HomeMy WebLinkAboutAging Services FinancialIOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Consolidated Financial Statements
December 31, 2023 and 2022
(With Independent Auditors' Report Thereon)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Table of Contents
Page
Independent Auditors' Report 1
Consolidated Financial Statements:
Balance Sheets 3
Statements of Operations and Changes in Net Assets 4
Statements of Cash Flows 6
Notes to Consolidated Financial Statements 8
2023 Supplementary Financial Statement Information
1.
UnityPoint Health Consolidating Balance Sheet and Statement of Operations
62
2.
UnityPoint Health — Des Moines and Subsidiaries Consolidating Balance Sheet and
Statement of Operations (Des Moines)
64 r
3.
Methodist Health Services Corporation and Subsidiaries Consolidating Balance Sheet and
Statement of Operations (Peoria)
66
4.
Trinity Regional Health System and Subsidiaries Consolidating Balance Sheet and
Statement of Operations (Quad Cities)
68
5.
Meriter Health Services, Inc. and Subsidiaries Consolidating Balance Sheet and Statement
of Operations (Madison)
70
6.
St. Luke's Healthcare and Subsidiaries Consolidating Balance Sheet and Statement of
Operations (Cedar Rapids)
72
7.
Allen Health Systems, Inc. and Subsidiaries Consolidating Balance Sheet and Statement
of Operations (Waterloo)
74
8.
St. Luke's Health System, Inc. and Subsidiaries Consolidating Balance Sheet and
Statement of Operations (Sioux City)
76
9.
Trinity Health Systems, Inc. and Subsidiaries Consolidating Balance Sheet and Statement
of Operations (Fort Dodge)
78
10.
Finley Tri-States Health Group, Inc. and Subsidiaries Consolidating Balance Sheet and
Statement of Operations (Dubuque)
80
11.
Affiliated Colleges Consolidating Balance Sheet and Statement of Operations
82
12. Supplementary Schedule of Financial Responsibility Data 84
KPMG LLP
4200 Wells Fargo Center
90 South Seventh Street
Minneapolis, MN 55402
Independent Auditors' Report
The Board of Directors
Iowa Health System and Subsidiaries d/b/a UnityPoint Health:
Opinion
We have audited the consolidated financial statements of Iowa Health System and Subsidiaries d/b/a
UnityPoint Health (the System), which comprise the consolidated balance sheets as of December 31, 2023 and
2022, and the related consolidated statements of operations and changes in net assets, and cash flows for the
years then ended, and the related notes to the consolidated financial statements.
In our opinion, the accompanying consolidated financial statements present fairly, in all material respects, the
financial position of the System as of December 31, 2023 and 2022, and the results of its operations and
changes in net assets, and its cash flows for the years then ended in accordance with U.S. generally accepted
accounting principles.
Basis for Opinion
We conducted our audits in accordance with auditing standards generally accepted in the United States of
America (GAAS). Our responsibilities under those standards are further described in the Auditors'
�.. Responsibilities for the Audit of the Consolidated Financial Statements section of our report. We are required to
be independent of the System and to meet our other ethical responsibilities, in accordance with the relevant
ethical requirements relating to our audits. We believe that the audit evidence we have obtained is sufficient
and appropriate to provide a basis for our audit opinion.
Responsibilities of Management for the Consolidated Financial Statements
Management is responsible for the preparation and fair presentation of the consolidated financial statements in
accordance with U.S. generally accepted accounting principles, and for the design, implementation, and
maintenance of internal control relevant to the preparation and fair presentation of consolidated financial
statements that are free from material misstatement, whether due to fraud or error.
In preparing the consolidated financial statements, management is required to evaluate whether there are
conditions or events, considered in the aggregate, that raise substantial doubt about the System's ability to
continue as a going concern for one year after the date that the consolidated financial statements are issued.
Auditors' Responsibilities for the Audit of the Consolidated Financial Statements
Our objectives are to obtain reasonable assurance about whether the consolidated financial statements as a
whole are free from material misstatement, whether due to fraud or error, and to issue an auditors' report that
includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and
therefore is not a guarantee that an audit conducted in accordance with GAAS will always detect a material
misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher
than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions,
misrepresentations, or the override of internal control. Misstatements are considered material if there is a
substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a
reasonable user based on the consolidated financial statements.
KPMG LLP, a Delaware limited liability partnership and a member firm of
the KPMG global organiution of independent member firms aMlialed with
KPMG International Limited, a private English company limited by guarantee.
"61
In performing an audit in accordance with GARS, we:
• Exercise professional judgment and maintain professional skepticism throughout the audit.
• Identify and assess the risks of material misstatement of the consolidated financial statements, whether
due to fraud or error, and design and perform audit procedures responsive to those risks. Such
procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the
consolidated financial statements.
• Obtain an understanding of internal control relevant to the audit in order to design audit procedures that
are appropriate in the circumstances, but not for the purpose of expressing an opinion on the
effectiveness of the System's internal control. Accordingly, no such opinion is expressed.
• Evaluate the appropriateness of accounting policies used and the reasonableness of significant
accounting estimates made by management, as well as evaluate the overall presentation of the
consolidated financial statements.
• Conclude whether, in our judgment, there are conditions or events, considered in the aggregate, that
raise substantial doubt about the System's ability to continue as a going concern for a reasonable
period of time.
We are required to communicate with those charged with governance regarding, among other matters, the
planned scope and timing of the audit, significant audit findings, and certain internal control related matters that
we identified during the audit.
Supplementary Information
Our audit was conducted for the purpose of forming an opinion on the consolidated financial statements as a
whole. The 2023 accompanying supplementary information in schedules 1 through 12 is presented for
purposes of additional analysis and is not a required part of the consolidated financial statements. Such
information is the responsibility of management and was derived from and relates directly to the underlying
accounting and other records used to prepare the consolidated financial statements. The information has been
subjected to the auditing procedures applied in the audit of the consolidated financial statements and certain
additional procedures, including comparing and reconciling such information directly to the underlying
accounting and other records used to prepare the consolidated financial statements or to the consolidated
financial statements themselves, and other additional procedures in accordance with GAAS. In our opinion, the
information is fairly stated in all material respects in relation to the consolidated financial statements as a whole.
K-PMC-x LEP
Minneapolis, Minnesota
April 24, 2024
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/b/a UNITYPOINT HEALTH
Consolidated Balance Sheets
December 31, 2023 and 2022
(In thousands)
Assets
2023
2022
Current assets:
Cash and cash equivalents
$
305,971
294,746
Short-term investments
233,202
216,670
Assets limited as to use - required for current liabilities
28,233
24,004
Patient accounts receivable, net
542.115
498,694
Other receivables
271,541
162,319
Inventories
98,802
97,788
Prepaid expenses
58,704
58,189
Assets held for sale
-
412,230
Total current assets
1,538,568
1,764.640
Assets limited as to use, noncurrent:
Held by trustee under bond indenture agreements
-
221
Internally designated for capital improvements
1,467,108
1,425.801
Internally designated for insurance resene
1,454
2,980
Total assets limited as to use, noncurrent
1,468,562
1,429.002
Property, plant and equipment, net
1,548.598
1,543,084
Operating lease right of use assets
162,795
174,639
Other long-term investments
1,139,138
1,138,491
Investments in joint ventures and other investments
158,018
150,840
Contributions receivable and other assets held in trust
93,240
85,798
Other
103,091
91,886
Total assets
$
6,212,010
6.378.380
Liabilities and Net Assets
Current liabilities:
Current maturities of long-term debt
$
275,063
344,830
Current portion of operating lease liabilities
29,980
31,402
Accounts payable
242.840
249,677
Accrued payroll
256.913
243,507
Accrued interest
9,991
11,828
Estimated settlements due to third -party payors
64,641
125,209
Other current liabilities
96,365
106,704
Liabilities held for sale
-
186,437
Total current liabilities
975,793
1,299,594
Long-term debt, net
781,554
963,538
Long-term operating lease liabilities
138.468
149,241
Other long-term liabilities
283,139
263,539
Total liabilities
2,178.954
2,675,912
Net assets:
Without donor restrictions:
Attributable to UnityPoint Health
3,778,898
3.407,404
Attributable to noncontrolling interests
42,701
35,896
Total without donor restrictions
3,821,599
3.443,300
With donor restrictions:
Attributable to UnityPoint Health
210,902
258,555
Attributable to noncontrolling interests
555
613
Total with donor restrictions
211,457
259.168
Total net assets
4,033.056
3,702.468
Total liabilities and net assets
$
6.212,010
6,378.380
See accompanying notes to consolidated financial statements
3
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/b/a UNITYPOINT HEALTH
Consolidated Statements of Operations and Changes in Net Assets
Years ended December 31, 2023 and 2022
(In thousands)
2023
2022
Operating revenues:
Patient service revenue $
4,341,231
3,836,982
Other operating revenue
453,007
465,287
Net assets released from restrictions used for operations
13,523
15,172
Total operating revenues
4,807,761
4,317,441
Operating expenses:
Salaries and wages
1,773,686
1,798,747
Provider compensation and services
697,473
646,620
Employee benefits
441,504
411,645
Supplies
934,347
857,584
Other expenses
687,607
596,170
Depreciation and amortization
158,447
158,656
Interest
40,598
32,685
(Benefit) provision for uncollectible accounts
(117)
706
Total operating expenses
4,733,545
4,502,813
Operating income (loss)
74,216
(185,372)
Nonoperating gains (losses):
Investment income (losses)
232,722
(197,117)
Other, net
(6,791)
33,234
Total nonoperating gains (losses), net
225,931
(163,883)
Excess (deficiency) of revenues over expenses from continuing operations
300,147
(349,255)
Discontinued operations
9,625
(422,572)
Excess (deficiency) of revenues over expenses
309,772
(771,827)
Less noncontrolling interest
(9,230)
(5,888)
Excess (deficiency) of revenues over expenses
attributable to UnityPoint Health $
300,542
(777,715)
4 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/b/a UNITYPOINT HEALTH
Consolidated Statements of Operations and Changes in Net Assets
Years ended December 31, 2023 and 2022
(In thousands)
2023
2022
Net assets without donor restrictions:
Excess (deficiency) of revenues over expenses
$ 300,542
(777,715)
Amortization of previously hedged interest rate swaps fair value
1,330
1,360
Net assets released from restrictions used for capital expenditures
14,531
14,130
Change in defined benefit pension plan gains (losses) and prior
costs and credits
2,682
(17,814)
Other, net
(795)
(4,923)
Transfers between net assets classes due to disaffiliation
61,078
—
Change in defined benefit pension plan (losses) gains and prior
costs and credits used for discontinued operations
(7,874)
22,341
Increase (decrease) in net assets without donor
restrictions, UnityPoint Health
371,494
(762,621)
Net assets without donor restrictions, noncontrolling interest:
Excess of revenues over expenses
9,230
5,888
Distributions of capital
(4,815)
(3,998)
Contributions of capital
2,350
1,852
Net assets released from restrictions used for capital expenditures
58
58
Other, net
(18)
(673)
Increase in net assets without donor
restrictions, noncontrolling interests
6,805
3,127
Net assets with donor restrictions:
Contributions
27,370
33,960
Investment income
2,803
4,703
Net assets released from restrictions used for operations
(13,523)
(15,172)
Net assets released from restrictions used for capital expenditures
(14,531)
(14,130)
Change in net unrealized gains (losses) on investments
4,921
(10,622)
Change in beneficial interest in net assets of affiliates
7,968
(4,483)
Other, net
(1,583)
(6,956)
Transfers between net assets classes due to disaffiliation
(61,078)
—
Change in net unrealized losses on investments and net
assets released from restrictions used for discontinued operations
—
(5,472)
Decrease in net assets with donor
restrictions, UnityPoint Health
(47,653)
(18,172)
Net assets with donor restrictions, noncontrolling interest:
Net assets released from restrictions used for capital expenditures
(58)
(58)
Decrease in net assets with donor
restrictions, noncontrolling interests
(58)
(58)
Increase (decrease) in net assets
330,588
(777,724)
Net assets, beginning of year
3,702,468
4,480,192
Net assets, end of year
$ 4,033,056
3,702,468
See accompanying notes to consolidated financial statements
5
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/b/a UNITYPOINT HEALTH
Consolidated Statements of Cash Flows
Years ended December 31, 2023 and 2022
(In thousands)
Operating activities:
Increase (decrease) in net assets
Items not requiring (providing) operating cash:
Loss on assets held for sale
Net (gain) losses on investments
Net unrealized gain on swaps
Restricted contributions, investment income govemment
grants received, net assets released for operations
Depreciation and amortization
Change in defined pension plans' liability
Amortization of bond premium and debt issuance costs, net
Gain on disposition of assets
Equity in earnings of joint ventures
Change in beneficial interest in net assets of affiliates
Provision for uncollectible accounts
Changes in:
Receivables
Inventories, prepaid expenses and other assets
Accounts payable, accrued liabilities and other liabilities
Due to third -party payors
Net cash provided by (used in) operating activities
Investing activities:
Capital expenditures
Proceeds from sale of assets
Cash received during disaffiliation
Decrease in loans receivable
Purchases of other long-term investments and assets limited to use
Proceeds from sales of other long-term investments and assets limited to use
Investments in joint ventures
Distributions received from joint ventures
Net cash provided by investing activities
Financing activities:
Proceeds from line -of -credit
Payments to line -of credit
Proceeds from commercial paper
Payments on commercial paper
Proceeds from issuance of long -tern debt
Payments of debt
Proceeds from restricted contributions, investment income
grants received and net assets released for operations
Net cash (used in) provided by financing activities
Decrease in cash and cash equivalents
Cash and cash equivalents, beginning of year
Cash and cash equivalents, end of year
Less cash and cash equivalents of discontinued operations, end of year
Cash and cash equivalents of continuing operations, end of year
1J
2023
2022
$ 330,588 (777,724)
- 382,609
(151,033) 321,001
(2,619) (40,755)
(16,650)
(23,491)
165,188
184,100
(2,682)
17,814
(6,253)
(2,391)
(910)
(9,033)
(25,225)
(30,883)
(7,968)
4,483
(117)
706
(145,637)
(18,460)
(2,161)
8,690
(53,830)
(253,210)
(67,055)
13,048
13,636
(223,496)
(144,263)
(209,875)
2,618
5,862
242,729
-
-
53
(1,451,061)
(2,928,741)
1,544,387
3,109,814
(9,512)
(16,395)
32,593
39,892
217,491 610
325,000
175,000
(350,000)
(75,000)
85,000
-
(85,000)
-
69,219
-
(298,855)
(38,659)
16,650
23,491
(237,986)
84,832
(6,859)
(138,054)
312,830
450,884
305,971
312,830
-
18,084
$ 305,971
/
294,746
(Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/b/a UNITYPOINT HEALTH
Consolidated Statements of Cash Flows
Years ended December 31, 2023 and 2022
(In thousands)
2023 2022
Supplemental cash flows information:
Interest paid (net of amount capitalized) $ 42,416 38,964
Property and equipment purchases in accounts payable 6,671 17,836
Disaffiliations:
Assets removed, less cash (754,167) —
Liabilities released (145,791) —
See accompanying notes to consolidated financial statements
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(1) Nature of Operations and Summary of Significant Accounting Policies
(a) Organization
Iowa Health System is an Iowa nonprofit corporation formed in December 1994. Iowa Health System
and its subsidiaries provide inpatient and outpatient care and physician services from seventeen
hospital facilities and various ambulatory service and clinic locations in Iowa, Illinois, and Wisconsin.
Primary, secondary, and tertiary care services are provided to residents of Iowa, Illinois, Wisconsin,
and adjacent states.
Iowa Health System publicly operates as UnityPoint Health (the System). The legal name of the parent
remains Iowa Health System, with the UnityPoint Health name reflecting a doing business as (d/b/a).
This "d/b/a" name reflects the transformation of clinical processes underway within the System and the
adaptation to better address the healthcare needs of communities, including building a model of
delivering healthcare that coordinates care around the patient while focusing on improving the quality of
care and reducing costs.
(b) Basis of Presentation
The consolidated financial statements include the accounts of UnityPoint Health and its subsidiaries
listed below:
• Central Iowa Health System and Subsidiaries (d/b/a UnityPoint Health — Des Moines) (Des Moines)
• Methodist Health Services Corporation and Subsidiaries (Peoria; Unaffiliated as of April 1, 2023)
• Trinity Regional Health System and Subsidiaries (Rock Island)
• Meriter Health Services, Inc. and Subsidiaries (Madison)
• St. Luke's Healthcare and Subsidiaries (Cedar Rapids)
• Allen Health Systems, Inc. and Subsidiaries (Waterloo)
• St. Luke's Health System, Inc. and Subsidiaries (Sioux City)
• Trinity Health Systems, Inc. and Subsidiaries (Fort Dodge)
• Finley Tri-States Health Group, Inc. and Subsidiaries (Dubuque)
• Iowa Physicians Clinic Medical Foundation (d/b/a UnityPoint Clinic)
• UnityPoint at Home
All significant intercompany balances and transactions have been eliminated in consolidation.
(c) Noncontrolling Interests
The consolidated financial statements include all assets, liabilities, revenue, and expenses of entities
that are controlled by the System and, therefore, consolidated. Noncontrolling interests in the
consolidated balance sheets and statements of operations and changes in net assets represent the
8 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
portion of net assets owned by entities outside the System and the portion of operating results
attributed to the noncontrolling ownership interests.
(d) Use of Estimates
The preparation of financial statements in conformity with accounting principles generally accepted in
the United States of America (U.S. GAAP) requires management to make estimates and assumptions
that affect the reported amounts of assets and liabilities and disclosure of contingent assets and
liabilities at the date of the financial statements and the reported amounts of revenue and expenses
during the reporting period. Actual results could differ from those estimates.
(e) Cash, Cash Equivalents, and Short -Term Investments
Cash equivalents consist of demand deposits, money market funds, and other debt securities with
original maturities of three months or less at the date of purchase, other than those included in assets
limited as to use or held in brokerage accounts. A portion of these balances are held in a pooled cash
management account, with the balances and activity remaining within the respective subsidiaries.
Short-term investments consist of debt securities with weighted average maturities between 91 and
365 days of the consolidated balance sheet date, and debt securitized products, other investments held
as part of deferred compensation arrangements whose distributions will occur within one year.
At times, the System's cash accounts exceeded federally insured limits. Management believes that the
institutions where cash accounts are maintained are financially stable and that the credit risk related to
deposits is minimal.
(t) Assets Limited as to Use
Assets limited as to use include amounts held by trustees under bond indenture agreements and
related documents, in addition to assets internally designated by the Board of Directors for identified
purposes and over which the Board of Directors retains control and may, at its discretion, subsequently
use for other purposes. Amounts required to meet current liabilities are classified as current assets.
(g) Inventories
Inventories consist of supplies and are stated at the lower of cost or market.
(h) Short -Term Investments, Other Long -Term Investments, Investments in Joint Ventures, and
Investment Income
Investments in equity securities with readily determinable fair values and all investments in
fixed -income securities are measured at fair value in the consolidated balance sheets. The fair values
are based on quoted market prices or dealer quotes.
Investments in joint ventures and other affiliates, which are more than 20% and not more than 50%
owned, are recorded using the equity method. Other investments are reported at cost, as adjusted for
permanent impairment in value, if any.
9 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The System classifies its investments as trading securities. Realized gains and losses from the sale of
investments, interest and dividends (except those earned as a function of operations), and investments
carried at fair value pursuant to Accounting Standards Codification (ASC) Topic 825, Financial
Instruments, are reported as nonoperating investment income (losses) unless restricted by a donor.
Income from investments restricted by donors is included as a component of the change in net assets
based upon the nature of the restriction.
The System elected the net asset value (NAV) as practical expedient option for its alternative
investments (including hedge funds and private equity funds) that are primarily limited liability
corporations and partnerships. Management has elected this option for the alternative investments
because it more accurately reflects the portfolio returns and consolidated financial position of the
System. Gains and losses on investments subject to the NAV option are reported in investment income
in nonoperating (losses) gains in the accompanying consolidated statements of operations and
changes in net assets.
Transfers in and out of Level 1 (quoted market prices), Level 2 (other significant observable inputs),
and Level 3 (significant unobservable inputs) are recognized on the actual transfer date.
(il Property, Plant and Equipment
Property, plant and equipment acquisitions are recorded at cost, less accumulated depreciation.
Depreciation is provided primarily using the straight-line method over the estimated useful lives of the
assets, including componentized building costs. Depreciation of assets under capital leases is provided
using the straight-line method over the shorter of the lease term or the estimated useful life of the
assets. Donated property, plant and equipment are recorded at fair value at the date of donation.
Property, plant, and equipment assets are depreciated on the straight-line method over the following
usual estimated useful lives:
Buildings
10-45 years
Fixed equipment
5-30 years
Moveable equipment
2-30 years
Computer software
3 years
10 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Property, plant, and equipment is stated at cost and is summarized at December 31 as follows:
Land
Land improvements
Buildings, improvements and fixed equipment
Moveable equipment
Less accumulated depreciation and amortization
Construction/information systems installation in progress
Net property, plant and equipment
2023
2022
$ 140,262
140,916
61,626
60,914
2,480,837
2,431,945
1,790,929
1,732,488
4,473,654
4,366,263
3,011,491
2,893,859
1,462,163
1,472,404
86,435
70,680
$ 1,548,598
1,543,064
Interest costs incurred on borrowed funds during the period of construction of capital assets are
capitalized as a component of construction in progress, net of interest earned on investments acquired
with the proceeds of the borrowing. During 2023 and 2022, the System capitalized $437 and $528 of
interest expense, respectively.
