TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) MATT WENZEL...................................................................... PRESIDENT/CEO	24.00 ................. 16.00	X	X		0	1,109,111	58,133
(2) JEREMY ALEXANDER...................................................................... CFO	40.00 ................. 3.00		X		0	588,955	47,947
(3) LOUIS KANZAVELOS...................................................................... PHYSICIAN	40.00 ................. 0.00			X	583,990	0	19,582
(4) GEORGI GREKOFF...................................................................... PHYSICIAN	40.00 ................. 0.00			X	493,442	0	46,476
(5) RICHARD TO...................................................................... PHYSICIAN	40.00 ................. 0.00			X	416,697	0	17,854
(6) BRENT WOODBURY...................................................................... PHYSICIAN	40.00 ................. 0.00			X	408,137	0	15,277
(7) CHARLES LAHAM...................................................................... PHYSICIAN	40.00 ................. 0.00			X	375,270	0	8,044
(8) BILL MALCOM...................................................................... CHAIRPERSON	1.00 ................. 1.00	X	X		0	0	0
(9) DAVE POLAND...................................................................... VICE CHAIRMAN	1.00 ................. 1.00	X	X		0	0	0
(10) VICKI STEPHENSON...................................................................... SECRETARY	1.00 ................. 1.00	X	X		0	0	0
(11) JOY ANDERSON...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(12) DR STEVE DAVIS...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(13) NEAL DODD...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(14) JASON HUTCHESON...................................................................... DIRECTOR (THROUGH FEB. 2022)	1.00 ................. 1.00	X			0	0	0
(15) JOANN LAMPE...................................................................... DIRECTOR (THROUGH DEC. 2021)	1.00 ................. 1.00	X			0	0	0
(16) KAREN MARINO...................................................................... DIRECTOR (THROUGH JAN. 2022)	1.00 ................. 1.00	X			0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
MUTUAL CONSULTING & MGMT SVC INC 1221 S GEAR AVENUE WEST BURLINGTON,IA52655	EXECUTIVE MANAGEMENT	5,515,394
WAPITI MEDICAL GROUP LC 107 FLYNN DRIVE SUITE 600 MILBANK,SD57252	STAFFING AGENCY	3,095,669
AYA HEALTHCARE INC PO BOX 123519 DALLAS,TX75312	STAFFING AGENCY	1,837,806
TRUSTED HEALTH INC 201 CALIFORNIA STREET SUITE 950 SAN FRANCISCO,CA94111	STAFFING AGENCY	1,642,829
KINDRED REHAB GROUP MANAGEMENT SERVICES PO BOX 502096 ST LOUIS,MO63150	REHABILITATION PROGRAM MGMT SERVICES	1,180,594
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 89

- TIN:

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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

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.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

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)		(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)		(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

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

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

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990) 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)		(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)		(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.)..

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

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990) 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

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

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

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

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

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

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer 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).

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

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

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (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.

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) .

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).

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

Did one or more disqualified persons (as defined 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.

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.

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

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

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

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

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.

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (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?

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

By reason of the relationship described in 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.

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

Activities Test. Answer lines 2a and 2b below.

Yes

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

Did the activities described 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.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

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

Schedule A (Form 990) 2021

Page 6

Part V

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

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

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

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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 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:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

Caution: An organization that 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 SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC		Employer identification number 42-0680407

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 SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC			Employer identification number 42-0680407
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

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 Bullet

Go 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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

31,441

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

31,441

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	SOUTHEAST IOWA REGIONAL MEDICAL CENTER PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION. THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," 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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

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 ........

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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.

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

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:

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

Endowment Funds.
Complete if the organization answered "Yes" 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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" 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 .....	15,229,064		15,229,064
b	Buildings ....	180,500,249	78,106,967	102,393,282
c	Leasehold improvements	13,895,612	9,710,302	4,185,310
d	Equipment ....	215,450,698	177,934,784	37,515,914
e	Other .....	7,630,047		7,630,047
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				166,953,617

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........	1,635,489	F
(3) Other (A) INSURANCE COMPANY ANNUITY DEPOSITS	20,942,342	F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	22,577,831

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.)

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	26,388,365
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

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

PART X, LINE 2:

THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE COMBINED FINANCIAL STATEMENTS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	5,153,882		5,153,882	1.010 %
b	Medicaid (from Worksheet 3, column a) . . . . .	56,340,056	38,580,990	17,759,066	3.470 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	61,493,938	38,580,990	22,912,948	4.480 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	123,802		123,802	0.020 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	7,261,773	3,420,225	3,841,548	0.750 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	76,599		76,599	0.010 %
j	Total. Other Benefits . .	7,462,174	3,420,225	4,041,949	0.780 %
k	Total. Add lines 7d and 7j .	68,956,112	42,001,215	26,954,897	5.260 %

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
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

4,581,840

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

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

Section B. Medicare

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

81,219,511

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

98,613,718

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

-17,394,207

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 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?1Name, 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)						Other (describe)
1	SOUTHEAST IOWA REGIONAL MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 WWW.GREATRIVERHEALTH.ORG 290147H	X	X	X	X	TRAUMA CENTER

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)

	SOUTHEAST IOWA REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

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

Yes

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..................................

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

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

Yes

If "Yes" (list url): SEE PART V, SECTION C

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

10b

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

12a

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

12a

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

12b

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

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SOUTHEAST IOWA REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

SEE PART V, SEC. C

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

SEE PART V, SEC. C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SEC. C

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

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

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

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	SOUTHEAST IOWA REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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?..................................

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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?............

