2017-05-14T10:01:23-05:00 2016-06-30 470617373 Catholic Health Initiatives 198 Inverness Drive West Englewood CO 80112 990 2015-07-01 420680448 Catholic Health Initiatives - Iowa Corp CATH 5156437218 1111 6th Avenue Des Moines IA 50314 Randall L Rubin SVP, CFO 2016-11-11 true Pamela Krohn P01210500 3032989100 2015 2021-01-29 14:40:06Z Mercy Medical Center - Des Moines Robert Ritz 1111 6th Avenue Des Moines IA 50314 804319755 false 0928 X www.mercydesmoines.org X 1965 IA Catholic Health Initiatives - Iowa Corp is a not-for-profit Catholic health care organization creating healthier communities through the operation of a 802-bed acute care hospital. 18 14 6605 500 589014 235547 5369766 8464425 734295892 746825588 10060568 13975526 33368492 35054216 783094718 804319755 49333434 59014874 0 286033520 309821893 0 38562 403076768 376541507 738443722 745378274 44650996 58941481 802523233 852911575 220998331 233970592 581524902 618940983 SEE SCHEDULE O false false 695000673 59014874 746825588 SEE SCHEDULE H 695000673 true true false true false false false false false false true true false false true true false true false false false false false false false false true true true true true false false false false false false false false false false false false true true true true false false true 0 0 6605 true true true false false false false false false false false false X 18 14 false false false false true true true true true false false false true true true true true false true true false X Randall L Rubin 5156437860 1111 6th Avenue Des Moines IA 50314 KYLE GALLES MD Secretary 1.0 0 X X 0 0 0 SHARON KRAUSE Treasurer 1.0 0 X X 0 0 0 KEVIN PRUST Vice Chair 1.0 1.0 X X 0 0 0 SUKU RADIA Chair 1.0 0 X X 0 0 0 DAVID VELLINGA CEO 40.0 20.0 X X 0 1814994 24639 ROBERT RITZ PRESIDENT 40.0 6.0 X X 13482 962878 92891 MARY COWNIE Director 1.0 1.0 X 0 0 0 BETH CROSS DIRECTOR 1.0 0 X 0 0 0 JOSEPH GARCIA Director 1.0 0 X 0 0 0 KERTY LEVY DIRECTOR 1.0 0 X 0 0 0 SR DOLORES PREISINGER RSM DIRECTOR 1.0 2.0 X 0 0 0 MICHAEL ROWAN FACHE Director & CHI COO EVP 1.0 59.0 X 0 3895913 57577 MARK TANNENBAUM DIRECTOR/Physician 40.0 0 X 894940 0 28743 WILLIAM YOUNG MD Director & Medical Director 1.0 0 X 138194 0 0 Terry Lillis Director 1.0 0 X 0 0 0 Kristina Brighton Director 1.0 0 X 0 0 0 Brenda Cushing Director 1.0 1.0 X 0 0 0 Monica L FRIEDMAN SPHR Director 1.0 0 X 0 0 0 RANDALL RUBIN SVP, CFO 40.0 7.0 X 121501 198204 43946 MICHAEL WEGNER SVP & COO 40.0 8.0 X 8829 549380 33861 JOSEPH LEVALLEY SVP Planning 40.0 0.0 X 410726 0 30781 JULIE YOUNGER SVP Iowa Heart 40.0 0 X 282668 0 23149 PHILIP COLLETIER Radiation Oncologist 40.0 X 25 907691 28715 WAEL HAIDAR Senior Vice President- Division 40.0 2.0 X 10348 839046 21390 DEV PURI Physician 40.0 40.0 X 25 899166 23230 GEORGE VOYNOV Radiation Oncologist 40.0 X 24 893977 28715 TROY MUNSON PHYSICIAN 40.0 40.0 X 25 1025294 46542 STEVE KUKLA SVP & CFO 0.0 60.0 X 435793 0 35003 2316580 11986543 519182 592 true true false MEDICAL CENTER ANESTHESIOLOGISTS 411 LAUREL SUITE 3170 DES MOINES IA 503143005 PHYSICIAN SERVICES 2521274 SIEMENS MEDICAL SOLUTIONS USA 40 Liberty Boulevard Malvern PA 19355 Medical Services 2476189 IOWA ORTHOPAEDIC CENTER PC PO BOX 1736 DES MOINES IA 503051736 PHYSICIAN SERVICES 2186195 RICOH USA INC 6101 Enterprise Park Dr 300 Chattanooga TN 37416 Business and printing services 2077907 CHEST INFECTIOUS DISEASES 1111 6TH AVENUE DES MOINES IA 50314 PHYSICIAN SERVICES 1922463 55 X 0 0 0 1442051 4447988 2574386 0 8464425 Patient Services 900099 733041405 733041405 0 0 Equity changes of unconsolidated orgs 900099 6599527 6599527 0 0 Accountable Care Organization 524298 5219525 5219525 0 0 Medicare/Medicaid 900099 1965131 1965131 0 0 0 0 0 0 0 0 0 0 746825588 5825775 0 20518 5805257 0 0 0 0 0 0 0 0 1864398 0 0 0 1864398 0 1864398 0 0 1864398 7765825 383926 0 0 7765825 383926 8149751 0 0 8149751 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Services Sold 900099 4382839 0 0 4382839 Laboratory Services 621500 5684960 0 568496 5116464 Pharmacy Services 446110 11752963 0 0 11752963 11369056 0 0 11369056 33189818 804319755 746825588 589014 48440728 X 42519741 42519741 16495133 16495133 2417172 1684487 694123 38562 250399293 241019320 9379973 12632157 12126871 505286 27432921 26335604 1097317 16940350 16262736 677614 1995741 1995741 82994821 67641966 15352855 0 3332280 29991 3302289 19112564 18615637 496927 25528035 25528035 19112994 17851536 1261458 1140246 1037624 102622 115352 40373 74979 5823581 5823581 7362110 809832 6552278 30617193 30415120 202073 3828171 3809030 19141 Unrelated Business Taxes 33000 33000 Medical Supplies 140550682 140550682 Repairs and maintenance 9846616 7384962 2461654 Bad debts 19018412 19018412 6129709 0 6129709 0 745378274 695000673 50339039 38562 13677 16198 41724673 82934264 0 0 115492221 135537083 0 0 1290196 1154220 14670141 16883225 2782043 2056503 783452781 436963522 355022970 346489259 0 0 248626769 246269442 0 4080015 4080015 18820528 17491366 802523233 852911575 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THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: IOWA HOSPITAL ASSOCIATION: $29,839 POLK COUNTY MEDICAL SOCIETY: $2,494 CATHOLIC HEALTH ASSOCIATION: $6,279 AMERICAN HOSPITAL ASSOCIATION: $10,327 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE ORGANIZATION PAYS DUES TO HEALTH CARE INDUSTRY GROUPS, A PORTION OF WHICH IS IDENTIFIED AS LOBBYING. THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: IOWA HOSPITAL ASSOCIATION: $29,839 POLK COUNTY MEDICAL SOCIETY: $2,494 CATHOLIC HEALTH ASSOCIATION: $6,279 AMERICAN HOSPITAL ASSOCIATION: $10,327 20119545 20119545 394209625 172188590 222021035 19145870 15614668 3531202 338177822 244978769 93199053 11799919 4181495 7618424 346489259 CHI OIP - Fixed Income CHI OIP - Equity Securities CHI Operating Investment Program, LP CHI OIP 246269442 F 246269442 Accrued Expenses 9876740 Intercompany Debt 119407899 Intercompany Payables 36921703 Unclaimed Property 6778 Environmental Remediation 668951 Intercompany Debt 166882071 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Catholic Health Initiatives - Iowa Corp's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2016, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements." true true X false false true true false true true 3654433 3654433 0.0050 18987845 18987845 0.0261 0 0.0 0 0 22642278 0 22642278 0.0312 35 74375 933404 933404 0.0013 13 2346 7094439 7094439 0.0098 4 8328 1335656 1335656 0.0018 0 0.0 14 10805 556551 556551 0.0008 66 95854 9920050 0 9920050 0.0137 66 95854 32562328 0 32562328 0.0448 2 1202 37817 37817 0.0001 0 0.0 5 2155 24208 24208 0.0000 1 65 8765 8765 0.0000 0 0.0 1 700 4495 4495 0.0000 3 10650 31190 31190 0.0000 0 0.0 0 0.0 12 14772 106475 0 106475 0.0001 true 19018412 0 184581804 192564963 -7983159 X true true 2 1 Mercy Medical Center - Des Moines 1111 6th Avenue Des Moines IA 50314 www.mercydesmoines.org 770033H X X X A 2 Mercy Medical Center - Westlakes 1601 60th Street West Des Moines IA 50266 www.mercydesmoines.org 770158H X X X A A false false true X X X X X X X X X 15 true true true true X http://www.mercydesmoines.org/communityinvolvement X true 15 true http://www.mercydesmoines.org/communityinvolvement false false true X X X X X X X true true X X X true X http://www.mercydesmoines.org/for-patients/financial-assistance X http://www.mercydesmoines.org/for-patients/financial-assistance X http://www.mercydesmoines.org/for-patients/financial-assistance X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - FACILITY REPORTING GROUP A: LINE 1 - Mercy Medical Center - Des Moines & LINE 2 - Mercy Medical Center - West Lakes. Mercy Medical Center - Des Moines was a member of the Community Health Needs Assessment Central Iowa Steering Committee, which included representatives from the United Way of Central Iowa, the three largest non-profit hospitals, the three county health departments, and the Greater Des Moines Partnership. Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - FACILITY REPORTING GROUP A: LINE 1 - Mercy Medical Center - Des Moines & LINE 2 - Mercy Medical Center - West Lakes. Iowa Health Des Moines and Broadlawns Medical Center Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - FACILITY REPORTING GROUP A: LINE 1 - Mercy Medical Center - Des Moines & LINE 2 - Mercy Medical Center - West Lakes. Unity Point Health Des Moines, Dallas County Public Health Dept, Polk County Public Health Dept, Warren County Health Services Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - FACILITY REPORTING GROUP A: LINE 1 - Mercy Medical Center - Des Moines & LINE 2 - Mercy Medical Center - West Lakes. The following applies to both Des Moines and Westlake. The two facilities are in close proximity to one another, define their community the same and share resources. The Central Iowa Health Needs Assessment (CHNA) was a collaboration among the three community based hospitals in our community - Mercy Medical Center-Des Moines, Unity Point - Des Moines, and Broadlawns Medical Center. These three hospitals serve multi-county areas, so the CHNA process included Polk, Warren and Dallas counties. Each county brought the information from their own county assessment to the table for discussion. As the workgroups refined the data and community input, a CHNA Steering Committee provided a final level of analysis and structure. The final report addresses six priorities, based on the potential for implementation and depth of impact. Those priorities include: A. Increase opportunities for expanded and alternative means of healthcare delivery to address issues limiting access to care To expand its patient reach and services, Mercy will: * Explore the development of a 23-hour observation crisis unit to be staffed by 1-2 nurses. This area would be for patients who are ready to be discharged home but don't have the family or support system to assist with their discharge and treatment plan. * Implement creative ways to treat all types of behavioral health patients as the need for this growing population intensifies and access to care moves to the forefront of behavioral health service needs in Iowa. * Examine opportunities to meet the health needs of the most vulnerable, especially the chronically homeless * Assess locations with increasing need and capacity B. Establish more vibrant communities and neighborhoods characterized by mixed- and joint-use spaces and facilities that are accessible and available to everyone, including public gathering places for diverse and integrated engagement, and designs that promote healthy lifestyles To enhance the surroundings for all to feel safe and welcome, Mercy will: * Provide volunteer teams for community activities, especially clean up and restoration activities for the most vulnerable residents. * Sponsor the Multi-cultural Market The 6th Avenue Corridor, Inc. , a summer-long festival featuring a diverse array of ethnic and multicultural products (textiles, artisan goods, food) while encouraging neighborhood activity and community-building. * Work with the city and county leaders as well as other partners to support success of a new streetscape. This will include new pedestrian safety features, aesthetic improvements, and sustainability concepts C. Expand statewide training efforts for all professionals working with children across the various health and child-serving systems in Trauma Informed Care, cultural competency, and mental health first aid To improve the care of children through the education of their providers, Mercy will: * Mercy will host, at minimum, two training opportunities per year for health care staff on the topics of trauma-informed care, the impact of adverse childhood experiences, toxic stress, and/or mental health first aid. These trainings will continue to increase awareness and gain understanding of these important issues. Trainings will also offer potential responses to consider implementing within our systems of care. * Mercy Children's Hospital and Clinics will continue to share the Connections Matter training with medical staff and communities by having other staff complete the train-the-presenter Connections Matter workshop and offer Connections Matter trainings. * Knowing that early