2020-06-01T09:09:35-05:00 2019-06-30 990 2018-07-01 208072234 OAKLAND MERCY HOSPITAL OAKL 4026855601 601 EAST 2ND STREET OAKLAND NE 68045 JESICA HANSON VP FINANCE, MERCYONE SIOUXLAND 4026855601 2020-06-01 170.232.229.230 2020-06-01 09:09:27 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 403A83BCAAA913A93C4B950ECE6CC8F4A14CBF47 2018 2020-09-23 17:36:50Z MERCYONE OAKLAND MEDICAL CENTER BETH HUGHES 801 FIFTH STREET SIOUX CITY IA 51101 6755129 0 X WWW.MERCYONE.ORG/OAKLAND/ X 2006 NE TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 10 5 0 5 0 0 374341 77795 7111153 6650891 4991 8407 118975 11858 7609460 6748951 6165 4658 0 0 3841418 3664543 0 0 0 3756700 3287139 7604283 6956340 5177 -207389 4609752 3669347 785623 1364261 3824129 2305086 X WE, MERCY HEALTH SERVICES-IOWA AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.OAKLAND MERCY HOSPITAL IS A MEMBER OF MERCY HEALTH SERVICES-IOWA AND TRINITY HEALTH. 0 0 6453923 4658 6653389 OAKLAND MERCY HOSPITAL (MERCYONE OAKLAND) WAS FOUNDED IN 1950 TO PROVIDE QUALITY HEALTH CARE TO THE RESIDENTS OF THE BURT COUNTY AREA AND SURROUNDING COMMUNITIES THROUGH A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES. CORE SERVICES ARE AVAILABLE INCLUDING ACUTE CARE, OUTPATIENT SURGERY, 24-HOUR EMERGENCY SERVICES, REHABILITATION AND OCCUPATIONAL MEDICINE. MERCYONE OAKLAND HAS 18 ACUTE CARE BEDS AND ALSO OPERATES THREE AFFILIATED MEDICAL CLINICS IN OAKLAND, LYONS, AND TEKAMAH, NEBRASKA. ALL THREE CLINICS ARE OPERATED AS RURAL HEALTH CLINICS.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS, AND AWARDS: WWW.MERCYONE.ORG/OAKLAND/ 6453923 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 58 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JESSICA HUGHES FINANCE DIRECTOR MERCYONE SIOUXLAND 7122792157 801 5TH STREET SIOUX CITY IA 51101 JON HEIDEMAN DIRECTOR; CHAIR 1.00 0.00 X X 0 0 0 JAMES VLACH DIRECTOR; SECRETARY 1.00 0.00 X X 0 0 0 CALVIN ANDERSON DIRECTOR AS OF 2/19 1.00 0.00 X 0 0 0 TRACY BENJES DIRECTOR 1.00 0.00 X 0 0 0 LAURA GAMBLE DIRECTOR & DIRECTOR CAH THROUGH 5/19 45.00 0.00 X 0 71176 7635 RITA GOING DIR & DIRECTOR CAH AS OF 5/19; RN 45.00 0.00 X 0 68042 12597 MARY HENDRIKS DIR; DIR MISSION MERCYONE SIOUXLAND 1.00 44.00 X 0 126170 42775 TRACIE MARTIN MD DIRECTOR; OAKLAND CLINIC PHYSICIAN 50.00 0.00 X 0 234001 32610 DIANE PRIEKSAT DIR; VP PROF SVCS MERCYONE SIOUXLAND 1.00 49.00 X 0 187550 34250 ROB STOWE DIRECTOR;EXEC DIR MERCYONE SIOUXLAND 1.00 44.00 X 0 124536 33573 AMY TOBIN DIRECTOR 1.00 0.00 X 0 0 0 GEORGE VON MOCK DIR/FIN DIR MERCY SIOUXLAND THR 3/19 1.00 44.00 X 0 123331 35104 BETH HUGHES PRESIDENT MERCYONE SIOUXLAND 1.00 54.00 X 0 396356 66083 RODNEY SCHLADER CFO THR 1/19; PRES N. IA REGION 1/19 1.00 54.00 X 0 409042 57197 JESICA HANSON VP FIN MERCYONE SIOUXLAND AS OF 1/19 1.00 49.00 X 0 0 0 PRADEEPA VIMALACHANDRAN OAKLAND CLINIC PHYSICIAN 50.00 0.00 X 0 281252 19442 PETER THIELE OAKLAND CLINIC PA-C 50.00 0.00 X 0 152496 35514 JAYMA BROWN NURSING DIRECTOR 50.00 0.00 X 0 101241 17824 0 2275193 394604 0 0 1 0 BROWNS MEDICAL IMAGING LLC 14315 C CIRCLE OMAHA NE 68144 IMAGING