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	SOUTHEAST IOWA REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 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
SOUTHEAST IOWA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 5: SOUTHEAST IOWA REGIONAL MEDICAL CENTER, PART OF GREAT RIVER HEALTH SYSTEM, CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS IN DES MOINES AND LEE COUNTIES. THE STUDY HAS THREE OBJECTIVES:1. TO CONDUCT AN ASSESSMENT THAT PROVIDES A FOUNDATION FOR SOUTHEAST IOWA REGIONAL MEDICAL CENTER AND ITS PARTNERS TO BUILD A CONSENSUS ABOUT THE AREA'S MOST CRITICAL HEALTH CARE NEEDS.2. TO MEET STATE AND FEDERAL REQUIREMENTS FOR HOSPITALS THAT MUST CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY 3 YEARS.3. TO DEVELOP ACTION PLANS FOR INTERVENTIONS TO ADDRESS CONCERNS HIGHLIGHTED BY THE COMMUNITY AND HEALTH DATA.INFORMATION WAS COLLECTED THROUGH VIRTUAL MEETINGS, PAPER AND ONLINE SURVEYS, KEY INFORMANT QUESTIONNAIRES, AND A REVIEW AND ANALYSIS OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS. THE SURVEY WAS MADE AVAILABLE AT SEVERAL LOCATIONS IN THE STUDY AREA. LOCATIONS WERE CHOSEN BASED ON EASE OF ACCESS AND TRAFFIC BUT WERE RESTRICTED BY COVID-19. THE SURVEY WAS DESIGNED TO ELICIT PUBLIC RESPONSES ABOUT HEALTH NEEDS IN DES MOINES AND LEE COUNTIES. THE SURVEY INCLUDED MULTIPLE CHOICE, OPEN-ENDED AND SCALED QUESTIONS THAT ASKED PEOPLE WHAT THEY PERCEIVED TO BE THE GREATEST AREAS OF COMMUNITY NEED. A TOTAL OF 1,204 SURVEYS WERE RETURNED AND ANALYZED, A DECREASE OF 46 PERCENT FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. DECREASES IN RESPONSES WERE TO BE EXPECTED DUE TO A SHORTENED SURVEY WINDOW AND REDUCED OPPORTUNITIES FOR DISBURSEMENT.INTERVIEWS WERE CONDUCTED WITH LOCAL PROFESSIONALS AND KEY INFORMANTS, INCLUDING PROFESSIONALS IN EDUCATION, LAW ENFORCEMENT, PUBLIC HEALTH AND SOCIAL SERVICES, AND OTHER PROFESSIONALS REPRESENTING UNDERSERVED POPULATIONS IN THE SERVICE AREA. PARTICIPANTS WERE ASKED TO IDENTIFY THE LARGEST HEALTH CONCERNS IN THE COMMUNITY AND TO SUGGEST WAYS TO IMPROVE UNMET HEALTH NEEDS. THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE FOR DES MOINES AND LEE COUNTIES WERE INVESTIGATED BY FOCUSING ON THE PROBLEMS INDICATED FROM THE INTERVIEWS AND COMMUNITY SURVEY. UTILIZING A STATISTICAL RANKING METHOD TO INCORPORATE INFORMATION FROM COLLABORATIVE MEETINGS, SURVEYS, AND THE INTERVIEWS, THE FOLLOWING FOUR UNMET HEALTH NEEDS WERE CHOSEN: MENTAL HEALTH SUBSTANCE MISUSE POVERTY AND EQUITY OBESITY AND OVERWEIGHTTHESE FOUR NEEDS WILL BE THE FOCUS OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER AND GREAT RIVER HEALTH SYSTEM'S EFFORTS TO IMPROVE THE HEALTH OF DES MOINES AND LEE COUNTIES.
SOUTHEAST IOWA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 6B: SOUTHEAST IOWA REGIONAL MEDICAL CENTER CONTINUALLY WORKS WITH PARTNERS AND STAKEHOLDERS OUTSIDE THE HOSPITAL TO MEET THE HEALTH NEEDS OF THE COMMUNITY. SOUTHEAST IOWA REGIONAL MEDICAL CENTER COLLABORATED WITH DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH, COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, BLESSING HEALTH KEOKUK, AND LEE COUNTY HEALTH DEPARTMENT ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT.
SOUTHEAST IOWA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 11: SOUTHEAST IOWA REGIONAL MEDICAL CENTER WORKED WITH DES MOINES AND LEE COUNTIES RESPECTIVE PARTNERS TO REVIEW THE DATA AND INFORMATION GATHERED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. AFTER REVIEWING THE DATA FROM THE SURVEY, VIRTUAL TOWN HALL MEETINGS, AND COMMENTS FROM THE KEY INFORMANT QUESTIONNAIRE, THE FOLLOWING HIGH PRIORITY HEALTH CONCERNS WERE SELECTED: MENTAL HEALTH SUBSTANCE MISUSE POVERTY AND EQUITY OBESITY AND OVERWEIGHTLEADERS AT SOUTHEAST IOWA REGIONAL MEDICAL CENTER HIGHLIGHTED THE FOLLOWING IMPLEMENTATION STRATEGIES, POTENTIAL IMPACTS, AND RESOURCES NEEDED FOR EACH FOCUS AREA.MENTAL HEALTH- EXPAND EXISTING PROGRAMS- GERIATRIC INPATIENT UNIT- RECRUITMENTSUBSTANCE MISUSE-OPIOID MANAGEMENT IMPROVEMENTS-PEER RECOVERY GROUP-SUPPORT AND PARTICIPATION IN COMMUNITY BASED INITIATIVES-FITNESS VOUCHER PILOT PROGRAMOBESITY/OVERWEIGHT -POPULATION HEALTH PLATFORM-LIVE HEALTHY LEE COUNTY-HEALTHY LIVING COMMUNITY EDUCATIONPOVERTY AND EQUITY-RURAL PUBLIC HEALTH WORKFORCE TRAINING NETWORK PROGRAM-SOCIAL DETERMINANTS OF HEALTH ASSESSMENT WORKFLOW-GOOD FAITH ESTIMATES-GREAT RIVER HEALTH FOUNDATION PARTNERSHIP WITH SOUTHEASTERN COMMUNITY COLLEGE
SOUTHEAST IOWA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 13H: SIRMC MAY USE PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY:THERE ARE INSTANCES WHEN A PATIENT/INDIVIDUAL MAY APPEAR TO BE ELIGIBLE FOR CHARITY-CARE DISCOUNTS, BUT THERE IS NO COMPLETED FINANCIAL ASSISTANCE FORM ON FILE BECAUSE OF A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER RESOURCES THAT COULD PROVIDE SUFFICIENT EVIDENCE TO DETERMINE ELIGIBILITY.1. INFORMATION IS PROVIDED WEEKLY TO AN OUTSIDE SOURCE. OUTSIDE SOURCE RETURNS RESULTS TO SOUTHEAST IOWA REGIONAL MEDICAL CENTER ABOUT PATIENT QUALIFICATIONS BASED ON OUR FINANCIAL ASSISTANCE POLICY.2. OUTSIDE SOURCE USES DEMOGRAPHIC AND HOUSEHOLD INFORMATION, AND CREDIT-SCORING TECHNOLOGY TO DETERMINE THE PERCENTAGE OF ASSISTANCE FOR WHICH A PATIENT MAY BE ELIGIBLE.3. SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL ATTEMPT TO CONTACT PATIENTS BASED ON THEIR PRESUMPTIVE ASSISTANCE QUALIFICATION TO ALLOW THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE.4. PATIENTS WILL NOT BE DISQUALIFIED FROM FINANCIAL ASSISTANCE BASED ON PRESUMPTIVE ASSISTANCE RESULTS.5. IF THE ACCOUNT IS PAST DUE AND THERE IS NO COMPLETED FINANCIAL ASSISTANCE APPLICATION OR SUPPORTING DOCUMENTATION, THE PATIENT'S ACCOUNT COULD BE CONSIDERED FOR FINANCIAL ASSISTANCE BASED ON OUTSIDE SOURCE'S RESULTS.6. PRESUMPTIVE ELIGIBILITY ALSO CAN BE DETERMINED BASED ON LIFE CIRCUMSTANCES INCLUDING: -ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED -FOOD STAMP ELIGIBILITY -HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC -LOW INCOME/SUBSIDIZED HOUSING PROVIDED AS A VALID ADDRESS -PARTICIPATION IN THE WOMEN INFANTS AND CHILDREN (WIC) PROGRAM -PATIENT IS DECEASED WITH NO KNOWN ESTATE -STATE-FUNDED PRESCRIPTION PROGRAMS -SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY7. IT ALSO IS ACCEPTABLE TO USE PROXY INFORMATION TO DETERMINE ELIGIBILITY WHEN INCOME LEVELS CANNOT BE DIRECTLY DETERMINED. SUCH INFORMATION COULD INCLUDE STATEMENTS LIKE "STAYS WITH FRIENDS OR "OCCASIONALLY WORKS."8. PATIENTS WHO MEET PRESUMPTIVE-CARE GUIDELINES MAY QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTS. THIS DETERMINATION IS AT THE DISCRETION OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER.9. IN A SITUATION, WHERE PRESUMPTIVE ELIGIBILITY IS GIVEN TO A PATIENT AND A FINANCIAL ASSISTANCE APPLICATION IS OBTAINED LATER, THE UPDATED ELIGIBILITY WILL BE BASED ON THE FINANCIAL ASSISTANCE APPLICATION WITH SUPPORTING DOCUMENTATION. IN THIS CASE, SOUTHEAST IOWA REGIONAL MEDICAL CENTER COULD ADJUST FINANCIAL ASSISTANCE UP TO THREE MONTHS BEFORE THE APPLICATION DATE.
SOUTHEAST IOWA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 20E: SIRMC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED.
PART V, SECTION B, LINES 7A AND 10A:	SIRMC'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT: HTTPS://WWW.GREATRIVERHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
PART V, SECTION B, LINE 16:	SIRMC'S FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT:HTTPS://WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-SERVICES/

