2020-07-07T13:23:02-05:00 2019-06-30 990 2018-07-01 421336618 MERCY MEDICAL CENTER - CLINTON INC MERC 5632445555 1410 NORTH 4TH STREET CLINTON IA 527322940 KIM DUWE REGIONAL VP FINANCE 5632445555 2020-07-07 170.232.237.226 2020-07-07 13:22:53 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 403A83BCAAA913A93C4B950ECE6CC8F4A14CBF47 2018 2020-11-06 18:47:13Z MERCYONE CLINTON MEDICAL CENTER KAY TAKES 1410 NORTH 4TH STREET CLINTON IA 527322940 99628698 0 X WWW.MERCYONE.ORG/CLINTON/ X 1989 DE TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 6 4 1268 177 115218 47362 217772 151026 95726010 94775277 3663668 3061873 1157196 1284697 100764646 99272873 38522 56154 0 0 52223178 49142983 0 0 0 51976921 52227755 104238621 101426892 -3473975 -2154019 138340107 133398596 31026357 29297007 107313750 104101589 X MERCYONE SERVES WITH FEDELITY TO THE GOSPEL AS A COMPASSIONATE, HEALING MINISTRY OF JESUS CHRIST TO TRANSFORM THE HEALTH OF OUR COMMUNITIES. MERCY MEDICAL CENTER - CLINTON IS A MEMBER OF MERCYONE. 0 0 95922742 56154 93718891 MERCY MEDICAL CENTER - CLINTON (MERCYONE CLINTON) IS LOCATED IN CLINTON, IOWA. MERCYONE CLINTON IS A FULL-SERVICE COMMUNITY HEALTH SYSTEM SERVING RESIDENTS IN CLINTON, IOWA AND SURROUNDING COMMUNITIES IN EASTERN IOWA AND NORTHWESTERN ILLINOIS. WITH A HISTORY DATING BACK MORE THAN 130 YEARS, MERCYONE CLINTON IS PROUD TO OFFER THE LATEST IN HEALTH AND MEDICAL SERVICES WITH A CARING, COMPASSIONATE AND PERSONAL TOUCH.MERCYONE CLINTON PROVIDES A BROAD RANGE OF SERVICES TO MEET THE HEALTH CARE NEEDS OF RESIDENTS IN THE BI-STATE AREA. WITH TWO MAIN CAMPUSES, MERCYONE CLINTON OPERATES 249 LICENSED BEDS, INCLUDING 86 LONG-TERM CARE BEDS. SERVICES INCLUDE A RADIATION ONCOLOGY CENTER IN AFFILIATION WITH THE UNIVERSITY OF IOWA HOSPITALS AND CLINICS, TWO CARDIAC CATHETERIZATION LABS, RENAL DIALYSIS AND A TRAUMA CENTER. RESIDENTS ALSO HAVE ACCESS TO THE SKILL OF MERCYONE CLINTON'S HOME HEALTH AND HOSPICE CARE, AS WELL AS QUALITY EQUIPMENT AND SUPPLIES THROUGH MERCY HOME MEDICAL EQUIPMENT. IN FISCAL YEAR 2019 THE HOSPITAL PROVIDED OVER 31,000 PATIENT DAYS OF HEALTH CARE SERVICES TO THE COMMUNITY.RECOGNIZING THE IMPORTANCE OF MAINTAINING HEALTH, MERCYONE CLINTON CREATES OPPORTUNITIES TO PROMOTE WELLNESS AND ASSIST PEOPLE TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH AND WELL-BEING. IN ADDITION, MERCYONE CLINTON SUPPORTS COMMUNITY PROGRAMS AND ACTIVITIES THAT ENHANCE THE CULTURAL AND ECONOMIC PROSPERITY OF ITS ASSOCIATES AND THE COMMUNITY AT LARGE.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS AND AWARDS: WWW.MERCYONE.ORG/CLINTON/ 95922742 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 208 0 1 1268 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X KIM DUWE 5635899977 1410 NORTH 4TH STREET CLINTON IA 527322940 ROBERT RITZ DIRECTOR; REGIONAL PRESIDENT & CEO 1.00 1.00 X X 0 0 0 MILTON AVERY DIRECTOR; CHAIR 1.00 1.00 X X 0 0 0 MARY CORITA HEID RSM DIRECTOR; VICE CHAIR 1.00 1.00 X X 0 0 0 SALLY JEFFCOAT DIR AS OF 3/19; TRINITY EVP GROWTH 1.00 54.00 X 0 1621782 73096 MAURITA SOUKUP RSM DIRECTOR 1.00 1.00 X 0 0 0 RALPH REEDER MD DIRECTOR 1.00 1.00 X 0 0 0 RODNEY SCHLADER TREAS THR 2/19; PRES NORTH IA REGION 1.00 54.00 X 0 409042 57197 MICHAEL WEGNER TREASURER AS OF 2/19; REGIONAL CFO 1.00 1.00 X 0 0 0 MARCIA SMITH SECRETARY; ASSOC. COUNSEL MERCYONE 1.00 44.00 X 0 410340 37098 AMY BERENTES INTERIM CEO THR 7/18; COO AS OF 7/18 20.00 30.00 X 0 218204 25158 KAY TAKES PRESIDENT EASTERN IOWA REGION 25.00 30.00 X 0 446684 49399 WILLIAM MURDOCK VP FINANCE THROUGH 2/19 49.00 1.00 X 0 191971 42050 KIM DUWE VP FINANCE EASTERN IOWA REGION 20.00 30.00 X 0 201130 35512 ABDULLAH FOAD MD PHYSICIAN, ORTHOPEDIC SURGERY 50.00 0.00 X 867710 0 46836 ROBERT MAGNUS MD PHYSICIAN, ORTHOPEDIC SURGERY 50.00 0.00 X 739036 0 51853 MOHAMMED IRSHAD MD PHYSICIAN, GASTROENTEROLOGY 50.00 0.00 X 629554 0 17521 DOUGLAS CODY MD PHYSICIAN, ENT 50.00 0.00 X 616633 0 54993 RICKY MADDOX MD PHYSICIAN, GENERAL SURGERY 50.00 0.00 X 485518 0 13273 SEAN WILLIAMS FORMER OFFICER 0.00 0.00 X 0 191084 14600 3338451 3690237 518586 37 1 1 0 APOGEE MEDICAL MANAGEMENT 2525 E CAMELBACK RD PHOENIX AZ 85016 HOSPITALISTS 1754216 GRAHAM CONSTRUCTION COMPANY 421 GRAND AVE DES MOINES IA 50309 CONSTRUCTION SERVICES 1496320 HEALTH CAROUSEL LLC 1700 MADISON RD CINCINNATI OH 45209 STAFFING SERVICES 1184419 IOWA EMERGENCY SERVICES LLC PO BOX 634850 CINCINNATI OH 45263 ER STAFFING PHYSICIANS 937588 MEDICAL ASSOCIATES OF CLINTON 849 13TH AVE N CLINTON IA 52732 PHYSICIAN ON-CALL AND MEDICAL DIRECTOR C 709978 25 36658 36451 77917 151026 NET PATIENT SERVICE REVENUE 622110 93521061 93521061 PHARMACY REVENUE 446110 1152625 1152625 LABORATORY UBI 621500 101591 101591 94775277 1347379 1347379 200664 66939 133725 133725 133725 1743656 259724 0 288886 1743656 -29162 1714494 1714494 CHILDCARE REVENUE 624410 533946 533946 CAFETERIA REVENUE 722514 405569 405569 MANAGEMENT REVENUE 541618 38933 25306 13627 172524 172524 1150972 99272873 93718891 115218 5287738 36680 36680 19474 19474 234021 234021 205684 205684 40252792 37948624 2304168 1201874 1134159 