4A (Expenses $ 49343771 including grants of $ 0) (Revenue $ 56229232)
HEALTH-CARE SERVICESUNITY HEALTHCARE IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE MUSCATINE COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. UNITY HEALTHCARE PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES TO TREAT INDIVIDUALS WITH DISEASES, ILLNESS AND INJURIES WITH VARYING COMPLEXITIES. IT PROVIDES SERVICES TO IMPROVE THE HEALTH OF PATIENTS AND TO BETTER THEIR QUALITY OF LIFE. ALL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S RACE, CREED, SEX, NATIONALITY, HANDICAP, AGE OR ABILITY TO COMPENSATE FOR SERVICES RENDERED. THESE INCLUDE, BUT ARE NOT LIMITED TO, GENERAL ACUTE CARE, SURGERIES, INTENSIVE CARE AND CRITICAL CARE, ONCOLOGY, MATERNAL/CHILD CARE, LABORATORY, PHARMACEUTICAL DRUGS, EMERGENCY SERVICES, OUTPATIENT CLINICS, CHECK-UPS AND RADIOLOGY. SOME OF THE SERVICES PROVIDED DO NOT GENERATE ENOUGH INCOME TO OFFSET THEIR COST. IN THE FISCAL PERIOD ENDED DECEMBER 31, 2021, UNITY HEALTHCARE ADMITTED 900 PATIENTS RESULTING IN A TOTAL OF 2,740 PATIENT DAYS. OUTPATIENT VISITS TOTALED 81,805 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 844. THERE WERE ALSO 16,868 EMERGENCY ROOM VISITS.

4B (Expenses $ 1762957 including grants of $ 62518) (Revenue $ 0)
COMMUNITY BENEFIT, INCLUDING CHARITY CARECHARITY CARE AND MEANS-TESTED PROGRAMS: UNITY HEALTHCARE PROVIDES CHARITY CARE AND OTHER MEANS-TESTED PROGRAMS WITH THE GOAL TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND ACCESS TO CARE. THIS INCLUDES HEALTH-CARE SERVICES REGARDLESS OF THE PATIENT'S INSURANCE COVERAGE OR FINANCIAL STATUS. CHARITY CARE AND PARTIAL TO FULL FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS ON A CASE-BY-CASE BASIS. CHARITY CARE WAS MADE AVAILABLE AT A VALUE OF $387,200 IN 2021. OFTENTIMES, UNITY HEALTHCARE RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. UNITY HEALTHCARE PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. UNITY HEALTHCARE'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $708,527 FOR 2021. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $1,095,727.OTHER BENEFITS: UNITY HEALTHCARE PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; CONTINUING EDUCATION FOR HEALTH PROFESSIONALS; SUBSIDIZED HEALTH SERVICES; RESEARCH; AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. UNITY HEALTHCARE COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. UNITY HEALTHCARE HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $667,230.

TRINITY MUSCATINE
PART V, SECTION B, LINE 5: THIS ASSESSMENT INCORPORATES DATA FROM MULTIPLE SOURCES, INCLUDING PRIMARY RESEARCH (THROUGH THE PRC COMMUNITY HEALTH SURVEY), AS WELL AS SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA). IT ALSO ALLOWS FOR TRENDING AND COMPARISON TO BENCHMARK DATA AT THE STATE AND NATIONAL LEVELS. SELECT OPERATIONS DATA FROM LOCAL PROVIDERS ALSO WERE SUMMARIZED. QUALITATIVE DATA ON COMMUNITY HEALTH CONCERNS WAS ALSO COLLECTED AND ANALYZED FROM OUR BI-STATE STEERING COMMITTEE, STAKEHOLDERS, AND THROUGH 21 FOCUS GROUPS REACHING 147 INDIVIDUALS FROM 12 SUB-POPULATIONS.

TRINITY MUSCATINE
PART V, SECTION B, LINE 6A: GENESIS HEALTH SYSTEM AND UNITYPOINT HEALTH-TRINITY MEDICAL CENTER

TRINITY MUSCATINE
PART V, SECTION B, LINE 6B: COMMUNITY HEALTH CARE, QUAD CITY HEALTH INITIATIVE, MUSCATINE COUNTY PUBLIC HEALTH DEPARTMENT, ROCK ISLAND COUNTY HEALTH DEPARTMENT, SCOTT COUNTY PUBLIC HEALTH DEPARTMENT

