH THE PRIMARY CARE PROVIDER, OUR EMERGENCY DEPARTMENT CONSISTENT CARE PROGRAM (EDCCP) HAS CONTINUED TO EXPAND THE CARE PLANS FOR INDIVIDUALS. IN ADDITION, THIS PROGRAM IS NOW AT JONES REGIONAL MEDICAL CENTER AS WELL AS HAS BEEN SPREAD THROUGHOUT UNITYPOINT HEALTH IN 3 STATES. THE EDCCP TEAM MEETS QUARTERLY TO DISCUSS OPPORTUNITIES, AS WELL AS HOSTS QUARTERLY CALLS WITH OTHER EDCCP PROGRAMS IN THE HEALTH SYSTEM AND A YEARLY FACE TO FACE MEETING. NEW STAFF COMING INTO OUR ED DEPARTMENT RECEIVES TRAINING ON EDCCP. IN 2014, WE ESTABLISHED A POPULATION HEALTH STEERING COMMITTEE TO ADDRESS THE HEALTH OF OUR POPULATION AND ACCESS TO SERVICES. REPRESENTATIVES OF ST. LUKE'S, CONTINUING CARE HOSPITAL AND JONES ARE PARTICIPANTS. IN 2014 A MEMBER OF THE CCH TEAM SERVED AS THE ELDERLY CONSORTIUM SECRETARY. CCH AND ST. LUKE'S HAVE JOINTLY HOSTED AT LEAST ONE ELDERLY CONSORTIUM MEETING IN 2014 AND 2015. CCH HAS ALSO PROVIDED EDUCATION TO THE CONSORTIUM IN 2014 AND 2015. ST. LUKE'S, JONES REGIONAL AND CCH ALL WORK WITH EACH PATIENT INDIVIDUALLY TO ENSURE THEY ARE ASSIGNED TO A PRIMARY CARE PROVIDER PRIOR TO DISCHARGE AND ASSIGNED TO AN AREA CARE COORDINATOR OR CARE NAVIGATOR (FOR HIGH RISK PATIENTS). SEXUAL HEALTH: PER OUR OBJECTIVES, WE HAVE A REPRESENTATIVE THAT REGULARLY ATTENDS THE SEXUAL HEALTH ALLIANCE OF LINN AND JOHNSON COUNTIES. OUR FAMILY HEALTH CENTER PROVIDES WEEKLY CLINICS AT JONES REGIONAL AND OTHER LOCATIONS. IN ADDITION, 24 EDUCATION / OUTREACH EFFORTS HAVE BEEN COMPLETED BY OUR FAMILY HEALTH CENTER SERVING OVER 2,000 PARTICIPATING STUDENTS.ORAL HEALTH: OUR DR. RHYS B. JONES DENTAL HEALTH CENTER CARES FOR LOW-INCOME CHILDREN AND DEVELOPMENTALLY-DISABLED INDIVIDUALS FROM EAST CENTRAL IOWA. IN 2015 YEAR TO DATE, THE CENTER HAS PROVIDED OVER 4,500 VISITS TO THIS POPULATION. OF THESE VISITS, THEY HAVE SERVED 900 NEW PATIENTS IN 2015. THEY CONTINUE TO DO DENTAL SCREENINGS FOR THE MAJORITY OF SCHOOLS THROUGHOUT LINN COUNTY.
ST. LUKE'S METHODIST HOSPITAL PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM THE FOLLOWING PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSISTANCE: THE U.S. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE FOOD STAMP PROGRAM, FAMILY INVESTMENT PROGRAM, BARNABAS UPLIFT, MISSION HEALTH, AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 8
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?14
Name and address Type of Facility (describe)
1 1 - WOMEN'S & CHILDREN'S CENTER
1100 FIRST AVENUE NE
CEDAR RAPIDS,IA52404
INPATIENT & OUTPATIENT - OB, LABOR & DELIVERY, NURSERY, PRE AND POSTPARTUM A
2 2 - WORK WELL SOLUTIONSTHERAPY PLUS
830 FIRST AVENUE NE
CEDAR RAPIDS,IA52402
OUTPATIENT PHYSICAL THERAPY
3 3 - WITWER CHILDREN'S THERAPYTHERAPY PLUS
3245 WILLIAMS PARKWAY SW SUITE 9
CEDAR RAPIDS,IA52404
OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY FOR CHILDREN
4 4 - CHEMICAL DEPENDENCY
1030 5TH AVENUE SUITE 110
CEDAR RAPIDS,IA52403
OUTPATIENT CHEMICAL DEPENDENCY UNIT
5 5 - FAMILY COUNSELING CENTER
225 12TH STREET NE SUITES 201 AND
203
CEDAR RAPIDS,IA52402
OUTPATIENT BEHAVIORAL HEALTH
6 6 - BREAST & BONE HEALTH
202 TENTH STREET SE SUITE 265
CEDAR RAPIDS,IA52402
OUTPATIENT RADIOLOGY
7 7 - WOUND HEALING CENTER
4251 RIVERCENTER COURT NE
CEDAR RAPIDS,IA52402
OUTPATIENT WOUND CLINIC
8 8 - ST LUKE'S CHILDREN'S CAMPUS
1075 NORTH CENTER POINT ROAD
HIAWATHA,IA52233
OUTPATIENT PHYSICAL THERAPY AND FAMILY COUNSELING
9 9 - CHILD PROTECTION CENTER
1095 NORTH CENTER POINT ROAD
HIAWATHA,IA52233
OUTPATIENT COUNSELING FOR ABUSED CHILDREN
10 10 - DIABETES EDUCATION CENTER
1002 4TH AVENUE SE
CEDAR RAPIDS,IA52402
OUTPATIENT DIABETES EDUCATION
11 11 - ST LUKE'S IMAGING SERVICES
2996 7TH AVENUE SUITE A
MARION,IA52302
OUTPATIENT IMAGING AND MAMMOGRAPHY SERVICES
12 12 - ST LUKE'S THERAPY PLUS
2996 7TH AVENUE SUITE C
MARION,IA52302
OUTPATIENT PHYSICAL THERAPY
13 13 - THERAPY PLUS
5313 NORTH PARK PLACE NE
CEDAR RAPIDS,IA52402
OUTPATIENT PHYSICAL THERAPY
14 14 - CHILDREN'S BEHAVIOR HEALTH SERVICES
4050 RIVER RIDGE DRIVE NE
CEDAR RAPIDS,IA52402
OUTPATIENT BEHAVIORAL HEALTH
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 9
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 6A: ST. LUKE'S METHODIST HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES.
PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE SEGMENT SPECIFIC COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO.
PART I, LINE 7G: THE NET COMMUNITY BENEFIT COST OF SUBSIDIZED HEALTH SERVICES OF $2,429,855 IS ATTRIBUTED TO A PHYSICIAN CLINIC.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 340,344.
PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. THE HOSPITAL CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH STATUS IN WAYS THAT MAY DIFFER FROM THE DIRECT SERVICES OF THE HOSPITAL ORGANIZATION AND MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. THE HOSPITAL EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, THE HOSPITAL EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COLLABORATE TO ADDRESS COMPLEX HEALTH ISSUES.THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH.
PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR ST. LUKE'S HOSPITAL. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2.
PART III, LINE 8: AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. IN ADDITION TO THESE ITEMS THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM DO NOT INCLUDE MEDICARE PHYSICIAN FEE SCHEDULE EXPENSE AND OFFSETTING REVENUE.THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY.