SERVICES 429710 HEALTH CAROUSEL LLC 1700 MADISON RD CINCINNATI OH 45209 STAFFING SERVICES 347003 REHABVISIONS 11623 ARBOR ST OMAHA NE 68144 REHABILITATION SERVICES 171140 MEDICAL SOLUTIONS 1010 N 102ND ST SUITE 300 OMAHA NE 68114 STAFFING SERVICES 158056 4 963 30791 46041 77795 NET PATIENT SVC REV 622110 6650891 6650891 6650891 8407 8407 7583 6178 1405 1405 1405 CAFETERIA REVENUE 722514 7955 7955 OTHER RELATED REVENUE 622110 2498 2498 10453 6748951 6653389 0 17767 X 4658 4658 426061 266611 159450 2542805 2438276 104529 501062 469135 31927 194615 178019 16596 1028879 973882 54997 37267 34089 3178 77578 70962 6616 147945 135329 12616 131382 120178 11204 14071 12871 1200 12745 11658 1087 304334 278381 25953 207992 190255 17737 MEDICAL SUPPLIES 478529 478529 INTERCO. PURCHASED SVCS 466279 426516 39763 BAD DEBT 197632 197632 EQUIPMENT MAINTENANCE 151663 138730 12933 30843 28212 2631 6956340 6453923 502417 0 122255 54416 1633937 1078739 25000 32729 190991 160583 34376 24403 4102777 2841946 1485549 1260831 987026 993074 130618 64572 4609752 3669347 457965 1029216 44194 68005 283464 267040 785623 1364261 X 3795259 2278574 28870 26512 3824129 2305086 4609752 3669347 X -207389 1467 -1313121 X X 0 1 X 1 1 1 X 0 0 0 0 0 1 634 0 0 0 634 0 PART II-B, LINE 1: MERCYONE OAKLAND 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 THE HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS THAT ARE USED FOR LOBBYING ACTIVITIES. 50000 50000 1475424 959534 515890 2457095 1762154 694941 120258 120258 0 1260831 INTERCOMPANY ACCOUNTS PAYABLE 61622 ASSET RETIREMENT OBLIGATION (FIN 47) 205418 267040 1 1 X 1 X 1 X 1 1 1 0 1 1 1 395 274601 274601 0.04060 5 1348 427518 359514 68004 0.01010 6 1743 702119 359514 342605 0.05070 1 4423 4423 0.00070 1 433 433 0.00010 1 353 422 422 0.00010 3 353 5278 5278 0.00090 9 2096 707397 359514 347883 0.05160 1 197632 0 2993273 3157639 -164366 X 1 1 1 1 OAKLAND MERCY HOSPITAL 601 EAST 2ND STREET OAKLAND NE 68045 WWW.MERCYONE.ORG/OAKLAND/ 080001 X X X X SKILLED NURSING CARE OAKLAND MERCY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X 1 16 1 WWW.MERCYONE.ORG/OAKLAND/ABOUT-US/COMMUNITY-BENEFIT/ 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X X 1 X 0 X X X X 1 X 0 0 OAKLAND MERCY HOSPITAL PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E:OAKLAND MERCY HOSPITAL (MERCYONE OAKLAND) 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 SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. OBESITY2. ACCESS TO CARE3. CANCER PREVENTION4. STANDARD MOTOR VEHICLE SAFETY OAKLAND MERCY HOSPITAL PART V, SECTION B, LINE 5: MERCYONE OAKLAND CONTRACTED WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT AND IONIA RESEARCH TO CONDUCT THE MOST RECENT CHNA. INPUT FROM DIVERSE SECTORS INVOLVED IN PUBLIC HEALTH WAS OBTAINED THROUGH KEY INFORMANT INTERVIEWS FROM GROUPS SUCH AS ALLIED HEALTH PROFESSIONALS, BEHAVIORAL HEALTH EXECUTIVES, EMERGENCY RESPONSE PLANNERS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY COLLEGE ADMINISTRATORS, HEALTH EDUCATION DIRECTORS, COMMUNITY HEALTH CENTER EXECUTIVES, BUSINESS LEADERS AND SCHOOL ADMINISTRATORS. THE