Form990


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)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 07-01-2021 , and ending 06-30-2022
BCheck if applicable:
CName of organization
Genesis Health System
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1227 E Rusholme Street
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Davenport, IA52803
D Employer identification number

42-1418847
E Telephone number

G Gross receipts $ 1,439,595,127
F Name and address of principal officer:
Joseph Malas
1227 E Rusholme Street
Davenport,IA52803
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.GENESISHEALTH.COM
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: 1994
M State of legal domicile: IA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: GENESIS HEALTH SYSTEM (GHS IOWA) EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 4,549
6 Total number of volunteers (estimate if necessary) ............. 6 138
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 1,001,056
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 337,613
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 20,199,597 18,706,089
9 Program service revenue (Part VIII, line 2g) ......... 514,503,461 510,023,398
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 19,737,711 10,415,507
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,478,783 2,044,568
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 556,919,552 541,189,562
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,438,037 1,597,304
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 248,307,255 268,628,496
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 280,609,596 296,312,833
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 530,354,888 566,538,633
19 Revenue less expenses. Subtract line 18 from line 12....... 26,564,664 -25,349,071
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,001,993,046 919,407,007
21 Total liabilities (Part X, line 26)............. 343,934,036 340,460,195
22 Net assets or fund balances. Subtract line 21 from line 20..... 658,059,010 578,946,812
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 (2021)
Form 990 (2021)
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: GENESIS HEALTH SYSTEM (GHS IOWA) EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED.
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 $ 315,477,221 including grants of $ 1,597,304 ) (Revenue $ 411,737,235 )
GENESIS HEALTH SYSTEM (GHS IOWA) IS A HEALTH SYSTEM LOCATED IN EASTERN IOWA CONSISTING OF THREE HOSPITAL FACILITIES, TWO IN DAVENPORT AND ONE IN DEWITT, IOWA. GENESIS MEDICAL CENTER - DAVENPORT, CONTAINING 502 LICENSED ACUTE CARE BEDS. STATISTICS INCLUDE 74,682 PATIENT DAYS AND 225,507 OUTPATIENT VISITS; GENESIS MEDICAL CENTER - DEWITT, CONTAINING 13 LICENSED ACUTE CARE AND SWING BEDS. STATISTICS INCLUDE 1,361 PATIENT DAYS AND 28,349 OUTPATIENT VISITS. GHS IOWA ALSO INCLUDES A FAMILY MEDICINE RESIDENCY PROGRAM THAT CONTINUES TO EDUCATE RESIDENTS IN THE HOSPITAL SETTING.
4b (Code:   ) (Expenses $ 102,967,130 including grants of $ 0 ) (Revenue $ 74,631,149 )
GENESIS HEALTH GROUP, A PHYSICIAN GROUP WITHIN GENESIS HEALTH SYSTEM (GHS IOWA) ENCOMPASSES A WIDE VARIETY OF SPECIALTIES AND FAMILY PRACTICE GROUPS SERVING IOWA, ILLINOIS AND SURROUNDING COMMUNITIES IN EASTERN IOWA AND WESTERN ILLINOIS.
4c (Code:   ) (Expenses $ 20,656,693 including grants of $ 0 ) (Revenue $ 23,655,014 )
GENESIS AT HOME VNA & HOSPICE, A VISITING NURSE AND HOSPICE CARE PROGRAM WITHIN GENESIS HEALTH SYSTEM (GHS IOWA) ENCOMPASSES HOME HEALTH SERVICES (INCLUDING PHYSICAL THERAPY, OCCUPATIONAL/SPEECH THERAPY, SKILLED NURSING, MEDICAL SOCIAL WORKER VISITS), COMMUNITY HOSPICE SERVICES, AND THE CLARISSA C. COOK HOSPICE HOUSE LOCATED IN BETTENDORF, IOWA. STATISTICS INCLUDE 96,564 HOME HEALTH SERVICE UNITS AND 41,923 HOSPICE/HOSPICE HOUSE DAYS.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet439,101,044
Form 990 (2021)
Form 990 (2021)
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 I.............
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 Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
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 I.........................
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 II....
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..............
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 IV..............
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
Yes
 
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 VIII.......
11c
 
No
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
Yes
 
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......................
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.........Click to see attachment
14b
Yes
 
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. ....
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............
18
 
No
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...................
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
 
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
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
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...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
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
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
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 ....
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.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? 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..Click to see attachment
29
Yes
 
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.............
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 VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
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
237
b
Enter the number of Forms W-2G included on 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
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
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
4,549
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
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
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
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
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
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
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
18
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
9
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
 
No
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
 
No
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
 
No
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
Yes
 
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
Yes
 
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 on 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 on 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 on 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
IL
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 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:
MediumBulletJoseph Malas1227 E RUSHOLME   DAVENPORT,IA528032498 (563) 421-6508
Form 990 (2021)
Form 990 (2021)
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 the 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, Form 1099-MISC, and/or box 1 of Form 1099-NEC) 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.

See the instructions for the order in which to list the persons above.
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/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(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) C DANA WATERMAN III
 
VICE CHAIR
 4.5
.................
2.5 		X   X       0 0 0
(2) DOUGLAS P CROPPER
 
PRESIDENT/CEO GHS
 50.0
.................
11.5 		X   X       1,224,686 0 42,529
(3) GREGORY J BUSH
 
TREASURER
 2.0
.................
2.0 		X   X       0 0 0
(4) PETER J BENSON
 
SECRETARY
 2.0
.................
2.0 		X   X       0 0 0
(5) STEVEN C BAHLS
 
CHAIR
 5.0
.................
3.0 		X   X       0 0 0
(6) CHRISTOPHER J COX
 
FORMER DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(7) DALE D ZUDE
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(8) DAVID C LARSON
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(9) DAVID HELLER
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(10) EDMUND P COYNE JR
 
Director
 2.0
.................
2.0 		X           0 0 0
(11) EDWIN V MOTTO MD
 
DIRECTOR
 6.0
.................
4.0 		X           0 0 0
(12) G CHRISTOPHER WAHLIG
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(13) KAREN FITZSIMMONS
 
DIRECTOR
 40.0
.................
2.0 		X           364,318 0 48,774
(14) LASHONDA POLITE
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(15) MARK C KILMER
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
(16) MARK D BAWDEN
 
DIRECTOR
 2.0
.................
3.5 		X           0 0 0
(17) MELISSA PEPPER
 
DIRECTOR
 2.0
.................
2.0 		X           0 0 0
Form 990 (2021)
Form 990 (2021)
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/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(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) PATRICIA S GROVES
 
DIRECTOR
 2.0
.......................2.0 		X           0 0 0
(19) ROBIN PETERSEN
 
DIRECTOR
 2.0
.......................2.0 		X           0 0 0
(20) JOSEPH MALAS
 
VP FINANCE, INTERIM CFO
 32.0
.......................8.0 		    X       343,054 0 21,952
(21) PAUL BOLLINGER
 
V.P. LEGAL AFFAIRS/Asst. Secretary
 32.0
.......................8.0 		    X       382,346 0 45,846
(22) JORDAN VOIGT
 
HOSPITAL PRESIDENT GMC DAVENPORT
 40.0
.......................0 		      X     700,822 0 48,049
(23) KURT A ANDERSEN
 
VP Physician Operations/Chief Medical Officer
 33.0
.......................7.0 		      X     771,583 0 45,350
(24) BRIAN CADY
 
PHYSICIAN
 40.0
.......................0 		        X   554,127 0 46,477
(25) CHRISTOPHER CROME
 
PHYSICIAN
 40.0
.......................0 		        X   489,366 0 20,958
(26) HEIDI S KAHLY-MCMAHON
 
V.P. Human Resources
 36.0
.......................4.0 		        X   520,969 0 25,769
(27) NAMRATA MALLIK
 
PHYSICIAN
 40.0
.......................1.5 		        X   636,834 0 24,160
(28) TODD GRAY
 
PHYSICIAN ADVISOR
 40.0
.......................0 		        X   472,853 0 23,144
(29) MARK G ROGERS
 
V.P. FINANCE/CFO/ASST TREASURER
 32.0
.......................8.0 		          X 515,382 0 907,028
(30) NIDAL HARB
 
FORMER CHIEF MEDICAL OFFICER
 33.0
.......................7.0 		          X 318,744 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 7,295,086 0 1,300,037
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 MediumBullet288
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
Cerner Corporation

PO Box 959156
St Louis,MO931959156 		Information Technology Services 18,716,560
Crothall Healthcare Inc

1500 Liberty Ridge Drive
Wayne,PA19087 		Maintenance/Enviromental Services 6,649,931
Renovo Solutions LLC

4 Executive Circle
Suite 185
Irvine,CA92614 		Maintenance Management Services for Medical Equipment 2,821,460
H R Accounts Inc

PO Box 672
5320 22nd Avenue
Moline,IL612660672 		Collection Services 2,808,975
Morrison Healthcare