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

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
PART I, LINE 3C:	SOUTHEAST IOWA REGIONAL MEDICAL CENTER (SIRMC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE.
PART I, LINE 7:	THE AMOUNTS INCLUDED IN PART I, LINES 7A-7D WERE CALCULATED USING COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. PART I, LINES 7E-7J ARE ACTUAL COSTS.
PART I, LINE 7G:	THE SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G IS MENTAL HEALTH SERVICES PROVIDED BY SIRMC.
PART I, LN 7 COL(F):	BAD DEBT EXPENSES OF $4,581,840 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F.
PART III, LINE 2:	MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENTS' FINANCIAL HISOTRY, CREDIT HISTORY, AND CURRENT ECONOMIC CONDITIONS.
PART III, LINE 3:	SOUTHEAST IOWA REGIONAL MEDICAL CENTER CONTRACTS WITH AN EXTERNAL ORGANIZATION. THE ORGANIZATION RECEIVES WEEKLY LISTINGS OF PATIENT RECEIVABLES FROM SIRMC'S PATIENT FINANCIAL SERVICES STAFF. THEY RETURN RESULTS TO SIRMC IDENTIFYING INDIVIDUALS WHO COULD QUALIFY FOR THE FINANCIAL ASSISTANCE PROGRAM. THE DATA IS BASED ON PATIENT INCOME AS WELL AS THEIR CREDIT REPORTING. THE RESULTS ARE APPLIED TO SIRMC'S FINANCIAL ASSISTANCE MATRIX TO IDENTIFY IF AN INDIVIDUAL WOULD QUALIFY AND FOR WHAT PERCENTAGE. SIRMC'S PATIENT FINANCIAL SERVICES STAFF THEN CONTACT THE PATIENT TO ACQUIRE A FINANCIAL ASSISTANCE APPLICATION.
PART III, LINE 4:	SEE THE "PATIENTS RECEIVABLES" PARAGRAPH IN NOTE 1 ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE.
PART III, LINE 8:	THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE (A) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (B) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; AND (C) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B:	AN EXCERPT FROM SIRMC'S FINANCIAL ASSISTANCE PROGRAM WRITTEN POLICY, RELATIONSHIP OF FINANCIAL ASSISTANCE PROGRAM TO COLLECTION POLICIES: SOUTHEAST IOWA REGIONAL MEDICAL CENTER MANAGEMENT HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, WHICH INCLUDES COLLECTION ACTION AND REPORTING TO CREDIT AGENCIES) THAT TAKE INTO ACCOUNT THE FOLLOWING: A) THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY; B) PATIENT'S GOOD FAITH EFFORT TO APPLY FOR GOVERNMENTAL PROGRAMS; C) PATIENT'S GOOD FAITH EFFORT TO APPLY FOR SOUTHEAST IOWA REGIONAL MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM; D) PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH PAYMENT AGREEMENTS MADE WITH SOUTHEAST IOWA REGIONAL MEDICAL CENTER. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL DO THE FOLLOWING: A) MAY OFFER EXTENDED PAYMENT PLANS; B) WILL NOT SEND UNPAID BALANCES TO OUTSIDE COLLECTION AGENCIES; C) WILL CEASE ALL COLLECTION EFFORTS WITH OUTSIDE COLLECTION AGENCIES. SOUTHEAST IOWA REGIONAL MEDICAL CENTER AND AGENCIES ACTING ON ITS BEHALF WILL NOT IMPOSE EXTRAORDINARY COLLECTION ACTIONS WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. REASONABLE EFFORTS SHALL INCLUDE: A) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; B) DOCUMENTATION THAT SOUTHEAST IOWA REGIONAL MEDICAL CENTER HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WIHT THE HOSPITAL'S APPLICATION REQUIREMENTS; C) DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL NOT SEND OUTSTANDING BALANCES TO AN OUTSIDE COLLECTION AGENCY UNTIL 120 DAYS FROM THE DATE THE BALANCE BECAME THE PATIENT'S RESPONSIBILITY. AN OUTSIDE AGENCY ACTING ON THE BEHALF OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL NOT TAKE EXTRAORDINARY COLLECTION AGENCY UNTIL AN ADDITIONAL 120 DAYS HAVE BEEN EXHAUSTED. EXTRAORDINARY COLLECTION ACTION INCLUDES BUT IS NOT LIMITED TO THE FOLLOWING: A) SELLING DEBT TO A THIRD PARTY OTHER THAN A COLLECTION AGENCY; B) REPORTING ADVERSE INFORMATION TO A CONSUMER CREDIT REPORTING AGENCY OR CREDIT BUREAU; C) FILING A CLAIM FOR UNPAID DEBT THROUGH THE COURT SYSTEM.
PART III, SECTION A, LINE 1:	THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.
PART VI, LINE 2:	SIRMC'S BOARD OF DIRECTORS IS COMMUNITY BASED. REPRESENTATIVES FROM VARIOUS SEGMENTS OF THE COMMUNITY MAKE UP THE BOARD. IN ADDITION, BOARD MEMBERS ARE SELECTED IN OUTLYING COMMUNITIES THAT SIRMC SERVES. THESE BOARD MEMBERS CONSTANTLY PROVIDE INPUT TO THE HEALTHCARE NEEDS OF OUR COMMUNITY THROUGH THE ANNUAL STRATEGIC PLANNING PROCESS.
