2020-07-15T13:32:37-05:00 2019-06-30 420714325 RSM US LLP 4650 E 53RD ST DAVENPORT IA 528073479 990 2018-07-01 420698295 MERCY MEDICAL CENTER MERC 3193986107 701 10TH ST SE CEDAR RAPIDS IA 52403 NATHAN VAN GENDEREN EXECUTIVE VP/CFO 3193986107 2020-06-09 1 JENIFER L CHASE P01306883 5638884000 173.20.82.182 2020-06-09 19:19:32 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9D8C4631151EF1E1BB3DDB3444689A82E6B5C400 2018 2021-01-29 14:40:06Z NATHAN VAN GENDEREN 701 10TH ST SE CEDAR RAPIDS IA 52403 455384678 0 0928 X WWW.MERCYCARE.ORG X 1900 IA TO CARE FOR THE SICK AND ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, GUIDED BY THE SPIRIT OF THE SISTERS OF MERCY. 28 25 2814 950 1224796 322111 5225828 2824748 328772367 337080026 8434276 9686638 -1159085 -1592343 341273386 347999069 14829040 5888315 0 0 155104967 165025921 0 0 0 164565783 170666779 334499790 341581015 6773596 6418054 573230191 591175878 197287969 219631338 375942222 371544540 X TO CARE FOR THE SICK AND ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, GUIDED BY THE SPIRIT OF THE SISTERS OF MERCY. 0 0 268559646 5888315 334464155 THE HOSPITAL PROVIDES MEDICAL HEALTH CARE, INCLUDING 24 HOURS A DAY, SEVEN DAYS A WEEK TRAUMA CENTER SERVICE, TO ALL PATIENTS ACCESSING THE SYSTEM, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO CERTAIN ESTABILISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO OR NOMINAL PAYMENT IS ANTICIPATED. ADDITIONALLY, EACH HOSPITAL DEPARTMENT ACCEPTS ALL PATIENTS WHO ARE COVERED BY GOVERNMENTAL INDIGENT PROGRAMS. SUCH INDIGENT PROGRAMS TYPICALLY REMIT AMOUNTS SUBSTANTIALLY LESS THAN CHARGES. THE FOLLOWING SUMMARIZES THE HOSPITAL'S CARE OF THE UNINSURED AND UNDERINSURED. COSTS IN EXCESS OF MEDICARE REIMBURSEMENT (COSTS OF PROVIDING THE SERVICES LESS THE AMOUNTS RECEIVED FROM MEDICARE ) - $20,160,000; OTHER COMMUNITY BENEFITS (INCLUDES SUBSIDIZED HEALTH SERVICES, FINANCIAL CONTRIBUTIONS) - $4,144,000; FREE SERVICE (TO PATIENTS WHO MEET MERCY'S FREE-SERVICE GUIDELINES - $4,770,000; COSTS IN EXCESS OF MEDICAID REIMBURSEMENT (COSTS OF PROVIDING THE SERVICES LESS THE AMOUNTS RECEIVED FROM MEDICAID) - $12,090,000, PHYSICIAN EDUCATION - $978,000. IN ADDITION, CHARITY CARE AND COMMUNITY SERVICE ARE PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR. THESE PROGRAMS PROVIDE A BONA FIDE COMMUNITY HEALTH NEED, INCLUDING: A. PUBLIC AND PROFESSIONAL EDUCATIONAL SEMINAR ARE OFFERED ON A VARIETY OF TOPICS INCLUDING JOINT REPLACEMENT SURGERY, PRENATAL EDUCATION, DIABETES, MENTAL HEALTH DISORDERS, AND NUMEROUS OTHER MEDICAL CONDITIONS OF MEDICAL AND PSYCHOSOCIAL NATURE. SPECIALIZED CANCER SEMINARS ARE ALSO FREQUENTLY OFFERED. B. HOSPITAL MEETING FACILITIES WHICH ARE FREQUENTLY USED WITHOUT CHARGE BY SUCH GROUPS AS THE AMERICAN HEART ASSOCIATION, IOWA BREAST CANCER FOUNDATION, HEALTHY LINN NETWORK ADVISORY COMMITTEE, OVEREATERS ANONYMOUS, CATHOLIC LAYMEN, UNITED WAY, CATHERINE MCAULEY CENTER FOR WOMEN, THE AMERICAN CANCER SOCIETY. M.S. SUPPORT GROUP, EASTERN IOWA ONCOLOGY NURSES SOCIETY, THE IOWA CANCER CONSORTIUM, RADIATION THERAPIST AND DOSIMETRIST, THE PARENT EDUCATION CONSORTIUM, ARC OF EAST CENTRAL IOWA, AND SEVERAL CANCER SUPPORT GROUPS. C. CONTRIBUTIONS OF APPROXIMATELY 176,000 HOURS TOWARD THE COMMON PURPOSE OF SERVING THE HEALTH CARE OF THE COMMUNITY. THE VALUE OF THESE CONTRIBUTIONS WAS APPROXIMATELY $2,348,000 AND WAS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS. 268559646 1 1 0 1 0 0 0 1 0 1 1 0 1 0 1 1 1 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 1 158 0 1 2814 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 28 25 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KAY CRIST 3193986107 701 10TH STREET SE CEDAR RAPIDS IA 52403 JOHN-PAUL BESONG MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 LYDIA BROWN MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 MICHELE BUSSE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BOB CATALDO MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 TIMOTHY L CHARLES PRESIDENT & CEO 40.00 X X 911772 0 69551 JACK COSGROVE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 CHRIS DEWOLF MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BARRIE ERNST MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 TONY GOLOBIC MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER LUANN HANNASCH MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 NICHOLAS HODGMAN MD MEMBER BOARD OF TRUSTEES 40.00 X 905231 0 21877 NANCY KASPAREK MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JAN KAZIMOUR MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER SHARON KERRIGAN MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BARB KNAPP MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER TERRY MALTBY MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 CHERYLE MITVALSKY CHAIRMAN 1.00 X X 0 0 0 DARREL MORF VICE CHAIRMAN/TREASURER 1.00 X X 0 0 0 RUE PATEL MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 FRED PILCHER MD MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 MARY QUASS MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JOHN RIFE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 CHARLES ROHDE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 AL RUFFALO MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 KYLE SKOGMAN MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JOHN SMITH MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER MAURITA SOUKUP SECRETARY 1.00 X X 0 0 0 SISTER RITA VALADE FORMER MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER MARGARET WEIGEL MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 NATHAN VANGENDEREN EXECUTIVE VP/CFO 40.00 X 491075 0 55372 TIMOTHY QUINN MD CHIEF OF CLINICAL OPERATIONS 40.00 X 632807 0 64937 MARY BROBST CHIEF NURSING OFFICER 40.00 X 327562 0 47140 JEFFREY CASH CHIEF INFORMATION OFFICER 40.00 X 326398 0 49366 NANCY HILL-DAVIS VP - HUMAN RESOURCES 40.00 X 266947 0 23739 AMANDEEP DHALIWAL MD PHYSICIAN 40.00 X 870477 0 8389 SHANE A GAILUSHAS MD PHYSICIAN 40.00 X 706623 0 21877 RYAN D HOLLENBECK MD PHYSICIAN 40.00 X 831665 0 30925 CHONG C LEE MD PHYSICIAN 40.00 X 1335634 0 27408 SHINY MATHEWKUTTY MD PHYSICIAN 40.00 X 699379 0 16176 8305570 0 436757 132 0 1 0 UNIVERSITY OF IOWA HEALTH CARE 200 HAWKINS DRIVE IOWA CITY IA 52242 HEALTHCARE PROFESSIONAL SERVICES 4832610 ONCOLOGY ASSOCIATES OF CEDAR RAPIDS 701 10TH STREET CEDAR RAPIDS IA 52403 HEALTHCARE PROFESSIONAL SERVICES 3709795 SOUND PHYSICIANS PO BOX 942936 LOS ANGELES CA 90074 HEALTHCARE PROFESSIONAL SERVICES 3252999 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA STREET 500 OMAHA NE 68154 HEALTHCARE PROFESSIONAL SERVICES 2079689 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 HEALTHCARE PROFESSIONAL SERVICES 1842082 51 2527822 296926 5493 2824748 PATIENT REVENUES 900099 231042672 231042672 LABORATORY REVENUE 621500 110377078 109580509 796569 FAMILY COUNSELING REVENUE 624100 280409 280409 LESS: PROVISION FOR BAD DEBT 900099 -4620133 -4620133 337080026 6918255 6918255 2528436 2262969 265467 265467 265467 104762244 55305 102047280 1886 2714964 53419 2768383 2768383 2606739 3073474 -466735 -466735 INVESTMENT PARTNERSHIP INCOME(LOS 561000 2417943 1989716 428227 MISCELLANEOUS REVENUE 900099 1550 1550 MRI JOINT VENTURE 621110 -3810568 -3810568 -1391075 347999069 334464155 1224796 9485370 5888315 5888315 4021603 3146630 874973 127441254 99714078 27727176 3971154 3107157 863997 20568341 16093322 4475019 9023569 7060327 1963242 131223 102673 28550 30845 24134 6711 3970 3106 864 27066339 21177562 5888777 1600029 1251913 348116 86923021 68011328 18911693 482763 377729 105034 4085130 3196335 888795 268460 210052 58408 116739 91340 25399 4658176 3644705 1013471 23687050 18533499 5153551 959299 750586 208713 UNRELATED BUSINESS INCO 67643 67643 CONTRACTED SERVICES 11063723 8656608 2407115 REPAIRS 2102858 1645343 457515 TAXES & LICENSES 1948768 1524778 423990 5470743 4280483 1190260 341581015 268559646 73021369 0 3797559 13103421 3070974 6235105 43496407 39891124 617655 792679 7837655 7682746 3844737 8336801 498485519 312333935 184088189 186151584 251859574 254005511 82033 0 74535408 74976907 573230191 591175878 37543949 53474783 105469496 104511718 54274524 61644837 197287969 219631338 X 326727077 321845853 21768488 22052009 27446657 27646678 375942222 371544540 573230191 591175878 X 6418054 3015767 -13831503 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 30845 30845 0 PART II-B, LINE 1: 18.1% OR $28,180 OF MEMBERSHIP DUES TO THE IOWA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES, 3.52% OR $1,971 OF MEMBERSHIP DUES TO THE CATHOLIC HEALTH ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES, AND 5.55% OR $694 OF MEMBERSHIP DUES TO THE CEDAR RAPIDS METRO ALLIANCE IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. X 0 38709974 188283 1202709 -86118 1113376 39073708 37681476 129753 1402741 -77440 581436 38709974 36037066 294653 1771320 -171611 593174 37681476 35173368 1481758 -43393 574667 36037066 34987320 298033 285414 397399 35173368 0.16620 0.70530 0.12850 0 1 1 20543864 20543864 301752922 188250638 113502284 172887462 121420330 51467132 3301271 2662967 638304 186151584 INVESTMENT IN MERCY MEDICAL CENTER FOUNDATION 71409899 C INVESTMENT IN CEDAR RAPIDS PHO 1321000 C SLEEP LAB JOINT VENTURE 1145000 C INVESTMENT IN MR ASSOCIATES 458000 C INVESTMENT IN MEDICAL MALL 343008 C INVESTMENT IN UMCSC 300000 C 74976907 INTEREST RATE SWAP AGREEMENTS 8920420 PENSION LIABILITY 41929323 SELF INSURANCE RESERVES 8757413 THIRD PARTY SETTLEMENTS 2037681 61644837 X 334124599 3015767 -18616865 -15601098 349725697 -1726628 -1726628 347999069 338522281 2203328 2203328 336318953 5262062 5262062 341581015 PART III, LINE 1A: THE ORGANIZATION HAS A SMALL COLLECTION OF ARTWORK. THE COLLECTION IS ON DISPLAY FOR PUBLIC VIEWING. THE MEDICAL CENTER HAS ELECTED NOT TO CAPITALIZE THEIR COLLECTION AS PERMITTED BY STATEMENT OF FINANCIAL ACCOUNTING STANDARDS (SFAS) NO. 116, ACCOUNTING FOR CONTRIBUTIONS RECEIVED AND CONTRIBUTIONS MADE. THE MEDICAL CENTER'S COLLECTIONS THAT HAVE BEEN DONATED ARE NOT RECOGNIZED AS ASSETS ON THE BALANCE SHEETS. NONE OF THE ARTWORK HAS BEEN SOLD TO RAISE FUNDS. PART V, LINE 4: MERCY HOSPITAL, CEDAR RAPIDS, IA ENDOWMENT FOUNDATION, INC., A RELATED ORGANIZATION, HOLDS THE ENDOWMENT FUNDS. THE FOUNDATION'S ENDOWMENT FUNDS ARE USED FOR THE HALL-PERRINE CANCER CENTER AND CANCER CENTER PROGRAMS, HALL RADIATION CENTER, OLDORF HOSPICE HOUSE, HOSPICE OF MERCY PROGRAMS, HALLMAR, WATTS LIBRARY, MERCY MEDICAL CENTER OPERATING AND CAPITAL PROJECTS, AND GENERAL ENDOWMENT FUNDS TO BE USED AT THE BOARD OF DIRECTOR'S DISCRETION. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HOSPITALS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE CONTINUED TAX EXEMPT STATUS OF BONDS ISSUED BY THE OBLIGATED GROUP, THE NATURE, THE CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2019 AND 2018, THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY. FORMS 990 AND 990T FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -2,275,414. CHANGE IN UNRECOGNIZED FUNDED STATUS OF RETIREMENT PLAN -11,995,943. CHANGE IN INTEREST IN NET ASSETS OF MERCY MEDICAL CENTER FOUNDATION 819,492. GRANT TO MERCYARE SERVICE CORPORATION INCLUDED WITH REVENUES -5,165,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES -2,203,328. LOSS ON SALE OF ASSETS 53,419. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) 383,422. REVENUE INCLUDED WITH EXPENSES ON AUDIT REPORT 43,643. AUXILIARY AND GIFT SHOP REVENUE NOT INCLUDED IN AUDIT REPORT -28,352. CONTRIBUTION REVENUE NOT RECORDED ON BOOKS 24,568. PART XII, LINE 2D - OTHER ADJUSTMENTS: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES 2,203,328. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT TO MERCYCARE SERVICE CORPORATION INCLUDED WITH REVENUES 5,165,000. REVENUES INCLUDED WITH EXPENSES ON AUDIT REPORT 43,643. LOSS ON SALE OF FIXED ASSETS 53,419. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 2402633 0 0 0 0 0 0 2402633 0 2402633 1 0 1 1 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 39087126 29711940 9375186 0.02740 43579254 30495051 13084203 0.03830 82666380 60206991 22459389 0.06570 260852 260852 0.00080 1997305 982217 1015088 0.00300 4808217 7671689 0 0.00000 521676 521676 0.00150 7588050 8653906 1797616 0.00530 90254430 68860897 24257005 0.07100 7319 7319 0.00000 439711 439711 0.00130 118442 118442 0.00030 565472 565472 0.00160 1 4620133 134133586 154295603 -20162017 X 1 1 1 MR ASSOCIATES LLP MRI SERVICES 0.33000 0.00000 0.33000 2 EASTERN IOWA SLEEP CENTER LLC SLEEP STUDIES 0.33000 0.00000 0.33000 3 PARAMOUNT HEALTH OPTIONS PAYOR CONTRACTING 0.40000 0.00000 0.60000 4 PCI REGIONAL MED MALL LLC MEDICAL SERVICES 0.10000 0.00000 0.80000 5 PCI LENDER LLC FINANCIAL SERVICES 0.07500 0.00000 0.85000 1 1 MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 WWW.MERCYCARE.ORG 570036H X X X X MERCY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE PART V X 1 18 1 SEE PART V 0 1 X 200.000000000000 400.000000000000 1 1 X X X 1 X HTTPS://WWW.MERCYCARE.ORG/FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.MERCYCARE.ORG/APP/FILES/PUBLIC/5043/FINANCIAL-ASSISTANCE-APPLIC X