PART VI, LINE 2: ST. LUKE'S METHODIST HOSPITAL CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN LINN COUNTY IOWA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, ST. LUKE'S IS A SPONSORING PARTNER OF THE LINN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT & HEALTH IMPROVEMENT PLAN (CHNA-HIP) STEERING COMMITTEE WHICH IS A COMMUNITY COLLABORATIVE CONVENED BY ST. LUKE'S, MERCY MEDICAL CENTER AND THE LINN COUNTY BOARD OF HEALTH TO ASSESS, ADDRESS AND MONITOR THE HEALTH NEEDS OF LINN COUNTY. THROUGH A PLANNED AND ORGANIZED EFFORT, CHNA-HIP DEVELOPS A HEALTH AGENDA BY IDENTIFYING SPECIFIC HEALTH PRIORITIES THAT ARE RELEVANT TO THE COMMUNITY. CHNA-HIP WORKS COLLECTIVELY TO ADDRESS THE PRIORITIES THROUGH LEVERAGING THE RESOURCES OF THE COMMUNITY. ST. LUKE'S METHODIST HOSPITAL, AS A SPONSORING AGENCY, ACTIVELY CONTRIBUTES TO THIS PROCESS AND ENGAGES IN THE IDENTIFIED PRIORITIES THAT MATCH ITS MISSION AND CAPACITY. EFFORTS ARE MONITORED IN PART BY OTHER PARTNER AGENCIES SUCH AS THE AREA SUBSTANCE ABUSE COUNCIL AND CEDAR RAPIDS COMMUNTY SCHOOL DISTRICT, WHICH MONITOR AND REPORT SPECIFIC INDICATORS TO ASSESS EFFECTIVENESS AND AID IN THE DEVELOPMENT OF NEW PLANS OR REFINING EXISTING ONES. FURTHER, CHNA-HIP HAS DEVELOPED A MEASUREMENT PROCESS TO EVALUATE EFFECTIVENESS AS WELL AS NEED. CHNA-HIP CONVENES 4 MEETINGS ANNUALLY TO SEEK PUBLIC INPUT ON HEALTH INITIATIVES. ST. LUKE'S METHODIST HOSPITAL IS ALSO A SPONSORING PARTNER IN CHNA-HIP. THIS COLLABORATIVE ALSO COMPLETES A COMMUNITY HEALTH ASSESSMENT. FROM THIS, PRIORITIES AND STRATEGIES HAVE BEEN IDENTIFIED. ST. LUKE'S METHODIST HOSPTIAL HAS ACTIVELY ENGAGED IN ADDRESSING AND MONITORING HEALTH ISSUES AND NEEDS AS A RESULT OF THIS PROCESS. ST. LUKE'S METHODIST HOSPITAL ALSO PARTICIPATES AS PART OF THE UNITED WAY COMMUNITY IMPACT COMMITTEE. THIS GROUP ACTIVELY ADDRESSES NEED AND STRATEGIES ASSOCIATED WITH HEALTH. MORE SPECIFICALLY, THIS GROUP OFTEN FOCUSES ON THE SOCIAL DETERMINANTS OF HEALTH AND HOW TO IMPACT THEM IN THE EFFORT TO RAISE THE COMMUNITY HEALTH STATUS. THIS WIDE BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR ST. LUKE'S TO ENGAGE IN VARIOUS AREAS OF SERVICE TO THE COMMUNITY THAT MAY BE OUTSIDE OF ITS TYPICAL EXPERTISE BUT WITHIN ITS EXISTING RESOURCES. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS ST. LUKE'S METHODIST HOSPITAL CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS OFTEN WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT.
PART VI, LINE 3: ST. LUKE'S METHODIST HOSPITAL PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR BROCHURES IN APPROPRIATE AREAS OF THE HOSPITAL (E.G., THE EMERGENCY DEPARTMENT, AND REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THE HOSPITAL OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE.
PART VI, LINE 4: ST. LUKE'S METHODIST HOSPITAL IS A 532-BED COMMUNITY HOSPITAL SERVING AN 8 COUNTY AREA. ST. LUKE'S METHODIST HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF ST. LUKE'S METHODIST HOSPITAL MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF BENTON, BUCHANAN, CEDAR, DELAWARE, IOWA, JOHNSON, JONES AND LINN. ST. LUKE'S METHODIST HOSPITAL ADMITS 18,367 INPATIENTS AND CARES FOR 53,539 EMERGENCY PATIENTS PER YEAR. ST. LUKE'S METHODIST HOSPITAL CARES FOR MORE INPATIENTS, OUTPATIENTS, EMERGENCY PATIENTS AND CARDIAC PATIENTS THAN ANY OTHER HOSPITAL IN CEDAR RAPIDS, IOWA. THERE ARE 9 OTHER HOSPITALS WITHIN THE 8-COUNTY SERVICE AREA. MEDIAN HOUSEHOLD INCOMES RANGE FROM $54,264-59,672 AND THE AVERAGE POVERTY RATE IS 10%. 49.2% OF ST. LUKE'S METHODIST HOSPITAL INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. LINN AND JOHNSON COUNTIES, THE ONLY COUNTIES IN THE SERVICE AREA WITH SIGNIFICANT MINORITY POPULATION, AVERAGE 86% CAUCASIAN; 5% AFRICAN-AMERICAN, 4% HISPANIC, 4% ASIAN AND 1% AMERICAN INDIAN.
PART VI, LINE 5: THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE.
PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). INITIALLY FORMED IN 1994, UNITYPOINT HEALTH IS THE STATE'S FIRST AND LARGEST INTEGRATED HEALTH SYSTEM, SERVING NEARLY ONE OF EVERY THREE PATIENTS IN IOWA. THROUGH RELATIONSHIPS WITH 32 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 280 PHYSICIAN CLINICS, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH MORE THAN 30,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 4.5 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $3.9 BILLION, UNITYPOINT HEALTH IS THE FOURTH LARGEST NONDENOMINATIONAL HEALTH SYSTEM IN AMERICA AND PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES TO IMPROVE THE HEALTH OF PEOPLE IN ITS COMMUNITIES. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES THROUGHOUT IOWA, AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THE STATE. IN 2015, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $507 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY UNITYPOINT HEALTH AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES.
PART VI, LINE 7, REPORTS FILED WITH STATES IA
Schedule H (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
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," on 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
2015
Open to Public
Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number
42-0504780
Part I
General Information on Grants and Assistance
1
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? ........................
2
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" on 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 (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) CEDAR RAPIDS MEDICAL EDUCATION FOUNDATION
1026 A AVENUE NE
CEDAR RAPIDS,IA52402
39-1894395 501(C)(3) 2,013,047       PROGRAM SUPPORT
(2) IOWA HEALTH SYSTEM
1776 WEST LAKES PARKWAY SUITE 400
WEST DES MOINES,IA502668239
42-1435199 501(C)(3) 21,954,016       PROGRAM SUPPORT
(3) JUNIOR ACHIEVEMENT OF EASTERN IOWA
324 3RD STREET SE SUITE 200
CEDAR RAPIDS,IA524011841
42-0919209 501(C)(3) 10,000       PROGRAM SUPPORT
(4) MATTHEW 25 MINISTRY HUB
201 THIRD AVENUE SW
CEDAR RAPIDS,IA52404
26-0467321 501(C)(3) 10,000       PROGRAM SUPPORT
(5) MOUNT MERCY UNIVERSITY
1330 ELMHURST DRIVE NE
CEDAR RAPIDS,IA52402
42-0681046 501(C)(3) 10,000       PROGRAM SUPPORT
(6) RONALD MCDONALD HOUSE CHARITIES OF EASTERN IOWA & WESTERN ILLINOIS
730 HAWKINS DR
IOWA CITY,IA52246
42-1189783 501(C)(3) 100,000       PROGRAM SUPPORT
(7) TANAGER PLACE
2309 C ST SW
CEDAR RAPIDS,IA52404
42-0688079 501(C)(3) 8,333       PROGRAM SUPPORT
(8) THE SAFE PLACE FOUNDATION
527 6TH AVENUE SE
CEDAR RAPIDS,IA52401
42-1348441 501(C)(3) 10,000       PROGRAM SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
8
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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
(1) SCHOLARSHIPS 10 52,450      
(2) OTHER 38 32,421      
(2)
(3)
(4)
(5)
(6)
(7)
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: ST. LUKE'S METHODIST HOSPITAL REQUIRES EACH RECIPIENT OF THE GRANTS MENTIONED IN PARTS II & III (OTHER THAN ASSISTANCE TO RELATED ORGANIZATIONS IN THE FORM OF WORKING CAPITAL) TO APPLY FOR THE GRANT AND OUTLINES A SERIES OF ELIGIBILITY STANDARDS THAT ARE REQUIRED TO BE MET. ST. LUKE'S METHODIST HOSPITAL THEN REVIEWS THESE APPLICATIONS AND, BASED ON NEED AND ELIGIBILITY, A COMMITTEE MAKES THE FINAL DECISION ON ALL GRANT RECIPIENTS.
Schedule I (Form 990) 2015