As of December 31, 2023 and 2022, the System has committed $157,933 and $131,427, respectively,
for costs related to various construction projects. The System plans to fund the majority of these
projects through internal funds, with supplemental debt financing for certain projects.
(j) Long -Lived Asset Impairment
The System evaluates the recoverability of the carrying value of long-lived assets whenever events or
circumstances indicate the carrying amount may not be recoverable. If a long-lived asset is tested for
recoverability and the undiscounted estimated future cash flows expected to result from the use and
eventual disposition of the asset is less than the carrying amount of the asset, the asset cost is
adjusted to fair value and an impairment loss is recognized as the amount by which the carrying
amount of a long-lived asset exceeds its fair value.
No asset impairment was recognized during the year ended December 31, 2023 or 2022.
(k) Other Assets
Other assets include certain intangible assets that are stated at cost less accumulated amortization. In
addition, other assets include goodwill. The System follows Accounting Standards Update
(ASU) 2017-04, Intangibles — Goodwill and Other (Topic 350): Simplifying the Test for Goodwill
Impairment, which simplifies the goodwill impairment test. Goodwill is an asset representing the future
economic benefits arising from other assets acquired as part of business combinations that are not
individually identified and separately recognized. The System has $38,590 of goodwill at December 31,
11 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
2023 and 2022. Annually, or when there is a triggering event, the System first performs a qualitative
assessment by evaluating all relevant events and circumstances to determine if it is more likely than
not that impairment exists. If necessary, based on qualitative factors, the System will perform an
impairment test of its goodwill and intangible assets using a discounted cash flow method, and any
identified impairment loss is recognized as expense. The impairment analysis performed during 2023
did not show the carrying amount exceeded fair value; therefore, no impairment was recognized during
2023. The impairment analysis performed during 2022 showed the carrying amount exceeded fair
value for one of the System's subsidiaries, and $1,000 of impairment was recognized in depreciation
and amortization expense in the accompanying consolidated statements of operations and changes in
net assets in 2022.
Other intangible assets at December 31, 2023 and 2022 were $3,580 and $4,187, respectively, which
are subject to amortization.
(/) NetAssets
Net assets are classified into two mutually exclusive classes: without donor restrictions and with donor
r
restrictions. The two classes are based on the presence or absence of donor -imposed restrictions. The
release of net assets from donor restrictions is recorded in the period in which the restrictions are met.
Contributions with donor -imposed restrictions that are met in the same reporting period are reported as
without donor restriction.
Donor -imposed restrictions are generally restricted for capital expenditures, passage of time, or other
donor -specified restrictions.
For entities in which the System has less than full ownership but has a controlling interest, a
noncontrolling interest is recorded for the portion of net assets controlled by unrelated parties.
(m) Excess (Deficiency) of Revenues over Expenses from Continuing Operations
Excess (deficiency) of revenues over expenses from continuing operations transactions affecting net
assets without donor restrictions are reflected in the consolidated statements of operations and
changes in net assets. Consistent with industry practice, changes in defined -benefit plans and
contributions of long-lived assets (including assets acquired with donor -restricted cash contributions)
are excluded from determination of the excess (deficiency) of revenues over expenses from continuing
operations. Transactions with donor restrictions are recorded as additions or deductions to net assets
with donor restrictions and are reflected in the consolidated statements of operations and changes in
net assets.
(n) Patient Service Revenue and Accounts Receivable
Patient service revenue is reported at the amount that reflects the consideration to which the System
expects to be entitled in exchange for providing patient care. These amounts, representing transaction
price, are due from patients, third -party payors (including health insurers and government programs),
and others and includes variable consideration for retroactive revenue adjustments due to settlement of
audits, reviews, and investigations. Generally, the System bills the patients and third -party payors
12 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
several days after the services are performed and/or the patient is discharged from the facility.
Revenue is recognized as performance obligations are satisfied.
Performance obligations are determined based on the nature of the services provided by the System.
Revenue for performance obligations satisfied over time is recognized based on actual charges
incurred in relation to total expected (or actual) charges. The System believes that this method
provides a reasonable depiction of the transfer of services over the term of the performance obligation
based on the inputs needed to satisfy the obligation. Generally, performance obligations satisfied over
time relate to patients in the System's hospitals receiving inpatient acute care and outpatient services.
The System measures the performance obligation from admission into the hospital to the point when it
is no longer required to provide services to that patient, which is generally at the time of discharge.
Revenue for performance obligations satisfied at a point in time is recognized when goods or services
are provided and the System does not believe it is required to provide additional goods or services.
Because all of its performance obligations relate to contracts with a duration of less than one year, the
System has elected to apply the optional exemption provided in ASC 606-10-50-14(a) and, therefore, is
not required to disclose the aggregate amount of the transaction price allocated to performance
obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied
or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute
care services at the end of the reporting period. The performance obligations for these contracts are
generally completed when the patients are discharged, which generally occurs within days or weeks of
the end of the reporting period.
The System determines the transaction price, which involves significant estimates and judgment,
based on standard charges for goods and services provided, reduced by explicit and implicit price
concessions, including contractual adjustments provided to third -party payors, discounts provided to
uninsured and underinsured patients in accordance with policy, and/or implicit price concessions based
on the historical collection experience of patient accounts. The System determines the transaction price
associated with services provided to patients who have third -party payor coverage based on
reimbursement terms per contractual agreements, discount policies, and historical experience. For
uninsured patients who do not qualify for charity care, the System determines the transaction price
associated with services on the basis of charges reduced by implicit price concessions. Implicit price
concessions included in the estimate of the transaction price are based on historical collection
experience for applicable patient portfolios. Patients who meet the System's criteria for free care
"charity" are provided care without charge and related amounts are not reported as revenue.
Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to
patient service revenue in the period of the change. Settlements with third -party payors for retroactive
adjustments due to audits, reviews, or investigations are considered variable consideration and are
included in the determination of the estimated transaction price for providing patient care using the
most -likely outcome method. These settlements are estimated based on the terms of the payment
agreements with the payor, correspondence from the payor, and historical settlement activity, including
an assessment to ensure that it is probable that a significant reversal in the amount of cumulative
revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is
subsequently resolved. Estimated settlements are adjusted in future periods as new information
13 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
becomes available or as years are settled or are no longer subject to such audits, reviews, and
investigations.
The System uses a portfolio approach to account for categories of patient contracts as a collective
group rather than recognizing revenue on an individual contract basis. The portfolios consist of major
payor classes for inpatient revenue and major payor classes and types of services provided for
outpatient revenue. Based on the historical collection trends and other analyses, the System believes
that revenue recognized by utilizing the portfolio approach approximates the revenue that would have
been recognized if an individual contract approach were used.
The percentage of patient service revenue by payor recognized in the years ended December 31 was
as follows:
2023 2022
Medicare 35 % 35 %
Medicaid 19 16
Wellmark/Blue Cross 22 23
Commercial and other 23 25
Self -pay 1 1
100 % 100 %
The percentage of patient accounts receivable by payor at December 31 was as follows:
2023
2022
Medicare
32 %
32 %
Medicaid
10
14
Wellmark/Blue Cross
22
21
Commercial and other
28
29
Self -pay
8
4
100 %
100 %
14 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The sources of patient service revenue, disaggregated by lines of service, for the years ended
December 31 were as follows:
2023 2022
Service lines:
Hospital $ 2,881,999 2,494,341
Physician services 669,597 651,181
Home health and hospice 264,857 241,284
Other 524,778 450,176
$ 4,341,231 3,836,982
Other operating revenue primarily includes income from joint ventures, reference lab, retail pharmacy,
grant revenue, college revenue, and shared savings revenue from value -based contracts with third
party payors. Revenue from services recorded as other operating revenue is primarily recognized at
t\ the time service is rendered. Other operating revenue for the years ended December 31, 2023 and
2022 was $453,007 and $465,287, respectively.
(o) Charity Care
The System provides care to patients who meet certain criteria under its charity care policy without
charge or at amounts less than established rates. Amounts determined to be charity care are not
reported as revenue.
(p) Contributions and Beneficial Interest in Net Assets
Unconditional promises to give cash and other assets are reported at fair value at the date the promise
is received. All contributions are considered to be available for unrestricted use unless specifically
restricted by the donor. Donor -imposed restrictions are considered fulfilled as soon as the stipulated
time has expired or the qualifying expenditure has been made. Donor -restricted contributions whose
restrictions are met within the same year as received are reported as unrestricted contributions.
Contributions not expected to be collected within a year are recorded at the present value of expected
future cash flows using a risk -free interest rate over the term of the contribution. Contributions of
property are recorded at fair value when received.
Interests in charitable trusts and perpetual trusts are carried at the present value of expected future
cash flows, which approximates fair value. The System's interest in the net assets (the Interest) of
certain foundations that raise and hold assets on behalf of the System is accounted for in a manner
similar to the equity method. The Interest is recorded at its beneficial interest in the underlying assets,
and changes in the Interest are included in the change in net assets. Transfers of assets between
these foundations and the System are recognized as increases or decreases in the Interest.
15 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(q) Estimated Malpractice Costs, Health Insurance, and Workers' Compensation
An annual estimated provision is accrued for the self -insured portion of medical malpractice, health
insurance, and workers' compensation claims and includes an estimate of the ultimate costs for both
reported claims and claims incurred but not reported.
Claims liabilities are recorded at the gross amount without consideration of insurance recoveries.
Expected recoveries are presented separately as receivables in the consolidated balance sheets.
(r) Interest Rate Swap Agreements
The System has entered into various interest rate swap agreements (the Swaps) to reduce the effect of
changes in cash flows primarily related to interest rate fluctuations on the System's various variable
rate debt.
As described in note 7, the changes in fair value for all swap agreements are recorded as a component
of nonoperating gains (losses) in excess (deficiency) of revenues over expenses as they do not qualify
for hedge accounting.
The Swaps are recognized in the consolidated balance sheets at fair value. The net cash payments or
receipts under the Swaps are recorded as an increase or decrease to other nonoperating income
(loss).
(s) Income Taxes
UnityPoint Health and most of its subsidiaries are classified as tax-exempt organizations as described
in Sections 501(c)(3) and 501(c)(2) of the Internal Revenue Code (the Code). Tax-exempt
organizations are not subject to federal and state income taxes on related income, pursuant to
Section 501(a) of the Code. These organizations are subject to federal and state income taxes to the
extent they have unrelated business income as described under provisions of Section 511 of the Code.
The System files Form 990 for substantially all of.its operating entities in the U.S. federal jurisdiction
and is no longer subject to examination by tax authorities for the years before 2020. The System has
no material uncertain tax positions.
Certain subsidiaries are subject to federal and state income taxes. Some of these corporations have
accumulated net operating loss carryforwards that are available to offset future taxable income, if any,
during the carryforward period. Deferred tax assets and liabilities related to these subsidiaries were not
material.
(t) Retirement Plans
Substantially all employees meeting age and length of service requirements participate in
defined -contribution plans. Certain subsidiaries also have defined -benefit plans, most of which have
been substantially frozen. Pension costs for the defined -benefit plans, which are composed of normal
costs and amortization of prior service costs related to defined -benefit plans, are funded currently.
16 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(in thousands)
(u) Lease Commitments
The System regularly enters into agreements with third parties to lease real estate and equipment over
various lengths of time. The System follows ASU 2016-02, Leases (Topic 842), which requires the
lessee to recognize right -of -use assets and liabilities for leases with lease terms of more than twelve
months. All leases greater than twelve months are evaluated for classification as either operating or
finance leases. For finance leases, the System recognizes both interest expense and depreciation
expense. For operating leases, the System recognizes rent expense, generally on a straight-line basis,
as part of other expenses.
Certain of the System's arrangements provide for maintenance costs to be the responsibility of the
System as incurred or charged by the lessor. The maintenance cost is a non -lease component that the
System elected to combine with the total monthly rental payment and account for the total cost as
operating lease expense.
Leases less than twelve months, or those that operate on month -to -month agreements, are deemed
short-term leases and are expensed as incurred.
(2) Charity Care
The System provides charity care and financial assistance discounts for medically necessary healthcare
services provided to persons who meet the System's policy. The policy provides a percentage discount to
the patient that decreases at gradually higher income levels or higher levels of household net assets. The
benchmark, which the income level is compared to, is the Federal Poverty Income Guideline and is
updated annually. Patients who are already receiving benefits from certain identified government programs
qualify for presumptive eligibility.
The availability of charity care is widely communicated to all patients, and patients are notified prior to
receiving services if their treatment does not fall within the guidelines of the policy. Amounts charged for
care that is provided to individuals eligible for charity may not be more than the amounts generally billed to
individuals who have insurance covering such care. Amounts billed are based on either the best, or an
average of the three best, negotiated commercial rates or Medicare rates.
Accounts that are classified by the System as charity care are not reported as patient service revenue. In
some cases, the charity care is subsidized by contributions from volunteer organizations or other donors.
Charity care subsidies are not material to the consolidated financial statements.
Cost of charity care is calculated by applying hospital specific cost -to -charge ratios to the total amount of
charity care deductions from gross revenue. The cost -to -charge ratio is calculated by taking the hospital
total expenses and gross charges and applying adjustments to remove the cost of nonpatient care activity,
Medicaid provider taxes paid, identifiable community benefit expenses, as well as gross patient charges
that are generated for identifiable community benefit services. The amount of charity care provided at cost
was $22,986 and $18,270 for the years ended December 31, 2023 and 2022, respectively.
Community benefit is also provided through reduced price services and free programs offered throughout
the year. The System provides an array of uncompensated activities and services intended to meet the
17 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
community health needs. These activities include wellness programs, community education programs, and
various health screening programs.
(3) Third -Party Reimbursement
As a provider of healthcare services, the System generally grants credit to patients without requiring
collateral or other security. The System routinely obtains assignments of (or is otherwise entitled to receive)
patients' benefits payable under their health insurance programs, plans, or policies. These health insurance
programs or providers are commonly referred to as third -party payors and include the Medicare and
Medicaid programs, Wellmark/Blue Cross, and various health maintenance and preferred provider
organizations.
A major portion of the System's revenue is derived from these third -party payors. Significant changes have
been made, and may be made, in certain of these programs, which could have a material, adverse impact
on the financial condition of the System. These changes include federal and state laws and regulations,
particularly those pertaining to Medicare and Medicaid.
The System has agreements with certain third -party payors that provide for payment of services at
amounts that differ from established rates. Third -party payor payment rates vary by payor and include
established charges; contracted rates less than established charges; prospectively determined rates per
discharge, bundled payment per episode of care, per procedure, or per diem; and retroactively determined
cost -based rates.
(a) Medicaid State Plans
The System has operations within states that have enacted a Medicaid State Plan. Under each of
these plans, a tax assessment is levied on certain hospital providers in order to provide funding for
Medicaid to obtain federal matching funds. A portion of these additional federal funds are then
redistributed to participating hospitals through increased Medicaid payments in order to help bring
Medicaid reimbursement closer to the cost of providing care. The allocation of these funds to specific
healthcare providers is based primarily on the amount of care provided to Medicaid recipients.
The System's aggregate tax assessment during 2023 and 2022 was $39,216 and $35,599,
respectively, and is included in operating expenses in the consolidated statements of operations and
changes in net assets. Additional Medicaid reimbursement in the same periods was $82,691 and
$80,299, respectively, and is included in patient service revenue in the consolidated statements of
operations and changes in net assets, resulting in a net increase in operating income of $43,475 and
$44,700 for 2023 and 2022, respectively.
As part of a partnership with the State of Iowa beginning July 1, 2023, the System participates in a
federal directed payment program. The primary use of the supplemental funding will be to expand
access and increase capacity for Iowa Medicaid beneficiaries through modernization and expansion of
healthcare facilities. In 2023, the System recognized $162,537 patient service revenue and $46,933 of
assessment fees in other expense from the program. As of December 31, 2023, the System included
$115,604 due from government agency in other receivables, reflected in current assets on the
consolidated balance sheets, related to the federal directed payment program.
18 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(4) Functional Expenses
The System provides general healthcare services, including hospital, physician, and home health and
hospice, and incurs related general and administrative expenses. Expenses related to providing these
services for the years ended December 31 were as follows:
2023
Hospital
Physician
Home health
services
services
and Hospice
Other
G&A
Total
Salaries and wages
$ 884,785
170,880
45,480
88,319
584,222
1,773,686
Physician compensation
and services
67,826
595,295
1,168
12,174
21,010
697,473
Employee benefits
184,854
57,734
11,450
23,176
164,290
441,504
Supplies
628,099
65,301
16,384
180,432
42,131
934,347
Other expenses
201,100
78,308
1,810
51,989
354.400
687,607
Depreciation and
amortization
48,776
7,767
140
4,278
97,486
158,447
Interest
120
175
-
22
40,281
40,598
(Benefit) provision for
uncollectible accounts
-
(31)
-
(12)
(74)
(117)
$ 2,015,560
975,429
78,432
360,378
1,303,746
4,733,545
2022
Hospital
Physician
Home health
services
services
and Hospice
Other
G&A
Total
Salaries and wages
$ 893,733
180.626
47,538
94,435
582,415
1,798,747
Physician compensation
and services
63,394
565,438
939
12,403
4,446
646,620
Employee benefits
172,634
53,661
11,094
25,145
149,111
411,645
Supplies
586,136
62,568
14,296
153,277
41,307
857,584
Other expenses
148,275
60,162
3,716
63,006
321,011
596,170
Depreciation and
amortization
46,229
7,776
153
5,444
99,054
158,656
Interest
66
243
-
22
32,354
32,685
(Benefit) provision for
uncollectible accounts
-
-
-
25
681
706
$ 1,910,467
930,474
77,736
353,757
1,230,379
4,502,813
The consolidated financial statements report certain expense categories that are attributable to more than
one healthcare service or support function. Therefore, these expenses require an allocation on a
reasonable basis that is consistently applied. Costs not directly attributable to a function are allocated
based on revenue.
19 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityFoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(5) Investments
(a) Investment Summary
A summary of short-term investments at December 31 is as follows:
2023
2022
U.S. Treasury obligations
$ 36,754
83,203
U.S. Government agency obligations
18,102
1,393
Asset -backed securities:
Other
77,102
24,695
Mortgage -backed securities:
Government
8,486
776
Non -government
6,070
8,405
Certificates of deposit
1,119
1,129
Corporate bonds
83,033
77,811
Municipal bonds
1,221
17,499
Mutual funds:
International
14
25
Index
255
317
Equity
215
247
Fixed income
58
75
Other
773
1,095
Total short-term investments
$ 233,202
216,670
A summary of investments reported as assets limited as to use at December 31 is as follows:
2023 2022
Held by trustees under bond indenture agreements:
Cash equivalents
Internally designated:
Cash equivalents
U.S. Treasury obligations
Asset -backed securities:
Other
Corporate bonds
Equity securities:
Domestic
International
$ — 221
14,881
701
2,721
2,619
1,675
1,020
1,368
1,477
6,658
7,480
1,991
1,800
20 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
2023
2022
Mutual funds:
Domestic $
—
3,271
International
247,249
240,694
Equity
242,734
217,318
Fixed income
538,308
526,081
Other
27
583
Alternative funds
119,022
124,069
Hedge funds
131,247
123,084
Private equity funds
94,567
96,032
Fund of funds
94,347
106,556
Total assets limited as to use
1,496,795
1,453,006
Less amount required to meet current obligations
28,233
24,004
Noncurrent portion of assets limited as to use $
1,468,562
1,429,002
Assets held by trustee under bond indenture agreements are required to be held in separate trust
accounts. A summary of these trust accounts aggregated by their required use at December 31 is as
follows:
2023 2022
Debt service accounts
221
Internally designated current and non -current assets are summarized below based on the designation
at December 31:
2023 2022
Capital improvements $ 1,467,108 1,425,801
Self -insured reserves 29,687 26,984
$ 1,496,795 1,452,785
21 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Investments presented as other long-term investments at December 31 are summarized as follows:
2023
2022
Cash equivalents
$ 9,197
566
U.S. Treasury obligations
5,792
26,492
U.S. Government agency obligations
25,893
25,746
Asset -backed securities:
Other
32,961
28,932
Mortgage -backed securities:
Government
9,272
5,641
Non -government
27,839
28,770
Corporate bonds
23,886
31,957
Municipal bonds
2,591
-
Equity securities:
Domestic
1,054
1,105
Mutual funds:
International
147,750
140,160
Index
18,086
15,212
Equity
153,097
134,182
Fixed income
321,717
351,815
Other
55,704
52,679
Alternative funds
77,956
77,070
Hedge funds
85,961
76,458
Private equity funds
61,938
59,654
Fund of funds
61,794
66,191
Insurance policies
16,650
14,760
Stock in transit
-
1,101
Total other long-term investments
$ 1,139,138
1,138, 491
22 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The following schedule summarizes the investment (loss) return and its classification in the
consolidated statements of operations and changes in net assets for the years ended December 31:
2023
2022
Investment return (loss):
Interest and dividends
$
92,591
85,337
Realized gains on sales of investments
1,777
114,243
Unrealized gains (losses) on trading investments
146,239
(402,544)
Equity in earnings of joint ventures
23,757
26,581
$
264,364
(176, 383)
Investment return (loss) calculation:
Net assets without donor restrictions
Other Operating Revenue
$
23,918
26,653
Nonoperating (losses) gains — investment (losses) income
232,722
(197,117)
Net assets with donor restrictions
7,724
(5,919)
$
264,364
(176,383)
(b) Alternative Investments
At December 31, 2023 and 2022, 25% and 26%, respectively, of the System's investments were
invested in alternative investment vehicles. These investments are included in either internally
designated or other long-term investments in the investment summary tables (previously presented)
based on the underlying investments. Due to the nature of the alternative investments and the need for
the fund managers to execute on long-term strategies, many of the vehicles contain specific lock -up
periods, restricted redemption timing, as well as advanced notice of redemption requests.