HTTPS://WWW.MERCYCARE.ORG/APP/FILES/PUBLIC/7416/PLAIN-LANGUAGE-FINANCIAL-AS X X X X X X 1 X 0 X X X X 1 X 0 0 MERCY MEDICAL CENTER PART V, SECTION B, LINE 5: THE 2018 ITERATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHA) AND COMMUNITY HEATH IMPROVEMENT PLAN (CHIP) WERE LED BY LINN COUNTY PUBLIC HEALTH AND CONDUCTED IN PARTNERSHIP WITH A MULTITUDE OF COMMUNITY PARTNERS, INCLUDING BOTH LINN COUNTY HOSPITALS, MERCY MEDICAL CENTER AND UNITYPOINT-ST. LUKE'S HOSPITAL, AND EASTERN IOWA HEALTH CENTER, LINN COUNTY'S FEDERALLY QUALIFIED HEALTH CENTER. THE ALIGNMENT OF THE CHA AND CHIP FOR ALL FOUR ENTITIES IN LINN COUNTY MINIMIZES DUPLICATION AND MAXIMIZES IMPACT, AS ALL AFOREMENTIONED ORGANIZATIONS ARE REQUIRED UNDER LAW OR BY FUNDERS TO ASSESS THE HEALTH OF THE COMMUNITY AND DEVELOP AN IMPLEMENTATION PLAN FOR MEETING IDENTIFIED NEEDS OF THE COMMUNITY. THE 2018 ITERATION OF THE CHA AND CHIP PROCESS ENGAGED 1,589 RESIDENTS AND 112 COMMUNITY PARTNERS FROM 53 ORGANIZATIONS. THE TOGETHER! HEALTHY LINN STEERING COMMITTEE CONSISTS OF THE FOLLOWING PARTNERS: ABBEHEALTH, ALLIANT ENERGY, AREA SUBSTANCE ABUSE COUNCIL, BETHANY LUTHERAN CHURCH, CEDAR RAPIDS CITY COUNCIL, CEDAR RAPIDS COMMUNITY SCHOOL DISTRICT, CITY OF CEDAR RAPIDS, CITY OF MARION POLICE DEPARTMENT, EASTERN IOWA HEALTH CENTER, GREATER CEDAR RAPIDS COMMUNITY FOUNDATION, IOWA STATE UNIVERSITY EXTENSION & OUTREACH, KIRKWOOD COMMUNITY COLLEGE, LINN COUNTY BOARD OF SUPERVISORS, LINN COUNTY PUBLIC HEALTH, MERCY MEDICAL CENTER, MOUNT MERCY UNIVERSITY, STATE OF IOWA SENATOR, THE GAZETTE, UNITED WAY OF EAST CENTRAL IOWA, AND UNITYPOINT HEALTH: ST. LUKE'S HOSPITAL AND JONES REGIONAL MEDICAL CENTER. IN ADDITION, THE SECONDARY SERVICE AREA PUBLIC HEALTH DEPARTMENTS WERE CONTACTED BY MERCY MEDICAL CENTER TO BETTER UNDERSTAND THEIR COUNTY NEEDS THROUGH UTILIZING THEIR MOST RECENT COMMUNITY HEALTH ASSESSMENT. THE TOGETHER! HEALTHY LINN COLLABORATIVE USES THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) FRAMEWORK TO GUIDE THE CHA AND CHIP PROCESS. THE MAPP FRAMEWORK IS A NATIONALLY RECOGNIZED FRAMEWORK FOR CONDUCTING COMMUNITY-WIDE STRATEGIC PLANNING TO IMPROVE COMMUNITY HEALTH. THE MAPP FRAMEWORK CONSISTS OF SIX PHASES, AND ALLOWS FOR THE COMMUNITY TO CONSIDER SOCIAL DETERMINANTS OF HEALTH AND HEALTH EQUITY AS IMPORTANT FACTORS WHICH INFLUENCE THE OVERALL HEALTH OF THE COMMUNITY. IN MARCH OF 2018, THE TOGETHER! HEALTHY LINN STEERING COMMITTEE PARTICIPATED IN A VISIONING WORKSHOP AND EXPRESSED MUTUAL COMMITMENT TO A HEALTHY COMMUNITY WHERE, "THE LOCAL PUBLIC HEALTH SYSTEM IS COLLABORATIVE, ENGAGED IN THE COMMUNITY, RESPONSIVE TO COMMUNITY NEEDS, EASY TO NAVIGATE, FOCUSED ON PREVENTION, AND CREATES ACCESS FOR ALL. THE SYSTEM IS DESIGNED FOR A CULTURE OF HEALTH, AND PROMOTES AN ACTIVE, SAFE, EMPOWERED, RESILIENT, AND CONNECTED COMMUNITY THAT EMBRACES DIVERSITY AND EQUITY." THIS SHARED COMMUNITY VISION WAS CREATED TO GUIDE THE DEVELOPMENT OF THE CHA AND CHIP. THE COMMUNITY HEALTH ASSESSMENT CONSISTED OF FOUR UNIQUE ASSESSMENTS, EACH MEASURING DIFFERENT ASPECTS OF THE HEALTH OF LINN COUNTY AND EXISTING ASSETS AVAILABLE WITHIN THE COUNTY. THE FOUR ASSESSMENTS INCLUDE COMMUNITY THEMES AND STRENGTHS (CTSA), COMMUNITY HEALTH STATUS, FORCES OF CHANGE AND LOCAL PUBLIC HEALTH SYSTEM. EACH ASSESSMENT HAD A SPECIFIC TARGET POPULATION, OR STAKEHOLDER GROUP OF FOCUS AND WAS GUIDED BY DISTINCT METHODOLOGIES. TOGETHER, THESE ASSESSMENTS WILL BE UTILIZED TO INFORM THE IDENTIFICATION OF PRIORITY STRATEGIC ISSUES THE COMMUNITY WILL ADDRESS IN THE 2019-2021 CHIP. THE CTSA IS A QUALITATIVE ANALYSIS OF PERCEPTIONS, THOUGHTS AND OPINIONS COMMUNITY MEMBERS HAVE REGARDING HEALTH. OF PARTICULAR INTEREST WAS IDENTIFYING NEEDS OF THE COMMUNITY, PERCEIVED QUALITY OF LIFE AND ASSETS AVAILABLE THAT MAY BE USED TO IMPROVE COMMUNITY HEALTH. FOR THIS ASSESSMENT, THE TARGET AUDIENCE INCLUDED COMMUNITY MEMBERS WHO WORK, RESIDE, WORSHIP, GO TO SCHOOL, OR SEEK ENTERTAINMENT IN LINN COUNTY. TO OBTAIN HIGH QUALITY INFORMATION FROM THE COMMUNITY REGARDING THEIR NEEDS, BARRIERS AND HEALTH PERCEPTIONS, THE SUBCOMMITTEE UTILIZED MULTIPLE ASSESSMENT STRATEGIES. THE ASSESSMENT PROCESS WAS GUIDED BY A CTSA SUBCOMMITTEE WITH REPRESENTATION FROM MULTIPLE ENTITIES AND ORGANIZATIONS WITHIN THE LOCAL PUBLIC HEALTH SYSTEM (LPHS) AND WAS ASSOCIATED WITH THE LARGER TOGETHER! HEALTHY LINN STEERING COMMITTEE. TO BEGIN, THE SUBCOMMITTEE REVIEWED THE CURRENT DATA AVAILABLE AND IDENTIFIED GAPS IN DATA FROM SPECIFIC POPULATIONS AND INFORMATION STILL NEEDING TO BE OBTAINED. THE GAP ANALYSIS INFORMED THE NEED TO GAIN ADDITIONAL DATA FROM OLDER ADULTS, DISABLED/SPECIAL NEEDS, LGBTQ+, RURAL, YOUNG CHILDREN, PARENTS, LOW-INCOME, MIDDLE TO LOWER-MIDDLE INCOME, RECENT COLLEGE GRADUATES AND MINORITY POPULATIONS. ONCE IDENTIFIED, THE GROUP SELECTED METHODS AND STRATEGIES TO REACH THE AFOREMENTIONED POPULATIONS. METHODS SELECTED INCLUDED A STICKER BOARD WITH AN OPEN-ENDED QUESTION, COMMUNITY SURVEY, WINDSHIELD SURVEY AND FOCUS GROUPS. IN MID-JUNE 2018, MEMBERS OF THE MAPP CORE GROUP CONDUCTED TWO FOCUS GROUPS. THE POPULATIONS WERE SELECTED BASED ON THE GAPS IN INFORMATION FOR SPECIFIC POPULATIONS NOTED BY THE SUBCOMMITTEE AND DECISION TO OVERSAMPLE LOW-INCOME AND MINORITY POPULATIONS. POPULATIONS OF INTEREST INCLUDED RESIDENTS AT GENEVA TOWER LOCATED IN DOWNTOWN CEDAR RAPIDS AND THE LGBTQ+ COMMUNITY, WHICH WAS HELD AT LINN COUNTY PUBLIC HEALTH. IN ADDITION TO THE METHODS SELECTED BY THE SUBCOMMITTEE, LINN COUNTY PUBLIC HEALTH ALSO EXPLORED THE USE OF VOX POP AND A STREET STALL (ALSO KNOWN AS WAILING WALL). DATA OBTAINED THROUGH THIS COMPREHENSIVE COMMUNITY ASSESSMENT WERE SYNTHESIZED INTO A SINGLE REPORT AND BROKEN DOWN INTO LOGICAL CATEGORIES TO RELAY ASSESSMENT FINDINGS. THE COMMUNITY HEALTH STATUS ASSESSMENT (CHSA) IS A QUANTITATIVE ANALYSIS WHICH ANSWERS THE QUESTIONS, "HOW HEALTHY ARE OUR RESIDENTS? AND "WHAT DOES THE HEALTH STATUS OF OUR COMMUNITY LOOK LIKE?" RESULTS OF THE CHSA PROVIDE AN UNDERSTANDING OF THE COMMUNITY'S HEALTH STATUS AND ENSURE THAT THE COMMUNITY'S PRIORITIES CONSIDER SPECIFIC HEALTH STATUS ISSUES, SUCH AS RATES OF INCREASING CHRONIC DISEASE AND SEXUALLY TRANSMITTED INFECTIONS. IN 2015, DURING THE PREVIOUS ITERATION OF THE CHA, AN INITIAL CHSA SUBCOMMITTEE PLANNED THE ASSESSMENT AND IDENTIFIED A LIST OF SPECIFIC INDICATORS AND SOURCES THAT MAY BE USED TO ACCESS THE DATA POINTS ASSOCIATED WITH THE ELEVEN CORE INDICATORS:-DEMOGRAPHIC CHARACTERISTICS-SOCIOECONOMIC CHARACTERISTICS-HEATH RESOURCE AVAILABILITY-QUALITY OF LIFE -BEHAVIORAL RISK FACTORS-ENVIRONMENTAL HEALTH