TRINITY MUSCATINE
PART V, SECTION B, LINE 11: THE MOST RECENT ASSESSMENT WAS CONDUCTED IN 2021. BASED ON THE ASSESSMENT, UNITYPOINT HEALTH - TRINITY DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN FOR 2022-2024 FOCUSED ON KEY AREAS IDENTIFIED THAT WILL GUIDE THE COMMUNITY WORK TRINITY DOES FOR THE NEXT THREE YEARS. THOSE AREAS INCLUDE HEALTHY LIFESTYLE (HEART DISEASE, STROKE, DIABETES, NUTRITION, OBESITY/WEIGHT, AND PHYSICAL ACTIVITY); CANCER; MENTAL HEALTH; AND ACCESS TO HEALTHCARE. SERVICE LINE LEADERS PROVIDED FEEDBACK ON WHAT WAS TO BE ADDRESSED AND ACCOMPLISHED BASED ON THE IDENTIFIED NEEDS.FOR 2021, WE ADDRESSED AREAS OF NEED IDENTIFIED IN THE 2018 CHNA, HEART DISEASE/STROKE; DIABETES/PHYSICAL ACTIVITY, NUTRITION & OBESITY; MENTAL HEALTH; CANCER; AND ACCESS TO HEALTHCARE WITH ACTIONS AND RESULTS DESCRIBED BELOW. WHILE CREATING THE COMMUNITY HEALTH IMPROVEMENT PLAN, AREAS OF IMPROVEMENT IDENTIFIED IN THE ASSESSMENT HAD TO BE PRIORITIZED BASED ON WHAT COULD REALISTICALLY BE ADDRESSED BY THE HOSPITAL SYSTEM, AND WHAT WAS ALREADY BEING ADDRESSED BY OTHER COMMUNITY ORGANIZATIONS AND CHNA PARTNERS. CONSIDERATIONS INCLUDED SERVICES THAT COULD BE ACTUALLY PROVIDED BY THE HOSPITAL RELATED TO THE NEED, THE FINANCIAL MEANS TO HAVE AN IMPACT, THE STAFFING AVAILABLE TO MEET THE NEED, AND WHAT NEEDS WERE BEING ADDRESSED BY OTHER ORGANIZATIONS WITHIN OUR COMMUNITY. HEART DISEASE/STROKE (5) 6-WEEK, EVIDENCE-BASED, PLANT FOCUSED COOKING CLASS SERIES (34 CLASSES), CALLED COOKING WITH HEART, WERE PRESENTED TO 64 PEOPLE. CONTINUED HEART TO HEART COMMUNITY EDUCATION SERIES WITH 5 PRESENTATIONS BY CARDIOLOGISTS REACHING 200 PEOPLE. THE TRINITY HEALTH FOUNDATION RAISED MORE THAN $140,000 FOR CARDIOVASCULAR SERVICES AT THE UNITYPOINT HEALTH CUP GOLF BENEFIT. TRINITY HIRED A PREVENTION & WELLNESS STRATEGIST TO THE TEAM, WHO HAS A FOCUS ON HEART HEALTH AND PROVIDES COMMUNITY EDUCATION AND SUPPORT ON THE TOPICS OF DISEASE PREVENTION, IMPROVING HEALTH THROUGH NUTRITION, AND OTHER PROVEN WELLNESS TECHNIQUES.DIABETES/PHYSICAL ACTIVITY, NUTRITION & OBESITYPRESENTED 4 COOKING WITH HEART FOR DIABETES SERIES (16 CLASSES), A 4-WEEK, EVIDENCE-BASED COOKING CLASS FOR PREVENTION OF DIABETES AND MANAGING BLOOD SUGAR WITH 4 DIETICIANS FROM TRINITY, UNITYPOINT CLINIC AND GENESIS HEALTH SYSTEM. NINETY-NINE PARTICIPANTS LEARNED HOW NUTRITION CAN HELP THEM LIVE WELL AND MANAGE BLOOD SUGARS THROUGH FOOD CHOICES, AND HOW TO PREPARE HEALTHY, DELICIOUS RECIPES. HEALTHY EATING VIDEOS WERE CREATED FOR BIG BROTHERS BIG SISTERS BY WELLNESS COACHES FOR AGES 6-11 AND 12-17. CALLED EAT THE RAINBOW THESE VIDEOS EXPLAINED THE HEALTH BENEFITS OF EATING ALL COLORS OF FRUITS AND VEGETABLES. 500 COMMUNITY MEMBERS WERE PROVIDED NUTRITION AND HEALTHY LIFESTYLE EDUCATION AT SEVEN EVENTS, INCLUDING DIABETES RISK ASSESSMENTS, HEALTHY PLATE TRAINING, AND SODIUM CONSIDERATIONS. MENTAL HEALTHROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH WORKED WITH THE STATE OF IOWA TO OBTAINCHAPTER 24 ACCREDITATION, WHICH IS A PRECURSOR TO APPLYING FOR DESIGNATION AS A COMMUNITY MENTAL HEALTH CENTER FOR MUSCATINE RYC CLINIC. THE ROBERT YOUNG CENTER'S $6.7 MILLION DOLLAR PROPOSED FY22 EASTERN IOWA REGION CRISIS SYSTEM CONTRACT WAS APPROVED BY THE REGION GOVERNING BOARD. THE EXPANSION OF CRISIS SERVICES FOR