67715 4567290 4306397 260893 2681322 2504008 177314 318840 297755 21085 106086 106086 117238 117238 10020842 9681012 339830 456014 425858 30156 1086990 1015108 71882 5141318 4801326 339992 2418140 2258230 159910 178542 166735 11807 88408 82562 5846 753673 753673 8425982 7868777 557205 493410 460781 32629 UBI TAXES 8000 8000 MEDICAL SUPPLIES 12144983 12144983 INTERCO. PURCHASED SVCS 3906845 3648488 258357 BAD DEBT 2962602 2962602 3599842 3405510 194332 101426892 95922742 5504150 0 614868 346791 11546690 13524908 87280 16971 2194556 2105699 196271 953927 130069336 98403720 32744011 31665616 49990782 47732409 31537646 29989571 1905000 410093 7523003 6652611 138340107 133398596 8321958 7985798 14967 9117 509580 517281 22179852 20784811 31026357 29297007 X 107313750 104101589 107313750 104101589 138340107 133398596 X -2154019 1027082 -2085224 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 14500 0 0 0 14500 0 PART II-B, LINE 1: MERCY MEDICAL CENTER - CLINTON HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED MERCY MEDICAL CENTER - CLINTON WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 0 1 X 905281 905281 86872685 65291854 21580831 40886853 33111866 7774987 1404517 1404517 31665616 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 9227560 F HEDGE FUNDS 6151707 F EQUITY METHOD INVESTMENTS 14610304 C 29989571 OTHER LONG-TERM LIABILITIES 34100 INTERCOMPANY NOTES PAYABLE 16620384 INTERCOMPANY PAYABLES 1502104 OTHER CURRENT LIABILITIES 917051 ASSET RETIREMENT OBLIGATION (FIN 47) 885528 DEFERRED COMPENSATION LIABILITY 825644 20784811 PART IV, LINE 2B: MERCY LIVING CENTER, A LONG TERM CARE FACILITY, HAS A CUSTODIAL ACCOUNT THAT IS FOR LONG TERM CARE RESIDENTS' PERSONAL USE. PART V, LINE 4: ENDOWMENTS HELD BY MERCY HEALTHCARE FOUNDATION - CLINTON FOR THE BENEFIT OF MERCY MEDICAL CENTER - CLINTON ARE REPORTED ON THE FORM 990 OF MERCY HEALTHCARE FOUNDATION - CLINTON. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 733 1164083 1164083 0.01180 4 15268 15815934 9233594 6582340 0.06690 5 16001 16980017 9233594 7746423 0.07870 23 2324 220408 140 220268 0.00220 4 2925 6473535 4880989 1592546 0.01620 15 3886 50605 50605 0.00050 42 9135 6744548 4881129 1863419 0.01890 47 25136 23724565 14114723 9609842 0.09760 2 213 122977 122977 0.00120 1 358 358 0.00000 3 213 123335 123335 0.00120 1 2962602 0 29345629 33732877 -4387248 X 1 1 1 CLINTON IMAGING SERVICES LLC MRI SERVICES 0.65000 0.35000 1 1 MERCY MEDICAL CENTER - CLINTON 1410 N 4TH STREET CLINTON IA 52732 WWW.MERCYONE.ORG/CLINTON/ 230056H X X X LAB, RADIOLOGY MERCY MEDICAL CENTER - CLINTON 1 0 0 1 X X X X X X X X X 17 1 0 1 1 X SEE SCHEDULE H, PART V, SECTION C X X 1 17 1 SEE SCHEDULE H, PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X 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 1 X 0 X X X X X 1 X 0 0 MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E:MERCY MEDICAL CENTER - CLINTON (MERCYONE CLINTON) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED TO BE SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. MENTAL HEALTH2. SUBSTANCE ABUSE, INCLUDING ALCOHOL, HEROIN, AND OPIOID ABUSE3. ACCESS TO HEALTH SERVICES, PRIMARY CARE PROVIDERS AND TRANSPORTATION4. NUTRITION, PHYSICAL ACTIVITY, AND OBESITY, INCLUDING COMMUNITY RESOURCES AND PARTNERSHIPS AND PROGRAM IMPLEMENTATION5. SUICIDE6. EDUCATION/POVERTY LEVELS7. COMMUNITY ENGAGEMENT MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 5: MERCYONE CLINTON, WORKING IN CONJUNCTION WITH THE GENESIS VISITING NURSES ASSOCIATION (VNA), HELD A SERIES OF MEETINGS WITH VARIOUS COMMUNITY AGENCIES AND ELECTED OFFICIALS TO REVIEW DATA AND PRIORITIZE LOCAL HEALTH ISSUES. THE VNA SERVES AS THE PUBLIC HEALTH NURSING AGENCY FOR CLINTON COUNTY, AND IS CONTRACTED TO HANDLE MOST OF THE COUNTY'S PUBLIC HEALTH FUNCTIONS. AS A RESULT, THE HEALTH ISSUES IDENTIFIED AS A PART OF THIS PROCESS BECAME THE PRIORITIES FOR CLINTON COUNTY, THE GEOGRAPHIC AREA WHERE MOST OF THE POPULATION THAT MERCYONE CLINTON SERVES RESIDE. MEETINGS WERE CONDUCTED WITH PUBLIC HEALTH ON DECEMBER 11, 2017 AND JANUARY 10, 2018. MEETINGS WERE CONDUCTED WITH OTHER AGENCIES AND ELECTED OFFICIALS ON DECEMBER 7, 2017 AND JANUARY 24, 2018. SURROUNDING COUNTIES: INPUT WAS SOUGHT FROM JACKSON, CARROLL, AND WHITESIDE COUNTIES AND WAS INCORPORATED BY REVIEWING COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT MATERIAL AND INCLUDING INPUT FROM KEY STAKEHOLDERS REPRESENTING EACH OF THE COUNTIES. FEEDBACK WAS RECEIVED FROM JACKSON AND WHITESIDE COUNTIES. CARROLL COUNTY DID NOT PROVIDE INPUT FOR THE CHNA. SURVEY OF THOSE WHO ARE POOR: MERCYONE CLINTON CONDUCTED FOCUS GROUPS WITH STAYING AHEAD, A GROUP OF INDIVIDUALS THAT ARE WORKING TO IMPROVE THEIR LIFE BY UNDERSTANDING THE ROOT CAUSES OF POVERTY AND WORK TOWARDS DEVELOPING ACTION PLANS TO MAINTAIN SELF-SUFFICIENCY. THE MISSION OF STAYING AHEAD IS TO IMPROVE LIVES, HELP WITH SELF-SUFFICIENCY AND CONTINUE THE MOMENTUM OF SUSTAINABILITY, WHICH HELPS MEMBERS OF THE COMMUNITY GET OUT OF POVERTY. SURVEYS WERE COLLECTED FROM THIS GROUP TO IDENTIFY THEIR HEALTH NEEDS. SURVEYING