Additional Data


Software ID:  
Software Version:  


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" on 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
2015
Open to Public Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
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 .........
1b
 
 
2
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? ..
2
 
 
3
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.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on 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 ............
7
 
No
8
Were any amounts reported on 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 .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
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 on 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 on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1THEODORE TOWNSEND JRBOARD MEMBER & PRESIDENT/CEO (i)

(ii)
479,095
-------------
0
142,764
-------------
0
63,134
-------------
0
152,346
-------------
0
21,247
-------------
0
858,586
-------------
0
0
-------------
0
2MILTON AUNAN II TO 1115SENIOR VP FINANCE/CFO (i)

(ii)
275,312
-------------
17,060
79,333
-------------
0
138,378
-------------
2,427
350
-------------
11,208
0
-------------
12,972
493,373
-------------
43,667
108,577
-------------
0
3MICHELLE NIERMANNSENIOR VP/COO (i)

(ii)
326,829
-------------
0
82,408
-------------
0
33,169
-------------
0
60,280
-------------
0
18,834
-------------
0
521,520
-------------
0
0
-------------
0
4MARGARET M BRADKEVP POST-ACUTE SVCS (i)

(ii)
192,815
-------------
0
24,098
-------------
0
396
-------------
0
21,726
-------------
0
6,984
-------------
0
246,019
-------------
0
0
-------------
0
5MICHAEL EASLEYADM DIR, FAC, PLNG & OPER (i)

(ii)
162,376
-------------
0
23,063
-------------
0
396
-------------
0
18,018
-------------
0
13,995
-------------
0
217,848
-------------
0
0
-------------
0
6CARMEN KLEINSMITHVP NURSING EXCELLENCE (i)

(ii)
192,113
-------------
0
25,222
-------------
0
258
-------------
0
19,911
-------------
0
13,554
-------------
0
251,058
-------------
0
0
-------------
0
7JOSEPH LINNVP OPERATIONS (i)

(ii)
179,910
-------------
0
25,222
-------------
0
138
-------------
0
10,646
-------------
0
21,072
-------------
0
236,988
-------------
0
0
-------------
0
8MARY ANN OSBORNSENIOR VP/CCO (i)

(ii)
299,348
-------------
0
79,054
-------------
0
44,214
-------------
0
96,454
-------------
0
13,042
-------------
0
532,112
-------------
0
0
-------------
0
9PEGGY PICKERINGDIR SURGICAL SVCS (i)

(ii)
138,378
-------------
0
19,653
-------------
0
396
-------------
0
16,306
-------------
0
15,163
-------------
0
189,896
-------------
0
0
-------------
0
10RITU BANSAL BDS MSDIR DENTAL HEALTH CENTER (i)

(ii)
156,929
-------------
0
0
-------------
0
54
-------------
0
7,721
-------------
0
342
-------------
0
165,046
-------------
0
0
-------------
0
11SHERYL BREHMPHARMACIST (i)

(ii)
151,082
-------------
0
500
-------------
0
3,079
-------------
0
12,675
-------------
0
12,725
-------------
0
180,061
-------------
0
0
-------------
0
12THOMAS HANSEN MDPHYSICIAN-PSYCHOLOGY (i)

(ii)
174,000
-------------
0
0
-------------
0
50
-------------
0
8,592
-------------
0
0
-------------
0
182,642
-------------
0
0
-------------
0
13PATRICK THIESADM DIR. MED. AFFAIRS/PHARM SVCS (i)

(ii)
161,287
-------------
0
21,425
-------------
0
3,419
-------------
0
9,219
-------------
0
21,427
-------------
0
216,777
-------------
0
0
-------------
0
14LORI WEIHDIR REG. OSC/CONTINUUM STRATEGY (i)

(ii)
145,141
-------------
0
22,747
-------------
0
-82
-------------
0
8,822
-------------
0
21,832
-------------
0
198,460
-------------
0
0
-------------
0
15TODD LANGAGER MD TO 1213FORMER PRESIDENT (CLC) (i)