INDICATORS-SOCIAL AND MENTAL HEALTH-MATERNAL AND CHILD HEALTH-DEATH, ILLNESS AND INJURY -COMMUNICABLE DISEASE -SENTINEL EVENTSDATA FROM THESE CATEGORIES WAS COMPILED AND PRESENTED AS A DASHBOARD, IDENTIFYING TRENDS, HEALTH INEQUITIES AND COMPARED LINN COUNTY RATES TO STATE AND NATIONAL RATES, WHEN APPLICABLE. IN THE 2018 CHSA, THE DASHBOARD CONCEPT WAS USED AGAIN, BUT A SUBCOMMITTEE DID NOT CONVENE TO INFORM THE DATA POINTS TO BE INCLUDED ON THE DASHBOARD, AS LINN COUNTY PUBLIC HEALTH HAD JUST COMPLETED THE 2017 HEALTH OF LINN COUNTY REPORT, A COMPREHENSIVE QUANTITATIVE ANALYSIS OF THE HEALTH OF LINN COUNTY. ON MAY 24, 2018 LINN COUNTY CONDUCTED THE FORCES OF CHANGE ASSESSMENT (FOCA) AT INDIAN CREEK NATURE CENTER IN CEDAR RAPIDS. MEMBERS FROM MULTIPLE SECTORS WITHIN LINN COUNTY'S LPHS WERE INVITED OR SELF-ELECTED TO PARTICIPATE IN THE ASSESSMENT. THE IDEAL PARTICIPANTS FOR THE FOCA ARE COMMUNITY LEADERS AND OFFICIALS WITH INSIGHT ON FACTORS, EVENTS AND TRENDS THAT MAY POTENTIALLY IMPACT THE HEALTH OF THE PUBLIC OR THE OPERATION OF THE LPHS. THIS ASSESSMENT FOCUSES ON ISSUES THAT ARE BROADER REACHING, SUCH AS FACTORS THAT IMPACT THE ENVIRONMENT IN WHICH THE LPHS OPERATES, STATE AND FEDERAL LEGISLATION, RAPID TECHNOLOGICAL ADVANCES, CHANGES IN THE ORGANIZATION OF HEALTH CARE SERVICES, OR FUNDING SHIFTS. METHODS SELECTED FOR THIS ASSESSMENT INCLUDED AN AFFINITY DIAGRAM, PRIORITIZATION ACTIVITY AND FORCE FIELD ANALYSIS.PARTICIPANTS WERE ASKED TO BRAINSTORM A LIST OF UNIQUE FORCES, TRENDS, OR EVENTS THAT MIGHT IMPACT THE HEALTH OF THE COMMUNITY. PARTICIPANTS THEN CREATED AN AFFINITY DIAGRAM WHICH RESULTED IN THIRTEEN SEPARATE IDEAS OR "CLUSTERS." EACH PARTICIPANT RECEIVED TEN STICKERS TO VOTE ON THE SPECIFIC FORCES THEY BELIEVED TO BE MOST CRITICAL TO THE HEALTH OF THE COMMUNITY AND WERE NOT ALLOWED TO VOTE FOR A FORCE MORE THAN ONCE. THE FACILITATORS TALLIED THE RESULTS AND TRANSFERRED THE FINAL CATEGORIES ONTO LARGE FLIP CHART PAPER IN PREPARATION FOR THE FORCE FIELD ANALYSIS, THE FINAL ACTIVITY OF THE FOCA. THE ANALYSIS AIMS TO IDENTIFY BOTH OPPORTUNITIES AND THREATS POSED BY EACH FORCE CATEGORY. THE TEN FORCES WERE WRITTEN ON FLIP CHART PAPER AND PLACED THROUGHOUT THE CONFERENCE ROOM WHERE EACH PARTICIPANT HAD FIVE MINUTES TO WRITE A LIST OF SPECIFIC OPPORTUNITIES OR THREATS ASSOCIATED WITH EACH FORCE CATEGORY. MERCY MEDICAL CENTER PART V, SECTION B, LINE 6A: LINN COUNTY PUBLIC HEALTH FACILITATED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL AND MERCY MEDICAL CENTER. BOTH HOSPITALS ARE LOCATED IN CEDAR RAPIDS, IA. MERCY MEDICAL CENTER PART V, SECTION B, LINE 6B: THIS PROCESS ALSO ENGAGED 1,589 RESIDENTS AND 112 COMMUNITY PARTNERS FROM 53 ORGANIZATIONS. IN ADDITION TO LINN COUNTY PUBLIC HEALTH AND UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL, THE TOGETHER! HEALTHY LINN STEERING COMMITTEE CONSISTS OF THE FOLLOWING PARTNERS: ABBEHEALTH, ALLIANT ENERGY, AREA SUBSTANCE ABUSE COUNCIL, BETHANY LUTHERAN CHURCH, CEDAR RAPIDS CITY COUNCIL, CEDAR RAPIDS COMMUNITY SCHOOL DISTRICT, CITY OF CEDAR RAPIDS, CITY OF MARION POLICE DEPARTMENT, EASTERN IOWA HEALTH CENTER, GREATER CEDAR RAPIDS COMMUNITY FOUNDATION, IOWA STATE UNIVERSITY EXTENSION & OUTREACH, KIRKWOOD COMMUNITY COLLEGE, LINN COUNTY BOARD OF SUPERVISORS, LINN COUNTY PUBLIC HEALTH, MERCY MEDICAL CENTER, MOUNT MERCY UNIVERSITY, STATE OF IOWA SENATOR, THE GAZETTE, UNITED WAY OF EAST CENTRAL IOWA, AND UNITYPOINT HEALTH: ST. LUKE'S HOSPITAL AND JONES REGIONAL MEDICAL CENTER. ADDITIONALLY, MERCY MEDICAL CENTER REQUESTED INPUT FROM THE PUBLIC HEALTH DEPARTMENTS OF BENTON, BUCHANAN, CEDAR, DELAWARE, IOWA, JOHNSON, JONES, AND TAMA COUNTIES IN REGARDS TO HEALTH PRIORITIES IN THEIR AREA. MERCY MEDICAL CENTER PART V, SECTION B, LINE 11: MERCY MEDICAL CENTER IS ADDRESSING THE THREE PRIORITY SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN A VARIETY OF WAYS. MERCY IS ADDRESSING THE SIGNIFICANT HEALTH NEED OF OBESITY BY PROVIDING NUTRITION EDUCATION AND COUNSELING THROUGH OUTPATIENT TREATMENT AND CLASSES, PROVIDING SPECIALIZED CARE FOR THE PREVENTION AND TREATMENT OF CHILDHOOD AND ADOLESCENT OBESITY THROUGH MERCY PEDIATRIC CLINIC, PROVIDING SURGICAL WEIGHT-LOSS OPTIONS TO HELP INDIVIDUALS ACHIEVE LIFELONG SUCCESS WITH WEIGHT CONTROL AND HEALTHY LIVING THROUGH MERCY'S BARIATRIC SURGERY CLINIC, PROVIDING NUTRITION INFORMATION TO MERCY'S PATIENTS, VISITORS, AND STAFF, AND CONTINUING THE PURCHASE OF LOCAL FOODS.MERCY MEDICAL CENTER IS ADDRESSING THE SIGNIFICANT HEALTH NEED OF MENTAL HEALTH BY EXPLORING OPTIONS FOR MORE PSYCHIATRIC CONSULTATIVE ROLES WITHIN MERCYCARE CLINICS, PROVIDING LINN-MAR AND PRAIRIE SCHOOL DISTRICTS WITH A MENTAL HEALTH URGENT CARE PROGRAM, PARTICIPATING IN THE DEVELOPMENT OF THE LINN COUNTY MENTAL HEALTH ACCESS CENTER, INCREASING EARLY INTERVENTION SERVICES FOR SUICIDE THROUGH NEWLY IMPLEMENTED SCREENING TOOL AND CREATION OF SAFETY PLAN/INTERVENTIONS AND PROVIDING WALK-IN ACCESS, SCREENING, ONGOING SUPPORT, AND TREATMENT AT SEDLACEK TREATMENT CENTER.MERCY MEDICAL CENTER IS ADDRESSING THE SIGNIFICANT HEALTH NEED OF SAFETY BY ENHANCING MERCY'S ANTI-HUMAN TRAFFICKING EFFORTS, SUPPORTING EFFORTS OF LOCAL SCHOOLS AND COMMUNITY PARTNERS TO ADDRESS BULLYING AND VIOLENCE, COMPLETING A WORKPLACE VIOLENCE PREVENTION GAP ANALYSIS AND DEVELOPING AND EXECUTING AN ACTION PLAN, IMPLEMENTING PHYSICAL ENVIRONMENT SAFETY IMPROVEMENTS HOSPITAL-WIDE, OFFERING TRAINING RELATED TO SAFETY BOTH INTERNALLY AND EXTERNALLY TO MERCY MEDICAL CENTER. MERCY MEDICAL CENTER DESCRIBES IN ITS MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY HOW IT IS ADDRESSING OTHER NEEDS IDENTIFIED IN THE CHNA. THESE INCLUDE: ACCESS TO HEALTH CARE, ACCESS TO HEALTHY FOOD, ACCESS TO MENTAL HEALTH SERVICES, AFFORDABLE HOUSING, BUILT ENVIRONMENT, CHRONIC DISEASE, NATURAL ENVIRONMENT, SEXUAL HEALTH, SUBSTANCE USE, AND TRANSPORTATION. SCHEDULE H, PART V, SECTION B, LINE 5, CONTINUED: LINN COUNTY CONDUCTED THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) BETWEEN THE MONTHS OF MAY AND JULY OF 2015. MEMBERS FROM MULTIPLE SECTORS WITHIN LINN COUNTY'S LPHS WERE INVITED TO PARTICIPATE IN THE ASSESSMENT. ENTITIES WITHIN THE LPHS INCLUDE ALL ORGANIZATIONS WHO MAY IMPACT THE HEALTH OF THE COMMUNITY SUCH AS COMMUNITY CENTERS, EMPLOYERS, ELECTED OFFICIALS, TRANSIT, PUBLIC HEALTH AGENCY, HOME HEALTH, LABORATORIES, FAITH-BASED ORGANIZATIONS, NON-PROFITS, COMMUNITY HEALTH CLINICS, HOSPITALS, DOCTORS, NURSING HOMES, DRUG TREATMENT, MENTAL HEALTH, SCHOOLS, NEIGHBORHOOD ORGANIZATIONS, CORRECTIONS, LAW ENFORCEMENT, FIRE AND EMS. THE INTENT OF THE LPHSA IS