TY 2014 Form 990 Schedule O

efile Public Visual Render ObjectId: 201523209349303322 - Submission: 2015-11-16 TIN: 42-1429225

SCHEDULE O
(Form 990 or 990-EZ)

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.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

JONES REGIONAL MEDICAL CENTER FOUNDATION

Employer identification number

42-1429225

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 IS PREPARED BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. 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 C, LINE 19	JONES REGIONAL MEDICAL CENTER 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 JONES REGIONAL MEDICAL CENTER'S WEBSITE (WWW.UNITYPOINT.ORG/ANAMOSA).

Return Reference

Explanation

FORM 990, PART VI, SECTION B, LINE 11

THE FORM 990 IS PREPARED BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. 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 C, LINE 19

JONES REGIONAL MEDICAL CENTER 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 JONES REGIONAL MEDICAL CENTER'S WEBSITE (WWW.UNITYPOINT.ORG/ANAMOSA).

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

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