23 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Alternative investments that have been estimated using the NAV per share as a practical expedient
consist of the following at December 31:
December 31, 2023
Unfunded
Redemption
Redemption
Fair value
commitments frequency
notice period
Diversified property
alltematiw fund $
156,141
—
Quarterly
95 days
Structured credit
altemative fund
128,995
—
Quarterly
65 days
Vista Fund
57,269
—
Quarterly
95 days
Diversified private equity
alternative fund 111
31,971
15,164
No specific lock -up provision****
NIA
Diversified private equity
altemathe fund IV
66,161
22,436
No specific lock -up provision****
N/A
Diversified private equity
altemative fund V
20,890
20,293
No specific lock -up provision****
NIA
Hedge fund segregated
portfolio
217,207
—
Based on holdings***
NIA
Energy debt alternative
fund
10,714
—
Semi-annual, 3 year lock -up*
95 days
Healthcare private equity
fund 1
1,726
168
No specific lock -up provision****
NIA
Healthcare private equity
fund 11
12,496
330
10 year lock -up**
NIA
Healthcare private equity
fund 111
9,475
2,814
10 year lock -up**
N/A
Health Velocity
13,787
1,590
No specific lock -up provision****
N/A
$
726,832
62,795
24 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a tlnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
December 31, 2022
Unfunded
Redemption
Redemption
Fair value
commitments
frequency
notice period
Diversified property
altematiw fund $
172,746
—
Quarterly
95 days
Structured credit
alternative fund
122,302
—
Quarterly
65 days
Vista Fund
56,495
—
Quarterly
95 days
Diversified private equity
altemathe fund III
39,490
13,504
No specific lock -up provision****
NIA
Diversified private equity
alternative fund IV
68,986
21,973
No specific lock -up provision****
NIA
Diversified private equity
alternative fund V
15,566
22,411
No specific lock -up provision****
NIA
Hedge fund segregated
portfolio
199,541
—
Based on holdings***
NIA
Energy debt altemathe
fund
22,342
—
Semi-annual, 3 year lock -up*
95 days
Healthcare private equity
fund 1
2,459
168
No specific lock -up provision****
N/A
Healthcare private equity
fund II
9,790
476
10 year lock -up**
N/A
Healthcare private equity
fund III
6,152
4,257
10 year lock -up**
NIA
Health Velocity
13,245
1,801
No specific lock -up provision***
NIA
$
729,114
64,590
* The remainder will be available pending wind -down.
** Subject to 10-year lockup based on initial subscriptions in the investment, which will expire in 2025
and 2030 for Fund 11 and III, respectively.
*** The liquidity of the segregated portfolio and the availability for redemptions will be determined
based on the liquidity and redemption terms set forth in the underlying funds. As a result, the
System's ability to obtain liquidity or redeem participating shares will be limited.
***` Private equity funds are nonredeemable so there is no tender or withdrawal process. The limited
partners agree to stay in the investment until the fund closes, at which time all remaining assets are
distributed back to the limited partners.
25 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
As of December 31, 2023, the alternative investment vehicles consist of three alternative funds, one
fund of funds, one hedge fund, and seven private equity funds. The investment strategy of the
diversified property fund of funds is to invest in income producing real estate properties utilizing a low
level of leverage. The structured credit alternative fund is a fixed -income fund with an objective of
generating high total returns using a strategy of investing in domestic credit markets, primarily through
collateralized debt obligations and other structured credit instruments, such as loan participations and
derivative instruments. The investment strategy of the energy debt alternative fund is to generate high
absolute returns by taking advantage of the energy and related industries, market dislocation, and
commodity price volatility, primarily by investing in debt securities, which are purchased or acquired at
a significant discount to fair value and/or offer higher coupon rates. The Vista Fund is an alternative
vehicle with an objective of capitalizing on dislocations in the market, specifically in interest rates,
foreign currency, and the shape of the yield curve. The hedge fund segregated portfolio has an
investment object to produce returns comparable to those of the equity markets over a full market cycle
while targeting substantially less volatility than equities by investing in a diversified portfolio of hedge
funds. The three diversified private equity alternative funds have an objective of investing in a
diversified set of private equity funds. The healthcare private equity funds have a strategy of investing
in early stage companies and entrepreneurs within the healthcare industry. There is no public market
for shares in these alternative investment vehicles. Health Velocity invests in private healthcare
industry companies, similar to the healthcare private equity funds. The value of the investments in the
funds is determined based on the fair values of the underlying investments, as determined by the NAV
per share.
In situations when investments do not have readily determinable fair values, the fund managers provide
the NAV per share, or its equivalent, to the System. The NAV provided by the fund managers is
supported by quoted market prices, operating results, balance sheet stability, growth, and other
business and market sector fundamentals of the private investment funds. The System follows
ASU 2009-12, Fair Value Measurements and Disclosures (Topic 820): Investments in Certain Entities
That Calculate Net Asset Value per Share (or Its Equivalent), which provided a practical expedient for
certain investments to use the NAV per share to measure fair value. Accordingly, the System uses the
NAV as a practical expedient for fair value for each of its alternative investments.
(c) Investments in Joint Ventures
At December 31, 2023 and 2022, investments in joint ventures amounted to $91,374 and $90,697,
respectively. Other investments also included in this line in the consolidated balance sheets consist
primarily of investments reported at cost and real estate held for investment.
26 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The joint ventures consist of 40 privately held healthcare organizations in which the System's
ownership interest ranges from 20% to 50%. The collective financial position of the joint ventures as of
and for the years ended December 31 were as follows:
2023
2022
(unaudited)
Total assets
$ 377,896
354,142
Total equity
190,886
182,111
Net revenues
563,671
502,129
Net income
64,347
70,056
The System's share of earnings on the investments in joint ventures is included in other operating
revenue in the consolidated statements of operations and changes in net assets. The System recorded
activity related to joint ventures for the years ended December 31 as follows:
Earnings on investments in joint ventures
New investments in joint ventures
Distributions received from joint ventures
2023 2022
$ 23,757 26,580
9,512 16,395
32,593 35,096
The System both purchases services and sells services and supplies to several joint ventures. In 2023
and 2022, services purchased from joint ventures totaled $7,662 and $10,751, respectively. Services
and supplies sold to joint ventures in 2023 and 2022 were $1,063 and $1,278, respectively.
(d) Investments at Cost
Investments reported at cost include direct equity and convertible -debt investments in early stage
companies within the healthcare industry. These investments are directed to generate financial and
strategic returns in companies with high -growth potential that are addressing areas of targeted
innovation within the System. The funds are drawn from the balance sheet, and the System has
governance approval to deploy a total of $100,000. The expectation is to invest the majority of the
allocated capital aggressively over the next three to four years. Financial returns on these investments
are anticipated throughout the next 10 to 12 years. These investments are reported based on the initial
cost of each investment. As of December 31, 2023 and 2022, the System has contributed $61,396 and
$52,054 to these investments, respectively.
27 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(6) Long -Term Debt
Long-term debt at December 31, 2023 and 2022 is summarized as follows:
Hospital Facility Revenue Bonds:
Series 2023A
Series 2020
Series 2018A
Series 2018B
Series 2018C
Series 2018D
Series 2018E
Series 2018F
Series 2017A
Series 2016D
Series 2016E
Series 2014A
Series 2014C
Series 2013E
Series 2012A
Series 2012C
Series 2005
Total hospital facility
revenue bonds
Finance lease obligations, net book
value: 2023 - $14,061; 2022 - $11,887
Line -of -credit
Other notes and mortgages
Current maturities
Unamortized bond issuance costs
Unamortized bond premium
Long-term portion
Payable
Issuance
Interest
through
type (1)
rate (2)
2023
2022
2035
Variable
4.72 % $
63,680
-
2050
Fixed
3.67
319,635
319,635
2035
Variable
4.55
-
68,270
2048
Fixed
5.00
47,380
55,435
2041
VRDB
4.20
40,965
52,825
2041
VRDB
3.75
40,955
52,815
2041
VRDB
4.00
40,295
52,940
2041
VRDB
4.10
41,005
52,875
2027
Fixed
3.15
--
17,472
2046
Fixed
4,00 - 5.00
-
34,180
2046
Fixed
4.00-5.00
147,500
151,200
2029
Fixed
5.00
46,285
51,500
2035
Fixed
4.47 - 5.00
69,145
69,145
2039
VRDB
4.00
68,725
70,055
2024
Fixed
2.88
1,550
3,100
2037
Fixed
3.43
14,350
15,725
2031
Fixed
1.45 - 4.00
1,900
2,085
943,370 1,069,257
2026 Fixed 0 - 9.05 15,386
13,857
2024 Variable Various 75,000
100,000
Various Fixed 1.00 - 8.00 6,944
104,168
1,040,700
1.287,282
(275,063)
(344,830)
(5,985)
(6,465)
21,902
27,551
$ 781,564 963.538
(1) Fixed rate, variable rate, or variable rate demand bonds (VRDB)
(2) Variable rates shown as of December 31, 2023, and do not include letter of credit and remarketing
fees.
On November 1, 2023, the System issued $63,830 of direct placement variable rate bonds, Series 2023A,
to refund the Series 2018A bonds, which were direct placement variable rate.
28 (Continued)
l
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The Series 2020, 2018B, 2018C, 2018D, 2018E, 2018F, 2016D, 2016E, 2014A, 2014C, 2013B, and 1992A
bonds (collectively, the Bonds) and the Series 2023A, 2018A, 2017A, 2012A, and 2012C direct note
obligations (collectively, the Notes) are general obligations of the System and its affiliates. The System is
required to meet certain operating and financial ratios contained in the master bond trust indenture, bond
insurance agreements, and bank letter of credit agreements (related to the variable rate demand bonds).
The Bonds and Notes are subject to the provisions of amended and restated master trust indentures, which
generally require monthly or quarterly deposits for principal and interest payments be made and certain
funds be maintained by the trustee for interest payment and bond retirement purposes. The Bonds and the
Notes are secured by the System's revenue.
The variable interest rates on substantially all of the bonds are adjusted daily or weekly by remarketing
agents. The bonds may be tendered by the bond holders each interest rate period. The System maintains
letters of credit that can be drawn on should the Series 2013B, 2018C, 2018D, 2018E, or 2018F variable
rate demand bonds not be remarketed. The letter of credit for the Series 2018C, 2018D, 2018E, and 2018F
bonds will expire in 2024, and thus the related debt is shown as current debt in the System's consolidated
financial statements as of December 31, 2023. The remaining letters of credit have varying expiration dates
and are renewable, subject to approval and at the option of the providers, through the term of the bonds.
Outstanding amounts under the letters of credit are due at the earlier of expiration of the agreement or over
a period of three years, commencing after an initial outstanding period of 366 days or more.
On December 1, 2014, the System established a $200,000 taxable commercial paper program. The
System did not have any commercial paper outstanding as of December 31, 2023 or 2022. The System's
commercial paper program is sold in tranches, with varying maturities of 1 to 270 days so that no more
than $25,000 will mature in any 5-business-day period.
On June 4, 2020, the System entered into a term loan agreement with an aggregate principal amount of
$100,000 and a maturity date in 2023, thus the debt is shown as current in the System's consolidated
financial statements as of December 31, 2022. This balance was repaid in full during 2023 and $0
outstanding as of December 31, 2023.
The System maintains three separate revolving line -of -credit facilities that provide for revolving credit in an
aggregate principal amount of up to $50,000 for one and two facilities that provides for revolving credit in
an aggregate principal amount of $100,000. The interest rates applicable to loans under the credit
agreements are based on SOFR plus certain margins, as defined in the agreements. Additionally, the
facilities carry a commitment fee, which is charged on the average daily undrawn portion of the facilities.
These agreements contain various financial covenants that mirror those in the System's master bond trust
indenture. The System had $75,000 and $100,000 outstanding on line -of -credits at December 31, 2023
and 2022, respectively. The line -of -credit facilities will expire during 2024, and the outstanding balances are
shown as current as of December 31, 2023 and 2022.
29 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Aggregate annual maturities of long-term debt during the years ending December 31 are as follows:
Accelerated
Scheduled
maturities with
maturities
letter of credit
based on debt
expirations
classification
2024
$ 275,063
275,063
2025
100,549
34,620
2026
30,150
31,615
2027
21,755
23,270
2028
10,315
11,945
Thereafter
602,868
664,187
$ 1,040,700
1,040,700
(7) Interest Rate Swaps
The System uses interest rate swap agreements as a risk management strategy to maintain acceptable
levels of exposure to the risk of changes in future cash flows due to interest rate fluctuations.
The System has no swaps that are currently designated as hedging instruments, and all changes in fair
values are recorded as a component of nonoperating gains (losses) in excess (deficiency) of revenues over
expenses from continuing operations. Effective January 1, 2018, one swap that was previously designated
as hedged was deemed to no longer be effective. As a result, the cumulative change in fair value of the
hedge previously deemed effective of $(15,036) is being amortized into income over the remaining life of
the swap agreement. As of December 31, 2023 and 2022, $(9,755) and $(10,635), respectively, of net
unrealized loss remains in net assets to be amortized, and $880 and $881 was amortized into other loss in
2023 and 2022, respectively. In previous years, the System reduced the notional amount of certain swap
agreements by $58,395 by paying $8,450 as of the date of the transactions to the counterparty. This fair
value remains a component of net assets without donor restrictions and is being amortized into interest
expense over the remaining life of the swap. As of December 31, 2023 and 2022, $4,649 and $5,068,
respectively, remain in net assets without donor restrictions to be amortized and $419 was amortized into
interest expense in 2023 and 2022.
The System has provisions within certain interest rate swap agreements that require it to post collateral
should the negative fair value of the agreements exceed certain thresholds that are dependent on the
System's credit rating.
30 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(in thousands)
The respective fair values of interest rate swaps in an asset -and -liability position for the System were as
follows as of December 31, 2023 and 2022:
Trade Maturity Notional System System Fair value
date date amount pays receives 2023 2022
2005 2035 77,320 3.5 % 62.4% of 3m SOFR+ 45 bps $ (3,342) (3,698)
2006 2037 112,750 3.8 61.9% of 1mSOFR+38 bps (11,374) (12,042)
2006 2023 27,700 3.5 61.9%of 1mSOFR+31 bps — (21)
2005 2035 38,660 3.3 62.4% of 1mSOFR+37 bps (1,473) (1,590)
2008 2026 6,400 3.5 63.0% of 1mSOFR+37 bps (76) (97)
2008 2024 1,550 3.5 63.0% of 1mSOFR+37 bps (2) (5)
2005 2032 19,700 3.5 67.0%of 1mSOFR+8 bps (1,154) (1,257)
$ (17,421) (18,710)
The aggregate fair value of the unhedged swap agreements is recorded as other long-term liabilities of
$(17,421) and $(18,710) as of December 31, 2023 and 2022, respectively. The change in fair value of
$1,289 and $39,395 is included as a component of other, net in nonoperating (loss) income for the years
ended December 31, 2023 and 2022, respectively. The net of what the System pays and receives is settled
monthly or quarterly on each swap agreement and is reported as other, net in nonoperating (loss) income.
The table below presents certain information regarding the System's interest rate swap agreements:
2023 2022
Other long-term liabilities:
Fair value of interest rate swap agreements $ (17,421) (18,710)
Net assets without donor restrictions:
Change in net assets without restrictions amortizing into
other, net $ 911 941
Nonoperating other, net:
Gain recognized in income from changes in
fair value of interest rate swaps $ 1,289 39,395
Loss recognized in income from amortization of
unrecognized losses in net assets without restrictions (911) (941)
(8) Liquidity
As part of the System's cash management policy, cash, and investments feature a high degree of safety
and liquidity to support general expenditures and debt service within one year in the normal course of
operations.
31 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The following table represents financial assets available for general expenditures within one year at
December 31:
Financial assets at December 31:
Cash and cash equivalents
Short-term investments
Assets limited as to use — required for current liabilities
Patient accounts receivable, net
Other receivables
Assets limited as to use, noncurent:
Held by trustee under bond indenture agreements
Internally designated
Other long-term investments
Contribution receivable and other assets held in trust
Total financial assets
Less amounts not available to be used within one year:
Funds held by trustee under bond indenture agreements
Assets internally designated for self -insured reserves
Assets internally designated for capital improvements
Other long-term investments
Assets attributable to noncontrolling interest
Donor restricted assets
Financial assets not available to be used within one year
Financial assets available to meet general expenditures $
2023 2022
305,971
294,746
233,202
216,670
28,233
24,004
542,115
498,694
115,604
—
221
1,468, 562
1,428, 781
1,139,138
1,138, 491
93,240
85,798
3,926,065
3,687,405
221
29,687
26,984
99,999
99,145
126,891
128,480
42,701
35,896
211,457
259,168
510,735 549,894
3,415,330 3,137,511
The System has certain board -designated and donor -restricted assets limited to use, which are available
for general expenditure within one year in the normal course of operations. Accordingly, these assets have
been included in the table above representing financial assets to meet general expenditures within
one year. The System has other assets limited to use under bond indenture agreement, for self-insurance
reserves, and for capital expenditures. However, at anytime the board can approve utilizing the assets
internally designated for capital improvements for general expenditures due within the next year, and as
such, those assets are included in the aforementioned table.
As part of the System's pooled cash management plan, cash in excess of daily requirements is invested in
short-term investments and money market funds.
The System maintains a $200,000 commercial paper program, as discussed in more detail in note 6. As of
December 31, 2023 and 2022, $200,000 remained available on the System's commercial paper program.
32 (Continued)
C
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The System maintains three separate revolving line -of -credit facilities that provide for revolving credit in
aggregate principal amount of up to $50,000 for one and two credit facilities that provides for revolving
credit in aggregate principal amount of $100,000, as discussed in more detail in note 6. As of
December 31, 2023 and 2022, $75,000 and $100,000, respectively, were drawn on these revolving line of
credit facilities. As of December 31, 2023, the System was in compliance with bond covenants. Long-term
debt is discussed in more detail in note 6.
(9) Retirement Benefit Plans
(a) Defined -Contribution Retirement Plans
The System has several defined -contribution benefit plans, which are available to substantially all
employees meeting age and length of service requirements. Participating employers annually
determine the amount, if any, of the System's contributions to the plans. Total benefit expenses under
the defined -contribution plans were approximately $74,397 and $70,377 for 2023 and 2022,
respectively. The System also has deferred compensation plans for certain employees. Total expenses
under the deferred compensation plans were $1,171 and $3,791 for 2023 and 2022, respectively. In
relation to the post retirement benefits, the System had liabilities of $1,316 and $2,804 included in
accrued payroll and $130,158 and $119,421 in other long-term liabilities as of December 31, 2023 and
2022, respectively.
(b) Defned-Benefit Plans
Prior to 2001, substantially all employees of four of the System's subsidiaries were covered by
noncontributory defined -benefit pension plans, three of which have subsequently been frozen to new
participants or terminated. The Allen Hospital (Waterloo) plan is not frozen, and participants are still
accruing benefits but it is closed to new participants. The System's funding policy is to make the
minimum annual contribution that is required by applicable regulations, plus such amounts as the
System may determine to be appropriate from time to time.
Upon the affiliation with Meriter Health Services, Inc. (Madison) during 2014, the System inherited their
defined -benefit pension plan. Substantially, all of the employees of Madison are eligible to participate in
the plan. Benefits under this plan are based primarily on years of service and employees'
compensation. As of December 31, 2014, Madison froze the plan for all nonunion and service union
covered employees. As of December 31, 2015, Madison froze the plan for all nurses' union
participants. Subsequent to these dates, no additional benefits are being accrued by the frozen
participants in the plan.
During 2024, the plan for Cedar Rapids will be terminated and participants will receive either a
lump -sum payment or have annuities purchased on their behalf as approved by the Board. As a result
of the plan terminating, an expected non -operating settlement expense of $55,437, based on plan
valuation at December 31, 2023, will be recognized in the consolidated statements of operations and
changes in net assets for the year ending December 31, 2024.
The System expects to contribute $8,405 to the plans in 2023. The System uses a December 31
measurement date for the plans.