PART VI, LINE 3:	NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM SIRMC IS DISSEMINATED BY VARIOUS MEANS AT SIRMC, WHICH INCLUDES - PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. SIRMC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. SIRMC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE SIRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM.
PART VI, LINE 4:	A REVIEW WAS CONDUCTED BY SIRMC TO ANALYZE THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY THE MEDICAL CENTER. THE REVIEW INDICATED THAT DES MOINES COUNTY COMPRISES THE MEDICAL CENTER'S PRIMARY SERVICE AREA AND THAT THE SECONDARY SERVICE AREA OF THE MEDICAL CENTER CONSISTS OF HENRY, LEE, AND LOUISA COUNTIES IN IOWA AND HANCOCK AND HENDERSON COUNTIES IN ILLINOIS. BASED ON THE US CENSUS BUREAU STATISTICAL ESTIMATES FOR 2020, THE PRIMARY SERVICE AREA POPULATION IS ESTIMATED AT 38,910 RESIDENTS. THE SECONDARY SERVICE AREA POPULATIONS ARE ESTIMATED TO TOTAL 68,399 RESIDENTS. OVER AGE 65 GROUP IS CURRENTLY 21.3% OF THE PRIMARY SERVICE AREA POPULATION, AS COMPARED TO 17.7% OF THE STATE OF IOWA POPULATION AND 16.8% OF THE UNITED STATES POPULATION. THE MEDIAN HOUSEHOLD INCOME IN THE PRIMARY SERVICE AREA IS $54,318 COMPARED TO THE STATE AND NATIONAL AVERAGES OF $65,429 AND $69,021, RESPECTIVELY. THE PRIMARY SERVICE AREA POPULATION BELOW POVERTY LEVEL IS 13.2% AS COMPARED TO THE STATE AND NATIONAL AVERAGES OF 11.1% AND 11.6%, RESPECTIVELY.SOUTHEAST IOWA REGIONAL MEDICAL CENTER IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA AND THE LARGEST SERVICE PROVIDER, INCLUDING THE BROADEST SCOPE OF SERVICES, IN THE PRIMARY AND SECONDARY SERVICE AREAS.
PART VI, LINE 5:	SOUTHEAST IOWA REGIONAL MEDICAL CENTER FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY COMPRISES MEMBERS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH.SOUTHEAST IOWA REGIONAL MEDICAL CENTER PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS.SOUTHEAST IOWA REGIONAL MEDICAL CENTER RECRUITS PHYSICIANS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, AND OTHER HEALTH PROFESSIONALS TO IMPROVE ACCESS TO HEALTH CARE IN THE HOSPITAL'S SERVICE AREA. IT ALSO PROMOTES HEALTH CAREER EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE'S NURSING AND OTHER PROGRAMS.SOUTHEAST IOWA REGIONAL MEDICAL CENTER PARTICIPATES IN COMMUNITY BENEFIT ACTIVITIES SUCH AS PARTNERING WITH LOCAL SCHOOLS, COMMUNITY EDUCATION, COMMUNITY INITIATIVE EVENTS, PRENATAL EDUCATION CLASSES, A PARTICIPATING IN HEALTH FAIRS.SOUTHEAST IOWA REGIONAL MEDICAL CENTER MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY. IT IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY.SURPLUS FUNDS OF THE HOSPITAL ARE INVESTED IN IMPROVING AND UPDATING CAPITAL EQUIPMENT, AND INCREASING THE SERVICES OFFERED TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED.
PART VI, LINE 6:	SOUTHEAST IOWA REGIONAL MEDICAL CENTER IS PART OF GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF TWO HOSPITALS, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME, ABOUT 25 PRIMARY-CARE AND SPECIALTY PHYSICIAN CLINICS, AND IS AFFILIATED WITH AN OUTPATIENT RENAL DIALYSIS CENTER.THE NON-HOSPITAL HEALTH CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL ARE: GREAT RIVER HEALTH SYSTEM-ANESTHESIA; GREAT RIVER HEALTH SYSTEM-AUDIOLOGY; GREAT RIVER HEALTH SYSTEM-BUSINESS HEALTH; GREAT RIVER HEALTH SYSTEM-CANCER CENTER; GREAT RIVER HEALTH SYSTEM-CARDIOLOGY; GREAT RIVER HEALTH SYSTEM-DIABETIC FOOT CLINIC; GREAT RIVER HEALTH SYSTEM-EYE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE, MERCY PLAZA; GREAT RIVER HEALTH SYSTEM-GASTROENTEROLOGY; GREAT RIVER HEALTH SYSTEM-HEALTHY LIVING; GREAT RIVER HEALTH SYSTEM-HERITAGE FAMILY PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE MEDICAL EQUIPMENT AND SUPPLIES; GREAT RIVER HEALTH SYSTEM-HERITAGE PARK PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE PARTNERS PHARMACY; GREAT RIVER HEALTH SYSTEM-KEOKUK; GREAT RIVER HEALTH SYSTEM-MEDIAPOLIS; GREAT RIVER HEALTH SYSTEM-MEDICINE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-MENTAL HEALTH; GREAT RIVER HEALTH SYSTEM-NEPHROLOGY; GREAT RIVER HEALTH SYSTEM-ORTHOPAEDIC SPECIALISTS; GREAT RIVER HEALTH SYSTEM-PULMONOLOGY; GREAT RIVER HEALTH SYSTEM-QUICK CARE; GREAT RIVER HEALTH SYSTEM-SURGEONS; GREAT RIVER HEALTH SYSTEM-UROLOGY; GREAT RIVER HEALTH SYSTEM-WAPELLO; GREAT RIVER HEALTH SYSTEM-WEST POINT; GREAT RIVER HEALTH SYSTEM-WOMEN'S HEALTH; GREAT RIVER HEALTH SYSTEM-WOUND AND HYPERBARIC; SOUTHEASTERN RENAL DIALYSIS.
PART VI, LINE 7:	SIRMC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION.