intervention is key in reducing the impacts of trauma and that the foundations of mental health are set in the first five years of life, Mercy will re-engage staff and medical providers within our clinics to increase referrals to our local 1st Five program. D. Identify additional sources of funding to create new and expand existing training programs in Psychiatry and Psychology and improve the mental health and disabilities training of primary care doctors and other primary care providers To work for an increase of behavioral health services, Mercy will: * Develop an assessment of current and emerging trends in Behavioral Health services; * Develop a forecast for the next 3 to 5 years; * Compare the current supply and resources compared to the projected resource needs based on the forecast of future demand. * While exploring collaboration alternatives, maximize the investment and services of Mercy's Behavioral Health service line * Provide increased mental health services to the underserved via House of Mercy programming E. Ensure access to high-quality pre-K and K-12 education for Central Iowa children To contribute to the education of all children in grades K-12, Mercy will: * Provide support and human resources to programs seeking volunteers in school settings * Maintain supportive mental health and substance abuse counselling for children and families in need of assistance through the House of Mercy * Provide learning opportunities to students interested in health care fields * Participate in Project SEARCH for young adults with learning disabilities * Partner with schools via GIRL POWER, an empowerment program to increase self-esteem and reduce risk behaviors F. Ensure access to health care services and education for Central Iowa's newcomer population To improve health care for the newest Iowans with diverse backgrounds, Mercy will: * Provide cultural and linguistic support to Limited English Proficiency (LEP) refugees served by the USCRI * Increase access to physical and mental health resources for Limited English Proficiency (LEP) refugees * Build the capacity of health care providers to provide culturally and linguistically appropriate services to refugees * Provide direct case management services to refugees in the community under supervision of USCRI Wellness Program staff * Conduct home visits, intakes and assessments of clients referred to the Wellness Program under supervision of Wellness Program staff; * Coordinate appointments and services, maintain appointment notes for clients enrolled in the Wellness Program; * Communicate with healthcare providers about ongoing barriers or needs of clients served in the Wellness Program, and work to eliminate these barriers. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - FACILITY REPORTING GROUP A: LINE 1 - Mercy Medical Center - Des Moines & LINE 2 - Mercy Medical Center - West Lakes. MERCY MEDICAL CENTER - DES MOINES BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25% - 100% OF CHARGES. Schedule H, Part V, Section B, Line 22 Facility A, 1 Facility A, 1 - FACILITY REPORTING GROUP A: LINE 1 - MERCY MEDICAL CENTER - DES MOINES & LINE 2 - MERCY MEDICAL CENTER - WEST LAKES. The hospital facility used the average of the negotiated commercial insurance rates for those services at the hospital facility. 18 Mercy Outpatient Cardiac Testing 5880 University Suite 211 West Des Moines IA 50266 ambulatory health care Mercy Ambulatory Surgery Center 411 Laurel Street Des Moines IA 50314 ambulatory health care Mercy Franklin Center 1818 48th Street Des Moines IA 50314 behavioral health RCG Mercy Des Moines LLC 920 Winter Street Waltham MA 024511457 physician services River Hills Surgery Center 1111 6th Avenue Des Moines IA 50314 surgery center Central Iowa Cyberknife 411 Laurel Street Des Moines IA 50314 physician office Mercy Weight Loss & Nutrition Center 12493 University Avenue Suite 110 West Des Moines IA 50325 ambulatory health care Mercy West Endoscopy 1601 NW 114th Street Suite 244 Clive IA 50325 ambulatory health care Mercy Outpatient Cardiac Testing 411 Laurel Street Des Moines IA 50314 ambulatory health care Mercy West Radiology 1601 NW 114th Street Suite 149 Clive IA 50325 medical imaging Mercy Cancer Center 411 Laurel Street Des Moines IA 50314 physician services West Lakes Surgery Center LLC 12499 University Avenue Suite 100 Clive IA 50325 surgery center Radiology Center 12495 University Avenue Clive IA 50325 medical imaging Mercy Sleep Center 1449 NW 128th Street Suite 100 Clive IA 50325 ambulatory health care Mercy Riverside Rehabilitation Center 730 East 2nd Street Des Moines IA 50309 rehabilitation center Mercy Cardiac & Pulmonary Rehabilitation 411 Laurel Street Des Moines IA 50314 ambulatory health care Mercy Atrium Imaging 411 Laurel Street Des Moines IA 50314 medical imaging Mercy Family Medicine Residency Center 250 Laurel Street Des Moines IA 50314 physician office Schedule H, Part VI LINES 2, 4 & 5: COMMUNITY BENEFIT NARRATIVE AND NEEDS ASSESSMENT, SCH H PART II The following applies to both Des Moines and Westlake. The two facilities are in close proximity to one another, define their community the same and share resources. Working with nearly thirty community-based organizations, Mercy Medical Center - Des Moines joined in an in-depth evaluation of the health of our community. Designed to identify needs and develop improvement strategies, the process engaged thousands of residents and vested leaders in this valuable discussion. Many services provided by Mercy continue to surface are areas of greatest need. Access to a medical home, need for coordinated specialty care and financial assistance for the uninsured and underserved were identified by the participants. These barriers, combined with needed access to healthy food, safe housing and public transportation, have guided the community-based activities for Mercy. Mercy Medical Center - Des Moines is a regional hospital, with a primary service area of three counties and a secondary reach to the surrounding six counties. The population served includes both urban and rural communities, with a