33 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The following tables set forth information about each defined -benefit plan:
December 31, 2023
Cedar
Madison Rapids Waterloo Total
Change in benefit obligation:
Benefit obligation, beginning of year 4
Service cost
Interest cost
Actuarial (gain) loss
Benefits paid
Benefit obligation, end of year
Change in fair value of plan assets:
Fair value of plan assets, beginning of year
Actual return on plan assets
Employer contributions
Benefits paid
Fair value of plan assets, end of year
Funded status, end of year
Accumulated benefit obligation $
Assets and liabilities recognized
in the consolidated balance sheets:
Noncurrent assets $
Noncurrent liabilities
$
182,366
111,428
12,323
306,117
--
-
264
264
9,562
5,848
673
16,083
1,818
11,232
227
13,277
(16,711)
(7,853)
(514)
(25,078)
177,035
120,655
12,973
310,663
197,136
124,271
13,430
334,837
16,575
6,644
1,150
24,369
8,000
-
405
8,405
(16,711)
(7,853)
(513)
(25,077)
205,000
123,062
14,472
342,534
27,965
2,407
1,499
31,871
177,035
120,655
12,973
310,663
27,965
2,407
1,499
31,871
27,965
2,407
1,499
31,871
34
(Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
December 31, 2023
Cedar
Madison
Rapids Waterloo
Total
Amounts recognized in net assets
without restrictions but not yet
recognized as components of net
periodic benefit cost:
Net loss
$
17,988
55,437 408
73,833
Net prior service credit
458
— —
458
$
18,446
55,437 408
74,291
Amounts expected to be recognized
within one year:
Net loss
$
—
— —
—
Net prior service credit
190
— —
190
$
190
— --
190
Other changes in plan assets recognized
in changes in net assets:
Net (gain) loss
$
(5,765)
12,265 120
6,620
Amount recognized due to settlement
(1,213)
— —
(1,213)
Amortization of net loss
(782)
(7,117) —
(7,899)
Prior seraice credit
(190)
— —
(190)
Total recognized in changes
in net assets
$
(7,950)
5,148 120
(2,682)
35 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Weighted -average assumptions used to
determine benefit obligations for the year
ended December 31, 2023:
Discount rate
Rate of compensation increase
Weighted -average assumptions used to
determine benefit costs for the year
ended December 31, 2023:
Discount rate
Expected return on plan assets
Rate of compensation increase
Components of net periodic benefit cost:
Service cost $
Interest cost
Expected return on plan assets
Amortization of prior service credit
Amortization of net (gain) loss
Net periodic benefit cost (benefit) $
December 31, 2023
Cedar
Madison Rapids Waterloo Total
5.34 % 4.71 % 6.38 % —
N/A NIA NIA —
5.46 %
5.46 %
5.60 %
—
5.45%
6.40%
7.95%
—
N/A
NIA
N/A
—
—
—
264
264
9,562
5,848
673
16,083
(8,992)
(7,677)
(1,043)
(17,712)
190
—
—
190
782
7,117
—
7,899
1,542
5,288
(106)
6,724
36
(Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Change in benefit obligation:
Benefit obligation, beginning of year $
Service cost
Interest cost
Actuarial (gain) loss
Benefits paid
Benefit obligation, end of year
Change in fair value of plan assets:
Fair value of plan assets, beginning of year
Actual return on plan assets
Employer contributions
Benefits paid
Fair value of plan assets, end of year
Funded status, end of year
Accumulated benefit obligation $
Assets and liabilities recognized
in the consolidated balance sheets:
Noncurrent assets $
Noncurrent liabilities
December 31, 2022
Cedar
Madison Rapids Waterloo Total
232,363
148,330
17,981
398,674
-
-
551
551
6,360
4,118
518
10,996
(36.446)
(33,194)
(6,263)
(75, 903)
(19,911)
(7,826)
(464)
(28,201)
182,366
111,428
12,323
306,117
259,247
155,700
16,725
431,672
(50,200)
(28,608)
(3,235)
(82,043)
8,000
5,004
405
13,409
(19,911)
(7,825)
(465)
(28,201)
197,136
124,271
13,430
334,837
14,770
12,843
1,107
28,720
182,366
111,428
12,323
306,117
14,770
12,843
1,107
28,720
14,770
12,843
1,107
28,720
37
(Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December31, 2023 and 2022
(In thousands)
Amounts recognized in net assets
without restrictions but not yet
recognized as components of net
periodic benefit cost:
Net loss
Net prior senAce credit
Amounts expected to be recognized
within one year.
December 31, 2022
Cedar
Madison Rapids Waterloo
Total
$ 25,747 50,288 287 76,322
649 — — 649
$ 26,396 50,288 287 76,971
Net loss $
Net prior service credit
Other changes in plan assets recognized
in changes in net assets:
Net (gain) loss $
Amount recognized due to settlement
Amortization of net loss
Prior service credit
Total recognized in changes
in net assets $
782
7,117
—
7,899
190
--
—
190
972
7,117
—
8,089
20,796
5,263
(1,777)
24,282
—
(6,240)
(35)
(6,275)
(190)
—
(3)
(193)
20,606
(977)
(1,815)
17,814
38
(Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
December 31, 2022
Cedar
Madison
Rapids
Waterloo
Total
Weighted -average assumptions used to
determine benefit obligations for the year
ended December 31, 2022:
Discount rate
5.46 %
5.46 %
5.60 %
—
Rate of compensation increase
N/A
N/A
N/A
—
Weighted -average assumptions used to
determine benefit costs for the year
ended December 31, 2022:
Discount rate
2.83 %
2.86 %
2.93 %
—
Expected return on plan assets
4.06
6.40
7.50
—
Rate of compensation increase
N/A
N/A
N/A
—
Components of net periodic benefit cost:
Service cost $
—
—
551
551
Interest cost
6,360
4,118
518
10,996
Expected return on plan assets
(9,199)
(9,850)
(1,251)
(20,300)
Amortization of prior service credit
190
—
3
193
Amortization of net (gain) loss
—
6,240
35
6,275
Net periodic benefit cost (benefit) $
(2,649)
508
(144)
(2,285)
The System has estimated the long-term rate of return on plan assets based primarily on historical
returns on plan assets, adjusted for changes in target portfolio allocations and recent changes in
long-term interest rates based on publicly available information.
Plan assets are held by bank -administered trust funds, which invest each plan's assets in accordance
with the provisions of the plan agreements. The plan agreements permit investment in common stocks,
corporate bonds and debentures, U.S. government securities, and other specified investments based
on certain target allocation percentages.
Asset allocation is primarily based on a strategy to provide stable earning while still permitting the plans
to recognize potential higher returns through investment in equity securities and limited exposure to
alternative investments.
Please see note 5 relating to the strategy of alternative investment funds. There are no unfunded
commitment related to these bank -administered trust funds.
39 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Target asset allocation percentages for 2023 and 2022 were as follows:
2023
Cedar
Madison Rapids Waterloo
Equity securities 10 % 10 % 17 %
Fixed income 90 90 77
Alternative investments — — 6
2022
Cedar
Madison Rapids Waterloo
Equity securities 25 % 10 % 37 %
Fixed income 65 90 48
Altemative investments 10 — 15
Plan assets are re -balanced quarterly. At December 31, 2023 and 2022, plan asset allocations are as
follows:
2023
2022
Cedar
Cedar
Madison
Rapids
Waterloo
Madison
rapids
Waterloo
Cash equivalents
3 %
— %
— %
2 %
— %
— %
U.S. Treasury obligations
—
13
15
—
21
9
Equity securities
—
—
—
—
—
—
Domestic
1
—
—
5
—
—
Wtual funds
—
—
—
—
—
—
Domestic
—
—
11
—
—
25
International
—
9
5
—
10
12
Equity
7
—
—
16
—
—
Fked income
3
78
58
6
69
36
Other
—
—
—
—
—
—
AlternaWe investments
—
—
4
—
—
8
Hedgefunds
86
—
—
71
—
—
Fund of Funds
—
—
7
—
—
10
100 %
100 %
100 %
100 %
100 %
100 %
40 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(c) Defined -Benefit Plan Assets
The valuation methodologies and inputs used for pension plan assets measured at fair value on a
recurring basis, as well as the general classification of pension plan assets pursuant to the valuation
hierarchy, are described below. There have been no significant changes in the valuation techniques
during the year ended December 31, 2023 or 2022.
Where quoted market prices are available in an active market, plan assets are classified within Level 1
of the valuation hierarchy. Level 1 plan assets include exchange traded equities and mutual funds, as
well as cash equivalents held in money market accounts. If quoted market prices are not available,
then fair values are estimated by using quoted prices of securities with similar characteristics or
independent asset pricing services and pricing models, the inputs of which are market based or
independently sourced market parameters, including, but not limited to, yield curves, interest rates,
volatilities, prepayments, defaults, cumulative loss projections, and cash flows. Such securities are
classified within Level 2 of the valuation hierarchy. Level 2 plan assets include U.S. Treasury
obligations and corporate debt. In certain cases where Level 1 or Level 2 inputs are not available, plan
assets are classified within Level 3 of the hierarchy. There are no Level 3 plan assets.
The value of certain plan assets classified as alternative investments is determined using the NAV (or
its equivalent) as a practical expedient.
41 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The following table presents the fair value measurements of the System's pension plans' assets
measured at fair value on a recurring basis and the level within the fair value hierarchy in which the fair
value measurements fall at December 31, 2023 and 2022:
Fair value measurements using
Quoted prices
in active
Significant
markets for
other
Significant
identical
observable
unobservable
assets
inputs
inputs
Fair value
(Level 1)
(Level 2)
(Level 3)
2023:
Cash equivalents
5,420
5,420
—
—
U.S. Treasury obligations
18,467
—
18,467
—
Equity securities:
Domestic
2,139
2,139
—
—
International
129
129
—
—
Mutual funds:
Domestic
1,618
1,618
—
—
International
11,415
11,415
—
—
Equity
13,579
13,579
—
—
Fixed income
110,232
110,232
—
--
Altemathe funds *
553
—
—
—
Hedge funds*
177,524
—
—
-
Fund of funds*
1,037
—
—
—
Accrued Income
421
—
—
—
$ 342,534
144,532
18,467
—
42 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(in thousands)
Fair value measurements using
Quoted prices
in active
Significant
markets for
other
Significant
identical
observable
unobservable
assets
inputs
inputs
Fair value
(Level1)
(Level2)
(Level3)
2022:
Cash equivalents
$ 3,234
5,311
—
—
U.S. Treasury obligations
26,734
—
26,734
—
Equity securities:
Domestic
10,348
10,348
—
—
Intemational
587
587
—
—
Mutual funds:
Domestic
3,350
3,350
—
—
Intemational
13,412
13,412
—
—
Equity
32,006
32,006
—
—
Fixed income
102,395
102,395
—
—
Altemathe funds *
1,033
—
—
—
Hedge funds*
140,008
—
—
—
Fund of funds*
1,404
—
—
—
Accrued Income
326
—
—
—
$ 334,837
167,409
26,734
—
Certain investments that are measured at fair value using the NAV per share (or its equivalent) as
a practical expedient have not been classified in the fair value hierarchy. The fair value amounts
included above are intended to permit reconciliation of the fair value hierarchy to amounts
presented in the change in fair value of plan assets above. There are no unfunded commitments
for these funds, and see Note 5 for strategy of each type of fund.
The following benefit payments, which reflect expected future service, as appropriate, are expected to
be paid as of December 31, 2023:
2024 $ 138,273
2025 15,616
2026 14,233
2027 14,219
2028 13,415
2029-2033 61,571
43 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(in thousands)
(10) Risk Management
The System's hospitals are primarily self -insured for professional and general liability for amounts of
$10,000 per claim with excess insurance exceeding this in aggregate. Other entities of the System maintain
their professional and general liability coverage primarily on a claims -made basis with no significant
deductibles.
The System is primarily self -insured for workers' compensation and employee healthcare claims. Workers'
compensation claims individually and in the aggregate that exceed certain amounts are covered by
insurance.
Property insurance is maintained with at least 90% replacement value coverage and minimal deductibles.
Network security and information privacy insurance, as well as business interruption insurance coverage
are also maintained by the System.
The System has accrued as other liabilities $163,781 and $193,419 for self -insured losses at
December 31, 2023 and 2022, respectively. These liabilities are presented on a gross basis, and the
expected offsetting insurance recoveries are reported as a receivable. The accrued liabilities are based on
management's evaluation of the merits of various claims, historical experience, and consultation with
external insurance consultants and actuaries, and these liabilities include estimates for incurred but not
reported claims. There can be no assurance that the accrued liabilities will be sufficient for the ultimate
amounts that will be paid for claims and settlements. Also, in the ordinary course of business, the System is
involved in other litigation and claims, none of which management believes will ultimately result in losses
that will adversely affect the System's consolidated net assets or results of operations to a material degree.
Cash and investments have been internally designated to be held for payments of claims, if any, which may
result from the self -insured or uninsured portion of liability insurance and workers' compensation claims. At
December 31, 2023 and 2022, cash and investments designated for this purpose amounted to $29,687 and
$26,984, respectively.
44 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(in thousands)
(11) Lease Commitments
Certain equipment and property are being leased with remaining terms ranging from less than 1 year to
27 years. Certain leases contain renewal options. The renewal options are included in the lease term only
for those situations in which they are reasonably certain to be renewed. The components of lease expense
for the years ended December 31, 2023 and 2022 were as follows:
2023
2022
Lease cost:
Finance lease cost:
Amortization of right -to -use assets $
5,669
4,509
Interest on lease liabilities
1,013
942
Operating lease cost
41,740
40,583
Short-term lease cost
19,334
22,885
Sublease income
(681)
(569)
Total lease cost, net of income $
67,075
68,350
Other information:
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows used in operating leases $
41,740
40,583
Operating cash flows used in finance leases
855
739
Finance cash flows used in finance leases
6,065
5,813
Right -of -use assets obtained in exchange for new operating lease liabilities
13,490
23,754
Right -of -use assets obtained in exchange for new finance lease liabilities
9,075
5,674
Weighted aaerage remaining lease term — finance leases
2.7 years
3.9 years
Weighted a\erage remaining lease term — operating leases
7.0 years
7.6 years
Weighted a\erage discount rate — finance leases
5.2 %
5.5 %
Weighted average discount rate — operating leases
4.0 %
3.9 %
45 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Aggregate annual payments of lease obligations during the years ending December 31 are as follows:
Operating
Finance
Leases
Leases
2024
$ 39,280
7,076
2025
33,657
5,559
2026
29,047
2,764
2027
22,981
970
2028
17,498
270
Thereafter
52,595
—
Total
195,058
16,639
Less: Present value discount
(26,610)
(1,253)
Total lease liability
$ 168,448
15,386
(12) Disclosures about Fair Value of Assets and Liabilities
Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an
orderly transaction between market participants at the measurement date. An entity must maximize the use
of observable inputs and minimize the use of unobservable inputs when measuring fair value. There is a
hierarchy of three levels of inputs that may be used to measure fair value:
Level 1 — Quoted prices in active markets for identical assets or liabilities
Level 2 — Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities,
quoted prices in active markets that are not active, or other inputs, that are observable or can be
corroborated by observable market data for substantially the full term of the assets or liabilities
Level 3 — Unobservable inputs supported by little or no market activity and are significant to the fair value of
the assets or liabilities.
(a) Financial Instruments Measured at Fair Value on a Recurring Basis
The valuation methodologies and inputs used for assets and liabilities measured at fair value on a
recurring basis and recognized in the accompanying consolidated balance sheets, as well as the
general classification of such assets and liabilities pursuant to the valuation hierarchy, are described
below. There have been no significant changes in the valuation techniques during the year ended
December 31, 2023 or 2022.
46 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(b) Investments
Where quoted market prices are available in an active market, securities are classified within Level 1 of
the valuation hierarchy. Level 1 securities include exchange traded equities and mutual funds,
certificates of deposit and cash equivalents held in money market accounts. If quoted market prices are
not available, then fair values are estimated by using quoted prices of securities with similar
characteristics or independent asset pricing services and pricing models, the inputs of which are
market based or independently sourced market parameters, including, but not limited to, yield curves,
interest rates, volatilities, prepayments, defaults, cumulative loss projections, and cash flows. Such
securities are classified within Level 2 of the valuation hierarchy. Level 2 securities include
U.S. Treasury obligations, U.S. government agency obligations, municipal bonds, collateralized
mortgage and other collateralized asset obligations, corporate debt, and certain beneficial interest in
perpetual trusts. In certain cases where Level 1 or Level 2 inputs are not available, securities are
classified within Level 3 of the hierarchy. Level 3 financial instruments include beneficial interest in
perpetual trusts, which are discussed below. Inputs and valuation techniques used for these Level 3
interests are described below.
Fair value determinations for Level 3 measurements of securities are the responsibility of management.
Management contracts with a pricing specialist to generate fair value estimates on a monthly or
quarterly basis. Management challenges the reasonableness of the assumptions used and reviews the
methodology to ensure the estimated fair value complies with accounting standards generally accepted
in the United States.
(c) Interest Rate Swap Agreements
The fair value is estimated using forward -looking interest rate curves and discounted cash flows that
are observable or can be corroborated by observable market data and, therefore, are classified within
Level 2 of the valuation hierarchy.
(d) Beneficial Interest in Perpetual Trusts
The fair value is estimated at the present value of the future distributions expected to be received over
the term of the agreement. Trusts that have a definite duration based on the terms of the trust
document, and where the System has the ability to redeem the investment for the underlying assets at
some future point, are classified within Level 2 of the valuation hierarchy due to the nature of the
valuation inputs. For trusts that are perpetual in nature in which the underlying assets will never be
available to the System, the interest is classified within Level 3 of the hierarchy.
(e) Fair Value Measurements
The following tables present the fair value measurements of assets and liabilities recognized in the
accompanying consolidated balance sheets measured at fair value on a recurring basis and the level
within the fair value hierarchy in which the fair value measurements fall at December 31, 2023 and
2022:
47 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
2023
Fair value
measurements using
Quoted prices
in active
Significant
marketsfor
other
Significant
identical
observable
unobservable
assets
inputs
inputs
Fair value
(Level1)
(Level2)
(Level3)
Investments:
Cash equivalents $
24,078
24,078
-
-
U.S. Treasury obligations
45,267
-
45,267
-
U.S. Gmemment agency obligations
43,995
-
43,995
-
Municipal bonds
3,812
-
3,812
-
Asset -backed securities:
Other
111,738
-
111,738
Mortgage -backed securities:
Gmemment
17,758
-
17,758
-
Non-govemment
33,909
-
33,909
-
Certificates of deposit
1,119
1,119
-
-
Corporate bonds
108,287
-
108,287
--
Equity securities:
Domestic
7,712
7,712
-
-
International
1,991
1,991
-
-
Mutual funds:
Domestic
-
-
International
395,013
395,013
-
-
Emerging markets
-
-
Index
18,341
18,341
-
-
Equity
396,046
396,046
-
-
Fixed income
860,083
860,083
-
-
Other
56,504
56,504
-
-
Alternative funds*
196,978
-
-
Hedge funds*
217,208
-
-
-
Private equity funds*
156,505
-
-
-
Fund of funds*
156,141
-
-
-
Other items at cost`*
16,650
-
16,650
-
Total short-term investments, assets limited
as to use and other long-term investments $
2,869,135
1,760,887
381,416
-
48 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
2023
Fair value measurements using
Quoted prices
in active
Significant
markets for
other
Significant
identical
observable
unobservable
assets
inputs
inputs
Fairvalue
(Levell)
(Level2)
(Level3)
Beneficial interests in perpetual trusts included
in contributions receivable
$ 19,650
—
5,501
14,149
Beneficial interests in charitable trusts included
in contributions receiable
257
—
257
—
Interest rate swap agreements included in
other long-term liabilities
(17,421)
—
(17,421)
—
2022
Fair Value Measurements Using
Quoted Prices
in Active
Significant
Markets for
Other
Significant
Identical
Observable
Unobservable
Assets
Inputs
Inputs
Fair Value
(Levell)
(Level2)
(Level3)
Imestments:
Cash equivalents
$ 1,488
1,488
—
—
U.S. Treasury obligations
112,314
—
112,314
—
U.S. Goremment agency obligations
27,139
—
27,139
—
Municipal bonds
17,499
—
17,499
—
Asset -backed securities:
Other
54,647
—
54,647
—
Mortgage -backed securities:
Gowmment
6,417
—
6,417
—
Non-gowmment
37,175
—
37,175
—
Certificates ofdeposit
1,129
1,129
—
—
Corporate bonds
111.245
—
111,245
—
Equity securities:
Domestic
8,585
8,585
—
—
International
1,800
1,800
—
—
49 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(in thousands)
Mutual funds:
Domestic $
International
Emerging markets
Index
Equity
Fixed income
Other
Alternative funds*
Hedge funds*
Private equity funds*
Fund of funds*
Other items at cost'*
Total short-term investments, assets limited
as to use and other long-term investments $
Beneficial interests in perpetual trusts included
in contributions receMble $
Beneficial interests in charitable trusts included
in contributions receivable
Interest rate wrap agreements included in
other long-term liabilities
Fair Value
3,271
380,879
15,529
351,747
877,971
54,357
201,139
199,542
155,686
172,747
15,861
2022
Fair Value Measurements Using
Quoted Prices
in Acfive
Significant
Markets for
Other
Significant
Identical
Observable
Unobservable
Assets
Inputs
Inputs
(Level1)
(Level2)
(Level3)
3,271 —
380,879 —
15,529 —
351,747 —
877,971 —
54,357 —
15,861
2,808,167 1,696,756 382,297
15,350 — 4,755
264 — 264
(18,710) — (18,710)
10,595
* Certain investments that are measured at fair value using the NAV per share (or its equivalent) as
a practical expedient have not been classified in the fair value hierarchy. The fair value amounts
included above are intended to permit reconciliation of the fair value hierarchy to the amounts
presented in the consolidated balance sheets.
*' Other items at cost primarily includes insurance policies and accrued interest.