TO ASSESS HOW ORGANIZATIONS WITHIN THE SYSTEM ARE DOING IN ADDRESSING THE TEN ESSENTIAL PUBLIC HEALTH SERVICES AND IS COMPLETED USING THE LOCAL INSTRUMENT OF THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS (NPHPS; CDC, 2015). THIS INSTRUMENT HELPS COMMUNITIES MEASURE NOT ONLY HOW THEY ARE DOING IN ADDRESSING THE OVERARCHING ESSENTIAL PUBLIC HEALTH SERVICES, BUT ALSO THE COMPETENCIES AND SUB-COMPETENCIES THAT FALL UNDER EACH SERVICE. THE LPHSA SUBCOMMITTEE DECIDED TO TAKE A TARGETED APPROACH IN GAINING FEEDBACK ON EACH OF THE ESSENTIAL PUBLIC HEALTH SERVICES BY SPLITTING PARTNERS WITHIN THE LPHS INTO FIVE WORKGROUPS EACH FOCUSING ON TWO OF THE ESSENTIAL PUBLIC HEALTH SERVICES. AN INITIAL SURVEY COVERING THE TARGETED PUBLIC HEALTH SERVICES WAS SENT TO THE MEMBERS OF THE WORKGROUPS IN JUNE OF 2015. THE WORKGROUPS WERE THEN CONVENED IN JULY OF 2015 TO ENGAGE IN FACILITATED DISCUSSIONS THAT COVERED THE COMPONENTS FALLING UNDER EACH OF THE TARGETED ESSENTIAL PUBLIC HEALTH SERVICES. FOLLOWING DISCUSSION, MEMBERS THEN RATED HOW WELL THE LPHS IS DOING IN ADDRESSING THE ESSENTIAL PUBLIC HEALTH SERVICES. ALL COMPONENTS WITH A "MINIMAL ACTIVITY OR "MODERATE ACTIVITY" RATING WERE HIGHLIGHTED IN A REPORT AS A NEEDED AREA OF IMPROVEMENT FOR THE LPHS TO ADDRESS MOVING FORWARD.IN AUGUST 2018, THE TOGETHER! HEALTHY LINN STEERING COMMITTEE REVIEWED DATA FROM 13 POTENTIAL STRATEGIC ISSUE CATEGORIES AND PRIORITIZED THREE ISSUES WHICH MUST BE ADDRESSED IN ORDER TO ACHIEVE THE TOGETHER! HEALTHY LINN VISION. FROM OCTOBER 2018 THROUGH DECEMBER 2018, COMMUNITY PARTNERS REVIEWED ASSESSMENT DATA RELATED TO THE THREE PRIORITY ISSUES AND IDENTIFIED A GOAL AND STRATEGIES THROUGH SMALL AND LARGE GROUP DISCUSSION WITH MULTI-VOTING. MERCY MEDICAL CENTER DID NOT RECEIVE ANY WRITTEN COMMENTS ON THE HOSPITAL FACILITY'S MOST RECENTLY CONDUCTED CHNA OR IMPLEMENTATION STRATEGY. HOWEVER, ON THE CHNA AND IMPLEMENTATION STRATEGY WEBPAGE OF THE MERCY WEBSITE, THERE IS A "CONTACT US" FORM THAT CAN BE FILLED OUT BY ANY INDIVIDUAL. THE SUBMITTED ONLINE FORM GOES TO MERCY'S MARKETING DEPARTMENT AND WOULD BE FORWARDED TO MERCY'S COMMUNITY BENEFIT OFFICE. ANY MAILED WRITTEN COMMENTS WOULD BE FORWARDED TO THE COMMUNITY BENEFIT OFFICE. SCHEDULE H, PART V, SECTION B, LINE 7A: HTTPS://WWW.MERCYCARE.ORG/APP/FILES/PUBLIC/9502/CHNA-2018.PDF SCHEDULE H, PART V, SECTION B, LINE 10A: HTTPS://WWW.MERCYCARE.ORG/APP/FILES/PUBLIC/9866/2018-CHNA-IMPLEMENTATION-STRATEGY.PDF PART I, LINE 3C: DISCOUNTED CARE IS AVAILABLE TO ALL MERCY MEDICAL CENTER PATIENTS WHO DO NOT HAVE ACTIVE MEDICAL INSURANCE COVERAGE, NOT JUST THOSE WITHIN A FEDERAL POVERTY GUIDELINE FAMILY INCOME LIMIT. IF PATIENTS STILL FIND THEMSELVES UNABLE TO PAY, THEY MAY APPLY FOR ADDITIONAL FINANCIAL ASSISTANCE. PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: MERCY MEDICAL CENTER UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO, AND THIS RATIO WAS USED IN COMPUTING THE INFORMATION REPORTED IN PART I, LINE 7. PART I, LINE 7G: NO COSTS ASSOCIATED WITH A PHYSICIAN CLINIC WERE REPORTED IN SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): BAD DEBT EXPENSE WAS NOT INCLUDED IN THE DENOMINATOR BECAUSE IT WAS REPORTED ON LINE 2D OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 26.42%. THIS PERCENTAGE INCREASES TO 71.59% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN THE TOTAL COMMUNTY BENEFIT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: MERCY MEDICAL CENTER (MERCY) PARTICIPATED IN A NUMBER OF COMMUNITY BUILDING ACTIVITIES THAT PROMOTED THE HEALTH OF THE COMMUNITIES IT SERVES. SPECIFICALLY, MERCY PARTICIPATES IN ACTIVITIES TO ADDRESS SOCIAL DETERMINANTS OF HEALTH. ADDRESSING SOCIAL DETERMINANTS OF HEALTH IS IMPORTANT FOR IMPROVING HEALTH AND REDUCING HEALTH DISPARITIES. THIS INCLUDED MERCY STAFF REPRESENTATION ON A NUMBER OF COALITIONS, COMMITTEES AND BOARDS SUCH AS BIG BROTHERS BIG SISTERS, THE CATHERINE MCAULEY CENTER, AND THE UNITED WAY OF EAST CENTRAL IOWA. ANNUALLY, MERCY STAFF PARTICIPATE IN THE UNITED WAY DAY OF CARING WHICH IS A DAY OF COMMUNITY SERVICE PARTNERING LOCAL BUSINESSES WITH NONPROFITS. STAFF ALSO PARTICIPATED IN WORKFORCE DEVELOPMENT EXPERIENCES WITH LOCAL HIGH SCHOOL STUDENTS. MERCY MADE FINANCIAL CONTRIBUTIONS TO NON-PROFIT ORGANIZATIONS THAT SUPPORT COMMUNITY-BUILDING EFFORTS, THE MAJORITY TO THOSE ORGANIZATIONS THAT PROVIDE COMMUNITY SUPPORT THROUGH THEIR PROGRAMS. PART III, LINE 2: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF THESE AMOUNTS, THEY ARE NOT REPORTED AS REVENUE IN THE AUDITED FINANCIAL STATEMENTS. THEREFORE, NO BAD DEBT EXPENSE IS RECOGNIZED FOR UNCOLLECTED AMOUNTS ON PATIENT ACCOUNTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 3: NOT APPLICABLE PART III, LINE 4: SEE PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 8: THE COSTS SHOWN FOR THE MEDICARE SHORTFALL ARE BASED ON TOTAL CHARGES OF ALL MEDICARE AND MEDICARE REPLACEMENT (PART C) PATIENTS. THE SHORTFALL IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES BY THE COST TO CHARGE RATIO CALCULATED ON WORKSHEET 2, LESS PAYMENTS WE RECEIVED FOR THESE SERVICES.THE MEDICARE COST REPORT IS NOT AN APPROPRIATE SOURCE TO DETERMINE THE COSTS FOR THESE PATIENTS. MANY ITEMS, INCLUDING ALL OUTPATIENT SERVICES FOR PATIENTS WHO ARE COVERED BY A MEDICARE REPLACEMENT PLAN (PART C) AND MANY SERVICES SUCH AS LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND OTHERS PAID ON A FEE FOR SERVICE BASIS, ARE NOT INCLUDED ON THE MEDICARE COST REPORT. IN ADDITION, HOSPICE, HOME HEALTH, AND DIALYSIS SERVICES, ALTHOUGH INCLUDED IN MEDICARE COST REPORT, DO NOT SHOW THE COSTS AND PAYMENTS ASSOCIATED WITH THESE SERVICES FOR MEDICARE BENEFICIARIES. FOR MERCY MEDICAL CENTER, 48% OF OUR GROSS CHARGES ARE GENERATED BY PATIENTS WITH MEDICARE AND MEDICARE REPLACEMENT (PART C) COVERAGE. ANOTHER 14% OF OUR GROSS CHARGES ARE GENERATED BY PATIENTS WITH MEDICAID COVERAGE. NEITHER GOVERNMENT PROGRAM HAS HISTORICALLY REIMBURSED ENOUGH TO COVER THE COSTS OF THE SERVICES PROVIDED TO THESE PATIENTS. IF WE DID NOT SERVE THESE PATIENT POPULATIONS, ANOTHER FACILITY WOULD HAVE TO PROVIDE THE SERVICE. PART III, LINE 9B: MERCY MEDICAL CENTER UNDERSTANDS PATIENTS MAY NOT HAVE THE ABILITY TO PAY FOR SERVICES NOR RECOGNIZE THE OPPORTUNITY THEY MAY HAVE TO RECEIVE FINANCIAL ASSISTANCE. TO AID IN THIS PROCESS, MERCY MEDICAL CENTER HAS IMPLEMENTED A PRESUMPTIVE CHARITY ELIGIBILITY PROGRAM (PCEP). PATIENTS WHO QUALIFY FOR THIS PROGRAM DO NOT COMPLETE PAPERWORK. MERCY MEDICAL CENTER UTILIZES AN OUTSIDE VENDOR TO ASSIST IN DETERMINING A PATIENT'S FINANCIAL RISK. MERCY