UnityPoint Clinic Urgent Care - West

2255 John F Kennedy Road
Dubuque, IA 52002

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IRS Form 990 Overview

As is true of all tax exempt organizations, UnityPoint Health and its tax exempt affiliate entities are required by federal law to file an annual informational return IRS Form 990 "Return of Organizations Exempt from Income Tax" and to make that report available to the public upon request. The governing board of UnityPoint Health is made up of community leaders from throughout its Iowa and western Illinois service region. These community leaders have determined that its mission is to improve the health of the people and communities it serves.

UnityPoint Health fully understands that its exemption from federal income tax is a privilege that must be continuously earned and maintained. UnityPoint Health is supportive of current IRS and Congressional efforts to increase the reporting of information concerning tax exempt organizations' activities. UnityPoint Health also is supportive of compliance with applicable law, transparency in its operations and disclosure of executive compensation, and wishes to continue its history of a strong, informed governance accountable to the constituents served by the organization.

UnityPoint Health is proud of these goals and considers many of its policies and practices to be industry leading. In its efforts to be a forward-thinking industry leader and transparent organization, UnityPoint Health corporate policies as well as the information made publicly available go beyond IRS requirements Examples include:

  • Executive compensation.

    UnityPoint Health has provided full and complete compensation and benefit information for top executives on its Web site for several years before it was required by the IRS. UnityPoint Health is currently in full compliance with IRS executive compensation reporting requirements.

  • Community benefit .

    Before required by the IRS, UnityPoint Health adopted reporting policies consistent with the Catholic Health Association (the standards eventually endorsed by the IRS and the Congressional oversight authorities) and the new IRS community benefit reporting standards. Tax-exempt hospitals have received criticism for reporting community benefit information using standards inconsistent with the Catholic Health Association, which in many cases resulted in reporting higher, inconsistent amounts. UnityPoint Health hospitals have used the Catholic Health Association's standards, thus ensuring its reporting is accurate and consistent with best practice standards and IRS reporting requirements.

  • Corporate compliance.

    UnityPoint Health and its affiliate entities collectively sponsor a corporate compliance team that develops systemwide policies to ensure compliance with the law, transparency and reliability of information, and the best nonprofit governance practices. More than 130 compliance policies are in place and are available to the public on the UnityPoint Health Web site. These policies include the topics of charity care, conflicts of interest and code of conduct standards, including business ethics.

Form 990 Table of Contents:

Core Form

Part I: Summary (Includes: Mission statement, number of board members, independent board members, volunteers and financial data)

Part II: Signature Block

Part III:  Program Service Accomplishments (Includes: Mission statement and program service accomplishments)

Part IV: Checklist of required schedules

Part V: Statements regarding other IRS Filings & Tax Compliance

Part VI: Governance, management and disclosure (Includes: Number of board members and independent board members, narratives of policies and public disclosure)

Part VII: Compensation of officers, directors, trustees, key employees, highest compensated employees and independent contractors

Part VIII: Statement of Revenue (Includes all income)

Part IX: Statement of Functional Expenses (Includes all expenses)

Part X: Balance Sheet


Schedule A: Public Charity Status and public support (Includes information from 2017-2021)

Schedule B: Schedule of Contributors (Contributions greater than $5,000 must be reported)

Schedule C: Lobbying expenditures

Schedule D: Supplemental Financial Statements (Includes: Donor funds, endowment funds, depreciation, investments, other liabilities and reconciliation of revenue and expenses per audit report)

Schedule E: Schools (Includes checklist and narratives that are to be completed by schools)

Schedule F: Statements of activities Outside the U.S.

Schedule G: Supplemental information regarding Fundraising or Gaming activities (Activities greater than $15,000 must be reported)

Schedule H: Hospitals (Includes: Facility information, charity care and other community benefits, community building activities and bad debt and collection practices.)

Schedule I: Grants and other assistance to organizations, governments and individuals in the U.S. (Includes: Grants, scholarships or other specific assistance greater than $5,000 that must be reported)

Schedule J: Compensation information (Completed for individuals that receive more than $150,000 in Part VII of core form)

Schedule K: Supplemental information on Tax Exempt Bonds

Schedule L: Transactions with interested persons (Includes: Conflict of interest information and excess benefit transactions)

Schedule M: Non-cash Contributions

Schedule N: Liquidation, Termination, dissolution or significant disposition of assets

Schedule O: Supplemental Information (Narratives and for the above schedules and core form are printed on this schedule)

Schedule R: Related Organizations and Unrelated Partnerships (Includes: Related tax-exempt organizations, related partnerships, related corporations or trusts and transactions with related organizations)

UnityPoint Health and its affiliate entities' most recent tax year IRS Form 990, and IRS Form 990-T is available on this Web site. Printed copies may be obtained by calling the UnityPoint Health Tax Services office at (515) 224-7132, visiting in person or sending a letter to UnityPoint Health Tax Services, 1776 West Lakes Parkway, Suite 400, West Des Moines, IA 50266.

The UnityPoint Health IRS Form 990 has been prepared as a Portable Document File (PDF). You must download the PDF file to your computer and have the Adobe Acrobat Reader application to view the pages of the document. If you don't have your computer configured to access PDF files, you may download the Adobe Acrobat Reader software for free from Adobe's Web site. We recommend you download the latest version of Acrobat Reader. It's available for both IBM compatibles and Macintosh. After downloading the software, follow the text files for direction on how to install the software on your computer.

Community Benefit

UnityPoint Health believes that, as an organization exempt from federal income tax, it has a responsibility to the public to provide community benefits, including charity care. When reporting community benefits, UnityPoint Health has adopted guidelines from collaboration between the Veterans Health Administration and the Catholic Health Association. This approach has support from U.S. Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) to improve tax-exempt organization transparency. The IRS adopted this approach as part of the Form 990 redraft for tax year 2008.

These standards define community benefits as programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. These community benefits increase access to health care and improve community health. To qualify as community benefits, the programs or activities cannot be provided for marketing purposes.

A community benefit must respond to an identified community need and meet at least one of the following criteria:

  • Generate a low or negative financial operating margin (or profit)
  • Respond to needs of special populations, such as persons living in poverty and other disenfranchised or economically disadvantaged persons
  • Supply services or programs that would likely be discontinued - or would need to be provided by another nonprofit organization or government provider - if the decision, of whether or not to provide the service or program, was made on a purely financial basis
  • Respond to public health needs
  • Involve education or research that improves overall community health

Community Benefit Includes:

  • Charity care (Care for which hospitals never expect to be reimbursed after determining a patient's inability to pay.)
  • Government-sponsored indigent health care - unpaid costs of public programs
  • Medicaid
  • State Children's Health Insurance Programs (SCHIP)
  • Medically indigent programs
  • Community Benefit Services

Community Benefit Does Not Include:

  • Bad debt (Uncollectible charges excluding contractual adjustments (negotiated discounts), arising from the failure to pay by patients whose health care has not been classified as charity care.) Contractual allowances or quick-pay discounts
  • Uncompensated Medicare (Cost of providing services that Medicare doesn't pay.)
  • Low or negative margin services resulting from opera rational inefficiencies

Criteria for Determining Community Benefit Services:
The cost of the program or services can be counted as quantifiable community benefit if the program:

  • Addresses an identified community need
  • Includes low-income and underserved persons
  • Has a relationship to the organization's mission
  • Meets a need that otherwise would have to be met by the government or another nonprofit organization

Do not count as quantifiable community benefit if the program is:

  • Provided for marketing purposes
  • For employees only
  • Required of all health care providers by rules or standards
  • Questionable as to whether it should be reported