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
SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number
42-0680407

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" 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	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) LEE COUNTY ECONOMIC DEVELOPMENT 2495 280TH ST MONTROSE,IA52639	04-3605260	501(C)(3)	10,000	N/A	N/A	SUPPORT COMMUNITY ENHANCEMENT AND WORKFORCE DEVELOPMENT
(2) ART GUILD OF BURLINGTON 301 JEFFERSON STREET BURLINGTON,IA52601	42-0932843	501(C)(3)	6,325	N/A	N/A	SUPPORT COMMUNITY ENHANCEMENT
(3) TRI STATE RODEO PO BOX 80 FORT MADISON,IA52627	42-0658297	501(C)(4)	10,000	N/A	N/A	PROMOTE COMMUNITY ACTIVE LIFESTYLE
(4) FORT MADISON ECONOMIC DEVELOPMENT 614 7TH STREET PO BOX 277 FORT MADISON,IA52627	42-1300666	501(C)(3)	10,000	N/A	N/A	SUPPORT COMMUNITY ENHANCEMENT AND WORKFORCE DEVELOPMENT
(5) GREAT RIVER HEALTH SYSTEM INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655	42-1193185	501(C)(3)	1,550,000	N/A	N/A	TRANSFER DUE TO MERGER
(6) HENRY COUNTY HEALTH CENTER INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655	86-2701018	501(C)(3)	2,106,366	N/A	N/A	TRANSFER DUE TO MERGER
(7) GRHS HOLDINGS INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655	42-1193186	501(C)(3)	164,598,296	N/A	N/A	TRANSFER DUE TO MERGER

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 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)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference	Explanation
PART I, LINE 2:	GRANTEES ARE REQUIRED TO PROVIDE FOLLOW-UP INFORMATION WHEN THE PROJECT IS CARRIED OUT OR COMPLETED. IF GRANTEES DON'T COMPLY, SIRMC DOES NOT PROVIDE FURTHER GRANTS TO THEM.

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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes 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 .....

Yes

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? ....

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

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

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

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

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

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

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:

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

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

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

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 ............

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 ..........................

