Seventy-seven Iowa hospitals collected $928.3 million in accelerated and advance Medicare payments that were available as a government stimulus to cover expenses in the COVID-19 pandemic’s early days last spring, an IowaWatch analysis of Centers for Medicare & Medicaid Services data shows.
Amounts for Iowa hospitals ranged from $92.8 million for MercyOne Des Moines Medical Center to $1 million for Sanford Medical Center in Rock Rapids, the data show.
Others of note included $76.6 million for UnityPoint Health-Iowa Methodist Center in Des Moines; $56.3 million for the Genesis Medical Center in Davenport; $55 million for MercyOne North Iowa Medical Center in Mason City; $41.7 million for Mercy Medical Center in Cedar Rapids; and $38.6 million for Saint Luke’s Hospital in Cedar Rapids.
See end of the story for each Iowa recipient and amount
The funds were part of $1.02 billion in accelerated and advance Medicare payments sent not only to Iowa hospitals, but to physicians, optometrists, chiropractors, psychiatrists, psychologists and other health care providers; facilities for skilled nursing and senior living; mental health care facilities; and others eligible for the accelerated and advance payments, the data show. They must be paid back to Medicare and Medicaid Services.
The Medicare payment programs, separate from funding healthcare providers received from programs such as the CARES Act and other COVID-19-related emergency plans, allowed applying health care providers to receive in advance three months of anticipated Medicare billings. Medicare distributed $100.3 billion nationwide before stopping accelerated payments for re-evaluation and suspended advance payments in April because of other available funding.
The 77 Iowa hospitals taking accelerated Medicare payments included 44 critical access hospitals with 25 or fewer beds and serving rural areas. The rural hospitals could seek ahead of time up to 125% of their anticipated Medicare payments for a six-month period, rules for the program stated. About 800 of the nation’s 1,330 critical access hospitals received accelerated Medicare payments earlier this year.
University of Iowa Hospitals and Clinics, which has received roughly $49 million in CARES fund distributions for the hospital and its physicians, did not apply for the accelerated and advance Medicare programs. Neither did others. Industry officials said in several IowaWatch interviews that some hospital leaders were skittish about the program’s payback plan.
See what Iowa healthcare providers have received in CARES Act funding here
That plan calls for hospitals taking accelerated payments to credit Medicare for billings until the advanced money is paid back, beginning 120 days after receiving funding. Those that cannot pay back the advances in full have to pay 10.25% interest on the balance owed after a certain amount of time has passed:
- Up to a year after receiving funds for critical access hospitals, inpatient acute care hospitals, cancer hospitals and children’s hospitals.
- Up to 210 days for long-term care hospitals, inpatient rehabilitation centers, inpatient mental health facilities, and their suppliers.
- Thirty days after the 120-day payback period ends for other healthcare providers.
UPDATE 9/30/20: APPROPRIATIONS RESOLUTION INCLUDES NEW TIMETABLE FOR PAYING BACK MEDICARE PAYMENTS
The Center for Medicare & Medicaid Services has told hospitals the U.S. Treasury Department set the interest rate and that it cannot waive or change the rate. The Treasury Department has declined to respond to multiple requests IowaWatch made in July, August and September for the reason the interest rate is in double digits.
Paying back the accelerated and advance payments is doable but challenging, Michael Topchik, national leader for the Chartis Center for Rural Health, said. It especially would be challenging for hospitals operating in the red with, say, 17 days of operating cash on hand, he said.
“For them to pay that back, that will take them from a position of stabilizing that hospital to just putting them back right where they were, with feet to the fire,” Topchik said.
Topchik said he and researchers at Chartis, part of the national healthcare delivery consulting firm iVantage Health Analytics, have heard the concerns about paying back the funds and, if stuck with it, the interest rate. But, he said, he wonders why roughly one-third of the country’s hospitals did not take the payments.
Hospitals’ financial performance played a key role in decisions.