OCCURRED ON DECEMBER 6 AND DECEMBER 13, 2017. MINORITY FOCUS GROUPS: MERCYONE CLINTON CONDUCTED SURVEYS WITH INFORMATION REFERRAL, A GROUP THAT REPRESENTS LOWER INCOME LEVELS AND AFRICAN AMERICAN AND HISPANIC GROUPS. THE SURVEYS WERE COLLECTED DURING FOOD PANTRY DAYS AND WHEN INDIVIDUALS WERE COMING IN FOR FINANCIAL ASSISTANCE FOR MEDICATIONS, HOUSING AND UTILITIES. THE SURVEYS COLLECTED WERE COMPRISED OF 21% AFRICAN AMERICAN, 11% HISPANIC, 58% CAUCASIAN AND 11% OTHER. SURVEYS WERE COLLECTED FOR TWO WEEKS IN DECEMBER 2017 AND TWO WEEKS IN JANUARY 2018. MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 6B: CLINTON COUNTY COMMUNITY FOCUS GROUP: AS A WAY TO GAIN INSIGHT INTO THE UNDERSERVED POPULATION, GENESIS VNA AND MERCYONE CLINTON CONVENED A SERIES OF MEETINGS WITH REPRESENTATIVES FROM VARIOUS ORGANIZATIONS WITHIN THE SERVICE AREA INCLUDING THE FOLLOWING:-BRIDGEVIEW COMMUNITY MENTAL HEALTH CENTER-CLINTON COUNTY BOARD OF HEALTH-CLINTON COUNTY BOARD OF SUPERVISORS-EASTERN IOWA COMMUNITY COLLEGE - CLINTON-GATEWAY IMPACT (SUBSTANCE ABUSE) COUNCIL-CLINTON COUNTY SHERIFF DEPARTMENT-CLINTON FIRE DEPARTMENT-FULTON SUPERINTENDENT (WHITESIDE COUNTY)-SISTERS OF SAINT FRANCIS-HILLCREST FAMILY SERVICES - WIC-HY-VEE GROCERY STORE-COMMUNITY HEALTH CLINIC-CLINTON SCHOOL DISTRICT-WOMEN'S HEALTH SERVICES-IOWA STATE EXTENSION SERVICE-IOWA STATE SENATE OFFICE-LUTHERAN SOCIAL SERVICES-UNITED WAY OF CLINTON COUNTY-VISITING NURSES OF IOWA (I-SMILE) DENTAL PROGRAM -YWCA MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 7D: MERCYONE CLINTON COMMUNICATED ITS CHNA TO THE BROADER COMMUNITY IN THE FOLLOWING WAYS: BY DISTRIBUTING COPIES TO INDIVIDUALS WHO SERVED ON THE CHNA STEERING COMMITTEE, BY DISTRIBUTING COPIES TO INDIVIDUALS WHO PARTICIPATED IN THE SOCIAL SERVICES FOCUS GROUP, AND BY PUBLISHING ARTICLES IN THE HOSPITAL'S NEWSLETTERS. MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 11: MAJOR PRIORITIES (IN ORDER OF PRIORITY):MENTAL HEALTH SERVICE: IN FISCAL YEAR 2019, THE HOSPITAL CONTINUED ITS SUPPORT FOR BRIDGEVIEW COMMUNITY MENTAL HEALTH CENTER'S OUTPATIENT BEHAVIORAL HEALTH SERVICES AND ITS OWN INPATIENT MENTAL HEALTH UNIT. MAINTAINING AN INPATIENT UNIT WAS SEEN AS CRITICAL SINCE THE NEXT NEAREST UNIT IS OVER 35 MILES AWAY AND MANY OF THOSE WHO ARE CHRONICALLY MENTALLY ILL HAVE TRANSPORTATION CHALLENGES. THE ANNUAL RENT SUBSIDY FOR BRIDGEVIEW IN FISCAL YEAR 2019 WAS $79,955, BASED ON THE MOST RECENT MEDICARE COST REPORT. THE ESTIMATED ANNUAL SUBSIDY TO THE MENTAL HEALTH UNIT CAN BE REFLECTED IN OTHER PARTS OF THE HOSPITAL'S FORM 990. HOWEVER, WHAT WOULD NOT BE INCLUDED IN THAT NUMBER IS THE SUBSIDY THE HOSPITAL PROVIDES FOR PROFESSIONAL CARE. DUE TO A SHORTAGE OF PSYCHIATRISTS IN THE COMMUNITY, THE HOSPITAL'S INPATIENT BEHAVIORAL HEALTH UNIT IS STAFFED BY A TELE-PSYCHIATRIST SERVICE. THE SUBSIDY TO MAINTAIN THAT SERVICE DURING FISCAL YEAR 2019 WAS $250,287.SUBSTANCE ABUSE: ALTHOUGH MERCYONE CLINTON DOES NOT CURRENTLY OFFER TREATMENT IN THESE AREAS, IN FISCAL YEAR 2019, THE HOSPITAL COLLABORATED WITH, AND WAS COMMITTED TO, SUPPORTING COMMUNITY AGENCIES WHO COULD MORE EFFECTIVELY ADDRESS SUBSTANCE ABUSE ISSUES. IN THE COMMUNITY, THE FOLLOWING ORGANIZATIONS HAD MORE EXPERIENCE AND CAPACITY TO ADDRESS THIS NEED: GATEWAY IMPACT COALITION AND THE CLINTON SUBSTANCE ABUSE AND PREVENTION COUNCIL. MERCYONE CLINTON PROVIDED THE GATEWAY IMPACT COALITION WITH FINANCIAL ASSISTANCE IN EXCESS OF $5,000 CASH AND IN-KIND DONATIONS. MERCYONE CLINTON PROVIDED MEETING SPACE TO COMMUNITY RESOURCES UNITED TO STOP HEROIN (CRUSH), AND SEVERAL HOSPITAL EMPLOYEES ACTIVELY SERVED ON THAT COALITION. IN FISCAL YEAR 2019, MERCYONE CLINTON COMPLETED OPIOID ABUSE EDUCATION WITH THE HOSPITAL'S EMPLOYEES, EMERGENCY ROOM PROVIDERS, AND COMMUNITY PHYSICIANS. EDUCATION IN THE COMMUNITY IS ONGOING AND OFTEN OCCURS "JUST IN TIME" IN THE ER. THIS ISSUE HAS RISEN TO THE TOP ON THE MOST RECENT CHNA, AND MERCYONE CLINTON IS CURRENTLY DEVELOPING NEW ACTION PLANS TO PROACTIVELY ADDRESS THIS IMPORTANT COMMUNITY ISSUE. COMMUNITY STAKEHOLDERS INCLUDING MERCYONE CLINTON APPLIED FOR A GRANT TO ASSIST PEOPLE WITH DRUG ADDICTION THROUGH A MEDICATION-ASSISTED TREATMENT (MAT) PROGRAM. THE MAT PROGRAM IS EXPECTED TO BE OPEN FOR PATIENTS IN OCTOBER 2019. ACCESS TO CARE: MERCYONE CLINTON SUPPORTED IMPROVED ACCESS TO CARE IN A VARIETY OF WAYS IN FISCAL YEAR 2019. FIRST, MERCYONE CLINTON CONTINUED OPERATING MERCY SPECIALTY CLINIC, A COMMUNITY BASED MEDICAL CLINIC, WHICH PROVIDES ENT, GASTROENTEROLOGY AND ORTHOPEDIC SERVICES. IN CONJUNCTION WITH THE CLINIC, CHARITY CARE AND FREE HEALTH SCREENINGS WERE PROVIDED. THE HOSPITAL ALSO ACTIVELY EXPANDED PRIMARY CARE AND SPECIALTY SERVICES BY RECRUITING MORE PROVIDERS. A FAMILY PRACTICE DOCTOR, NURSE PRACTITIONER, GENERAL SURGEON AND TWO ORTHOPEDIC SURGEONS WERE ADDED DURING FISCAL YEAR 2019. THE RATIO OF RESIDENTS TO PROVIDERS, AS EVIDENCED BY THE 2018 COUNTY HEALTH RANKINGS IS, 2,160:1 IN JACKSON COUNTY, 1,840:1 IN CLINTON COUNTY, 1,210:1 IN CARROLL COUNTY, AND 1,680:1 IN WHITESIDE COUNTY. THIS SUPPORTS THE NEED TO