2019-05-03T13:26:13-05:00 2018-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2017-07-01 391902797 MANNING REGIONAL HEALTHCARE CENTER MANN 7126552072 1550 6TH STREET MANNING IA 51455 AMY MCLAUGHLIN CFO 7126552072 2019-05-02 1 WENDY R COOLEY P01523804 4023302660 209.34.201.180 2019-05-02 15:53:36 CD P A532DB5264189C1BF118C5B3DB29FD281B4BE385 5D066E2939FE45487034BD10C4A0DC94BE27FEF9 2017 2019-02-21 02:37:17Z AMY MCLAUGHLIN 1550 6TH STREET MANNING IA 51455 16849575 0 X WWW.MRHCIA.COM X 1997 IA MANNING REGIONAL HEALTHCARE CENTER (MRHC) IS A LICENSED CRITICAL ACCESS HOSPITAL THAT PROVIDES THE FOLLOWING HEALTHCARE SERVICES FOR THE MANNING, IA AND SURROUNDING COMMUNITIES: ACUTE AND SKILLED CARE, EMERGENCY CARE, OUTPATIENT SPECIALTY CLINICS, NURSING HOME CARE, SURGERY, ANCILLARY SERVICES (I.E. - LABORATORY AND RADIOLOGY), FAMILY PRACTICE PHYSICIAN SERVICES AND SUBSTANCE ABUSE TREATMENT. MRHC HAS 17 LICENSED SWING-BEDS USED FOR ACUTE AND SKILLED CARE, 16 LICENSED, PARTIAL-RESIDENTIAL, SUBSTANCE ABUSE TREATMENT BEDS (UNDER THE MANNING FAMILY RECOVERY CENTER - A DISTINCT PART UNIT) AND 46 LICENSED LONG-TERM CARE BEDS (UNDER THE MANNING PLAZA). ALL THE MRHC ACTIVITIES ARE PROVIDED BY LICENSED PROFESSIONALS AS REQUIRED BY THE REGULATIONS GOVERNING A HOSPITAL AND NURSING HOME. 6 6 258 60 3602 2342 139182 143163 17830573 16401699 99641 225824 84177 78889 18153573 16849575 11911 10498 0 0 8877954 9305392 0 0 399 9040080 9364033 17929945 18679923 223628 -1830348 31367494 29563016 21469636 21520499 9897858 8042517 X MANNING REGIONAL HEALTHCARE CENTER (MRHC) WILL PROVIDE A COMPASSIONATE, HOLISTIC HEALTH CARE EXPERIENCE THE COMMUNITY CAN TRUST. 0 0 12373740 10818172 THE MANNING REGIONAL HEALTH CARE CENTER IS A 17-BED FACILITY FEDERALLY DESIGNATED AS A CRITICAL ACCESS HOSPITAL. HOSPITAL SERVICES INCLUDE ACUTE AND SKILLED CARE, EMERGENCY CARE, OUTPATIENT SPECIALTY CLINICS, SURGERY, AND ANCILLARY (I.E. - LABORATORY AND RADIOLOGY) SERVICES. 2999785 2222128 THE MANNING PLAZA (THE PLAZA) PROVIDES INTERMEDIATE CARE TO THE ELDERLY. THE PLAZA IS A 46-BED LONG-TERM CARE FACILITY OFFERING 24-HOUR NURSING CARE AND SPECIALIZED DIETARY SERVICE. IT ALSO OFFERS RECREATIONAL PROGRAMS, REHABILITATIVE SERVICES AND SOCIAL SERVICES. 1147488 3122854 THE MANNING FAMILY RECOVERY CENTER (MFRC) PROVIDES SAFE, EFFICIENT, AND EFFECTIVE CHEMICAL DEPENDENCY TREATMENT TO CHEMICALLY DEPENDENT INDIVIDUALS AND THEIR FAMILIES ACROSS IOWA AND NEBRASKA. SERVICES INCLUDE DETOX AND OUTPATIENT CHEMICAL DEPENDENT TREATMENT, CO-DEPENDENCY TREATMENT, AFTERCARE, OUTREACH SERVICES, EMPLOYEE ASSISTANCE PROGRAMMING, AND OWI EVALUATION/EDUCATION. THE MFRC IS A 16-BED CO-ED MULTI-LEVEL TREATMENT CENTER. 