EXTENDED TO NOVEMBER 15, 2018 Exempt Organization Business Income Tax Return. (and proxy tax under section 6033(e))

Transcription

1 Form Department of the Treasury Internal Revenue Service For calendar year 0 or other tax year beginning, and ending. Go to for instructions and the latest information. Do not enter SSN numbers on this form as it may be made public if your organization is a 0(c)(). OMB No. -0 Open to Public Inspection for 0(c)() Organizations Only Employer identification number A Check box if Name of organization ( Check box if name changed and see instructions.) D (Employees trust, see address changed instructions.) B Exempt under section Print ABBEHEALTH, INC. - X 0( c )( 0 ) or E Unrelated business activity codes Number, street, and room or suite no. If a P.O. box, see instructions. (See instructions.) Type 0(e) 0(e) 0 N TH AVE, NO. A Book value of all assets C F Group exemption number (See instructions.) at end of year,0,. G Check organization type X 0(c) corporation 0(c) trust 0(a) trust Other trust H Describe the organization s primary unrelated business activity. RENTAL INCOME I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? ~~~~~~ X Yes No If "Yes," enter the name and identifying number of the parent corporation. SEE STATEMENT J The books are in care of ABBEHEALTH, INC. Telephone number -- Part I Unrelated Trade or Business Income (A) Income (B) Expenses (C) Net b b c Less returns and allowances c Balance ~~~ Other income (See instructions; attach schedule) ~~~~~~~~~~~~ Total. Combine lines through,00.,.. Part II Deductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contributions, deductions must be directly connected with the unrelated business income.) T 0A 0(a) City or town, state or province, country, and ZIP or foreign postal code (a) HIAWATHA, IA a Gross receipts or sales Cost of goods sold (Schedule A, line ) ~~~~~~~~~~~~~~~~~ Gross profit. Subtract line from line c ~~~~~~~~~~~~~~~~ a Capital gain net income (attach Schedule D) ~~~~~~~~~~~~~~~ Net gain (loss) (Form, Part II, line ) (attach Form ) ~~~~~~ Capital loss deduction for trusts ~~~~~~~~~~~~~~~~~~~~ Income (loss) from partnerships and S corporations (attach statement) ~~~ Rent income (Schedule C) ~~~~~~~~~~~~~~~~~~~~~~ Unrelated debt-financed income (Schedule E) ~~~~~~~~~~~~~~ Interest, annuities, royalties, and rents from controlled organizations (Sch. F)~ Investment income of a section 0(c)(), (), or () organization (Schedule G) Exploited exempt activity income (Schedule I) ~~~~~~~~~~~~~~ Advertising income (Schedule J) ~~~~~~~~~~~~~~~~~~~~ Compensation of officers, directors, and trustees (Schedule K) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Salaries and wages ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repairs and maintenance Bad debts ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Interest (attach schedule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Taxes and licenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Charitable contributions (See instructions for limitation rules) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ STATEMENT SEE STATEMENT Depreciation (attach Form ) Less depreciation claimed on Schedule A and elsewhere on return Depletion Contributions to deferred compensation plans EXTENDED TO NOVEMBER, 0 Exempt Organization Business Income Tax Return (and proxy tax under section 0(e)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total deductions. Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ c a b c ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Employee benefit programs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess exempt expenses (Schedule I) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess readership costs (Schedule J) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other deductions (attach schedule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Unrelated business taxable income before net operating loss deduction. Subtract line from line ~~~~~~~~~~~~ Net operating loss deduction (limited to the amount on line 0) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT Unrelated business taxable income before specific deduction. Subtract line from line 0 ~~~~~~~~~~~~~~~~~ Specific deduction (Generally $,000, but see line instructions for exceptions) ~~~~~~~~~~~~~~~~~~~~~ a 0 b 0 0,00.,....,00 Unrelated business taxable income. Subtract line from line. If line is greater than line, enter the smaller of zero or line LHA For Paperwork Reduction Act Notice, see instructions. Form 0-T (0) ABBEHEALTH, INC. -