IowaWatch reviewed certified financial data for each Iowa hospital earlier this year and found that 44 of the state’s 118 hospitals ended the last fiscal year for which they reported with a negative balance. Most of the hospitals in that analysis are in small, rural regions but a few were short-term acute care hospitals in urban areas, IowaWatch reported. (That 44 hospitals showed up in that analysis and also is the number of critical access hospitals drawing accelerated Medicare payments is a statistical coincidence.)
Even a larger hospital faces difficulty paying back accelerated payments, Kirk Norris, president of the Iowa Hospital Association, said. Norris said a hospital could pay back accelerated payments but then end up having to furlough workers when Medicare money doesn’t come in later.
Norris suggested that rural hospitals would survive COVID-19 financially if the accelerated payments became forgiven loans but no congressional action is pending to do that.
“This whole thing has really been … as much about lost revenue as it has been expenses that you previously didn’t have,” Norris said.
Revenue losses are expected to continue, he said. A large part of the reason is the loss of clinical procedures small hospitals normally rely on but which have been delayed or canceled while the hospitals deal with COVID-19. Moreover, some patients are skipping or delaying medical checkups that produce hospital income because they wrongly fear going to the medical facility may not be safe. Or, they think a discomfort they feel is not serious enough to be checked, several hospital leaders and industry analysts at the state and national level said in IowaWatch interviews.
Mark Holmes, director of the Sheps Center for Health Services Research at the University of North Carolina, used mild heart attacks as one example. A lot of heart attacks can be mild enough that a person suffering it doesn’t feel compelled to go to a hospital, he said.
“They might have stayed home,” Holmes said. “They might have died in their house and just never have seen the health care system, interacted with the health care system because they were too scared to go in,”
RELATED STORY: INDUSTRY LEADERS EXPECTED COVID-19 TO TAKE SOME IOWA HOSPITALS DOWN
National stimulus efforts have included $175 billion in two initial rounds of CARES Act funding; another $10 billion for rural hospitals; payments of $12 billion in May and $10 billion in July for hospitals with high COVID-19 admissions; other distributions to safety net hospitals, children’s hospitals, assisted living facilities and nursing homes; and payroll protection plan payments for hospitals with 500 or fewer employees.
The Center for Medicare & Medicaid Services suspended the accelerated program April 24 to re-evaluate its use because of other revenue sources the federal government made available to healthcare providers.
Here is a list that IowaWatch compiled from the Center for Medicare & Medicaid Services data, showing the healthcare professionals and institutions in Iowa taking accelerated and advanced Medicare payments as of mid-May, before the program was suspended.
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This IowaWatch story was republished by The Des Moines Register, The Gazette (Cedar Rapids, IA), The Courier (Waterloo-Cedar Falls, IA), Storm Lake Times, Ottumwa Courier, The Hawk Eye (Burlington, IA), KCCI.com and MSN.com under IowaWatch’s mission of sharing stories with media partners.
| Recipient | Facility type | Location | Amount |
| Monroe County Hospital | Critical Access Hospital | Albia | $4,022,578 |
