2023-05-09T10:03:51-05:00 2022-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2021-07-01 420680448 CATHOLIC HEALTH INITIATIVES - IOWA CORP CATH 5156437218 1111 6TH AVENUE DES MOINES IA 50314 RANDALL L RUBIN SVP, CFO 5156437218 2023-05-09 1 RANDALL RUBIN 999009999 ANGELA NOEL P01051055 3032989100 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MERCY MEDICAL CENTER - DES MOINES KARL KEELER 1111 6TH AVENUE DES MOINES IA 50314 899251353 0 0928 X HTTPS://WWW.MERCYONE.ORG/DESMOINES/ X 1965 IA CATHOLIC HEALTH INITIATIVES - IOWA CORP IS A NOT-FOR-PROFIT CATHOLIC HEALTH CARE ORGANIZATION CREATING HEALTHIER COMMUNITIES THROUGH THE OPERATION OF A 802-BED ACUTE CARE HOSPITAL. 19 14 6254 450 11983368 0 27577508 21441454 757312685 751622774 26355395 19636596 93595950 106550529 904841538 899251353 55276848 69069547 0 0 327721145 345907251 0 0 0 480055704 549954592 863053697 964931390 41787841 -65680037 1114579485 935566495 369730355 288508986 744849130 647057509 AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 0 0 907120424 69069547 751622774 SEE SCHEDULE H 907120424 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 X 0 0 6254 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 19 14 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X RANDALL RUBIN 5156437860 1111 6TH AVENUE DES MOINES IA 50314 ROBERT RITZ DIRECTOR/CEO MERCY HEALTH NETWORK 1.00 50.00 X 0 1997683 45071 MATTHEW BROWN DIRECTOR/SYS SVP-OPERATIONS TRANSFORMATION 1.00 40.00 X 0 1555781 45718 MICHAEL WEGNER DIRECTOR, INTERIM PRESIDENT MERCYONE 40.00 0.00 X X 1286950 0 39835 SEAN WILLIAMS PRESIDENT NETWORK HOSPITAL 40.00 0.00 X 1141969 0 37789 KENT CARR SVP-PHYSICIAN ENTERPRISE 40.00 0.00 X 1043933 0 10299 DAVID HOCKMUTH CARDIOTHORACIC SURGEON 40.00 0.00 X 959573 0 43919 MARK TANNENBAUM DIRECTOR (PARTIAL YEAR)/PHYSICIAN 40.00 0.00 X 925580 0 49467 KARL KEELER PRESIDENT (PARTIAL YEAR) 40.00 5.00 X X 875021 0 46745 AARON FROM CARDIOLOGIST 40.00 0.00 X 861493 0 42475 MUDASSIR MALIK CARDIOLOGIST 40.00 0.00 X 799300 0 42744 HIJINIO CARREON DIV SVP MHN PHYSICIAN ENTERPRISE 50.00 0.00 X 724670 0 49305 NEIL HORNING DIRECTOR/PULMONOLOGIST CRITICAL CARE 1.00 0.00 X 0 705728 42426 LINDA GOODWIN SYS SVP NURSING INNOVATION CARE TRANSFORMATION 50.00 0.00 X 655742 0 36627 RANDALL RUBIN SVP, CFO 50.00 5.00 X 582795 0 43599 JORDAN HARROP CHIEF OPERATING OFFICER 50.00 0.00 X 393381 0 42015 STEPHEN NOWAK DIRECTOR/PHYSICIAN 1.00 0.00 X 945 69210 0 EMILY ABBAS DIRECTOR 1.00 0.00 X 0 0 0 ESPNOLA CARTMILL DIRECTOR 1.00 0.00 X 0 0 0 BRENDA CUSHING CHAIR 1.00 0.00 X X 0 0 0 STEPHEN FELTZ MD DIRECTOR 1.00 0.00 X 0 0 0 MONICA FRIEDMAN SPHR VICE CHAIR 1.00 0.00 X X 0 0 0 GLEN HALL DIRECTOR 1.00 0.00 X 0 0 0 BRIAN JOHNSON DIRECTOR 1.00 0.00 X 0 0 0 TERRY LILLIS TREASURER 1.00 0.00 X X 0 0 0 THERESA MCCONEGHEY SECRETARY 1.00 0.00 X X 0 0 0 PATRICIA MCDERMOTT DIRECTOR 1.00 0.00 X 0 0 0 ERIN DRINNIN DIRECTOR 1.00 0.00 X 0 0 0 MAURITA SOUKUP DIRECTOR 1.00 0.00 X 0 0 0 TIMOTHY MILLER DIRECTOR 1.00 0.00 X 0 0 0 CHRIS NELSON DIRECTOR 1.00 0.00 X 0 0 0 10251352 4328402 618034 350 0 1 0 HEALTHCARE REALTY SERVICES INC 3310 W END AVE NASHVILLE TN 37203 REAL ESTATE SERVICES 6479801 MEDICAL STAFFING SOLUTION 1085 KERN AVE RICE LAKE WI 54868 STAFFING SERVES 5271104 WALDINGER CORP 2601 BELL AVE DES MOINES IA 50321 MECHANICAL CONTRACTOR 2758734 GE PRECISION HEALTHCARE LLC PO BOX 74008831 CHICAGO IL 60674 IT SERVICES 2610676 MAGELLA MEDICAL ASSOC OF GA PC PO BOX 277279 ATLANTA GA 30384 MEDICAL SERVICES 2534710 116 10366501 10213523 861430 21441454 NET PATIENT SERVICES 900099 737462546 737462546 0 0 INSURANCE 524298 7905569 7905569 0 0 EQUITY CHANGES OF UNCO 900099 4260244 4260244 0 0 INTERCOMPANY TRANSACTI 900099 1994415 1994415 0 0 751622774 3174935 3174935 1659252 0 1659252 1659252 1659252 16132621 329040 0 0 16132621 329040 16461661 16461661 PHARMACY SERVICES 446110 34217631 0 0 34217631 LABORATORY SERVICES 621500 29959125 0 11983368 17975757 SERVICES SOLD 900099 20497245 0 0 20497245 20217276 20217276 104891277 899251353 751622774 11983368 114203757 X 69069547 69069547 6346471 6346471 278448983 267068688 11380295 13208560 12675240 533320 28928576 27764888 1163688 18974661 18215675 758986 3042 2890 152 33024 33024 167837578 156744080 11093498 4100246 36902 4063344 9836926 9581166 255760 37616406 37616406 18099554 16904983 1194571 861901 784330 77571 77709 