235153 10498 238545 OTHER MISCELLANEOUS SERVICES 235153 10498 238545 16756166 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 0 0 1 57 0 1 258 1 1 1 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X AMY MCLAUGHLIN CFO 7126558123 1550 6TH STREET MANNING IA 51455 BRET RICHARDS PRESIDENT 1.50 X X 0 0 0 SHARON KELDERMAN VICE PRESIDENT (THRU 12/17) 0.50 X X 0 0 0 VIRGINIA RASMUSSEN TREASURER/SECRETARY 0.50 X X 0 0 0 CHRIS BEHRENS DIRECTOR 0.50 X 0 0 0 LARRY HAGEDORN DIRECTOR 0.50 X 0 0 0 RUTH OHDE DIRECTOR (THRU 10/17) 0.50 X 0 0 0 JEAN VOEGE DIRECTOR 0.50 X 0 0 0 JACOB RANNIGER DIRECTOR 0.50 X 0 0 0 JOHN O'BRIEN CEO 40.00 X 189021 0 11544 AMY MCLAUGHLIN CFO 40.00 X 86648 0 5136 ISABELLA AHANOGBE PHYSICIAN 40.00 X 359439 0 6699 DR DOUGLAS MCLAWS PHYSICIAN 40.00 X 279482 0 28713 KIM JAHN CIO 40.00 X 101938 0 8034 1016528 0 60126 4 0 1 1 MERCY HEALTH NETWORK DEPT CH14370 PALANTINE IL 60055 OFFICER COMPENSATION 502249 PSYCHIATRIC MEDICAL CARE LLC PO BOX 305172 DEPT141 NASHVILLE TN 372305172 PSYCHIATRIC SERVICES 243957 EMERGENCY PRACTICE ASSOC PO BOX 1260 WATERLOO IA 50704 ER COVERAGE 240924 GRAPETREE MEDICAL STAFFING 1003 23RD ST MILFORD IA 51351 CONTRACT NURSING STAFF 202748 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 685012674 CONTRACT NURSING STAFF 197914 9 143163 143163 PATIENT CARE, ACUTE & CLINIC, M'C 624100 8520853 8520853 PATIENT CARE, ACUTE & CLINIC, INS 624100 6390985 6390985 LONG TERM CARE 623000 951278 951278 340B PROGRAM 624100 442012 442012 IMMUNIZATION CLINIC REVENUE 624100 3640 3640 92931 92931 16401699 156637 156637 69187 0 69187 69187 69187 CAFETERIA REVENUE 900099 75287 75287 POET BIOREFINING INCOME 900099 3602 3602 78889 16849575 16401699 3602 301111 X 10498 10498 292349 292349 7341945 6742540 599405 116627 105686 10941 1044421 1037106 7315 510050 467881 42169 66390 66390 20475 20475 83475 83475 2297953 2071018 226935 156441 68889 87463 89 1013332 837227 175969 136 123398 29437 93961 381640 381640 43493 34923 8502 68 673284 673284 1683912 1683912 99741 87909 11832 FEDERAL INC TAX - UBIT 1611 1611 MEDICAL SUPPLIES 1663611 1663611 BAD DEBT EXPENSE 412850 412850 DIETARY/FOOD & SUPPLIES 303293 303293 339134 144462 194566 106 18679923 16756166 1923358 399 217 169 9384976 8367650 1763338 1995994 284174 266312 107133 129346 29906756 11359189 19595943 18547567 69976 0 161737 255978 31367494 29563016 1062088 1082065 66185 28992 19703869 19370671 637494 1038771 21469636 21520499 X 9852495 7954616 45363 87901 9897858 8042517 31367494 29563016 -1830348 -24993 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4494 4494 0 PART II-B, LINE 1: MANNING REGIONAL HEALTHCARE CENTER (MRHC) PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA), IOWA HEALTH CARE ASSOCIATION (IHCA), AMERICAN HEALTH CARE ASSOCIATION (AHCA), AMERICAN HOSPITAL ASSOCIATION (AHA), LEADINGAGE (LA) AND LEADINGAGE IOWA (LAI). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. IN FISCAL YEAR 2018, MRHC PAID DUES OF $8,907, $3,378, $1,102, $6,607, $537 AND $903 OF WHICH 24%, 15%, 25%, 23%, 4% AND 8% REPECTIVELY, WERE ESTIMATED TO BE NON-DEDUCTIBLE EXPENSES (BY THE ASSOCIATIONS) FOR LOBBYING ACTIVITIES. 397528 397528 21690893 6676270 15014623 6252887 4187561 2065326 1565448 495358 1070090 18547567 CAPITAL LEASE OBLIGATIONS 57211 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 981560 1038771 X 16411732 -24993 -24993 16436725 412850 412850 16849575 18267073 0 18267073 412850 412850 18679923 PART X, LINE 2: THE HEALTHCARE CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HEALTHCARE CENTER HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HEALTHCARE CENTER TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HEALTHCARE CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTHCARE CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2018 AND 2017, THE HEALTHCARE CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 412,850. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 412,850. 1 1 1 X 1 X 1 1 1 0 1 1 101 115428 115428 0.00630 3401943 1338464 2063479 0.11300 101 3517371 1338464 2178907 0.11930 268 13800 1275 12525 0.00070 304 7110 600 6510 0.00040 9027 9027 0.00050 572 29937 1875 28062 0.00160 673 3547308 1340339 2206969 0.12090 1 412850 0 6268871 6411661 -142790 X 1 1 1 1 MANNING REGIONAL HEALTHCARE CENTER 1550 6TH STREET MANNING IA 51455 WWW.MRHCIA.COM 140058H X X X X OUTPATIENT PHYSICIAN CLINIC, SKILLED NURSING FACILITY, CHEM DEP REHAB CENTER MANNING REGIONAL HEALTHCARE CENTER 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.MRHCIA.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 15 1 WWW.MRHCIA.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 200.000000000000 300.000000000000 X X X X X X X 1 1 X X X 1 X WWW.MRHCIA.COM/FINANCIAL-INFORMATION X WWW.MRHCIA.COM/FINANCIAL-INFORMATION X WWW.MRHCIA.COM/FINANCIAL-INFORMATION X X X X X X 1 X 0 X X X X X 1 X 0 0 MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 5: THE HEALTHCARE CENTER INVITED COMMUNITY MEMBERS TO TOWN HALL MEETINGS REGARDING THE CHNA AND FROM THERE CONDUCTED SURVEYS TO REACH THE MAJORITY OF THE POPULATION. THE FOLLOWING LIST OUTLINES PARTNERS INVITED TO TOWN HALL: LOCAL HOSPITAL, PUBLIC HEALTH COMMUNITY, MENTAL HEALTH COMMUNITY, FREE CLINICS, COMMUNITY-BASED CLINICS, SERVICE PROVIDERS, LOCAL RESIDENTS, COMMUNITY LEADERS, OPINION LEADERS, SCHOOL LEADERS, BUSINESS LEADERS, LOCAL GOVERNMENT, FAITH-BASED ORGANIZATIONS AND PERSONS (OR ORGANIZATIONS SERVING THEM), PEOPLE WITH CHRONIC CONDITIONS, UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS. THE HEALTHCARE CENTER ALSO COLLABORATED WITH MEMBERS OF VARIOUS HEALTH IMPROVEMENT PLAN COMMITTEES FROM CARROLL COUNTY PUBLIC HEALTH. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 11: A COMMITTEE WAS FORMED FOR EACH NEED THAT AROSE FROM THE ASSESSMENT. COMMITTEES SET GOALS AND TIMELINES TO IMPROVE UPON THOSE NEEDS AND MEET ON A REGULAR BASIS TO WORK TOWARDS MEETING THOSE GOALS. THERE ARE NO SIGNIFICANT NEEDS THAT AREN'T BEING ADDRESSED. SOME INSIGNIFICANT "NEEDS" ARE NOT BEING ADDRESSED. FOR EXAMPLE, IF ONE PERSON COMMENTED EXPRESSING A WANT/NEED, BUT NO ONE ELSE IN THE SURVEY MENTIONED THIS SAME NEED, THE COMMENT WAS DETERMINED TOO INSIGNIFICANT TO BE ADDRESSED IN THIS YEAR'S ACTION PLAN. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 13B: PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF THE FEDERAL POVERY GUIDELINES MAY BE ELIGIBLE FOR DISCOUNTED CARE ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE. THIS DETERMINATION IS AT THE DISCRETION OF MANNING REGIONAL HEALTH CARE; HOWEVER THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO COMMERCIALLY INSURED, MEDICAID, OR MEDICARE, PATIENTS. SUCH FINANCIAL ASSISTANCE SHALL BE REVIEWED AND APPROVED BY THE CFO. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 13H: IN EVALUATING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, FAMILY SIZE IS A FACTOR TAKEN INTO ACCOUNT IN ADDITION TO INCOME LEVEL, INSURANCE STATUS, ETC. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS ALSO MADE PUBLICLY AVAILABLE BY MANNING REGIONAL HEALTHCARE CENTER'S DESIGNATION OF DEPARTMENTS OR INDIVIDUALS WHO CAN EXPLAIN THE FINANCIAL ASSISTANCE AND PAYMENT PROGRAMS, AND BY INSTRUCTING STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING ANY FINANCIAL ASSISTANCE OR PAYMENT PROGRAM TO THE PROPER RESPRESENTATIVE. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 20E: MANNING REGIONAL HEALTHCARE CENTER CONTRACTS WITH A THIRD PARTY ORGANIZATION (MED-PLAN SERVICES, LTD AND TRI-STATE ADJUSTMENTS, INC.(TSA)), AS AN EARLY OUT COLLECTION VENDOR. PART OF THE PROCESS MED-PLAN AND TSA PERFORMS ON BEHALF OF MRHC IS TO CALL PATIENTS, INFORM THEM OF THE OPTION OF FINANCIAL ASSISTANCE, AND SEND PATIENTS THE APPLICATION SHOULD THEY BE QUALIFIED OR IF THEY REQUEST IT. MED-PLAN AND TSA DOCUMENT THE PATIENT COMMUNICATIONS WITHIN OUR PATIENT MANAGEMENT SYSTEM. PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: MANNING REGIONAL HEALTHCARE CENTER'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: THE PATIENT CARE COST TO CHARGE RATIO WAS USED TO DETERMINE CHARITY CARE AT COST. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST AS DERIVED FROM MANNING REGIONAL HEALTHCARE CENTER'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: THERE ARE NO SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 412,850. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION CURRENTLY DOES NOT ENGAGE IN COMMUNITY BUILDING ACTIVITIES. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTHCARE CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTHCARE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTHCARE CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: NO AMOUNT OF BAD DEBT IS INCLUDED AS COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, AND 9 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE AND "FINANCIAL ASSISTANCE/CHARITY CARE". PART III, LINE 8: "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT, D, E, H AND M WORKSHEETS, OR PS&R. NONE OF THE SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: PART 1 OF THE PATIENT FINANCIAL ASSISTANCE POLICY "GUIDELINES" SECTION PROVIDES THAT ONCE THE RESPONSIBLE PARTY HAS BEEN DETERMINED TO BE ELIGIBLE FOR PATIENT FINANCIAL ASSISTANCE, A BILL WILL NOT BE SENT TO THE RESPONSIBLE PARTY. PART VI, LINE 2: MANNING REGIONAL HEALTH CENTER INCLUDES INPUT AND INFORMATION FROM REPRESENTATIVES OF THE MEDICAL STAFF, BOARD COMMITTEE, AND HOSPITAL ADMINISTRATIVE STAFF TO REVIEW THE TREATMENT OF PATIENTS TO DETERMINE MEDICAL NECESSITY AND OTHER CRITERIA ARE MET IN ORDER TO PROMOTE MAXIMUM TREATMENT BENEFITS. THIS GROUP OVERSEES THE QUALITY OF PATIENT CARE, ASSURING RESOURCES ARE USED APPROPRIATELY TO PROMOTE OPTIMAL PATIENT CARE. PART VI, LINE 3: PATIENTS ARE MADE AWARE THROUGH A FINANCIAL ASSISTANCE INFORMATION PACKET, USUALLY OBTAINED AT ADMISSION. THOSE