| Amana Family Practice Clinic | Healthcare Providers | Amana | $70,954 |
| Mary Greeley Medical Center | Short Term Acute Care Hospital | Ames | $21,688,891 |
| Jones Regional Medical Center | Critical Access Hospital | Anamosa | $4,224,411 |
| Cass County Memorial Hospital | Critical Access Hospital | Atlantic | $8,959,927 |
| Iowa Specialty Hospital-Belmond | Critical Access Hospital | Belmond | $4,813,987 |
| Genortho | Ambulatory Surgery Center | Bettendorf | $276,818 |
| Eastern Iowa Dermatology | Dermatologist | Bettendorf | $274,656 |
| Genesis Hospice: Clarissa C. Cook Hospice House | Hospice | Bettendorf | $2,331,086 |
| UnityPoint Health – Trinity | Short Term Acute Care Hospital | Bettendorf | $8,548,271 |
| Board of Trustees Grand Charity | Skilled Nursing/Senior Living | Bettendorf | $124,496 |
| Davis County Hospital & Clinics | Critical Access Hospital | Bloomfield | $5,046,012 |
| Heritage Medical Equipment & Supplies | Medical Supplies | Burlington, West Burlington | $185,181 |
| Wellendorf ENT, PC | Ear, nose, throat practice | Carroll | $36,852 |
| Lease Eye MD PC | Eye Care Equipment | Carroll | $46,000 |
| Saint Anthony Regional Hospital | Short Term Acute Care Hospital | Carroll | $10,518,326 |
| Cedar Falls Medical Center | Short Term Acute Care Hospital | Cedar Falls | $3,811,126 |
| Martin Health Center | Skilled Nursing/Senior Living | Cedar Falls | $515,728 |
| MercyCare Community Physicians | Healthcare Providers | Cedar Rapids | $1,410,276 |
| Mercycare Management Inc. | Healthcare Providers | Cedar Rapids | $74,414 |
| Physicians Clinic of Iowa | Healthcare Providers | Cedar Rapids | $6,421,569 |
| Spanda Inc. | Healthcare Providers | Cedar Rapids | $24,550 |
| Medical Laboratories LC | Medical Lab Testing | Cedar Rapids | $419,320 |
| Dr. D.M. Fitzgerald Associates | Optometrist | Cedar Rapids | $75,944 |
| Reutzel Pharmacy Aim Healthcare Inc. | Pharmacy | Cedar Rapids | $21,410 |
| Radiology Consultants of Iowa | Radiology services | Cedar Rapids | $1,000,000 |
| Mercy Medical Center | Short Term Acute Care Hospital | Cedar Rapids | $41,746,387 |
| Saint Luke’s Hospital | Short Term Acute Care Hospital | Cedar Rapids | $38,649,107 |
| Manor Care of Cedar Rapids | Skilled Nursing/Senior Living | Cedar Rapids | $424,394 |
| MercyOne Centerville Medical Center | Critical Access Hospital | Centerville | $3,139,640 |
| Fresenius Kidney Care Cline Family Dialysis Center | Dialysis Center | Centerville | $135,794 |
| Lucas County Health Center | Critical Access Hospital | Chariton | $3,840,048 |
| Fresenius Medical Care, North Iowa | Dialysis Center | Charles City | $454,712 |
| Cherokee Regional Medical Center | Critical Access Hospital | Cherokee | $5,773,882 |
| Great Plains Healthcare | Healthcare Providers | Cherokee | $19,724 |
| Careage Hills Rehabilitation & Healthcare | Skilled Nursing/Senior Living | Cherokee | $170,340 |
| Clarinda Regional Health Center | Critical Access Hospital | Clarinda | $8,230,290 |
| Pure Health Services | Home Health Care | Clarinda | $60,000 |
| BCP Clarinda | Skilled Nursing/Senior Living | Clarinda | $27,882 |
| Iowa Specialty Hospital-Clarion | Critical Access Hospital | Clarion | $8,748,271 |
| Clarion Wellness and Rehabilitation Center | Skilled Nursing/Senior Living | Clarion | $161,082 |
| Riverbend Chiropractic and Wellness | Chiropractic | Clinton | $2,093 |
| Dr. Randy R. Robinson | Healthcare Providers | Clinton | $41,703 |
| Dr. Steven E Craig, DPM | Podiatrist | Clinton | $24,500 |
| MercyOne Clinton Medical Center | Short Term Acute Care Hospital | Clinton | $13,462,263 |