PO Box 102289
Atlanta,GA30368 		Food Management Services 2,287,247
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet95
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 1,034,136
e Government grants (contributions)1e 14,335,083
f All other contributions, gifts, grants, and similar amounts not included above1f 3,336,870
g Noncash contributions included in lines 1a - 1f:$ 1g 1,418,227
h Total. Add lines 1a-1f.......MediumBullet 18,706,089
Program Service RevenueAmt Business Code
2a OUTPATIENT REVENUE 621400 820,420,209 820,420,209    
b INPATIENT REVENUE 900099 547,272,926 547,272,926    
c CLINIC/NURSING REVENUE 621400 138,573,623 138,573,623    
d HOME HEALTH SERVICES 621400 26,353,599 26,353,599    
e PROFESSIONAL HEALTH SERVICES 621400 16,631,852 15,630,796 1,001,056  
f All other program service revenue. -1,039,228,811 -1,039,228,811 0 0
g Total. Add lines 2a–2f .....MediumBullet 510,023,398
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 11,978,162     11,978,162
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents     6a
b Less: rental expenses     6b
c Rental income or (loss) 0 0 6c
d Net rental income or (loss).......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 211,322 894,773,761 7a
b Less: cost or other basis and sales expenses 402,030 896,145,708 7b
c Gain or (loss) -190,708 -1,371,947 7c
d Net gain or (loss).........MediumBullet -1,562,655     -1,562,655
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a 3,726,571
b Less: cost of goods sold .. 10b 1,857,827
c Net income or (loss) from sales of inventory..MediumBullet 1,868,744     1,868,744
Business Code Miscellaneous Revenue
11a VENDOR REBATES 900099 12,348 12,348    
b NUTRITIONAL SERVICES 900099 67,229 67,229    
c AMBULANCE 900099 61,447 61,447    
d All other revenue .... 34,800 34,800 0 0
e Total. Add lines 11a–11d ...... MediumBullet 175,824
12 Total revenue. See instructions.....MediumBullet 541,189,562 509,198,166 1,001,056 12,284,251
Form 990 (2021)
Form 990 (2021)
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 .... 1,570,009 1,570,009
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 27,295 27,295
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 4,039,311 413,092 3,626,218 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 45,845 45,845    
7 Other salaries and wages........ 227,492,765 186,417,072 41,075,693  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,373,418 4,482,013 891,405  
9 Other employee benefits ....... 16,747,490 13,173,978 3,573,512  
10 Payroll taxes ........... 14,929,667 12,035,457 2,894,210  
11 Fees for services (non-employees):        
a Management ...... 3,543,148 771,692 2,771,456  
b Legal ......... 901,921   901,921  
c Accounting ........... 288,996   288,996  
d Lobbying ........... 93,681   93,681  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 1,045,173   1,045,173  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 92,570,774 64,126,248 28,444,526 0
12 Advertising and promotion .... 995,761 86,409 909,352  
13 Office expenses ....... 4,469,448 234,356 4,235,092  
14 Information technology ...... 11,122,248 993,845 10,128,403  
15 Royalties ..        
16 Occupancy ........... 21,545,328 17,102,970 4,442,358  
17 Travel ............ 1,403,473 846,408 557,065  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 540,910 337,752 203,158  
20 Interest ........... 3,619,666   3,619,666  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 34,736,948 23,179,392 11,557,556  
23 Insurance ... 1,677,527 1,291,855 385,672  
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 FEDERAL AND STATE INCOME TAX 252,167   252,167  
b MEDICAL AND PHARMACEUTICAL 54,586,948 54,278,000 308,948  
c PATIENT SUPPLY COST OF 51,721,135 51,721,135    
d Food, Beverages, and Other Operational Supplies 6,345,574 5,049,251 1,296,323  
e All other expenses 4,852,007 916,970 3,935,037 0
25 Total functional expenses. Add lines 1 through 24e 566,538,633 439,101,044 127,437,588 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 (2021)
Form 990 (2021)
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 ........ 19,449,361 1 17,935,967
2 Savings and temporary cash investments ......... 77,014,637 2 39,911,772
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 95,752,065 4 94,609,244
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 13,003,744 7 13,118,900
8 Inventories for sale or use ............ 13,539,062 8 13,069,550
9 Prepaid expenses and deferred charges ...... 8,786,434 9 8,267,676
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 921,669,550
b Less: accumulated depreciation 10b 649,176,854 277,296,184 10c 272,492,696
11 Investments—publicly traded securities . 336,365,156 11 297,137,873
12 Investments—other securities. See Part IV, line 11 ..... 80,607,365 12 77,046,493
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ............... 506,348 14 506,348
15 Other assets. See Part IV, line 11 ........... 79,672,690 15 85,310,488
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,001,993,046 16 919,407,007
Liabilities 17 Accounts payable and accrued expenses ..... 81,348,206 17 110,816,880
18 Grants payable ...   18  
19 Deferred revenue ......... 76,003 19 433,219
20 Tax-exempt bond liabilities ......... 145,538,828 20 142,397,252
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 116,970,999 25 86,812,844
26 Total liabilities. Add lines 17 through 25.. 343,934,036 26 340,460,195
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 638,015,585 27 560,575,372
28 Net assets with donor restrictions ........... 20,043,425 28 18,371,440
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 658,059,010 32 578,946,812
33 Total liabilities and net assets/fund balances ........ 1,001,993,046 33 919,407,007
Form 990 (2021)
Form 990 (2021)
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
541,189,562
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
566,538,633
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-25,349,071
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
658,059,010
5
Net unrealized gains (losses) on investments ...............
5
-52,128,990
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
-1,634,137
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
578,946,812
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 on
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
 
No
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
 
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
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- 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
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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 failed 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) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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 5 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) 2021

Schedule A (Form 990) 2021
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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 on 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) 2021

Schedule A (Form 990) 2021
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
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 on 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 on 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) 2021

Schedule A (Form 990) 2021
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 on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

Schedule A (Form 990) 2021
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 0.015 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 0.035 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) 2021

Schedule A (Form 990) 2021
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2021 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2021 		(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2021:
a From 2016.......  
b From 2017.......  
c From 2018.......  
d From 2019.......  
e From 2020.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2021 distributable amount  
i Carryover from 2016 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2021 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2021 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2021, 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 2021. 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 2022. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2017.....  
b Excess from 2018.....  
c Excess from 2019.....  
d Excess from 2020.....  
e Excess from 2021.....  
Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021
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) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2021)
Schedule B (Form 990) (2021) Page 2
Name of organization
Genesis Health System
  		Employer identification number
42-1418847
Part I
Contributors
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) (2021)
Schedule B (Form 990) (2021)
Page 3
Name of organization
Genesis Health System
  		Employer identification number

42-1418847
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) (2021)
Schedule B (Form 990) (2021)
Page 4
Name of organization
Genesis Health System
  		Employer identification number

42-1418847
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) (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE C
(Form 990)

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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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
Genesis Health System
 
Employer identification number

42-1418847
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. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

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.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
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) 2018 (b) 2019 (c) 2020 (d) 2021 (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) 2021


Schedule C (Form 990) 2021
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)
Yes|No
(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)? ........
Yes
 
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
Yes
 
0
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
 
5,212
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
88,469
j
Total. Add lines 1c through 1i ....................................................................................................
93,681
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
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Part II-B, Line 1b. PAID STAFF OR MANAGEMENT: GENESIS HEALTH SYSTEM (GHS Iowa) HAD ONE STAFF MEMBER INVOLVED IN LOBBYING ACTIVITIES ON A PART TIME BASIS. THEIR LOBBYING ACTIVITIES WERE FOCUSED ON SENDING LETTERS OR PUBLICATIONS TO GOVERNMENT OFFICIALS OR LEGISLATORS AND MEETING WITH OR CALLING GOVERNMENT OFFICIALS OR LEGISLATORS ON HEALTHCARE RELATED MATTERS. Part II-B, Line 1d. MAILINGS TO MEMBERS, LEGISLATURES, OR THE PUBLIC: EMPLOYEES OF GENESIS HEALTH SYSTEM ( GHS IOWA) ARE ENCOURAGED TO PARTICIPATE IN THE IOWA HOSPITAL ASSOCIATION'S "IHA ACTION ALERTS." THE EMPLOYEES PARTICIPATE BY RESPONDING TO E-MAIL ALERTS WHICH ALLOWS THEM TO VOICE THEIR OPINIONS TO THEIR STATE REPRESENTATIVES ON HEALTHCARE RELATED MATTERS (NOT CANDIDATE-SPECIFIC). THERE IS NO DIRECT COST TO GENESIS HEALTH SYSTEM (GHS IOWA) REGARDING THIS ACTIVITY. Part II-B, Line 1g. DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: GENESIS HEALTH SYSTEM (GHS IOWA) HAD ONESTAFF MEMBER INVOLVED IN LOBBYING ACTIVITIES ON A PART TIME BASIS. THEIR LOBBYING ACTIVITIES WERE FOCUSED ON SENDING LETTERS OR PUBLICATIONS TO GOVERNMENT OFFICIALS OR LEGISLATORS AND MEETING WITH OR CALLING GOVERNMENT OFFICIALS OR LEGISLATORS ON HEALTHCARE RELATED MATTERS. THE DIRECT COSTS RELATED TO THEIR LOBBYING ACTIVITIES INCLUDED: SALARIES- $5,212. Part II-B, Line 1i. OTHER LOBBYING ACTIVITIES: IN FISCAL YEAR 2022, GENESIS HEALTH SYSTEM (GHS IOWA) RECEIVED PROFESSIONAL LOBBYING AND GOVERNMENTAL RELATIONS CONSULTING SERVICES FROM EIDE & HEISINGER, LLC AT A COST OF $25,000. LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED; 18.60% OF MEMBERSHIP DUES TO THE IOWA HOSPITAL ASSOCIATION, OR $23,677, 25.56% OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OR $16,289, 55% OF MEMBERSHIP DUES TO THE AMERICAN MEDICAL ASSOCIATION, OR $5,125, AND VARIOUS OTHER ASSOCIATIONS- $18,358.
Schedule C (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2

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.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2021

Schedule D (Form 990) 2021
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 .... 20,151,901 16,641,933 15,498,706 14,081,104 13,249,656
b Contributions ... 218,922 455,141 528,855 937,158 166,432
c Net investment earnings, gains, and losses -2,392,475 3,878,888 708,244 562,187 739,721
d Grants or scholarships ... 5,000 5,000 5,000 5,000 5,000
e Other expenditures for facilities
and programs ... 		326,837 684,952      
f Administrative expenses .... 167,722 134,109 88,872 76,743 69,705
g End of year balance ...... 17,478,789 20,151,901 16,641,933 15,498,706 14,081,104
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet33.6 %
b
Permanent endowment SchDMd Bullet66.4 %
c
Term endowment SchDMd Bullet0 %
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 .....   12,989,630 12,989,630
b Buildings ....   408,247,689 226,715,027 181,532,662
c Leasehold improvements   30,345,513 23,800,327 6,545,186
d Equipment ....   438,920,397 388,776,401 50,143,996
e Other .....   31,166,321 9,885,099 21,281,222
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 272,492,696
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
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) INVESTMENT IN GENVENTURES, INC		 26,307,911 C

(B) INVESTMENT IN MISERICORDIA ASSURANCE, LTD.		 120,000 C

(C) INVESTMENT IN HEI COOP		 7,480,381 C

(D) INVESTMENT IN SPRING PARK SURGERY CENTER, LLC		 3,562,769 C

(E) INVESTMENT IN GENGASTRO, LLC		 26,882,962 C

(F) INVESTMENT IN GENORTHO, LLC		 2,733,382 C

(G) INVESTMENT IN GENRAD IMAGING, LLC		 2,695,417 C

(H) OTHER INVESTMENTS - GMC		 28,655 C

(I) INVESTMENT IN UNIVERSITY OF IOWA HEALTH ALLIANCE, LLC		    

(J) INVESTMENT IN DAVITA DIALYSIS, LLC		 2,525,623 C

(K) INVESTMENT IN WELLMARK		 0 C

(L) Investment in Wellspire, LLC		 1,932,593 C

(M) Investment in Premier Healthcare		 672,702 C

(N) Investment in Exela Holdings		 2,104,098 C
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 77,046,493
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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)Interest in Net Assets of Foundation 16,701,920
(2)Deferred Compensation Annuity 23,340,551
(3)Cash surrender Value of Life Insurance 9,518,304
(4)Goodwill & Covenant Not to Compete 820,444
(5)Sercurity Escrow and Other Assets 359,655
(6)Interest Receivable 360,046
(7)Lease Right of Use Assets 34,209,568
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 85,310,488
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  
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 86,812,844
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) 2021

Schedule D (Form 990) 2021
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  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
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  
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  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
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
Schedule D, Part V, Line 4 Intended uses of endowment funds GENESIS HEALTH SERVICES FOUNDATION, A RELATED ORGANIZATION, HOLDS THE ENDOWMENT FUNDS. THE INTENDED USE OF THE FOUNDATION'S ENDOWMENT FUNDS ARE AS FOLLOWS: SCHOLARSHIPS FOR EDUCATION IN THE MEDICAL FIELD, CHARITY CARE FOR THE INDIGENT, EMPLOYEE EMERGENCY ASSITANCE, VISITING NURSE, HOSPICE HOUSE, DIABETIC CARE, PEDIATRIC HOSPICE, DIALYSIS CARE, AND BREAST HEALTH SERVICES.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Uncertainty in income taxes: GHS Iowa, GHS Illinois, GMC - Aledo, the Genesis Foundation, Genesis Philanthropy and the Workers' Compensation Trust each files a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax exempt status of each entity, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income. Unrelated business taxable income is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the more likely than not recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for uncertain tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Forms 990 and 990T filed by GHS Iowa, GHS Illinois, GMC - Aledo, the Genesis Foundation, Genesis Philanthropy and the Workers' Compensation Trust are subject to examination by the IRS up to three years from the extended due date of each return. GenVentures is a taxable organization and currently files income tax returns in the U.S. federal jurisdiction and various state jurisdictions. There were no uncertain tax positions as of June 30, 2022 and 2021.
Schedule D (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region		 (f) Total expenditures
for and investments
in the region
Central America and the Caribbean 0 0 Investments   0
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .... 0 0 0
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021
Schedule F (Form 990) 2021
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of noncash
assistance 		(h) Description
of noncash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
 