growing number of people residing in the 3-county primary service area (Polk, Dallas and Warren.) These residents have a median household income of $61,721, with roughly 8 percent of persons living below the poverty level. Of those who live below the poverty level, 52 percent are single-parent homes with children under 5 years of age. With an increasing immigrant and refugee population relocating to Iowa, approximately 10 percent of our 3-county area speak a language other than English at home. The largest non-native population has Hispanic origin. Another demographic factor impacting Iowa's demand for health care service is our elderly, with 14.9 percent of our residents being over 65 years of age. The uninsured population of our 3-county service area is approximately eight percent. Medicare and Medicaid cover 22 percent of our population. Mercy is one of two large health care systems in our community. In addition, Polk and Dallas Counties each have a county hospital. Mercy Medical Center - Des Moines is an 802-bed acute care, not-for-profit Catholic hospital situated on three campuses. Founded by the Sisters of Mercy in 1893, Mercy is Des Moines' longest continually operating hospital and one of the largest employers in the state, with more than 6,600 employees and a medical staff of more than 950 physicians and allied health professionals. As the first Catholic hospital to serve the community, Mercy embraced the mission of the founding religious congregation, which has since joined with other religious congregations to form Catholic Health Initiatives. CHI serves as the parent corporation of its MBOs which are comprised of 104 hospitals, including four academic medical centers, and 30 critical access facilities; community health service organizations; accredited nursing colleges; home health agencies; and other facilities that span the inpatient and outpatient continuum of care. Together, these facilities provided $1.1 billion in charity care and community benefit in the 2016 fiscal year, including services for the poor, free clinics, education and research. Mercy is one of the Midwest's largest referral centers, offering a variety of specialty services that are unique to Iowa and the region. In addition, a 24-hour emergency room is open to all individuals regardless of ability to pay. While a participant in Medicare and Medicaid, Mercy also deploys a robust financial assistance program for the uninsured and underserved, meeting the needs of all seeking care. Dedicated to serving our entire community, Mercy is enriched by a board of directors comprised of civic-minded leaders. Working in conjunction with this esteemed team, Mercy's leadership evaluates and dedicates resources to the promotion of a healthy community and an improvement in the lives of those we serve. One example of Mercy's commitment to unmet needs exists in the House of Mercy. Initially developed to provide safe and supportive housing for vulnerable women and their children, the House of Mercy is now one of Iowa's largest providers of transitional housing and clinical services for parenting women with addiction. The House of Mercy is dedicated to assisting pregnant, parenting/non-parenting, and adolescent/adult women in developing personal responsibility and independence through counseling, education, and medical care in collaboration with other caring individuals. It is home to 11 vital human service and health care related programs and, on average, houses nearly 170 women and children in the residential treatment program. During their stay, women gain the skills they need to live independently, deal with addiction, overcome the effects of trauma and effectively parent their children. Mercy Medical Center - Des Moines is included in the Official Catholic Directory as a tax-exempt hospital. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care When Catholic Health Initiatives (the ultimate parent organization to CHI-Iowa Corp established its financial assistance policy it was determined that establishing a household income scale based on the HUD very low income guidelines more accurately reflects the socioeconomic dispersions among the 69 urban and rural communities in 19 states served by CHI hospitals and health care facilities. In comparing HUD guidelines to the Federal Poverty Guidelines ("FPG"), we find that on average HUD guidelines compute to approximately 200% to 250% (and sometimes 300%) of FPG. CHI-Iowa Corp bases its financial assistance eligibility on HUD's 130% of Very Low Income Guidelines based on geography, and affords the uninsured and underinsured the ability to obtain financial assistance write-offs, based on a sliding scale, ranging from 25%-100% of charges. An individual's income under the HUD guidelines is a significant factor in determining eligibility for financial assistance. However, in determining whether to extend discounted or free care to a patient, the patient's assets may also be taken into consideration. For example, a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's basic financial (and ultimately physical) well-being and survival. Such a patient may be extended discounted or free care based upon the facts and circumstances. Schedule H, Part I, Line 7g Subsidized Health Services There are no physician clinics included in subsidized health services. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 19018412 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using the organization's cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. The cost-to-charge ratio for the year ended 6/30/2016 was computed using the following formula: Operating expense (before restructuring, impairment and other losses) divided by gross patient revenue. Based on that formula, $603,906,515/ $2,725,872,155 results in a 22.15% cost-to-charge ratio. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 22.15%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Catholic Health Initiatives - Iowa Corp does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Catholic Health Initiatives - Iowa Corp does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives (CHI). The consolidated footnote reads as follows: "The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented on the consolidated statements of operations as a deduction from patient services revenues (net of contractual allowances and discounts) since CHI accepts and treats substantially all patients without regard to the ability to pay." Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Using essentially the same Medicare cost report principles as to the allocation of general services costs and "apportionment" methods, the "CHI Workbook" calculates a payers' gross allowable costs by service (so as to facilitate a corresponding comparison between gross allowable costs and ultimate payments received). The term "gross allowable costs" means costs before any deductibles or co-insurance are subtracted. CHI Iowa Corp's ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. Although not presented on the Medicare cost report, in order to facilitate a more accurate understanding of the "true" cost of services (for "shortfall" purposes) the CHI Workbook allows a health care facility not to offset costs that Medicare considers to be non-allowable, but for which the facility can legitimately argue are related to the care of the facility's patients. In addition, although not reportable on the Medicare cost report, the CHI workbook includes the cost of services that are paid via a set fee-schedule rather than being reimbursed based on costs (e.g. outpatient clinical laboratory). Finally, the CHI Workbook allows a facility to include other health care services performed by a separate facility (such as a physician practice) that are maintained on separate books and records (as opposed to the main facility's books and records which has its costs of service included within a cost report). True costs of Medicare computed using this methodology: Total Medicare Revenue: $184,581,804 Total Medicare costs: $192,564,963 Surplus or Shortfall $(7,983,159) CHI Iowa Corp believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as "subsidized health services." Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Catholic Health Initiatives - Iowa Corp's debt collection policy provides that Catholic Health Initiatives - Iowa Corp will perform a reasonable review of each inpatient account prior to turning an account for to a third-party collection agent and prior to instituting any legal action for non-payment, to assure that the patient and patient guarantor are not eligible for any assistance program (e.g. Medicaid) and do not qualify for coverage through Catholic Health Initiatives - Iowa Corp community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the Catholic Health Initiatives - Iowa Corp community assistance policy is required to be returned immediately by the third-party collection agent to Catholic Health Initiatives - Iowa Corp for appropriate follow-up. Catholic Health Initiatives - Iowa Corp requires its third-party collection agents to include a message on all statements indicating that if a patient or patient guarantor meets certain stipulated income requirements, the patient or patient guarantor may be eligible for financial assistance. All of Catholic Health Initiatives' (CHI) hospitals' contracts with third party collection agencies include the following standards: * Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; * Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and * No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiatives Mission, Core Values and Standard of Conduct to make sure all patients are treated with dignity and respect. Schedule H, Part V, Section B, Line 16a FAP website A - Mercy Medical Center - Des Moines: Line 16a URL: http://www.mercydesmoines.org/for-patients/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website A - Mercy Medical Center - Des Moines: Line 16b URL: http://www.mercydesmoines.org/for-patients/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - Mercy Medical Center - Des Moines: Line 16c URL: http://www.mercydesmoines.org/for-patients/financial-assistance; Schedule H, Part VI, Line 3 Patient education of eligibility for assistance CHI Iowa Corp, along with its affiliated outpatient facilities are part of Catholic Health Initiatives "CHI". CHI has a written policy (Stewardship policy No. 15) governing the procedures for determining and informing patients about the entity's financial assistance policy. All hospital facilities included in the filing organization have adopted the policy. The policy states the organization will include information concerning its financial assistance policy on its website. In addition, CHI Iowa Corp prominently displays its financial assistance policy in both English and Spanish in obvious locations throughout the hospitals, including the emergency rooms and other patient intake areas, as well as in CHI Iowa Corp outpatient facilities. In addition, CHI Iowa Corp registration clerks are trained to provide consultation to those who have no insurance or potentially inadequate insurance concerning their financial options including application for Medicaid and for financial assistance under CHI Iowa Corp's financial assistance policy. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the financial assistance policy and procedures including an application for assistance. CHI Iowa Corp registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non English-speaking individuals. CHI Iowa Corp's staff will also assist the patient/guarantor with applying for other available coverage (such as Medicaid), if necessary. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies. Schedule H, Part VI, Line 6 Affiliated health care system CHI Iowa Corp, along with its affiliated outpatient facilities are part of Catholic Health Initiatives. Catholic Health Initiatives (CHI) is a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 104 hospitals, including four academic medical centers, and 30 critical access facilities; community health service organizations; accredited nursing colleges; home health agencies; and other facilities that span the inpatient and outpatient continuum of care. Together, these facilities provided $1.1 billion in financial assistance and community benefit in the 2016 fiscal year, including services for the poor, free clinics, education and research. CHI provides strategic planning and management services as well as centralized "shared services" for the MBOs. The provision of centralized management and shared services - including areas such as accounting, human resources, payroll and supply chain -- provides economies of scale and purchasing power to the MBOs. The cost savings achieved through CHI's centralization enable MBOs to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. CHI Iowa Corp operates with its wholly owned affiliates and community partners, along with its fundraising arm, the Mercy Foundation of Des Moines, IA, to serve the health care needs of the Polk, Dallas and Warren county, Iowa communities. Schedule H, Part VI, Line 7 State filing of community benefit report IA true Primary Healthcare 3506 E 29th Des Moines IA 50317 421350092 501 ( c ) 3 1766289 Community support YMCA of Greater Des Moines 101 Locust St Des Moines IA 50309 420680438 501 ( c ) 3 722755 Community support Greater Des Moines Partnership 700 Locust St Suite 100 Des Moines IA 50309 421489668 501 ( c ) 6 370000 Community support Community Foundation of Greater DSM 2771 104th St Suite 1 Urbandale IA 50322 751835298 501 ( c ) 3 145000 Community support Iowa Economic Development Authority Fdn 200 E Grand Ave Des Moines IA 50309 426004572 501 ( c ) 3 7500 Community support American Diabetes Association 1701 N Beauregard St Alexandria VA 22311 131623888 501 ( c ) 3 7500 Community support Des Moines Playhouse 831 42nd St Des Moines IA 50312 420710259 501 ( c ) 3 10000 Community support March of Dimes 207 E Reynolds Rd Lexington KY 40517 131846366 501 ( c ) 3 21500 Community support Operation Downtown 700 Locust Suite 100 Des Moines IA 50309 861058466 501 ( c ) 6 15000 Community support Alzheimers Association 225 N Michigan Ave Chicago IL 60601 133039601 501 ( c ) 3 5000 Community support Des Moines Marathon 526 39th St Des Moines IA 50312 203197356 501 ( c ) 3 5000 Community support Bras for the Cause Iowa 5465 Mills Civic Parkway St 260 West Des Moines IA 50266 260446913 501 ( c ) 3 10000 Community support Strands of Strength Inc 520 S 18th Street West Des Moines IA 50265 454145232 501 ( c ) 3 10000 Community support American Heart Association 7272 Greenville Ave Dallas TX 75231 135613797 501 ( c ) 3 15000 Community support Catholic Charities of Iowa 601 Grand Ave Des Moines IA 50309 420680464 501 ( c ) 3 45000 Community support Des Moines University 3200 Grand Ave Des Moines IA 50312 420730347 501 ( c ) 3 5000 Community support Make a Wish Foundation of IA 3024 104th St Ste 101 Urbandale IA 50322 421310530 501 ( c ) 3 18525 Community support National Multiple Sclerosis Society 200 12th Ave S Minneapolis MN 55415 410790658 501 ( c ) 3 7500 Community support North River Education Services 5695 SE 68th Pl Carlisle IA 50047 760747681 501 ( c ) 3 6500 Community support Courage League Sports 4405 121st St Urbandale IA 50322 461443733 501 ( c ) 3 5000 Community support Ankeny Community Foundation 410 W First St Ankeny IA 50023 203850596 501 ( c ) 3 8333 Community support Ronald McDonald House Cent IA 1441 Pleasant St Des Moines IA 50314 421117423 501 ( c ) 3 5000 Community support On With Life Foundation 715 SW Ankeny Blvd Ankeny IA 50023 421399777 501 ( c ) 3 5000 Community support Bravo Greater Des Moines 1915 Grand Ave Des Moines IA 50309 203598346 501 ( c ) 3 6000 Community support ALS Association of IA Chapter 3636 Westown Parkway West Des Moines IA 50266 300051272 501 ( c ) 3 10000 Community support Innervisions Healthcare 1355 50th St Ste 400 West Des Moines IA 50266 453790483 501 ( c ) 3 5000 Community support Iowa Clinic Healthcare Foundation 5950 University Ave West Des Moines IA 50266 810599749 501 ( c ) 3 5000 Community support Healthy Birthday PO Box 71093 Clive IA 50325 263998964 501 ( c ) 3 10000 Community support Junior Achievement of Central IA 6100 Grand Ave Des Moines IA 50312 420759070 501 ( c ) 3 10000 Community support National Assn of Childrens Hospitals 600 13th St NW Washington DC 20005 510120256 501 ( c ) 3 5833 Community support Mercy Medical Center Centerville One St Josephs Drive Centerville IA 52544 420680308 501( c ) 3 398662 Program support Mercy Clinics Inc 1111 6th Avenue Des Moines IA 50314 421193699 501( c ) 3 36096191 Program support Mercy Health Network 1111 6th Avenue Des Moines IA 50314 421478417 501( c ) 3 2685069 Program support 33 0 Charity Care/Financial Assistance 16495133 Book See Statement Schedule I, Part III, Column (f) Description of Non-Cash Assistance Charity Care/Financial Assistance: Reduction or write-off of patient services Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. All grants are reviewed and monitored by the grants manager. Each grant is assigned a grant administrator who coordinates grant compliance with the grants manager. Grant reimbursements are received through the financial operations department. Grant expenditures require the same approval as non-grant expenditures through the accounts payable approval matrix. All periodic reports to the granting agency for grants that require this are filed timely with the appropriate agency. In addition, the organization undergoes a federal A-133 grant audit annually by an independent auditor. false true false false false false false true false DAVID VELLINGA CEO 0 717250 0 824380 0 273364 0 15195 0 9444 0 1839633 0 0 ROBERT RITZ PRESIDENT 13482 640190 0 264977 0 57711 0 72925 3326 16640 16808 1052443 0 0 MICHAEL ROWAN FACHE Director & CHI COO EVP 0 1273340 0 1763164 0 859409 0 15775 0 41802 0 3953490 0 242516 MARK TANNENBAUM DIRECTOR/Physician 752645 0 138519 0 3776 0 15775 0 12968 0 923683 0 0 0 STEVE KUKLA SVP & CFO 335487 0 50671 0 49635 0 15775 0 19228 0 470796 0 0 0 RANDALL RUBIN SVP, CFO 121501 164763 0 18128 0 15313 15117 0 2698 26131 139316 224335 0 0 MICHAEL WEGNER SVP & COO 8829 420041 0 74480 0 54859 0 15775 3326 14760 12155 579915 0 0 JOSEPH LEVALLEY SVP Planning 319517 0 35074 0 56135 0 15775 0 15006 0 441507 0 0 0 JULIE YOUNGER SVP Iowa Heart 241514 0 21528 0 19626 0 15325 0 7824 0 305817 0 0 0 PHILIP COLLETIER Radiation Oncologist 25 617706 0 287979 0 2006 0 15775 0 12940 25 936406 0 0 WAEL HAIDAR Senior Vice President- Division 10096 498683 0 220085 252 120278 0 18022 3368 0 13716 857068 0 0 DEV PURI Physician 25 610315 0 287979 0 872 0 14984 0 8246 25 922396 0 0 GEORGE VOYNOV Radiation Oncologist 24 605126 0 287979 0 872 0 15775 0 12940 24 922692 0 0 TROY MUNSON PHYSICIAN 0 996341 0 0 25 28953 0 15775 0 30767 25 1071836 0 0 Schedule J, Part I, Line 4a SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES (CHI) AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE.. THERE WERE NO REPORTABLE INDIVIDUALS WHO RECEIVED SEVERANCE PAYMENTS DURING THE 2015 CALENDAR YEAR. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Compensation for the top management official was established and paid by Catholic Health Initiatives (CHI), a related organization. CHI used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan During the 2015 calendar year Catholic Health Initiatives (CHI), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs/Presidents and other CHI employees at the level of Senior Vice President and above. The following reportable individuals were eligible to participate in that plan: Michael Rowan David Vellinga Robert Ritz During 2015 the following contributions were made by CHI to the deferred compensation plan: Robert Ritz - $57,150 During 2015 the following distributions were made by CHI from the deferred compensation plan: Michael Rowan - $242,516 Due to the "super" vesting rules under the CHI deferred compensation plan, participants who have met certain requirements such as age, years of service or more than 5 years of plan participation are eligible to receive their 2015 contributions in cash. These cash payouts are included in the participant's reportable compensation in column (iii) Other Reportable Compensation on Schedule J Part II. During 2015, the following contributions that would have been made by CHI to the deferred compensation plan were paid in cash: David Vellinga - $107,651 Michael Rowan - $313,628 Schedule J, Part I, Line 7 Non-fixed payments CATHOLIC HEALTH INITIATIVES - IOWA CORP MAINTAINS A VARIABLE PAY PROGRAM FOR DIRECTORS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OUTCOMES, QUALITY IMPROVEMENT, LEVEL OF COMMUNITY BENEFIT PROVIDED, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, NO AWARD IS PAYABLE UNDER THIS PROGRAM UNLESS OPERATING MARGIN AND CHARITY CARE LEVELS ARE ACHIEVED AT A DESIGNATED PERCENT OF BUDGET. Form 990, Part III, Line 1 MISSION STATEMENT THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION. Form 990, Part VI, Line 15a PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL The organization's top management official's compensation is paid by Catholic Health Initiatives (CHI), a related organization. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Korn Ferry Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Korn Ferry Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Korn Ferry Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September 13, 2016. In addition, Korn Ferry Hay Group completed a comprehensive review of all positions at the level of vice president and above in the fall of 2014 to determine and validate appropriate compensation levels. These levels have been reviewed annually since and revised based on market data, where applicable. Form 990, Part VI, Line 16b JOINT VENTURE WRITTEN POLICY OR PROCEDURE CATHOLIC HEALTH INITIATIVES - IOWA CORP HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, CATHOLIC HEALTH INITIATIVES' SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. Form 990, Part VI, Line 1a Delegate broad authority to a committee PURSUANT TO SECTION 8.6 OF THE BYLAWS OF CATHOLIC HEALTH INITIATIVES - IOWA CORP, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, AND THE PRESIDENT AND CEO, EACH OF WHOM SERVES AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND SUCH OTHER VOTING MEMBERS AS MAY BE APPOINTED BY THE BOARD. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. Form 990, Part VI, Line 6 Classes of members or stockholders The sole member of the corporation is Catholic Health Initiatives, a Colorado nonprofit corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Catholic Health Initiatives has the power to appoint, remove, or replace the members of the board of directors. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders he organization's corporate member is Catholic Health Initiatives (CHI). Pursuant to Section 5.4 of the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: *Substantial change in the mission or philosophy of Catholic Health Initiatives - Iowa Corp; *Amendment of the corporate documents of Catholic Health Initiatives - Iowa Corp; *Approve members of the Catholic Health Initiatives - Iowa Corp board; *Removal of a member of the governing body of Catholic Health Initiatives - Iowa Corp; *Approval of issuance of debt by Catholic Health Initiatives - Iowa Corp; *Approval of participation of Catholic Health Initiatives - Iowa Corp in a joint venture; *Approval of formation of a new corporation by Catholic Health Initiatives - Iowa Corp; *Approval of a merger involving Catholic Health Initiatives - Iowa Corp; *Approval of the sale of all or substantially all of the assets of the Catholic Health Initiatives - Iowa Corp; *To require the transfer of assets by Catholic Health Initiatives - Iowa Corp to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts; *Adoption of long range and strategic plans for Catholic Health Initiatives - Iowa Corp. Pursuant to Section 5.5 of the organization's bylaws, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Form 990, Part VI, Line 11b Review of form 990 by governing body The organization's accounting personnel work with the Cathlic Health Initiatives (CHI) tax department personnel to prepare the form 990. When available, the CFO reviews the return, and