| Total Body Chiropractic | Chiropractic | Clive | $1,464 |
| Iowa Ear Center | Hearing Services | Clive | $153,486 |
| MercyOne Clive Rehabilitation Hospital | Rehabilitation Hospital | Clive | $2,714,523 |
| Corridor Radiology LLC | Radiology services | Coralville | $80,000 |
| Radiologic Medical Pro Comp | Radiology services | Coralville | $182,000 |
| CHI Health Mercy Corning | Critical Access Hospital | Corning | $3,734,161 |
| Wayne County Hospital | Critical Access Hospital | Corydon | $4,677,620 |
| Ridge Family Practice | Healthcare Providers | Council Bluffs | $16,297 |
| Hopp Physical Therapy | Physical Therapy | Council Bluffs | $30,000 |
| Alegent Health Mercy Hospital | Short Term Acute Care Hospital | Council Bluffs | $10,515,600 |
| Methodist Jennie Edmundson Hospital | Short Term Acute Care Hospital | Council Bluffs | $15,033,052 |
| Greater Regional Medical Center | Critical Access Hospital | Creston | $13,550,288 |
| Crest Haven Care Center | Skilled Nursing/Senior Living | Creston | $46,000 |
| Spring Park Surgery Center, L.L.C. | Ambulatory Surgery Center | Davenport | $600,000 |
| Mississippi Medical Plaza LC | Healthcare Providers | Davenport | $229,568 |
| Plastic Surgery Center PC | Healthcare Providers | Davenport | $22,000 |
| Heartland Hospice Services | Hospice | Davenport | $1,573,124 |
| Select Specialty Hospital Quad Cities | Long Term Hospital Care | Davenport | $2,382,955 |
| Quad City Physical Therapy & Spine | Physical Therapy | Davenport | $11,388 |
| Genesis Medical Center, East Rusholme Street | Short Term Acute Care Hospital | Davenport | $56,280,016 |
| Kahl Home for the Aged & Infirmed | Skilled Nursing/Senior Living | Davenport | $562,828 |
| Manor Care of Davenport | Skilled Nursing/Senior Living | Davenport | $219,784 |
| Verdi Eye Clinic | Eye care – laser treatments | Davenport, Clinton, Rock Island Ill. | $89,218 |
| Winneshiek Medical Center | Critical Access Hospital | Decorah | $9,102,571 |
| Mercy River Hills Surgery Center | Ambulatory Surgery Center | Des Moines | $296,486 |
| Surgery Center of Des Moines | Ambulatory Surgery Center | Des Moines | $575,000 |
| Medical Center Anesthesiology | Anesthesiologists | Des Moines | $743,662 |
| Primary Health Care Inc. | Healthcare Providers | Des Moines | $146,409 |
| Chi National Home Care | Home Health Care | Des Moines | $1,386,146 |
| Select Specialty Hospital – Des Moines | Long Term Hospital Care | Des Moines | $2,451,896 |
| Alpha Allied Services | Mental Health practitioners | Des Moines | $1,353 |
| Dr. Jeffrey L. Koenen | Optometrist | Des Moines | $1,689 |
| Orthopaedic Outpatient Surgery Center | Orthopedics | Des Moines | $295,203 |
| USPT Physical Therapy | Physical Therapy | Des Moines | $38,718 |
| RCG Mercy Des Moines | Renal Care Center | Des Moines | $710,979 |
| MercyOne Des Moines Medical Center | Short Term Acute Care Hospital | Des Moines | $92,799,950 |
| UnityPoint Health-Iowa Methodist Center | Short Term Acute Care Hospital | Des Moines | $76,570,088 |
| BCP Union Park | Skilled Nursing/Senior Living | Des Moines | $63,588 |
| Discovery Trail Healthcare | Skilled Nursing/Senior Living | Des Moines | $344,682 |
| Evangelical Retirement Homes | Skilled Nursing/Senior Living | Des Moines | $176,000 |
| Riverside Healthcare Inc. | Skilled Nursing/Senior Living | Des Moines | $166,259 |
| Chi National Home Care | Hospice | Des Moines, Johnston | $1,050,831 |
| Genesis Medical Center, DeWitt | Critical Access Hospital | DeWitt | $2,272,838 |
| MercyOne Dubuque Medical Center | Short Term Acute Care Hospital | Dubuque | $24,711,659 |