3 Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2021
Schedule F (Form 990) 2021Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
noncash
assistance 		(g) Description
of noncash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2021
Schedule F (Form 990) 2021
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2021
Schedule F (Form 990) 2021
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
Schedule F, Part I, Line 3 Method used to account for expenditures on org's financial statements CENTRAL AMERICA AND THE CARIBBEA
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2021
Additional Data


Software ID: 21014044
Software Version: 2021v4.2



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 Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
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) . . . 		    2,695,677 0 2,695,677 0.48 %
b Medicaid (from Worksheet 3, column a) . . . . .     80,620,206 58,209,308 22,410,898 3.96 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .         0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 83,315,883 58,209,308 25,106,575 4.43 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     930,847 0 930,847 0.16 %
f Health professions education (from Worksheet 5) . . .     3,103,782 1,828,521 1,275,261 0.23 %
g Subsidized health services (from Worksheet 6) . . . .     3,523,816 1,666,657 1,857,159 0.33 %
h Research (from Worksheet 7) .         0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     1,024,722 0 1,024,722 0.18 %
j Total. Other Benefits . . 0 0 8,583,167 3,495,178 5,087,989 0.90 %
k Total. Add lines 7d and 7j . 0 0 91,899,050 61,704,486 30,194,564 5.33 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 0 0 0 0 %
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 Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
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
11,508,216
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
109,576,538
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
123,290,213
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-13,713,675
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 %
1GENGASTRO LLC
  		AMBULATORY SURGERY CENTER 84 % 0 % 16 %
2GENORTHO LLC
  		ORTHOPAEDIC SURGERY CENTER 40 % 0 % 60 %
3SPRING PARK SURGERY CENTER LLC
  		OUTPATIENT SURGICAL CENTER 40 % 0 % 60 %
4GENRAD IMAGING LLC
  		DIAGNOSTIC IMAGING CENTER 50 % 0 % 50 %
5DAVITA DIALYSIS LLC
  		OUTPATIENT DIALYSIS CENTER 20 % 0 % 80 %
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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?2Name, 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
2 GENESIS MEDICAL CENTER - DAVENPORT
1227 E RUSHOLME STREET
DAVENPORT,IA52803
820011H
WWW.GENESISHEALTH.COM 		X X         X      
1 GENESIS MEDICAL CENTER - DEWITT
1118 11TH STREET
DEWITT,IA52742
WWW.GENESISHEALTH.COM
230149H 		X X     X   X      
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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)
GENESIS MEDICAL CENTER - DAVENPORT
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): 		2
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 21
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 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.GENESISHEALTH.COM/COMMUNITY
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GENESIS MEDICAL CENTER - DAVENPORT
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 Was widely publicized 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
WWW.GENESISHEALTH.COM
b
WWW.GENESISHEALTH.COM
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
GENESIS MEDICAL CENTER - DAVENPORT
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
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
e
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
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
GENESIS MEDICAL CENTER - DAVENPORT
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2021
Schedule H (Form 990) 2021
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)
GENESIS MEDICAL CENTER - DEWITT
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 20
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   No
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   No
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 20
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.GENESISHEALTH.COM/COMMUNITY
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GENESIS MEDICAL CENTER - DEWITT
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 Was widely publicized 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
WWW.GENESISHEALTH.COM
b
WWW.GENESISHEALTH.COM
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
GENESIS MEDICAL CENTER - DEWITT
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
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
e
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
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
GENESIS MEDICAL CENTER - DEWITT
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2021
Schedule H (Form 990) 2021
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - GENESIS MEDICAL CENTER - DAVENPORT. The sponsors of this study, Community Health Care, Inc., Genesis Health System, Muscatine County Public Health, Quad City Health Initiative, Rock Island County Health Department, Scott County Health Department and UnityPoint Health-Trinity, collaborate on improving health status and quality of life in the Quad Cities region. This work together is rooted in periodic, comprehensive community health assessments that meet the information and reporting needs of all partners. Understanding our community's health status is the foundation for developing community education, resources, and programs that will advance our community's health. The assessment informs the creation of community health improvement plans for the study sponsors. In addition, the study sponsors encourage other organizations also to use this information to inform strategic planning, grant writing and project development. For the 2021 Quad Cities Community Health Assessment, our coordinated approach included primary data collection, secondary data analysis, and qualitative data gathering from community members in our bi-state area. The study sponsors engaged PRC, Inc. to collect secondary data and implement a community health survey. Select operations data from local providers also were summarized. Special consideration was given to how we could increase our understanding of topics such as the impact of COVID-19, health disparities, and social determinants of health. The following document provides PRC, Inc.'s bi-state findings in detail as well as information obtained through local partners. Documents produced as part of the 2021 Quad Cities Community Health Assessment process are available for review online at quadcities.healthforecast.net. This Community Health Assessment is a systematic, data-driven approach to determining the health status, behaviors, and needs of residents in Scott, Muscatine, and Rock Island counties - it is a follow-up to similar studies conducted in the Quad Cities Area (Scott and Rock Island counties) in 2002, 2007, 2012, 2015, and throughout the full three-county area in 2018. Subsequently, this information may be used to inform decisions and guide efforts to improve community health and wellness. This study was sponsored by a collaboration of local organizations, including: Community Health Care, Inc.; Genesis Health System; Muscatine County Public Health; Quad City Health Initiative; Rock Island County Health Department; Scott County Health Department; and UnityPoint Health-Trinity. The portion of the study conducted by PRC was funded by Genesis Health System and UnityPoint Health-Trinity. The following staff from the sponsoring organizations comprised the assessment Steering Committee. Steering Committee: Brooke Barnes, Scott County Health Department Taryn Bautista, Genesis Health System Sherri Behr DeVrieze, UnityPoint Health-Trinity Tom Bowman, Community Health Care, Inc. Nicole Carkner, Quad City Health Initiative (QCHI) Michele Dane, Genesis Health System Rikki Hetzler, UnityPoint Health-Trinity Muscatine Public Health Janet Hill, Rock Island County Health Department Daniel Joiner, UnityPoint Health-Trinity Cheri Lewis, Quad City Health Initiative (QCHI) Nita Ludwig, Rock Island County Health Department Tiffany Peterson, Scott County Health Department Christy Roby Williams, UnityPoint Health-Trinity Muscatine Public Health The Steering Committee was guided by the input from Stakeholder Committees that were convened to support data collection and the identification of community health priorities. The Steering Committee thanks the following community members who participated in this process. The Steering Committee would like to acknowledge staff from the Scott County Emergency Management Agency for conversations about how this assessment can inform broader community-recovery planning efforts. The Steering Committee also appreciates the contributions of Lara Paxton, MPH student, St. Ambrose University, who supported this assessment as an intern. Rock Island and Scott Counties Stakeholder Committee: Dr. Ron Boesch, Palmer College of Chiropractic Clinics Carol Brenner, MetroLINK Debra Brownson, Skip-a-Long Family and Community Services Denise Bulat, Bi-State Regional Commission Sheriff Gerry Bustos, Rock Island County Sheriff's Department Dave Donovan, Scott County EMA Gina Ekstrom, Davenport Community School District Laura Fontaine, World Relief Quad Cities Linda Frederiksen, Medic EMS Deborah Freiburg, Rock Island County Board of Health Mayor Bob Gallagher, City of Bettendorf Dr. Ann Garton, St. Ambrose Institute for Person-Centered Care Rev. Dr. Melvin Grimes, Churches United of the Quad City Area Dr. Kathleen Hanson, Scott County Board of Health Dr. Kristin Humphries, East Moline School District Jerry Jones, MLK Jr. Community Center Leslie Kilgannon, Quad Cities Housing Cluster Brycie Kochuyt, Alternatives for the Older Adult Sheriff Tim Lane, Scott County Sheriff's Department Shirleen Martin, Davenport NAACP Health Committee Member Dr. Amy Maxeiner, Black Hawk College Mike Miller, River Bend Food Bank Tammy Reed, Rock Island County NAACP Health Committee Chair, TASC Anamaria Rocha, Mercado on Fifth Paul Rumler, Quad Cities Chamber Alicia Sanders, Rock Island-Milan School District Dr. Rachel Savage, Moline-Coal Valley School District Sarah Stevens, The Project of the Quad Cities Brian Strusz, Pleasant Valley School District Kelly Thompson, Quad Cities Community Foundation Dr. Cheryl True, True Lifestyle Medicine Clinic Deb Waymack, Deere & Company Dr. Rich Whitaker, Vera French Community Mental Health Center Marci Zogg, United Way Quad Cities Muscatine County Stakeholder Committee: Brenda Arthur-Miller, West Liberty Community School District Pastor Susan Bantz, Muscatine Ministerial Association Bob Barrett, City of Wilton Steve Brauns, Wilton Ministerial Association Diana Broderson, City of Muscatine Joe Burnett, Wilton Community School District Clint Christopher, Muscatine Community School District Scott Dahlke, Muscatine Center for Social Action Dr. Naomi DeWinter, Muscatine Community College Dennis Duke, UnityPoint Health - Robert Young Center Jerry Ewers, City of Muscatine - Fire and Emergency Medical Services Megan Francis, Muscatine Senior Resources Michelle Garvin, Wester Drug Pharmacy and Wellness Father Guillermo Trevino, Jr., West Liberty St. Joseph Catholic Church Karen Harper RPH, Muscatine County Board of Health Bob Hartman, City of West Liberty Erika Hayes, UnityPoint Health - Trinity Muscatine Rikki Hetzler, UnityPoint Health - Trinity Muscatine Angela Johnson, UnityPoint Health - Trinity Muscatine Anthony Kies, City of Muscatine - Police Department William Koellner, Muscatine County Board of Health Melanie Langley, Iowa Department of Human Services Dana Larue, Non-Emergency Transport Laurie Ludman, Iowa Department of Human Services Dr. Michael Maharry, University of Iowa Hospitals and Clinics Stephanie Martin, West Liberty Chamber of Commerce Kadie McCory, Mississippi Valley Child Protection Center Rosa Mendoza, Diversity Service Center of Iowa Mary Odell, Muscatine Health Support Funds Shane Orr, United Way of Muscatine Damaris Ortega, UnityPoint Health - Trinity Muscatine Occupational Medicine Dr. Dustaff Persaud, Mercy Family Medicine Lindsey Phillips, Trinity Muscatine Foundation Board of Directors Cheryl Plank, Vision 2020 Muscatine Tina Plett, Community Health Care, Inc., Muscatine Medical Clinic Eric Reader, Greater Muscatine Chamber of Commerce and Industry Erick Recinos, UnityPoint Health - Trinity Glenda Reichert - UnityPoint Health - Trinity Muscatine Judge Tom Reidel, 7th Judicial District - Iowa Department of Corrections Sheriff Quinn Reiss, Muscatine County Sherriff's Department Christy Roby Williams, UnityPoint Health - Trinity Muscatine Public Health Daniel Salazar, Racial Justice Fund Committee of Community Foundation of Greater Muscatine Nick Salazar, LULAC - League of United Latin American Citizens of Iowa Santos Saucedo, Muscatine County Board of Supervisors Charla Schafer, Community Foundation of Greater Muscatine Pastor Ty Thomas, Calvary Church Muscatine Felicia Toppert, Muscatine County Community Services Kim Warren, Aligned Impact Muscatine Brandy Werling-Marquez, Wilton Chamber of Commerce Steve Wieskamp, Rock Valley Physical Therapy Destiny Williams, Racial Justice Fund Committee of Community Foundation of Greater Muscatine Brian Wright, Emergency Management Agency
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - GENESIS MEDICAL CENTER - DAVENPORT. UNITY POINT HEALTH-TRINITY
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - GENESIS MEDICAL CENTER - DAVENPORT. COMMUNITY HEALTH CARE, QUAD CITY HEALTH INITIATIVE, ROCK ISLAND COUNTY HEALTH DEPARTMENT, Muscatine County Board of Health, AND THE SCOTT COUNTY HEALTH DEPARTMENT