RECRUIT PHYSICIANS TO THE AREA. DURING FISCAL YEAR 2019, $71,207 WAS SPENT ON RECRUITING PHYSICIANS/PROVIDERS TO PURSUE EMPLOYMENT OPPORTUNITIES IN OUR SERVICE AREA. THE HOSPITAL CONTINUED TO HELP PATIENTS IN FINANCIAL NEED ACCESS CARE BY PROVIDING TRANSPORTATION TO AND FROM THE HOSPITAL OR TO OTHER MEDICAL PROVIDERS. IN FISCAL YEAR 2019, THE CONTRIBUTIONS FOR TRANSPORTATION WITH MEDIC, AN AMBULANCE SERVICE, CAB OR BUS VOUCHERS WAS $44,602. NUTRITION, PHYSICAL ACTIVITY AND OBESITY: BASED ON THE RWJ FOUNDATION COUNTY HEALTH RANKINGS FROM 2019, CLINTON COUNTY CONTINUED TO SEE AN INCREASE IN ADULT OBESITY, 32%, AND PHYSICAL INACTIVITY, 27%, COMPARED TO THE NATIONAL RANKINGS OF 26% AND 19% RESPECTIVELY. WWW.COUNTYHEALTHRANKINGS.ORGTHE 2017 CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM PREVALENCE OF OBESITY INDICATED SEVEN STATES HAVING THE HIGHEST PERCENTAGE (>35%) OF ADULTS WITH OBESITY. IOWA WAS ONE OF THESE SEVEN STATES. WWW.CDC.GOV/OBESITY/DATA/PREVALENCE-MAPS.HTMLTHE HOSPITAL IS ADDRESSING WEIGHT LOSS AND PHYSICAL ACTIVITY THROUGH ITS CONTINUED EFFORTS IN THE LOCAL LET'S LIVE HEALTHY CLINTON INITIATIVE, BY WORKING IN AREA SCHOOLS ON NUTRITION AND PHYSICAL ACTIVITY PROGRAMS, DIABETES PREVENTION, COMPLETE HEALTH IMPROVEMENT PROGRAM (CHIP) AND A NEW PROGRAM CALLED JUST FOR YOU-WEIGHT LOSS PROGRAM. THE PROGRAMS WERE PROVIDED TO THOSE IN NEED BY OFFERING IT FREE AND/OR PROVIDING SCHOLARSHIPS TO OFFSET THE COST OF THE PROGRAMS. THE CLINTON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED A GOAL TO "DECREASE OR MAINTAIN THE PERCENTAGE OF ADULTS OVER THE AGE OF 18 IN CLINTON COUNTY WHO REPORT NO PHYSICAL ACTIVITY ON THE COUNTY HEALTH RANKINGS." IN CONJUNCTION WITH THE COUNTY'S HEALTH GOAL, THE HEALTHY LIFESTYLE COALITION DEVELOPED A MASTER STRATEGIC PLAN. THE MASTER PLAN TARGETED THREE AREAS - EAT WELL, MOVE MORE, AND FEEL BETTER. THE EAT WELL SUBCOMMITTEE WORKED TO EXPAND THE DONATION GARDEN PROGRAM, A SCHOOL GREENHOUSE AND HEALTHY CONCESSIONS AT SCHOOL SPORTING EVENTS. THE MOVE MORE SUBCOMMITTEE WORKED TO EXPAND THE BIKE SHARE PROGRAM, SEMI-STRUCTURED RECESS, CAMPAIGNS TO REDUCE SCREEN TIME IN THE SCHOOLS, EXPANDING THE WALKING SCHOOL BUS PROGRAM, AND EDUCATION ON THE 5-2-1-0 HEALTHIEST STATE INITIATIVE IN THE SCHOOLS. THE FEEL BETTER SUBCOMMITTEE BEGAN REORGANIZING THE TOBACCO COALITION, BREATHE EASY, AND DEVELOPING A NEW MISSION AND VISION WITH INITIATIVES THAT FOCUS ON POLICY, SYSTEM AND ENVIRONMENT TO REDUCE NICOTINE. IN ADDITION, THE FEEL BETTER GROUP CONTINUED WORKING ON EXPANDING THE ADVERSE CHILDHOOD EXPERIENCES (ACES) TRAINING TO MORE CHILD CARE PROVIDERS. THE PARTNERSHIP OF THESE COMMITTEES INCLUDE, BUT NOT LIMITED TO, MERCYONE, YWCA, PUBLIC HEALTH, CITY MANAGER, ASSISTANT ENGINEER, LOCAL AREA SUPERINTENDENTS, IOWA STATE EXTENSION OFFICE, COUNTY BOARD OF HEALTH, CHAMBER OF COMMERCE, CLINTON COMMUNITY COLLEGE, CLINTON HERALD, AND MEDICAL ASSOCIATES.SECONDARY PRIORITIES: WHILE NOT THE TOP AREAS OF FOCUS FOR MERCYONE CLINTON'S COMMUNITY BENEFIT PROGRAM, THE HOSPITAL ALSO WORKED ON A VARIETY OF OTHER HEALTH ISSUES INCLUDING THE FOLLOWING: TOBACCO USE, FOOD INSECURITY, PRESCRIPTION ASSISTANCE, TRANSPORTATION, EXERCISE, DIABETES, HEART DISEASE/HIGH BLOOD PRESSURE, SENIOR SERVICES, CANCER AWARENESS/PREVENTION AND LOW BIRTH WEIGHT BABIES.ISSUES NOT TO BE ADDRESSED BY MERCYONE CLINTON: MERCYONE CLINTON CANNOT REALISTICALLY ADDRESS, EITHER DIRECTLY OR INDIRECTLY, ALL OF THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA. TIME, MONEY, AND OTHER RESOURCES ARE TOO LIMITED. HOWEVER, MERCYONE CLINTON DOES LOOK FOR OPPORTUNITIES TO PARTNER WITH, SUPPORT, OR ENCOURAGE OTHER ORGANIZATIONS IN THE COMMUNITY WHO CAN MORE EFFECTIVELY AND/OR TIMELY ADDRESS OTHER HEALTH NEEDS IN THE COMMUNITY. LISTED BELOW ARE THE REMAINING ISSUES AND THE CORRESPONDING ALTERNATIVE PROVIDER. SUICIDE: COMPETING PRIORITIES EXCLUDED THIS NEED FROM BEING DIRECTLY ADDRESSED IN THE IMPLEMENTATION STRATEGIES. MERCYONE CLINTON DID KEEP THIS HEALTH NEED IN MIND WHEN DEVELOPING THE MENTAL HEALTH AND SUBSTANCE ABUSE IMPLEMENTATION STRATEGY. A HIGH INCIDENCE OF SUICIDE MAY BE ATTRIBUTED TO THE MENTAL HEALTH AND SUBSTANCE ABUSE IN THE AREA. EDUCATION/POVERTY LEVELS: COMPETING PRIORITIES EXCLUDED THIS NEED FROM BEING DIRECTLY ADDRESSED IN THE IMPLEMENTATION STRATEGIES.COMMUNITY ENGAGEMENT: COMPETING PRIORITIES EXCLUDED THIS NEED FROM BEING DIRECTLY ADDRESSED IN THE IMPLEMENTATION STRATEGIES, BUT MERCYONE CLINTON SUPPORTED COMMUNITY EVENTS/PROGRAMS THAT RELATED TO THE TOP HEALTH NEEDS. MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 15E: THE HOSPITAL PROVIDES ASSISTANCE WITH SIGNING UP FOR MEDICARE OR MEDICAID. MERCY MEDICAL CENTER - CLINTON PART V, SECTION B, LINE 20E: IF AN INDIVIDUAL REGISTERS AS SELF-PAY HE/SHE MEETS WITH A FINANCIAL COUNSELOR. MERCY MEDICAL CENTER - CLINTON - PART V, SECTION B, LINE 7A: WWW.MERCYONE.ORG/CLINTON/ABOUT-US/COMMUNITY-BENEFIT/ MERCY MEDICAL CENTER - CLINTON - PART V, SECTION B, LINE 10A: WWW.MERCYONE.ORG/CLINTON/ABOUT-US/COMMUNITY-BENEFIT/ MERCY MEDICAL CENTER - CLINTON - PART V, SECTION