| UnityPoint Health – Finley Hospital | Short Term Acute Care Hospital | Dubuque | $12,893,986 |
| Ennoble Nursing and Rehabilitation | Skilled Nursing/Senior Living | Dubuque | $391,208 |
| Manor Care of Dubuque | Skilled Nursing/Senior Living | Dubuque | $587,052 |
| MercyOne Dyersville Medical Center | Critical Access Hospital | Dyersville | $1,310,843 |
| Colonial Manor of Elma | Skilled Nursing/Senior Living | Elma | $123,000 |
| Avera Holy Family Hospital | Critical Access Hospital | Estherville | $6,877,195 |
| Gypsum Creek Healthcare | Healthcare Providers | Fort Dodge | $157,718 |
| Dr. Terry D. Moehnke | Optometrist | Fort Dodge | $11,467 |
| Medical Arts Eyecare PLC | Optometrist | Fort Dodge | $28,500 |
| Trinity Regional Medical Center | Short Term Acute Care Hospital | Fort Dodge | $15,648,711 |
| QHC Fort Dodge Villa Care Center | Skilled Nursing/Senior Living | Fort Dodge | $65,114 |
| Advance Physical Therapy-Blessing Corp Services/Ft. Madison | Physical Therapy | Fort Madison | $41,827 |
| Fort Madison Community Hospital | Short Term Acute Care Hospital | Fort Madison | $6,216,763 |
| UnityPoint Health – Grinnell Regional Medical Center | Short Term Acute Care Hospital | Grinnell | $4,373,901 |
| Grinnell Health Care Center | Skilled Nursing/Senior Living | Grinnell | $80,466 |
| Creekside Inc. | Skilled Nursing/Senior Living | Grundy Center | $86,000 |
| George C. Grape Community Hospital | Critical Access Hospital | Hamburg | $2,128,537 |
| American Baptist Homes of the Midwest / Elm Crest | Skilled Nursing/Senior Living | Harlan | $266,522 |
| Hawarden Community Hospital | Critical Access Hospital | Hawarden | $2,424,904 |
| Humboldt County Memorial Hospital | Critical Access Hospital | Humboldt | $5,002,547 |
| QHC Humboldt North | Skilled Nursing/Senior Living | Humboldt | $26,907 |
| QHC Humboldt South | Skilled Nursing/Senior Living | Humboldt | $80,079 |
| Family Health Care of Siouxland – Indian Hills Clinic | Healthcare Providers | Indian Hills | $209,715 |
| Outpatient Surgery Center LLC | Ambulatory Surgery Center | Iowa City | $408,575 |
| Mercy Iowa City | Short Term Acute Care Hospital | Iowa City | $23,335,207 |
| Greene County Medical Center | Critical Access Hospital | Jefferson | $4,784,562 |
| Wesley Retirement/Community Services, Wesley at Home | Home Health Care | Johnston | $3,346,152 |
| Brio of Johnston | Skilled Nursing/Senior Living | Johnston | $466,373 |
| Chi Living Communities / Bishop Drumm Retirement Center | Skilled Nursing/Senior Living | Johnston | $385,719 |
| UnityPoint Health Keokuk | Short Term Acute Care Hospital | Keokuk | $2,011,853 |
| Van Buren County Hospital | Critical Access Hospital | Keosauqua | $3,277,204 |
| Knoxville Hospital and Clinics | Critical Access Hospital | Knoxville | $6,590,388 |
| Floyd Valley Hospital | Critical Access Hospital | LeMars | $5,670,703 |
| Halsteds PC / Groetken Family Eye Care | Optometrist | LeMars | $4,977 |
| Hawkeye Clinic of LeMars | Optometrist | LeMars | $9,498 |
| Madrid Home for the Aging | Skilled Nursing/Senior Living | Madrid | $204,205 |
| Jackson County Regional Health Center | Critical Access Hospital | Maquoketa | $3,356,114 |
| Crestridge | Skilled Nursing/Senior Living | Maquoketa | $60,814 |
| Compass Memorial Healthcare | Critical Access Hospital | Marengo | $5,755,260 |
| Dennis L. Dozier LMSW | Clinical Social Work | Marion | $5,152 |
| Crestview Acres | Skilled Nursing/Senior Living | Marion | $47,591 |
| Marshalltown Vision / Eyecare Associates | Optometrist | Marshalltown | $43,325 |
| UnityPoint Health Marshalltown | Short Term Acute Care Hospital | Marshalltown | $5,896,985 |