27198 50511 3983470 3983470 7897834 868762 7029072 35653119 35417808 235311 4097958 4077468 20490 MEDICAL SUPPLIES 193708460 193708460 0 0 RESTRUCTURING / IMPAIRM 40791891 30593918 10197973 0 REPAIRS AND MAINTENANCE 15030243 11272682 3757561 0 UNRELATED BUSINESS TAXE -26613 0 -26613 0 10351844 4326368 6025476 964931390 907120424 57810966 0 15574 5006 152323561 23763595 0 132688553 130059691 0 0 507486 25000 24606206 26146315 2626221 2056570 692581093 381580903 369709709 311000190 0 342551914 329773300 0 4080015 0 85470246 112736828 1114579485 935566495 154141560 97322559 0 5316355 645215 0 0 0 0 0 210272440 190541212 369730355 288508986 X 744849130 647057509 0 744849130 647057509 1114579485 935566495 X -65680037 -32061610 -49974 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 33024 0 0 0 33024 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: IOWA HOSPITAL ASSOCIATION: $22,998 POLK COUNTY MEDICAL SOCIETY: $2,085 CATHOLIC HEALTH ASSOCIATION: $3,156 AMERICAN HOSPITAL ASSOCIATION: $4,785 4787610 45695 -182403 4650902 4066102 278 734495 13265 4787610 1189648 2722449 154005 4066102 1106052 20096 63500 1189648 1006037 5000 95015 1106052 0.89000 0.00000 0.11000 0 1 1 25067555 25067555 399925471 221326622 178598849 33013511 24980688 8032823 203982037 129590095 74391942 30592519 5683498 24909021 311000190 CSH OPERATING INVESTMENT POOL 329773300 F 329773300 INTERCOMPANY RECEIVABLES 66958891 INVESTMENTS IN UNCONSOLIDATED ORGANIZATIONS 7635280 RIGHT OF USE ASSETS, NET 38142657 112736828 INTERCOMPANY PAYABLES 79460851 INTERCOMPANY DEBT 70429522 UNCLAIMED PROPERTY 29157 ENVIRONMENTAL REMEDIATION 846436 LEASE LIABILITY 39775246 190541212 X PART V, LINE 4: MERCY FOUNDATION USES ENDOWMENT FUNDS AS DIRECTED BY THE ENDOWMENT DOCUMENTS. THESE ENDOWMENT FUNDS FURTHER MERCY'S EXEMPT PURPOSE BY FUNDING EQUIPMENT PURCHASES FOR TAX-EXEMPT HEALTHCARE NEEDS AND FUNDING HOSPITAL TAX-EXEMPT OPERATIONS. PART X, LINE 2: CATHOLIC HEALTH INITIATIVES - IOWA CORP'S FINANCIAL INFORMATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE FOLLOWING DISCLOSURE: COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 1 0 1 1 0 4379687 0 4379687 0.00450 0 54249665 0 54249665 0.05620 0 0 0 58629352 58629352 0.06070 1 5356 502126 0 502126 0.00050 1 0 4000000 0 4000000 0.00410 1 0 801218 0 801218 0.00080 0 0 0 0 2 0 381950 0 381950 0.00040 5 5356 5685294 5685294 0.00580 5 5356 64314646 64314646 0.06650 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 1 28281266 0 155168768 194827758 -39658990 X 1 1 4 1 MERCY MEDICAL CENTER - DES MOINES 1111 6TH AVENUE DES MOINES IA 50314 HTTPS://WWW.MERCYONE.ORG/DESMOINES 770033H X X X A 2 MERCY MEDICAL CENTER - WESTLAKES 1601 60TH STREET WEST DES MOINES IA 50266 HTTPS://WWW.MERCYDESMOINES.ORG 770158H X X X A 3 MERCYONE CLIVE REHABILITATION HOSPITAL 1401 CAMPUS DR CLIVE IA 50325 HTTPS://WWW.MERCYREHABDESMOINES.COM/ 770123H X REHABILITATION SERVICES A 4 CLIVE BEHAVIORAL HEALTH HOSPITAL 1450 NW 114TH ST CLIVE IA 50325 HTTPS://CLIVEBEHAVIORAL.COM/ 770124H X BEHAVIORAL HEALTH SERVICES A FACILITY REPORTING GROUP - A 1 1 1 X X X X X X X X X 21 1 1 1 1 X SEE PART V, PAGE 8 X 1 22 1 HTTPS://WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/ 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B, LINE 2: CLIVE BEHAVIORAL HEALTH OPENED FEBRUARY 22, 2021. THE FACILITY IS A PARTNERSHIP BETWEEN UNIVERSAL HEALTH SERVICES (UHS) AND MERCYONE. PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. PART V, SECTION B, LINE 5: INPUT WAS COLLECTED FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH SURVEYS CONDUCTED VIA TELEPHONE (LANDLINE AND CELL PHONE), AS WELL AS THROUGH ONLINE QUESTIONNAIRES. IN ALL, 537 AREA ADULTS COMPLETED THE COMMUNITY HEALTH SURVEY. TO SOLICIT INPUT FROM INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS IMPLEMENTED AS PART OF THIS PROCESS. IN ALL, 66 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. PARTICIPANTS INCLUDED TWO (2) PHYSICIANS, SIX (6) PUBLIC HEALTH REPRESENTATIVES (INCLUDING DALLAS COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, AND WARREN COUNTY PUBLIC HEALTH), FOUR (4) SOCIAL SERVICES PROVIDERS, 48 COMMUNITY LEADERS, AND SIX (6) OTHER HEALTH PROVIDERS. THROUGH THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW INCOME, MINORITY, OR OTHER MEDICALLY UNDERSERVED POPULATIONS. A COMPLETE LIST OF PARTICIPANTS IS AVAILABLE ON PAGE 