B, LINE 9: AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC. MERCY MEDICAL CENTER - CLINTON, PART V, LINE 16A, FAP WEBSITE: WWW.MERCYONE.ORG/CLINTON/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE MERCY MEDICAL CENTER - CLINTON, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MERCYONE.ORG/CLINTON/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE MERCY MEDICAL CENTER - CLINTON, PART V, LINE 16C: FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MERCYONE.ORG/CLINTON/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE 3 1 - MERCY LIVING CENTER - NORTH 600 14TH AVE NORTH CLINTON IA 52732 LONG TERM CARE 2 - MERCY SPECIALTY CLINIC 1410 NORTH 4TH STREET CLINTON IA 52732 OUTPATIENT CLINIC 3 - CLINTON IMAGING SERVICES 1410 NORTH 4TH STREET CLINTON IA 52732 MRI DIAGNOSTIC SERVICES PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: MERCY MEDICAL CENTER - CLINTON (MERCYONE CLINTON) REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, MERCYONE CLINTON INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $2,962,602, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: THE COMMUNITY BUILDING PROGRAMS SUPPORTED BY MERCYONE CLINTON ARE INTENDED TO PROMOTE THE OVERALL HEALTH OF OUR COMMUNITY. MANY ARE AIMED AT IMPROVING THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, CHALLENGING FAMILY SITUATIONS, FINANCIAL CHALLENGES, AND ENVIRONMENTAL PROBLEMS. MERCYONE CLINTON SUPPORTS THE CHAMBER OF COMMERCE, CLINTON REGIONAL DEVELOPMENT CORPORATION, COMMUNITY RESOURCES UNITED TO STOP HEROIN (CRUSH), UNITED WAY, AND THE YWCA. MERCYONE CLINTON ALSO PROVIDES LEADERSHIP SUPPORT AND PARTICIPATION IN COMMUNITY DEVELOPMENT ACTIVITIES, AND PROVIDES IN-KIND AND FINANCIAL SUPPORT TO UNITED WAY, CRUSH, AND BRIDGEVIEW COMMUNITY HEALTH CENTER IN ORDER TO SUPPORT THEIR EFFORTS TO ADDRESS THE CHALLENGES IN OUR COMMUNITY AT THE ROOT OF MANY HEALTH PROBLEMS. OTHER COMMUNITY BUILDING ACTIVITIES ARE AS FOLLOWS: COMMUNITY CHILDCARE: THE CLINTON COUNTY REGION HAS APPROXIMATELY 1,900 CHILD CARE SPACES AVAILABLE AND 7,800 CHILDREN AGE 0-12. CLINTON IS CONSIDERED A CHILD CARE DESERT AND AS A RESULT, MERCYONE CLINTON IS ONE OF 5 FACILITIES THAT PROVIDES AND SUBSIDIZES CHILDCARE TO SUPPORT THIS COMMUNITY NEED. CLINTON SCHOOLS: MERCYONE CLINTON PROVIDES SUPPORT AS REQUESTED FOR CAREER DEVELOPMENT PROGRAMS. DURING FISCAL YEAR 2019, MERCYONE CLINTON PROVIDED FINANCIAL AND IN-KIND SUPPORT TO PROJECT SEARCH, A PROGRAM TO ASSIST WITH JOB SKILLS FOR STUDENTS WITH LEARNING DISABILITIES. SIX STUDENTS PARTICIPATED IN THE PROGRAM WITH EACH SERVING IN THREE DIFFERENT ROTATIONS THROUGHOUT THE SCHOOL YEAR.ADVOCACY - BROADER COMMUNITY: LEADERSHIP AND ASSOCIATES ARE ACTIVELY ENGAGED IN ADVOCACY EFFORTS TO IMPROVE MEDICAL ACCESS AND COVERAGE FOR ALL. ADVOCACY EFFORTS ARE TARGETED AT IMPROVING CARE FOR THE UNINSURED AND UNDERINSURED IN OUR COMMUNITY.IN-KIND BOARD MEMBER: MERCYONE CLINTON OFFERS IN-KIND TIME SPENT AS A BOARD MEMBER ON ROTARY, UNITED WAY EXECUTIVE BOARD, AND THE YWCA. PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: MERCYONE CLINTON USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, MERCYONE CLINTON IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, MERCYONE CLINTON IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: MERCYONE CLINTON IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED.FOR PATIENT ACCOUNTS RECEIVABLE RESULTING FROM REVENUE RECOGNIZED PRIOR TO JULY 1, 2018, PATIENT ACCOUNTS RECEIVABLE WERE REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED. PRIOR TO THIS DATE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS ESTABLISHED TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. GENERALLY, THIS ALLOWANCE WAS ESTIMATED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES FOR EACH TYPE OF PAYER. UNDER THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE ("ASU") NO. 2014-09 "REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606)," WHICH WAS ADOPTED EFFECTIVE JULY 1, 2018, AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE SUBSEQUENT TO THE ADOPTION OF ASU NO. 2014-09 ON JULY 1, 2018, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE."PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION. PART III, LINE 8: MERCYONE CLINTON DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - MERCYONE CLINTON ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL USES PATIENT DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCYONE CLINTON COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. MERCYONE CLINTON OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. MERCYONE CLINTON HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. MERCYONE CLINTON MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - MERCYONE CLINTON SERVES A 16 ZIP CODE AREA ALONG THE MISSISSIPPI RIVER IN EASTERN IOWA AND WESTERN ILLINOIS. ITS PRIMARY AND SECONDARY SERVICE AREAS HAVE A TOTAL POPULATION OF APPROXIMATELY 52,762. WHILE THE OVERALL POPULATION IS DECLINING, THE NUMBER OF RESIDENTS 65 YEARS OF AGE AND OLDER IS PROJECTED TO INCREASE. THE ETHNICITY OF MERCYONE