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

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

Cat. No. 50053T

Schedule J (Form 990) 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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MATT WENZEL PRESIDENT/CEO	(i) (ii)	0 ------------- 856,956	0 ------------- 248,615	0 ------------- 3,540	0 ------------- 14,500	0 ------------- 43,633	0 ------------- 1,167,244	0 ------------- 0
2JEREMY ALEXANDER CFO	(i) (ii)	0 ------------- 492,989	0 ------------- 94,670	0 ------------- 1,296	0 ------------- 14,500	0 ------------- 33,447	0 ------------- 636,902	0 ------------- 0
3LOUIS KANZAVELOS PHYSICIAN	(i) (ii)	581,199 ------------- 0	0 ------------- 0	2,791 ------------- 0	4,750 ------------- 0	14,832 ------------- 0	603,572 ------------- 0	0 ------------- 0
4GEORGI GREKOFF PHYSICIAN	(i) (ii)	462,676 ------------- 0	25,000 ------------- 0	5,766 ------------- 0	14,500 ------------- 0	31,976 ------------- 0	539,918 ------------- 0	0 ------------- 0
5RICHARD TO PHYSICIAN	(i) (ii)	413,708 ------------- 0	0 ------------- 0	2,989 ------------- 0	0 ------------- 0	17,854 ------------- 0	434,551 ------------- 0	0 ------------- 0
6BRENT WOODBURY PHYSICIAN	(i) (ii)	405,470 ------------- 0	0 ------------- 0	2,667 ------------- 0	0 ------------- 0	15,277 ------------- 0	423,414 ------------- 0	0 ------------- 0
7CHARLES LAHAM PHYSICIAN	(i) (ii)	374,470 ------------- 0	0 ------------- 0	800 ------------- 0	0 ------------- 0	8,044 ------------- 0	383,314 ------------- 0	0 ------------- 0

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

PART I, LINE 1A

MATT WENZEL, HEALTH/SOCIAL CLUB DUES, $5,693. THIS AMOUNT WAS INCLUDED IN TAXABLE COMPENSATION.

PART I, LINE 3

THE COMPENSATION OF THE OFFICERS IS PAID BY RIVERVIEW SYSTEMS LTD., A RELATED ORGANIZATION, BUT DETERMINED BY GREAT RIVER HEALTH SYSTEM. THE FOLLOWING WERE USED BY GREAT RIVER HEALTH SYSTEM IN DETERMINING THE OFFICERS COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE

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

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.
SchKMediumBullet

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
SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number
42-0680407

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	IOWA FINANCE AUTHORITY	52-1699886	462466BV4	05-31-2017	25,545,000	REFUND OF PRIOR ISSUE (7/24/08)		X		X		X
B	DES MOINES COUNTY IOWA	42-6004310	250087AA1	04-04-2012	60,000,000	REFUND PRIOR ISSUE (7/25/01) & CONSTRUCT, RENOVATE, EXPAND & EQUIP FACILITY		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	12,115,000		40,666,667
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	25,545,000		60,000,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	284,957		616,000
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............			30,076,758
11 Other spent proceeds .............	25,260,043		29,307,242
12 Other unspent proceeds .............
13 Year of substantial completion .............	2000		2013
	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
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
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

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

Cat. No. 50193E

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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		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?
c Are there any research agreements that may result in private business use of bond-financed property? .............		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?
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 ....
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 .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X
b Exception to rebate? ........	X		X
c No rebate due? .........	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

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
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
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
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/30/2017 ISSUER NAME: DES MOINES COUNTY, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 11/20/2013
SCHEDULE K, PART IV, LINE 2C	NOTE REGARDING THE 11/30/2017 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY.
SCHEDULE K, PART IV, LINE 2C	NOTE REGARDING THE 11/20/2013 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CONCULATIONS ARE NECESSARY.

Schedule K (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete 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 image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

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 ..	X	1	44,500	FMV
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 ( )
26 Other ( )
27 Other ( )
28 Other ( )

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

Yes

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

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

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)

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
PART I, COLUMN (B):	THE NUMBER OF CONTRIBUTIONS WAS USED IN PART I.

