Audit 321825

Title: Reporting Entity Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, either the cost principles in OMB Circular A-122, Cost Principles for Non-Profit Organizations, or the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected to not use the 10% de minimis indirect cost rate allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Iowa Health System and Subsidiaries d/b/a UnityPoint Health (the System) under programs of the federal government for the years ended December 31, 2023 and 2022. Iowa Health System and Subsidiaries d/b/a UnityPoint Health include: Central Iowa Health System and Subsidiaries d/b/a UnityPoint Health – Des Moines, Des Moines, Iowa; St. Luke’s Healthcare and Subsidiaries, Cedar Rapids, Iowa; Allen Health Systems, Inc. and Subsidiaries, Waterloo, Iowa; St. Luke’s Health System, Inc., Sioux City, Iowa; Finley Tri States Health Group, Inc. and Subsidiaries, Dubuque, Iowa; Trinity Health System, Inc. and Subsidiaries, Fort Dodge, Iowa; Trinity Regional Health System and Subsidiaries, Rock Island, Illinois; Methodist Health Services Corporation and Subsidiaries, Peoria, Illinois and Meriter Health Services, Inc. and Subsidiaries, Madison, Wisconsin (collectively, the System). 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. The accompanying notes are an integral part of this Schedule. The information in this Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System.

Title: Basis of Accounting Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, either the cost principles in OMB Circular A-122, Cost Principles for Non-Profit Organizations, or the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected to not use the 10% de minimis indirect cost rate allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, either the cost principles in OMB Circular A 122, Cost Principles for Non Profit Organizations, or the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10% de minimis indirect cost rate allowed under the Uniform Guidance. For the years ended December 31, 2023 and 2022, the System had no expenditures in the form of noncash assistance, had no federally provided insurance in effect, or loans or loan guarantees outstanding at year end.

Title: Loan Programs Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, either the cost principles in OMB Circular A-122, Cost Principles for Non-Profit Organizations, or the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected to not use the 10% de minimis indirect cost rate allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The federal loan programs listed subsequently are administered directly by the System, and balances and transactions relating to these programs are included in the System’s consolidated financial statements. Loans outstanding at the beginning of the year and loans made during the year are included in the federal expenditures presented in the Schedule. The balance of loans outstanding at December 31, 2023 and 2022, consists of: ALN 93.264 - Nurse Naculty Loan Program - 2023: 262,351; 2022: 264,173 ALN 93.364 - Federal Nursing Student Loans - 2023: 1,233,399; 2022: 1,069,590 The following schedule represents loans advanced by the System for the years ended December 31, 2023 and 2022: ALN 93.264 - Nurse Faculty Loan Program - 2023: 31,375; 2022: 39,081 ALN 93.364 - Federal Nursing Student Loans - 2023: 206,515; 2022: 209,752

Title: COVID 19 Provider Relief Fund Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, either the cost principles in OMB Circular A-122, Cost Principles for Non-Profit Organizations, or the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected to not use the 10% de minimis indirect cost rate allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The Provider Relief Fund (PRF) program is administered by the Health Resources and Services Administration to support eligible providers during the COVID 19 Pandemic and was approved for funding originally under the Coronavirus Aid, Relief and Economic Securities Act. Funds were provided to eligible providers to support healthcare related expenses or lost revenues attributable to the Coronavirus without application but rather with terms and conditions. These terms and conditions required acceptance through an online portal or the funds were to be returned. The System accepted the terms and conditions. The accompanying schedule of expenditures of Federal awards includes PRF for Reporting Period 5 (defined as payments received between January 1, 2022 to June 30, 2022. The Tax Identification Numbers (TIN) for the System’s entities that received PRF funds for Reporting Period 5 is as follows: St Luke’s Methodist Hospital 420504780 STL Care Company 421276632 Jones Regional Med Center 421487967 Anamosa Area Ambulance Service 421466284 Medical Labs Of Eastern Iowa 271814458 Finley Hospital 420680354 Allen Memorial Hospital 420698265 Black Hawk Grundy Mental Hlth 420733463 UnityPoint Health-Marshalltown 815034179 Central IA Hospital Corp 420680452 Younker Rehab Therapy Services 815031103 Eyerly Ball 420942273 Grinnell Regional Medical Ctr 420933383 Meriter Hospital Inc 390806367 Meriter Laboratories 391293620 Methodist Medical Center 370661223 Proctor Hospital 370681540 Belcrest Services LTD 371196307 Proctor Health Systems 364147437 Pekin Hospital 370692351 Pekin ProHealth 371117052 Trinity Medical Center 362739299 Trinity Muscatine 420680337 Trinity Regional Med Center 421009175 Berryhill Mental Health Center 420937390 Sioux City Regional Med Center 421019872 UnityPoint Clinic 421411630 UnityPoint At Home 421477471