CLINTON'S SERVICE AREA IS PRIMARILY WHITE. CLINTON AND JACKSON COUNTIES REGISTER 94.2% AND 97.4% OF RESIDENTS, RESPECTIVELY, AS WHITE, WHILE 96.6% OF CARROLL COUNTY RESIDENTS AND 94.9% OF WHITESIDE COUNTY RESIDENTS IDENTIFY AS WHITE. CLINTON COUNTY HAS THE HIGHEST PERCENTAGE OF BLACK OR AFRICAN-AMERICAN POPULATION, AT 2.8%. JACKSON, CARROLL, AND WHITESIDE COUNTY ALL REPORTED LESS THAN 2% OF RESIDENTS AS BLACK OR AFRICAN-AMERICAN. WHITESIDE COUNTY HAS THE HIGHEST PERCENTAGE OF RESIDENTS WITH A HISPANIC ETHNICITY, AT 11.6%. CLINTON COUNTY REPORTS 2.9%, CARROLL COUNTY REPORTS 3.3%, AND JACKSON COUNTY REPORTS 1.3% HISPANIC OR LATINO.ACCORDING TO THE US CENSUS BUREAU IN 2015, THE MEDIAN HOUSEHOLD INCOME FOR ILLINOIS AND IOWA WAS $59,590 AND $54,843 RESPECTIVELY. THE MEDIAN HOUSEHOLD INCOME FOR THE UNITED STATES WAS $55,775. WHEN COMPARED TO STATE AND NATIONAL DATA, ALL FOUR COUNTIES IN THE SERVICE AREA HAVE MEDIAN HOUSEHOLD INCOMES THAT ARE SIGNIFICANTLY LOWER. WHITESIDE COUNTY HAS THE LOWEST HOUSEHOLD INCOME AT $45,463, FOLLOWED BY JACKSON COUNTY AT $49,956, CARROLL COUNTY AT $50,432, AND CLINTON COUNTY AT $52,945.THE MEDICAL CENTER CONSISTS OF AN ACUTE CARE HOSPITAL AND A STRONG CONTINUUM OF SERVICES FOR SENIORS (A NURSING HOME, DEMENTIA UNIT, TRANSITIONAL CARE BEDS, AND HOME CARE AND HOSPICE). PART VI, LINE 5: OTHER INFORMATION - MERCYONE CLINTON HAS AN OPEN MEDICAL STAFF. AS A SOLE COMMUNITY PROVIDER, WE OFFER MANY SERVICES TO THE COMMUNITY THAT WOULD OTHERWISE BE UNAVAILABLE. IN ADDITION TO TRADITIONAL ACUTE CARE SERVICES, WE OFFER EMERGENCY SERVICES REGARDLESS OF ABILITY TO PAY, RADIATION ONCOLOGY, RENAL DIALYSIS, HOME CARE, HOSPICE CARE, WOUND CARE AND INPATIENT BEHAVIORAL HEALTH. WE ALSO HAVE A COMMUNITY INSTITUTIONAL REVIEW BOARD, WHICH APPROVES ANY MEDICAL-RELATED RESEARCH REQUESTS.MERCYONE CLINTON OFFERS MANY OPPORTUNITIES FOR STUDENTS PURSUING MEDICAL-RELATED CAREERS TO GAIN CLINICAL EXPERIENCE. THIS INCLUDES, BUT IS NOT LIMITED TO, PHYSICIANS, NURSES, LAB TECHNICIANS, EEG, RADIOLOGY, PHARMACY AND RESPIRATORY THERAPY.WE PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE IN MANY WAYS. MERCYONE CLINTON HAS A VERY ACTIVE AND EXPANSIVE VOLUNTEER PROGRAM, WHICH OFFERS OPPORTUNITIES ACROSS THE CONTINUUM, FROM ACUTE CARE TO LONG-TERM CARE AND HOSPICE. MAJOR COMMUNITY BENEFIT PROGRAMS ARE LISTED BELOW ALONG WITH THE DESCRIPTION OF THEIR IMPACT ON IMPROVING HEALTH IN THE COMMUNITY.PRENATAL EDUCATION: PROVIDES EDUCATION TO LOW INCOME FAMILIES TO PROMOTE HEALTHY OUTCOMES FOR MOTHER AND BABY. THE MAJORITY OF DELIVERIES AT OUR HOSPITAL ARE WITH MOTHERS WHO ARE AT OR BELOW THE POVERTY LEVEL. EVIDENCE HAS DOCUMENTED THAT EDUCATION HAS AN IMPACT ON HEALTHY PREGNANCIES AND HEALTHY BABIES. IN ADDITION, MERCYONE CLINTON IS ACTIVELY MOVING TO BECOME A CERTIFIED BABY FRIENDLY SITE. BABY FRIENDLY HOSPITALS ARE HOSPITALS THAT ARE RECOGNIZED FOR ENCOURAGING BREASTFEEDING AND MOTHER/BABY BONDING, WHICH IS KNOWN TO PROVIDE HEALTH BENEFITS FOR INFANTS, CHILDREN, AND MOTHERS.AMBULANCE AND CAB SERVICE: PROVIDE TRANSPORTATION FOR ADDITIONAL MEDICAL CARE OR TRANSPORTATION HOME. ACCESS TO CARE CONTINUES TO BE A GAP IN OUR COMMUNITY. MANY PATIENTS ARRIVE IN OUR ER AND DO NOT HAVE TRANSPORTATION AVAILABLE TO RETURN HOME. DRUG ENDANGERED CHILD TASK FORCE: WORKS ON REDUCING THE RISK FOR DRUG-ENDANGERED CHILDREN BORN IN OUR FACILITY. PRESCRIPTION ASSISTANCE: DURING FISCAL YEAR 2019, MERCYONE CLINTON PROVIDED $5,560 IN FREE PRESCRIPTIONS TO LOW INCOME INDIVIDUALS BEING DISCHARGED FROM THE HOSPITAL. WHILE THE INITIAL FOCUS OF THIS PROGRAM WAS ON CONGESTIVE HEART FAILURE PATIENTS, WHICH STARTED IN FISCAL YEAR 2016, MERCYONE CLINTON EXPANDED THE PROGRAM TO INCLUDE A BROADER RANGE OF INPATIENTS. DIABETES: DIABETES IS CLEARLY A SIGNIFICANT ISSUE FOR OUR SERVICE AREA RESIDENTS. THERE ARE SEVERAL WAYS THAT MERCYONE CLINTON ADDRESSED THIS ISSUE IN FISCAL YEAR 2019. MERCYONE CLINTON TRAINED TWO LIFESTYLE COACHES TO FACILITATE THE PREVENT T2 CLASSES. PREVENT T2 IS A CENTERS FOR DISEASE CONTROL RECOGNIZED DIABETES PREVENTION PROGRAM (DPP). THE CERTIFIED DIABETES EDUCATOR AND COMMUNITY WELLNESS COORDINATOR PROVIDED THREE-YEAR PROGRAMS IN FISCAL YEAR 2019. THE PREVENT T2 PROGRAM IS FREE AND SPECIFIC FOR PRE-DIABETICS. IN ADDITION, A PROCESS WAS DEVELOPED WITH THE LOCAL COMMUNITY CLINIC AND PRIMARY CARE PHYSICIANS TO INITIATE REFERRALS FOR THE PREVENT T2 PROGRAM. SUBSIDIZED PROGRAMS: BRIDGEVIEW MENTAL HEALTH PROVIDES FINANCIAL SUBSIDY TO THE PROGRAM, WHICH PROVIDES MENTAL HEALTH SERVICES TO COUNTY FUNDED AND OTHER LOW INCOME AND/OR UNINSURED PATIENTS IN OUR COMMUNITY. SPECIALTY CLINIC SUBSIDY PROVIDES GI, ENT AND ORTHOPEDIC SERVICES TO PATIENTS IN THE COMMUNITY, OPERATING AT A LOSS, DUE IN PART TO ACCEPTANCE OF MEDICAID AND CHARITY CARE PATIENTS. THE PREGNANCY CENTER ASSISTS WITH SUPPORT FOR MOTHERS WITH UNPLANNED PREGNANCIES AND PROMOTES AND PROVIDES EDUCATION ON HEALTHY RELATIONSHIPS. REDUCING THE NUMBER OF SUBSEQUENT PREGNANCIES IN YOUNG WOMEN UNDER 20 IS ONE OF THE GOALS/STRATEGIES FOR THE CLINTON COUNTY HEALTH IMPROVEMENT PLAN.CERTIFIED