(ii)
0
-------------
469,328
0
-------------
0
0
-------------
3,748
0
-------------
13,250
0
-------------
28,251
0
-------------
514,577
0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
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 4B NONQUALIFIED RETIREMENT PLAN EARNINGS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGES TO THEIR ACCOUNTS: MILTON AUNAN II $350; MICHELLE NIERMANN $47,030; MARY ANN OSBORN $64,106 AND THEODORE TOWNSEND JR. $136,423. NONQUALIFIED RETIREMENT PLAN DISTRIBUTIONS: THE FOLLOWING INDIVIDUAL(S) PARTICIPATED IN AND RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED PLAN: MILTON AUNAN II $108,577. PAYOUTS ARE MADE WITH VESTED FUNDS, AS ESTABLISHED BY PLAN DOCUMENTS.
Schedule J (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2015
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) DENISE EASLEY FAMILY MEMBER OF KEY EMPLOYEE MICHAEL EASLEY 96,003 EMPLOYMENT   No
(2) EASTERN IOWA SLEEP CENTER LLC
 
COMMON BOARD MEMBER/OFFICER 407,000 INVESTMENT   No
(3) IOWA HEALTH SYSTEM CONTRACTING SERVICES LC
 
COMMON BOARD MEMBER/KEY EMPLOYEE 1,662,034 PERFORMANCE OF SERVICES   No
(4) JALYNN LINN FAMILY MEMBER OF KEY EMPLOYEE JOSEPH LINN 57,530 EMPLOYMENT   No
(5) JENNIFER O'DONNELL FAMILY MEMBER OF KEY EMPLOYEE CARMEN KLEINSMITH 75,542 EMPLOYMENT   No
(6) LINN COUNTY ANESTHESIOLOGISTS
 
COMMON BOARD MEMBER/OFFICER 826,231 CONTRACT PHYSICIANS   No
(7) LYDIA CHRISTOFFERSEN FAMILY MEMBER OF BOARD MEMBER TERRI CHRISTOFFERSEN 59,662 EMPLOYMENT   No
(8) MR ASSOCIATES LLP
 
COMMON BOARD MEMBER/OFFICER 5,298,000 IMAGING SERVICES, RENT, PAYROLL SERVICES, SUPPLIES, OTHER   No
(9) PCI LENDER LLC
 
COMMON BOARD MEMBER/OFFICER 342,469 INVESTMENT   No
(10) PCI REGIONAL MEDICAL MALL LLC
 
COMMON BOARD MEMBER/OFFICER 857,448 INVESTMENT AND RENT   No
(11) PHYSICIANS CLINIC OF IOWA PC
 
COMMON BOARD MEMBER/OFFICER 2,842,510 MEDICAL DIRECTOR AND OTHER   No
(12) ST LUKE'S DEVELOPMENT COMPANY
 
COMMON BOARD MEMBER/OFFICER 951,000 RENT, MANAGEMENT FEES, LEASED EMPLOYEES, SUPPLIES, ETC.   No
(13) ST LUKE'S - COE STEAM INC
 
COMMON BOARD MEMBER/OFFICER 333,135 INVESTMENT   No
(14) THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC
 
COMMON BOARD MEMBER/OFFICER/KEY EMPLOYEE 7,667,000 INVESTMENT, RENT, FINANCIAL/PAYROLL SERVICES, SUPPLIES, ETC.   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
Software Version:  