2 Form 0-T (0) ABBEHEALTH, INC. - Part III Tax Computation Organizations Taxable as Corporations. See instructions for tax computation. Controlled group members (sections and ) check here X See instructions and: a b c () $ () $ () $ Enter organization s share of: () Additional % tax (not more than $,0) $ () Additional % tax (not more than $0,000) ~~~~~~~~~~~~~ $ Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax on the amount on line from: Proxy tax. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Tax on Non-Compliant Facility Income. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total. Add lines, and to line c or, whichever applies Part IV Tax and Payments a Foreign tax credit (corporations attach Form ; trusts attach Form ) ~~~~~~~~ a b c d e Total credits. Add lines a through d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other taxes. Check if from: Form Form Form Form Other (attach schedule) Total tax. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a Payments: A 0 overpayment credited to 0 ~~~~~~~~~~~~~~~~~~~ b 0 estimated tax payments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ c Tax deposited with Form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Foreign organizations: Tax paid or withheld at source (see instructions) ~~~~~~~~~~ f g Other credits and payments: Total payments. Add lines a through g ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax due. If line is less than the total of lines and, enter amount owed ~~~~~~~~~~~~~~~~~~~ Overpayment. If line is larger than the total of lines and, enter amount overpaid ~~~~~~~~~~~~~~ 0 Enter the amount of line you want: Credited to 0 estimated tax Refunded Part V Statements Regarding Certain Activities and Other Information (see instructions) At any time during the 0 calendar year, did the organization have an interest in or a signature or other authority Yes No Sign Here Enter your share of the $0,000, $,000, and $,,000 taxable income brackets (in that order): Income tax on the amount on line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax rate schedule or Schedule D (Form ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Alternative minimum tax Other credits (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ General business credit. Attach Form 00 ~~~~~~~~~~~~~~~~~~~~~~ Credit for prior year minimum tax (attach Form 0 or ) ~~~~~~~~~~~~~~ Subtract line e from line 0 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Backup withholding (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~ Credit for small employer health insurance premiums (Attach Form ) Form ~~~~~~~~ Form Other Total Estimated tax penalty (see instructions). Check if Form 0 is attached ~~~~~~~~~~~~~~~~~~~ over a financial account (bank, securities, or other) in a foreign country? If YES, the organization may have to file FinCEN Form, Report of Foreign Bank and Financial Accounts. If YES, enter the name of the foreign country here Paid Preparer Use Only During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? ~~~~~~~~~ If YES, see instructions for other forms the organization may have to file. Enter the amount of tax-exempt interest received or accrued during the tax year $ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. = = PRESIDENT & CEO Signature of officer Date Title Print/Type preparer s name Preparer s signature Date Check Firm s name Firm s address b c d a b c d e f g self- employed Firm s EIN Phone no. c 0 e 0 Page May the IRS discuss this return with the preparer shown below (see instructions)? Yes No if PTIN X X Form 0-T (0) ABBEHEALTH, INC. -

3 Form 0-T (0) ABBEHEALTH, INC. - Page Schedule A - Cost of Goods Sold. Enter method of inventory valuation N/A Inventory at beginning of year ~~~ Inventory at end of year ~~~~~~~~~~~~ Purchases ~~~~~~~~~~~ Cost of goods sold. Subtract line Cost of labor~~~~~~~~~~~ from line. Enter here and in Part I, a Additional section A costs line ~~~~~~~~~~~~~~~~~~~~ (attach schedule) ~~~~~~~~ a Do the rules of section A (with respect to b Other costs (attach schedule) ~~~ b property produced or acquired for resale) apply to Total. Add lines through b the organization? Schedule C - Rent Income (From Real Property and Personal Property Leased With Real Property) (see instructions). Description of property Yes No () () () () () () () (a). From personal property (if the percentage of rent for personal property is more than % but not more than 0%) Rent received or accrued (b) From real and personal property (if the percentage of rent for personal property exceeds 0% or if the rent is based on profit or income) (a) Deductions directly connected with the income in columns (a) and (b) (attach schedule) () Total Total (c) Total income. Add totals of columns (a) and (b). Enter (b) Total deductions. Enter here and on page, here and on page, Part I, line, column (A) Part I, line, column (B) Schedule E - Unrelated Debt-Financed Income (see instructions). Deductions directly connected with or allocable. Gross income from to debt-financed property. Description of debt-financed property or allocable to debtfinanced property (a) Straight line depreciation (b) Other deductions (attach schedule) (attach schedule) () () () () () () () (). Amount of average acquisition. Average adjusted basis. Column divided. Gross income. Allocable deductions debt on or allocable to debt-financed of or allocable to by column reportable (column (column x total of columns property (attach schedule) debt-financed property x column ) (a) and (b)) (attach schedule) Enter here and on page, Part I, line, column (A). Enter here and on page, Part I, line, column (B). Totals ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total dividends-received deductions included in column % % % % Form 0-T (0) ABBEHEALTH, INC. -