| MercyOne North Iowa Medical Center | Short Term Acute Care Hospital | Mason City | $55,046,626 |
| BCP Mediapolis | Skilled Nursing/Senior Living | Mediapolis | $173,905 |
| CHI Health Missouri Valley | Critical Access Hospital | Missouri Valley | $4,080,282 |
| Longview Home Inc. | Skilled Nursing/Senior Living | Missouri Valley | $95,541 |
| QHC Mitchellville | Skilled Nursing/Senior Living | Mitchellville | $16,060 |
| Ringgold County Hospital | Critical Access Hospital | Mount Ayr | $5,551,396 |
| Davis Radiology PC | Radiology services | Mount Pleasant | $338,030 |
| UnityPoint Health – Trinity | Short Term Acute Care Hospital | Muscatine | $3,840,296 |
| Lutheran Homes Society | Skilled Nursing/Senior Living | Muscatine | $472,231 |
| MercyOne New Hampton | Critical Access Hospital | New Hampton | $4,272,147 |
| Dr. Riley F. Uglum/Eye Care Associates Of New Hampton | Optometrist | New Hampton | $37,984 |
| New Hampton Care Center | Skilled Nursing/Senior Living | New Hampton | $119,000 |
| Mercy Medical Center-Newton | Short Term Acute Care Hospital | Newton | $5,218,236 |
| Newton Village | Skilled Nursing/Senior Living | Newton | $131,659 |
| Dennis Shemann | No available information | No available information | $2,357 |
| MercyOne Oelwein Medical Center | Critical Access Hospital | Oelwein | $2,689,140 |
| Burgess Health Center | Critical Access Hospital | Onawa | $5,199,797 |
| Elmwood Care Center | Skilled Nursing/Senior Living | Onawa | $127,000 |
| Clarke County Hospital | Critical Access Hospital | Osceola | $7,304,422 |
| Mahaska Health County Hospital | Critical Access Hospital | Oskaloosa | $8,267,924 |
| Fresenius Medical Care, Ottumwa | Dialysis Center | Ottumwa | $239,845 |
| Ottumwa Regional Health Center | Short Term Acute Care Hospital | Ottumwa | $11,126,603 |
| Pella Regional Health Center | Critical Access Hospital | Pella | $9,808,291 |
| Child and Family Eyecare PC | Optometrist | Pella | $38,000 |
| Herman L. Rowley Memorial Trust | Skilled Nursing/Senior Living | Perry | $141,375 |
| Pocahontas Community Hospital | Critical Access Hospital | Pocahontas | $3,270,868 |
| MercyOne Primghar Medical Center | Critical Access Hospital | Primghar | $1,864,416 |
| Orthopaedic Specialists PC | Orthopedics | Quad Cities | $230,000 |
| Accordius Health at St. Mary’s | Skilled Nursing/Senior Living | Quad Cities | $272,208 |
| Sanford Medical Center Rock Rapids | Critical Access Hospital | Rock Rapids | $1,092,644 |
| Rock Rapids Care Center | Skilled Nursing/Senior Living | Rock Rapids | $121,856 |
| Sunny Knoll Care Center | Skilled Nursing/Senior Living | Rockwell City | $85,000 |
| Loring Hospital | Critical Access Hospital | Sac City | $3,684,950 |
| Shenandoah Medical Center | Critical Access Hospital | Shenandoah | $6,707,106 |
| Osceola Regional Health Center | Critical Access Hospital | Sibley | $2,023,473 |
| Sioux Center Health Center | Critical Access Hospital | Sioux Center | $5,386,568 |
| Patrick A. Walding DC PC | Chiropractic | Sioux City | $3,037 |
| David Van Wagner MD PC | Healthcare Providers | Sioux City | $33,718 |
| Qualicenters Sioux City LLC | Healthcare Providers | Sioux City | $874,761 |
| Siouxland Medical Education Foundation Inc. | Healthcare Providers | Sioux City | $154,285 |
| Siouxland Mental Health Center | Mental Health practitioners | Sioux City | $42,658 |
| TKC Optical | Optometrist | Sioux City | $15,119 |
| James V. Snowden | Psychologists | Sioux City | $5,055 |
| MercyOne Siouxland Medical Center | Short Term Acute Care Hospital | Sioux City | $26,003,692 |