Schedule M (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1A	THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND TWO OR MORE ADDITIONAL BOARD MEMBERS. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE.
FORM 990, PART VI, SECTION A, LINE 2	MATT WENZEL AND JEREMY ALEXANDER HAVE BUSINESS RELATIONSHIPS BY SERVING AS OFFICERS AND/OR BOARD MEMBERS OF FOR-PROFIT ENTITIES RELATED TO SIRMC.
FORM 990, PART VI, SECTION A, LINE 3	ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR SOUTHEAST IOWA REGIONAL MEDICAL CENTER ARE PROVIDED BY MUTUAL CONSULTING AND MANAGEMENT SERVICES, INC. MUTUAL CONSULTING AND MANAGEMENT SERVICES IS A SUBSIDIARY OF RIVERVIEW SYSTEMS LTD, WHICH IS A SUBSIDIARY OF GREAT RIVER HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 4	THE ARTICLES OF INCORPORATION WERE REVISED TO REFLECT MERGER WITH RELATED ORGANIZATION. FORT MADISON COMMUNITY HOSPITAL WITH GREAT RIVER MEDICAL CENTER. THE SURVIVING ORGANIZATION WAS RENAMED SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION A, LINE 6	GREAT RIVER HEALTH SYSTEM INC., IS THE SOLE MEMBER OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER, GREAT RIVER HEALTH SYSTEM, INC (GRHS), HAS THE SOLE POWER TO ELECT OR REMOVE ALL BOARD MEMBERS OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER. THE NOMINATING COMMITTEE SHALL PRESENT A RECOMMENDATION FOR THE ELECTION OF DIRECTORS TO THE BOARD, WHICH UPON APPROVAL OF THE BOARD AND THE SUBSEQUENT APPROVAL OF GRHS, SHALL BE ELECTED TO THE BOARD.
FORM 990, PART VI, SECTION A, LINE 7B	THE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER APPROVAL OF THE SOLE MEMBER: A. MERGER, CONSOLIDATION, OR DISSOLUTION OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER WITH ANY OTHER CORPORATION OR LEGAL ENTITY. B. ANY CHANGE IN SOUTHEAST IOWA REGIONAL MEDICAL CENTER'S ARTICLES OF INCORPORATION OR BYLAWS. C. ELECT OR REMOVE THE BOARD OF DIRECTORS. D. APPROVE STRATEGIC OR OTHER BUSINESS PLANS. E. APPROVE CAPITAL AND OPERATING BUDGETS. F. APPROVE ANY INDEBTEDNESS. G. TRANSFER, SALE OR CLOSURE OF ANY FACILITY , DEPARTMENT OR FUNCTION. H. APPROVE ANY CHARITABLE DISBURSEMENT IN EXCESS OF $100,0000. I. SALE , DISPOSITION OR ANY ENCUMBRANCES OF ANY REAL ESTATE OWNED. J. ADOPT, AMEND OR TERMINATE EMPLOYEE BENEFIT PROGRAMS. K. APPOINT OR TERMINATE CEO. L. APPROVE THE ELECTION OF ANY OFFICER OR CHAIRPERSON. M. TAKE ANY ACTION NECESSARY DEEMED IN THE BEST INTERESTS OF THE HOSPITAL SYSTEM.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE ACCOUNTANT, DIRECTOR OF FINANCE AND CFO. ANY NECESSARY ADJUSTMENTS ARE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD OF DIRECTORS ARE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT.
FORM 990, PART VI, SECTION B, LINE 12C	BOTH CORPORATE AND SUBSIDIARY BOARD MEMBERS ARE PROVIDED EDUCATION REGARDING CONFLICTS OF INTEREST. THIS EDUCATION IS PROVIDED BY THE CHIEF COMPLIANCE OFFICER. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. RELATIONSHIPS NOTED ON THIS FORM MAY BE DISCUSSED WITH THE RESPECTIVE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS RELATING TO THE TRANSACTION IN QUESTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. CONFLICT OF INTEREST PROCEEDINGS ARISING FROM CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES.
FORM 990, PART VI, SECTION B, LINE 15A	COMPENSATION OF OFFICERS IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM, INC. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE CORPORATE BOARD OF DIRECTORS IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF THREE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON AN ANNUAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYSTEM, INC. PARTICIPATES IN AND UTILIZES EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP BIANNUALLY TO ASSESS AND VALIDATE THE ENTIRETY OF EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2022.
FORM 990, PART VI, SECTION C, LINE 19	SOUTHEAST IOWA REGIONAL MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 90,002,530. MANAGEMENT AND GENERAL EXPENSES 4,004,398. FUNDRAISING EXPENSES 21,390. TOTAL EXPENSES 94,028,318.
FORM 990, PART XI, LINE 9:	CHANGE IN BENEFICIAL INTEREST IN TRUST -232,737.
FORM 990, PART XII, LINE 2C:	THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR 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:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

SOUTHEAST IOWA REGIONAL MEDICAL
CENTER INC

Employer identification number

42-0680407

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)GREAT RIVER HEALTH SYSTEM INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 42-1193185	HEALTH CARE	IA	501(C)(3)	LINE 12C, III-FI	N/A		No
(2)GREAT RIVER HEALTH FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 42-1446727	SUPPORT RELATED ORGANIZATIONS	IA	501(C)(3)	LINE 12B, II	GREAT RIVER HEALTH SYSTEMS INC		No
(3)GRHS HOLDINGS INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 42-1193186	SUPPORT RELATED ORGANIZATIONS	IA	501(C)(3)	LINE 12B, II	GREAT RIVER HEALTH SYSTEMS INC		No
(4)HENRY COUNTY HEALTH CENTER INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 86-2701018	HOSPITAL	IA	501(C)(3)	LINE 3	GREAT RIVER HEALTH SYSTEMS INC		No

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

Cat. No. 50135Y

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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?
(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	Yes	No
(1) RIVERVIEW SYSTEMS LTD 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1191960	MEDICAL SERVICES	IA	N/A	C					No
(2) GREAT RIVER MEDICAL SERVICES INC 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1493449	MEDICAL SERVICES	IA	N/A	C					No
(3) MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1349668	MANAGEMENT SERVICES	IA	N/A	C					No
(4) HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1191957	PHARMACY	IA	N/A	C					No
(5) HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1191958	MEDICAL SUPPLY	IA	N/A	C					No

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

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	7
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,310
6	Total number of volunteers (estimate if necessary) .............	6	260
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	134,019
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	69,747,787	52,801,561
9	Program service revenue (Part VIII, line 2g) .........	226,056,254	307,954,230
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	674,467	874,483
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,109,457	9,087,002
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	297,587,965	370,717,276
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	5,849,123	168,393,959
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	89,969,945	165,178,126
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 22,806
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	130,900,555	183,122,071
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	226,719,623	516,694,156
19	Revenue less expenses. Subtract line 18 from line 12.......	70,868,342	-145,976,880
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	412,016,891	268,865,294
21	Total liabilities (Part X, line 26).............	76,325,438	87,497,042
22	Net assets or fund balances. Subtract line 21 from line 20.....	335,691,453	181,368,252