4 Form 0-T (0) ABBEHEALTH, INC. - Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions) Exempt Controlled Organizations. Name of controlled organization. Employer. Net unrelated income. Total of specified. Part of column that is. Deductions directly identification (loss) (see instructions) payments made included in the controlling connected with income number organization s gross income in column Page () ABBE MANAGEMENT () CORPORATION - () () Nonexempt Controlled Organizations () () () () () () () (). Taxable Income. Net unrelated income (loss). Total of specified payments Part of column that is included. Deductions directly connected (see instructions) made in the controlling organization s with income in column gross income. Description of exploited activity. Description of income. Amount of income. Gross unrelated business income from trade or business Enter here and on page, Part I, line, col. (A).. Expenses directly connected with production of unrelated business income Enter here and on page, Part I, line, col. (B). Enter here and on page, Part I, line, column (A).. Net income (loss) from unrelated trade or business (column minus column ). If a gain, compute cols. through. Add columns and Enter here and on page, Part I, line, column (A). Add columns and. Enter here and on page, Part I, line, column (B).. Deductions Total deductions directly connected. Set-asides. and set-asides (attach schedule) (attach schedule) (col. plus col. ). Gross income. Expenses from activity that attributable to is not unrelated column business income Enter here and on page, Part I, line, column (B). Totals Schedule I - Exploited Exempt Activity Income, Other Than Advertising Income (see instructions) () () () () STATEMENT..,00.,00.,. Totals J,00.,. Schedule G - Investment Income of a Section 0(c)(), (), or () Organization (see instructions). Excess exempt expenses (column minus column, but not more than column ). Enter here and on page, Part II, line. Totals Schedule J - Advertising Income (see instructions) Part I Income From Periodicals Reported on a Consolidated Basis. Name of periodical. Gross. Direct advertising advertising costs income. Advertising gain or (loss) (col. minus col. ). If a gain, compute cols. through.. Circulation. Readership income costs. Excess readership costs (column minus column, but not more than column ). () () () () Totals (carry to Part II, line ()) Form 0-T (0) ABBEHEALTH, INC. -

5 Form 0-T (0) ABBEHEALTH, INC. - Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns through on a line-by-line basis.) () () () () Totals from Part I. Name of periodical. Gross. Direct advertising advertising costs income Enter here and on page, Part I, line, col. (A). Enter here and on page, Part I, line, col. (B).. Advertising gain or (loss) (col. minus col. ). If a gain, compute cols. through.. Circulation. Readership income costs. Excess readership costs (column minus column, but not more than column ). Enter here and on page, Part II, line. Totals, Part II (lines -) Schedule K - Compensation of Officers, Directors, and Trustees (see instructions). Percent of. Compensation attributable Title time devoted to. Name. to unrelated business business () () () () Total. Enter here and on page, Part II, line % % % % Page Form 0-T (0) ABBEHEALTH, INC. -