DATA WAS COLLECTED THROUGH COMMUNITY-LEVEL HEALTH SURVEYS ADMINISTERED ONLINE AND THROUGH THE MAIL IN FEBRUARY 2016. PATRONS WERE INVITED TO TAKE THE SURVEY BY MEANS OF SEVERAL ROUTES-INCLUDING PUBLIC PRESS RELEASES AND RADIO PUBLIC SERVICE ANNOUNCEMENTS, CHAMBER OF COMMERCE NEWSLETTERS, THROUGH EMPLOYERS, SENIOR CITIZEN CENTERS, SOCIAL MEDIA POSTS, AND FLYERS THAT WERE POSTED OR FLYERS THAT WERE DISTRIBUTED TO SCHOOL STUDENTS VIA MASS DISTRIBUTION EFFORTS. THOSE INTERESTED IN TAKING THE SURVEYS WERE ENCOURAGED TO DO SO ONLINE OR WERE INVITED TO REQUEST HARD-COPY SURVEYS. HARD-COPY SURVEYS WERE ALSO AVAILABLE IN SPANISH BY CALLING THE TOLL-FREE NUMBER LISTED. POSTAGE-PAID RETURN ENVELOPES WERE INCLUDED IN SURVEY MAILINGS. THE SECONDARY DATA SOURCES INCLUDED THE CDC, U.S. CENSUS BUREAU, HEALTHY COUNTIES DATABASE (ROBERT WOOD JOHNSON FOUNDATION), NEBRASKA VITAL RECORDS, NATIONAL CENTER FOR HEALTH STATISTICS, 2013 ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT COMMUNITY HEALTH ASSESSMENT, 2010-2014 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES, AND HEALTHY PEOPLE 2020. FOCUS GROUPS WERE THEN EMPLOYED IN APRIL 2016 TO FURTHER REFINE THE PROCESS. PARTICIPANTS IN THE FOCUS GROUPS WERE FROM A CROSS SECTION OF THE SERVICE AREA INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. PARTICIPANTS INCLUDED ELECTED OFFICIALS, HEALTH CARE PROFESSIONALS, DENTAL ADVOCATES, CITIZENS AT LARGE, BEHAVIORAL HEALTH, MENTAL HEALTH, SCHOOLS, CHURCHES, NOT-FOR-PROFIT AGENCIES, LAW ENFORCEMENT, TRIBAL REPRESENTATIVES, AND PREVENTION ORGANIZERS. OAKLAND MERCY HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL'S CHNA WAS CONDUCTED WITH ST. FRANCIS MEMORIAL HOSPITAL AND FAITH REGIONAL HEALTH SERVICES. OAKLAND MERCY HOSPITAL PART V, SECTION B, LINE 6B: COLLABORATING ORGANIZATIONS INCLUDED BAKER COUNSELING, BURT COUNTY COMMISSIONERS BOARD, DEPARTMENT OF HEALTH AND HUMAN SERVICES, DINKLAGE MEDICAL CLINIC, DISTRICT 7 PROBATION, FRANCISCAN CARE SERVICES, HOME INSTEAD SERVICE CARE, CUMING COUNTY JUVENILE DIVERSION, IONIA RESEARCH, LAND O'FROST, MADISON PUBLIC SCHOOLS, MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM, MT. OLIVE LUTHERAN CHURCH, NEBRASKA STATE SENATOR DISTRICT 16, NENCA, NORFOLK COMMUNITY HEALTH CARE CLINIC, NORFOLK POLICE DIVISION, NORFOLK PUBLIC SCHOOLS, NORTHEAST COMMUNITY COLLEGE, NORTHEAST NEBRASKA AREA AGENCY ON AGING, NORTHEAST NEBRASKA COMMUNITY ACTION PARTNERSHIP, OAKLAND HEIGHTS, OAKLAND-CRAIG SCHOOLS, PONCA TRIBE OF NEBRASKA, REGION 4, STANTON HEALTH CENTER, WEST POINT CHAMBER OF COMMERCE, WEST POINT LIVING CENTER, WEST POINT PUBLIC SCHOOLS, WISNER CARE CENTER, AND WOMEN'S EMPOWERING LIFELINE. OAKLAND MERCY HOSPITAL PART V, SECTION B, LINE 11: MERCYONE OAKLAND ADDRESSED ALL OF THE NEEDS IDENTIFIED IN THE CHNA DURING FISCAL YEAR 2019 IN THE FOLLOWING WAYS:IN THE AREA OF OBESITY: WE CONTINUED AN AGREEMENT WITH ANYTIME FITNESS, WHICH PROVIDES MONTHLY LUNCH AND LEARN MEETINGS EITHER AT THE HOSPITAL OR AT THEIR GYM. THE GYM OFFERS REDUCED MEMBERSHIP FEES FOR MERCYONE OAKLAND AND CLINICS COLLEAGUES. A FREE SWIM AEROBICS