50 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(t) Level 3 Reconciliation
The following is a reconciliation of the beginning and ending balances of recurring fair value
measurements recognized in the accompanying consolidated balance sheets using significant
unobservable (Level 3) inputs:
Beneficial
interest in
perpetual
trusts
Balance, December 31, 2021
$ 9,455
Change in beneficial interest in perpetual trusts
1,140
Balance, December 31, 2022
10,595
Change in beneficial interest in perpetual trusts
3,554
Balance, December 31, 2023
$ 14,149
(g) Goodwill
Goodwill is evaluated for impairment when qualitative events indicate goodwill might be impaired. If the
System performs an impairment test, any impairment loss is recognized as expense when it is
determined that the carrying amount of the goodwill exceeds its implied fair value. The key inputs used
to assess for potential impairment are a qualitative analysis of the applicable reporting unit and a
quantitative discounted cash flow analysis.
(h) Unobservable (Level 3) Inputs
The following table presents quantitative information about unobservable inputs used in recurring and
nonrecurring Level 3 fair value measurements:
Recurring:
Beneficial interests in perpetual trusts $
2023
Adjustment
Fair Value Valuation Technique to NAV
14,149 Present value of future NIA
distributions expected
to be received over
term of agreement
Nonrecurring:
Goodwill $ 38,590 Discounted cash flow NIA
51 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Recurring:
Beneficial interests in perpetual trusts $
Nonrecumng:
Goodwill
(13) Net Assets with Donor Restrictions
2022
Fair Value Valuation Technique
10,595 Present value of future
distributions expected
to be received over
term of agreement
38,590 Discounted cash flow
Adjustment
to NAV
N/A
N/A
Net assets with donor restrictions are available for the following purposes or periods as of December 31:
2023
2022
Purchase of equipment
$ 13,787
25,547
Indigent care/operations
89,796
104,877
Health education
9,196
6,969
For use in future periods
386
24,210
Investments to be held in perpetuity
98,292
97,565
Total with donor restrictions
$ 211,457
259,168
The portion of restricted net assets that have restrictions on the usage of income include restrictions for the
support of operations, capital and equipment, education, patient assistance, and research. Included in
investments to be held in perpetuity is $48,512 and $52,741 of donor endowed corpus as of December 31,
2023 and 2022, respectively. The remainder of $49,780 and $44,824 primarily consists of accumulated
earnings on donor endowed corpus and perpetual trusts as of December 31, 2023 and 2022, respectively.
Net assets released from restrictions were $28,054 and $29,302 in 2023 and 2022, respectively. Net
assets were released from restriction by incurring expenses satisfying the restricted purposes or by
occurrence of other events specified by donors including support of operations, capital and equipment,
education, patient and employee assistance, and research.
(14) Related -Party Transactions
System purchases a variety of services and products, including leases, from companies affiliated with
members of the Boards of Directors of the System and/or its subsidiaries. Services and products
purchased from these affiliated companies during 2023 and 2022 totaled $43,903 and $47,167,
respectively. In addition, the System purchases services from several joint ventures and sells services and
supplies to several joint ventures in which the System is also an investor.
52 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The System has recorded contribution receivables for amounts held by nonconsolidated foundations on
behalf of the System of $66,421 and $62,718 as of December 31, 2023 and 2022, respectively.
Contributions received from nonconsolidated foundations and other related parties were $916 and $1,589
in 2023 and 2022, respectively.
The System believes these transactions are consummated under commercially reasonable business
arrangements.
(15) Commitments and Contingencies
The healthcare industry is subject to numerous laws and regulations of federal, state, and local
governments. Compliance with these laws and regulations can be subject to government review and
interpretation, as well as regulatory actions unknown and unasserted at this time. Government activity has
increased with respect to investigations and allegations concerning possible violations of regulations by
healthcare providers, which could result in the imposition of significant fines and penalties as well as
significant repayments of previously billed and collected revenues for patient services. The System has a
corporate compliance plan intended to meet federal guidelines. As a part of this plan, the System performs
periodic internal reviews of its compliance with laws and regulations. As part of the System's compliance
efforts, the System investigates and attempts to resolve and remedy all reported or suspected incidents of
material noncompliance with applicable laws, regulations, or policies on a timely basis. The System
believes that these compliance programs and procedures lead to substantial compliance with current laws
and regulations.
The System is in various stages of responding to inquiries and investigations by regulators. These various
inquiries and investigations could result in fines and/or financial penalties, which could be material. At this
time, the System is unable to estimate the possible liability, if any, that may be incurred as a result of these
inquiries and investigations, but the System does not believe it would materially affect the financial position
of the System.
Guarantees
The System has guaranteed $35,761 and $33,477, which is outstanding at December 31, 2023 and 2022,
respectively, relating to long-term debt for the construction of a family practice residency program
education facility, a managed facility's building project, and debt related to joint ventures. For 2023 and
2022, the System made no payments on these guarantees.
(16) Endowment
The System's endowment consists of individual funds established for a variety of purposes. The
endowment includes both donor -restricted endowment funds and funds designated by the governing body
to function as endowments (board -designated endowment funds). As required by U.S. GAAP, net assets
associated with endowment funds, including board -designated endowment funds, are classified and
reported based on the existence or absence of donor -imposed restrictions.
The System's governing body has interpreted the State of Iowa Prudent Management of Institutional Funds
Act (SPMIFA) as requiring preservation of the fair value of the original gift as of the gift date of the
53 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
donor -restricted endowment funds absent explicit donor stipulations to the contrary. As a result of this
interpretation, the System classifies as permanently restricted net assets: (a) the original value of gifts
donated to the permanent endowment, (b) the original value of subsequent gifts to the permanent
endowment, and (c) accumulations and deductions to the permanent endowment made in accordance with
the direction of the applicable donor gift instrument at the time the accumulation is added to the fund. The
remaining portion of donor -restricted endowment funds is classified as temporarily restricted net assets
until those amounts are appropriated for expenditure by the System in a manner consistent with the
standard of prudence prescribed by SPMIFA. In accordance with SPMIFA, the System considers several
factors in making a determination to appropriate or accumulate donor -restricted endowment funds
including, duration and preservation of the fund, purposes of the fund, general economic conditions,
possible effect of inflation and deflation, expected total return from investment income and appreciation or
depreciation of investments, other resources of the System, and investment policies of the System.
The composition of net assets by type of endowment fund at December 31, 2023 and 2022 was as follows:
Without
donor
With donor
restriction
restriction
Total
December 31, 2023:
Donor -restricted endowment funds
$ —
67,320
67,320
Board -designed endowment funds
139,134
—
139,134
Total endowment funds
139,134
67,320
206,454
December 31, 2022:
Donor -restricted endowment funds
—
72,211
72,211
Board -designed endowment funds
134,707
—
134,707
Total endowment funds
$ 134,707
72,211
206,918
54 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Changes in endowment net assets for the years ended December 31, 2023 and 2022 were as follows:
Without
donor
With donor
restriction
restriction
Total
Endowment net assets, December 31, 2021
$ 159,808
78,960
238,768
Investment return:
Investment income
2,179
710
2,889
Net appreciation
(17,387)
(7,778)
(25,165)
Total investment return
(15,208)
(7,068)
(22,276)
Contributions
—
2,680
2,680
Appropriation of endowment assets for
expenditure
(9,893)
(2,361)
(12,254)
Endowment net assets. December 31, 2022
134,707
72,211
206,918
Investment return:
Investment income
2,714
1,631
4,345
Net depreciation
10,324
4,589
14,913
Total investment return
13,038
6,220
19,258
Contributions
—
2,617
2,617
Disaffiliation
(2,746)
(11,948)
(14,694)
Appropriation of endowment assets for
expenditure
(5,865)
(1,780)
(7,645)
Endowment net assets. December 31, 2023
$ 139,134
67,320
206,454
As of December 31, 2023 and 2022, the corpus of the aforementioned donor -restricted endowment funds
was $48,512 and $52,741, respectively. In addition, the net amount of earnings in excess of expenditures
as of December 31, 2023 and 2022 was $18,808 and $19,470, respectively.
From time to time, the fair value of assets associated with individual donor -restricted endowment funds
may fall below the level the System is required to retain as a fund of perpetual duration pursuant to donor
stipulation or SPMIFA. In accordance with U.S. GAAP, deficiencies of this nature are reported in without
donor restriction net assets and amount to $15 and $355 at December 31, 2023 and 2022, respectively.
The System has adopted investment and spending policies for endowment assets that attempt to provide a
predictable stream of funding to programs and other items supported by its endowment while seeking to
maintain the purchasing power of the endowment. Endowment assets include those assets of
donor -restricted endowment funds the System must hold in perpetuity as well as those of board -designated
funds. Under the System's policies, endowment assets are invested in a manner that is intended to
55 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
produce results that exceed applicable benchmarks while assuming a prudent level of investment risk. The
System expects its endowment funds to provide an average net rate of return of approximately 8% annually
over time. Actual returns in any given year may vary from this amount.
To satisfy its long-term rate of return objectives, the System relies on a total return strategy in which
investment returns are achieved through net investment income, including dividends, interest, and
recognized appreciation, as well as unrealized capital appreciation. The System targets a diversified asset
allocation that places a greater emphasis on equity -based investments to achieve its long-term return
objectives within prudent risk constraints.
In general, the System has a policy (the spending policy) of appropriating for expenditure each year
4%-5% of its endowment fund's average fair value over the prior 12 quarters through the year-end
proceeding the year in which expenditure is planned. In establishing this policy, the System considered the
long-term expected return on its endowment. A management fee of 1 %-1.5% is also typically charged to
the endowment funds annually to cover administrative costs of managing the endowment and the
fundraising operations. Accordingly, over the long term, the System expects the current spending policy to
allow its endowment to grow at an average of 2%-2.5% annually. This is consistent with the System's
objective to maintain the purchasing power of endowment assets held in perpetuity or for a specified term, C
as well as to provide additional real growth through new gifts and investment return.
(17) Financial Responsibility Standards
The System participates in federal Title IV student financial assistance programs, which require it to meet
standards of financial responsibility based on criteria determined by the U.S. Department of Education
(ED), as set forth in 34 CFR 688. The criteria for private institutions include the annual calculation by ED of
a financial responsibility composite score, as further outlined in 34 CFR 688, using audited financial
statements submitted through ED's eZ-Audit system. The composite score has been and will continue to be
based on three ratios: primary reserve, equity, and net income. These ratios utilize various financial data,
some of which are made up of a summation of multiple items presented in the consolidated financial
statements and footnotes, as of December 31, 2023. The instances where the input amount consists of a
total of more than one individually presented financial amount are detailed in the table below, input amount
consists of a total of more than one individually presented financial amount are detailed in the table below.
56 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
Amount not used
as input on
Input
supplementary
Required input perstandards
Ratio(s) Used
Amount
schedule
Reference
NetAsset wih donor resirictans:
Primary Reserve, Equi $
98,292
Net asset restictd in perpelu y:
Donor endowed carpus
48,512
Not 13, NetAsset with Donor ResYiclons
Acmmulaled earnings on donor endowed
corpus and perpetual trusts
49,780
Not 13, NelAssetwih DonorResftnS
Net asset with donor resticiams:
Primary Reserve, Equiy
113,165
Purchase of equipment
13,787
Not 13,NetAssetwihDonor Reslydons
Indgentcarefoperafons
89,796
Not 13, NetAssetwih DonorReStiCions
Healh educafon
9,196
Not 13, NetAssetwih Donor Resttions
For use in ihirre periods
386
Not 13, NetAssetwlth Donor Resirdons
Propery, planland equipment, net(in iudes
Constucion in progress and CapM leases):
Primary Reserve
1,548,598
Prop", plantand equipment—posimphmenhton
wiihoutouttanding debtor original purchase
1,462,163
Not ifl, Property, Plant and Equpment
Construction in process
86,435
Not i(), Propery, Plantand EquQment
Intangible asset:
Prirery Reserve, Equk
42,170
Goodwll
38,590
Not I (k), Ober Asset
Ober intengibleasset
3,580
Not I(k),OherAsset
Postemploymentand pension Ibblik
Prmary Reserve
131,474
Post•errploymentacerued payroll
1,316
Not 9(a), Deined-Contibuion RelrementPlans
Postempbymentoher long-term frabhTdes
130,158
Not 9(a), Deined-Contibuion RefrementPlans
PosWaploymentand pension liaNdes disconinued
operafans:
Primary Reserve
—
Post-employmentoher long-term fabliies
—
Not 18, DiscconinuedOperafons
Total expenses wilhoutdonorresttcions:
Primary Reserve
4,733,545
Total expenses
4,733,545
Consoidaled Stale entof Operaions and Changes
Ohercorrpmentofnetperiodicpension cost:
PfinaryReserve
6,723
Service cost
264
Not 9(b), Deined Benefflans
Intrestcost
16,083
Not 9(b), Deined BeneitPlans
Expected return on plan asset
(17,712)
Not 9(b), Deined Beneft Plans
Armrizafon ofprlor servloe credit
190
Not 9(b), Deined BeneBlPlans
Amorizaian ofnetloss
7,898
Not 9(b), Deined Benek Plans
57 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
(18) Discontinued Operations
On December 10, 2021, the System signed a nonbinding letter of intent to transition Methodist Health
Services Corporation and Subsidiaries (Central Illinois) to The Carle Foundation, d/b/a Carle Health (Carle
Health). Accordingly, on October 28, 2022, the System and Carle Health signed a strategic affiliation
agreement, to transition Central Illinois to Carle Health. The transition was effective April 1, 2023 with the
System and Central Illinois signing a mutual agreement to terminate its affiliation agreement. Under the
terms of the strategic affiliation agreement, Carle Health paid $242,729 in cash on April 1, 2023 for Central
Illinois' assets and assumed all related liabilities ($75,000 one-time fee and $167,729 for net intercompany
liabilities). The calculation of the loss on the disposal of Central Illinois as of December 31, 2022 is as
follows:
Loss on Disposal of Discontinued Operations:
One -Time Fee from Carle Health to the System
$
75,000
Assets Transferred (Prior to Loss):
Cash and cash equivalents
$
18,084
Short-term investments
5,579
Net patient accounts receivable
83,645
Other Current Assets
44,165
Assets Limited as to use
15,757
Property, plant and equipment
327,357
Other Assets
316,842
Total Assets
$
811,429
Liabilities Transferred:
Accounts Payable
$
27,360
Other Current Liabilities
117,167
Long Term Debt
1,134
Other Long Term Liabilities
208,159
Total Liabilities
$
353,820
Central Illinois Region Net Assets:
Without donor restrictions
$
396,531
With donor restrictions
61,078
Total Net Assets
$
457,609
Loss on Disposal of Discontinued Operation
$
(382,609)
Disposals that represent a strategic shift that should have or will have a major effect on the System's
operations and financial results qualify as discontinued operations. The results of discontinued operations
are reported in discontinued operations in the consolidated statements of operations and changes in net
58 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
assets for current and prior periods commencing in the period in which the business meets the criteria of a
discontinued operation, and include any gain or loss recognized on closing or adjustment of the carrying
amount to fair value less cost to sell.
With the affiliation termination of Central Illinois completed in 2023, the System is no longer maintaining a
presence in Central Illinois and surrounding communities. Because the System's operations in Central
Illinois are a major part of the System's operations and financial results, the System determined in 2022
that the transition of Central Illinois represented a strategic shift. Accordingly, the assets and liabilities of
Central Illinois were segregated and reported as held for sale in the consolidated balance sheets as of
December 31, 2022. Furthermore, the activities of Central Illinois have been segregated and reported as
discontinued operations in the consolidated statements of operations and changes in net assets for all
periods presented.
The following table presents a reconciliation of the carrying amounts of major classes of assets and
liabilities of the discontinued operation to total assets and liabilities of the disposal group classified as held
for sale in the consolidated balance sheets as of December 31, 2022:
2022
Discontinued Operations Balance Sheet:
Carrying amounts of major classes of assets included as part of
discontinued operations (after loss):
Cash and cash equivalents
$ 18,084
Patient accounts receivable
83,645
Other receivables
25,136
Investments
236,261
Total major classes of assets of the discontinued operation
363,126
Other assets included in the disposal group classified as held for sale
49,104
Total assets of the disposal group classified as held for
sale in the consolidated balance sheet
412,230
Carrying amounts of major classes liabilities included as part of
discontinued operations:
Accounts payable
27,360
Accrued payroll
31,756
Total major classes of liabilities of the discontinued operation
59,116
Other liabilities included in the disposal group classified as held for sale
127,321
Total liabilities of the disposal group classified as held for sale
in the consolidated balance sheet
$ 186,437
59 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The following table presents a reconciliation of the major classes of line items from discontinued operations
to the loss reported in discontinued operations for the year ended December 31, 2023:
2023
2022
Major classes of line items reported in discontinued operations:
Patient service revenue $
169,644
625,941
Other operating revenue
22,679
79,574
Salaries and wages
(59,687)
(240,085)
Provider compensation and services
(34,215)
(124,149)
Employee benefits
(14.733)
(52,605)
Supplies
(28,537)
(109,001)
Other income and expenses not considered major
(45,526)
(219,638)
Gain (loss) on discontinued operations related to
major classes of revenues over expenses
9,625
(39,963)
Loss on sale of discontinued operations
--
(382,609)
Total gain (loss) on discontinued operations that is
presented in the consolidated statement of
operations and changes in net assets $
9,625
(422,5721
Summarized condensed cash flow information for the discontinued operations for the year ended
December 31, 2023 are as follows:
2023 2022
Net cash used by operating activities $ (242,339) (31,391)
Net cash provided in investing activities 223,554 19,172
Net cash provided by in financing activities 700 3,704
Decrease in cash and cash equivalents of
discontinued activities $ (18,085) (8,515)
c
60 (Continued)
IOWA HEALTH SYSTEM AND SUBSIDIARIES
(d/b/a UnityPoint Health)
Notes to Consolidated Financial Statements
December 31, 2023 and 2022
(In thousands)
The noncontributory defined -benefit plan for Central Illinois has been included in the assets held for sale
balances. Central Illinois had $0 and $12,340 of post -employment other long-term liabilities as of
December 31, 2023 and 2022 respectively. No balances were included in discontinued operations on the
consolidated statement of operations and changes in net assets as of December 31, 2023. The other
components of net periodic pension costs for Central Illinois were $0 and $9,368 of interest cost, $0 and
$18,356 of expected return of plan assets, and $0 and $1,222 amortization of the net loss, which were
included in discontinued operations on the consolidated statement of operations and changes in net assets
as of December 31, 2023 and 2022, respectively.
Central Illinois recognized $192,977 and $708,865 of total operating revenues, which was classified as
discontinued operations on the consolidated statement of operations and changes in net assets as of
December 31, 2023 and 2022, respectively. As of the disaffiliation date of April 1, 2023, the entire balance
of Central Illinois net assets with donor restriction were transferred to net assets without donor restrictions
and then removed from the balance sheet as noted on the consolidated statements of operations and
change in net assets as of December 31, 2023.
(19) Subsequent Events
Subsequent events have been evaluated through April 24, 2024, which is the date the consolidated
financial statements were issued. UnityPoint Health is not aware of any material subsequent events that
would require recognition or disclosure in the consolidated financial statements, other than described
below.
During July of 2024, the defined -benefit pension plan for Cedar Rapids will be terminated and participants
will receive either a lump -sum payment or have annuities purchased on their behalf. See note 9 for
additional details relating to the plan.
61
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IOWA HEALTH SYSTEM AND SUBSIDIARIES
dm)a Unitypelnt Health
UNITYPOINT HEALTH - DES MOINES AND SUBSIDIARIES (DES MOINES)
Consolidating Schedule - Balance Sheet Informmban
Year ended December 31, 2023
(In thousands)
Assets
C." ril assets:
Cash and cash equivalent&
Sion-mtm nvesenent&
Assets limited as to use-regmred for cu(ront liriwlieas
Patient accounts receivable, less eatimabd urt4ollactibles
Other recih.bfe.
I -be.
Prepaidespenses
Due nom aRri h.
Total currant swab
Assets I mind as to use, nenarrent
Held by mr.me under bond indenture a9reemi ne,
Innmtammallyy ddesignated for apd:d impravm.nt&
signatdonzurance reserve
Total assets limited as to use, noncwi,nt
Pmpti plant and equipment net
Operadmg lease ROU asset&
Othn long•brm imit'"ents
tnvastmmts mjoiat ventures and oIn.r lfwszVmenls
Conblbutkn...eewaMe, net
Other
Due hour aRnbti s
Total .... ls
Liabilities and Net Assets
Cu nmt liabilities:
Current maturities of fang -term debt
Current portion of aperoong Was. rab4ibes
Arr unls Payable
Accrued petit
Acwed nt eat
Esbmated sottlement& due to third -party payers
Medical claims payable
Due m affiliates
Other a mens kablfides
Tot./wmonlliabdides
Lono-t-debt not
Lon9
-tunnaperadn9loaas liabilities
Older mng•mrm Igbilioes
Duce to xPotiams
To at liabaW.
Net.ssets(de6ca):
VA:=donor vDictlons.
AM
:bumble to UnilyPolnt Healer
AM bunM. b nonantmimi; intercat
Total xithw donor r.strlaeans
Win donor reablctions:
AlbibutaMe b Un4Pofnt Xeafdl
AOribulabo tononconsodinginterest
Total vdth donor rasbfcden.
Total net swat& (deC i
Tool lbbad.... d ne(.asat&
DeBniWns.