MEDICAL CENTER USES BILLING AND COLLECTION RECOMMENDATIONS FROM THE IOWA HOSPITAL ASSOCIATION. THESE RECOMMENDATIONS INCLUDE: - MERCY MEDICAL CENTER WILL PROVIDE THE SAME INFORMATION CONCERNING SERVICES AND CHARGES TO ALL PATIENTS. - MERCY MEDICAL CENTER WILL NOT KNOWINGLY SEND A PATIENT'S BILL TO A COLLECTION AGENCY BEFORE INITIAL FINANCIAL ELIGIBILITY ASSISTANCE DETERMINATION HAS BEEN MADE. - MERCY MEDICAL CENTER WILL REVIEW THE PATIENT'S RECORD TO DETERMINE IF REASONABLE EFFORTS WERE UNDERTAKEN TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED AND/OR IF FINANCIAL ASSISTANCE IS APPROPRIATE BEFORE ANY COLLECTION AGENCY ASSIGNMENT. PART VI, LINE 2: MERCY MEDICAL CENTER UNDERSTANDS THE NEED FOR ONGOING ASSESSMENT AND USES DATA AND INFORMATION OBTAINED FROM HOSPITAL FINANCIAL ASSISTANCE CASES, COMMUNITY FREE CLINICS, UNITED WAY OF EAST CENTRAL IOWA AND THE LOCAL PUBLIC HEALTH DEPARTMENT REPORTS TO MODIFY CURRENT ACTIVITIES AND CREATE NEW PROGRAMS TO ADDRESS HEALTH NEEDS. ADDITIONALLY, MERCY MEDICAL CENTER RECEIVES REQUESTS FROM LOCAL NON-PROFIT ORGANIZATIONS FOR FINANCIAL AND IN-KIND SUPPORT TO ADDRESS COMMUNITY NEEDS FOR WHICH THEY PROVIDE PROGRAMS AND SERVICES. MERCY MEDICAL CENTER UTILIZES ALL OF THIS INFORMATION, IN ADDITION TO THE CHNA TO COMPLETE A COMMUNITY BENEFIT PLAN FOR THE HOSPITAL. PART VI, LINE 4: MERCY MEDICAL CENTER (MERCY) SERVES A PRIMARY SERVICE AREA (PSA) OF LINN COUNTY AND A SECONDARY SERVICE AREA (SSA) OF EIGHT COUNTIES (BENTON, BUCHANAN, CEDAR, DELAWARE, IOWA, JOHNSON, JONES AND TAMA). THE MAJORITY OF MERCY'S PATIENTS FOR BOTH INPATIENT AND OUTPATIENT SERVICES LIVE IN LINN COUNTY. THE COMMUNITY ADDITIONALLY INCLUDES THOSE COUNTIES ADJACENT TO LINN COUNTY AND WITHIN A REASONABLE DRIVING TIME TO THE HOSPITAL. THE TOTAL POPULATION OF LINN COUNTY IN 2018 WAS 225,909. THE TOTAL POPULATION OF BOTH PRIMARY AND SECONDARY SERVICE AREAS WAS 513,495. THE PROJECTED 10 YEAR POPULATION GROWTH FOR THE PSA IS 2% AND THE SSA, 1%, ANNUALLY. DEMOGRAPHICS FOR THE COMBINED SERVICE AREA ARE AS FOLLOWS:50.1% MALE, 49.9% FEMALE93.4% CAUCASIAN2.3% AFRICAN AMERICAN1.2% NATIVE AMERICAN1.4% ASIAN/PACIFIC1.5% TWO OR MORE RACES3.5% HISPANIC18.0% OF PERSONS LIVING IN MERCY'S COMBINED SERVICE AREA ARE AGE 65 OR OLDER 93.0% ARE HIGH SCHOOL GRADUATES WHILE 24.4% HOLD A BACHELOR'S DEGREE OR HIGHER THE MEDIAN HOUSEHOLD INCOME IS $60,194THE PERCENTAGE OF PEOPLE LIVING BELOW POVERTY LEVEL IS 9.28% AS COMPARED TO 11.8% FOR ALL OF IOWA THE AVERAGE PERSONS PER HOUSEHOLD ARE 2.43FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS ARE PRESENT IN BENTON, BUCHANAN, DELAWARE, IOWA, JONES, LINN AND TAMA COUNTIES AS OF OCTOBER 2019, THE UNEMPLOYMENT RATE FOR LINN COUNTY IS 2.5%. THE EIGHT CONTIGUOUS UNEMPLOYMENT RATES RANGE FROM 1.5-2.2%. LINN COUNTY FEATURES A DIVERSE EMPLOYER BASE INCLUDING MANUFACTURING, TRADE, EDUCATION, SERVICE, FINANCE AND AGRICULTURE. UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL IS LOCATED IN LINN COUNTY AND SERVES A SIMILAR GEOGRAPHIC SERVICE AREA AS MERCY MEDICAL CENTER. ADDITIONALLY, THE UNIVERSITY OF IOWA AND MERCY IOWA CITY ARE LOCATED IN JOHNSON COUNTY, REGIONAL MEDICAL CENTER IS LOCATED IN DELAWARE COUNTY, UNITYPOINT HEALTH - JONES REGIONAL MEDICAL CENTER IS LOCATED IN JONES COUNTY, AND VIRGINIA GAY HOSPITAL IS LOCATED IN BENTON COUNTY. PART VI, LINE 5: MERCY MEDICAL CENTER'S BOARD OF TRUSTEES IS MADE UP OF VOLUNTEERS, THE MAJORITY OF WHOM ARE RESIDENTS WITHIN THE PRIMARY SERVICE AREA. THE BOARD CONSISTS OF 27 MEMBERS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. THE CEO OF THE CORPORATION AND THE PRESIDENT OF THE MEDICAL STAFF ADDITIONALLY SERVE AS EX-OFFICIO, VOTING MEMBERS. THE GOVERNANCE STRUCTURE ENSURES THAT COMMUNITY INTERESTS ARE REPRESENTED IN DECISION-MAKING FOR THE ORGANIZATION. IN ADDITION, THREE SEATS ARE ALLOCATED TO WOMEN RELIGIOUS WHO ENSURE THE ORGANIZATION REMAINS TRUE TO ITS CHARITABLE MISSION. THERE ARE CURRENTLY FIVE WOMEN RELIGIOUS SERVING ON THE BOARD. MERCY MEDICAL CENTER MAINTAINS AN OPEN MEDICAL STAFF, AS PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS.MERCY MEDICAL CENTER UTILIZES OPERATING INCOME SURPLUSES TO FUND CAPITAL EXPENDITURES. THE PROPOSED CAPITAL ITEMS ARE REVIEWED BY STAFF, MEDICAL STAFF AND ADMINISTRATION TO ENSURE ITEMS WILL PROVIDE ONGOING HIGH QUALITY, LOW COST CARE TO PATIENTS AND ALIGN WITH THE STRATEGIC INITIATIVES FOR THE FACILITY. ANY EXCESS OPERATING FUNDS RETAINED BY THE ORGANIZATION ARE USED FOR FUTURE CAPITAL IMPROVEMENTS OR OPERATING FUNDS AS NEEDED.MERCY MEDICAL CENTER CONTRIBUTES TO THE HEALTH OF THE COMMUNITIES IT SERVES IN A NUMBER OF WAYS. MERCY PROVIDES REPRESENTATION ON SEVERAL COMMUNITY BOARDS, COALITIONS AND COMMITTEES ADDRESSING HEALTH NEEDS. EXAMPLES INCLUDE:-THE ARC OF EAST CENTRAL IOWA BOARD-COMMUNITY HEALTH FREE CLINIC BOARD-LINN COUNTY MENTAL HEALTH ACCESS CENTER PLANNING COMMITTEE-MY CARE COMMUNITY, WHICH CONSISTS OF SOCIAL SERVICE, PUBLIC HEALTH, AND HEALTHCARE PROVIDERS IN LINN COUNTY -GEMS OF HOPE BOARD-HAWKEYE AREA COMMUNITY ACTION PROGRAM-WAYPOINT SERVICES MERCY EMPLOYEES HAVE PARTICIPATED IN THE TRAINING OF HEALTH CARE PROFESSIONS STUDENTS, PROVIDING HEALTH EDUCATION TO THE COMMUNITY, OFFERING SUPPORT OF HEALTH PREVENTION AND PROMOTION ACTIVITIES, THROUGH SCREENINGS AND SUPPORT GROUPS, SUPPORTING STROKE CAMP FOR STROKE SURVIVORS AND THEIR CAREGIVERS AND PROVIDING STAFF, MEDICATION AND SUPPLIES FOR A DIABETES CAMP FOR CHILDREN WITH DIABETES, PROVIDING IN-KIND PRINTING TO MULTIPLE NONPROFITS, DONATING AUTOMATIC EXTERNAL DEFIBRILLATORS TO LOCAL CHURCHES, SCHOOLS, AND NONPROFITS, AND COORDINATING ACTIVITIES TO SUPPORT LOCAL NONPROFITS. MERCY LAUNCHED AN EARLY-RECOVERY-AFTER-SURGERY PROGRAM TO DECREASE THE USE OF PRESCRIPTION OPIOIDS LINKED TO LONGER HOSPITAL RECOVERY TIMES, AND COLLABORATES WITH A COMMUNITY TASKFORCE TO ADDRESS. MERCYCARE HEALTH PARTNERS CLINIC CREATES AFFORDABLE, ACCESSIBLE CARE FOR PEOPLE WITH COMPLEX MEDICAL ISSUES WHO FACE BARRIERS TO ACHIEVING THEIR HEALTH GOALS. TO INCREASE ACCESS TO MEDICAL CARE IN RURAL IOWA, MERCYCARE TAMA AND MERCYCARE MONTICELLO OFFER PRIMARY CARE SERVICES. CANCER, HEART, SURGERY, AND UROLOGY SPECIALISTS ALSO TRAVEL TO CLINICS OUTSIDE CEDAR RAPIDS TO CREATE EASIER ACCESS FOR PATIENTS IN MANCHESTER, VINTON, ANAMOSA, AND TAMA. THE FAMILY CAREGIVERS CENTER OF MERCY OPENED ITS DOORS IN DECEMBER 2015 AS IOWA'S FIRST COMPREHENSIVE CENTER FOR FAMILY CAREGIVERS. THE OVERALL GOAL OF THE CENTER IS TO REDUCE THE STRESS OF THE FAMILY CAREGIVER AND KEEP THEM HEALTHIER BY PROVIDING EMOTIONAL SUPPORTING AND CONNECTING THEM TO