10 OF THE CHNA. PART V, SECTION B, LINE 6A: MERCYONE DES MOINES MEDICAL CENTER, MERCYONE CLIVE REHABILITATION HOSPITAL, CLIVE BEHAVIORAL HEALTH, BROADLAWNS MEDICAL CENTER, AND UNITYPOINT HEALTH-DES MOINES COLLABORATED ON A JOINT CHNA. PART V, SECTION B, LINE 6B: THE ASSESSMENT WAS CONDUCTED WITH POLK COUNTY HEALTH DEPARTMENT, DALLAS COUNTY HEALTH DEPARTMENT, WARREN COUNTY HEALTH SERVICES, UNITED WAY OF CENTRAL IOWA, EVERYSTEP, AND MID IOWA HEALTH FOUNDATION. PART V, LINE 7A, CHNA WEBSITE: HTTPS://WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/HTTPS://CLIVEBEHAVIORAL.COM/ABOUT-US/HTTPS://WWW.MERCYREHABDESMOINES.COM/PATIENT-EXPERIENCE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 11: THE SIGNIFICANT HEALTH NEEDS IDENTIFIED, IN ORDER OF PRIORITY INCLUDE: 1) MENTAL HEALTH, 2) RESPIRATORY DISEASE, 3) NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT, 4) SUBSTANCE ABUSE, 5) HEART DISEASE AND STROKE, 6) ACCESS TO HEALTH CARE SERVICES, 7) INFANT HEALTH AND FAMILY PLANNING, 8) INJURY AND VIOLENCE, 9) DISABILITY AND CHRONIC PAIN, 10) SEXUAL HEALTH, 11) CANCER. MERCYONE - DES MOINES MEDICAL CENTER, MERCYONE CLIVE REHABILITATION HOSPITAL, AND CLIVE BEHAVIORAL HEALTH, IN COLLABORATION WITH HOUSE OF MERCY AND COMMUNITY PARTNERS, ARE FOCUSING ON DEVELOPING AND/OR SUPPORTING INITIATIVES TO IMPROVE THE FOLLOWING HEALTH NEEDS:1. MENTAL HEALTH: CLIVE BEHAVIORAL HEALTH IS ADDING AND EXPANDING OUTPATIENT BEHAVIORAL HEALTH PROGRAMS. FOR EXAMPLE, CLIVE BEHAVIORAL HEALTH HAS INCREASED CAPACITY FOR THEIR ADOLESCENT INTENSIVE OUTPATIENT PROGRAM TO APPROXIMATELY 30 ADOLESCENTS. 2. ACCESS TO HEALTH CARE: MERCYONE - DES MOINES IS LEVERAGING TECHNOLOGY TO MAKE CARE MORE ACCESSIBLE. FOR EXAMPLE, MERCYONE HAS LAUNCHED A REMOTE PATIENT MONITORING PROGRAM FOR PEOPLE WITH CHRONIC HEALTH CONDITIONS, LAUNCHED A SYMPTOM CHECKER AIDING PATIENTS IN ACCESSING THE RIGHT LEVEL OF CARE, AND WILL SOON BE IMPLEMENTING A PATIENT ACTIVATION SURVEY TO BETTER STRATIFY PATIENTS' HEALTH LITERACY. MERCYONE - DES MOINES IS ALSO MAKING STRIDES IN IDENTIFYING AND REMOVING TRANSPORTATION AND MEDICATION COST BARRIERS. FOR EXAMPLE, MERCYONE - DES MOINES MEDICAL CENTER IS SCREENING FOR HEALTH RELATED SOCIAL NEEDS IN BOTH THEIR DES MOINES AND WEST DES MOINES EMERGENCY DEPARTMENT LOCATIONS AND COMMUNITY HEALTH WORKERS ARE EMBEDDED IN EACH LOCATION TO ASSIST PATIENTS IN NAVIGATING COMMUNITY RESOURCES AND PUBLIC ASSISTANCE PROGRAMS. 3. SUBSTANCE ABUSE: HOUSE OF MERCY AND CLIVE BEHAVIORAL HEALTH ARE DEVELOPING NEW ACCESS POINTS AND EXPANDING SERVICES FOR SUBSTANCE USE DISORDER (SUD) TREATMENT. FOR EXAMPLE, CLIVE BEHAVIORAL HEALTH LAUNCHED AN ADULT SUD PROGRAM WITH CAPACITY FOR APPROXIMATELY 30-40 PATIENTS. HOUSE OF MERCY IS ALSO TAKING STEPS TO INCREASE THE NUMBER OF COUNSELORS TRAINED AND CERTIFIED TO PROVIDE EVIDENCE-BASED COUNSELING AND THERAPEUTIC TECHNIQUES. FIVE (5) COUNSELORS HAVE BEEN TRAINED ON DIALECTICAL BEHAVIORAL THERAPY (DBT), THREE (3) ADDITIONAL CLINICIANS WILL BE TRAINED THIS MONTH, AND THREE (3) CLINICIANS HAVE BEEN TRAINED IN CHILD PARENT PSYCHOTHERAPY, TWO (2) ADDITIONAL CLINICIANS WILL BE TRAINED. ADDITIONALLY, HOUSE OF MERCY HAS EXPANDED MENTAL HEALTH ACCESS POINTS BY PROVIDING A THERAPIST TO SEE STUDENTS AT FOUR CATHOLIC SCHOOLS. 4. INFANT HEALTH AND FAMILY PLANNING: MERCYONE MEDICAL CENTER IS WORKING TO REDUCE STILLBIRTH RATES AMONG WOMEN OF COLOR. FOR EXAMPLE, A COMMUNITY HEALTH WORKER DEDICATED TO THE OBSTETRIC EMERGENCY DEPARTMENT WAS HIRED IN DECEMBER 2022 TO ASSIST PATIENTS IN NAVIGATING COMMUNITY RESOURCES, APPLYING FOR PUBLIC ASSISTANCE PROGRAMS, AND IDENTIFYING A MEDICAL HOME THAT MEETS THE PATIENT'S PRENATAL CARE NEEDS AND PREFERENCES. 5. HEART DISEASE AND STROKE: MERCYONE CLIVE REHABILITATION HOSPITAL IS COMPLETING A GAP ANALYSIS TO IDENTIFY POPULATIONS WHO MAY BENEFIT FROM PHYSICAL MEDICINE AND REHABILITATION PROGRAMS BUT ARE NOT CURRENTLY ABLE TO BE CARED FOR AT THE HOSPITAL. FOR EXAMPLE, THE HOSPITAL ADDED THE ABILITY TO CARE FOR PATIENTS WITH A LEFT VENTRICULAR ASSIST DEVICE THROUGH AN EMPLOYEE EDUCATION PROGRAM AND ARE CURRENTLY PROVIDING EDUCATION TO IMPROVE THAT ABILITY TO TREAT PATIENTS WITH THROMBOSIS. THE HOSPITAL IS ALSO WORKING TOWARDS A STROKE CERTIFICATION THROUGH THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF).MERCYONE - DES MOINES MEDICAL CENTER, MERCYONE CLIVE