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - GMC Davenport. With following the Genesis Health System's mission along with coordinating with the Quad City Health Initiative Implementation plan, Genesis Medical Center Silvis will be focusing and delivering on the following programs and resources to address the needs of the community: Community Education and Outreach Health Screening Support Groups Counseling Self-Help Immunizations Other Community Programs Family Support Services In-Home Services Meals/Nutrition Services Transportation Services Cash and In-Kind Donations Medical Education and Research III. Community Health Improvement Initiatives Infant Health: Multi-year plan in coordination with the Quad City Health Initiative, Unity Point QC, the Rock Island and Scott County Health Departments and Community Health Care to reduce the number of low birth weight infants. Form the multi-disciplinary task force - health care organization leaders, providers and target population Understand the size and scope of the health issue Determine the area of focus to reduce low birth weight births Implement strategies Evaluate progress Mental Health: Continue our efforts to support community mental health programs through: - Collaboration with Vera French to support programs such as "ACT" Assertive Community Treatment, MST Multisystemic therapy for teens, etc. - Behavioral health services provided via our emergency department and inpatient unit -Support Family Connects - moms with post-partum depression Participate in the Quad Cities Behavioral Health Coalition programs (e.g.the Zero Suicide Initiative) Advocate for improved funding for mental health services Nutrition, Physical Activity and Weight: Collaborate with community partners to educate the public re the importance of healthy diet and regular exercise such as Be Healthy QC Implement a Food Pharmacy to help diabetic patients with limited resources obtain and use healthy foods to control their diabetes. Provision of exercise equipment at area parks. Continue Genesis programs: -YMCA membership discount for staff and their families -Healthy Lifestyle Sponsorships such as Bix 7 -Center for Weight Management and Bariatric Surgery Access to Healthcare: Continue Genesis support for: -421-DOCS - assistance for finding a primary care provider -Recruiting primary care providers and specialists Expansion of Genesis emergency and convenient care services in growing population areas (e.g. Eldridge Convenient Care Clinic) Expansion of telehealth services for: -Non-emergent, basic health care -Consultations with specialists especially for patients living in rural areas Diabetes Prevention and Treatment: Genesis Health System FY 2022 Strategic Goal - Achieve breakthrough performance in lowering the hemoglobin A1C rate to improve the health of our community. Achieved by: -Continued monitoring of high risk patients -Ongoing education Implementation of a Food Pharmacy to help diabetic patients, with limited resources, obtain and use healthy foods to control their diabetes.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Genesis Medical Center Dewitt. Part V, Section B, Line 5: To complete the community health needs assessment, existing health -related data were collected via the online community commons community health needs assessment report tool at HTTP://www.communitycommons.org/maps-data. This site allows for identification of 87 distinct health and social indicators at the county level , along with comparisons to state and national data, and health people 2020 targets, where available. Once an indicators report was generated, relevant indicators were reviewed to determine how Clinton County compared to available state/national data (see the "detailed health indicators" section of this document. Data was also collected by Genesis Health system Business Intelligence and Communications departments. Information gaps: Because this CHNA relies on existing datasets, it is limited in scope to those indicators currently available through database collection. It does not include a primary research component and many important issues are unaddressed (e.g. access to healthcare). Another limitation is that most measures included in this assessment represent data that are several years old. Community Stakeholder Input: Genesis Medical Center DeWitt got input from public health officials and other community stakeholders through a series of meetings. The organizations involved include: * Westwing Senior Living * Clinton County Public Health Department * GMC DeWitt * Patient Health Services Jack County Board of Health * GMC DeWitt Social Services * GMC DeWitt Community Health Liaison Genesis Medical Center Dewitt also conducts a community survey to local organizations for input on CHNA and implementation strategy.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - GENESIS MEDICAL CENTER - DEWITT:. Genesis Health System, in collaboration with Clinton County Health Department, continues to address the significant needs identified in the most recent CHNA through our ongoing programs and resources. These programs include: Healthy Behaviors: Integrated health, wellness activities, smoking cessation, physical activity and weight status: * Switch program completed for DeWitt area families by extension office * School nurse was provided extension office 5210 healthy eating habits posters for education at DeWitt Schools * Diabetes CCM program * Implementation of Food Pharmacy * Continue Genesis support for primary and specialty care services * Expansion of Genesis emergency and convenient care services in areas of growing population/need * Expansion on telehealth services * Concussion management built into the school's initial assessment for baseline of any student athlete * Coverage for treatment at athletic events (Northeast, DeWitt, and Calamus/Wheatland schools) Decrease Youth Risky Behaviors: Teenage pregnancy, marijuana use: * DeWitt/Camanche coalition attendance provided by Wanda Haack and/or Ann Bixby * Scott Drug provides drop box for unused medication disposal * DeWitt/Camanche Coalition provided education at local schools Mental Health Awareness and Services: Suicide prevention and awareness, medication disposal, education on adverse childhood experience (ACE): * Connections Matter * CNO and RN became educated trainers; provided education to Med/Surg and ED units at GMC-DeWitt and DeWitt Lion's Club * Education provided to VNA staff and hosted at GMC-DeWitt * Respite House support provided through DeWitt and GHS Foundations. House provided through lease agreement with GMC-DeWitt * Continued contract with Eastern Iowa Grant providing telepsyche services within the ED and RN Care Coordination for mental health services from ED to community RN Care Coordinator * Continue efforts to support community mental health programs * Participate in Zero Suicide program * Advocate for improved funding for mental health services
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 9
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?42
Name and address Type of Facility (describe)
1 BETTENDORF HEALTH PLEX
2140 53RD AVENUE
BETTENDORF,IA52722 		OUTPATIENT PHYSICIAN CLINIC AND IMAGING SERVICES
2 GENESIS IMAGING CENTER 53RD STREET
1970 E 53RD STREET
DAVENPORT,IA52807 		OUTPATIENT RADIOLOGY SERVICES
3 CENTRAL PARK MEDICAL PAVILIONS 1 & 2
1351 W CENTRAL PARK AVENUE
DAVENPORT,IA52804 		O/P CANCER, INFUSION, WOUND, & PHYSICIAN CLINIC
4 GENESIS MEDICAL PLAZA
2535 MAPLECREST ROAD
BETTENDORF,IA52722 		O/P REHAB, PAIN, PHYS THERAPY, DIABETES, HOME HEALTH, SPINE CTR & PHSY CLINIC
5 Davenport HealthPlex
3200 West Kimberly Rd
Davenport,IA52806 		Outpatient Physician Clinic/Physical Therapy
6 MEDICAL OFFICE BUILDING #1 and #2
1228 E RUSHOLME STREET
DAVENPORT,IA52803 		O/P MAMMOGRAPHY & DIALYSIS SERVICES
7 ILLINI LARSON CENTER
855 ILLINI DRIVE
SILVIS,IL61282 		OUTPATIENT LAB & PHYSICIAN CLINIC
8 VISITING NURSE ASSOC & HOSPICE HOUSE
2546 TECH DRIVE
BETTENDORF,IA52722 		HOME HEALTH & HOSPICE
9 ELDRIDGE FAMILY PRACTICE
301 N 4TH AVENUE
ELDRIDGE,IA52748 		OUTPATIENT PHYSICIAN CLINIC
10 GENESIS CONVENIENT CARE - ILLINOIS
2350 41ST STREET
MOLINE,IL61265 		OUTPATIENT URGENT CARE CLINIC
11 Woodlands Family Practice
4321 53rd Ave
Bettendorf,IA52722 		Outpatient Physician Clinic
12 GHG-Valley View Moline
615 valley Vew Dr Suite 305
Moline,IL61265 		Outpatient Physician Clinic
13 GENESIS HEALTH GROUP
865 LINCOLN ROAD
BETTENDORF,IA52722 		OUTPATIENT PHYSICIAN CLINIC
14 GENESIS PHYSICAL REHAB - VALLEY FAIR
2300 53RD STREET
BETTENDORF,IA52722 		O/P PHYSICAL THERAPY CLINIC
15 PHYSICAL THERAPY & SPORTS MEDICINE
1702 E 53RD STREET
DAVENPORT,IA52807 		O/P PHYSICAL THERAPY & SPORTS PERF CLINIC
16 FAMILY PRACTICE AT WEST CAMPUS
1345 W CENTRAL PARK AVENUE
DAVENPORT,IA52804 		OUTPATIENT PHYSICIAN CLINIC
17 GENESIS PSYCHOLOGY ASSOCIATES
4455 E 56TH STREET
DAVENPORT,IA52804 		OUTPATIENT COUNSELING CLINIC
18 Dewitt Family Practice
1008 11th St
Dewitt,IA52742 		Outpatient Physician Clinic
19 GENGASTRO LLC
2222 53RD AVENUE
BETTENDORF,IA52722 		AMBULATORY SURGERY CENTER
20 ELDRIDGE PHYSICAL THERAPY
170 S 4TH AVENUE
ELDRIDGE,IA52748 		OUTPATIENT PHYSICAL THERAPY CLINIC
21 MOLINE HEALTHPLEX
3900 28TH AVENUE
MOLINE,IL61265 		OUTPATIENT PHYSICIAN CLINIC
22 GENORTHO LLC
2300 53RD STREET
BETTENDORF,IA52722 		ORTHOPEDIC SURGERY CENTER
23 GENRAD IMAGING LLC
1970 E 53RD STREET
DAVENPORT,IA52807 		DIAGNOSTIC IMAGING CENTER
24 Genesis PT &Sports Medicaine-Bettendorf
2300 53rs Ave STE LL02
Bettendorf,IA52722 		Outpatient Physical Therapy Clinic
25 GHS OCCUPATIONAL HEALTH - DAVENPORT
3319 SPRING STREET
DAVENPORT,IA52807 		OUTPATIENT OCCUPATIONAL HEALTH
26 Durant FAMILY PRACTICE
619 5th
Durant,IA52747 		OUTPATIENT PHYSICIAN CLINIC
27 Genesis Physcial Therapy Davenport
1820 West 3rd St
Davenport,IA52801 		Outpatient Physical Therapy Clinic and Physician Clinic
28 GENESIS OCCUPATIONAL HEALTH
2350 41ST STREET
MOLINE,IL61265 		OUTPATIENT OCCUPATIONAL HEALTH
29 DEWITT AMBULANCE
1220 11TH STREET
DEWITT,IA52742 		AMBULANCE SERVICES
30 Genesis Physical Therapy at LeClaire
1003 Canal Shore Drive
LeClaire,IA52753 		Outpatient Physical Therapy Clinic
31 Genesis Physical Therapy Clinton
1647 Lincoln Way
Clinton,IA52732 		Outpatient Physical Therapy Clinic
32 GHS - AUGUSTANA PT CLINIC
639 38TH STREET
ROCK ISLAND,IL61201 		OUTPATIENT PHYSICAL THERAPY CLINIC
33 SPRING PARK SURGERY CENTER LLC
3319 SPRING STREET STE 202A
DAVENPORT,IA52807 		OUTPATIENT SURGICAL CENTER
34 VISITING NURSE ASSOC & HOSPICE HOUSE
611 NORTH 2ND AVE
CLINTON,IA52732 		HOME HEALTH & HOSPICE
35 IA CITY PEDIATRIC PT CLINIC
2451 CORAL CT
CORALVILLE,IA52241 		OUTPATIENT PHYSICAL THERAPY CLINIC
36 BLUE GRASS FAMILY MEDICAL
413 S MISSISSIPPI
BLUE GRASS,IA52726 		OUTPATIENT PHYSICIAN CLINIC
37 CONVENIENT CARE NOW E KIMBERLY
1823 E KIMBERLY RD
DAVENPORT,IA52807 		Outpatient Urgent Care clinic
38 Genesis Sports Medicine Rock Island
1025 30th Street
Rock Island,IL61201 		Outpatient Physical Therapy Clinic
39 Conveniet Care Now W Locust
2351 West locust Street
Davenport,IA52804 		Outpatient Urgent Care Clinic
40 GENESIS HEART INSTITUTE
1236 E RUSHOLME STREET
DAVENPORT,IA52803 		O/P CARDIAC DIAGNOSTIC & REHAB CARE
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 10
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
Schedule H, Part I, Line 6a Community benefit report prepared by related organization GENESIS HEALTH SYSTEM (GHS ILLINOIS) AND GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO)
Schedule H, Part I, Line 7g Subsidized Health Services No costs associated with a physician clinic were reported in subsidized health services.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Genesis Health System (GHS Iowa) utilized Worksheet 2 to calculate its cost-to-charge ratio. The calculated cost-to-charge ratio was used to calculate the cost of Charity Care and Unreimbursed Medicaid. Costs of the "Other Benefits" reported in 7e -7i were compiled throughout the year in the community benefit database (i.e., CBISA) that Genesis Health System utilizes.
Schedule H, Part II Community Building Activities No building activities for tax year 2021.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount In accordance with Healthcare Financial Management Association Statement No. 15, Bad Debt is reported at the full-established charge from the most recent audited financial report. Payments received after an account had been written off to bad debt were credited to a bad debt recovery account. Discounts on patient accounts provided by third-party payers were written off to a contractual allowance account.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology Genesis Health System uses Avadyne Health to process aging patient accounts. Avadyne Health's collection process utilizes publicly available information to ensure all aging patient accounts receive financial assistance in accordance to Genesis Health System policy before being deemed bad debt. Genesis Health System reported zero dollars for the estimated amount of the organization's bad debt attributable to patients eligible under the organization's financial assistance policy.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The System determines the transaction price based on standard charges for goods and services provided to patients, reduced by explicit price concessions consisting of contractual adjustments provided to third-party payors, discounts provided to uninsured patients in accordance with the System's policy, and/or implicit price concessions provided to uninsured patients based on historical collection experience. The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts expected to be collected based on the System's collection history with similar classes of patients. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay are recorded as bad debt expense. Bad debt expense for the years ended June 30, 2022 and 2021, was not material.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs No Medicare shortfalls were included in community benefit. The Medicare cost report shortfall represents the difference between the total revenue received from Medicare based on Medicare cost report reimbursement rates and the costs incurred by GHS Iowa in providing healthcare services to the elderly. The total Medicare shortfall, which includes fee screen services, was $13,713,675. In 2021, the percent of persons 65 years and over in Rock Island and Scott Counties was 17.0%. In accordance with GHS Iowa's mission statement, "To Provide Compassionate, Quality Health Services to All Those in Need," the elderly were served despite the total Medicare loss of $13,713,675. GHS Iowa has a clear mission to serve all those in need and to improve the health of the community including the elderly. Furthermore, there are no for-profit hospitals in the community, and therefore GHS Iowa is one of two tax-exempt healthcare organizations in the community who provide access to healthcare for Medicare patients. Accordingly, it is GHS Iowa's position for the reasons stated above that the total Medicare shortfall of $13,713,675 represents a Community Benefit. Pursuant to the instructions to the Form 990, Schedule H, the Medicare shortfall is not included in Part I, line 7. If the total Medicare shortfall was included in Part I, line 7, then Part I, line 7k, Column f would be 2.42%.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Every effort is made to determine a patient's eligibility for financial assistance. If eligible, payment plans are made available based on their resources and income. All balances owing after financial assistance allowances have been taken are payable in monthly payments in accordance with the organization's financial assistance policy.
Schedule H, Part V, Section B, Line 16a FAP website - GENESIS MEDICAL CENTER - DEWITT: Line 16a URL: WWW.GENESISHEALTH.COM; - GENESIS MEDICAL CENTER - DAVENPORT: Line 16a URL: WWW.GENESISHEALTH.COM;
Schedule H, Part V, Section B, Line 16b FAP Application website - GENESIS MEDICAL CENTER - DEWITT: Line 16b URL: WWW.GENESISHEALTH.COM; - GENESIS MEDICAL CENTER - DAVENPORT: Line 16b URL: WWW.GENESISHEALTH.COM;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - GENESIS MEDICAL CENTER - DEWITT: Line 16c URL: WWW.GENESISHEALTH.COM; - GENESIS MEDICAL CENTER - DAVENPORT: Line 16c URL: WWW.GENESISHEALTH.COM;