6 SCHEDULE O (Form 0) (Rev. December 0) Department of the Treasury Internal Revenue Service Name Consent Plan and Apportionment Schedule for a Controlled Group Attach to Form 0, 0-C, 0-F, 0-FSC, 0-L, 0-PC, 0-REIT, or 0-RIC. Information about Schedule O (Form 0) and its instructions is available at OMB No. -0 Employer identification number ABBEHEALTH, INC. - Part I Apportionment Plan Information Type of controlled group: a Parent-subsidiary group b Brother-sister group c X Combined group d Life insurance companies only This corporation has been a member of this group: a X For the entire year. b From, until. This corporation consents and represents to: a Adopt an apportionment plan. All the other members of this group are adopting an apportionment plan effective for the current tax year which ends on, and for all succeeding tax years. b X Amend the current apportionment plan. All the other members of this group are currently amending a previously adopted plan, which was in effect for the tax year endingdecember, 0, and for all succeeding tax years. c Terminate the current apportionment plan and not adopt a new plan. All the other members of this group are not adopting an apportionment plan. d Terminate the current apportionment plan and adopt a new plan. All the other members of this group are adopting an apportionment plan effective for the current tax year which ends on, and for all succeeding tax years. If you checked box c or d above, check the applicable box below to indicate if the termination of the current apportionment plan was: a Elected by the component members of the group. b Required for the component members of the group. If you did not check a box on line above, check the applicable box below concerning the status of the group s apportionment plan (see instructions). a No apportionment plan is in effect and none is being adopted. b An apportionment plan is already in effect. It was adopted for the tax year ending for all succeeding tax years., and If all the members of this group are adopting a plan or amending the current plan for a tax year after the due date. a b (including extensions) of the tax return for this corporation, is there at least one year remaining on the statute of limitations from the date this corporation filed its amended return for such tax year for assessing any resulting deficiency? See instructions. N/A. (i) (ii) Yes. The statute of limitations for this year will expire on. On, this corporation entered into an agreement with the Internal Revenue Service to extend the statute of limitations for purposes of assessment until No. The members may not adopt or amend an apportionment plan.. Required information and elections for component members. Check the applicable box(es) (see instructions). a The corporation will determine its tax liability by applying the maximum tax rate imposed by section to the entire amount of its taxable income. b The corporation and the other members of the group elect the FIFO method (rather than defaulting to the proportionate method) for allocating the additional taxes for the group imposed by section (b)(). c The corporation has a short tax year that does not include December. For Paperwork Reduction Act Notice, see Instructions for Form Schedule O (Form 0) (Rev. -0) 0-0- JWA ABBEHEALTH, INC. -

7 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part II Taxable Income Apportionment (See instructions) Caution: Each total in Part II, column (g) for each component member must equal taxable income from Form 0, page, line 0 or the comparable line of such member s tax return. Total (a) Group member s name and employer identification number (b) Tax year end (Yr-Mo) Taxable Income Amount Allocated to Each Bracket Page (c) % (d) % (e) % (f) % (g) Total (add columns (c) through (f)) ABBEHEALTH, INC. - - ABBE MANAGEMENT CORPORATION - - AGING SERVICES, INC ALLEN MEMORIAL HOSPITAL CORPORATION -0 - BELCREST SERVICES LTD - - BROADBAND, INC. - - CENTRAL IOWA HOSPITAL CORPORATION -00-0,00,00,.,. HCP CORPORATION - -,, HEALTH PLUS INC - - HNC SERVICES -0 - IOWA HEALTH FOUNDATION - - IOWA HEALTH SYSTEM - -,.,. 0,00,00,00,.,,. Schedule O (Form 0) (Rev. -0) 0-0- JWA 0

8 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part II Taxable Income Apportionment (See instructions) Caution: Each total in Part II, column (g) for each component member must equal taxable income from Form 0, page, line 0 or the comparable line of such member s tax return. (a) Group member s name and employer identification number (b) Tax year end (Yr-Mo) Taxable Income Amount Allocated to Each Bracket Page (c) % (d) % (e) % (f) % (g) Total (add columns (c) through (f)) IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION - - KEOKUK AREA HOSPITAL -0 - KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY, INC. - - MEDIMORE, INC MERITER HEALTH SERVICES, INC. - -,.,. MERITER HOSPITAL, INC MERITER MANAGEMENT SERVICES, INC. - - METHODIST HEALTH VENTURES, INC METHODIST MEDICAL CENTER OF ILLINOIS -0 - METHODIST SERVICES, INC. - - NORTHWEST IOWA HOSPITAL CORPORATION - -,0.,0. PEKIN MEMORIAL HOSPITAL -0 - Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

9 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part II Taxable Income Apportionment (See instructions) Caution: Each total in Part II, column (g) for each component member must equal taxable income from Form 0, page, line 0 or the comparable line of such member s tax return. (a) Group member s name and employer identification number (b) Tax year end (Yr-Mo) Taxable Income Amount Allocated to Each Bracket Page (c) % (d) % (e) % (f) % (g) Total (add columns (c) through (f)) PEKIN PROHEALTH, INC. - - PRECEDENCE, INC. -0-0,. 0,. PROCTOR HOSPITAL PROVIDER RESOURCE MANAGEMENT, INC ST. LUKE'S METHODIST HOSPITAL ,.,. STL HEALTH RESOURCES CO. - -,.,. THE FINLEY HOSPITAL THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH -0 - TRIMARK PHYSICIANS GROUP - - TRINITY HEALTH ENTERPRISES, INC. -0 -,.,. TRINITY HEALTH SYSTEMS, INC. - - TRINITY MEDICAL CENTER - -,.,. Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