REHABILITATION HOSPITAL, AND CLIVE BEHAVIORAL HEALTH ACKNOWLEDGE THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH ARE THE MOST PRESSING, UNDER- ADDRESSED AND WITHIN ITS ABILITY TO INFLUENCE. MERCYONE - DES MOINES MEDICAL CENTER, MERCYONE CLIVE REHABILITATION HOSPITAL, AND CLIVE BEHAVIORAL HEALTH DO NOT INTEND TO ADDRESS THE FOLLOWING HEALTH NEEDS:- RESPIRATORY DISEASE (COVID-19) - THIS NEED WAS NOT SELECTED TO ADDRESS DUE TO THE EVOLVING NATURE OF THE COVID-19 PANDEMIC. MERCYONE WILL CONTINUE TO WORK COLLABORATIVELY WITH STATE AND PUBLIC HEALTH OFFICIALS TO CONTINUE TO RESPOND TO THE EVOLVING COMMUNITY HEALTH NEEDS OF THE COVID-19 PANDEMIC. - NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT - COMMUNITY STAKEHOLDERS WHO RATED THIS DOMAIN AS A MAJOR PROBLEM PRIMARILY SHARED CONCERNS AROUND ACCESS AND AFFORDABILITY OF HEALTHY FOOD OPTIONS AS WELL AS SAFE OUTDOOR SPACES. MERCYONE WILL CONTINUE TO COLLABORATE WITH THE COMMUNITY ORGANIZATIONS WHO ARE ALREADY LEADING INITIATIVES TO ADDRESS THIS NEED. - INJURY AND VIOLENCE - THIS NEED WAS NOT SELECTED AS IT WAS RANKED AS A LOWER PRIORITY BY COMMUNITY STAKEHOLDERS. - DISABILITY AND CHRONIC PAIN - THIS NEED WAS NOT SELECTED AS IT WAS RANKED AS A LOWER PRIORITY BY COMMUNITY STAKEHOLDERS. - SEXUAL HEALTH - THIS NEED WAS NOT SELECTED AS IT WAS RANKED AS A LOWER PRIORITY BY COMMUNITY STAKEHOLDERS. - CANCER - THIS NEED WAS NOT SELECTED AS IT WAS RANKED AS A LOWER PRIORITY BY COMMUNITY STAKEHOLDERS. PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS. PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE 18 1 - MERCY OUTPATIENT CARDIAC TESTING 5880 UNIVERSITY SUITE 211 WEST DES MOINES IA 50266 AMBULATORY HEALTH CARE 2 - MERCY AMBULATORY SURGERY CENTER 411 LAUREL STREET DES MOINES IA 50314 AMBULATORY HEALTH CARE 3 - MERCY FRANKLIN CENTER 1818 48TH STREET DES MOINES IA 50314 BEHAVIORAL HEALTH 4 - RCG MERCY DES MOINES LLC 920 WINTER STREET WALTHAM MA 02451 PHYSICIAN SERVICES 5 - RIVER HILLS SURGERY CENTER 1111 6TH AVENUE DES MOINES IA 50314 SURGERY CENTER 6 - CENTRAL IOWA CYBERKNIFE 411 LAUREL STREET DES MOINES IA 50314 PHYSICIAN OFFICE 7 - MERCY WEIGHT LOSS & NUTRITION CENTER 12493 UNIVERSITY AVENUE SUITE 110 WEST DES MOINES IA 50325 AMBULATORY HEALTH CARE 8 - MERCY WEST ENDOSCOPY 1601 NW 114TH STREET SUITE 244 CLIVE IA 50325 AMBULATORY HEALTH CARE 9 - MERCY OUTPATIENT CARDIAC TESTING 411 LAUREL STREET DES MOINES IA 50314 AMBULATORY HEALTH CARE 10 - MERCY WEST RADIOLOGY 1601 NW 114TH STREET SUITE 149 CLIVE IA 50325 MEDICAL IMAGING 11 - MERCY CANCER CENTER 411 LAUREL STREET DES MOINES IA 50314 PHYSICIAN SERVICES 12 - WEST LAKES SURGERY CENTER LLC 12499 UNIVERSITY AVENUE SUITE 100 CLIVE IA 50325 SURGERY CENTER 13 - RADIOLOGY CENTER 12495 UNIVERSITY AVENUE CLIVE IA 50325 MEDICAL IMAGING 14 - MERCY SLEEP CENTER 1449 NW 128TH STREET SUITE 100 CLIVE IA 50325 AMBULATORY HEALTH CARE 15 - MERCY RIVERSIDE REHABILITATION CENTER 730 EAST 2ND STREET DES MOINES IA 50309 REHABILITATION CENTER 16 - MERCY CARDIAC & PULMONARY REHABILITATION 411 LAUREL STREET DES MOINES IA 50314 AMBULATORY HEALTH CARE 17 - MERCY ATRIUM IMAGING 411 LAUREL STREET DES MOINES IA 50314 MEDICAL IMAGING 18 - MERCY FAMILY MEDICINE RESIDENCY CENTER 250 LAUREL STREET DES MOINES IA 50314 PHYSICIAN OFFICE PART I, LINE 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE:- THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.- THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS.- THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:- RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS;- HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE. PART I, LINE 7: COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS. PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: CATHOLIC HEALTH INITIATIVES - IOWA CORP MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. CATHOLIC HEALTH INITIATIVES - IOWA CORP'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. CATHOLIC HEALTH INITIATIVES - IOWA CORP ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, CATHOLIC HEALTH INITIATIVES - IOWA CORP DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4: CATHOLIC HEALTH INITIATIVES - IOWA CORP DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES." PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. CATHOLIC HEALTH INITIATIVES - IOWA CORP'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $ 39,658,990 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 2: MERCYONE IS SCREENING FOR HEALTH RELATED SOCIAL NEEDS IN PRIMARY CARE, PEDIATRICS, AND THE EMERGENCY DEPARTMENT TO ASSESS THE SOCIAL DETERMINANTS OF HEALTH IN THE COMMUNITIES WE SERVE (E.G. FOOD INSECURITY, HOUSING INSTABILITY, TRANSPORTATION NEEDS). MERCYONE IS ALSO PARTICIPATING IN A COMMUNITY ENGAGEMENT COLLABORATIVE WITH HEALTH CARE AND PAYER PARTNERS THAT UTILIZE COMMUNITY RESOURCE DIRECTORIES POWERED BY THE SAME VENDOR. AS A COLLABORATIVE WE REVIEW WHAT RESOURCE DOMAINS ARE SEARCHED IN OUR COVERAGE AREA (E.G. FOOD, HOUSING, GOODS, TRANSIT, HEALTH, MONEY, CARE, ETC.) AND WHICH COMMUNITY BASED ORGANIZATIONS SEEKERS ARE INTERACTING WITH MOST ON THE COMMUNITY RESOURCE DIRECTORY. WORKING WITH NEARLY THIRTY COMMUNITY-BASED ORGANIZATIONS, MERCY MEDICAL CENTER - DES MOINES JOINED IN AN IN-DEPTH EVALUATION OF THE HEALTH OF OUR COMMUNITY. DESIGNED TO IDENTIFY NEEDS AND DEVELOP IMPROVEMENT STRATEGIES, THE PROCESS ENGAGED THOUSANDS OF RESIDENTS AND VESTED LEADERS IN THIS VALUABLE DISCUSSION.MANY SERVICES PROVIDED BY MERCY CONTINUE TO SURFACE ARE AREAS OF GREATEST NEED. ACCESS TO A MEDICAL HOME, NEED FOR COORDINATED SPECIALTY CARE AND FINANCIAL ASSISTANCE FOR THE UNINSURED AND UNDERSERVED WERE IDENTIFIED BY THE PARTICIPANTS. THESE BARRIERS, COMBINED WITH NEEDED ACCESS TO HEALTHY FOOD, SAFE HOUSING AND PUBLIC TRANSPORTATION, HAVE GUIDED THE COMMUNITY-BASED ACTIVITIES FOR MERCY. PART VI, LINE 3: INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. PART VI, LINE 4: THE SERVICES AREA FOR THE CHNA INCLUDES POLK, WARREN, AND DALLAS COUNTIES IN IOWA. THIS COMMUNITY DEFINITION WAS DETERMINED BASED ON THE ZIP CODES OF RESIDENCE OF MERCYONE PATIENTS AS WELL AS THE PATIENTS AND CLIENTS OF COLLABORATING HOSPITALS AND ORGANIZATIONS. POLK, WARREN, AND DALLAS COUNTIES TOGETHER ENCOMPASS 1,730.37 SQUARE MILES AND HOUSE A TOTAL POPULATION OF 616,787 RESIDENTS, ACCORDING TO LATEST CENSUS ESTIMATES. IN THE SERVICE AREA, 25.4% OF THE POPULATION ARE CHILDREN AGE 0-17; ANOTHER 61.7% ARE AGE 18 TO 64, WHILE 12.9% ARE AGE 65 AND OLDER. IN LOOKING AT RACE INDEPENDENT OF ETHNICITY (HISPANIC OR LATINO ORIGIN), 85.9% OF RESIDENTS ARE WHITE AND 5.6% ARE BLACK. A TOTAL OF 7.6% OF RESIDENTS ARE HISPANIC OR LATINO. TWO IN THREE TOTAL SERVICE AREA ADULTS AGE 18 TO 64 (66.3%) REPORT HAVING HEALTH CARE COVERAGE THROUGH PRIVATE INSURANCE. ANOTHER 28.9% REPORT COVERAGE THROUGH A GOVERNMENT-SPONSORED PROGRAM (E.G., MEDICAID, MEDICARE, MILITARY BENEFITS). AMONG ADULTS AGE 18 TO 64, 4.8% REPORT HAVING NO INSURANCE COVERAGE FOR HEALTH CARE EXPENSES. THE LATEST CENSUS ESTIMATE SHOWS 9.5% OF THE SERVICE AREA POPULATION LIVE BELOW THE FEDERAL POVERTY LEVEL. AMONG THE SERVICE AREA POPULATION AGE 25 AND OLDER, AN ESTIMATED 7.6% DO NOT HAVE A HIGH SCHOOL EDUCATION, WHICH IS WELL BELOW THE NATIONAL PERCENTAGE. MERCY MEDICAL CENTER - DES MOINES IS A REGIONAL HOSPITAL, WITH A PRIMARY SERVICE AREA OF THREE COUNTIES AND A SECONDARY REACH TO THE SURROUNDING SIX COUNTIES. THE POPULATION SERVED INCLUDES BOTH URBAN AND RURAL COMMUNITIES, WITH A GROWING NUMBER OF PEOPLE RESIDING IN THE 3-COUNTY PRIMARY SERVICE AREA (POLK, DALLAS AND WARREN.) THESE RESIDENTS HAVE A MEDIAN HOUSEHOLD INCOME OF $61,721, WITH ROUGHLY 8 PERCENT OF PERSONS LIVING BELOW THE POVERTY LEVEL. OF THOSE WHO LIVE BELOW THE POVERTY LEVEL, 52 PERCENT ARE SINGLE-PARENT HOMES WITH CHILDREN UNDER 5 YEARS OF AGE. WITH AN INCREASING IMMIGRANT AND REFUGEE POPULATION RELOCATING TO IOWA, APPROXIMATELY 10 PERCENT OF OUR 3-COUNTY AREA SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME. THE LARGEST NON-NATIVE POPULATION HAS HISPANIC ORIGIN. ANOTHER DEMOGRAPHIC FACTOR IMPACTING IOWA'S DEMAND FOR HEALTH CARE SERVICE IS OUR ELDERLY, WITH 14.9 PERCENT OF OUR RESIDENTS BEING OVER 65 YEARS OF AGE. THE UNINSURED POPULATION OF OUR 3-COUNTY SERVICE AREA IS APPROXIMATELY EIGHT PERCENT. MEDICARE AND MEDICAID COVER 22 PERCENT OF OUR POPULATION.MERCY IS ONE OF TWO LARGE HEALTH CARE SYSTEMS IN OUR COMMUNITY. IN ADDITION, POLK AND DALLAS COUNTIES EACH HAVE A COUNTY HOSPITAL. PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITY(IES) PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY(IES) HAVE AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES REPRESENTS DIVERSE PROFESSIONAL EXPERTISE AND LIFE