Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 | |||||
| (A)
BROADLAWNS MEDICAL CENTER |
426005830 | 3 | Yes | 83,551 | 0 | |
| (B)
CENTRAL IOWA HOSPITAL CORPORATION |
420680452 | 3 | Yes | 432,814 | 0 | |
| (C)
VA CENTRAL IOWA HEALTH CARE SYSTEM |
741612229 | 6 | Yes | 98,795 | 0 | |
| (D)
UNIVERSITY OF IOWA HOSPITALS AND CLINICS |
426004813 | 6 | Yes | 334,139 | 0 | |
|
Total 4
|
949,299 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.).. | ||||||
| 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 | ||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SECTION A, LINE 2: | THE CONSORTIUM SUPPORTS THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS, WHICH IS NOT REQUIRED TO OBTAIN RECOGNITION OF ITS PUBLIC CHARITY STATUS BECAUSE IT IS A STATE UNIVERSITY. THE CONSORTIUM SUPPORTS THE VA CENTRAL IOWA HEALTH CARE SYSTEM, WHICH IS NOT REQUIRED TO OBTAIN RECOGNITION OF ITS PUBLIC CHARITY STATUS BECAUSE IT IS A GOVERNMENTAL AGENCY. |
| SECTION D, LINE 3: | BROADLAWNS MEDICAL CENTER, CENTRAL IOWA HOSPITAL CORPORATION AND THE UNIVERSITY OF IOWA, SUPPORTED ORGANIZATIONS OF THE ORGANIZATION AND FULL MEMBERS, DESIGNATE THEIR REPRESENTATIVES TO THE BOARD OF DIRECTORS; APPROVE AMENDMENTS TO ARTICLES AND BYLAWS, APPROVE MERGERS, CONSOLIDATIONS OR DISSOLUTIONS; AND OVERSEE THE GENERAL MANAGEMENT AND CONTROL OF THE BUSINESS AND AFFAIRS OF THE CORPORATION. THE VA CENTRAL IOWA HEALTH CARE SYSTEM, SUPPORTED ORGANIZATION OF THE ORGANIZATION AND AFFILIATE MEMBER, DESIGNATES ITS REPRESENTATIVES TO THE BOARD OF DIRECTORS AND MAY PARTICIPATE IN DISCUSSION ON ALL ISSUES BUT HAS NO RIGHT TO VOTE AND NO FINANCIAL OR LEGAL RESPONSIBILITY TO THE ORGANIZATION. |
| SECTION E, LINE 1(C): | THE CONSORTIUM SUPPORTS THE MEDICAL PROGRAMS OF THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS AND THE VA CENTRAL IOWA HEALTH CARE SYSTEM (GOVERNMENTAL AGENCIES EXEMPT UNDER CODE SECTION 170(C)(1)). |
| SECTION E, LINE 2B: | THE CONSORTIUM PROVIDES MEDICAL TRAINING TO UNIVERSITY OF IOWA CARVER COLLEGE OF MEDICINE (UICCOM) MEDICAL STUDENTS; COORDINATES MEDICAL TRAINING FOR THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS (UIHC) RESIDENT PHYSICIANS; THE UICCOM FACULTY APPOINTMENT AND REAPPOINTMENT PROCESS FOR DES MOINES FACULTY INVOLVED IN THE TEACHING OF MEDICAL STUDENTS AND UIHC RESIDENT PHYSICIANS; AND PROVIDES EDUCATIONAL OFFERINGS AND COORDINATES THE SCHEDULING OF CERTIFICATION COURSES FOR MEMBER INSTITUTIONS, WHICH INCLUDES THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS AND THE VA CENTRAL IOWA HEALTH CARE SYSTEM (GOVERNMENTAL AGENCIES EXEMPT UNDER CODE SECTION 170(C)(1)). WITHOUT THE INVOLVEMENT OF THE DES MOINES AREA MEDICAL EDUCATION CONSORTIUM, MEMBER ENTITIES WOULD NEED TO SEPARATELY FACILITATE THESE ACTIVITIES FOR THEIR STAFF AND/OR STUDENTS. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | BROADLAWNS MEDICAL CENTER, A COUNTY AGENCY, CENTRAL IOWA HOSPITAL CORPORATION, A TAX-EXEMPT IOWA NONPROFIT CORPORATION, THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS, A STATE AGENCY, AND VA CENTRAL IOWA HEALTH CARE SYSTEM, A FEDERAL AGENCY, ARE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | BROADLAWNS MEDICAL CENTER, CENTRAL IOWA HOSPITAL CORPORATION AND THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS DESIGNATE REPRESENTATIVES TO THE BOARD OF DIRECTORS. THE VA CENTRAL IOWA HEALTH CARE SYSTEM IS INVOLVED IN ALL DISCUSSIONS REGARDING THE DESIGNATION OF REPRESENTATIVES TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | BROADLAWNS MEDICAL CENTER, CENTRAL IOWA HOSPITAL CORPORATION AND THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS MUST APPROVE AMENDMENTS TO ARTICLES AND BYLAWS, AND APPROVE DISSOLUTIONS OR MERGER. THE VA CENTRAL IOWA HEALTH CARE SYSTEM IS INVOLVED IN ALL DISCUSSIONS REGARDING THE APPROVAL OF AMENDMENTS TO ARTICLES AND BYLAWS AND APPROVAL OF DISSOLUTIONS OR MERGER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY THE IOWA HEALTH SYSTEM TAX SERVICES DEPARTMENT USING INFORMATION GATHERED FROM THE FINANCIAL SERVICES AND ADMINISTRATIVE OFFICES OF THE ORGANIZATION. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE EXECUTIVE DIRECTOR FOR REVIEW. ONCE REVIEWED A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUESTED TO COMPLETE A QUESTIONNAIRE TO REPORT POTENTIAL CONFLICTS OF INTEREST. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED UNTIL THE QUESTIONNAIRES ARE COMPLETED AND RETURNED. THE ANNUAL QUESTIONNAIRES INCLUDE AN ACKNOWLEDGEMENT THAT THE OFFICER, DIRECTOR, OR KEY EMPLOYEE: 1) HAS READ AND UNDERSTANDS THE POLICY; 2) AGREES TO COMPLY WITH THE POLICY; 3) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 4) 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. THE RESULTS ARE COMPILED CENTRALLY AND REVIEWED BY THE EXECUTIVE DIRECTOR AND ADMINISTRATIVE DIRECTOR. THE DETAILED RESULTS ARE REPORTED TO THE BOARD OF DIRECTORS. THE INFORMATION DISCLOSED IS USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS QUESTIONNAIRES. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY OFFICER, DIRECTOR, OR KEY EMPLOYEE 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 OFFICER, DIRECTOR, OR KEY EMPLOYEE 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, 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 1) SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS, 2) SHALL DECIDE IF 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, OR KEY EMPLOYEE WHO VIOLATES THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE DIRECTOR IS REIMBURSED BY A SET CONTRACTUAL PAYMENT AS A MANAGEMENT SERVICE TO THE ORGANIZATION. THIS IS BASED ON FAIR MARKET VALUE. THE ORGANIZATION REIMBURSES A SEPARATE ENTITY FOR THE ADMINISTRATIVE DIRECTOR'S SALARY. THIS SALARY IS BASED UPON THE COMPARISON OF LIKE POSITIONS AND MARKETS ACROSS THE STATE. 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 ARTICLES OF INCORPORATION ARE AVAILABLE THROUGH THE SECRETARY OF STATE'S OFFICE. OTHER GOVERNING DOCUMENTS MAY BE AVAILABLE UPON REQUEST. THE ORGANIZATION WILL PROVIDE COPIES OF ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 156,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,000. |
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| Software Version: |