Schedule H, Part VI, Line 2 Needs assessment The sponsors of this study, Community Health Care, Inc., Genesis Health System(GHS Illinois), Muscatine County Public Health, Quad City Health Initiative, Rock Island County Health Department, Scott County Health Department and UnityPoint Health-Trinity, collaborate on improving health status and quality of life in the Quad Cities region. This work together is rooted in periodic, comprehensive community health assessments that meet the information and reporting needs of all partners. Understanding our community's health status is the foundation for developing community education, resources, and programs that will advance our community's health. The assessment informs the creation of community health improvement plans for the study sponsors. In addition, the study sponsors encourage other organizations also to use this information to inform strategic planning, grant writing and project development. For the 2021 Quad Cities Community Health Assessment, our coordinated approach included primary data collection, secondary data analysis, and qualitative data gathering from community members in our bi-state area. The study sponsors engaged PRC, Inc. to collect secondary data and implement a community health survey. Select operations data from local providers also were summarized. Special consideration was given to how we could increase our understanding of topics such as the impact of COVID-19, health disparities, and social determinants of health. The following document provides PRC, Inc.'s bi-state findings in detail as well as information obtained through local partners. Documents produced as part of the 2021 Quad Cities Community Health Assessment process are available for review online at quadcities.healthforecast.net. This Community Health Assessment is a systematic, data-driven approach to determining the health status, behaviors, and needs of residents in Scott, Muscatine, and Rock Island counties - it is a follow-up to similar studies conducted in the Quad Cities Area (Scott and Rock Island counties) in 2002, 2007, 2012, 2015, and throughout the full three-county area in 2018. Subsequently, this information may be used to inform decisions and guide efforts to improve community health and wellness. A Community Health Assessment provides information so that communities may identify issues of greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact on community health status. This Community Health Assessment will serve as a tool toward reaching three basic goals: To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life. To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors that historically have had a negative impact on residents' health. To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care. Genesis Medical Center Dewitt utilizes the community health needs assessment (CHNA) conducted by Genesis Health System Business Intelligence and communications department as well partnering with Clinton County Health Department in 2020.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Information on the availability of financial assistance is posted in visible locations in the admission departments of the hospitals. In addition, the hospital registration staff make available informative brochures for patients in the Emergency Room registration area explaining their eligibility for assistance. Genesis Health System (GHS Iowa) provides patient financial counselors on each hospital campus to discuss options with the patients. Patient Financial Services prepares and provides a letter to each patient, explaining their current balance and advising them of their options. A phone number is provided with the letter encouraging the patient to call if needed.
Schedule H, Part VI, Line 4 Community information Genesis Health System's (GHS Illinois) mission is to provide quality, compassionate care for all those in need. GHS Illinois lives its mission each day by serving a 10-County region of Eastern Iowa and Western Illinois, including both urban and rural areas. The region served by GHS Illinois (Davenport-Moline-Rock Island, IA - IL. Metropolitan statistical area - Henry County, IL, Mercer County, IL, Muscatine County IA, Rock Island, IL., and Scott County, IA.) has a population of 359,208. According to the US Census Bureau American Community Survey Five Year Estimates (2015-2019), Whites made up 84.0% of the MSA population with 8.1% Black or African-American and 7.9% Hispanic or other origin. In the Quad Cities area, 23.4% of the population are infants, children, or adolescents (age 0-17); another 59.6% are 18-64, while 17.0% are age 65 and older. According to estimates from the US Census Bureau American Community Survey, 12.5% of Quad Cities area residents (Scott and Rock Island Counties) live below the Federal poverty Lack of health insurance among adults age 18 to 64 is reported by 5.7% of Scott County, IA residents and 8.7% of Rock Island County, IL residents. The Quad Cities area percentage of adults who smoked in 2021 was 20.5%. The percentage of adults who were obese in 2021 was 40.5% in Rock Island County, Illinois and 42.1% in Scott County, Iowa. Obesity rates in both Scott County, IA and Rock Island County, IL are higher than national benchmarks. GMC DeWitt serves the residents of Clinton County, primarily those residing in Dewitt and the surrounding towns. With a population of 47,218, made of age groups of 0-17 (22.82%), 18-44 (30.03%), 45-64 (28.09%), and 65+ (19.06%). Population living areas were 67.77% in urban and 32.23% in rural. Other statistic was population made up of white (93.77%), black or African American (2.67%), Asian (.73%), and other (2.83%). Statistic percentages are according to the U.S. Census Bureau American Community Survey 2014-18 5 year estimates.
Schedule H, Part VI, Line 5 Promotion of community health Genesis Health System's Board of directors is a diverse representation of persons who reside in the primary service area that Genesis Health System serves. Genesis Health System executives and employees serve on dozens of volunteer boards throughout the region on important projects and initiatives, such as homeless shelters, mental health, downtown redevelopment and events and festivals. Genesis Health System employees serve the communities where they live by serving in elected offices in city and county government. Genesis Health System extends medical staff privileges to all qualified physicians in its communities. Genesis Health System has endeavored to improve access to health care for the communities it serves by participating in appropriate joint ventures that offer needed health care services to under-served areas. Genesis Health System schedules dozens of health screenings and immunizations throughout the year at a reduced cost. These include screenings for diabetes, stroke and heart disease and public flu immunization clinics. Genesis Health System providers translation services based on a percentage of the diversity of the population. Each year, Genesis Health System provides the community with dozens of classes and events promoting health and health education. Hundreds of residents in the region served by Genesis Health System learn CPR, First Aid, parenting skills, and newborn care by enrolling in classes. Genesis Health System supplies medical supplies and equipment to Globus, which is a third party company that helps companies share and transfer research data. Genesis Health System maintains an active effort to advocate for access to health care in Iowa and Illinois State government and in Washington D.C. Genesis Health System employees also participate in a voter voice initiative to advocate on important health issues with City, County, State, and National elected officials. Surplus funds resulting from efficient operations and cost-containment measure are re-invested in the healthcare operations of Genesis Health System to improve the healthcare services that Genesis Health System provides. Advances in medical equipment and technology, staff education, and new medical services are examples of operation investments that ultimately improve the health of the communities that Genesis Health System serves. As part of Genesis Health System, GMC DeWitt is committed to the promotion of community health. The hospital participates in programs such as housing for persons with mental illness.
Schedule H, Part VI, Line 6 Affiliated health care system Nature of business: Genesis Health System - Iowa (GHS Iowa), an Iowa nonprofit corporation, and Genesis Health System - Illinois (GHS Illinois), an Illinois not-for-profit corporation, have identical governing boards, management and bylaws and can act jointly. GHS Iowa is also the sole member of Genesis Health Services Foundation, Genesis Philanthropy, Genesis Accountable Care Organization, LLC and Genesis Health System Workers' Compensation Plan and Trust, the sole stockholder of GenVentures, Inc., a member of Misericordia Assurance Company, Ltd. and a partner in GenGastro, LLC. GHS Illinois is the sole member of Genesis Medical Center - Aledo (GMC - Aledo), and is a partner in The Larson Center Partnership. GHS Iowa, GHS Illinois and GMC - Aledo collectively represent the Obligated Group on certain components of the System's long-term debt. GHS Iowa and GHS Illinois operate the following business units: Genesis Health System provides administrative, management, information technology and other support services to its affiliates. Genesis Clinical Services operates physician medical practices, convenient care practices and an occupational medicine clinic and provides behavioral health services to the residents of eastern Iowa and western Illinois. Genesis Medical Center- Davenport (GMC - Davenport) is licensed as a 502-bed acute care hospital which provides services from two hospital facilities located in Davenport, Iowa. Genesis Family Medical Center (GFMC) is a family practice residency training program that operates clinics in Davenport and Blue Grass, Iowa to provide a clinical setting for the residents to treat patients. Genesis Medical Center- DeWitt (GMC - DeWitt) is certified as a critical access hospital, which has 13-acute care and swing beds, which are dually licensed for Medicare and Medicaid services and which provide services from its facility in DeWitt, Iowa. In June 2019, GMC - Dewitt entered into a lease agreement, whereby GMC - Dewitt began leasing the assets and operations of its long-term care facility to a joint venture, Wellspire, LLC. The System has a 40% ownership interest in Wellspire, LLC. Genesis Visiting Nurse Association and Hospice (VNA) provides home health care, community nursing services and hospice services to patients in eastern Iowa and western Illinois. Genesis Medical Center- Silvis (GMC - Silvis) is licensed as a 145-bed acute care hospital which provides services from its facility in Silvis, Illinois. Mini Hospital Nursing Home (INH) operates Crosstown Square. Crosstown Square is an independent living facility containing 64 rentable apartments and three guest rooms that offers services designed to provide independent living apartments for seniors. Crosstown Square is managed by Wellspire, LLC, which is one of the System's joint ventures. GHS Iowa and GHS Illinois have a controlling ownership interest or membership in the following organizations: Genesis Medical Center- Aledo (GMC - Aledo) is certified as a critical access hospital, which has 22-acute care and swing beds, as well as a physician clinic, which provides services from its facility in Aledo, Illinois. Genesis Health Services Foundation (Genesis Foundation) is an organization whose mission is to develop, manage and grant charitable support to meet the health-related needs of the communities served by Genesis Health System. GenGastro, LLC (d/b/a the Center for Digestive Health) is a limited liability company, which operates a single-specialty gastroenterology ambulatory surgery center located in Bettendorf, Iowa. Genesis Health System sold an interest in September 2021 reducing their ownership from 90% to an 83.75% ownership interest in GenGastro, LLC. The Larson Center Partnership (LCP) is a for-profit real estate partnership which owns a medical office building adjacent to GMC - Silvis and leases space for clinics, laboratory, pharmacy and offices to GMC - Silvis and other third-party organizations. GHS Illinois is a general partner and owns approximately 82.6% of LCP. Gen Ventures, Inc. (Gen Ventures) is a wholly-owned for-profit corporation which operates the following divisions, primarily in the Quad Cities: Genesis at Home, Continuing Care sells and leases home medical equipment, provides intravenous therapy services, including sales of related solutions and supplies to patients, and provides retail pharmaceutical and over-the-counter products to patients and employees of the System. GenProperties owns, leases and/or manages office space in 14 medical office buildings located in Bettendorf, Davenport, Eldridge, LeClaire and Muscatine, Iowa. Crescent Laundry provides commercial laundry services to health care facilities in eastern Iowa and in north-central Illinois. Genesis Accountable Care Organization, LLC (Genesis ACO) is an Iowa limited liability company formed in December 2011. Its purpose is to engage in lawful business related to the creation and organization of a "physician-driven" network to act as, and/or participate in, an Accountable Care Organization within the meaning of the federal Patient Protection and Affordable Care Act. The company is also organized to develop a clinically integrated network of providers including physicians, health professionals, hospitals and ancillary providers working together to promote high quality, coordinated and efficient care to patients including members of various managed care payors and the community at large. Genesis Philanthropy is a wholly-owned tax-exempt entity formed in 2013, which partners with other hospital foundations to form a regional network to attract donors to help fund specific health-related causes and promote wellness in the region. Genesis Health System Workers' Compensation Plan and Trust (Workers' Compensation Trust) provides a fund which is used to pay workers' compensation claims and costs for the benefit of Genesis Health System. Misericordia Assurance Company, Ltd. (Misericordia) is a wholly-owned Cayman-based captive insurance company which underwrites the general and professional liability risks of Genesis Health System and affiliates. Genesis Health System and its related organizations are collectively referred to as the System.
Schedule H, Part VI, Line 7 State filing of community benefit report IL, IA
Schedule H (Form 990) 2021
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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Genesis Health System
 