DIABETES CENTER PROVIDES EDUCATION AND MEDICAL MANAGEMENT FOR DIABETIC PATIENTS IN OUR COMMUNITY.HEALTHY VENDING: OUR HEALTH SYSTEM IS COMPLIANT WITH THE LIVE YOUR LIFE GREEN LOGO SNACK CRITERIA AND 60% OF THE SNACKS IN THE CAMPUS VENDING MACHINES MEET THE SNACK CRITERIA.SMOKE-FREE CAMPUS: MERCYONE CLINTON IS A SMOKE FREE CAMPUS AND UPDATED ITS POLICY TO BE A NICOTINE FREE CAMPUS, WHICH INCLUDES E-CIGARETTES.MERCYONE CLINTON ACTIVELY PARTICIPATES IN A VARIETY OF LOCAL COALITIONS INCLUDING THE BREATHE EASY COALITION (ANTI-TOBACCO), LET'S LIVE HEALTHY CLINTON (LLHC), A HEALTHY LIFESTYLE COALITION FOCUSING ON EAT WELL, MOVE MORE AND FEEL BETTER. KEY STAKEHOLDERS ARE CLINTON SCHOOLS, PUBLIC HEALTH, CITY OF CLINTON, IOWA STATE EXTENSION OFFICE, YWCA, CLINTON COMMUNITY COLLEGE, CLINTON VISITOR BUREAU, HY-VEE, AND GATEWAY IMPACT COALITION (ANTI-DRUG), WHICH INCLUDES CRUSH - "COMMUNITY RESOURCES UNITED TO STOP HEROIN."MERCYONE CLINTON IS IN PHASE 3 OF OUR BABY-FRIENDLY JOURNEY. MANY CHANGES HAVE OCCURRED IN FISCAL YEAR 2019. MERCYONE CLINTON WORKS WITH OUR COMMUNITY CLINIC, MEDICAL ASSOCIATES, TO PROVIDE THEM WITH THE REQUIRED INFORMATION AND SUPPORT TO GET THEM READY FOR THE BABY FRIENDLY DESIGNATION. WE WILL APPLY FOR PHASE 4 IN APRIL 2020 AND ONCE THAT APPLICATION IS RECEIVED, BABY-FRIENDLY WILL PERFORM A SITE VISIT TO DESIGNATE OUR SITE BABY-FRIENDLY.MERCYONE CLINTON PROVIDES HEALTH EDUCATION TO THE ENTIRE SERVICE AREA. IN FISCAL YEAR 2019, 40 PEOPLE PARTICIPATED IN THE FREE PREVENT T2 PROGRAM AND 6 SCHOLARSHIPS WERE GIVEN TO PEOPLE IN FINANCIAL NEED FOR A LIFESTYLE MEDICINE PROGRAM CALLED, CHIP (COMPLETE HEALTH IMPROVEMENT PROGRAM.) PATIENTS AND/OR PEOPLE PARTICIPATING IN COMMUNITY HEALTH EDUCATION PROGRAMS IN NEED OF TRANSPORTATION WERE GIVEN PASSES TO GET TO AND FROM THEIR APPOINTMENTS OR CLASSES. IN FISCAL YEAR 2019, 514 RIDES WERE GIVEN TO PATIENTS OR PARTICIPANTS BY MEANS OF CAB, PARATRANSIT, OR AMBULANCE ADDRESSING THE SOCIAL INFLUENCERS OF HEALTH WITHIN OUR SERVICE AREA. PART VI, LINE 6: MERCYONE CLINTON IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER HOSPITALS DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2019, EVERY TRINITY HEALTH ENTITY FOCUSED ON: 1. REDUCING TOBACCO USE 2. REDUCING OBESITY PREVALENCE3. ADDRESSING AT LEAST ONE SIGNIFICANT HEALTH NEED IDENTIFIED BY THEIR HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT4. ADDRESSING AT LEAST ONE SOCIAL INFLUENCER OF HEALTH TRINITY HEALTH ACKNOWLEDGES THAT SOCIAL INFLUENCERS OF HEALTH - SUCH AS ADEQUATE HOUSING, PERSONAL SAFETY AND ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE - HAVE A SIGNIFICANT IMPACT ON THE HEALTH OF ITS COMMUNITIES. IN AN EFFORT TO ADDRESS SOME OF THESE INFLUENCERS, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI) IN FISCAL YEAR 2016 TO ADVANCE COMMUNITY PARTNERSHIPS THAT FOCUS ON IMPROVING THE HEALTH AND WELL-BEING IN COMMUNITIES SERVED BY THE HOSPITALS OF TRINITY HEALTH. TCI IS A SHARED FUNDING MODEL AND TECHNICAL-ASSISTANCE INITIATIVE SUPPORTING EIGHT TRINITY HEALTH HOSPITALS AND THEIR COMMUNITY PARTNERS TO IMPLEMENT POLICY, SYSTEM, AND ENVIRONMENTAL CHANGE STRATEGIES TO PREVENT TOBACCO USE AND CHILDHOOD OBESITY, AND TO AFFECT CHANGE RELATED TO THE SOCIAL INFLUENCERS OF HEALTH. IN FISCAL YEAR 2019, TRINITY HEALTH INVESTED $3.7 MILLION IN TCI AND HAS LEVERAGED OVER $6.5 MILLION IN COMMUNITY MATCH FUNDING TO DATE. ADDITIONALLY, TRINITY HEALTH'S GOOD SAMARITAN INITIATIVE (GSI) INVESTED $751,000 IN NINE REGIONAL HEALTH MINISTRIES TO SUPPORT THE INTEGRATION OF 16 COMMUNITY HEALTH WORKERS INTO CARE MANAGEMENT TEAMS. TRINITY HEALTH CONTINUES TO EXPAND THE NATIONAL DIABETES PREVENTION PROGRAM THROUGH THE SUPPORT OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION. IN ADDITION TO THE PROGRAMMATIC SPENDING DESCRIBED ABOVE, THE SYSTEM DEPLOYED NEW AND RENEWED LOANS OF $5.3 MILLION FOR PLACE-BASED INVESTING TO IMPROVE ACCESS TO AFFORDABLE HOUSING, HEALTHY FOODS, EDUCATION, AND ECONOMIC DEVELOPMENT. THE COMMUNITY-INVESTING PROGRAM ALSO HAS OUTSTANDING LOAN COMMITMENTS OF $6.0 MILLION TO COMMUNITY INFRASTRUCTURE PROJECTS, WHICH WILL BE DEPLOYED IN FUTURE YEARS.TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FISCAL YEAR 2019, TRINITY HEALTH INVESTED NEARLY $1.2 BILLION IN COMMUNITY BENEFIT, SUCH AS INITIATIVES SUPPORTING THOSE WHO ARE POOR AND VULNERABLE, HELPING TO MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, AND MOVING FORWARD POLICY, SYSTEM, AND ENVIRONMENTAL CHANGE.