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 505,475,989 including grants of $ 168,393,959 ) (Revenue $ 307,879,344 )
	SOUTHEAST IOWA REGIONAL MEDICAL CENTER (SIRMC) IS A TWO CAMPUS HOSPITAL. ONE IS LOCATED IN FORT MADISON, IOWA, A 50 BED HOSPTIAL AND THE OTHER IS LOCATED IN WEST BURLINGTON, IOWA, IS A 378-BED REGIONAL MEDICAL CENTER OFFERING ACUTE AND INTERMEDIATE CARE TO RESIDENTS OF SOUTHEAST IOWA, WEST CENTRAL ILLINOIS AND NORTHEAST MISSOURI. THE HOSPITAL OFFERS COMPREHENSIVE MEDICAL, EXTENSIVE SURGICAL, AND EMERGENCY CARE SERVICES. DURING FISCAL YEAR ENDING 6/30/22, SIRMC HAD 7,359 PATIENT ADMISSIONS AND 66,483 PATIENT DAYS OF MEDICAL CARE. SIRMC ALSO HAD 187,801 OUTPATIENT VISITS, 44,384 EMERGENCY ROOM VISITS AND 12,393 HOME HEALTH-CARE VISITS. SIRMC PROVIDES MEDICAL SERVICES REGARDLESS OF ABILITY TO PAY AND ACCEPTS MEDICARE AND MEDICAID.THE HOSPITAL'S 160-BED KLEIN CENTER OFFERS LONG-TERM AND SKILLED CARE ON THE HOSPITAL'S CAMPUS. THE CANCER CENTER, WHICH PROVIDES MEDICAL AND RADIATION THERAPY SERVICES FOR THE TREATMENT OF VARIOUS FORMS OF CANCER AND BLOOD DISEASES, OFFERS THE LATEST THREE-DIMENSIONAL TREATMENT-PLANNING COMPUTER TECHNOLOGY AVAILABLE IN ONLY A FEW HEALTH-CARE CENTERS IN THE STATE. THE WELLNESS PLAZA IS HOME TO ONE OF THE STATE'S PREMIER REHABILITATION AND FITNESS PROGRAMS.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses505,475,989

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,277,536	1,698,066	213,313

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	45,662,026
e	Government grants (contributions)		1e	5,615,295

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,524,240

g	Noncash contributions included in lines 1a - 1f:$		1g	44,500

h Total. Add lines 1a-1f.......		52,801,561

		Business Code
2a	PATIENT SERVICE INCOME	621110	284,522,683	284,522,683
b	OTHER OPERATING INCOME	621300	22,938,581	22,863,695	74,886
c	SE RENAL DIALYSIS K-1	621400	492,966	492,966
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		307,954,230

3 Investment income (including dividends, interest, and othersimilar amounts) ......			550,179			550,179
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,064,357	6a
b	Less: rental expenses		622,125	6b
c	Rental income or (loss)		442,232	6c
d	Net rental income or (loss).......			442,232		59,133	383,099
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	52,028	18,570,964	7a
b	Less: cost or other basis and sales expenses	11,253	18,287,435	7b
c	Gain or (loss)	40,775	283,529	7c
d	Net gain or (loss).........			324,304			324,304
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..
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..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS INCOME		900099	8,644,770			8,644,770
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			8,644,770
12	Total revenue. See instructions.....			370,717,276	307,879,344	134,019	9,902,352

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	168,393,959	168,393,959
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,814,136		1,814,136
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	137,822,517	137,355,315	466,359	843
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,510,992	4,476,904	34,051	37
9	Other employee benefits .......	11,233,065	11,157,826	75,239
10	Payroll taxes ...........	9,797,416	9,773,375	23,976	65
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,077,190	1,077,190
c	Accounting ...........	98,748	98,748
d	Lobbying ...........	31,441		31,441
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	94,028,318	90,002,530	4,004,398	21,390
12	Advertising and promotion ....
13	Office expenses .......	1,227,937	1,176,457	51,480
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	4,533,405	4,531,285	2,120
17	Travel ............	231,306	230,514	321	471
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	1,167,299	1,167,299
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	13,821,104	13,049,465	771,639
23	Insurance ...	4,844,528	2,796,619	2,047,909
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	27,215,591	27,213,563	2,028
b	DRUGS	22,767,555	22,767,227	328
c	BAD DEBT	4,581,840	4,581,840
d	REPAIRS/MAINTENANCE	3,043,377	3,026,363	17,014
e	All other expenses	4,452,432	2,599,510	1,852,922
25	Total functional expenses. Add lines 1 through 24e	516,694,156	505,475,989	11,195,361	22,806
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			10,805,325	1	889,137
2	Savings and temporary cash investments .........			15,943,887	2	7,767,411
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			28,334,169	4	41,286,511
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 .......
					5
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) ...
					6
7	Notes and loans receivable, net ...........			203,043	7	2,965,515
8	Inventories for sale or use ............			4,836,418	8	3,892,615
9	Prepaid expenses and deferred charges ......			2,778,041	9	2,347,973
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	432,705,670
b	Less: accumulated depreciation	10b	265,752,053	138,850,138	10c	166,953,617
11	Investments—publicly traded securities .			18,097,969	11	15,396,363
12	Investments—other securities. See Part IV, line 11 .....			165,793,674	12	22,577,831
13	Investments—program-related. See Part IV, line 11 ..			10,346,784	13	3,349,029
14	Intangible assets ...............				14	524,292
15	Other assets. See Part IV, line 11 ...........			16,027,443	15	915,000
16	Total assets. Add lines 1 through 15 (must equal line 33)...			412,016,891	16	268,865,294

17	Accounts payable and accrued expenses .....	28,315,904	17	27,730,445
18	Grants payable ...		18
19	Deferred revenue .........	1,484,002	19	119,076
20	Tax-exempt bond liabilities .........	39,786,581	20	33,259,156
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 .........
			22
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	6,738,951	25	26,388,365
26	Total liabilities. Add lines 17 through 25..	76,325,438	26	87,497,042

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	324,382,022	27	170,307,714
28	Net assets with donor restrictions ...........	11,309,431	28	11,060,538
	Organizations that do not follow FASB ASC 958, check here 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 ...........	335,691,453	32	181,368,252
33	Total liabilities and net assets/fund balances ........	412,016,891	33	268,865,294