Employer identification number
42-1418847
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
noncash assistance		 (h) Purpose of grant
or assistance
(1) GENESIS HEALTH SYSTEM WORKER'S COMPENSATION & TRUST
1227 E Rusholme Street
Davenport,IA52803 		39-1905171 501 ( C ) (3) 1,352,317       CLAIM PAYMENTS
(2) Genesis Philanthropy
1227 E Rusholme Street
Davenport,IA52803 		46-2452851 501 ( C ) (3) 193,472       HEALTHCARE RELATED CONTRIBUTIONS
(3) Genesis Health Services Foundation
1227 E Rusholme Street
Davenport,IA52803 		42-1421670 501 ( C ) (3) 5,620       CME PROGRAM
(4) The Project of the Quad Cities
1701 River Drive
Davenport,IA52801 		42-1358032 501 (C)(3) 6,000       Gala Sponsorship
(5) Quad City Symphony
327 BRADY ST
Davenport,IA52801 		46-6017663 501 ( C ) (3) 10,000       Sponsorships-Seasonal concerts
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
5
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) 2021

Schedule I (Form 990) 2021
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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) MEDICAL SUPPLIES TO INDIVIDUALS/MEDICAL MISSION 2729   27,295 FMV MEDICAL AND PHARMACEUTICAL SUPPLIES DONATED TO PATIENTS AND MERCY MISSION
(1)
(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
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE GENESIS HEALTH SYSTEM (GHS IOWA) STAFF REQUIRES RECEIPTS AND OTHER DOCUMENTATION PRIOR TO RELEASING FUNDS FOR PROJECTS AND SERVICES WITHIN THE SCOPE OF THE ORGANIZATION'S MISSION. PROPER AUTHORIZATION OF GRANT REQUESTS IS ALSO REQUIRED. STAFF FOLLOWS THE ORGANIZATION'S FUNDING ADMINISTRATIVE POLICY TO ENSURE THAT GRANTS ARE BEING APPROVED AND UTILIZED CORRECTLY.
Schedule I (Form 990) 2021



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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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
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 on 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 on 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
Yes
 
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 nonfixed
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) 2021

Schedule J (Form 990) 2021
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, 1099-MISC compensation, and/or 1099-NEC (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
1DOUGLAS P CROPPER
 
PRESIDENT/CEO GHS 		(i)

(ii)		 853,301
-------------
0 		232,416
-------------
0 		138,969
-------------
0 		22,144
-------------
0 		20,385
-------------
0 		1,267,216
-------------
0 		0
-------------
0
2KAREN FITZSIMMONS
 
DIRECTOR 		(i)

(ii)		 361,255
-------------
0 		300
-------------
0 		2,763
-------------
0 		21,264
-------------
0 		27,510
-------------
0 		413,092
-------------
0 		0
-------------
0
3MARK G ROGERS
 
V.P. FINANCE/CFO/ASST TREASURER 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		515,382
-------------
0 		907,028
-------------
0 		0
-------------
0 		1,422,411
-------------
0 		0
-------------
0
4PAUL BOLLINGER
 
V.P. LEGAL AFFAIRS/Asst. Secretary 		(i)

(ii)		 275,460
-------------
0 		44,449
-------------
0 		62,438
-------------
0 		20,396
-------------
0 		25,450
-------------
0 		428,192
-------------
0 		0
-------------
0
5JOSEPH MALAS
 
VP FINANCE, INTERIM CFO 		(i)

(ii)		 255,628
-------------
0 		34,614
-------------
0 		52,812
-------------
0 		6,911
-------------
0 		15,042
-------------
0 		365,006
-------------
0 		0
-------------
0
6NIDAL HARB
 
FORMER CHIEF MEDICAL OFFICER 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		318,744
-------------
0 		0
-------------
0 		0
-------------
0 		318,744
-------------
0 		0
-------------
0
7KURT A ANDERSEN
 
VP Physician Operations/Chief Medical Officer 		(i)

(ii)		 485,307
-------------
0 		93,930
-------------
0 		192,347
-------------
0 		22,146
-------------
0 		23,205
-------------
0 		816,934
-------------
0 		0
-------------
0
8JORDAN VOIGT
 
HOSPITAL PRESIDENT GMC DAVENPORT 		(i)

(ii)		 398,420
-------------
0 		92,513
-------------
0 		209,888
-------------
0 		21,469
-------------
0 		26,580
-------------
0 		748,871
-------------
0 		0
-------------
0
9HEIDI S KAHLY-MCMAHON
 
V.P. Human Resources 		(i)

(ii)		 309,390
-------------
0 		46,516
-------------
0 		165,063
-------------
0 		1,463
-------------
0 		24,306
-------------
0 		546,738
-------------
0 		0
-------------
0
10TODD GRAY
 
PHYSICIAN ADVISOR 		(i)

(ii)		 470,672
-------------
0 		300
-------------
0 		1,881
-------------
0 		1,693
-------------
0 		21,451
-------------
0 		495,997
-------------
0 		0
-------------
0
11NAMRATA MALLIK
 
PHYSICIAN 		(i)

(ii)		 623,209
-------------
0 		12,890
-------------
0 		735
-------------
0 		20,796
-------------
0 		3,364
-------------
0 		660,995
-------------
0 		0
-------------
0
12BRIAN CADY
 
PHYSICIAN 		(i)

(ii)		 552,005
-------------
0 		300
-------------
0 		1,822
-------------
0 		23,765
-------------
0 		22,712
-------------
0 		600,604
-------------
0 		0
-------------
0
13CHRISTOPHER CROME
 
PHYSICIAN 		(i)