10 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part II Taxable Income Apportionment (See instructions) Caution: Each total in Part II, column (g) for each component member must equal taxable income from Form 0, page, line 0 or the comparable line of such member s tax return. (a) Group member s name and employer identification number (b) Tax year end (Yr-Mo) Taxable Income Amount Allocated to Each Bracket Page (c) % (d) % (e) % (f) % (g) Total (add columns (c) through (f)) TRINITY PHYSICIAN HOSPITAL ORGANIZATION, LTD. -0 -,.,. TRINITY REGIONAL MEDICAL CENTER -0 - UNITYPOINT AT HOME - -,.,. UNITYPOINT HEALTH - MARSHALLTOWN -0 - Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

11 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part III Income Tax Apportionment (See instructions) Page Total (a) Group member s name Income Tax Apportionment (b) (c) (d) (e) (f) (g) (h) % % % % % % Total income tax (combine lines (b) through (g)) ABBEHEALTH, INC. ABBE MANAGEMENT CORPORATION AGING SERVICES, INC. ALLEN MEMORIAL HOSPITAL CORPORATION BELCREST SERVICES LTD BROADBAND, INC. CENTRAL IOWA HOSPITAL CORPORATION,0,,.,,. HCP CORPORATION,.,. HEALTH PLUS INC HNC SERVICES IOWA HEALTH FOUNDATION IOWA HEALTH SYSTEM,00.,00.,0, 0,.,,. Schedule O (Form 0) (Rev. -0) 0-0- JWA

12 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part III Income Tax Apportionment (See instructions) Page Income Tax Apportionment (a) Group member s name (b) (c) (d) (e) (f) (g) (h) % % % % % % Total income tax (combine lines (b) through (g)) IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION KEOKUK AREA HOSPITAL KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY, INC. MEDIMORE, INC. MERITER HEALTH SERVICES, INC. 0,. 0,. MERITER HOSPITAL, INC. MERITER MANAGEMENT SERVICES, INC. METHODIST HEALTH VENTURES, INC. METHODIST MEDICAL CENTER OF ILLINOIS METHODIST SERVICES, INC. NORTHWEST IOWA HOSPITAL CORPORATION,.,. PEKIN MEMORIAL HOSPITAL Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

13 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part III Income Tax Apportionment (See instructions) Page Income Tax Apportionment (a) Group member s name (b) (c) (d) (e) (f) (g) (h) % % % % % % Total income tax (combine lines (b) through (g)) PEKIN PROHEALTH, INC. PRECEDENCE, INC.,.,. PROCTOR HOSPITAL PROVIDER RESOURCE MANAGEMENT, INC. ST. LUKE'S METHODIST HOSPITAL,.,. STL HEALTH RESOURCES CO.,0,0 THE FINLEY HOSPITAL THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH TRIMARK PHYSICIANS GROUP TRINITY HEALTH ENTERPRISES, INC.,.,. TRINITY HEALTH SYSTEMS, INC. TRINITY MEDICAL CENTER,.,. Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

14 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part III Income Tax Apportionment (See instructions) Page Income Tax Apportionment (a) Group member s name (b) (c) (d) (e) (f) (g) (h) % % % % % % Total income tax (combine lines (b) through (g)) TRINITY PHYSICIAN HOSPITAL ORGANIZATION, LTD.,.,. TRINITY REGIONAL MEDICAL CENTER UNITYPOINT AT HOME,.,. UNITYPOINT HEALTH - MARSHALLTOWN Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

15 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part IV Other Apportionments (See instructions) Page Other Apportionments (a) Group member s name (b) (c) (d) (e) (f) Accumulated AMT Phaseout of Penalty for Other earnings exemption AMT exemption failure to pay credit amount amount estimated tax ABBEHEALTH, INC. ABBE MANAGEMENT CORPORATION AGING SERVICES, INC. ALLEN MEMORIAL HOSPITAL CORPORATION BELCREST SERVICES LTD BROADBAND, INC. CENTRAL IOWA HOSPITAL CORPORATION HCP CORPORATION HEALTH PLUS INC HNC SERVICES IOWA HEALTH FOUNDATION IOWA HEALTH SYSTEM,.,.,.,.,.,.,,00,0,,00,.,,.,., Total,00 0,00,00 Schedule O (Form 0) (Rev. -0) 0-0- JWA