EXPERIENCE IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITY(IES) TREAT PERSONS PAYING THEIR BILL WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT. MERCY MEDICAL CENTER - DES MOINES IS AN 802-BED ACUTE CARE, NOT-FOR-PROFIT CATHOLIC HOSPITAL SITUATED ON THREE CAMPUSES. FOUNDED BY THE SISTERS OF MERCY IN 1893, MERCY IS DES MOINES' LONGEST CONTINUALLY OPERATING HOSPITAL AND ONE OF THE LARGEST EMPLOYERS IN THE STATE, WITH MORE THAN 6,300 EMPLOYEES AND A MEDICAL STAFF OF MORE THAN 950 PHYSICIANS AND ALLIED HEALTH PROFESSIONALS. AS THE FIRST CATHOLIC HOSPITAL TO SERVE THE COMMUNITY, MERCY EMBRACED THE MISSION OF THE FOUNDING RELIGIOUS CONGREGATION, WHICH HAS SINCE JOINED WITH OTHER RELIGIOUS CONGREGATIONS TO FORM CATHOLIC HEALTH INITIATIVES. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH AS A SINGLE MINISTRY IN EARLY 2019.OUR COMMITMENT TO SERVE THE COMMON GOOD IS DELIVERED THROUGH THE DEDICATED WORK OF THOUSANDS OF PHYSICIANS, ADVANCED PRACTICE CLINICIANS, NURSES, AND STAFF; THROUGH CLINICAL EXCELLENCE DELIVERED ACROSS A SYSTEM OF 140 HOSPITALS AND MORE THAN 1,500 CARE CENTERS SERVING 21 STATES; AND THROUGH MORE THAN $5 BILLION ANNUALLY IN CHARITY CARE, COMMUNITY BENEFITS, AND GOVERNMENT PROGRAM SERVICES.WITH A LARGE GEOGRAPHIC FOOTPRINT REPRESENTING DIVERSE POPULATIONS ACROSS THE U.S. AND A MISSION TO SERVE THE MOST VULNERABLE, COMMONSPIRIT IS A LEADER IN ADVANCING THE SHIFT FROM SICK CARE TO WELL CARE, AND ADVOCATING FOR SOCIAL JUSTICE.COMMONSPIRIT HEALTH ALSO SUPPORTS A RANGE OF COMMUNITY HEALTH PROGRAMS, RESEARCH PROGRAMS, VIRTUAL CARE SERVICES, AND HOME HEALTH PROGRAMS ADDRESSING THE ROOT CAUSES OF POOR HEALTH SUCH AS ACCESS TO QUALITY CARE AND HEALTH EQUITY, AFFORDABLE HOUSING, SAFE NEIGHBORHOODS, AND A HEALTHY ENVIRONMENT.MERCY IS ONE OF THE MIDWEST'S LARGEST REFERRAL CENTERS, OFFERING A VARIETY OF SPECIALTY SERVICES THAT ARE UNIQUE TO IOWA AND THE REGION. IN ADDITION, A 24-HOUR EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. WHILE A PARTICIPANT IN MEDICARE AND MEDICAID, MERCY ALSO DEPLOYS A ROBUST FINANCIAL ASSISTANCE PROGRAM FOR THE UNINSURED AND UNDERSERVED, MEETING THE NEEDS OF ALL SEEKING CARE.DEDICATED TO SERVING OUR ENTIRE COMMUNITY, MERCY IS ENRICHED BY A BOARD OF DIRECTORS COMPRISED OF CIVIC-MINDED LEADERS. WORKING IN CONJUNCTION WITH THIS ESTEEMED TEAM, MERCY'S LEADERSHIP EVALUATES AND DEDICATES RESOURCES TO THE PROMOTION OF A HEALTHY COMMUNITY AND AN IMPROVEMENT IN THE LIVES OF THOSE WE SERVE. ONE EXAMPLE OF MERCY'S COMMITMENT TO UNMET NEEDS EXISTS IN THE HOUSE OF MERCY. INITIALLY DEVELOPED TO PROVIDE SAFE AND SUPPORTIVE HOUSING FOR VULNERABLE WOMEN AND THEIR CHILDREN, THE HOUSE OF MERCY IS NOW ONE OF IOWA'S LARGEST PROVIDERS OF TRANSITIONAL HOUSING AND CLINICAL SERVICES FOR PARENTING WOMEN WITH ADDICTION. THE HOUSE OF MERCY IS DEDICATED TO ASSISTING PREGNANT, PARENTING/NON-PARENTING, AND ADOLESCENT/ADULT WOMEN IN DEVELOPING PERSONAL RESPONSIBILITY AND INDEPENDENCE THROUGH COUNSELING, EDUCATION, AND MEDICAL CARE IN COLLABORATION WITH OTHER CARING INDIVIDUALS. IT IS HOME TO 11 VITAL HUMAN SERVICE AND HEALTH CARE RELATED PROGRAMS AND, ON AVERAGE, HOUSES NEARLY 170 WOMEN AND CHILDREN IN THE RESIDENTIAL TREATMENT PROGRAM. DURING THEIR STAY, WOMEN GAIN THE SKILLS THEY NEED TO LIVE INDEPENDENTLY, DEAL WITH ADDICTION, OVERCOME THE EFFECTS OF TRAUMA AND EFFECTIVELY PARENT THEIR CHILDREN. MERCYONE MEDICAL CENTER - DES MOINES IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN - BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. 1 ABOVE & BEYOND CANCER 1915 GRAND AVE DES MOINES IA 50309 420680438 501(C)(3) 25000 0 COMMUNITY SUPPORT BRAVO GREATER DES MOINES 1915 GRAND AVE DES MOINES IA 50309 203598346 501(C)(3) 10000 0 COMMUNITY SUPPORT COMMUNITY FOUNDATION OF GREATER DES MOINES 2771 104TH ST STE 1 URBANDALE IA 50322 751835298 501(C)(3) 115000 0 COMMUNITY SUPPORT GREAT OUTDOORS FOUNDATION PO BOX 8071 DES MOINES IA 50301 421441098 501(C)(3) 50000 0 COMMUNITY SUPPORT HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 501(C)(3) 950000 0 PROGRAM SUPPORT IOWA CATHOLIC RADIO PO BOX 838 DES MOINES IA 50304 201935653 501(C)(3) 29502 0 COMMUNITY SUPPORT MERCY CLINICS INC 1111 6TH AVE DES MOINES IA 50314 421193699 501(C)(3) 62200050 0 PROGRAM SUPPORT MERCY MEDICAL CENTER CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 501(C)(3) 602779 0 PROGRAM