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 1 CLINTON REGIONAL DEVELOPMENT CORPORATION 144 8TH AVENUE SOUTH CLINTON IA 52732 420738495 501(C)(4) 20000 COMMUNITY SUPPORT 0 1 PRESCRIPTION ASSISTANCE 170 5560 TRANSPORTATION ASSISTANCE 514 12120 "SCHOLARSHIPS" FOR HEALTHIER LIVING KITS 6 1794 PART I, LINE 2: DONATIONS MADE BY MERCY MEDICAL CENTER - CLINTON TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 0 1 0 0 0 0 0 0 0 SALLY JEFFCOAT DIR AS OF 3/19; TRINITY EVP GROWTH 0 917976 0 424196 0 279610 0 12375 0 60721 0 1694878 0 0 RODNEY SCHLADER TREAS THR 2/19; PRES NORTH IA REGION 0 375559 0 28921 0 4562 0 20625 0 36572 0 466239 0 0 MARCIA SMITH SECRETARY; ASSOC. COUNSEL MERCYONE 0 379290 0 22487 0 8563 0 12375 0 24723 0 447438 0 0 AMY BERENTES INTERIM CEO THR 7/18; COO AS OF 7/18 0 207933 0 9353 0 918 0 13253 0 11905 0 243362 0 0 KAY TAKES PRESIDENT EASTERN IOWA REGION 0 333740 0 56242 0 56702 0 20625 0 28774 0 496083 0 0 WILLIAM MURDOCK VP FINANCE THROUGH 2/19 0 179824 0 9802 0 2345 0 9094 0 32956 0 234021 0 0 KIM DUWE VP FINANCE EASTERN IOWA REGION 0 178596 0 20409 0 2125 0 9288 0 26224 0 236642 0 0 ABDULLAH FOAD MD PHYSICIAN, ORTHOPEDIC SURGERY 865422 0 0 0 2288 0 8250 0 38586 0 914546 0 0 0 ROBERT MAGNUS MD PHYSICIAN, ORTHOPEDIC SURGERY 735424 0 0 0 3612 0 12375 0 39478 0 790889 0 0 0 MOHAMMED IRSHAD MD PHYSICIAN, GASTROENTEROLOGY 625000 0 0 0 4554 0 16500 0 1021 0 647075 0 0 0 DOUGLAS CODY MD PHYSICIAN, ENT 615661 0 0 0 972 0 16500 0 38493 0 671626 0 0 0 RICKY MADDOX MD PHYSICIAN, GENERAL SURGERY 483310 0 0 0 2208 0 12375 0 898 0 498791 0 0 0 SEAN WILLIAMS FORMER OFFICER 0 114186 0 0 0 76898 0 3504 0 11096 0 205684 0 0 PART I, LINE 3 MERCY MEDICAL CENTER - CLINTON IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MERCY MEDICAL CENTER - CLINTON'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MERCY MEDICAL CENTER - CLINTON'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2018, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2018. THE FOLLOWING PAYOUTS FOR 2018 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: SALLY JEFFCOAT - $229,074 KAY TAKES - $46,310 SEAN WILLIAMS - $72,053 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION OR RETENTION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($275,000 FOR 2018). THE FOLLOWING PAYOUTS FOR 2018 FOR THIS PLAN IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: RODNEY SCHLADER - $0 MARCIA SMITH - $3,145 FORM 990, PART I, ITEM C DBA: MERCYONE CLINTON MEDICAL CENTER DBA: MERCY MEDICAL CENTER - CLINTON DBA: MERCY HOME CARE & HOSPICE - CLINTON DBA: MERCY LIVING CENTER - NORTH DBA: MERCY SPECIALTY CLINIC - CLINTON DBA: MERCY HOME MEDICAL EQUIPMENT DBA: MERCY WOUND CARE CENTER DBA: MERCYONE MEDICAL GROUP CLINTON FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF MERCY MEDICAL CENTER - CLINTON (MERCYONE CLINTON) ARE MERCY HEALTHCARE FOUNDATION - CLINTON (THE CLASS A MEMBER) AND MERCY HEALTH SERVICES-IOWA CORP. (THE CLASS B MEMBER). SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A THE SYSTEM PARENT, TRINITY HEALTH CORPORATION, APPOINTS THE DIRECTORS OF MERCYONE CLINTON. THE BOARD OF DIRECTORS ELECTS THE BOARD OFFICERS. FORM 990, PART VI, SECTION A, LINE 7B MERCY HEALTH SERVICES-IOWA, CLASS B MEMBER, AND TRINITY HEALTH CORPORATION, SYSTEM PARENT, MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. MERCY HEALTH SERVICES-IOWA MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. AS CLASS A MEMBER, MERCY HEALTHCARE FOUNDATION - CLINTON MUST APPROVE THE SALE OF SUBSTANTIALLY ALL ASSETS TO, OR MERGER OF MERCYONE CLINTON WITH, AN ENTITY NOT AFFILIATED WITH TRINITY HEALTH CORPORATION. MERCY HEALTHCARE FOUNDATION - CLINTON MUST ALSO APPROVE ANY MODIFICATIONS TO GOVERNING DOCUMENTS THAT WOULD CHANGE THE VOTING OR APPROVAL RIGHTS OF THE CLASS A MEMBER. AS THE PARENT OF THE NATIONAL TRINITY HEALTH SYSTEM, CERTAIN POWERS ARE RESERVED TO TRINITY HEALTH CORPORATION. THESE INCLUDE THE AUTHORITY TO ADOPT OR MODIFY THE ORGANIZATION'S GOVERNING DOCUMENTS, TO APPROVE MAJOR CHANGES SUCH AS A MERGER OR DISSOLUTION, AND TO APPROVE SIGNIFICANT FINANCE MATTERS IN EXCESS OF CERTAIN LIMITS ESTABLISHED BY TRINITY HEALTH CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR MERCYONE CLINTON IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MERCYONE CLINTON HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF MERCYONE CLINTON, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF MERCYONE CLINTON AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF MERCYONE CLINTON (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCYONE CLINTON OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MERCYONE CLINTON (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF MERCYONE CLINTON. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MERCYONE CLINTON IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND VICE PRESIDENT FINANCE COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO AND VICE PRESIDENT FINANCE OF MERCYONE CLINTON ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FOR OTHER EXECUTIVES WHO ARE NOT PART OF THE REBUTTABLE PRESUMPTION PROCESS, TRINITY HEALTH USES A MARKET ANALYSIS TO DETERMINE THE APPROPRIATENESS OF THE EXECUTIVE'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MERCYONE CLINTON IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, MERCYONE CLINTON INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. MERCYONE CLINTON'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -2,085,224. FORM 990, PART XII, LINE 2: MERCYONE CLINTON'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY19 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. 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