(ii)		 487,697
-------------
0 		690
-------------
0 		979
-------------
0 		1,904
-------------
0 		19,054
-------------
0 		510,324
-------------
0 		0
-------------
0
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
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
Schedule J, Part I, Line 1a Travel for companions TRAVEL FOR COMPANIONS: IN TAX YEAR 2021, THE FOLLOWING TYPES OF LISTED INDIVIDUALS REPORTED IN PART VII RECEIVED THE TRAVEL FOR COMPANIONS BENEFIT: 6 DIRECTORS, 3 HCE, 1 KE, AND 1 OFFICERS. ALL INDIVIDUALS REIMBURSED GHS IOWA IN FULL AND NONE OF THE BENEFIT WAS LISTED AS TAXABLE COMPENSATION.
Schedule J, Part I, Line 4a Severance or change-of-control payment The following individuals received severance pay from Genesis Health System (GHS Iowa) during the calendar year 2021: Nidal Harb, $253,935 and Mark Rogers, $515,382.40. This information is included in reportable compensation on form 990, Part VII and Schedule J, Part II, if applicable.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The following individuals participated in a supplemental ROTH indexed universal life(IUL) plan in 2021 sponsored by Genesis health System (GHS IA): Kurt A. Andersen- $110,253, Paul Bollinger- $40,882, Jordan Voigt-$92,213, Andrew Andresen-$46,378, and Heidi Kahly-McMahon-$56,165. The dollar amount represents the current year contribution made by GHS IA on behalf of the individuals to the plan in 2021. This information is included in reportable compensation on the form 990, Part VII and Schedule J, Part II. Split-dollar life insurance participants are Douglas P. Cropper-established in 2016 and sponsored by Genesis Health System(GHS IA). GHS IA deposited funds into life insurance policies on the participant's life. During life, and subject to the policies generating sufficient values, the participant can borrow from one of the policies. The borrowing is monitored and limited so the policies do not lapse. At the participant's death, the organization recovers premiums plus interest plus additional key-person insurance proceeds. There were no loans or contributions in 2021.
Schedule J (Form 990) 2021

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Genesis Health System
 
Employer identification number
42-1418847
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A IOWA FINANCE AUTHORITY
  		52-1699886 46246PLP4 06-24-2010 90,995,000 REFUND 12-23-97 AND 08-02-00 BOND ISSUE; RENOVATE AND EQUIP FACILITY X     X   X
B IOWA FINANCE AUTHORITY
  		52-1699886 46246PMG3 11-26-2013 121,000,000 CONSTRUCT AND EQUIP EAST CAMPUS TOWER X     X   X
C Iowa Finance Authority
  		52-1699886   12-28-2017 27,500,000 Partially defease 6-24-10 Bonds   X   X   X
D Iowa Finance Authority
  		52-1699886   07-22-2021 130,470,000 Entirely defease 11-26-13 Bonds   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 88,395,000 5,215,000 12,395,000 4,900,000
2 Amount of bonds legally defeased .............. 0 115,785,000    
3 Total proceeds of issue .................. 95,545,195 125,205,892 27,500,000 130,470,000
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ............... 0      
7 Issuance costs from proceeds ............... 1,478,186 1,267,563   801,836
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds ............. 23,700,000 123,844,399    
11 Other spent proceeds ............. 70,367,009   27,500,000 129,668,164
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2010 2013 2017 2021
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X     X   X   X
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X X   X  
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X   X
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   X   X   X  
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? ............. X   X   X   X  
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? X   X   X   X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0.91 % 0.91 % 0.91 % 0.91 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 % 0 % 0 %
6 Total of lines 4 and 5 ............. 0.91 % 0.91 % 0.91 % 0.91 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........ X   X   X   X  
c No rebate due? .........   X   X   X   X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X     X   X
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K, Part II, Line 3 Part II, Line 3, Column A - Investment earnings are the source of the difference between the issue price and the total proceeds of the issue. Part II, Line 3, Column B - Investment earnings are the source of the difference between the issue price and the total proceeds of the issue.
Schedule K (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2

Schedule L
(Form 990)
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.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the 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) 2021
Schedule L (Form 990) 2021
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) GENVENTURES INC
  		JOSEPH MALAS IS AN OFFICER OF GENVENTURES, INC. 34,434,396 GENVENTURES, INC. PAID GENESIS HEALTH SYSTEM (GHS IOWA) AS A COMMON PAYMASTER AND REIMBURSEMENT OF INTEREST.   No
(2) GENVENTURES INC
  		JOSEPH MALAS IS AN OFFICER OF GENVENTURES, INC. 16,953,505 GENESIS HEALTH SYSTEM (GHS IOWA) PAID GENVENTURES, INC. FOR FACILITY LEASE PAYMENTS, MEDICAL SUPPLIES, LAUNDRY SERVICES, AND A LOAN ADVANCE.   No
(3) CARDIOVASCULAR MEDICINE PC
  		EDMUND P. COYNE, JR., M.D. IS A DIRECTOR OF CARDIOVASCULAR MEDICINE, PC. 1,055,248 HEALTHCARE PROFESSIONAL SERVICES   No
(4) QUAD CITY BANK & TRUST COMPANY
  		PETER BENSON IS AN OFFICER AND MARK KILMER IS THE CHAIRMAN OF THE BOARD OF QUAD CITY BANK & TRUST 268,538 INTEREST EXPENSE, DEPOSIT ACCOUNT, CREDIT CARD SERVICE, LOCK BOX FEES, AND INTEREST INCOME   No
(5) KALYN PETERSEN
  		CLAIRE MOTTO IS THE DAUGHER OF ROBIN PETERSEN, DIRECTOR OF GHS IA 19,481 REPORTABLE COMPENSATION AS AN EMPLOYEE   No
(6) KRISTI SOUTHERLAND
  		KRISTI SOUTHERLAND IS THE SISTER OF KURT A. ANDERSEN, A KEY EMPLOYEE OF GHS IA 26,364 REPORTABLE COMPENSATION AS AN EMPLOYEE   No
(7) Main Street AmusementsQC River Bandits
  		David Heller was president/CEO of Main Street Amusements and Co-owner of the QC River Bandits 105,850 Sponsorship and ticket purchase expenses   No
(8) AUGUSTANA COLLEGE
  		STEVEN C. BAHLS IS AN OFFICER AND A BOARD MEMBER OF AUGUSTANA COLLEGE 371,011 AUGUSTANA PAID GHS IA FOR EMPLOYEE ASSITANCE PROGRAM, HEALTH CLINIC, AND COVID-19 TESTING SERVICES.   No
(9) AUGUSTANA COLLEGE
  		STEVEN C. BAHLS IS AN OFFICER AND A BOARD MEMBER OF AUGUSTANA COLLEGE 54,250 GHS IA PAID AUGUSTANA COLLEGE FOR RENT SPACE AND PROGRAM UNDERWRITING RADIO SERVICES.   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( Miscellaneous Supplies ) X 53 37,847 Market value
26 Other Right pointing arrow large image ( TEMPORARY NURSING STAFF TO ASSIST WITH COVID-19 PANDEMIC RESPONSE ) X 5,554 1,380,380 Market value
27 Other Right pointing arrow large image ( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2021)
Schedule M (Form 990) (2021)
Page 2
Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
Schedule M, Part I Explanations of reporting method for number of contributions Other - Miscellaneous Supplies PART I, COLUMN B IS REPORTED USING A COMBINATION OF NUMBER OF CONTRIBUTIONS AND ITEMS CONTRIBUTED. Other - TEMPORARY NURSING STAFF TO ASSIST WITH COVID-19 PANDEMIC RESPONSE Number of Hours
Schedule M (Form 990) (2021)

Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE O
(Form 990)