CEDAR, MUSCATINE, SCOTT, JACKSON, AND CLINTON COUNTIES INCLUDES CRISIS STABILIZATION, RESIDENTIAL AND COMMUNITY-BASED SERVICES FOR CHILDREN AND ADULTS, PEER SUPPORT, JAIL-BASED SERVICES, CARE COORDINATION, MEDICATION BRIDGE APPOINTMENTS, TRAINING, AND OTHER MENTAL HEALTH SERVICES. CADS PROVIDED 847 HOURS OF EDUCATION AND TRAINING TO 2,819 STUDENTS AND ADULTS ON PREVENTION OF GAMBLING, DRUG OVERDOSE, ALCOHOL ABUSE, DRUG ABUSE, TOBACCO USE, PRESCRIPTION DRUG ABUSE, AND VIOLENCE, AS WELL AS SKILLS BUILDING AND A STRONG AFRICAN AMERICAN FAMILIES PROGRAM. RYC'S CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC PARTICIPATED IN THE NAACP RESOURCE FAIR WITH 200 PEOPLE AND PROVIDED A GRIEF AND SUICIDE PREVENTION PRESENTATION AT A HEALTH AND WELLNESS COMMUNITY EVENT.CANCERTRINITY AND GILDA'S CLUB PROVIDED FREE, IN-HOME COLON CANCER SCREENING TESTS, THANKS TO A GRANT FROM IOWA CANCER CONSORTIUM. 575 KITS WERE DISTRIBUTED, 68 WERE RETURNED, A 12% RETURN RATE, AND 5 WERE POSITIVE. COORDINATED THE FOLLOW-UP CARE WITH THEIR PRIMARY CARE PROVIDER OR SPECIALTY PROVIDERS. PARTNERED WITH 8 ORGANIZATIONS, PARISH NURSES, LOCAL BARBER SHOPS, AND CHURCHES TO DISTRIBUTE THE KITS. HOSTED 3 COLON CANCER SCREENING WORKSHOPS AND TRAINED STAFF AT COMMUNITY HEALTH CARE ON THE COLON CANCER SCREENING KITS. THREE FREE COOKING WITH HEART FOR CANCER CLASS SERIES (12 CLASSES), WITH 100 PARTICIPANTS WAS PROVIDED. SUSAN G. KOMEN BREAST CANCER FOUNDATION, AFTER RESTRUCTURING, PROVIDED TRINITY HEALTH FOUNDATION WITH $50,000 FOR BREAST HEALTH SERVICES, PATIENT SERVICES, TECHNOLOGY, ACCESS TO CARE, AND FUTURE INNOVATIONS. VIDEOS ON VAPING FACTS CREATED FOR AGES 6-11 AND 12-17 AT BIG BROTHERS BIG SISTERS EDUCATION ON NUTRITION AND CANCER, SCREENING FOR BREAST, LUNG AND COLON CANCERS, AND BREAST CANCER AWARENESS PROVIDED AT 4 EVENTS FOR 300 PEOPLE.ACCESS TO HEALTHCARETRINITY PARTNERED WITH THE PROJECT OF THE QC TO ENSURE ALL MEMBERS OF OUR COMMUNITY HAVE SAFE, EQUITABLE ACCESS TO HEALTHCARE WITH PLANS FOR LGBTQ SAFE ZONES IN ALL UNITYPOINT CLINICS AND TRAINING TO ALL STAFF MEMBERS. LAUNCHED NEW SOCIAL SERVICES RESOURCE CALLED TOGETHER WE CARE TO HELP PEOPLE FIND ASSISTANCE WITH FOOD, HOUSING, TRANSPORTATION, EMPLOYMENT AND MORE. A $6 MILLION PROJECT SERVING THE MUSCATINE COMMUNITY PRIORITIZES FACILITY UPGRADES TO ALLOW LOCAL MEDICAL PROVIDERS MORE OF THE RESOURCES THEY NEED TO PROVIDE HIGH-QUALITY, PERSONAL CARE CLOSER TO HOME. HEALTHPARTNERS UNITYPOINT HEALTH BEGAN OFFERING FULL HEALTH INSURANCE PLANS TO SMALL BUSINESSES WITH <50 EMPLOYEES IN SCOTT & MUSCATINE COUNTIES WITH 27 PLAN OPTIONS. PARISH NURSES PROVIDED 537 HOURS OF TRANSPORTATION SERVICES TO 516 PERSONS IN ILLINOIS AND IOWA QUAD CITIES. THE QUAD CITIES REGIONAL SERVICES FOR VETERANS PROJECT WAS HELD VIRTUALLY FROM OCTOBER 1 TO NOVEMBER 19 TO PROVIDE VETERANS ACCESS TO VA, RYC, AND COMMUNITY RESOURCES. FORTY VETERANS WERE SERVED. PROVIDED $40,573 IN FREE MEDICATIONS TO 662 PATIENTS. REDUCED TOTAL AREA NO-SHOW RATE IN CLINICS BY 3% SINCE 2019. OUTREACH COORDINATOR PROVIDED EDUCATION TO 55 PERSONS ON 5 OCCASIONS AT CHRISTIAN CARE MEN'S HOMELESS SHELTER. 868 HOURS OF ASSISTANCE BY OUR FINANCIAL CONSULTING/MARKETPLACE TEAM WAS PROVIDED TO THE COMMUNITY DURING OPEN ENROLLMENT, AS WELL AS EDUCATION ON INSURANCE COVERAGE OPTIONS THROUGHOUT THE YEAR.