SUPPORT PRIMARY HEALTH CARE 3506 E 29TH DES MOINES IA 50317 421350092 501(C)(3) 2348744 0 COMMUNITY SUPPORT RONALD MCDONALD HOUSE OF CENTRAL IOWA 1441 PLEASANT ST DES MOINES IA 50314 421117423 501(C)(3) 20000 0 COMMUNITY SUPPORT STRANDS OF STRENGTH INC 1310 TULIP TREE LANE WEST DES MOINES IA 50266 454145232 501(C)(3) 25000 0 COMMUNITY SUPPORT UNITYPOINT HEALTH 1776 WESTLAKES PKWY WEST DES MOINES IA 50266 421435199 501(C)(3) 25000 0 COMMUNITY SUPPORT MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 501(C)(3) 2618400 0 PROGRAM SUPPORT 13 0 PART I, LINE 2: ALL GRANTS ARE REVIEWED AND MONITORED BY THE GRANTS MANAGER. EACH GRANT IS ASSIGNED A GRANT ADMINISTRATOR WHO COORDINATES GRANT COMPLIANCE WITH THE GRANTS MANAGER. GRANT REIMBURSEMENTS ARE RECEIVED THROUGH THE FINANCIAL OPERATIONS DEPARTMENT. GRANT EXPENDITURES REQUIRE THE SAME APPROVAL AS NON-GRANT EXPENDITURES THROUGH THE ACCOUNTS PAYABLE APPROVAL MATRIX. ALL PERIODIC REPORTS TO THE GRANTING AGENCY FOR GRANTS THAT REQUIRE THIS ARE FILED TIMELY WITH THE APPROPRIATE AGENCY. IN ADDITION, THE ORGANIZATION UNDERGOES A FEDERAL A-133 GRANT AUDIT ANNUALLY BY AN INDEPENDENT AUDITOR. X X X X X 1 1 0 0 0 0 0 0 0 ROBERT RITZ DIRECTOR/CEO MERCY HEALTH NETWORK 0 1235352 0 542654 0 219677 0 16733 0 28338 0 2042754 0 0 MATTHEW BROWN DIRECTOR/SYS SVP-OPERATIONS TRANSFOR 0 685543 0 869398 0 840 0 16179 0 29539 0 1601499 0 0 MICHAEL WEGNER DIRECTOR, INTERIM PRESIDENT MERCYONE 776342 0 487996 0 22612 0 17275 0 22560 0 1326785 0 0 0 SEAN WILLIAMS PRESIDENT NETWORK HOSPITAL 351135 0 70257 0 720577 0 17275 0 20514 0 1179758 0 0 0 KENT CARR SVP-PHYSICIAN ENTERPRISE 12089 0 75436 0 956408 0 9322 0 977 0 1054232 0 0 0 DAVID HOCKMUTH CARDIOTHORACIC SURGEON 953529 0 500 0 5544 0 16275 0 27644 0 1003492 0 0 0 MARK TANNENBAUM DIRECTOR (PARTIAL YEAR)/PHYSICIAN 810444 0 109592 0 5544 0 17100 0 32367 0 975047 0 0 0 KARL KEELER PRESIDENT (PARTIAL YEAR) 566383 0 287706 0 20932 0 18307 0 28438 0 921766 0 0 0 AARON FROM CARDIOLOGIST 744940 0 115713 0 840 0 17100 0 25375 0 903968 0 0 0 MUDASSIR MALIK CARDIOLOGIST 682327 0 115713 0 1260 0 17100 0 25644 0 842044 0 0 0 HIJINIO CARREON DIV SVP MHN PHYSICIAN ENTERPRISE 582629 0 118377 0 23664 0 17351 0 31954 0 773975 0 0 0 NEIL HORNING DIRECTOR/PULMONOLOGIST CRITICAL CARE 0 701616 0 500 0 3612 0 16782 0 25644 0 748154 0 0 LINDA GOODWIN SYS SVP NURSING INNOVATION CARE TRAN 510193 0 115881 0 29668 0 19038 0 17589 0 692369 0 0 0 RANDALL RUBIN SVP, CFO 465287 0 94704 0 22804 0 17911 0 25688 0 626394 0 0 0 JORDAN HARROP CHIEF OPERATING OFFICER 320928 0 56956 0 15497 0 16265 0 25750 0 435396 0 0 0 PART 1, LINE 4A: CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2021 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUALS' W-2 INCOME AND REPORTABLE COMPENSATION ON PART VII AND SCHEDULE J, PART II, COLUMN (B)(III): KENT CARR, $956,062 AND SEAN WILLIAMS, $712,167. PART 1, LINE 4B: DURING THE 2021 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2021 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2021, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: ROBERT P. RITZ, $202,733 FORM 990, PART V, LINE 1C PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH ARE MADE BY COMMONSPIRIT HEALTH. THEREFORE, NO FORMS 1099 ARE ISSUED BY CATHOLIC HEALTH INITIATIVES - IOWA CORP. COMMONSPIRIT HEALTH FILES THE FORMS 1099 AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAME WINNINGS. THE FORMS 1099 ISSUED ON BEHALF OF CATHOLIC HEALTH INITIATIVES - IOWA CORP ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 1A PURSUANT TO SECTION 8.6 OF THE BYLAWS OF CATHOLIC HEALTH INITIATIVES - IOWA CORP, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE BYLAWS OF CATHOLIC HEALTH INITIATIVES - IOWA CORP THE ENTITY'S SOLE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A COMMONSPIRIT HEALTH HAS THE POWER TO APPOINT, REMOVE, OR REPLACE THE MEMBERS OF THE BOARD OF DIRECTORS. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE CATHOLIC HEALTH INITIATIVES - IOWA CORP *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE CATHOLIC HEALTH INITIATIVES - IOWA CORP *APPROVE MEMBERS OF THE CATHOLIC HEALTH INITIATIVES - IOWA CORP BOARD *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE CATHOLIC HEALTH INITIATIVES - IOWA CORP *APPROVAL OF ISSUANCE OF DEBT BY CATHOLIC HEALTH INITIATIVES - IOWA CORP *APPROVAL OF PARTICIPATION OF CATHOLIC HEALTH INITIATIVES - IOWA CORP IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY CATHOLIC HEALTH INITIATIVES - IOWA CORP *APPROVAL OF A MERGER INVOLVING THE CATHOLIC HEALTH INITIATIVES - IOWA CORP *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CATHOLIC HEALTH INITIATIVES - IOWA CORP *TO REQUIRE THE TRANSFER OF ASSETS BY THE CATHOLIC HEALTH INITIATIVES - IOWA CORP TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR CATHOLIC HEALTH INITIATIVES - IOWA CORP PURSUANT TO SECTION 5.5 OF THE ORGANIZATION'S BYLAWS, COMMONSPIRIT HEALTH MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. SUBSEQUENT TO REVIEW BY THE CHIEF FINANCIAL OFFICER, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NONSUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. SUBSEQUENT TO E-FILING, THE FINAL E-FILED FORM 990 IS PRESENTED TO THE BOARD AT A REGULARLY SCHEDULED BOARD MEETING. FORM 990, PART VI, LINE 16B CATHOLIC HEALTH INITIATIVES - IOWA CORP HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, COMMONSPIRIT HEALTH'S SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF THE EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; AND (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE ORGANIZATION USES A THIRD-PARTY CONSULTANT TO SURVEY COMPENSATION TRENDS ANNUALLY AND TO RECOMMEND A COMPENSATION RANGE FOR THE CEO. THIS RECOMMENDATION IS PRESENTED TO THE BOARD FOR FINAL DETERMINATION AND APPROVAL. THE SALARIES ARE COMPARED TO INDUSTRY STANDARDS AND GUIDELINES FOR APPROPRIATENESS. THIS PROCESS WAS LAST UNDERTAKEN IN JUNE 2021 FOR CALENDAR YEAR 2022. LINE 15B: FOR OFFICERS AND KEY EMPLOYEES, CATHOLIC HEALTH INITIATIVES - IOWA CORP USES A THIRD PARTY CONSULTANT TO ANNUALLY SURVEY COMPENSATION TRENDS AND RECOMMEND COMPENSATION RANGES. THESE RECOMMENDATIONS ARE PRESENTED TO THE BOARD, WHICH MAKES THE FINAL COMPENSATION DECISIONS. THE DECISIONS ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG OR ARE AVAILABLE ON THE IOWA SECRETARY OF STATE'S WEBSITE. THE ORGANIZATION'S BYLAWS AND CONFLICT OF INTEREST POLICY ARE NOT PUBLICLY AVAILABLE. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 501,245. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 501,245. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 38,151,686. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,151,686. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 50,817,528. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,817,528. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 35,427,266. MANAGEMENT AND GENERAL EXPENSES 9,417,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,844,640. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 31,846,355. MANAGEMENT AND GENERAL EXPENSES 1,676,124. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,522,479. FORM 990, PART XI, LINE 9: ERROR SUSPENSE BILLING AND REVENUE -49,974. MHN ACO LLC 1111 6TH AVE DES MOINES IA 50314 812764963 PHYSICIAN SERVICES IA CHI-IA CORP PERINATAL CENTER OF IOWA LLC 1111 6TH AVE DES MOINES IA 50314 830397103 PHYSICIAN SERVICES IA CHI-IA CORP ONECARE LLC DBA MERCY ACO 1111 6TH AVE DES MOINES IA 50314 454498644 ACCOUNTABLE CARE ORGANIZATION BUSINESS IA CHI-IA CORP ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(C)(3) LINE 3 ACH 0 ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH-COMM MEM HOSPITAL OF MO VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 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501(C)(3) LINE 3 BSLHV 0 BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 INACTIVE PA 501(C)(3) LINE 12A, I CSH 0 BRAZOSPORT HEALTH FOUNDATION INC 100 MEDICAL DRIVE LAKE JACKSON TX 77566 760080110 FUNDRAISING FOUNDATION TX 501(C)(3) LINE 12A, I TCHB 0 BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(C)(3) LINE 3 TCHB 0 BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HOSPITAL TX 501(C)(3) LINE 3 SLH-CO 0 BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 REHABILITATION TX 501(C)(3) LINE 10 SJSC 0 CALIFORNIA HOSPITAL MEDICAL CENTER FOUNDATION 1401 SOUTH GRAND AVENUE LOS ANGELES CA 90015 954000909 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DCC 0 CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HOSPITAL ND 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES - COLORADO 9100 EAST MINERAL CIRCLE CENTENNIAL CO 80112 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