RESOURCES. MERCY PROVIDES IN-KIND LAB AND RADIOLOGY SERVICES FOR THE CITY'S TWO FREE CLINICS. MERCY WORKS WITH THE CEDAR RAPIDS COMMUNITY SCHOOL DISTRICT TO OFFER ELECTRONIC HEALTH RECORDS AT METRO CARE CONNECTION SCHOOL-BASED HEALTH CENTERS. MERCY HONORED THE LIFETIME ACCOMPLISHMENTS OF SR. MARY LAWRENCE HALLAGAN WITH A NON-PROFIT COMMUNITY CENTER THAT OPENED SEPT. 6, 2011 TO PROVIDE SPACE AND DIRECT CLIENT SERVICES TO NONPROFIT ORGANIZATIONS AT 420 6TH STREET, CEDAR RAPIDS. TENANTS INCLUDE: GEMS OF HOPE; KIDS FIRST LAW CENTER; YOUNG PARENTS NETWORK AND BOYS & GIRLS CLUB; CATHOLIC CHARITIES; AND METRO CATHOLIC OUTREACH. THESE AGENCIES SHARE MERCY'S VISION TO ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. TOGETHER, WE MAKE A DIFFERENCE IN THE LIVES OF MANY. MERCY LEASES THE SPACE FOR $1 PER YEAR, PLUS THE COST OF MONTHLY UTILITIES.MERCY SUPPORTS THE CEDAR RAPIDS MEDICAL SELF-SUPPORTED MUNICIPAL IMPROVEMENT DISTRICT THE MEDICAL QUARTER REGIONAL MEDICAL DISTRICT (MEDQUARTER) TO ENHANCE OUR COMMUNITY'S NATIONALLY RECOGNIZED REPUTATION FOR HIGH-QUALITY, LOW-COST CARE WITH A CONCENTRATED AREA OF MEDICAL SERVICES THAT ARE EASILY ACCESSIBLE.MERCY MEDICAL CENTER PARTNERS WITH UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL TO SUPPORT A FAMILY PRACTICE RESIDENCY PROGRAM. A COMMUNITY-BASED PROGRAM UNDERSCORES A COMMITMENT TO THE CONCEPT OF THE PATIENT-CENTERED MEDICAL HOME. THE MEDICAL HOME IS A COMMUNITY HEALTH CENTER, A FEDERALLY QUALIFIED HEALTH CENTER, ONE WHICH ALLOWS RESIDENTS TO CARE FOR THE NEEDS OF BOTH RURAL AND URBAN UNDERSERVED POPULATIONS. MERCY MEDICAL CENTER HAS COMMITTED A FULL-TIME EQUIVALENT TO THE ROLE OF DIRECTOR OF COMMUNITY BENEFIT AND PATIENT RELATIONS. IN ADDITION, MERCY ADMINISTRATION BUDGETS 2 HOURS PER FULL-TIME EQUIVALENT THAT IS USED TO SUPPORT COMMUNITY BENEFIT ACTIVITIES AND PRECEPTING HEALTH PROFESSIONS STUDENTS. THE DIRECTOR OF COMMUNITY BENEFIT AND PATIENT RELATIONS REPORTS TO THE VICE PRESIDENT OF MISSION INTEGRATION, WHO REPORTS TO THE PRESIDENT & CHIEF EXECUTIVE OFFICER (CEO). PART VI, LINE 7, REPORTS FILED WITH STATES IA 1 MERCYCARE SERVICE CORPORATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 421199429 501(C)(3) 5165000 FOR USE IN CONTINUING OPERATIONS MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 510233180 501(C)(3) 255108 FOR USE IN CONTINUING OPERATIONS AND CONTRIBUTION FOR ESPECIALLY FOR YOU RACE AGAINST BREAST CANCER FOUR OAKS FAMILY AND CHILDREN SERVICES 5400 KIRKWOOD BLVD SW CEDAR RAPIDS IA 52404 420998726 501(C)(3) 35000 GENERAL SUPPORT ESPECIALLY FOR YOU RACE AGAINST BREAST CANCER 701 10TH STREET SE CEDAR RAPIDS IA 52403 421199429 501(C)(3) 40000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION INC 1035 N CENTER POINT RD SUITE B HIAWATHA IA 52233 135613797 501(C)(3) 36000 GENERAL SUPPORT UNITED WAY OF EAST CENTRAL IOWA 317 7TH AVENUE SE STE 401 CEDAR RAPIDS IA 52401 420861239 501(C)(3) 13975 1454 FAIR MARKET VALUE IN KIND DONATIONS GENERAL SUPPORT JUVENILE DIABETES FOUNDATION (JDRF) 1026 A AVENUE NE SUITE 113 PO BOX 3026 CEDAR RAPIDS IA 52402 231907729 501(C)(3) 10000 GENERAL SUPPORT ORCHESTRA IOWA INC 119 THIRD AVENUE SE CEDAR RAPIDS IA 52401 420772544 501(C)(3) 10000 GENERAL SUPPORT GEMS OF HOPE INC 420 6TH STREET SE CEDAR RAPIDS IA 52401 203155610 501(C)(3) 7500 GENERAL SUPPORT ALZHEIMER'S DISEASE & RELATED DISORDERS ASSOCIATION 317 7TH AVENUE SE STE 402 CEDAR RAPIDS IA 52401 133039601 501(C)(3) 7500 GENERAL SUPPORT ZACH JOHNSON FOUNDATION PO BOX 2336 CEDAR RAPIDS IA 52406 272683100 501(C)(3) 6500 GENERAL SUPPORT WAYPOINT 318 5TH STREET SE CEDAR RAPIDS IA 52401 420680307 501(C)(3) 5000 GENERAL SUPPORT CHAINS INTERRUPTED PO BOX 583 CEDAR RAPIDS IA 52406 814426353 501(C)(3) 6000 GENERAL SUPPORT LINN COUNTY MEDICAL SOCIETY 813 1ST AVE SE CEDAR RAPIDS IA 52402 237410746 501(C)(6) 5000 GENERAL SUPPORT UNIVERSITY OF IOWA 105 JESSUP HALL IOWA CITY IA 52242 426004813 STATE OF IOWA 5200 GREAT IOWA NURSES PROGRAM HAWKEYE AREA COMMUNITY ACTION PROGRAM INC 1515 HAWKEYE DRIVE HIAWATHA IA 52233 420898405 501(C)(3) 5000 GENERAL SUPPORT NFC CEDAR RAPIDS LLC 1110 OLD MARION RD SUITE A CEDAR RAPIDS IA 52402 824992170 501(C)(3) 10000 GENERAL SUPPORT LINN COUNTY PUBLIC HEALTH 510 13TH ST NW CEDAR RAPIDS IA 52405 426004338 501(C)(3) 32820 GENERAL SUPPORT 17 1 PART I, LINE 2: ALL CHECKS ARE ISSUED DIRECTLY TO THE ORGANIZATION TO BE USED AT THEIR DISCRETION. 1 X X X X 0 1 0 0 0 0 0 1 0 TIMOTHY L CHARLES PRESIDENT & CEO 673822 0 221192 0 16758 0 54279 0 15272 0 981323 0 0 0 NICHOLAS HODGMAN MD MEMBER BOARD OF TRUSTEES 622792 0 281359 0 1080 0 0 0 21877 0 927108 0 0 0 NATHAN VANGENDEREN EXECUTIVE VP/CFO 372724 0 110576 0 7775 0 33269 0 22103 0 546447 0 0 0 TIMOTHY QUINN MD CHIEF OF CLINICAL OPERATIONS 486603 0 137337 0 8867 0 41345 0 23592 0 697744 0 0 0 MARY BROBST CHIEF NURSING OFFICER 257777 0 59748 0 10037 0 25244 0 21896 0 374702 0 0 0 JEFFREY CASH CHIEF INFORMATION OFFICER 250946 0 65545 0 9907 0 24537 0 24829 0 375764 0 0 0 NANCY HILL-DAVIS VP - HUMAN RESOURCES 220843 0 39332 0 6772 0 6642 0 17097 0 290686 0 0 0 AMANDEEP DHALIWAL MD PHYSICIAN 590492 0 279499 0 486 0 0 0 8389 0 878866 0 0 0 SHANE A GAILUSHAS MD PHYSICIAN 495661 0 196507 0 14455 0 0 0 21877 0 728500 0 0 0 RYAN D HOLLENBECK MD PHYSICIAN 573593 0 257586 0 486 0 0 0 30925 0 862590 0 0 0 CHONG C LEE MD PHYSICIAN 1319108 0 0 0 16526 0 0 0 27408 0 1363042 0 0 0 SHINY MATHEWKUTTY MD PHYSICIAN 538420 0 140065 0 20894 0 0 0 16176 0 715555 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2018: MARY BROBST - $18,369, JEFFERY CASH - $17,662, TIMOTHY L CHARLES - $47,404, TIMOTHY QUINN M.D. - $34,470, AND NATHAN VAN GENDEREN - $26,394. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY THE ORGANIZATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2018. PART I, LINE 7 BONUS PAYMENTS ARE MADE ANNUALLY BASED ON NUMEROUS CRITERIA SUCH AS THE ORGANIZATION'S CASH FLOW BUDGET, OPERATING MARGIN, QUALITY RESULTS, AS WELL AS PERSONAL METRICS AND GOALS. A CITY OF CEDAR RAPIDS IOWA 426004336 150543AA4 2003-04-10 30000000 REIMBURSE HOSPITAL FOR COSTS OF ACQUIRING AND CONSTRUCTING FACILITIES 0 0 0 B CITY OF CEDAR RAPIDS IOWA 426004336 150543AB2 2005-11-17 58405000 ADVANCE REFUND OF 1999 BONDS 0 0 0 C IOWA FINANCE AUTHORITY 521699886 4624466EQ 2012-12-13 45604359 REIMBURSE HOSPITAL FOR CAPITAL 0 0 0 A 5550000 30000000 1288620 28711380 2003 0 0 1 1 B 20430000 58405000 1552500 56852500 2005 0 1 1 1 C 6115000 45604359 604359 45000000 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 UBS AG 29.000000000000 0 0 0 0 1 B 0 0 0 1 1 1 UBS AG 24.000000000000 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF CEDAR RAPIDS, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2008 ISSUER NAME: CITY OF CEDAR RAPIDS, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 04/01/2009 MERCY CARE MANAGEMENT INC SEE BELOW IN PART V 1723730 MERCY CARE MANAGEMENT, INC. PAID MERCY MEDICAL CENTER RENT. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B TIMOTHY L. CHARLES IS AN OFFICER, AND KYLE SKOGMAN IS A MEMBER OF THE BOARD OF TRUSTEES OF MERCY MEDICAL CENTER AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, ALL THE AFOREMENTIONED INDIVIDUALS WERE OFFICERS OR MEMBERS OF THE BOARD OF DIRECTORS OF MERCY CARE MANAGEMENT, INC. X 1 5493 FAIR MARKET VALUE 0 0 0 PART I, COLUMN (B): MERCY MEDICAL CENTER IS REPORTING THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MERCY MEDICAL CENTER IS MERCYCARE SERVICE CORPORATION, AN IOWA NONPROFIT CORPORATION. THE SOLE MEMBER HAS THE EXCLUSIVE POWER TO APPOINT, AFTER CONSIDERATION OF ANY RECOMMENDATIONS FROM THE CORPORATION'S BOARD OF TRUSTEES, ANY TRUSTEE TO THE CORPORATION'S BOARD AND TO REMOVE ANY TRUSTEE FROM THE CORPORATION'S BOARD AT ANY TIME FOR ANY REASON. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF MERCY MEDICAL CENTER, MERCYCARE SERVICE CORPORATION HAS THE EXCLUSIVE POWER TO APPOINT, AFTER CONSIDERATION OF ANY RECOMMENDATIONS FROM THE CORPORATION'S BOARD OF TRUSTEES, ANY TRUSTEE TO THE CORPORATION'S BOARD AND TO REMOVE ANY TRUSTEE FROM THE CORPORATION'S BOARD AT ANY TIME FOR ANY REASON. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF MERCY MEDICAL CENTER, MERCYCARE SERVICE CORPORATION HAS THE POWER TO APPROVE THE FOLLOWING ACTIONS: 1. AMEND, REPEAL, OR RESTATE THE ARTICLES OF INCORPORATION; 2. ANY MATTER DIRECTLY RELATED TO THE RELIGIOUS PRINCIPLES AND MORAL PHILOSOPHY OF THE SISTERS OF MERCY; 3. ADOPT OR CHANGE THE PHILOSOPHY AND MISSION OF THE CORPORATION; 4. SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, AND MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER ENTITY; 5. DISSOLUTION OF THE CORPORATION; 6. ADOPTION OR AMENDMENT TO LONG-TERM STRATEGIC PLANS; 7. ADOPTION OR AMENDMENT TO ANNUAL CAPITAL OR OPERATING BUDGETS; AND 8. APPOINTMENT OR REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED WITH THE EXECUTIVE COMMITTEE (SUBCOMMITTEE OF THE BOARD OF TRUSTEES) PRIOR TO FILING THE FORM. THE COMMITTEE IS PROVIDED WITH GENERAL BACKGROUND INFORMATION REGARDING THE FORM 990, AND THE FORM ITSELF (INCLUDING ATTACHMENTS) IS REVIEWED. UPON REQUEST, THE TAX RETURN WILL BE AVAILABLE FOR REVIEW BY THE BOARD OF TRUSTEES. MEMBERS OF THE EXECUTIVE COMMITTEE AND MANAGEMENT ARE AVAILABLE TO ANSWER QUESTIONS FROM THE TRUSTEES ON THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES, AS WELL AS EACH EMPLOYEE TO DISCLOSE ANY INTEREST IN, OBLIGATION OR DUTY TO, OR ACTIVITY FOR ANY CONCERN IN WHICH A DIRECTOR, OFFICER, KEY EMPLOYEE, OR EMPLOYEE OR THEIR FAMILY MEMBER MAY BE INVOLVED THAT: MIGHT CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OR MIGHT HAVE THE APPEARANCE OF ADVERSELY AFFECTING THE DIRECTOR'S, OFFICER'S, KEY EMPLOYEE'S, OR EMPLOYEE'S JUDGMENT OR ACTIONS IN PERFORMING HIS/HER DUTIES TOWARDS MERCY. ALL DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES SHALL FILE AN INITIAL CONFLICT OF INTEREST REPORT UPON HIRE AND SHALL BE REQUIRED TO FILE AN UPDATED REPORT IMMEDIATELY IF ANY CHANGES OCCUR WHICH RESULT IN A CONFLICT OF INTEREST OR FINANCIAL INTEREST. ALL DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES (SUPERVISOR AND ABOVE), PHYSICIANS, AND ANY EMPLOYEE IN A POSITION TO INFLUENCE A PURCHASE DECISION SHALL RE-SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WITH ANY NECESSARY CHANGES, EACH YEAR AND IMMEDIATELY IF ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. ALL BOARD MEMBERS SHALL SUBMIT IN WRITING A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND CONFLICTING INTERESTS. THE STATEMENT SHALL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR AND AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT IS SET BY THE MERCYCARE SERVICE CORPORATION'S COMPENSATION COMMITTEE. THE COMMITTEE USES MERCER (US) INC. FOR THE REVIEW OF SALARIES AND COMPARES THEM TO COMPARABLE ENTITIES IN THE REGION. THIS PROCESS WAS LAST COMPLETED AND DOCUMENTED ON MARCH 29, 2018. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) -383,422. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -11,995,943. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -2,275,414. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY AND GIFT SHOP 28,352. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 819,492. CONTRIBUTION REVENUE NOT RECORDED FOR BOOKS -24,568. FORM 990, PART XI, LINE 2C THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. MERCYCARE ACCOUNTABLE CARE ORGANIZATION LLC 701 10TH STREET SE CEDAR RAPIDS IA 52403 833158753 ACCOUNTABLE CARE ORGANIZATION IA -542 111271 MERCY MEDICAL CENTER MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION INC 701 10TH STREET SE CEDAR RAPIDS IA 52403 510233180 FUNDRAISING FOR MERCY MEDICAL CENTER IA 501(C)(3) LINE 12B, TYPE II MERCY MEDICAL CENTER 1 MERCYCARE SERVICE CORPORATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 421199429 HEALTHCARE OVERSIGHT IA 501(C)(3) LINE 12B, TYPE II N/A 0 MR ASSOCIATES LLP 1455 SHERMAN ROAD HIAWATHA IA 52233 421260463 MEDICAL IMAGING IA MERCY MEDICAL CENTER RELATED 1469085 2368390 0 1 0.33330 UNIVERSITY OF IOWA AFFILIATED HEALTH PROVIDERS LC 200 HAWKINS DRIVE IOWA CITY IA 52242 421432272 ACCOUNTABLE CARE ORGANIZATION IA N/A EASTERN IOWA SLEEP CENTER 600 7TH STREET CEDAR RAPIDS IA 52401 260310416 SLEEP STUDIES IA RELATED 243207 1242329 0 1 0.33330 MERCY CARE MANAGEMENT INC PO BOX 786 CEDAR RAPIDS IA 52406 421198970 MEDICAL CLINICS IA N/A C 0 MERCY PHYSICIANS ASSOCIATES (SUB OF MERCY CARE MANAGEMENTINC) PO BOX 786 CEDAR RAPIDS IA 52406 421442443 MEDICAL SERVICES IA N/A C 0 MERCY PHYSICIAN SERVICES (SUB OF MERCY CARE MANAGEMENTINC) PO BOX 786 CEDAR RAPIDS IA 52406 421442442 SUPPORT SERVICES IA N/A C 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 MERCY CARE MANAGEMENT INC A 1723730 FAIR MARKET VALUE MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION A 1 FAIR MARKET VALUE MERCYCARE SERVICE CORPORATION B 5165000 FAIR MARKET VALUE MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION B 255108 FAIR MARKET VALUE MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION C 2187146 FAIR MARKET VALUE MERCYCARE SERVICE CORPORATION C 365244 FAIR MARKET VALUE MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION Q 722686 FAIR MARKET VALUE