WITHOUT INSURANCE ARE PROVIDED THE INFORMATION PACKET AT ADMISSION, AND THE PACKET IS PROVIDED AS PART OF THE DISCHARGE PROCESS FOR ER SERVICES. ADDITIONALLY, MANNING REGIONAL HEALTH CARE CENTER HAS CONTRACTED WITH A THIRD-PARTY VENDOR FOR BILLINGS AND COLLECTIONS. THE VENDOR CONTACTS FORMER PATIENTS BY TELEPHONE DURING THE 2ND 30 DAYS THAT AN INVOICE IS PAST DUE. PATIENTS ARE SCREENED FOR FINANCIAL ASSISTANCE NEEDS WITH THAT TELEPHONE CALL.THE FINANCIAL ASSISTANCE INFORMATION PACKET, INCLUDING THE APPLICATION, ARE ALSO AVAILABLE ON THE HEALTH CENTER'S WEBSITE. PART VI, LINE 4: THE COMMUNITY INCLUDES THE CITIES OF MANNING (POPULATION 1500), TEMPLETON (POPULATION 350), AND MANILLA (POPULATION 900) ALONG WITH OTHER SURROUNDING RURAL COMMUNITIES IN WEST CENTRAL IOWA. MANNING, IOWA IS 90 MILES NORTHWEST OF DES MOINES, IOWA, 80 MILES NORTHEAST OF OMAHA, NEBRASKA AND 80 MILES SOUTHEAST OF SIOUX CITY, IOWA. PART VI, LINE 5: MANNING GENERAL HOSPITAL PROVIDES OUTPATIENT CLINICS IN WHICH SPECIALTY DOCTORS COME TO MANNING ON A REGULAR BASIS. THE HOSPITAL ALSO SPONSORS FREE EDUCATIONAL SEMINARS ON VARIOUS HEALTH TOPICS TO THE COMMUNITY. THE MANNING FAMILY RECOVERY CENTER PROVIDES ALCOHOLICS ANONYMOUS, AL-ANON, AND NARCOTICS ANONYMOUS MEETINGS. THE CENTER ALSO PROVIDES A FREE, OPEN TO THE PUBLIC, EDUCATION PROGRAM THAT EXPLORES CHEMICAL DEPENDENCY AND ITS EFFECTS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES IA 0 0 0 0 0 0 0 0 0 JOHN O'BRIEN CEO 186650 0 0 0 2371 0 0 0 11544 0 200565 0 0 0 ISABELLA AHANOGBE PHYSICIAN 359439 0 0 0 0 0 0 0 6699 0 366138 0 0 0 DR DOUGLAS MCLAWS PHYSICIAN 279482 0 0 0 0 0 7174 0 21539 0 308195 0 0 0 FORM 990, PART VII, SECTION A, LINE 5: THE COMPENSATION FOR JOHN O'BRIEN, CEO, AND AMY MCLAUGHLIN, CFO, WAS PAID BY MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, AN UNRELATED ORGANIZATION. MR. O'BRIEN RECEIVED COMPENSATION AND BENEFITS OF $200,565 FOR 2017. MS. MCLAUGHLIN RECEIVED COMPENSATION AND BENEFITS OF $91,784 DURING 2017. FORM 990, PART VI, SECTION A, LINE 3 MANAGED CONTRACT AFFILIATION AGREEMENT WITH MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, IOWA - THE ADMINISTRATOR OF MANNING REGIONAL HEALTHCARE CENTER (MRHC) IS AN EMPLOYEE OF MERCY BUT REPORTS TO THE MRHC BOARD OF DIRECTORS. THE CFO IS ALSO AN EMPLOYEE OF MERCY AND REPORTS TO THE CEO. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCIAL STATEMENT PREPARATION AND RECORDING PROCESSES OF MRHC ARE THE PRIMARY RESPONSIBILITIES OF THE CFO. UPON RECEIVING THE FORM 990 ORGANIZER DURING THE AUDIT BY SEIM JOHNSON, LLP, THE CFO BEGINS TO PREPARE DOCUMENTATION FOR THE FORM 990. UPON THE SUBMISSION OF THE FORM 990 ORGANIZER TO THE PREPARER, SEIM JOHNSON, LLP, ANY QUESTIONS ARE CLARIFIED AND ANSWERED. PRIMARY REVIEWING RESPONSIBILITY OF THE FORM 990 LIES WITH THE CFO AND CEO. IT IS ALWAYS THE INTENT TO HAVE THE FORM 990 PREPARED AND REVIEWED PRIOR TO THE INITIAL FILING DEADLINE, BUT IF FOR ANY REASON THIS CANNOT BE ACHIEVED, REQUESTS TO EXTEND THE FILING DEADLINE ARE FILED. EACH MEMBER OF THE BOARD OF DIRECTORS IS GIVEN A COPY OF THE FORM 990 TO REVIEW BEFORE FILING IS COMPLETED. FORM 990, PART VI, SECTION B, LINE 12C THROUGHOUT THE YEAR, ANY ISSUE THAT INVOLVES A CONFLICT OF INTEREST WITH A TRUSTEE, DIRECTOR, OFFICER, OR KEY EMPLOYEE WOULD REQUIRE THAT THE INDIVIDUAL BE SEPARATED FROM THE DECISION-MAKING PROCESS RELATED TO THE POTENTIAL CONFLICT OF INTEREST. IN REGARD TO ANNUAL COMPLIANCE, THE REFERENCE TO THE CONFLICT OF INTEREST POLICY OUTLINES CURRENT PRACTICES. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY AND UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FULFILLMENT OF THIS OBJECTIVE WILL FALL UNDER THE MRHC ADMINISTRATIVE POLICY REVIEW PROCESS. FORM 990, PART VI, SECTION B, LINE 15 MANNING REGIONAL HEALTHCARE CENTER (MRHC) DETERMINES COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES BY CONSULTING THE CURRENT IOWA HOSPITAL ASSOCIATION (IHA) SALARY SURVEY. THIS SURVEY IS DONE ANNUALLY WITH THE HOPE OF 100% PARTICIPATION OF ALL IOWA HOSPITALS. MRHC USES THE INFORMATION FROM ITS PEER GROUP AS COMPARATIVE DATA FOR DETERMINING WAGES. THE PEER GROUP IS SELECTED BY MRHC AND CONSISTS OF HOSPITALS IN THE VICINITY OF MRHC AND HOSPITALS THAT ARE APPROXIMATELY THE SAME SIZE AS MRHC. MRHC WILL ALSO FACTOR IN YEARS OF EXPERIENCE WHEN DETERMINING WAGES FOR NEWLY HIRED EMPLOYEES OR WHETHER OR NOT MARKET INCREASES ARE NEEDED FOR EXISTING KEY EMPLOYEES OR OFFICERS. IN ADDITION TO ASSESSING MARKET INFORMATION, ANY ANNUAL COMPENSATION INCREASES (I.E. - MERIT RAISES) ARE DETERMINED BY ASSESSING FACILITY-WIDE FINANCIAL PERFORMANCE AND INSTITUTED CONSISTENTLY FOR ALL POSITIONS FACILITY-WIDE. FOR THE CEO POSITION SPECIFICALLY, AS THAT POSITION IS MANAGED THROUGH MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, THE SALARY AND COMPENSATION IS DETERMINED BY MIKE TRACHTA, MERCY NETWORK VICE PRESIDENT, IN CONJUNCTION WITH THE MRHC BOARD OF DIRECTORS. TO DETERMINE THE SALARY, THE IHA SALARY SURVEY IS FIRST REVIEWED, WHICH RECOGNIZES SALARY RANGES BASED ON HOSPITAL REVENUES, NUMBER OF FTE'S AND ALSO BASED ON CAH. A CHICAGO-BASED COMPANY, HR ADVANTAGE, IS ALSO USED IN A SURVEY COMPILING COMMUNITY DEMOGRAPHICS. FORM 990, PART VI, SECTION C, LINE 19 MRHC PROVIDES INFORMATION REGARDING THESE DOCUMENTS TO INDIVIDUALS AND BUSINESSES UPON REQUEST. AS THE ORGANIZATION IS A NOT-FOR-PROFIT ENTITY, IRS FILINGS ARE AVAILABLE VIA PUBLIC PORTALS (I.E. GUIDESTAR) THAT FACILITATE THE PRESENTATION OF THIS DATA. FORM 990, PART IX, LINE 11G ANESTHESIA FEES: PROGRAM SERVICE EXPENSES 213,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 213,700. PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 157,093. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 157,093. PHARMACY FEES: PROGRAM SERVICE EXPENSES 151,256. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 151,256. EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 388,124. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 388,124. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,160,845. MANAGEMENT AND GENERAL EXPENSES 226,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,387,780. FORM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS TAKES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.