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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
Return Reference Explanation
Form 990, Part VI, Line 11b Review of form 990 by governing body Prior to submitting the form 990 to the IRS, it is reviewed at the organization's finance committee meeting, and then it is e-mailed to the organization's board of directors' one week in advance of a scheduled meeting. At the board of directors meeting, internal management reviews the form 990 with the board of directors. Suggested changes from all of the reviews are considered for inclusion in the final form 990 submitted to the IRS. Internal management review is also completed of the compiled information and is provided to the vice president, finance/CFO; vice president, legal affairs; vice president, human resources; and chief compliance risk officer of the organization's corporate member.
Form 990, Part VI, Line 12c Conflict of interest policy ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, OR MEMBER OF A BOARD OR BOARD COMMITTEE OF GENESIS HEALTH SYSTEM (GHS IOWA) OR AN AFFILIATE, SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT WILL BE CONSIDERED BY MANAGEMENT, THE BOARD, OR A COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING GHS IOWA, OR AN AFFILIATE, OR WITH RESPECT TO DESIGNATED FACILITIES AND ACTIVITIES, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH PERSON ADVOCATE HIS OR HER POSITION INFORMALLY THROUGH PRIVATE CONTACT, COMMUNICATION AND DISCUSSION WITH ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE APPLICABLE TRANSACTION OR ARRANGEMENT.
Form 990, Part VI, Line 15a Process to establish compensation of top management official Each executive position is evaluated using a formal evaluation plan that is established by an outside consultant. At the present time, the consultant uses a point system for job evaluation. The point values are based on "know how", "problem solving", "accountability", and other job attribute specific to the position. Once the point value is set for a position, market comparisons for jobs with the same organizational impact can be compared for salary purposes and establish pay ranges. The design of the pay ranges for executives is based on market data. The midpoint of each pay range is established at the 50th percentile of the market comparisons. A minimum and maximum are established off of the midpoint. Specific pay rates for executives are subject to CEO and compensation committee and the Genesis Health System (GHS Iowa) board of directors' approval. Pay ranges are reviewed each year to determine the need for revision. When market conditions suggest an adjustment to pay ranges, data will be presented to the compensation committee for its review. The specific pay ranges are subjected to CEO, compensation committee, and GHS Iowa board of director approval. The president and CEO have the authority and responsibility to establish and adjust, within the range approved by the compensation committee and GHS Iowa board of directors, the base compensation of each executive employed by GHS Iowa, at appropriate times. The GHS Iowa board of directors shall establish and adjust, within the range approved by the compensation committee, the base compensation for the CEO of GHS Iowa, at appropriate times, The Last time this process was formally undertaken was November 2020.
Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
Form 990, Part VII, Section A, Line 1a GENESIS HEALTH SYSTEM (GHS ILLINOIS), GENESIS MEDICAL CENTER, ALEDO, GENESIS HEALTH SERVICES FOUNDATION, GENESIS PHILANTHROPY AND GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ARE RELATED ORGANIZATIONS OF GENESIS HEALTH SYSTEM (GHS IOWA). THE AMOUNTS REPORTED AS REPORTABLE COMPENSATION FOR THE OFFICERS, KEY EMPLOYEES, AND HIGHLY COMPENSATED EMPLOYEES, UNLESS OTHERWISE NOTED ELSEWHERE IN PART VII, ARE FOR SERVICES RENDERED ON BEHALF OF ALL ORGANIZATIONS. IT WOULD BE ADMINISTRATIVELY IMPRACTICABLE FOR MEMBERS OF THE GOVERNING BOARD AND THE EXECUTIVE TEAM TO BREAKOUT THEIR HOURS DEVOTED AS WELL AS THEIR REPORTABLE COMPENSATION AMONG EACH ORGANIZATION. ALL REPORTABLE COMPENSATION, UNLESS OTHERWISE NOTED IN PART VII, IS PAID BY GHS IOWA.
Form 990, Part VIII, Line 2f Other Program Service Revenue Charity Care - Total Revenue: -7770902, Related or Exempt Function Revenue: -7770902, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Bad Debt - Total Revenue: -2203617, Related or Exempt Function Revenue: -2203617, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Contractuals - Total Revenue: -1044335380, Related or Exempt Function Revenue: -1044335380, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Healthcare related Revenue - Total Revenue: 1681958, Related or Exempt Function Revenue: 1681958, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Partnership Revenue - Total Revenue: -505377, Related or Exempt Function Revenue: -505377, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other Program Revenue - Total Revenue: 13904507, Related or Exempt Function Revenue: 13904507, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Misc Revenue - Total Revenue: 34800, Related or Exempt Function Revenue: 34800, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees ANESTHESIA SERVICES - Total Expense: 1476893, Program Service Expense: 1476893, Management and General Expenses: , Fundraising Expenses: ; BLOOD BANK SERVICES - Total Expense: 1649837, Program Service Expense: 1649837, Management and General Expenses: , Fundraising Expenses: ; COLLECTION SERVICES - Total Expense: 6208418, Program Service Expense: , Management and General Expenses: 6208418, Fundraising Expenses: ; Signage SERVICES - Total Expense: 9640, Program Service Expense: 3839, Management and General Expenses: 5801, Fundraising Expenses: ; ENVIRONMENTAL SERVICES - Total Expense: 4148232, Program Service Expense: 4017186, Management and General Expenses: 131046, Fundraising Expenses: ; HEALTH CARE PROFESSIONAL SERVICES - Total Expense: 5271155, Program Service Expense: 5097627, Management and General Expenses: 173528, Fundraising Expenses: ; HEALTH-RELATED IMAGING SERVICES - Total Expense: 12925771, Program Service Expense: 12925771, Management and General Expenses: , Fundraising Expenses: ; HEALTHCARE DATA SYSTEM/STRATEGIC PLANNING: - Total Expense: 5244181, Program Service Expense: , Management and General Expenses: 5244181, Fundraising Expenses: ; IT OUTREACH SERVICES - Total Expense: 15737386, Program Service Expense: , Management and General Expenses: 15737386, Fundraising Expenses: ; LAB SERVICES - Total Expense: 5345933, Program Service Expense: 5345933, Management and General Expenses: , Fundraising Expenses: ; LAUNDRY SERVICES: - Total Expense: 29664, Program Service Expense: 29614, Management and General Expenses: 50, Fundraising Expenses: ; MAINTENANCE SERVICES - Total Expense: 9391016, Program Service Expense: 9122926, Management and General Expenses: 268090, Fundraising Expenses: ; NUTRITIONAL SERVICES - Total Expense: 2235964, Program Service Expense: 2235964, Management and General Expenses: , Fundraising Expenses: ; OUTSIDE HEALTHCARE-RELATED SERVICES - Total Expense: 16183138, Program Service Expense: 16183138, Management and General Expenses: , Fundraising Expenses: ; PATIENT TRANSPORT SERVICES - Total Expense: 29545, Program Service Expense: 29545, Management and General Expenses: , Fundraising Expenses: ; PHYSICAL THERAPY SERVICES - Total Expense: 2293974, Program Service Expense: 2293974, Management and General Expenses: , Fundraising Expenses: ; ROOM AND BOARD SERVICES - Total Expense: 632816, Program Service Expense: 630566, Management and General Expenses: 2250, Fundraising Expenses: ; TRANSCRIPTIONS SERVICES - Total Expense: 75709, Program Service Expense: , Management and General Expenses: 75709, Fundraising Expenses: ; VISITING NURSE OUTSIDE SERVICES - Total Expense: 360076, Program Service Expense: 348635, Management and General Expenses: 11441, Fundraising Expenses: ; TRANSLATIONS SERVICES - Total Expense: 343301, Program Service Expense: 15, Management and General Expenses: 343286, Fundraising Expenses: ; EMERGENCY ROOM SERVICES - Total Expense: 950150, Program Service Expense: 950150, Management and General Expenses: , Fundraising Expenses: ; DIALYSIS SERVICES - Total Expense: 1495520, Program Service Expense: 1495520, Management and General Expenses: , Fundraising Expenses: ; OUTSIDE PHAMRACY SERVICES - Total Expense: 289115, Program Service Expense: 289115, Management and General Expenses: , Fundraising Expenses: ; COMMUNICATION SERVICES - Total Expense: 243340, Program Service Expense: , Management and General Expenses: 243340, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN NET ASSETS OF GENESIS HEALTH SERVICES FOUNDATION - -1671984; NON-CASH CONTRIBUTIONS NOT REPORTED ON BOOKS - 37847;
Form 990, Part XII, Line 2c THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2
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 Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Genesis Health System
 
Employer identification number

42-1418847
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) GENESIS ACCOUNTABLE CARE ORGANIZATION LLC
1227 E RUSHOLME STREET
DAVENPORT,IA52803
45-4168932 		ACCOUNTABLE CARE SERVICES IA 3,154,003 9,846,076 GENESIS HEALTH SYSTEM (GHS IOWA)
 
(2) SPIN ECHO LLC
1227 E RUSHOLME STREET
DAVENPORT,IA52803
42-1491373 		PROPERTY MANAGEMENT IA 95,603 0 GENVENTURES INC
 








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)GENESIS HEALTH SYSTEM (GHS ILLINOIS)
801 ILLINI DRIVE

silvis,IL61282
36-3616314 		HEALTHCARE IL 501(c)(3) 3 GENESIS HEALTH SYSTEM (GHS IOWA)
 
Yes
 
(2)GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST
1227 E RUSHOLME STREET

DAVENPORT,IA52803
39-1905171 		EMPLOYEE/BENEFIT/TRUST IA 501(c)(3) Type I GENESIS HEALTH SYSTEM (GHS IOWA)
 
Yes
 
(3)DAVENPORT HOSPITAL AMBULANCE CORPORATION
1204 E HIGH STREET

DAVENPORT,IA52803
42-1186903 		AMBULANCE TRANSFERS IA 501(c)(3) Type I GENESIS HEALTH SYSTEM (GHS IOWA)
 
Yes
 
(4)GENESIS HEALTH SERVICES FOUNDATION
1227 E RUSHOLME STREET

DAVENPORT,IA52803
42-1421670 		CHARITY IA 501(c)(3) 7 GENESIS HEALTH SYSTEM (GHS IOWA)
 
Yes
 
(5)GENESIS PHILANTHROPY
1227 E RUSHOLME STREET

DAVENPORT,IA52803
46-2452851 		CHARITY IA 501(c)(3) 10 GENESIS HEALTH SYSTEM (GHS IOWA)
 
Yes
 
(6)GENESIS MEDICAL CENTER ALEDO
309 NW NINTH AVENUE

ALEDO,IL61231
45-4475683 		HEALTHCARE IL 501(c)(3) 3 GENESIS HEALTH SYSTEM (GHS ILLINOIS)
 
Yes
 


For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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) GENGASTRO LLC

2222 53RD AVENUE
BETTENDORF,IA52722
56-2315623 		AMBULATORY SURGERY CENTER IA GENESIS HEALTH SYSTEM (GHS IOWA)
  		Related 3,277,598 540,345   No     No 82 %
(2) SPRING PARK SURGERY CENTER LLC

3319 SPRING STREET STE 202A
DAVENPORT,IA52807
42-1483989 		OUTPATIENT SURGICAL CENTER IA GENESIS HEALTH SYSTEM (GHS IOWA)
  		Related 1,078,731 2,604,257   No     No 40 %
(3) LARSON CENTER PARTNERSHIP LLC

801 ILLINI DRIVE
SILVIS,IL61282
36-3738454 		PROPERTY MANAGEMENT IL NA
  		N/A                
(4) GENORTHO LLC

2300 53RD AVENUE
BETTENDORF,IA52722
20-3406994 		ORTHOPAEDIC SURGERY CENTER IA GENESIS HEALTH SYSTEM (GHS IOWA)
  		Related 2,592,187 1,044,674   No     No 52 %
(5) GENRAD IMAGING LLC

1970 E 53RD STREET
DAVENPORT,IA52807
45-3571628 		DIAGNOSTIC IMAGING CENTER IA GENESIS HEALTH SYSTEM (GHS IOWA)
  		Related 2,391,334 2,864,572   No     No 50 %
(6) GENRAD IMAGING ILLINOIS LLC

1970 E 53RD STREET
DAVENPORT,IA52807
46-2452851 		DIAGNOSTIC IMAGING CENTER IL NA
  		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) GENVENTURES INC

1227 E RUSHOLME STREET
DAVENPORT,IA52803
42-1269171 		SUPPORT SERVICES/PROPERTY MANAGEMENT IA GENESIS HEALTH SYSTEM (IOWA)
  		C Corporation -1,618,741 43,906,593 100 % Yes  
(2) GENESIS HEART INSTITUTE

1236 E RUSHOLME STREET
DAVENPORT,IA52803
42-1504979 		HEALTHCARE MANAGEMENT IA Genesis Health Sysytem (Iowa)
  		C Corporation 0 0 100 % Yes  
(3) MISERICORDIA ASSURANCE COMPANY LTD

 
 
98-0457943 		OTHER FINANCIAL VEHICLE   Genesis Health System (Iowa)
  		C Corporation 0 18,844,757 100 % Yes  
(4) MOB 1 OWNERS' ASSOCIATION

1227 E RUSHOLME STREET
DAVENPORT,IA52803
27-0865075 		PROPERTY MANAGEMENT IA NA
  		C Corporation       Yes  






Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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
Yes
 
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
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
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
Yes
 
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
Yes
 
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
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
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) GenVentures Inc

 A 177,442 FMV
(2) Genesis Health Services Foundation

 C 1,028,025 FMV
(3) Gen Gastro LLC

 H 3,366,432 FMV
(4) Spring Park Surgery Center

 H 1,057,440 FMV
(5) GenOrthro LLC

 H 2,649,857 FMV
(6) GenVentures Inc

 K 6,273,741 FMV
(7) Larson Center Partnership

 K 458,516 FMV
(8) Larson Center Partnership

 J 419,990 FMV
(9) Genesis Health System Workers' Compensation and Trust

 B 1,352,317 FMV
(10) Genesis Health System Workers' Compensation and Trust

 L 1,734,421 FMV
(11) Davenport Hosptial Ambulance

 M 208,547 FMV
(12) Genesis Medical Center Aledo

 P 16,222,248 FMV
(13) Genesis Health System Illinois

 P 112,750,602 FMV
(14) Davenport Hospital Ambulance

 P 74,288 FMV
(15) GenVentures Inc

 P 1,553,512 FMV
(16) Genesis Health System Illinois

 Q 144,340,992 FMV
(17) Genesis Health System Foundation

 Q 1,579,066 FMV
(18) Genesis Medical Center Aledo

 Q 20,577,885 FMV
(19) Genventures Inc

 Q 34,256,954 FMV
(20) Genesis Philanthropy

 Q 529,461 FMV
(21) GenVentures Inc

 R 9,126,252 FMV
(22) GenRad LLC

 H 2,399,650 FMV
(23) GENESIS HEALTH SERVICES FOUNDATION

 R 291,420 FMV
(24) GENESIS PHILANTHROPY

 R 54,178 FMV
(25) MISERICORDIA ASSURANCE COMPANY

 M 2,416,650 FMV
(26) GENESIS PHILANTHROPY

 B 193,472 FMV
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

Additional Data


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