16 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part IV Other Apportionments (See instructions) Page Other Apportionments (a) Group member s name (b) (c) (d) (e) (f) Accumulated AMT Phaseout of Penalty for Other earnings exemption AMT exemption failure to pay credit amount amount estimated tax IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION KEOKUK AREA HOSPITAL KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY, INC.,. MEDIMORE, INC.,.,00,0 MERITER HEALTH SERVICES, INC. MERITER HOSPITAL, INC. 0,. MERITER MANAGEMENT SERVICES, INC.,. METHODIST HEALTH VENTURES, INC.,. METHODIST MEDICAL CENTER OF ILLINOIS METHODIST SERVICES, INC. NORTHWEST IOWA HOSPITAL CORPORATION PEKIN MEMORIAL HOSPITAL Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

17 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part IV Other Apportionments (See instructions) Page Other Apportionments (a) Group member s name (b) (c) (d) (e) (f) Accumulated AMT Phaseout of Penalty for Other earnings exemption AMT exemption failure to pay credit amount amount estimated tax PEKIN PROHEALTH, INC.,. PRECEDENCE, INC.,. PROCTOR HOSPITAL,00, PROVIDER RESOURCE MANAGEMENT, INC.,. ST. LUKE'S METHODIST HOSPITAL STL HEALTH RESOURCES CO.,. THE FINLEY HOSPITAL THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH TRIMARK PHYSICIANS GROUP TRINITY HEALTH ENTERPRISES, INC.,. TRINITY HEALTH SYSTEMS, INC. TRINITY MEDICAL CENTER Total Schedule O (Form 0) (Rev. -0) 0-0- JWA 0

18 Schedule O (Form 0) (Rev. -0) ABBEHEALTH, INC. - Part IV Other Apportionments (See instructions) Page Other Apportionments (a) Group member s name (b) (c) (d) (e) (f) Accumulated AMT Phaseout of Penalty for Other earnings exemption AMT exemption failure to pay credit amount amount estimated tax TRINITY PHYSICIAN HOSPITAL ORGANIZATION, LTD.,. TRINITY REGIONAL MEDICAL CENTER UNITYPOINT AT HOME UNITYPOINT HEALTH - MARSHALLTOWN Total Schedule O (Form 0) (Rev. -0) 0-0- JWA

19 Form Department of the Treasury Internal Revenue Service Name Alternative Minimum Tax - Corporations Attach to the corporation s tax return. Go to for instructions and the latest information. Note: See the instructions to find out if the corporation is a small corporation exempt Adjustments and preferences: a Depreciation of post- property ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Amortization of certified pollution control facilities ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ c Amortization of mining exploration and development costs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Amortization of circulation expenditures (personal holding companies only) ~~~~~~~~~~~~~~~~~~~~~ e f g h i j Adjusted gain or loss ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Long-term contracts ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Merchant marine capital construction funds ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Section (b) deduction (Blue Cross, Blue Shield, and similar type organizations only) ~~~~~~~~~~~~~~~~ Tax shelter farm activities (personal service corporations only) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Passive activities (closely held corporations and personal service corporations only) ~~~~~~~~~~~~~~~~~ k Loss limitations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ l Depletion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ m Tax-exempt interest income from specified private activity bonds ~~~~~~~~~~~~~~~~~~~~~~~~~~ n o Intangible drilling costs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other adjustments and preferences ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ * Pre-adjustment alternative minimum taxable income (AMTI). Combine lines through o ~~~~~~~~~~~~~~~ a b c d e a b c from the alternative minimum tax (AMT) under section (e). Taxable income or (loss) before net operating loss deduction ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Adjusted current earnings (ACE) adjustment: ACE from line of the ACE worksheet in the instructions ~~~~~~~~~~~~~ Subtract line from line a. If line exceeds line a, enter the difference as a negative amount. See instructions ~~~~~~~~~~~~~~~~~~~~~~~ Multiply line b by % (). Enter the result as a positive amount ~~~~~~~~~ Enter the excess, if any, of the corporation s total increases in AMTI from prior year ACE adjustments over its total reductions in AMTI from prior year ACE adjustments. See instructions. Note: You must enter an amount on line d (even if line b is positive) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ACE adjustment. If line b is zero or more, enter the amount from line c If line b is less than zero, enter the smaller of line c or line d as a negative amount ~~~~~~~~~~~~~ Combine lines and e. If zero or less, stop here; the corporation does not owe any AMT ~~~~~~~~~~~~~~~ Alternative tax net operating loss deduction. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Alternative minimum taxable income. Subtract line from line. If the corporation held a residual interest in a REMIC, see instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exemption phase-out (if line is $,000 or more, skip lines a and b and enter -0- on line c): Subtract $,000 from line. If completing this line for a member of a controlled group, see instructions. If zero or less, enter -0- ~~~~~~~~~~~~~~~~~ Multiply line a by % () ~~~~~~~~~~~~~~~~~~~~~~~~~ Exemption. Subtract line b from $0,00 If completing this line for a member of a controlled group, see instructions. If zero or less, enter -0- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Subtract line c from line. If zero or less, enter -0- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Multiply line by 0% (0) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Alternative minimum tax foreign tax credit (AMTFTC). See instructions ~~~~~~~~~~~~~~~~~~~~~~~~ Tentative minimum tax. Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Regular tax liability before applying all credits except the foreign tax credit ~~~~~~~~~~~~~~~~~~~~~~ Alternative minimum tax. Subtract line from line. If zero or less, enter -0-. Enter here and on Form 0, Schedule J, line, or the appropriate line of the corporation s income tax return a b c d a b a b c d e f g h i j k l m n o e c OMB No Employer identification number ABBEHEALTH, INC. - JWA For Paperwork Reduction Act Notice, see separate instructions. Form (0) * SEE ALSO pmo STATEMENT ABBEHEALTH, INC. -