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
2015
Open to Public
Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
Return Reference Explanation
FORM 990, PART V, LINES 1A & 1B CASH DISBURSEMENTS ARE CENTRALIZED THROUGH THE PARENT ORGANIZATION, IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THE PARENT MAKES THE PAYMENTS AND FILES THE RELATED FORMS 1099 AND 1096 ON BEHALF OF ALL UNITYPOINT HEALTH SYSTEM RELATED ORGANIZATIONS.
FORM 990, PART VI, SECTION A, LINE 2 DOUG OLSON AND AMY REASNER: BUSINESS RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 6 ST. LUKE'S HEALTHCARE, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B IOWA HEALTH SYSTEM, AS SOLE MEMBER OF ST. LUKE'S HEALTHCARE, APPROVES APPOINTMENT OF BOARD OF DIRECTORS, APPROVES AMENDMENTS TO ARTICLES AND BYLAWS, APPROVES STRATEGIC AND BUSINESS PLAN, SELECTION AND REMOVAL OF CEO, APPROVES INCURRED INDEBTEDNESS, APPROVES MANAGED CARE STRATEGY, APPROVES TRANSFER OF ASSETS, MERGER, ACQUISITION AND DISSOLUTIONS, BUDGETS, AND SIGNIFICANT CORPORATE TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A SUBCOMMITTEE OF THE BOARD REVIEWS THE FORM 990 AND REPORTS BACK TO THE FULL BOARD. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND REPORTING PHYSICIANS ARE REQUESTED TO COMPLETE A QUESTIONNAIRE TO REPORT POTENTIAL CONFLICTS OF INTEREST. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE ANNUAL QUESTIONNAIRES INCLUDE AN ACKNOWLEDGEMENT THAT THE OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN: 1) HAS ACCESS TO A COPY OF THE CONFLICT OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. SENIOR ADMINISTRATIVE STAFF AT ALL RELATED ORGANIZATIONS PROVIDE INFORMATION TO A CENTRAL COORDINATOR RELATED TO THE IDENTIFICATION OF WHICH INDIVIDUALS SHOULD RECEIVE THE QUESTIONNAIRE FOR COMPLETION. THE RESULTS ARE COMPILED CENTRALLY AND REVIEWED BY THE IOWA HEALTH SYSTEM COMPLIANCE OFFICER AND DIRECTOR OF INTERNAL AUDIT. THE DETAIL RESULTS ARE REPORTED TO A COMMITTEE OF THE SYSTEM BOARD. THE RESULTS RELATED TO SPECIFIC REGIONAL PARENT COMPANIES, THEIR HOSPITALS AND RELATED ORGANIZATIONS, ARE DISTRIBUTED IN DETAIL TO THE CHAIRPERSON OF THE REGIONAL PARENT ORGANIZATION, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND COMPLIANCE MANAGER. THESE INDIVIDUALS ARE ALSO REMINDED OF THE APPROPRIATE PROCESS TO BE FOLLOWED DURING THE YEAR TO ADDRESS POTENTIAL CONFLICTS OF INTEREST THAT RELATE TO MATTERS THAT ARE BROUGHT TO THE BOARD OF DIRECTORS FOR ACTION. THE INFORMATION DISCLOSED IS USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICAID QUESTIONNAIRES. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN TOGETHER WITH ALL MATERIAL FACTS, SHOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST OCCURS OR BECOMES A MATTER OF BOARD ACTION. ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN HAVING A CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT BE PRESENT DURING GENERAL DISCUSSION NOR VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM FOR PURPOSES OF THE MATTER OR ITEM AS TO WHICH A CONFLICT EXISTS. THE BOARD SHOULD EXCLUDE THE INDIVIDUAL FROM ANY DISCUSSION OR VOTE IN WHICH THE BOARD DECIDES WHETHER OR NOT A CONFLICT OF INTEREST EXISTS. IN CASES IN WHICH AN OFFICER, DIRECTOR, KEY EMPLOYEE, REPORTING PHYSICIAN OR THE INDIVIDUAL'S HOUSEHOLD MEMBER HAS A CONFLICT OF INTEREST IN AN ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN AT THE DIRECTION OF THE BOARD OF DIRECTORS: 1) AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL 1) DECIDE IF A CONFLICT OF INTEREST EXISTS, 2) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION; 3) IN ORDER TO APPROVE THE ARRANGEMENT OR TRANSACTION, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED MEMBERS, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED MEMBERS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS SHALL CONTAIN: 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; 2) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH; IN ORDER TO PROTECT THE ORGANIZATION'S BEST INTERESTS, APPROPRIATE DISCIPLINARY ACTION MAY BE TAKEN WITH RESPECT TO AN OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN WHO VIOLATES THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS ("COMMITTEE") CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS ANNUAL REVIEW COMPARES THE TOTAL COMPENSATION AND VALUE OF BENEFITS PROVIDED TO EACH EXECUTIVE, ON A POSITION BY POSITION BASIS, TO THAT PROVIDED TO FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED ORGANIZATIONS. THIS REVIEW IS CONDUCTED BY THE COMMITTEE WITH THE ASSISTANCE OF A NATIONAL, INDEPENDENT COMPENSATION CONSULTANT REPORTING DIRECTLY TO THE COMMITTEE. THE COMMITTEE HAS BEEN DELEGATED THE RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION AND IS MADE UP ENTIRELY OF INDEPENDENT DIRECTORS WITHIN THE MEANING OF THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE FEDERAL INCOME TAX INTERMEDIATE SANCTIONS RULES. THE COMPENSATION CONSULTANT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT, PERFORMS THESE VALUATIONS ON A REGULAR BASIS, IS QUALIFIED TO MAKE THE VALUATIONS OF THE SERVICES INVOLVED, AND HAS SO INDICATED IN A WRITTEN CERTIFICATION TO THE COMMITTEE. BASED UPON THE ADVICE OF THE COMPENSATION CONSULTANT, AND APPLYING THE BOARD'S COMPENSATION PHILOSOPHY, THE COMMITTEE ESTABLISHES THE OVERALL ADJUSTMENT IN COMPENSATION AND BENEFITS FOR APPROXIMATELY THE TOP FIFTY EXECUTIVES IN THE ENTIRE HEALTH SYSTEM (SEVERAL OF WHICH ARE EMPLOYEES OF THE FILING ORGANIZATION) AND DELEGATES TO THE CEO THE AUTHORITY TO MAKE ADJUSTMENTS, CONSISTENT WITH THE COMMITTEE'S DIRECTION, FOR THE OTHER EXECUTIVES. THE COMMITTEE DETERMINES ALL ASPECTS OF THE COMPENSATION AND BENEFITS OF THE CEO. THE COMMITTEE INTENTIONALLY TAKES ALL THE STEPS NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES, INCLUDING CONTEMPORANEOUS SUBSTANTIATION OF ALL COMMITTEE MEETINGS AND ACTIONS. THE ORGANIZATION BELIEVES IT IS IN FULL COMPLIANCE WITH SECTION 4958 OF THE IRC, PROVIDES NO MORE THAN REASONABLE AND FAIR MARKET VALUE COMPENSATION AND BENEFITS FOR ITS EMPLOYEES AND DOES NOT PROVIDE ANY EXCESS COMPENSATION OR BENEFITS AS PROHIBITED BY SECTION 4958. THE ANNUAL REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2015 FOR THE FOLLOWING INDIVIDUALS: MILTON AUNAN II, B. LANNIE CHECKETTS, MICHELLE NIERMANN, MARY ANN OSBORN, AND THEODORE TOWNSEND, JR. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, LEGAL DEPARTMENT. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE ON THE IOWA HEALTH SYSTEM WEBSITE, WWW.UNITYPOINT.ORG.
FORM 990, PART XI, LINE 9: CHANGES IN PENSION LIABILITY 4,176,780. FUND BALANCE TRANSFER TO UNITYPOINT CLINIC -276,404. FORGIVENESS OF AMOUNTS OWED FROM AFFORDABLE HOUSING NETWORK 16,667.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST LUKE'S METHODIST HOSPITAL
 
Employer identification number

42-0504780
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

(1) CARDIOLOGISTS LC
1026 A AVE NE
CEDAR RAPIDS,IA52402
27-1095420
CARDIOLOGY SERVICES IA 9,662 155,001 ST LUKE'S METHODIST HOSPITAL
 
(2) MEDICAL LABORATORIES OF EASTERN IOWA LC
1026 A AVE NE
CEDAR RAPIDS,IA52402
27-1814458
MEDICAL LABORATORY SERVICES IA 17,857,324 4,351,946 ST LUKE'S METHODIST HOSPITAL
 








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?
Yes No
(1)ALLEN COLLEGE
1825 LOGAN AVENUE

WATERLOO,IA50703
42-1351526
EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS IA 501(C)(3) 170(B)(1) (A)(II) ALLEN HEALTH SYSTEMS INC
 
 
No
(2)ALLEN HEALTH SYSTEMS INC
1825 LOGAN AVENUE

WATERLOO,IA50703
42-1201924
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(3)ALLEN MEMORIAL HOSPITAL CORPORATION
1825 LOGAN AVENUE

WATERLOO,IA50703
42-0698265
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ALLEN HEALTH SYSTEMS INC
 
 
No
(4)ANAMOSA AREA AMBULANCE SERVICE
101 GRANT WOOD DRIVE

ANAMOSA,IA52205
42-1466284
PROVIDE AMBULANCE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'SJONES REGIONAL MEDICAL CENTER
 
 
No
(5)BLACK HAWK-GRUNDY MENTAL HEALTH CENTER INC
3251 WEST NINTH STREET

WATERLOO,IA50702
42-0733463
MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC
 
 
No
(6)CENTRAL IOWA HEALTH PROPERTIES CORPORATION
1200 PLEASANT STREET

DES MOINES,IA50309
42-1233759
PROPERTY HOLDING COMPANY IA 501(C)(2)   CENTRAL IOWA HEALTH SYSTEM
 
 
No
(7)CENTRAL IOWA HEALTH SYSTEM
1200 PLEASANT STREET

DES MOINES,IA50309
42-1189791
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(8)CENTRAL IOWA HOSPITAL CORPORATION
1200 PLEASANT STREET

DES MOINES,IA50309
42-0680452
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) CENTRAL IOWA HEALTH SYSTEM
 