CIHC - Central Iowa Hospital Corporaoon
UPHF - UnhyPoint Health Foundation
CIHP-Centel Im a Health Praperde. Corporation
E8-Eyerly Ball Mental Health SeMces
CRMC - G6.1.11 Regional Medial Canmr
So. .-innying lndepondent i udit-".pom
3chodula2
CIHC
UPHF
CIHP
ES
CRMC
IMP
YRTS
UPC
UPAH
Ellinnations
Consolidated
S 24,408
1,728
12
0.105
2.508
770
(80)
-
-
-
35,532
19,578
957
-
-
578
-
-
-
-
-
21,113
13,767
--
-
-
_
_
_
13,767
142,895
_
-
7.675
9,130
2,779
489
-
-.-
-
755,90g
71.351
16
0
453
4.459
-
-
-
-
-
76,285
19,923
96
-
-
1,620
59
-
-
-
-
21.700
3,203
64
1g
58
214
384
56
-
_
3.297
39862
20.170
264
-
1.649
-
712
(30.535)
31.946
334.797
23.042
320
8,371
19,158
3.992
1,177
-
-
(30.539)
360,308
776.695
118.048
-
3,270
-.
-
-
-
-
897.013
490
-
-
-
496
776.191
110,048
-.
3,270
-
.-
-
-
-
-
897.509
320.710
119
17,300
1.118
13,050
5,694
1.413
-
-
-
359.440
11,786
26
4.089
80
-
4,187
21D5
-
-
--
22.273
21,860
73,579
-
-
7.211
-
-
-
102,650
70.411
-
-
-
-
-
17.975
35.118
(59.598)
63,912
-
12,201
-
38
1.431
-
...
-
_
-
13.760
51180
1
-
-
36
14
-
...
-
5.231
4.769
-
-
_
_
_
_
S IS45.7D0
227.1 US
21.715
12877
40.916
13,887
4.695
17.975
35.118
(94.906).
1.825.083
$ 207
-
-
79
1.272
-
.-
-
1.638
2,761
26
82
79
401
326
-
-
-
3,735
35.341
220
Sol
91
2.674
21199
41
-
-
-
41,177
40,509
326
10
1.312
2,326
739
179
-
-
-
45.401
4,752
-
-
-
1,643
-
-
....
-
-
6,395
30159
19.063
1
9,522
-
2,001
-
-
(30,5
21.226
40
745
756
2,097
1
fit
(1
(1)
24) .865.6
135,035
20.275
1.399
2.240
16.341
4676
2.547
(1)
-
(30,540)
153.972
592
-
-
-
88
2,226
-
-
-
.-
2.686
9,218
4.007
1
(167)
3,819
1.798
-
-
--
18,676
49.410
103
-
-
2,293
-
-.
-
-
-
51.696
90.809
3.669
-
1.200
-
-
(4,769)
904889
285,144
24.037
SAGS
2.241
21335
10,721
4.345
(1)
-
(35.309)
318.349
1.202.894
134,306
16.309
10,63E
12171
183
350
17.672
33.512
-
1.428.033
-
-
-
-
2.9n
2.910
1.202.694
134.305
16,309
10,636
12.171
3.166
350
17.572
33.512
1,431.016
57,662
68.763
-
-
7,010
-
-
3"
1.608
(59.597)
75.748
57,E62
66,763
7.010
304
mfi
(59.587)
75.748
1.260.556
203.069
15309
10.636
19.161
3.166
350
17.976
35.11e
(59.597)
1.506.764
S 1541700
227.105
21.715
12.877
40.916
13,887
4A95
17,975
35.116
(9a,Si
1.025,083
UPC-UnityPoint Clink, UPHDM portion
UPAH - UnityPamt at Home. UPNDM portion
IDIP - Iowa Dulino.d. Imaging 8 Prooedule Center
YRTS - Younker Rehab Therapy Services
64
fOWA HEALTH SYSTEM AND SUBSIDIARIESSchedule
2
dfbfa UnihrPaTnl Health
UNITYPOINT HEALTH - DES MOINES AND SUBSIDIARIES
CUES MOINES)
Consolidating Schedule - Revenue and Gains. Expenses and
Losses Information
Year ended December 31, 2023
(In thousands)
CIHC UPHF CIHP EB
GRMC
!DIP
YRTS
UPC
UPAH
Eliminallons
Consolidated
Unrestricted revenues:
Net patient service revenue
$ 1,018,563 - - 13.291
62.143
10,764
4.855
176.324
97,830
-
1,382,773
Other operating revenue
128,056 1,538 5,270 3,643
2.218
5
26
15.676
3,274
(9,837)
149.569
Net assets released from restrictions used for operations
6,685 552 -
75
-
6
4
274
6.596
Total operating revenue
1.152.304 2.090 5.270 16,934
64.436
10.769
4.890
191,004
101.378
(9,837)
1,5391238
Expenses:
Salaries and wages
379.056 2,006 59 10,052
21,275
2.068
3.100
40,716
25.934
-
484,266
Physician componsadan and services
124.108 - - 125
12,857
3.806
-
100,093
78
(2,328)
238,739
Employee bonefits
79.879 423 17 2.141
5.961
313
780
t3.677
6,778
(72)
109,897
Supplies
211,228 695 (3) 183
9,083
384
38
20.999
48,959
(35)
291.531
Other expenses
205.508 1,206 2,921 2.394
13,255
2,414
931
56.919
19.624
(7,345)
298,827
Depredation and amortization
28,918 1 563 178
1.829
463
136
2.527
319
-
34.924
interest
Provision for uncollectible accounts
6,905 - - -
64
55
-
160
-
(57)
7,127
25 1 -
3
-
-
29
Total operating expenses
1,0369627 4.331 3,548 15.073
64,327
9,503
4.985
235.091
101.692
(9.837)
1.465.340
Operating Income (loss)
115,677 (2,241) 1.722 1.861
109
1.266
(95)
(44,0871
(314)
73.898
Nonoperating gains (losses);
Investmentincome
63,545 16,472 - 254
75
-
-
-
-
-
79,346
Other, net
- (15) - -
($I
-
-
-
(23)
Total nonoperating gains (tosses), net
63.546 15.457 - 254
67
-
-
79.323
Revenue over (under) expenses before gain (loss)
on bond refinancing transactions
179,222 13.216 1.722 2,115
176
1,266
(95)
(44,087)
(314)
-
153,221
Gain (loss) on discontinued operations
Excess (deficiency) ofrevenues over expenses
179.222 13,21(1 1.722 2,115
176
1,266
(95)
(44,087)
(314)
-
153,221
Less noncontro8inginleiest
- -
-
(633)
-
-
(633)
Excess (deficiency) of revenues over expenses attributable
to UnllyPcinl Health
$ 179,222 13.216 1,722 2,115
175
633
(95)
(44,081)
W14)
162,18,
Definitions:
CIHC» Central Iowa Hospilal Corporation
UPC - UnityPoinl Clinic, UPHDM portion
UPHF - UnityPoint Health Foundation
UPAH - UnityPoint at Home. UPHDM portion
CIHP- Central Iowa Health Properties Corporation
ID1P- Iowa Diagnostic imaging 8 Procedure Center
EB - Eyerly Ball Mental Health Services
YRTS- Younker Rehab Therapy Services
GRMC-Grinnell Regional Medical Center
See accompanying independent audifoW report
65
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Assets
Currant assets'
Cash and Cash aquiWahmis
Short4erm hum,tments
Assets limited as to use - required for current liabilities
Pobent axounts receivable, less estimated uncollectibles
Olherreceiv.bles
Inv al-s
Prepaid a.pansee
Due from affiliates
Total current assets
Assets limited as to use, nonwnonl:
Internally designated for capital improvements
Internally designated for insurance reserve
Total assets limited as to use, noncurrent
Property, plant and equipment. net
Operating lease ROU assets
Other long-term Investments
tnve,unents in Joint ventures and other Investments
Contributions receivable, net
Ogler
Co. tom affiliates
Total .,,.is
Llabllltts and Net Assets
Conant liabilities:
Current maturities of long-term debt
Current portion of aD,,.t.g lease liabbli..
ACL4.nts payable
A-ed payroll
Estimated settlements due to third -party payers
Due fe aUAiates
Ott current fiablttes
Total current liabilities
Long-term debt net
Long-term operating lease liabilities
OIAWCn94erm lmbilio..
Due 1. affiliates
Total liabilities
Net .,,.%(defie4).
Without donorrestric0ons:
Amibutable to Unitypoint Health
Attributable to nonconbolling Interest
Total -%out danar ...tri.t.ns
iMth donor testacaane:
Adributable to UnityPoint Health
Atbibutable to ruin conbolling Interest
Total with donor rashictom
Total net assets (deficil)
Total liabilities and net assets
Defaitnns.
TRHS-Trinity Regional Health System
TMC -Trinity, Medal Center
THF-Trinity Health Foundation
7HE-T�inty Health Entehprlses. Inc.
TM - Trinity Museabne
See accompanying Independent auditors' report
$.h.dule4
IOWA
HEALTH SYSTEM AND SUBSIDIARIES
Nora UnityPoint Health
TRINITY REGIONAL
HEALTH SYSTEM AND SUBSIDIARIES (QUAD CITIES)
ConsoW.U.9
$Chedule - Balance Sheet Inlormallon
Year ended December 31.2023
(In thousands)
TRHS
TMC
THE THE
TM
TCN
AIC
SCA
UPC
UPAH
Ellmleallons
Consolidated
s 15
2,907
940 8
9,099
4.072
125
6.093
-
-.
-
24,059
-
1,345
687 6
8428
2.613
-
-
-
-
-
12.979
-
549
- -
-
-
`.
_
_
_
_
549
-
62.277
- -
7,223
-
04j
2.020
-
-
-
62,3D8
4
18.8$5
2 632
3,760
4
-
403
-
--
--
23.666
-
9,615
-.. 100
1.150
-
-
1.126
-
-
-
11,991
12
2,113
- -
69
23
-
288
-
-
2.605
4.829
10.739
138 -
2.545
-
(8472)
9,779
4.660
98.400
1,787 746
33.080
6,612
111
10.730
-
-
(8,472)
147,034
30,417
145.656
- -
12.734
-
_
-
-
-
-
188.807
-
20
- -
20
30,417
145,076
- -
12.734
-
-
-
15
156.444
- 123
27.D14
896
1,891
2.283
-
-
-
i8B,6G6
99
994
- -
-
-
-
18,311
-
--
.-
19 404
-
9,496
12.062 3
7.851
1.396
-
-
-
31.596
1,432
22,477
- --
-
4,740
-
-
2.824
1,569
(14,]t6j
18.732
-
-
407 -
-
-
-
-
-
_
4
19
1,879
(f) 1
290
-
2.725
35,667
-
-
40,57474
-
10.484
- -
-
-
_
_
-
nD.4e4Ii
s 36.642
445684D
15,115 873
80,969
134644
4.727
66,985
2,824
1.569
3 268L
636,122
It
429
-- -
313
-
-
306
-
-
-
1.048
84
497
-
-
1.197
-
-
-
1,778
228
18.669
57 85
1.547
20
9
10,191
-
-
-
30.812
5.608
11.412
104 62
1,617
113
-
599
-
-
-
19,515
-
2.049
-
299
-
-
-
-
2.348
128
33102
- 83 44
3,075
92
-
-
-
(8472)
28.132
1,737
Wage
25 (4)
1.002
1.001
673
13.242
7,785
76.046
269 187
7,853
1.232
9
12.966
-
-
(8,472)
95,875
110
- -
1,729
-
316
384
-
-
-
2,539
15
524
- -
-
-
-
17.339
-
-
-
17,878
1,031
21,512
24 -
1,952
-
-
..-
-
-
-
25,319
-
154,406
- -
16,SB9
-
(10.4841
160,591
9.631
251.678
293 181
28.123
1,2]2
325
30.689
(18.956)
303.202
27,211
185,798
2,241 668
52,59t
7,672
2.342
4.077
2,824
1,451
(1,492)
286.001
-
2.060
31,619
33,678
27.211
165.797
2,241 686
52.591
7.672
4402
36.298
2,824
14451
(IA92)
31§,679
-
8,365
12.681 -
255
4.740
-
-
-
118
(12,818)
13,241
-
0,365
12.501
255
4.740
-
118
(12.8181.
13,241
27.211
194,162
14,822 686
52.B46
12,412
4.402
36,296
2.824
1.569
(14,310)
332.920
s 36.842
445.940
15.115 873
80.962
13.644
4.727
66.985
2.824
1.569
(33,266)
636.122
TCN -Trinity College of Nulsing 8 Health Suences
AIC - Advanced Imaging Center
SCA- SCA Surpery
UPC - UnityPalnl Clime. TRHS Parton
UPAH - UnityPoint at Hama, TA He portion
Be
Schedule 4
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dlbfa UnityPoint Health
TRINITY REGIONAL HEALTH SYSTEM AND SUBSIDIARIES (QUAD CITIES)
Consolidating Schedule —Revenue and Gains. Expenses and Losses Information
Year ended December 31, 2023
(In thousands)
TRHS TMC
THE
THE
TM
TCN
AtC
SCA
UPC
UPAH
Eliminations
Consolidated
Unrestricted revenues:
Net patient service revenue
S — 440,196
—
—
63.456
—
3,264
27.849
67,249
48,070
—
650,064
Other operating revenue
(42) 39,419
37
2,735
3.434
2,569
27
18
10,633
1,490
(5,151)
55,369
Net assets released from restrictions used for operations
42 321
159
—
1
207
11
72
813
Total operating revenue
— 479,936
196
2,735
66,891
2.776
3.291
27.867
78,093
49.632
(5.151)
706.266
Expenses:
Salado. and wages
18.102 143,063
475
610
16,485
1.978
871
6,159
19,721
13,025
—
220.489
Physician compensation and services
9 55,238
—
—
12,885
—
26
—
50,71D
144
(829)
118,183
Emptayee benefits
3,490 29,575
81
134
3,889
464
143
1.233
6,699
3,626
(227)
49,307
Supplies
106 96.052
21
2,333
6.769
45
378
8,473
8.525
23.173
(11)
144,944
Other expenses
(21.788) 132,434
327
140
13,378
1,047
1,280
6,093
25.455
8,954
(4,061)
163,269
Depreciation and amortization
1 14.079
—
34
1,939
120
155
804
770
59
—
17,961
Interest
— 9,116
—
—
717
—
2
11
34
—
(23)
9,857
Provision for uncolrecliblo amounts
— (5)
—
—
—
(24)
(44)
—
(73)
Total operating expenses
— 478,552
904
3.251
56.062
3,654
2.831
22,729
112.114
48.991
(5,151)
723,937
Opem6ng Income (loss)
— 1.354
(708)
(516)
1R829
(878)
460
6.136
(34.021)
641
(17,671)
Nonopemting gains (losses):
Investment Income
2,426 11.946
464
(18)
2,308
359
—
—
—
—
—
17,485
Other, net
Total nonoperating gains (losses), not
2.426 11.946
464
(18)
2.308
359
—
—
17,485
Revenue over (under) expenses before gain (toss)
on bond refinancing transactions
2.426 13.330
(244)
(534)
13.137
(519)
460
5,138
(34,021)
641
—
(186)
Gain (loss) on discon(inued operations
_
Excess (deficiency) or revenues war expenses
2.426 13,330
(244)
(534)
13,137
(519)
460
5,138
(34,021)
$41
—
(1S6)
Less noncontrolling Interest
— —
—
—
(226)
(3.791)
{4,017)
Excess (deficiency) of revenues wet expenses attributable
to Unity Point Health
$ 2,428 13.330
(244)
(534)
13,/37
(519)
234
1,347
(34,021)
641
(4,2(3)
Definitions:
TRHS —Trinity Regional Health System
TCN — Trinlly College of Nursing & Health Sciences
TMC —Trinity Medical Center
AIC —Advanced Imaging Center
THE — Trinity Health Foundation
SCA — SCA Surgery
THE — Trinity Health Enterprises, Inc.
UPC — UnityPoint Clinic. TRHS portion
TM — Trinity Muscatine
UPAH — UnityPoint at Home, TRHS portion
See accompanying indopendent auditors' report.
69
Schedule 5
IOWA HEALTH SYSTEM AND SUBSIDIARIES
drbla UnityPoint Health
MERITER HEALTH SYSTEM, INC. AND SUBSIDIARIES (MADISON)
Consolidating Schedule - Balance Sheet Information
Year ended December 31, 2023
(In thousands)
Assets
MHS
MH
MF
MMS
UPAH
Eliminations
Consolidated
Current assets:
Cash and rash equivalents
5 740
44,422
840
1,013
-
-
47,015
Short -teen investments
-
12,229
-
-
-
-
12,229
Patient accounts receivable, less estimated uncolleclibles
-
65.715
-
509
-
-
66,224
Other receivables
-
6,827
64
2,197
-
-
9,088
Inventories
-
7,145
-
-
-
-
7,145
Prepaid expenses
(12)
805
2
144
-
-
939
Due from affiliates
1,057
346,544
344
20.343
-
(368,116)
172
Total current assets
1.785
483,6B7
1,250
24,2D8
-
(368,116)
142,812
Properly, plant and equipment, net
-
280,89D
-
1,202
-
(51D)
281.582
Operating lease ROU assets
-
5,280
-
-
-
-
5,280
Other long-term investments
5.296
508.246
23,390
7,444
-
-
544,376
Investments in joint ventures and other investments
5,095
43.165
-
3,733
56
(19,229)
32,820
Contributions receivable, net
-
-
511
-
-
-
611
Other
440
24.544
73
2,381
-
-
27.438
Due from affiliates
-
1.600
-
-
-
-
1,600
Total assets
S 12,616
1,347.412
25.224
38.966
56
(387,855)
1,036,419
Liabilities and Net Assets
Current liabilities:
Current maturities of long-term debt
-
Current portion of operating lease liabilities
-
696
-
-
-
-
696
Accounts payable
255
46,714
1.473
1,310
-
(39)
49.713
Accrued payroll
832
21,152
116
1,484
-
-
23.584
Estimated settlements due to third -party payers
-
7,754
-
-
-
-
7,754
Due to affiliates
25
355,965
572
23,100
-
(366,120)
11.542
Other current liabilities
2
765
13
54
-
7
841
Total current liabilities
1,114
433,045
2,174
25,948
-
(368,152)
94,130
Long-term debt, net
-
-
-
-
-..
-
-
Long-term operating lease liabilities
-
4,5a4
-
-
-
-
4.584
Other long-term liabilities
931
1,193
3
1,623
-
-
3,750
Due to affiliates
-
138,780
-
-
-
-
138,780
Total liabilities
2,045
577,603
2,177
27,571
-
(368.152)
241.244
Net assets (deficit):
Total without donor restrictions
10,571
761,555
12,112
11.395
56
(10,365)
785,327
Total with donor restrictions
-
8,251
10.935
-
-
(9,338) _
9.848
Total net assets (deficit)
10.571
769.809
23.047
11.395
56
(19,703)
795.175
Total liabilities and net assets
S 12,616
1,347.412
25.224
38.966
56
(387.855)
1.036.419
Definitions:
MHS-Meriter Health Services, Inc.
MH - Meriter Hospital, Inc.
MF - Meriter Foundation, Inc.
MMS - Meriter Management Services
UPAH - UnityPoint at Home. MHS portion
See accompanying independent auditors' report.
70
f
Schedule 5
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dlbla UnityPoint Health
MERITER HEALTH SYSTEM, INC. AND SUBSIDIARIES (MADISON)
Consolidating Schedule —Revenue and Gains, Expenses and Losses Information
Year ended December 31. 2023
(In thousands)
MHS
MH
MF
MMS UPAH
Eliminations
Consolidated
Unrestricted revenues:
Net patient service revenue $
—
565.906
—
1,970 —
—
558,876
Other operating revenue
4.131
24,451
1.400
25,778 —
(30.254)
25.506
Net assets released from restrictions used for operations
—
415
5
— —
—
420
Total operating revenue
4,131
591.772
1.405
27.748 —
(30.254)
594,802
Expenses:
Salaries and wages
2,991
203,049
749
11.641 —
—
218.330
Physician compensation and services
—
46.644
—
79 —
(956)
45,767
Employee benefits
629
53.738
168
3,340 —
—
57,875
Supplies
—
119,595
13
6,236 —
—
124,844
Other expenses
857
121.926
1,477
8,007 —
(29,526)
102,741
Depreciation and amortization
—
23.124
—
314 —
—
23.438
Interest
—
7,056
—
— —
—
7.056
Provision for uncoileclible accounts
—
—
—
—
Total operating expenses
4,477
575.132
2,407
28.517 —
(30.482)
580,051
Operating income Qoss)
(346)
16,640
0.002)
(769) —
228
14,761
Nonopemting gains (losses):
Investment income
450
53,963
1,304
609 —
—
56,326
Other, net
(71)
(2,259)
(6)
(211) —
—
(2.547)
Total nonoperating gains (losses), net
379
51,704
1.298
398 —
—
53.779
Revenue over (under) expenses before gain (loss)
on bond refinancing transactions
33
68,344
296
(371) —
228
68.530
Gain (loss) on discontinued operations
—
—
—
— —
—
—
Excess (deficiency) of revenues over expenses
33
68,344
296
(371) —
228
68.530
Less noncontrolling interest
—
—
—
— —
—
—
Excess (deficiency) of revenues over expenses attributable
to UngyPoint Health 5
33
68,344
296
371 —
228
68.530
Definitions
MHS — Merger Health Services, Inc.
MH—Merter Hospital, Inc.
MF—Merger Foundation, Inc.