CLASS WAS OFFERED TO THE COMMUNITY IF SIGNED UP THROUGH THE HOSPITAL. DIABETES EDUCATION CLASSES WERE OFFERED TO PATIENT REFERRALS AS WELL AS OTHERS IN AREA COMMUNITIES. THE COURSE INCLUDED EDUCATION WITH A REGISTERED DIETICIAN, REGISTERED NURSE, AND THE ORGANIZATION'S NUTRITIONAL SERVICES MANAGER. A REGISTERED NURSE ON STAFF CONTINUED TO VOLUNTEER HER TIME TO WRITE ARTICLES FOR OUR LOCAL NEWSPAPERS THAT INCLUDE EDUCATIONAL INFORMATION AND INFORMATION ABOUT UPCOMING HEALTH AND WELLNESS EVENTS. OUR HEALTH PROVIDERS IN THE CLINIC REVIEW PATIENTS' HISTORIES, THEN COACH AND COUNSEL THEM ON HEALTH RISKS (RISKY BEHAVIOR, OBESITY, AND PREVENTION) AND DIRECT THEM TOWARD PROPER TREATMENT. CALCULATION OF BODY MASS INDEX IS ALSO DONE DURING VISITS. MERCYONE OAKLAND CONTINUED OFFERING RED BRICK, AN EMPLOYER-SPONSORED WELLNESS PROGRAM TO ENCOURAGE AND TRACK PHYSICAL ACTIVITY AND DIET.IN THE AREA OF ACCESS TO CARE: A NEW PROVIDER WAS RECENTLY ADDED, INCREASING ACCESS TO CARE FOR THE COMMUNITY. CHANGES IN CLINIC HOURS WERE ALSO RECENTLY MADE TO IMPROVE ACCESS. SOME OF OUR PROVIDERS HAVE EXTENDED THEIR HOURS TO BE AVAILABLE LATE IN THE AFTERNOON/EARLY EVENING. MERCYONE OAKLAND AGAIN HELD A FLU VACCINE CLINIC AT THE SENIOR CITIZEN CENTER. FLU VACCINATIONS WERE ALSO AVAILABLE WITH NO APPOINTMENT NECESSARY AT THE MERCYONE OAKLAND CLINIC. WE CONTINUE TO HAVE A 24/7 EMERGENCY ROOM STAFFED BY OUR PROVIDERS. WE ALSO HAVE ACCESS TO E-EMERGENCY THAT ENHANCES THE CARE GIVEN BY OUR PROVIDERS IN THE EMERGENCY ROOM. MERCYONE OAKLAND EDUCATES MEDICARE RECIPIENTS ABOUT AVAILABLE SUPPLEMENTAL COVERAGE OPTIONS. CANCER PREVENTION AND SCREENING: MERCYONE OAKLAND CONTINUED AS A CORPORATE SPONSOR FOR THE RELAY FOR LIFE TEAM, CODE PURPLE. OUR COLLEAGUES HELPED WITH FUNDRAISERS AND THE RELAY FOR LIFE EVENT. MERCYONE OAKLAND CLINICS CONTINUED A MAMMOGRAPHY AWARENESS PROJECT. EACH MONTH THE CLINIC RUNS A LIST OF PATIENTS WHO HAD ORDERS FOR A MAMMOGRAM. THE NAMES ARE CROSS-CHECKED TO MAKE SURE THOSE PATIENTS RECEIVE OR SCHEDULE THEIR MAMMOGRAM. MERCYONE OAKLAND OFFERED COMMUNITY EDUCATION ON SELF-BREAST EXAMS AND MAMMOGRAM SCREENINGS. MOTOR VEHICLE SAFETY: MERCYONE OAKLAND AGAIN SPONSORED A BOOTH IN THE BURT COUNTY 4-H YOUTH EDUCATION CENTER DURING THE BURT COUNTY FAIR. EDUCATION WAS PROVIDED ON THE EFFECTS OF DRIVING WHILE UNDER THE INFLUENCE USING SPECIAL GOGGLES THAT PROVIDED VIRTUAL INTERACTION. CAR SEAT SAFETY CHECKS WERE ALSO OFFERED TO THE COMMUNITY. OAKLAND MERCY HOSPITAL 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. OAKLAND MERCY HOSPITAL PART V, SECTION B, LINE 16J: THE HOSPITAL SENT PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY TO THE SIOUXLAND COMMUNITY HEALTH CENTER. OAKLAND MERCY HOSPITAL - PART V, SECTION B, LINE 7A: WWW.MERCYONE.ORG/OAKLAND/ABOUT-US/COMMUNITY-BENEFIT/ OAKLAND MERCY HOSPITAL - PART V, SECTION B, LINE 16A: WWW.MERCYONE.ORG/OAKLAND/FOR-PATIENTS/ OAKLAND MERCY HOSPITAL - PART V, SECTION B, LINE 16B: WWW.MERCYONE.ORG/OAKLAND/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE OAKLAND MERCY HOSPITAL - PART V, SECTION B, LINE 16C: WWW.MERCYONE.ORG/OAKLAND/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE 3 1 - OAKLAND MERCY MEDICAL CLINIC 211 N ENGDAHL AVE OAKLAND NE 68045 OUTPATIENT CLINIC 2 - LYONS MERCY MEDICAL CLINIC 200 MAIN STREET LYONS NE 68038 OUTPATIENT CLINIC 3 - TEKAMAH MERCY MEDICAL CLINIC 1121 S 13TH STREET TEKAMAH NE 68061 OUTPATIENT CLINIC 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: OAKLAND MERCY HOSPITAL (MERCYONE OAKLAND) 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 OAKLAND INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE: (WWW.TRINITY-HEALTH.ORG/MERCYONE-SIOUX-CITY-IA). 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, $197,632, 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 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 OAKLAND 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 OAKLAND IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, MERCYONE OAKLAND 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 OAKLAND 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 OAKLAND 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 OAKLAND 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 AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED. MERCYONE OAKLAND ALSO WORKS COLLABORATIVELY WITH OTHER AGENCIES AND, IN PARTICULAR, THE ELKHORN LOGAN VALLEY HEALTH DEPARTMENT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCYONE OAKLAND 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 OAKLAND 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 OAKLAND HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. MERCYONE OAKLAND 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 OAKLAND'S PRIMARY SERVICE AREA IS BURT COUNTY AND THE SURROUNDING COUNTIES IN NORTHEAST NEBRASKA. THE PRIMARY HOSPITAL IS LOCATED IN OAKLAND, NEBRASKA AND OPERATES THREE RURAL HEALTH CLINICS IN OAKLAND, LYONS AND TEKAMAH. MERCYONE OAKLAND IS AN OWNED FACILITY OF MERCYONE SIOUXLAND MEDICAL CENTER AND PART OF THE MERCYONE NETWORK, WHICH ALSO MANAGES THE PENDER COMMUNITY HOSPITAL IN THURSTON COUNTY. MERCYONE OAKLAND'S SERVICE AREA IS CONSIDERED RURAL. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $46,988. THE PER CAPITA INCOME FOR THE COUNTY WAS $28,841. ABOUT 6.20% OF FAMILIES AND 9.70% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 7.70% OF THOSE UNDER AGE 18 AND 6.20% OF THOSE AGES 65 OR OVER. PART VI, LINE 5: OTHER INFORMATION - MERCYONE OAKLAND HAS EMPLOYEES WHO ARE ENGAGED IN OUR COMMUNITY. WE HAVE INDIVIDUALS WHO SERVE ON COMMITTEES IN OUR SCHOOL, NURSING HOMES, PUBLIC HEALTH DEPARTMENT AND REGIONAL MEDICAL RESPONSE SYSTEM. OUR BOARD IS DIVERSE AND INCLUDES A MEMBER OF THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT. PART VI, LINE 6: MERCYONE OAKLAND 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 1 0 0 0 0 0 0 0 MARY HENDRIKS DIR; DIR MISSION MERCYONE SIOUXLAND 0 125731 0 0 0 439 0 8157 0 34618 0 168945 0 0 TRACIE MARTIN MD DIRECTOR; OAKLAND CLINIC PHYSICIAN 0 233738 0 0 0 263 0 10175 0 22435 0 266611 0 0 DIANE PRIEKSAT DIR; VP PROF SVCS MERCYONE SIOUXLAND 0 174721 0 8891 0 3938 0 14096 0 