| FORM 990, PART VI, SECTION A, LINE 7B |
PRESIDENT SHALL BE CEO OF ST. LUKE'S HEALTH SYSTEM. PRESIDENT AND EXECUTIVE VICE PRESIDENT MAY ONLY BE REMOVED WITH APPROVAL OF ST. LUKE'S HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION B, LINE 11 |
THE FORM 990 IS PREPARED BY THE IOWA HEALTH SYSTEM TAX SERVICES DEPARTMENT USING INFORMATION GATHERED FROM THE FINANCIAL SERVICES AND ADMINISTRATIVE OFFICES OF THE ORGANIZATION. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE EXECUTIVE DIRECTOR FOR REVIEW. ONCE REVIEWED A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C |
A DESIGNATED PERSON WITHIN THE ORGANIZATION AND OTHER RELATED ORGANIZATIONS SUBJECT TO THIS POLICY SHALL SEND DISCLOSURE QUESTIONNAIRES TO ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND HIGHLY COMPENSATED EMPLOYEES. PERSONS REQUIRED TO REPORT WHO HAVE NOT RETURNED QUESTIONNAIRES WILL BE CONTACTED AND FOLLOW-UP WILL CONTINUE ON A REGULAR BASIS IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE INFORMATION DISCLOSED WILL BE USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICARE QUESTIONNAIRES. THE DUTY TO IDENTIFY AND DISCLOSE POTENTIAL CONFLICTS OF INTEREST IS A DUTY THAT IS ONGOING. ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND HIGHLY COMPENSATED EMPLOYEES SHALL IMMEDIATELY DISCLOSE SUCH POTENTIAL CONFLICT OR DUALITY OF INTEREST AS SOON AS THE INTEREST OCCURS. DISCLOSURE SHOULD BE MADE TO THE COVERED PERSON'S SUPERVISOR, THE CHIEF EXECUTIVE OFFICER OF THE COMPANY, OR THE BOARD CHAIR OF THE COMPANY, AS APPLICABLE. |
| FORM 990, PART VI, SECTION B, LINE 15 |
THE ORGANIZATION RELIES ON AN UNRELATED ORGANIZATION TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION BASED ON FAIR MARKET VALUE. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION C, LINE 19 |
ST. LUKE'S HEALTH FOUNDATION MAKES AVAILABLE TO THE PUBLIC THE ORGANIZATION'S BOARD OF DIRECTORS LIST ON ITS WEBSITE. FORM 990 TAX INFORMATION, CONFLICT OF INTEREST POLICY, AND WHISTLEBLOWER POLICY ARE AVAILABLE TO THE PUBLIC THROUGH LINKS AT ST. LUKE'S HEALTH SYSTEM'S WEBSITE (WWW.UNITYPOINT.ORG/SIOUXCITY). |
| FORM 990, PART XI, LINE 9: |
MISCELLANEOUS OTHER ADJUSTMENTS -2,685. |
Attach to Form 990 or 990-EZ.