20 ABBEHEALTH, INC. - Adjusted Current Earnings (ACE) Worksheet J See ACE Worksheet Instructions. Pre-adjustment AMTI. Enter the amount from line of Form ~~~~~~~~~~~~~~~~~~~~~~~~~~ ACE depreciation adjustment: a AMT depreciation ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a b ACE depreciation: () Post- property ~~~~~~~~~~ b() () Post-, pre- property ~~~~~~ b() () Pre- MACRS property ~~~~~~~ b() () Pre- original ACRS property ~~~~~ b() () Property described in sections (f)() through () ~~~~~~~~~~ b() () Other property ~~~~~~~~~~~~~ b() () Total ACE depreciation. Add lines b() through b() ~~~~~~~~~~~ b() c ACE depreciation adjustment. Subtract line b() from line a ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Inclusion in ACE of items included in earnings and profits (E&P): a Tax-exempt interest income ~~~~~~~~~~~~~~~~~~~~~~~~~~ a b Death benefits from life insurance contracts ~~~~~~~~~~~~~~~~~~~ b c All other distributions from life insurance contracts (including surrenders) ~~~~~~ c d Inside buildup of undistributed income in life insurance contracts ~~~~~~~~~~ d e Other items (see Regulations sections.(g)-(c)()(iii) through (ix) for a partial list) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e f Total increase to ACE from inclusion in ACE of items included in E&P. Add lines a through e ~~~~~~~~~~~~~ Disallowance of items not deductible from E&P: a Certain dividends received ~~~~~~~~~~~~~~~~~~~~~~~~~~~ a b Dividends paid on certain preferred stock of public utilities that are deductible under section (as affected by P.L. -, Div. A, section (a)()(a), Dec., 0, Stat. 0) ~~~~~~~ b c Dividends paid to an ESOP that are deductible under section 0(k) ~~~~~~~~~ c d Nonpatronage dividends that are paid and deductible under section (c) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d e Other items (see Regulations sections.(g)-(d)()(i) and (ii) for a partial list) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e f Total increase to ACE because of disallowance of items not deductible from E&P. Add lines a through e ~~~~~~~~ Other adjustments based on rules for figuring E&P: a Intangible drilling costs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a b Circulation expenditures ~~~~~~~~~~~~~~~~~~~~~~~~~~~ b c Organizational expenditures ~~~~~~~~~~~~~~~~~~~~~~~~~~ c d LIFO inventory adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~ d e Installment sales ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e f Total other E&P adjustments. Combine lines a through e ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Disallowance of loss on exchange of debt pools ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Acquisition expenses of life insurance companies for qualified foreign contracts ~~~~~~~~~~~~~~~~~~~ Depletion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Basis adjustments in determining gain or loss from sale or exchange of pre- property ~~~~~~~~~~~~~~~ Adjusted current earnings. Combine lines, c, f, f, and f through. Enter the result here and on line a of Form c f f f ABBEHEALTH, INC. -

21 ABBEHEALTH, INC. - }}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T CONTRIBUTIONS STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION/KIND OF PROPERTY METHOD USED TO DETERMINE FMV AMOUNT }}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}} CONTRIBUTION N/A. }}}}}}}}}}}}}} TOTAL TO FORM 0-T, PAGE, LINE 0. ~~~~~~~~~~~~~~ STATEMENT(S) ABBEHEALTH, INC. -

22 ABBEHEALTH, INC. - }}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T PARENT CORPORATION S NAME AND IDENTIFYING NUMBER STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} CORPORATION S NAME IDENTIFYING NO }}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}} IOWA HEALTH SYSTEM - STATEMENT(S) ABBEHEALTH, INC. -

23 ABBEHEALTH, INC. - }}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T CONTRIBUTIONS SUMMARY STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} QUALIFIED CONTRIBUTIONS SUBJECT TO 0% LIMIT CARRYOVER OF PRIOR YEARS UNUSED CONTRIBUTIONS FOR TAX YEAR 0,0 FOR TAX YEAR 0,00 FOR TAX YEAR 0, FOR TAX YEAR 0,0 FOR TAX YEAR 0,0 TOTAL CARRYOVER TOTAL CURRENT YEAR % CONTRIBUTIONS TOTAL CONTRIBUTIONS AVAILABLE TAXABLE INCOME LIMITATION AS ADJUSTED EXCESS % CONTRIBUTIONS EXCESS 0% CONTRIBUTIONS TOTAL EXCESS CONTRIBUTIONS }}}}}}}}}}}}}}, }}}}}}}}}}}}}}, 0 }}}}}}}}}}}}}}, 0, }}}}}}}}}}}}}} ALLOWABLE CONTRIBUTIONS DEDUCTION 0 }}}}}}}}}}}}}} TOTAL CONTRIBUTION DEDUCTION 0 ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ STATEMENT(S) ABBEHEALTH, INC. -

24 ABBEHEALTH, INC. - }}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T NET OPERATING LOSS DEDUCTION STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} LOSS PREVIOUSLY LOSS AVAILABLE TAX YEAR LOSS SUSTAINED APPLIED REMAINING THIS YEAR }}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} //0,0.,0. //0.. //,.,0.,.,. //,.,.,. //,, }}}}}}}}}}}}}}, }}}}}}}}}}}}}} NOL CARRYOVER AVAILABLE THIS YEAR,.,. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ STATEMENT(S) ABBEHEALTH, INC. -

25 ABBEHEALTH, INC. - }}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T SCHEDULE F - DEDUCTIONS OF CONTROLLED ORGANIZATIONS STATEMENT DIRECTLY CONNECTED WITH COLUMN INCOME }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} ACTIVITY DESCRIPTION NUMBER AMOUNT TOTAL }}}}}}}}}}} }}}}}}}} }}}}}}}}}}}}} }}}}}}}}}}}}} DEPRECIATION,. REPAIRS,. PURCHASED SERVICES,. ADMINISTRATION AND GENERAL,. SUPPLIES. UTILITIES 0. - SUBTOTAL - TOTAL OF FORM 0-T, SCHEDULE F, COLUMN,. }}}}}}}}}}}}},. ~~~~~~~~~~~~~ STATEMENT(S) ABBEHEALTH, INC. -

26 ABBEHEALTH, INC. - }}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM AMT CONTRIBUTIONS STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} CARRYOVER OF PRIOR YEARS UNUSED CONTRIBUTIONS FOR TAX YEAR 0 FOR TAX YEAR 0 FOR TAX YEAR 0 FOR TAX YEAR 0 FOR TAX YEAR 0 TOTAL CARRYOVER CURRENT YEAR CONTRIBUTIONS TOTAL CONTRIBUTIONS % OF TAXABLE INCOME AS ADJUSTED EXCESS CONTRIBUTIONS ALLOWABLE CONTRIBUTIONS,0,00,,0,0 }}}}}}}}}}}}}}, }}}}}}}}}}}}}}, 0 }}}}}}}}}}}}}}, ~~~~~~~~~~~~~~ 0 ~~~~~~~~~~~~~~ AMT CHARITABLE DEDUCTION 0 REGULAR CONTRIBUTION DEDUCTION 0 }}}}}}}}}}}}}} AMT CONTRIBUTION ADJUSTMENT 0 ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ STATEMENT(S) ABBEHEALTH, INC. -