20154 0 221800 0 0 ROB STOWE DIRECTOR;EXEC DIR MERCYONE SIOUXLAND 0 124304 0 0 0 232 0 6028 0 27545 0 158109 0 0 GEORGE VON MOCK DIR/FIN DIR MERCY SIOUXLAND THR 3/19 0 123094 0 0 0 237 0 5396 0 29708 0 158435 0 0 BETH HUGHES PRESIDENT MERCYONE SIOUXLAND 0 279798 0 25000 0 91558 0 51030 0 15053 0 462439 0 0 RODNEY SCHLADER CFO THR 1/19; PRES N. IA REGION 1/19 0 375559 0 28921 0 4562 0 20625 0 36572 0 466239 0 0 PRADEEPA VIMALACHANDRAN OAKLAND CLINIC PHYSICIAN 0 251117 0 30000 0 135 0 9420 0 10022 0 300694 0 0 PETER THIELE OAKLAND CLINIC PA-C 0 152300 0 0 0 196 0 9581 0 25933 0 188010 0 0 PART I, LINE 3 OAKLAND MERCY HOSPITAL (MERCYONE OAKLAND) IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MERCYONE OAKLAND'S CEO IS PAID DIRECTLY BY TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MERCYONE OAKLAND'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, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT IN CALENDAR 2018. THIS AMOUNT IS INCLUDED IN PART VII, SECTION A, COLUMN (E): JAYMA BROWN - $37,152 THE FOLLOWING IS A PARTICIPANT 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 ACCRUAL FOR 2018 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: BETH HUGHES - $39,583 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF OAKLAND MERCY HOSPITAL (MERCYONE OAKLAND) IS MERCY HEALTH SERVICES-IOWA (MHS-IA). SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A MHS-IA IS THE SOLE MEMBER OF MERCYONE OAKLAND. MHS-IA HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MERCYONE OAKLAND. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, MHS-IA MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. MHS-IA MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS AND MODIFICATIONS TO GOVERNING DOCUMENTS. 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 OAKLAND 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 OAKLAND 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 OAKLAND, 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 OAKLAND 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 OAKLAND (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCYONE OAKLAND 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 OAKLAND (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 OAKLAND. 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 OAKLAND IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO 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 CFO OF MERCYONE OAKLAND 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 OAKLAND 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 OAKLAND INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. (WWW.TRINITY-HEALTH.ORG/MERCYONE-SIOUX-CITY-IA). MERCYONE OAKLAND'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 9,875. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,875. MISC. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 58,651. MANAGEMENT AND GENERAL EXPENSES 5,468. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,119. RECRUITMENT: PROGRAM SERVICE EXPENSES 3,636. MANAGEMENT AND GENERAL EXPENSES 339. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,975. LAUNDRY/LINEN SERVICES: PROGRAM SERVICE EXPENSES 9,652. MANAGEMENT AND GENERAL EXPENSES 900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,552. CONSULTING FEES: PROGRAM SERVICE EXPENSES 4,068. MANAGEMENT AND GENERAL EXPENSES 379. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,447. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 374,091. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 374,091. BILLING SERVICES: PROGRAM SERVICE EXPENSES 10,821. MANAGEMENT AND GENERAL EXPENSES 1,009. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,830. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 503,088. MANAGEMENT AND GENERAL EXPENSES 46,902. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 549,990. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO/FROM AFFILIATES -1,313,121. FORM 990, PART XII, LINE 2: MERCYONE OAKLAND'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY19 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 114 WOODLAND STREET HARTFORD CT 06105 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA STREET COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 CARING PARTNERS HOME HEALTH INC 1200 EARHART RD ANN ARBOR MI 48105 201681131 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 GLACIER HILLS INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A 0 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION 250 MERCY DRIVE DUBUQUE IA 52001 262227941 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIANS SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232515999 HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMBRACING AGE INC 333 BUTTERNUT DRIVE DEWITT NY 13214 461051881 PACE PROGRAM NY 501(C)(3) LINE 12B, II ST JOSEPH'S HEALTH INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 HOME AIDE SERVICE OF EASTERN NEW YORK INC 1 FARREN CARE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL INC 1 GLACIER HILLS FOUNDATION 1200 EARHART RD ANN ARBOR MI 48105 208072723 FOUNDATION MI 501(C)(3) LINE 12A, I GLACIER HILLS INC 1 GLACIER HILLS INC 1200 EARHART RD ANN ARBOR MI 48105 381891500 SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 GLEN EDDY INC 1 GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTH CARE SERVICES MI 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 ST MARY'S HEALTH CARE SYSTEM INC 1 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 GOTTLIEB MEMORIAL FOUNDATION 701 WEST NORTH AVENUE MELROSE PARK IL 60160 743260011 FOUNDATION IL 501(C)(3) LINE 12C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 HACKLEY LIFE COUNSELING 125 E SOUTHERN AVENUE MUSKEGON MI 49442 381386362 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MERCY HEALTH PARTNERS 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HEART CENTER OF GREATER WATERBURY INC 114 WOODLAND STREET HARTFORD CT 06105 830416893 MANAGEMENT CT 501(C)(3) LINE 12A, I N/A 0 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY NY 12180 141725101 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HOLY CROSS CARENET INC PO BOX 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