TRINITY MUSCATINE
PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM THE FOLLOWING PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSISTANCE: THE U.S. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE FOOD STAMP PROGRAM; WOMEN, INFANTS & CHILDREN (WIC); AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. THIRD PARTY AGENCIES ARE USED TO ASSIST WITH COLLECTIONS AND, IF THOSE AGENCIES PROVIDE A STATEMENT REGARDING A PATIENT'S LIKELY INCOME LEVEL, THAT INFORMATION IS USED IN DETERMINING THE ELIGIBILITY STATUS AND THE LEVEL OF DISCOUNT AVAILABLE. STATE LAW REQUIREMENTS THAT OFFER ADDITIONAL AND/OR MORE STRINGENT ELIGIBILITY REQUIREMENTS WILL BE FOLLOWED FOR THOSE STATES.

PART I, LINE 6A:
UNITY HEALTHCARE'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES.

PART I, LINE 7:
A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ -385.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. COMMUNITY SUPPORT INCLUDES THE HOURS TRINITY MUSCATINE EMPLOYEES SPENT PARTICIPATING IN THE DAY OF CARING (UNITED WAY). THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH.

PART III, LINE 4:
THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR TRINITY MUSCATINE. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2.

PART III, LINE 8:
AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS.

PART III, LINE 9B:
AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY.

PART VI, LINE 7, REPORTS FILED WITH STATES
IA

PART VI, LINE 2:
TRINITY MUSCATINE CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN THE MUSCATINE COUNTY AREA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. TRINITY MUSCATINE'S PUBLIC HEALTH DEPARTMENT WORKS COLLABORATIVELY WITH THE AREA SCHOOLS, BOARD OF HEALTH, BOARD OF SUPERVISORS, AND OTHER LOCAL AGENCIES TO ASSESS, ADDRESS AND MONITOR THE HEALTH NEEDS OF THE MUSCATINE AREA. TRINITY MUSCATINE ALSO PARTICIPATES AS PART OF THE MUSCATINE COMMUNITY HEALTH ASSOCIATION, EMPOWERING HEALTHY BEHAVIORS COMMITTEE, COMMUNITY FOUNDATION OF GREATER MUSCATINE, AND HEALTHY HOMETOWNS. THESE GROUPS ACTIVELY ADDRESS THE NEED AND STRATEGIES ASSOCIATED WITH OPTIMAL HEALTH OUTCOMES. MORE SPECIFICALLY, THESE GROUPS OFTEN FOCUS ON THE SOCIAL DETERMINANTS OF HEALTH AND HOW TO IMPACT THEM IN THE EFFORT TO RAISE THE COMMUNITY HEALTH STATUS. THIS WIDE BASED COLLABORATIVE PROVIDES OPPORTUNITIES FOR TRINITY MUSCATINE TO ENGAGE IN VARIOUS AREAS OF SERVICE TO THE COMMUNITY THAT MAY BE OUTSIDE OF ITS TYPICAL EXPERTISE BUT WITHIN ITS EXISTING RESOURCES. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS, UNITY HEALTHCARE CONTINUALLY MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND THE RESOURCES IT CAN LEVERAGE TO ADDRESS THEM. INDIVIDUAL DEPARTMENTS OFTEN WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT.