MMS— Merger Management Services
UPAH — UnityPoint at Home, MHS portion
See accompanying independent auditors'report
71
Schedule 6
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dlblo UnilyPoint Health
St. Luke's Healthcare and Subsidiaries (Cedar Rapids)
Consolidating Schedule -Balance Sheet Information
Year ended December 31. 2023
(in thousands)
Assets
SLMH
CARE
JRMC
ABBE
UPC
UPAH
Eliminations
Consolidated
Current assets:
Cash and cash equivalents
S 3,200
1.446
14,802
8,974
-
-
-
28.422
Shod -term Investments
358
-
11.778
173
-
-
-
12,309
Assets limited as to use - required for current liabilities
4,921
-
-
-
-
-
-
4.921
Patient accounts receivable, less estimated uncolleelibtes
55,407
2,850
4.756
3.823
-
-
-
66,636
Otherrecelvables
35,903
-
4.421
1,331
-
-
-
44.655
Inventories
10.304
-
641
-
-
-
-
10,945
Prepaid expenses
2.187
29
77
132
-
-
-
2.425
Due from affiliates
12,579
5.244
1.881
700
(14.430)
5,974
Total current assets
127.859
9.369
38.356
15.133
-
-
(14.430)
176,287
Assets limbed as to use, noncurrent:
Internally designated for capital improvements
167,851
-
-
-
-
-
-
167,861
Internally designated forinsurance reserve
Sao
580
Total assets limited as to use, noncurrent
168.431
-
-
-
-
-
-
168,431
Properly, plant and equipment, net
156,872
13,682
19,059
5,616
-
-
-
195.129
Operating lease ROU assets
10,988
-
931
(3)
-
-
-
11.916
Other long-term investments
62,970
-
23.200
15,935
-
-
-
ID2,114
Investments in joint ventures and other investments
14,598
-
-
-
4,517
3,875
(7,486)
15,504
Contributions receivable, net
44.323
-
1.728
1.141
-
-
-
47.192
Other
4.090
-
1
35
-
-
-
4,126
Due from affiliates
555
(See)
Total assets
S $90.708
22.951
83.275
37,857
4,517
3.875
(22.484)
720.699
Liabilities and Net Assets
Current liabilities:
Current maturities of long-term debt
S -
-
-
79
-
-
-
79
Current portion oroperating lease liabilities
2,185
-
238
242
-
-
-
2.665
Accounts payable
15.341
1,069
1,299
648
-
-
-
18,257
Accrued payroll
16,115
421
1.979
2,101
-
-
-
20.616
Estimated settlements due to third -party payers
1,750
-
1,733
-
-
-
-
3,483
Due to affiliates
34.540
155
1.319
1,652
-
-
(14,430)
23,236
Other current liabilities
7,351
344
987
6,882
Total current liabilities
77,282
1.645
6,912
5.609
-
-
(14,430)
77.018
Long-term debt, net
-
-
--
177
-
-
-
177
Long -tens operating lease liabilities
8,622
-
682
(230)
-
-
_ -
9.066
Other long-term liabilities
12,472
-
15
107
-
-
-
12,594
Due to affiliates
78.677
(568)
78.100
Total liabilities
177.053
1.645
7.609
5.655
(14.998)
176,964
Net assets (deficit):
Without donor restrictions:
Attributable to UnilyPoint Health
363,957
21.305
73.943
31.759
4,455
2.719
(7,486)
490,653
Attributable to noneontrolling interest
(180)
(180)
Total without donor restrictions
363.777
21,306
73.943
31,75g
4,455
2.719
(7.486)
490.473
Win donor restrictions:
Attributable to UnityPoinl Health
49.323
-
1.723
443
62
1,1$6
-
52.707
Attributable to nanconlrolling interest
sss
555
Total with donor restrictions
49,878
1.723
443
62
1,158
53.262
Total net assets (deficit)
413,666
21,306
75,666
32.202
4,517
3,a75
(7,486)
543.735
Total liabilities and net assets
S 590.708
22.951
83,275
37.857
4.517
3.875
(22.484)
720.699
Definitions:
SLMH - St. Luke's Methodist Hospital
ABBE -Abbe. Inc.
CARE - STL Care Company
UPC - UnityPoinl Clinic, SLHC portion
JRMC -Jones Regional Medical Center
UPAH - UnityPoint at Home, SLHC portion
See accompanying independent audhors'report
72
l
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dlbfa UnityPoint Health
St. Luke's Healthcare and Subsidiaries (Cedar Rapids)
Consolidating Schedule - Revenue and Gains, Expenses and Losses Information
Year ended December 31, 2023
(In thousands)
Unrestricted revenues:
Net patient service revenue g
Other operating revenue
Net assets released from restrictions used for operations
Total operating revenue
Expenses
Salaries and wages
Physician compensation and services
Employee benefits
Supplies
Other expenses
Depreciation and amortization
Interest
Provision for uncollectible accounts
Total operating expenses
Operating income (loss)
Nonoperating gains (losses):
Investment income
Other, net
Total nonoperating gains (losses), net
Revenue over (under) expenses before gain (loss)
on bond refinancing transactions
Gain (loss) on discontinued operations
Excess (deficiency) of revenues over expenses
Less noncontrolling Interest
Excess (deficiency) of revenues over expenses attributable
to UnityPoint Health $
Definitions:
SLMH - St. Luke's Methodist Hospital
CARE - STL Care Company
JRMC-Jones Regional Medical Center
See accompanying independent auditors' report
Schedule 6
SLMH
CARE
JRMC
ABBE
UPC
UPAH
Eliminations
Consolidated
430,511
12,348
50,324
27,940
63,574
23.754
-
608.451
42.949
173
5,385
9,060
7.561
389
(11,184)
54,333
1,569
-
53
4
12
228
-
1,866
475,029
12,521
55.762
37,004
71,147
24.371
(11,184)
664,650
152,528
7,278
14,187
21,242
17,620
4,877
-
217,732
34,792
-
8,463
1,708
47,409
7
(610)
91,769
37,523
764
4,231
5,454
5,839
1,295
-
55,106
91.558
1,084
6,433
902
6,811
12,349
(16)
119.121
105,786
3,540
10,791
5.232
21,757
5,940
(10,547)
142,499
13,024
575
1,491
769
764
59
-
16,682
4,980
-
-
12
-
-
(11)
4,981
(71)
-
-
55
-
- _
-
(16)
440,120
13,241
45.596
35,374
100,200
24,527
(11,184)
647,874
34,909
(720)
10,166
1.630
(29,053)
(156)
-
16,776
18,272
15
2,648
1,535
-
-
-
22,470
(5,287)
-
-
-
-
-
-
(5,287)
12.985
15
2,648
1,535
-
-
-
17,183
47,894
(705)
12,814
3,165
(29,053)
(156)
-
33,959
47,894
(705)
12,814
3,165
(29,053)
(156)
-
33,959
32
-
-
-
-
-
-
32
47,926
(705)
12,814
3,165
(29,053)
(156)
-
33,991
ABBE -Abbe, Inc.
UPC - UnityPoint Clinic, SLHC portion
UPAH - UnityPoint at Home, SLHC portion
73
Assets
Cut' It assess.
Cash andcosh equivolents
Short•tam Investments
Assets limited es to use —required for current li.Wites
Patient accounts wceivable, less estimated uncollectibles
Other receivables
Inventories
Prepaid expenses
Due [,am WNiales
Total Current assets
A.ats limited as to use, I .... nenc
Held by trustee under bond indenture agreements
Internally designated for capital improvements
Internally desipneled for insuranea reserve
Total assets limited os to use, nonwrrent
Property, plant and equipment net
Operating lease ROU assets
Other long-term Investments
Investments in Joint ventures and other investments
Conbibuoonsleceivabfe, net
Other
Co. from affiliates
Total assets
Uabllldes and Nol A-11
Cunent liabilities:
Current matelities of I.ngdam debt
Current portion of operating lease babilitee
Amounts payable
Accrued payroll
Accrued Interest
Estimated settlements Were third -part' payers
Due to .t6liet.s
Other wnent h.biti6es
Total 4unen18abilibes
Lang4am debt net
Lang.tam operating leas. liabilities
Other long-term liabilities
Due to afillates
Total liabilities
Net ossets (de6u0.
Wlhout donor resbiceon.
Amibutable to UniryPoint Nealth
Ataihutable to nanconholling interest
Total Vnthoul donor leshlctian4
Wth it nor restrictions:
Attributable to UniryPoint Health
Aenbuloble to nanconholling ml—et
Total with donor restrictions
Total net awots(defcit)
Total liabilities and net assets
Definitions:
AHS —Allen Health System
AMH —Allen Memorial Hospital Corporation
MFAH— Memenal Foundation of Allen Hospital
AC —Allen College
Marshaalmvn — Mmshallt.— Hospital
See accompanying Independent auditors ,.port
Schedule 7
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d7bfa UniryPoint Health
Allen Health
Systems, Inc. and Subsidiaries (Waterloo)
Conaolidadng Schedule —Balance Sheet Information
Year ended Dmarnber 31.2023
(In thousands)
AHS
AMH MFAH
AC
Marshalltown
BHGMHC
UMPA
UPC
UPAH
Eftinations
C... olldated
5 —
6,830 1,604
508
2,127
26
446
—
—
—
11,541
—
4,451 0ss
4
210
22
—
—
—
—
5,397
—
3.907 —
—
—
—
—
—,
3.907
—
41,095 —
9,480
524
2,O87
—
—
—
53,186188
—
24.725 —
(159)
2,970
360
065
—
—
—
2VIII
—
8,616 —
—
1.575
—
—
10,191
—
1,208 —
151
134
2
104
—.
—
—
1,599
33.919
4,651 209
14,187
2.069
122
—
—
(50,19H
5,866
33,919
95.469 2,508
14.691
19.474
1,056
3,502
—
—
(50,181)
120A48
—
141 —
—
—
—
—
—
141
—
141 --•
—
......
—
—
—
—�
—
141
—
112.560 —
—
$1.966
1,918
3.435
—
—
12,280)
177.602
—
11.616
1,496
97
—
—
—
—
13,211
—
157,261 17,005
2
$23
992
—
—
—
—
175.06
39,571
7.385 964
15,791
1.241
....
—
17.805)
10,8
(62,711)
0
—
4.409
303
—
—
4.
4, 712
—
7,196 —
771
45
15
1
—
—
—
8,030030
S 73.490
391,654 24586
31.255
84.850
4,078
6,941
(7,005)
10,626
1115.182)
504.793
S —
— —
—
32
2.149
—
—
—
2,181
—
1,521 —
—
409
32
—
—
—
1.962
—
9,865 66
02
3,063
24
409
—
—
—
13.590
—
12,851 Be
629
2,696
279
227
—
—
—
16.770
IS
9
2.520
22.065 8
92
36,977
262
—
—
(50,191)
12,053
—
6,887 3
10
IA21
1
5
8.327
2.020
54,685 167
$13
45,410
599
2,874
—
—
(50,191)
$7.177
—
—
—
—
124
—
—
—
124
--
10,014
(2)
1.105
65
—
—
—
—
11,292
—
22.029 B
700
977
400
—
—
—
—
24,174
48,600
60.836 —
—
109.438
511420
WS84 175
1,511
47.582
1,124
2A98
(50,791)
202.203
22,070
237.501 2,270
13.976
36,211
2,946
3,444
(7,605)
10.460
(41.029
271.528
—
-- —
—
—
—
499
1.029
1,528
22.070
237.501 2270
13.970
36.211
2,046
3,943
(7,8051
10A00
(42,8891
278.685
—
6.569 22,441
15,766
1,057
108
—
—
166
122.102)
24.005
—
66569 22,441
15,766
1,057
108
Ise
(22.1021
24.005
22.070
244.070 24,711
29.744
37,268
2,954
3,943
(7.805)
10.626
(64.991)
302.590
S 731490
391.654 24.886
31,255
84,850
4.078
6,941
(7,8051
10,626
(175,1e21
504,793
BHGMHC — Blxk Havk•Grundy Menlat Health Center
UMPA—United Medical Park ASC
UPC— UniryPoint Clinic, AHS portion
UPAH— UniryPoint at Home, AHS potion
74
Unrestricted revenues:
Net patient service revenue
Other operating revenue
Net assets released from restrictions used for operations
Total operating revenue
Expenses
Salaries and wages
Physician compensation and services
Employee benefits
Supplies
Other expenses
Depreciation and amortization
Interest
Provision for uncollectible accounts
Total operating expenses
Operating income (loss)
Nonoperaling gains (losses):
Investment Income
Other, net
Total nonopera0ng gains (losses), net
Revenue over (under) expenses before gain (loss)
on bond refinancing transactions
Gain (loss) on discontinued operations
Excess (deficiency) of revenues over expenses
Less nonconlrotling Interest
Excess (deficiency) or revenues over expenses attributable
to UnityPoint Health
Definitions:
AHS-Allen Health System
AMH-Allen Memorial Hospital Corporation
MFAH - Memorial Foundation of Allen Hospital
AC -Allen College
Marshalltown - Marshalltown Hospital
See accompanying Independent audilors'report
IOWA HEALTH SYSTEM AND SUBSIDIARIES
drbfa UnityPalnt Health
Allen Health Systems, Inc, and Subsidiaries (Waterloo)
Consolidating Schedule -Revenue and Gains, Expenses and Losses Information
Year ended December 31, 2023
(In thousands)
AHS AMH MFAH
$ - 325.384
-
2,584 40.258
21
- 445
6
2.584 366.087
27
- 106,728
608
- 36.058
-
- 24,874
147
- 87,956
8
- 67.201
200
- 11.970
-
2,584 3,862
-
- 8
-
2.584 338.667
963
- 27.430
(936)
- 12.828
358
- 370
(101
- 13,198
348
- 40,628
(588)
40.628
(588)
S - 40,628
(5881
BHGMHC - Black Hawk -Grundy Mental Health Center
UMPA - United Medical Park ASC
UPC - UnityPoint Clinic, AHS portion
UPAH - UnityPoint at Home, AHS portion
75
Schedule 7
AC
Marshalltown
BFIGMHC
UMPA
UPC
UPAH
Eliminations
Consolidated
72.006
3,956
14.769
69,511
34.979
(421)
520.184
10,480
3.627
1,612
123
10,833
900
(12,969)
57.469
1.009
107
339
-
12
66
-
1.984
11.489
75.740
5,907
14.892
80.356
35.945
(13.39D)
579,637
6,954
23,539
3.021
2,468
18.037
8,058
-
169,413
12
12,816
2.276
60.126
69
(2,59D)
100.786
1,731
6.115
1.010
722
5.873
2,181
(15)
42.638
88
9.759
23
4.703
5.509
17,934
(10)
126,070
3.205
14.484
522
3,635
23,951
7.596
(8,191)
112,603
-
4,661
89
961
809
61
(676)
17.765
2.59D
-
197
(20)
-
(2,584)
6.629
53
-
-
-
-
-
-
61
12.043
73.863
6,941
12.676
114.385
35,919
(14.066)
583.965
(554)
1,877
(1.0341
2.216
(34,029)
26
676
(4.328)
(2)
24
34
-
-
-
-
13,242
-
-
-
-
-
-
-
360
(2)
24
34
-
-
-
-
13.602
(556)
1,901
(1,000)
2,216
(34,D29)
26
676
9.274
(556)
1,901
(1,000)
2,216
(34,029)
26
676
9.274
-
-
-
(975)
-
-
(297)
(1.272)
(556)
1.901
1�( 0 01
1.241
___..(34.029)
26
379
8,002
Schedule 8
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dlbla UnItyPOlbt Health
St. Luke's Health System, Inc. (Sioux City(
Consolidating Schedule —Balance Sheet Information
Year ended December 31. 2023
(in thousands)
Assets
SLHS SLRMC
SLHR
PSSDS
UPC
UPAH
Eliminations
Consolidated
Current assets:
Cash and cash equivalents
$ 67 4,315
270
4,223
—
—
—
8,875
Short-term invesirroma
59 2599
99
—
—
—
—
Assetslimitedastouse— required for current liabilities
— 3,757
—
—
—
—
—
3.757
3
Patient accounts receivable, less estimated uneolleciibles
— 30,887
363
1,713
-.
-
(25)
,9J8
32.938
Other receivables
232 12,511
—
7
—
._
—
12,750
Inventories
— 4,813
9
$75
—
—
--
5.697
Prepaid expenses
7 606
—
62
—
—
—
676
Due In —affiliates
4.162 54,444
12
Total current assets
4,517 113.932
753
6,080
—
—
(55,955)
70,127
Assets limited as to use, noncurranl:
Internally designated for capital improvements
— 37,456
—
—
—
—
—
37,486
Internally designated for insurance reserve
— f89
_
_
164
Total assets limited as to use, noncurrent
— 37,655
—
....
—
—
—
37,655
Properly, plant and equipment, net
6,971 60,307
934
1,771
—
—
—
69.983
Operating Lease ROU Assests
— 94
—
—
—
—
—
94
Other long-term investments
33 4,751
55
—
—
—
—
4,839
Investments in joinlventures and other Investments
11,804 181
—
—
2,601
15.076
—
29,662
Contributions receivable, net
— 4,818
—
—
—
--
—
4,818
Other
(i) (692)
(2)
2,026
1,331
Total assets
6 23.324 221.046
1,740
10.677
21601
15,076
(55,955)
218.609
Liabilities and Net Assets
Current liabilities:
Current portion of operating lease liabilities
S — 26
—
—
—
—
—
26
Accounts payable
12 6.639
42
570
—
—
(25)
708
Accrued payroll
— 8,091
117
184
—
—
—
8.392
Estimated set0ements duo to Ihhd-party payam
— 593
—
--
—
—
593
Due to affiliates
920 8,925
52,955
1
—
—
(55,930)
6,871
Other current liabilities
409 4,603
143
—
5,155
Total current liabilities
1.341 28,827
53,257
755
—
—.
(55,955)
28,225
Long-term operating lease liabilities
— fig
—
—
—
--
—
68
Other long-term liabilities
— 13,995
162
—
—
—
—
14,157
Due to affiliates
940 36.252
37,192
Total liabilities
2,281 79,142
53,419
755
(55,955)
79,642
Net assets (deficit):
Without &— restrictions:
Attributable to UnityPcinl Health
19.918 136,537
(51,679)
5.231
2.601
15,076
—
127.664
Attributable to noncontrolling interest
— —
—
4.697
4.691
Total Without donor restrictions
19,918 1364537
(51,679)
9,922
2,601
15.076
132.375
VAth donorresbictions:
Attributable to UnhyPolnt Health
11125 5,367
—
—
—
—
—
6.492
Attributable to noncontrolling interest
_
Total Will, donor restdc6ons
1,125 5.367
—
6.492
Total net assets (deficit)
21.043 141,904
(51,679)
9.922
2.601
15,076
138A67
Total liabilities and net assets
5 23.324 221,046
1,740
10.677
2,601
15.076
(55,955)
215.509
Definitions:
SLHS — St. Luke's Health System
PSSDS— Pierce Street Same Day
Surgery
SLRMC — St. Luke's Regional Medical Center
UPC — UnityPaint Clinic, SLHS portion
SLHR — 31. Luke's Health Resources
UPAH — UnilyPoini at Homo. SLHS portion
See accompanying independent auditors' report
76
Schedule 8
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dli UnityPoint Health
SL Luke's Health System, Inc (Sioux City)
Consolidating Schedule - Revenue and Gains. Expanses and Losses Information
Year ended December 31. 2023
(In thousands)
SLHS
SLRMC
SLHR
PSSDS
UPC
UPAH
Eliminations
Consolidated
Unrestricted revenues.
Net patient service revenue
S -
209,270
1,736
16.149
15,94E
16.858
-
269,959
Other 0"laang ravenue
1.735
8.614
-
92
29,513
292
(2.994)
36,152
Net assets released immrestrictians used forapeia0ans
-
762
2
754
Total operating revenue
1.735
218.536
1.736
16.241
44ASI
17,150
_ (2,994)
296,865
Expenses
Salaries and wages
-
80,46B
1,14g
2,555
7.702
3.499
-
95.453
Physician compensation and services
-
29.481
150
-
9.841
-
(10D)
39.372
Employee benefits
-
17.338
327
703
2.403
699
-
21.750
supplies
1
37,667
80
3,460
2.493
8.762
(4)
52,359
Other, expenses
1,139
45.600
311
2,534
22.927
3.404
Depreciation and amortization
271
5,774
39
300
324
33
-
6,741
Interest
125
2.669
-
9
-
-
-
2,803
Provision for uncollettibla accounts
-
(29)
-
(291
Total operating expenses
1,533
216.868
2.056
9.501
45.850
164597
(2.994)
291,471
Operating income ties$)
202
(3321
t320)
6.680
(1,389)
553
Nonoperating gains (losses);
investment income
8
3,638
9
-
-
-
-
3,555
Other, net
Total nonoperabag gains (losses). net
8
3.638
9
3.655
Revenue over (under) expenses before gain (loss)
on bond refinancing transactions
210
3.306
1311)
6,680
(1,369)
553
-
9049
Gain (loss) on it! sconunued operations
Excess (deficiency) of revenues over expenses
210
3,306
(311)
6,680
(1,369)
$53
--
9.049
Less noneonlrolling interest
-
-
-
(3,340)
(3.340)
Excess (deficiency) of revenues over expenses a0butable
to UnityPoint Health
S 210
3,306
(311j
3,34D
(1,3891
553
6.709
Definitions;
SLHS - St Luke's Health System
PSSDS - Pleree
Stwet Same Day
Surgery
SLRMC - St Luke's Regional Medical Center
UPC -UnityPoint Clinic, SLHS portion
SLHR - St Luke's Health Resources
UPAH - UnityPolnt at Home. SLHS
portion
See accompanying independent auditors'report
w
Schedute9
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dWa UnityPomt Health
Trinity Health Systems, Inc. snit Subsldianes (Fort Dodge)
Conwlidabng Schedule - Balance Sheet Inlcrmatian
Year ended December 31. 2023
pn thousands)
Assets
THS TRMC THE
TPG
BMHC
UPC
UPAH
Eliminations
Consolidated
torrent a:sea
Cash and cash equivalents
5 4 5.353 340
115
4,270
-
-
-
10,0B2
Short-term inv.sbn.nts
112 3,509 198
-
3.635
-
-
-
7,534
Assets limited as to use- required for current liabilides
-- 1,331 -
-
-
-
-
1,331
Patient amounts receivable, less call mated uncolleebbles
- 16,675
(2)
327
-
-
-
17=0
Other receivables
103 12,457 9
-
909
-
-
-
13,478
Inventories
- 4,080 135
-
-
-
-
4,19$
Prepaid e,p.n...