 
No
(9)DES MOINES AREA MEDICAL EDUCATION CONSORTIUM INC
1415 WOODLAND AVE SUITE 130

DES MOINES,IA50309
42-1412497
COORDINATION OF MEDICAL EDUCATION PROGRAMS IA 501(C)(3) 509(A)(3), TYPE III  
 
No
(10)FINLEY TRI-STATES HEALTH GROUP INC
350 NORTH GRANDVIEW AVENUE

DUBUQUE,IA52001
42-1307495
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(11)FRIENDS OF THE BLACK HAWK-GRUNDY MENTAL HEALTH CENTER
3820 HILLSIDE DRIVE

CEDAR FALLS,IA50613
42-1372380
CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC
 
 
No
(12)HULT CENTER FOR HEALTHY LIVING INC
5409 N KNOXVILLE AVE

PEORIA,IL61614
36-3510390
HEALTH EDUCATION TO THE COMMUNITY IL 501(C)(3) 170(B)(1) (A)(VI) PROCTOR HOSPITAL
 
 
No
(13)IOWA HEALTH FOUNDATION
1415 WOODLAND AVE SUITE E-200

DES MOINES,IA50309
42-1467682
CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) CENTRAL IOWA HEALTH SYSTEM
 
 
No
(14)IOWA HEALTH SYSTEM
1776 WEST LAKES PKWY 400

WEST DES MOINES,IA50266
42-1435199
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III  
 
No
(15)IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
8101 BIRCHWOOD COURT

JOHNSTON,IA50131
42-1411630
PRIMARY HEALTH CARE SERVICES IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM
 
 
No
(16)MEMORIAL FOUNDATION OF ALLEN HOSPITAL
1825 LOGAN AVENUE

WATERLOO,IA50703
42-1201138
CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC
 
 
No
(17)MERITER FOUNDATION INC
202 SOUTH PARK STREET

MADISON,WI53715
23-7098688
CHARITABLE FUNDRAISING WI 501(C)(3) 170(B)(1) (A)(VI) MERITER HEALTH SERVICES INC
 
 
No
(18)MERITER HEALTH SERVICES INC
202 SOUTH PARK STREET

MADISON,WI53715
39-1412318
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE WI 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(19)MERITER HOSPITAL INC
202 SOUTH PARK STREET

MADISON,WI53715
39-0806367
HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) MERITER HEALTH SERVICES INC
 
 
No
(20)MERITER MEDICAL GROUP INC
202 SOUTH PARK STREET

MADISON,WI53715
05-0545222
SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES WI 501(C)(3) 509(A)(3), TYPE II MERITER HOSPITAL INC
 
 
No
(21)METHODIST HEALTH SERVICES CORPORATION
221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-1111135
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM
 
 
No
(22)METHODIST MEDICAL CENTER FOUNDATION
221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
51-0186460
CHARITABLE FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) METHODIST HEALTH SERVICES CORPORATION
 
 
No
(23)METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-0661223
HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION
 
 
No
(24)METHODIST SERVICES INC
221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-1111134
OFFICE RENTAL IL 501(C)(3) 509(A)(2) METHODIST HEALTH SERVICES CORPORATION
 
 
No
(25)NELLIE R SHERWOOD TRUST
1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-6061621
PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY IA 501(C)(3) 509(A)(3), TYPE I ST LUKE'S METHODIST HOSPITAL
 
Yes
 
(26)NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED
720 KENYON DRIVE

FORT DODGE,IA50501
42-0937390
MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC
 
 
No
(27)NORTHWEST IOWA HOSPITAL CORPORATION
2720 STONE PARK BLVD

SIOUX CITY,IA51104
42-1019872
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTH SYSTEM INC
 
 
No
(28)PROCTOR HEALTH CARE INCORPORATED
5409 N KNOXVILLE AVE

PEORIA,IL61614
37-1133412
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION
 
 
No
(29)PROCTOR HEALTH SYSTEMS
5409 N KNOXVILLE AVE

PEORIA,IL61614
36-4147437
PRIMARY HEALTH CARE SERVICES IL 501(C)(3) 170(B)(1) (A)(III) PROCTOR HEALTH CARE INCORPORATED
 
 
No
(30)PROCTOR HOSPITAL
5409 N KNOXVILLE AVE

PEORIA,IL61614
37-0681540
HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) PROCTOR HEALTH CARE INCORPORATED
 
 
No
(31)SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS
221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-6181831
FUND SELF-INSURANCE PLAN IL 501(C)(3) 509(A)(3), TYPE I METHODIST MEDICAL CENER OF ILLINOIS
 
 
No
(32)SHARED MAGNETIC RESONANCE IMAGING FACILITY INC
1104 JOHN NOLEN DRIVE

MADISON,WI53713
39-1534744
MEDICAL TECHNOLOGY WI 501(C)(3) 509(A)(3), TYPE I  
 
No
(33)SIOUXLAND PACE INC
313 COOK STREET

SIOUX CITY,IA51103
26-1120134
ALL-INCLUSIVE CARE FOR THE ELDERLY IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTH SYSTEM INC
 
 
No
(34)ST LUKE'S HEALTH RESOURCES
2720 STONE PARK BLVD

SIOUX CITY,IA51104
42-1059182
OUTPATIENT CLINICS AND HEALTHCARE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'S HEALTH SYSTEM INC
 
 
No
(35)ST LUKE'S HEALTH SYSTEM INC
2720 STONE PARK BLVD

SIOUX CITY,IA51104
42-1294091
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM
 
 
No
(36)ST LUKE'S HEALTHCARE
1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-1487968
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(37)ST LUKE'S METHODIST HOSPITAL
1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-0504780
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTHCARE
 
 
No
(38)ST LUKE'SJONES REGIONAL MEDICAL CENTER
1795 HIGHWAY 64 EAST

ANAMOSA,IA52205
42-1487967
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTHCARE
 
 
No
(39)STL CARE COMPANY
1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-1276632
IMPROVE PUBLIC HEALTH SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'S HEALTHCARE
 
 
No
(40)THE DUBUQUE VISITING NURSE ASSOCIATION
350 NORTH GRANDVIEW AVENUE

DUBUQUE,IA52001
42-0680410
PUBLIC HEALTH SERVICES/HOME CARE IA 501(C)(3) 509(A)(2) FINLEY TRI-STATES HEALTH GROUP INC
 
 
No
(41)THE FINLEY HOSPITAL
350 NORTH GRANDVIEW AVENUE

DUBUQUE,IA52001
42-0680354
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) FINLEY TRI-STATES HEALTH GROUP INC
 
 
No
(42)THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
2701 17TH STREET

ROCK ISLAND,IL61201
36-3678909
MENTAL HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(VI) TRINITY REGIONAL HEALTH SYSTEM
 
 
No
(43)TRIMARK PHYSICIANS GROUP
802 KENYON ROAD

FORT DODGE,IA50501
45-3791448
SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC
 