PART VI, LINE 3:
THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE TO ALL PATIENTS AND WITHIN THE COMMUNITY. COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. THE CENTRAL BILLING OFFICE IS AVAILABLE BY PHONE TO ANSWER QUESTIONS ABOUT THE POLICY, OR PATIENTS SHOULD GO TO THE CASHIER'S OFFICE AT THE HOSPITAL TO OBTAIN THIS INFORMATION. THE PLAIN LANGUAGE SUMMARY IS OFFERED AS PART OF THE PATIENT INTAKE AND/OR DISCHARGE PROCESS AND INCLUDED WHEN A PATIENT IS SENT WRITTEN NOTICE THAT EXTRAORDINARY COLLECTION ACTIONS MAY BE TAKEN AGAINST HIM/HER. THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND ALL FINANCIAL ASSISTANCE FORMS ARE AVAILABLE IN ENGLISH AND IN ANY OTHER LANGUAGE IN WHICH LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS CONSTITUTE THE LESSER OF 1,000 PERSONS OR MORE THAN 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. THESE TRANSLATED DOCUMENTS WILL BE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL.

PART VI, LINE 4:
TRINITY MUSCATINE IS AN 80-BED COMMUNITY HOSPITAL SERVING MUSCATINE AREA OF EASTERN IOWA. TRINITY MUSCATINE IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.90% OF TRINITY MUSCATINE'S MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF MUSCATINE AND LOUISA. TRINITY MUSCATINE ADMITS APPROXIMATELY 1,000 INPATIENTS AND CARES FOR OVER 15,000 EMERGENCY PATIENTS PER YEAR. TRINITY MUSCATINE CARES FOR MORE INPATIENTS, OUTPATIENTS, EMERGENCY PATIENTS AND CARDIAC PATIENTS THAN ANY OTHER HOSPITAL IN THE MUSCATINE AREA OF EASTERN IOWA. THERE ARE NO OTHER HOSPITALS WITHIN THE 2-COUNTY SERVICE AREA. MEDIAN INDIVIDUAL INCOMES RANGE FROM $60,435 TO $63,034 AND THE AVERAGE POVERTY RATE IS 9%.57% OF TRINITY MUSCATINE INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. MUSCATINE AND LOUISA COUNTIES ARE ABOUT 79% CAUCASIAN AND 17% HISPANIC.

PART VI, LINE 5:
THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE.

PART VI, LINE 6:
THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). AS THE NATION'S 13TH LARGEST NONPROFIT HEALTH SYSTEM, UNITYPOINT HEALTH PROVIDES PROGRESSIVE AND HIGH QUALITY SERVICES ACROSS ITS 9 REGIONS WHICH SPAN IOWA, WESTERN ILLINOIS AND SOUTHERN WISCONSIN. THIS REGIONAL CARE MODEL HAS BEEN SUCCESSFUL IN ACHIEVING STANDARDIZED LEVELS OF PERFORMANCE AND KEEPING CARE LOCAL. WITH $4.9B IN TOTAL OPERATING REVENUE, UNITYPOINT HEALTH EMPLOYS APPROXIMATELY 33,000 TEAM MEMBERS AND OPERATES 20 REGIONAL HOSPITALS, 19 COMMUNITY NETWORK HOSPITALS AND OVER 435 CLINICS. AS A KEY COMPONENT OF UNITYPOINT HEALTH, UNITYPOINT CLINIC IS A 1,180 PROVIDER MULTISPECIALTY GROUP THAT IS BUILT ON THE FOUNDATION OF CARE DELIVERY, INNOVATION AND EXPERIENCE. REPRESENTED BY OVER 40 SPECIALTIES, UPC IS A FORWARD-THINKING DELIVERY PROVIDER AND IS ON THE LEADING EDGE OF CARE DELIVERY WITH ITS TELEHEALTH, AMBULATORY AND URGENT CARE PROGRAMS. THE DIVERSIFIED HEALTH SYSTEM ALSO INCLUDES UNITYPOINT ACCOUNTABLE CARE, UNITYPOINT HEALTH COLLEGES, UNITYPOINT AT HOME AND EXTENDS HEALTH COVERAGE THROUGH THE HEALTHPARTNERS UNITYPOINT INSURANCE PLAN. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THEIR REGIONS. IN 2021, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $672 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY UNITYPOINT HEALTH AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES.