4A (Expenses $ 249052221 including grants of $ 8929819) (Revenue $ 291428614)
HEALTH-CARE SERVICES`ALLEN MEMORIAL HOSPITAL CORPORATION IS AN IMPORTANT ELEMENT OF THE HEALTH-CARE DELIVERY SYSTEM THAT THE GREATER CEDAR VALLEY COMMUNITIES RELY ON EVERY DAY. IT IS COMMITTED TO PROVIDING QUALITY HEALTH-CARE AND TO USING ITS RESOURCES TO THE GREATEST COMMUNITY BENEFIT. ALLEN MEMORIAL HOSPTIAL CORPORATION 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, MENTAL HEALTH CARE, CARDIOLOGY, ONCOLOGY, REHABILITATION, BEHAVIORAL DISORDER PROGRAMS, MATERNAL/CHILD CARE, LABORATORY, PHARMACEUTICAL DRUGS, WOUND CARE, 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, ALLEN MEMORIAL HOSPITAL CORPORATION ADMITTED 9,727 PATIENTS WITHOUT NEWBORNS AND NICU AND 10,917 PATIENTS WITH NEWBORNS AND NICU; RESULTING IN A TOTAL OF 42,443 PATIENT DAYS WITHOUT NEWBORNS AND NICU, AND 44,769 PATIENT DAYS WITH NEWBORNS AND NICU. OUTPATIENT VISITS TOTALED 231,291 AND TOTAL OUTPATIENT SURGERY REGISTRATIONS FOR THE SAME PERIOD WERE 4,741. THERE WERE ALSO 34,816 EMERGENCY ROOM VISITS AND 1,313 BABIES DELIVERED.

4B (Expenses $ 29070479 including grants of $ 11269933) (Revenue $ 0)
CHARITY CARE, MEANS-TESTED PROGRAMS AND OTHER COMMUNITY BENEFITSCHARITY CARE AND MEANS-TESTED PROGRAMS: ALLEN MEMORIAL HOSPITAL CORPORATION 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 $1,406,762 IN 2021. OFTEN TIMES, ALLEN MEMORIAL HOSPITAL CORPORATION RECEIVES PAYMENTS FROM PAYORS OR PATIENTS THAT ARE LESS THAN IT CHARGES FOR SERVICES. ALLEN MEMORIAL HOSPITAL CORPORATION PARTICIPATES IN MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH-CARE PROGRAMS. ALLEN MEMORIAL HOSPITAL CORPORATION'S NET COST OF PROVIDING CARE FOR WHICH IT RECEIVES PAYMENT BELOW ITS COST IS $8,919,790 FOR 2021. TOTAL CHARITY CARE AND MEANS-TESTED PROGRAMS REPORTED VALUE: $10,326,552.OTHER BENEFITS: ALLEN MEMORIAL HOSPITAL CORPORATION PROVIDES SEVERAL OTHER BENEFITS THAT ASSIST THE COMMUNITY. PROGRAMS MAY INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUCH AS PREVENTION AND HEALTH SCREENINGS; HEALTH PROFESSIONAL'S EDUCATION; SUBSIDIZED HEALTH SERVICES; RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. ALLEN MEMORIAL HOSPITAL CORPORATION COLLABORATES WITH OTHER HOSPITALS, CHURCHES, SCHOOLS, CHAMBERS OF COMMERCE AND DAYCARE CENTERS TO IMPROVE COMMUNITY HEALTH AND EXPAND ACCESS TO HEALTH CARE. ALLEN MEMORIAL HOSPITAL CORPORATION HAS DEDICATED STAFF TO ASSIST COMMUNITY BENEFIT EFFORTS. TOTAL OTHER BENEFITS REPORTED VALUE: $18,743,927.

ALLEN MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 5: HEALTHCARE PROVIDERS AND ALLIED SERVICE ORGANIZATIONS CAME TOGETHER AS PARTNERS TO WRITE AND PUBLISH TWO ONLINE SURVEYS TO IDENTIFY THE COMMUNITY HEALTH NEEDS OF CEDAR VALLEY RESIDENTS AND SOCIAL SERVICE AGENCIES. THE ONLINE SURVEY FOR RESIDENTS WAS PUBLISHED FROM MARCH 1-MAY 15, 2019, AND DREW 1,554 UNIQUE RESPONSES. THE PARALLEL SURVEY FOR SOCIAL SERVICE AGENCIES RAN CONCURRENTLY AND DREW 41 RESPONSES. BOTH SETS OF RESPONSES WERE SIGNIFICANTLY LARGER THAN RESPONSES TO PRIOR COMMUNITY HEALTH NEEDS SURVEYS PUBLISHED IN 2013 AND 2016. THE IMPROVED RESPONSE RATES SPEAK TO THE DILIGENCE OF THE SURVEY PARTNERSHIP AND THE BROAD ACCEPTANCE OF ONLINE POLLING. THE ONLINE SURVEY MONKEY FOR RESIDENTS WAS SUPPLEMENTED BY PAPER SURVEYS DISTRIBUTED TO AND COLLECTED FROM MEMBERS OF MINORITY CHURCH CONGREGATIONS. RESPONSES WERE TABULATED BY THE POLITICAL SCIENCE DEPARTMENT OF THE UNIVERSITY OF NORTHERN IOWA USING SURVEY MONKEY ANALYTICS. ONCE THE INITIAL RESPONSES ARRIVED, THE PARTNERS REACHED OUT TO GATHER ADDITIONAL RESPONSES FROM MINORITY POPULATIONS TO HELP MATCH THE OVERALL RETURN TO THE MARKET PROFILE. THE RESIDENT SURVEY WAS EXTENDED 45 DAYS PAST ITS ORIGINAL DEADLINE TO ENSURE ADDITIONAL RETURNS.THE ASSESSMENT PARTNERSHIP ASKED 68 COMMUNITY ORGANIZATIONS TO PARTICIPATE IN THE AGENCY SURVEY. FORTY-ONE AGENCIES COMPLETED THE SURVEY. SOME IDENTIFIED THEMSELVES IN MORE THAN ONE CATEGORY. AGENCY PARTICIPANTS REPRESENT THE INTERESTS OF AFRICAN AMERICAN, HISPANIC, BOSNIAN, ASIAN, INDIAN, BURMESE, AMERICAN INDIAN AND CONGOLESE POPULATIONS LIVING IN THE CEDAR VALLEY, PREDOMINATELY IN BLACK HAWK COUNTY. THEY ALSO REPRESENT THE INTERESTS OF AND SERVE RESIDENTS LIVING IN POVERTY; WOMEN AND CHILDREN; WOMEN AND CHILDREN AT-RISK; PRESCHOOL CHILDREN; ADULTS 65+; THE DISABLED; THE UNDEREMPLOYED AND UNEMPLOYED; THE MEDICALLY-UNDERSERVED; RESIDENTS SUFFERING FROM MENTAL ILLNESS AND/OR ADDICTION; RESIDENTS LIVING WITH FOOD INSECURITY; ENGLISH LANGUAGE LEARNERS AND THE LGBTQ COMMUNITIES. AGENCY PARTICIPANTS WERE RECRUITED SPECIFICALLY FOR THEIR KNOWLEDGE ANDRECORD OF SUCCESSFUL SERVICE TO ONE OR MORE MEDICALLY-UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS IN THE CEDAR VALLEY.

ALLEN MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 6A: MERCYONE WATERLOO

ALLEN MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 6B: ALLEN HOSPITAL HAS PARTNERED WITH BLACK HAWK COUNTY GAMING ASSOCIATION, BLACK HAWK COUNTY PUBLIC HEALTH DEPARTMENT, CEDAR VALLEY UNITED WAY, PEOPLES COMMUNITY HEALTH CLINIC OF WATERLOO, SUCCESSLINK, AND THE UNIVERSITY OF NORTHERN IOWA DEPARTMENTS OF LIBRARY AND POLITICAL SCIENCE.

ALLEN MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 11: THE 2017-2019 COMMUNITY HEALTH NEEDS ASSESSMENT PRIORITIZED THREE NEEDS: MENTAL HEALTH ACCESS AND SERVICE; WOMEN'S AND CHILDREN'S HEALTH; AND NUTRITION, OBESITY AND WELLNESS. THE FOLLOWING SUMMARIZES SPECIFIC ACTIONS TAKEN TO ADDRESS THESE NEEDS AND THEIR IMPACT.MENTAL HEALTH: THESE PROGRAMS AND INITIATIVES HAVE BEEN ADDED IN 2017-2019 TO HELP THE COMMUNITY MEET MENTAL HEALTH SERVICE NEEDS:-STEPPING UP (LOCAL AFFILIATION WITH NATIONAL EFFORT TO KEEP MENTALLY ILL OUT OF JAIL)-JAIL DIVERSION (IN PARTNERSHIP WITH STEPPING UP AND BLACK HAWK COUNTY)-COLLABORATION AMOUNT COURTS, LAW ENFORCEMENT, SUBSTANCE ABUSE, MENTAL HEALTH PROVIDERS-ADULT CRISIS STABILIZATION CENTER ESTABLISHED AND FUNDED-PATHWAYS DETOXIFICATION PROGRAM ESTABLISHED AND FUNDED-MEDICATION ASSISTED TREATMENT PROGRAMS ESTABLISHED AND FUNDED-BEHAVIORAL HEALTH CONSULTANTS ADDED TO THE ALLEN HOSPITAL EMERGENCY DEPARTMENT-BROADER, FASTER ACCESS TO ELECTRONIC HEALTH RECORDS TO IMPROVE CARE COORDINATION FOR MENTAL HEALTH PARTNERS PRESENTING TO THE ER OR OFF-CAMPUS SITES-MENTAL HEALTH RECOVERY CENTER BEDS ADDED TO ALLEN HOSPITAL ED (SEPARATE UNIT)-CRISIS INTERVENTION TRAINING ADDED FOR LOCAL LAW ENFORCEMENT-SUPPORT LENT TO PASS CHANGES IOWA CODE CHAPTER 228 (DISCLOSURE OF MH INFORMATION)-SUPPORT LENT TO PASS CHANGES TO IOWA CODE 229 (HOSPITALIZATION OF MH PATIENTS)-COMPLEX NEEDS IMPLEMENTED INTO LAW-CHILDREN'S MENTAL HEALTH SYSTEM PASSED INTO LAW BY GOVERNOR REYNOLDS-INCREASED MH ARNPS GRADUATING FROM ALLEN COLLEGE AND PRACTICING LOCALLY-CONTINUED SCHOOL-BASED MH SERVICES, ALTHOUGH DEMAND OUTSTRIPS SUPPLY-INTEGRATED MH SERVICES WITH UNITYPOINT AT HOME-ADDED OPEN-ACCESS SCHEDULING TO BLACK HAWK-GRUNDY MENTAL HEALTH CENTER, SERVING 6,000 MH OUTPATIENTS-ADDED MOBILE CRISIS SERVICES WITH AREA LAW ENFORCEMENT-PARTNERING WITH CEDAR VALLEY UNITED WAY TO IDENTIFY/ADDRESS ADVERSE CHILDHOOD EXPERIENCES (ACES); ADDED ACES SURVEY TO 2020-2022 CHNA WOMEN AND CHILDREN'S HEALTH: THESE PROGRAMS AND INITIATIVES HAVE BEEN ADDED IN 2017- 2019 TO HELP THE COMMUNITY MEET WOMEN AND CHILDREN'S SERVICES-ALIGNED ALLEN WOMEN'S HEALTH, OB AND NICU TO CARE FOR MORE HIGH-RISK PREGNANCIES;-PLACED CASE WORKERS WITH SUCCESS STREET IN METROPOLITAN SCHOOLS.-RAISED FUNDS TO ADD THREE LABOR/DELIVERY/RECOVERY SUITES AND THREE ADDITIONAL NICU SUITES-ADDING SIX POSTPARTUM ROOMS-ADDED TWO NEW PROVIDERS TO MEET PATIENT DEMAND-CONTINUED PROGRAM TO KEEP BABIES AS YOUNG AS 30 WEEKS GESTATION AT ALLEN HOSPITAL NICU, WITH EXCELLENT RESULTS-GREATLY EXPANDED PEDIATRIC SERVICES TO THE MARKET WITH THE OPENING OF PRAIRIE PARKWAY IN CEDAR FALLS-LAUNCHED LGBTQ CLINIC AT PRAIRIE PARKWAY IN CEDAR FALLS-REDESIGNED AND EXPANDED FOUR URGENT CARE CLINICS IN THE MARKET, WITH AVERAGE DOOR-TO-DOOR TIMES OF LESS THAN 30 MINUTES-ADDED 3D BREAST TOMOSYNTHESIS MAMMOGRAPHY ON A WALK-IN BASIS AT THREELOCATIONS: ALLEN HOSPITAL, UNITED MEDICAL PARK, PRAIRIE PARKWAY-CO-SPONSORED VISION TO LEARN TO DIAGNOSE AND PROVIDE GLASSES TO WATERLOO SCHOOL CHILDREN WITH VISION PROBLEMS (PROGRAM IS BEING EXPANDED SYSTEM-WIDE IN 2019-2020 SCHOOL YEAR)- CARED FOR 2,643 PATIENTS AT ALLEN WOMEN'S HEALTH IN 2018 * 79% OF PATIENTS SEEN IN 2017 LIVE IN EXTREME POVERTY (INCOME OF JUST $12,000) * 1,752 RECEIVED STD TEST (BLACK HAWK COUNTY HAS HIGHEST CHLAMYDIA ANDGONORRHEA RATES IN IOWA) *343 PATIENTS RECEIVED NEW BIRTH CONTROL, INCLUDING 23% WHO ASKED FOR AND RECEIVED A LARC (LONG-ACTING REVERSIBLE CONTRACEPTION) *FUNDED FOR 9 COUNTIES, PROVIDING SERVICES TO 24-SERVED 547 CHILDREN FROM 27 COUNTIES AT THE ALLEN CHILD PROTECTION CENTER *77% WERE ALSO GIVEN A MEDICAL EVALUATION *PROVIDED 499 FORENSIC INTERVIEWS TO AREA COURTS AND LAW ENFORCEMENT *93% OF OFFENDERS WERE KNOWN TO THE CHILD IN 2018 *86% OF ALLEGATIONS WERE SEXUAL ABUSE; 7% PHYSICAL ABUSE; 2% NEGLECT *PROVIDED 25 COMMUNITY TRAINING SESSIONS TO 753 PARTICIPANTS IN 2018 NUTRITION, OBESITY, WELLNESS: THESE PROGRAMS AND INITIATIVES HAVE BEEN ADDED OR EXPANDED IN 2017-2019 TO HELP COMMUNITY NEEDS REGARDING NUTRITION, OBESITY, AND WELLNESS:-ADDED A COMMUNITY DEMONSTRATION KITCHEN TO NEW PRAIRIE PARKWAY OUTPATIENT CENTER, WITH PERIODIC HEALTHY COOKING AND NUTRITION CLASSES-ADDED GET GROWING: EATING HEALTHY FOR LIFE HANDS-ON, SUMMER-LONG GARDENING AND NUTRITION PROGRAM FOR KIDS AT PRAIRIE PARKWAY-EXPANDED ALLEN EAP SERVICES TO CONTRACT WITH 60 AREA COMPANIES. EAP FOCUS IS ONPREVENTION AND EARLY INTERVENTION IN WORK, FAMILY AND PERSONAL ISSUES THAT MIGHT OTHERWISE DERAIL EMPLOYEES AND CAUSE PREVENTABLE DISRUPTION TO THEMSELVES, THEIR FAMILIES AND EMPLOYERS-EXPANDED CORPORATE/OCCUPATIONAL HEALTH WELLNESS SERVICES: *ADDED OCCUPATIONAL HEALTH CLINIC IN CEDAR FALLS *PROVIDE ONSITE WELLNESS SCREENINGS *PROVIDE HEALTH-RISK ASSESSMENTS *DESIGN AND IMPLEMENT QUARTERLY WELLNESS CHALLENGES *PROVIDE EDUCATIONAL PRESENTATIONS, COOKING DEMONSTRATIONS *PROVIDE ONSITE WEIGHT MANAGEMENT PROGRAMS-EXPANDED UNITYPOINT CLINIC WELLNESS THERAPIES: *EXERCISE *BIOFEEDBACK *MINDFULNESS AND RELAXATION TECHNIQUES *FOOD, MOOD AND COGNITION EDUCATION *ADDED INTENSIVE BEHAVIOR THERAPY FOR WEIGHT MANAGEMENT PROGRAM (IBT) *ADDED HEALTHY EATING ACTIVE LIFESTYLE PROGRAM (HEAL) *ADDED SCULPSURE TO SHED BODY FAT *CONTINUED NUTRITION

ALLEN MEMORIAL HOSPITAL CORPORATION
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 US. 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:
ALLEN MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.UNITYPOINT.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES.

PART I, LINE 7:
A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE 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 $ 40,578.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. THE HOSPITAL CONTRIBUTES FINANCIALLY TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT ADDRESS THE BROADER NEEDS OF THE COMMUNITY. THESE DONATIONS ALLOW OTHER NON-PROFIT ORGANIZATIONS TO FULFILL THEIR MISSIONS TO IMPROVE THE WELL BEING OF THE COMMUNITY AND CONTRIBUTE TO ITS OVERALL HEALTH STATUS IN WAYS THAT MAY DIFFER FROM THE DIRECT SERVICES OF THE HOSPITAL ORGANIZATION AND MAXIMIZE THE RESOURCES THEY HAVE TO WORK WITH. THE HOSPITAL EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS ON A WIDE VARIETY OF HEALTH SUBJECTS THAT ADVANCE THEIR WORK. FURTHER, THE HOSPITAL EMPLOYEES ARE MEMBERS OF MANY NON-PROFIT BOARDS TO PROVIDE LEADERSHIP OR COLLABORATE TO ADDRESS COMPLEX HEALTH ISSUES. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH.

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

PART III, LINE 8:
AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE 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:
COMMUNITY HEALTH IS INEXTRICABLY TIED TO SOCIAL HEALTH. ALLEN HOSPITAL REACHES OUT TO IDENTIFY THE SOCIAL DETERMINANTS OF HEALTHCARE AND AFFECT DETERMINANTS IN REAL TIME. WE DO THAT THROUGH ONGOING PARTNERSHIPS, FORMAL AND INFORMAL, WITH OTHER ORGANIZATIONS SERVING THE COMMUNITY. EXAMPLES INCLUDE:THE ALLEN COLLEGE ENGAGEMENT SALVATION ARMY PARTNERSHIP, WHICH PROVIDES A FREE, COMMUNITY CLINIC THROUGHOUT THE YEAR. THE CLINIC PROVIDES CHECKUPS, SCREENINGS, TREATMENT OF MINOR ILLNESS, MEDICATION ASSISTANCE AND REFERRALS TO 1,200 RESIDENTS PER YEAR. IT ALSO PROVIDES ALLEN HOSPITAL WITH REAL-TIME INDICATORS OF CHANGING HEALTHCARE NEEDS OR OUR UNDERSERVED POPULATIONS.THE CEDAR VALLEY ADVERSE CHILDHOOD EXPERIENCES (ACES) COALITION, IN PARTNERSHIP WITH OTHER AREA PROVIDERS, MAJOR PHILANTHROPIC FOUNDATIONS IN OUR AREA, AND THE CEDAR VALLEY UNITED WAY, THE LEAD AGENCY. THE ACES EFFORT IS BOTH BROAD AND DEEP, REACHING ACROSS THE COMMUNITY TO IDENTIFY ROOT CAUSES OF ADULT HEALTH PROBLEMS. THE GOAL OF THE WORK IS TO LESSEN ADULT HEALTH CONCERNS BY REDUCING ACES IN AREA FAMILIES. THE AREA CHNA COALITION INCLUDED ACES QUESTIONS IN ITS 2019 SURVEY TO HELP ADVANCE THE PROJECT.THE BLACK HAWK COUNTY CHILD CARE COALITION, WHICH HAS IDENTIFIED CHILD CARE AS AN ABSOLUTE HEALTH, SOCIAL AND EMPLOYMENT PRIORITY FOR THE ENTIRE REGION. AFFORDABLE CHILD CARE IS PARTICULARLY CRITICAL FOR FAMILIES STRUGGLING TO GET OUT OF POVERTY AND FOR SINGLE-PARENT FAMILIES.THE CEDAR VALLEY MENTAL HEALTH SUMMIT, A BI-ANNUAL CONVOCATION OF AREA AGENCIES, PROVIDERS, AND FUNDERS TO ADDRESS MENTAL HEALTH CARE AS AN ESSENTIAL PART OF COMMUNITY HEALTH. LIKE THE ACES COALITION, IT BRINGS MANY ORGANIZATIONS TOGETHER TO FOCUS COLLECTIVE EFFORT ON A COMMON PROBLEM.PROJECT SEARCH, WHICH TEAMS ALLEN HOSPITAL WITH THE WATERLOO SCHOOLS TO GIVE SPECIAL NEEDS HIGH-SCHOOL SENIORS ON THE JOB TRAINING AND EXPERIENCE. THE PROGRAM IS ENTERING ITS FOURTH RATE WITH A GRADUATION RATE OF ALMOST 100% AND AN EQUALLY HIGH PLACEMENT RATE INTO PERMANENT JOBS FOR GRADUATES. PROJECT SEARCH ADDRESSES AN OFT-OVERLOOKED POPULATION COHORT WHO CAN BE SEMI-INDEPENDENT AND SELF-SUPPORTING WITH THE RIGHT START AND COMMUNITY SUPPORT.THE CEDAR VALLEY EQUITY INITIATIVE WORKSHOP ON RACISM AND HEALTH. THIS IS ANOTHER INITIATIVE THAT FOCUSES ON ROOT CAUSES OF HEALTHCARE OUTCOMES, INCLUDING BOTH RACIAL AND ECONOMIC DISPARITIES IN PRIMARY CARE AND CONSEQUENT HEALTH ISSUES.SUCCESS STREET AND HEALTH EDUCATION IN THE WATERLOO SCHOOLS. ALLEN WOMEN'S HEALTH PROVIDES SEX EDUCATION THROUGHOUT THE WATERLOO SCHOOLS AND OFFERS BOTH THE TOGETHER FOR YOUTH AND YOUNG PARENTS TOGETHER COMMUNITY GROUPS TO HELP TEENS AND YOUNG PARENTS NAVIGATE HEALTHCARE ISSUES FOR THEMSELVES AND THEIR BABIES. ALL THREE PROGRAMS FOSTER FRANK, TWO-WAY DISCUSSION AMONG AREA TEENS AND PROVIDERS AND PROVIDE A CLEAR, CURRENT LOOK AT COMMUNITY HEALTH NEEDS.

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:
ALLEN MEMORIAL HOSPITAL IS A 201-BED COMMUNITY HOSPITAL SERVING THE CEDAR VALLEY OF IOWA. ALLEN MEMORIAL HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME HERE, REGARDLESS OF REASON OR CIRCUMSTANCE.80% OF ALLEN MEMORIAL HOSPITAL'S MARKET RESIDENTS LIVE WITHIN THE IOWA COUNTIES OF BLACK HAWK, BREMER, BUCHANAN, FAYETTE, TAMA AND BUTLER. ALLEN MEMORIAL HOSPITAL ADMITS APPROXIMATELY 10,700 INPATIENTS AND CARES FOR 29,000 EMERGENCY PATIENTS PER YEAR. ALLEN MEMORIAL HOSPITAL CARES FOR MORE INPATIENTS, OUTPATIENTS, EMERGENCY PATIENTS AND CARDIAC PATIENTS THAN ANY OTHER HOSPITAL IN THE CEDAR VALLEY OF IOWA. THERE ARE 5 OTHER HOSPITALS WITHIN THE 6-COUNTY SERVICE AREA. MEDIAN HOUSEHOLD INCOMES RANGE FROM $49,834 TO $72,209 AND THE AVERAGE POVERTY RATE IS 9.5%.69.0% OF ALLEN MEMORIAL HOSPITAL INPATIENTS ARE ELIGIBLE FOR MEDICARE OR MEDICAID. BLACK HAWK COUNTY, THE ONLY COUNTY IN THE SERVICE AREA WITH SIGNIFICANT MINORITY POPULATION, IS 84% CAUCASIAN AMERICAN AND BOSNIAN, 10% AFRICAN-AMERICAN, 4% HISPANIC AND 1% ALL OTHER MINORITY POPULATIONS.

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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.

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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.