| UnityPoint Health St. Luke’s Regional Medical Center | Short Term Acute Care Hospital | Sioux City | $19,117,445 |
| Orthopaedics PC | Orthopedics | Spencer | $119,037 |
| Spencer Municipal Hospital | Short Term Acute Care Hospital | Spencer | $12,715,502 |
| Hawkeye Health Services Inc. | Home Health Care | Urbandale | $1,378,325 |
| Hospice of the Midwest | Hospice | Urbandale | $1,600,000 |
| Iowa Hospice LLC | Hospice | Urbandale | $2,075,709 |
| Chladek Orthotic & Prosthetic, Inc. | Orthopedics | Urbandale | $21,101 |
| Community Health Centers of Iowa | Healthcare Providers | Various locations | $1,661 |
| McFarland Clinic PC | Healthcare Providers | Various locations | $15,738,735 |
| Mercy Services | Healthcare Providers | Various locations | $1,467,568 |
| Heartland Home Healthcare | Home Health Care | Various locations | $235,205 |
| Recover Health of Iowa | Home Health Care | Various locations | $225,951 |
| UnityPoint at Home | Home Health Care | Various locations | $8,070,205 |
| Gentiva Certified Healthcare | Hospice | Various locations | $899,616 |
| Central Iowa Hospital Corporation | Medical Group | Various locations | $315,041 |
| Radiology Partners of Iowa Inc. | Radiology services | Various locations | $120,304 |
| Physiotherapy Associates | Rehabilitation Center | Various locations | $55,950 |
| WellSpire | Senior Living Services | Various locations | $73,949 |
| Abcm Corporation | Skilled Nursing/Senior Living | Various locations | $3,066,665 |
| Hearthstone, A Ministry of WesleyLife | Skilled Nursing/Senior Living | Various locations | $319,027 |
| Premier Estates | Skilled Nursing/Senior Living | Various locations | $1,626,410 |
| Residential Alternatives of Illinois | Skilled Nursing/Senior Living | Various locations | $912,619 |
| Southfield Wellness Community/Webster Care Corp. | Skilled Nursing/Senior Living | Various locations | $185,000 |
| Unlimited Development, Inc. | Skilled Nursing/Senior Living | Various locations | $778,580 |
| Iowa Physicians Foundation | Healthcare Providers | Various locations, Des Moines | $14,016,847 |
| Eye Care of Iowa PC | Optometrist | Various locations/Des Moines | $4,498 |
| Fresenius Medical Care, Quad Cities | Dialysis Center | Various locations/Quad Cities | $454,892 |
| Washington County Hospital | Critical Access Hospital | Washington | $5,036,157 |
| Covenant Medical Center (MercyOne Waterloo Medical Center) | Short Term Acute Care Hospital | Waterloo | $21,981,540 |
| UnityPoint Health-Allen Hospital | Short Term Acute Care Hospital | Waterloo | $24,952,744 |
| Manor Care of Waterloo | Skilled Nursing/Senior Living | Waterloo | $256,053 |
| Waverly Health Center | Critical Access Hospital | Waverly | $5,154,343 |
| Northern Iowa Therapy Associates | Rehabilitation Center | Waverly | $529,893 |
| Van Diest Medical Center | Critical Access Hospital | Webster City | $3,400,000 |
| Crestview Nursing & Rehabilitation | Skilled Nursing/Senior Living | Webster City | $194,605 |
| Prairie Creek Healthcare Inc. | Skilled Nursing/Senior Living | West Bend | $138,167 |
| Great River Medical Center | Short Term Acute Care Hospital | West Burlington | $33,889,467 |
| Great River Physicians and Clinics | Healthcare Providers | West Des Moines | $2,468,849 |
| Avalon Hospice Iowa | Hospice | West Des Moines | $330,655 |
| Edgewater, a WesleyLife Community for Healthy Living | Skilled Nursing/Senior Living | West Des Moines | $525,330 |
| Manor Care of West Des Moines | Skilled Nursing/Senior Living | West Des Moines | $203,479 |
| Zearing Health Care Center | Skilled Nursing, Rehabilitation | Zearing | $1,928 |