- 514
2
-
-
-
516
Cue hots affLates
- 11.662 12
436
102
(7.9191
4,205
Total current assets
219 55,641 694
551
9,245
-
-
(7,9t9)
58.431
Asses limited as to use, noncurrent
Intemally designated for capital improvements
- 69,823 -
-
_
_
.._
-
06.823
Internaly de sign ated for insurance reserve
- 48
48
Total assets limited as to use, noacun.nt
- 66.071 -
.-.
-
-
-
-
$6.871
Property, plant and equipment net
6 73.474 21
-
286
-
-
-
73.787
Op -brig lease ROU assets
1.945
-
-
-
._
-
1,945
Other lonp-term m-th ants
662 2.409 26,453
14,190
2.020
-
45.734
Invesbnents in Joint -la'.. and other investments
30.731 30,5a8
-
29
1,214
3,560
(51.44D)
4,680
Cantribubons receivable, net
7,358
-
-
-
-
7,358
Other
V) 529
1
12
1
612
Total assets
S 31.617 231.625 34,526
14.742
11,592
1,215
3.680
169.359)
259.018
LlablllUes and Net Assets
Curt..t h.bi'.i.es:
Current portion of opc,.bhg leas. liabilities
5 - 524 -
-
-
-
-
524
Accounts payable
5,435 4
5
34
-
-
-
6,478
Accrued payroll
332 6.892 110
-
360
--
-
-
7,692
Es.mated settlements due to third -party payers
422
7
-
-
429
DuetoalSlist..
142 5,302 Gas
6.847
444
-
(7,919)
5,501
Other current liabilities
- 3.403 -
1
1
3.405
Total current lubi6.es
474 21,978 799
6.852
843
1
-
f7,918)
23,029
Long-term opemdng lease liabilities
1.402 -
-
_
_
._
1,402
Other lonl4erm liabilities
660 4.596 -
14.190
34
-
-
-
19.450
Due to atfliales
- 2.600
2,600
Total liab6itles
1,134 30.578 799
214042
877
t
47.9101
46.511
Net assets (de6dt):
Total without donor restrictions
30,483 190,609 22.085
(6,300)
10,686
1,214
3,196
(52,617)
109.246
Wth donal testric.ons
- 10.350 11.642
28
464
(8,624)
13,861
Total with d-riestric64ns
30.483 201.049 33.727
(6.300)
10,715
1.214
3.660
(61,441)
213.107
Total net assets(debol)
3D.483 201.049 33.727
(6,300)
t0,7ti
1.214
3.660
(614411
213,107
Total liabilities and net assets
S 31.617 231,825 34.526
14.742
11.592
1.215
3E60
169.359)
259.618
Carte ons:
THS-Trinity, Health Systems
BMHC-Seryhiil Mental Health Clinic
TRMC -Trinity Reliance Medical Center
UPC- UnityPoint Clinic, THS portion
THE - Trinity Health Foundation
UPAH» UnityPoinl at Home, THS portion
TPG-Trimark Physicians Group
See....panymp Independent-rd.rs'r,part
78
IOWA HEALTH SYSTEM AND SUBSIDIARIES
Schedule 9
cMa Uni(yPoint Health
Trinity Health Systems, Inc. and Subsechanes (Fort Dodge)
Consoilda6ng Schedule — Revenue and Gains. Expenses end Losses
Informaten
Year ended December 31. 2023
it. tho tti.da)
THS TR)4C THE TPG
BMHC
UPC
UPAH
Ellminallons
Consolidated
Un—Victed—enues'.
Netpadentsene—evenue
$ 161,239 —
30 6.125
9.264
23.530
—
200,188
Other op".1mg—c.u.
Z388 18.$26 331
— 724
1,856
460
(1,224)
23.079
Natassets rHeased from res0ic5ons used for aperatons
— 121 5
6
124
256
Total operating revenue
2.346 179.856 336
30 6,855
11,120
24.134
(1.224)
223.523
Expenses
Salaries and wages
2,857 52,232 323
— 1,897
2,765
5,932
—
68,006
PhyslnanwMensation andservices
29,558 —
— 2.596
10,216
—
(31)
42,339
Employee benefits
SOS 12.732 71
1 674
841
11633
16,457
Supplies
— 27.432 76
23
736
11,491
(11)
39.747
Other expenses
14 39.705 158
3 339
4.076
5.274
(1,102)
43.387
Depredaban and.—tataban
7 S,G.4 4
— 37
110
71
—
5.859
Interest
— 591
Provision far -collectible accounts
— (7)
Total operating expenses
3,383 167,870 932
4 5.566
16,748
24.401
11.224)
219.378
Opneting income (loss)
(997) 12010 INS)
26 1.289
9.626)
(267)
4.145
Noneperating gains posses)'.
Investment income
(28) 6,214 2.529
— 444
—
_
—
9,159
Omer, net
Total nonoperating gains(Iosses). net
_ (28) 6,214 2.529
444
9.169
Revenue over (under) expenses before gun pass)
on bondrefinan mg bansaceens
(1,025) 18.230 2,233
26 1,733
(7.626)
(267)
—
13,3D4
Gain (loss) on disconlinoed operabans
_
Excess(de5aenry)o/revenues over expenses
(1,025) 19,230 2,233
26 1.733
(7,626)
(267)
—
13,304
Less noneenbolling interest
Excess (de8aency) of Ievenues over expenses attributable
to UnityP4im Health
$ (1,025) 18.230 2,233
26 1.733
[7,626)
(2671
13,304
Definitions
THS— Trinity Health Systems
BMHC — Benyhili Mental Health Clinic
TRMC— Trinity Reponal Medical Center
UPC—UnityPotnt Crinic, THS por0on
THE—Tnnrty Health Foundaban
UPAH—UnityPoint at Home. THS portion
TPG — Trimark Physltlens Group
See accompanying independent auditors report
m
Assets
Current assets:
Cash and cash equivalents
Shod -term Investments
Patient accounts receivable, less estimated uncolleclihles
Other receivables
Inventories
Prepaid expenses
Due from militates
Total current assets
Assets limited as to use, noncurrent:
Internally designated for capital improvements
Total assets limited as to use, noncurrent
Property. plant and equipment, net
Operating lease ROU assets
Other long -tern investments
Investments In joint ventures and other investments
Contributions receivable, net
Other
Total assets
Liabilities and Net Assets
Current liabilities:
Current portion of operating lease liabilities
Accounts payable
Accrued payroll
Estimated settlements due to third -party payers
Due to affiliates
Other current liabilities
Total current liabilities
Long -tern operating lease liabilities
Other long-term liabilities
Due to affiliates
Total liabilities
Net assets (deficit):
Without donor restr(dions
Total without donor restrictions
Total with donor restrictions
Total net assets (deficit)
Total liabilities and net assets
Definitions:
TRI-ST - Finley TriStales Health Group, Inc.
Finley - The Finley Hospital
VNA-Visiting Nurse Association
See accompanying independent auditors'repod
Schedule 10
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dibra UnifyPoint Health
Finley Td-Stales Health Group, Inc. and Subsidiaries (Dubuque)
Consolidating Schedule- Balance Sheet Information
Year ended December 31.2023
(In thousands)
TRI-ST
Finley
VNA
UPC
UPAH
Eliminations
Consolidated
S -
3,099
480
-
-
-
3.579
-
1,949
-
-
-
-
1,949
-
18,178
35
-
-
--
10.213
-
5,985
494
-
-
-
6,479
-
2,653
-
-
--
-
2,653
-
752
5
-
-
-
757
2.313
317
.-
(921)
1.709
-
34,929
1.331
-
-
(921)
35.339
109.129
-
-
109.129
-
109,129
-
-
-
-
109.129
-
74,808
268
-
-
-
75.078
-
3,018
515
-
-
-
3,533
-
2.422
-
-
-
-
2.422
14
1,730
-
95
72
-
1,911
-
10,827
2,359
-
-
-
13,186
-
347
(1)
-
-
-
346
S 14
237.210
4,472
95
72
(921)
240.942
$ -
820
43
-
-
-
863
-
4,324
18
-
-
-
4,342
-
5.953
366
-
-
-
6.329
-
596
-
-
-
-
595
-
3,160
950
-
-
(921)
3.189
-
2.167
16
-
-
2.183
-
17,030
1,393
-
-
(921)
17.502
-
2.258
488
-
-
-
2.746
-
3.978
-
-
-
-
3,978
-
16.650
-
-
-
16,650
-
39.916
1,861
-
(921)
40.876
14
185,463
224
95
72
-
185.888
14
188,463
224
95
72
-
188,868
-
10.831
2.367
-
-
-
13.198
14
197.294
2.591
95
72
-
200.066
S 14
237,210
4,472
95
72
(921)
240,942
UPAH-UnityPotnt at Home, TRI-ST portion
UPC - UnilyPoint Clinic, TRI-ST portion
80
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dlbla UnityPoint Hearth
Finley Tri-States Health Group, Inc. and Subsidiaries (Dubuque)
Consolidating Schedule —Revenue and Gains. Expenses and Losses Information
Year ended December 31, 2023
(In thousands)
TRIST
Finley
VNA
Unrestricted revenues:
Net patient service revenue $ —
134,847
27
Other operating revenue —
6,511
3,463
Net assets released from restrictions used for operations _ _ —
533
269
Total operating revenue —
141,891
3.759
Expenses
Salaries and wages —
51.341
2.512
Physician compensation and services —
12,549
—
Employee benefits —
12,580
817
Supplies —
23,195
90
Other expenses —
35.462
481
Depreciation and amortization —
5.466
23
Interest —
1.264
—
Provision for uncollectible accounts —
(12)
—
Total operating expenses —
141.845
3,923
Operating income (loss) —
46
(164)
Nonoperating gains (losses):
Investment income —
10,134
1
Other, net —
—
—
Total nonoperating gains (losses), net —
10.134
1
Revenue over (under) expenses before gain (loss)
on bond refinancing transactions --
10.180
(163)
Gain (loss) on discontinued operations —
—
—
Excess (deficiency) of revenues over expenses —
10,180
(163)
Less noncontmlling interest —
—
—
Excess (deficiency) of revenues over expenses attributable
to UnityPotnt Health S
10,180
(163)
Definitions:
TRI-ST—Finley TO -States Health Group, Inc. UPAH—UnityPaint at Home. TRI-ST portion
Finley — The Finley Hospital UPC — UnilyPoinl Clinic, TRI-ST portion
VNA—Visiting Nurse Association
See accompanying independent auditors' report
all
UPC UPAH
— 569
1.229 —
1,229 569
643 24
166 —
149 6
— 465
172 79
1
1.130 575
99 (6)
99 (6)
99 (6)
99 (6)
Schedule 10
Eliminations Coasclldated
— 135,443
(66) 11,117
— 802
(86) 147,362
—
64,520
(66)
12.649
—
13.552
(5)
23,746
(15)
36,179
—
5.490
—
1,264
—
(12)
(86) 147.387
(25)
10.135
10.135
— 10,110
-- 10,1t0
— 10.110
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/bla UnityPoint Health
Affiliated Colleges
Balance Sheet
Year ended December 31, 2023
(in thousands)
Assets
Current assets:
Cash and cash equivalents
Short-term investments
Student loan and other receivables
Prepaid expenses
Due from affiliates
Total current assets
Property, plant and equipment, net
Other long-term investments
Interest in net assets of foundation
Other
Total assets
Liabilities and Net Assets
Current liabilities:
Accounts payable
Accrued payroll
Due to affiliates
Other current liabilities
Total current liabilities
Other long-term liabilities
Total liabilities
Net assets (deficit):
Without donor restrictions:
Attributable to UnityPoint Health
Total without donor restrictions
With donor restrictions:
Attributable to UnityPoint Health
Total with donor restrictions
Total net assets (deficit)
Total liabilities and net assets
Schedule 11
TCN
AC
SLC
Consolidated
4,072
508
258
4,838
2,513
4
-
2,517
4
(159)
31
(124)
23
151
46
220
-
14,187
-
14,187
6,612
14.691
335
21,638
896
-
271
1,167
1,396
2
-
1,398
4.740
15,791
4,328
24,859
-
771
491
1,262
$ 13,644
31.255
5,425
50,324
$ 26
82
24
132
113
629
38
780
92
92
-
184
1,001
8
81
1,090
1,232
811
143
2,186
-
700
11
711
1,232
1.511
154
2,897
7.672
13.978
377
22,027
7,672
13,978
377
22,027
4,740
15,766
4,894
25.400
4.740
15,766
4,894
25,400
12.412
29.744
5.271
47,427
$ 13,644
31.255
5.425
50,324
Definitions:
TCN - Trinity College of Nursing & Health Sciences (Quad Cities)
AC -Allen College (Waterloo)
SLC - St. Luke's College (Sioux City)
Note 1: Fixed assets utilized by AC belong to their parent hospital corporation, Allen Memorial Hospital Corporation (AMH), and thus
are not reflected in the balance sheet of the College. AC receives the benefit of using certain space within AMH's facilities,
but donated revenue and donated expense is not reflected within the income statement of AC.
Note 2: Certain assets and liabilities, such as accrued liabilities, are also not shown separately on the AC balance sheet, but rather included in AMH.
See accompanying independent auditors' report
82
a-
IOWA HEALTH SYSTEM AND SUBSIDIARIES
d/b/a UnityPoint Health
Affiliated Colleges
Revenue and Gains, Expenses and Losses Information
Year ended December 31, 2023
(In thousands)
Revenue:
Tuition and student revenue
Grant revenue
Other revenue
Net assets released from restrictions used for operations
Total operating revenue
Salaries and wages
Physician compensation and services
Employee benefits
Supplies
Other expenses
Depreciation and amortization
Provision for uncollectible accounts
Total expenses
Total operating expenses
Operating income (loss):
Investment income
Total nonoperating gains, net
Revenues over (under) expenses
Total nonoperating gains (losses), net
Schedule 11
TCN
AC
SLC
Consolidated
$ 2,489
10,156
2,871
15,516
41
273
25
339
39
50
102
191
207
1,009
9
1,225
2,776
11,488
3,007
17,271
1,978
6,954
2,241
11,173
—
12
2
14
464
1,731
566
2,761
45
88
81
214
1.047
3,204
1,241
5,492
120
—
77
197
—
53
(29)
24
3,654
12.042
4,179
19,875
6,430
23,530
7,186
37,146
359
(2)
—
357
359
(2)
—
357
(519)
(556)
(1,172)
(2,247)
$ 5,911
22,974
6,014
34,899
Definitions:
TCN — Trinity College of Nursing & Health Sciences (Quad Cities)
AC —Allen College (Waterloo)
SLC — St. Luke's College (Sioux City)
See accompanying independent auditors' report
83
Schedule 112
IOWA HEALTH SYSTEM AND SUBSIDIARIES
dfb/a UNITYPOINT HEALTH
Supplementary Sdndun of Firsormial Reep—bigy Dab
Year ended December 31, 2023
(m meunnde)
Amountreported
In financial
Amount used for
statements or
financial
dlsclosed under
responsibility
Financial Isma,t
U.S ZAP
ntlolnput
Location In tlnandal statements or related notes
Pnmary [ea.—.6. aaperdabla not-san:
No assets.rithout donor[estakoonv
$ 3.621,SS9
—
COnsoliddbd Balance Shoals
Assatownh donor restrictions
211,457
—
Consoldated Balance Sheets
Net as sets mth donor resticlam; matnoed in perpetuity
—
98,292
Not. 16. Endowment
Nat risen vMnd— resbictons: 01wrtarpumosa or time.
—
113.166
NOW 17. Finandal Rasponsbiliy Standards
purchase of equipment
—
13,787
lMipent ce[ayoperatore
—
89.796
Health edumbon
—
9.1gg
Foruse In hdure periods
—
3W
Annuites x+th donorrasbro.ns;
—
—
TGrntendomn.1%W'thdo-I restrictions
—
—
L'do m. fund, with donor —trimans.
—
—
SaeuredandUrrsocuredralatedpadyrecelvahlca;
...
-
UnsacursdrelatedPa[yneeiablaa:
—
—
Uneecuradathatidandwryassetr.
—
—
Property. plant and equipment not(indudas ComtrueOon In progress and Capital lasses).
1,548,599
—
Consandand Balance Shoats
Prapedy, plantaM agrdpmenl- proimpleme ntaton(includes Capita Lea year
--
-
Propsny.plant anal equipment- PasaenpementaOan MN outmoding debt foronginal purhase (irlctodes Capital teases): —
—
Propedy.plant end aqrapment-post-implementation wtthoutoutstanding debt for original purchase. 1,462.163
—
Note l (h). Property Pnm and Equipment
ConstrOm- In Process'
66.435
—
Note Ilh). Property Plant and Equipment
Lease nghW—a asset net
162.
—
Conn dated Balance Sheets
Lease jtml01use asset Post -implementation'
162.795
Intangbla.veto;
—
42.170
Note 17, Financial Raspanabdrty S. lords
PostromPlaymantand pension Gabihtes.
—
131474
Not. 17, Financial Responsibility Standards
Lang-tarm debt -tor tang te[mpurpo6es.
55
761.4
—
Censokul,d Balance Shoals
Leng0rm dobt-for tang nrm purposes preamplamsnn0on
—
Longnrmdett-nrlang nrm purposes posHmplemennaon
78I.SS4
—
Consolidated Data,. Sheets
Line of credit far C... lmclun in Process:
—
—
Lea senghtcf—asset ,ability:
—
—
Consoldated Balance Shoes
Preimptemem0on righsof— leases liabilrb-
—
Poattimplemanntonrightc/wee leases habilitiae
166.446
—
Consolidsnd Balance Shoes
Total Espensesand Losses
—
—
Pnmary Reserve Rat.: Ton[ Expenses and Los..
Total..penes widnut donor restriction. -tab, direcvy from StatementoIActiuib-
4.733.545
—
Nate 17. Financial Responsibdiy Standards
Non -Operating and Not lmestrwm(l.-y
(6,791)
Consolidand Stanmans ef0peratells and Changes in Net Asses
Offer mmpanents of not p.—IJI. pennon cosh:
—
8.459
NOW 17. Finandal Responsibility Standards
IntoWal oust
—
16.083
NOW 17. Financial Rsaponsibili y Standards
Eap-tod N. on plan arias
—
(t7,712)
NOW 17. Financial Respansibilp Standards
Arror"Dri of prior service credit
-.
190
NOW 17, Financial Nast ..bility Stand me
Anur0ta0on of net(gainyloss
—
7.898
Non 17, Finandal Reap—ibilily Standard,
Change In value al spninnrart agreements:
_
Odor base.,
—
—
Net invasvnentlow.a.:
Pension -reland 11u1941 other than net wriodic toss:
—
—
-
Equity R960; Modified Not Asses:
Netessos wiWmdonorresvicfions
3,821,599
—
Consotidantl Balance Sheets
Natesws widldono[nstricvone
211,457
—
Consolidate Balance Shoals
Lease `III asset pwolplemenuton
_
—
P—Inplemannacn rightoPuse laasaa liah9ities
—
—
(nnngbla ossas
—
-.
Note 17, Finandal Rasp—lbiliy Standards
Unucned reland partyroceivaWes
—
—
lJow ad nlatod wdY .the=.
Equity Rato'. ModRed Aswus
Total asses
8.212.010
—
Cops Wated Bal.nce Sheets
Leass rigntcWse asset pre-impnmenntlon
—
—
Im azble assets
—
—
NOW 17, Financial Roswnvlitiy Standards
Unsacurod[elate4 parry receivables
—
—
Umecundrelatedparty other assets
—
—
Nal Income Ra00'. Change m Nat Asses NhTout Donor Restnctrans;
Change in NetAsses eivaut Donor Resviction
371.494
—
Consolidated 5unmons ofOperations and Changes in Net Asses
Nat Income Not. Tunl Revenues and Gain. -
To tal Opentrnp Rev and Other Adducts: (Gains)
6,516.626
—
Consalidand Stanmans of Operaeana and Changes In Net Assay
Tout Opentne Rev and OdrerAdditions (Gains) discontnued opetbt—
708,685
NOW 18.DiscerranuedOwrat—
Investm a tnhenapproprialedforsp-ling
1.700
—
Footnote 10, Endowment
N—Op2t.,; Revenue and Other Gams
225,931
—
COnsohdand Stamens of Operafions and Changes in Not Assets
500 acccmpanyug indepondent auditors'repclt