 
No
(44)TRINITY BUILDING CORPORATION
802 KENYON ROAD

FORT DODGE,IA50501
42-1376187
PROPERTY HOLDING COMPANY IA 501(C)(2)   TRINITY HEALTH SYSTEMS INC
 
 
No
(45)TRINITY HEALTH FOUNDATION
802 KENYON ROAD

FORT DODGE,IA50501
42-1222381
CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) TRINITY HEALTH SYSTEMS INC
 
 
No
(46)TRINITY HEALTH FOUNDATION
2701 17TH STREET

ROCK ISLAND,IL61201
36-3321751
CHARITABLE FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) TRINITY REGIONAL HEALTH SYSTEM
 
 
No
(47)TRINITY HEALTH SYSTEMS INC
802 KENYON ROAD

FORT DODGE,IA50501
42-1222877
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(48)TRINITY MEDICAL CENTER
2701 17TH STREET

ROCK ISLAND,IL61201
36-2739299
HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) TRINITY REGIONAL HEALTH SYSTEM
 
 
No
(49)TRINITY REGIONAL HEALTH SYSTEM
2701 17TH STREET

ROCK ISLAND,IL61201
36-3351952
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
 
No
(50)TRINITY REGIONAL HOSPITAL AUXILIARY
802 KENYON ROAD

FORT DODGE,IA50501
42-6081474
CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES IA 501(C)(3) 509(A)(2) TRINITY REGIONAL MEDICAL CENTER
 
 
No
(51)TRINITY REGIONAL MEDICAL CENTER
802 KENYON ROAD

FORT DODGE,IA50501
42-1009175
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC
 
 
No
(52)UNITY HEALTHCARE
1518 MULBERRY AVENUE

MUSCATINE,IA52761
42-0680337
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) TRINITY REGIONAL HEALTH SYSTEM
 
 
No
(53)UNITY HEALTHCARE FOUNDATION
1518 MULBERRY AVENUE

MUSCATINE,IA52761
42-1525031
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE I TRINITY REGIONAL HEALTH SYSTEM
 
 
No
(54)UNITYPOINT AT HOME
11333 AURORA AVENUE

URBANDALE,IA50322
42-1477471
HOME HEALTH CARE IA 501(C)(3) 509(A)(2) IOWA HEALTH SYSTEM
 
 
No
(55)UNITYPOINT HEALTH AT WORK
1776 WEST LAKES PKWY 400

WEST DES MOINES,IA50266
81-0872241
EMPLOYER ONSITE MEDICAL SERVICES AND OCCUPATIONAL MEDICINE IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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


Yes No Yes No
(1) ADVANCED IMAGING CENTER LLC

615 VALLEY VIEW DRIVE
MOLINE,IL61265
36-4356301
DIAGNOSTIC RADIOLOGY CENTER IA N/A
                 
(2) ALLEN MEMORIAL HOSPITAL ORTHOPEDIC CO-MANAGEMENT CO LLC

1825 LOGAN AVE
WATERLOO,IA50703
45-3237125
ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
                 
(3) CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC

1200 PLEASANT ST
DES MOINES,IA50309
27-3625869
CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
                 
(4) CENTRAL IOWA ONCOLOGY CO-MANAGEMENT COMPANY

1200 PLEASANT STREET
DES MOINES,IA50309
45-3017991
ONCOLOGY MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
                 
(5) CENTRAL IOWA SURGICAL SERVICES CO-MANAGEMENT CO LLC

1200 PLEASANT ST
DES MOINES,IA50309
47-1608704
SURGICAL MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
                 
(6) DUBUQUE ENDOSCOPY CENTER LC

1515 DELHI STREET SUITE 500
DUBUQUE,IA52001
20-1597161
AMBULATORY SURGERY CENTER IA N/A
                 
(7) ENSEVA - HIAWATHA LLC

755 METZGER DRIVE
HIAWATHA,IA52233
45-3437363
COLLOCATION FACILITY IA N/A
                 
(8) FINLEY DEPT OF SURGERY CO-MGMT CO LLC

350 N GRANDVIEW AVE
DUBUQUE,IA52001
42-2808785
SURGERY DEPARTMENT MANAGEMENT SERVICES IA N/A
                 
(9) HEALTH CARE AFFILIATES OF THE TRI-STATES LLC

350 N GRANDVIEW AVE
DUBUQUE,IA52001
42-1428503
PROVIDE ACCESS TO LICENSED SOFTWARE IA N/A
                 
(10) IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC

1200 PLEASANT STREET
DES MOINES,IA50309
03-0482623
OUTPATIENT DIAGNOSTIC IMAGING IA N/A
                 
(11) IOWA HEALTH SYSTEM CONTRACTING SERVICES LC

1776 WEST LAKES PKWY 400
WEST DES MOINES,IA50266
42-1511142
GROUP PURCHASING IA N/A
                 
(12) LAKEVIEW SURGERY CENTER LC

1200 PLEASANT STREET
DES MOINES,IA50309
42-1516120
SURGERY CENTER IA N/A
                 
(13) MERITER UW PHYSICIANS CONTRACTING COMPANY LLC

202 SOUTH PARK STREET
MADISON,WI53715
39-1998819
HEALTH SERVICES WI N/A
                 
(14) MISSISSIPPI VALLEY SLEEP DISORDER CENTER LC

3400 DEXTER COURT
DAVENPORT,IA52807
42-1489697
MEDICAL LABORATORY SERVICES IA N/A
                 
(15) MMCI ORTHOPEDIC CO-MANAGEMENT COMPANY LLC

221 NE GLEN OAK AVE
PEORIA,IL61636
46-1219459
ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES IL N/A
                 
(16) MMCI SURGERY CO-MANAGEMENT COMPANY LLC

221 NE GLEN OAK AVE
PEORIA,IL61636
47-1323385
SURGERY MANAGEMENT & ADMINISTRATIVE SERVICES IL N/A
                 
(17) MR ASSOCIATES LLP

1956 1ST AVENUE NE
CEDAR RAPIDS,IA52402
42-1260463
OWN AND OPERATE MR UNIT IA ST LUKE'S METHODIST HOSPITAL
 
RELATED 2,008,363 692,423   No   Yes   33.330 %
(18) ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC

1200 PLEASANT STREET
DES MOINES,IA50309
42-1508092
AMBULATORY SURGERY CENTER IA N/A
                 
(19) REGIONAL HEALTH PARTNERS LLC

1258 W SOUTH ST
KEWANEE,IL61443
80-0899158
AMBULATORY HEALTH CLINICS IL N/A
                 
(20) REHABILITATION THERAPY SERVICES LLC

416 ST MARKS CT 110
PEORIA,IL61603
81-0584193
REHABILATION THERAPY IL N/A
                 
(21) SLRMC CARDIOVASCULAR CO-MANAGEMENT COMPANY LLC

2720 STONE PARK BLVD
SIOUX CITY,IA51104
45-5322324
CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
                 
(22) THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC

1075 FIRST AVENUE SE
CEDAR RAPIDS,IA52403
72-1550812
AMBULATORY SURGERY CENTER. IA ST LUKE'S METHODIST HOSPITAL
 
RELATED 3,395,417 6,920,300   No   Yes   50.000 %
(23) TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC

4500 UTICA RIDGE RD
BETTENDORF,IA52722
27-2562753
ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICES IA N/A
                 
(24) TRINITY ONCOLOGY SERVICES CO-MANAGEMENT COMPANY LLC

500 JOHN DEERE ROAD
MOLINE,IL61265
90-0953327
ONCOLOGY MANAGEMENT SERVICES IL N/A
                 
(25) UNITYPOINT AT WORK LC

1825 LOGAN AVE
WATERLOO,IA50703
47-2181113
OCCUPATIONAL MEDICINE IA N/A
                 
(26) UPHT-SCA HOLDINGS LLC

569 BROOKWOOD VILLAGE SUITE 901
BIRMINGHAM,AL35209
47-3564984
AMBULATORY SURGERY CENTER INVESTMENT DE N/A
                 
(27) WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC

1660 60TH STREET
WEST DES MOINES,IA50266
27-1414600
ORTHOPEDIC SERVICE LINES MANAGEMENT IA N/A
                 
(28) WEST LAKES SLEEP CENTER LLC

5950 UNIVERSITY AVENUE SUITE 2
WEST DES MOINES,IA50266
26-3193923
SLEEP DISORDER DIAGNOSTIC TESTING FACILITY IA N/A
                 
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
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) BELCREST SERVICES LTD

5409 N KNOXVILLE AVE
PEORIA,IL61614
37-1196307
MEDICAL SERVICES IL N/A
C         No
(2) BROADBAND INC

1776 WEST LAKES PKWY 400
WEST DES MOINES,IA50266
27-3819741
INFORMATION TECHNOLOGY MGMT. IA N/A
C         No
(3) DELHI POINT CONDO ASSOCIATION

350 N GRANDVIEW
DUBUQUE,IA52001
42-1467002
REAL ESTATE MANAGEMENT IA N/A
C         No
(4) HCP CORPORATION

202 SOUTH PARK STREET
MADISON,WI53715
39-1177562
REAL ESTATE RENTAL WI N/A
C         No
(5) HEALTH PLUS INC

5409 N KNOXVILLE AVE
PEORIA,IL61614
37-1295532
MANAGED CARE ADMINISTRATION IL N/A
C         No
(6) HNC SERVICES

1776 WEST LAKES PKWY 400
WEST DES MOINES,IA50266
27-0987243
FIBER OPTIC NETWORK SERVICES IA N/A
C         No
(7) MEDIMORE INC

1776 WEST LAKES PKWY 400
WEST DES MOINES,IA50266
42-1414390
MANAGED CARE IA N/A
C         No
(8) MERITER HEALTH ENTERPRISES INC

202 SOUTH PARK STREET
MADISON,WI53715
39-1293620
MANAGEMENT SERVICES WI N/A
C         No
(9) MERITER MANAGEMENT SERVICES INC

202 SOUTH PARK STREET
MADISON,WI53715
39-1458235
ADMINISTRATIVE SERVICES WI N/A
C         No
(10) METHODIST HEALTH VENTURES INC

PO BOX 87
PEORIA,IL61650
37-1140939
PHARMACY/OFFICE STAFFING IL N/A
C         No
(11) METHODIST PHYSICIAN SERVICES INC

PO BOX 87
PEORIA,IL61650
36-3858550
MEDICAL SERVICES IL N/A
C         No
(12) PRECEDENCE INC

4622 PROGRESS DRIVE STE A
DAVENPORT,IA52807
37-1288604
MANAGED MENTAL CARE IA N/A
C         No
(13) PROVIDER RESOURCE MANAGEMENT INC

PO BOX 87
PEORIA,IL61650
37-1223550
RESOURCE MANAGEMENT IL N/A
C         No
(14) PHYSICIANS PLUS INSURANCE CORPORATION

2650 NOVATION PARKWAY SUITE 400
MADISON,WI53713
39-1565691
FEDERALLY QUALIFIED HMO WI N/A
C         No
(15) RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC

700 E UNIVERSITY AVE
DES MOINES,IA50316
26-1271143
SPECIALTY PHYSICIANS MEDICAL CARE IA N/A
C         No
(16) STL HEALTH RESOURCES CO

1026 A AVE NE
CEDAR RAPIDS,IA52402
42-1193499
PHYSICIAN OFFICE RENTAL IA ST LUKE'S METHODIST HOSPITAL
 
C 150,751 4,684,760 100.000 %   No
(17) TRINITY HEALTH ENTERPRISES INC

2701 17TH ST
ROCK ISLAND,IL61201
36-3320141
RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY IL N/A
C         No
(18) TRINITY PHYSICIAN HOSPITAL ORGANIZATION LTD

4622 PROGRESS DRIVE STE A
DAVENPORT,IA52807
36-3924720
MANAGED HEALTH CARE IA N/A
C         No
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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) STL HEALTH RESOURCES

E 71,000 BASED ON GAAP, CASH, AND/OR FMV.





Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
SCHEDULE R, PARTS I - IV: IOWA HEALTH SYSTEM AND SUBSIDIARIES (D/B/A UNITYPOINT HEALTH) IOWA HEALTH SYSTEM IS AN IOWA NONPROFIT CORPORATION FORMED IN DECEMBER 1994. IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM 32 HOSPITAL FACILITIES AND VARIOUS AMBULATORY SERVICE AND CLINIC LOCATIONS IN IOWA, ILLINOIS AND WISCONSIN. PRIMARY, SECONDARY AND TERTIARY CARE SERVICES ARE PROVIDED TO RESIDENTS OF IOWA, ILLINOIS, WISCONSIN AND ADJACENT STATES. ON APRIL 16, 2013, IOWA HEALTH SYSTEM BEGAN BEING PUBLICLY KNOWN AS UNITYPOINT HEALTH (THE SYSTEM). THIS NAME CHANGE REFLECTS THE TRANSFORMATION OF CLINICAL PROCESSES UNDERWAY WITHIN THE SYSTEM AND THE ADAPTATION TO BETTER ADDRESS THE HEALTH CARE NEEDS OF COMMUNITIES, INCLUDING BUILDING A MODEL OF DELIVERING HEALTH CARE THAT COORDINATES CARE AROUND THE PATIENT WHILE FOCUSING ON IMPROVING THE QUALITY OF CARE AND REDUCING COSTS. THE LEGAL NAME OF THE PARENT REMAINS IOWA HEALTH SYSTEM, WITH THE UNITYPOINT HEALTH NAME REFLECTING A DOING BUSINESS AS (D/B/A).
Schedule R (Form 990) 2015

Additional Data


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