any necessary revisions are included in the final version which is approved for filing with the IRS. Subsequent to review by the chief financial officer, the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Subsequent to e-filing, the final e-filed form 990 is presented to the board at a regularly scheduled board meeting. Form 990, Part VI, Line 12c Conflict of interest policy Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy in place to maintain the integrity of all of its activities. The policy applies to CHI Board of Stewardship Trustees and members of its committees; all board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each person has a general ongoing obligation to promptly and fully report to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must report the actual or potential conflict as soon as she/he becomes aware of it. In any situation where the person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI Entity may reject a Person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential COI. If the C-CIRC determines that there is a potential or actual conflict of interest that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing person be allowed to participate in the activity or transaction subject to restrictions as outlined in the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and the manager do not agree with the review decision, interpretation of the Policy, or seek exemption or exception, the manager shall consult with the manager's Vice President (or higher if the manager is a Vice President) to reach a determination. If the matter remains unresolved, it shall be referred to the CHI Vice President of Human Resources and the CHI Corporate Responsibility Officer. If they are unable to reach agreement, the matter shall be referred to the CHI General Counsel, whose decision shall be final. Reviews and determinations involving board and board committee members and corporate officers will be the responsibility of the board, board executive committee, or board chair, with guidance from the Legal Services Group (LSG). Annual COI disclosures of all trustee and corporate officers will be reviewed by the CHI Senior Vice President, Legal Services, and General Counsel or his or her designee who will report potential conflicts to the applicable Board Chair. The Board Chair or designee shall make such further investigation of any conflict of interest disclosures as he or she may deem appropriate. If the conflict involves the Board Chair, the Vice Chair will assume the Chair's role. Based on review and evaluation of the relevant facts and circumstances, the Board Chair will make an initial determination as to whether a conflict of interest exists and whether, pursuant to the COI Policy, review and approval or other action by the Board is required. A written record of the Board Chair's determination, including relevant facts and circumstances, will be made. The Board Chair shall then make an appropriate report to the Executive Committee of the Board concerning such review, evaluation and determination. If a difference of opinion exists between the Board Chair and another Trustee as to whether the facts and circumstances of a given situation constitute a conflict of interest or whether Board review and approval or other action is required within the COI Policy, the matter shall be submitted to the Board's Executive Committee, which shall make a final determination as to the matter presented. Such determination, including relevant facts and circumstances, will be reflected in the Executive Committee minutes and will be reported to the Board. When any conflict of interest is considered by the board, the trustee or corporate officer, as appropriate, must disclose all of the material facts to the Board. The trustee shall not vote and the trustee or corporate officer shall not use his or her personal influence on the matter. The trustee or corporate officer shall be excused from the meeting during discussion and vote on the conflict of interest. In reviewing such transactions between CHI or CHI Entities and vendors or other contractors who are, or are affiliated with, Trustees or Corporate Officers, the Board will act as it would in reviewing transactions with unrelated third parties. The transaction is not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. The Board must approve the transaction by a majority of the Trustees on the Board, without counting the vote of any individual who has an interest in the transaction. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy. Form 990, Part VI, Line 15b Process to establish compensation of other employees For officers and key employees, Catholic Health Initiatives - Iowa Corp uses a third-party consultant to annually survey compensation trends and recommend compensation ranges. These recommendations are presented to the board, which makes the final compensation decisions. The decisions are documented in the board minutes. Form 990, Part VI, Line 19 Required documents available to the public Catholic Health Initiatives - Iowa Corp's organizing documents are available at www.sos.state.ia.us. The organization's conflict of interest policy is not publicly available. The organization's financial statements are included in the Catholic Health Initiatives' consolidated audited financial statements available at www.catholichealthinit.org or at http://www.DacBond.com. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 11369056, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 11369056; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 0, Program Service Expense: 0, Management and General Expenses: 0, Fundraising Expenses: 0; Contract Labor - Other - Total Expense: 4880989, Program Service Expense: 4880989, Management and General Expenses: , Fundraising Expenses: ; Medical Director Fees - Total Expense: 4646132, Program Service Expense: 4646132, Management and General Expenses: , Fundraising Expenses: ; Other Contracted Professionals - Total Expense: 7810279, Program Service Expense: 7810279, Management and General Expenses: , Fundraising Expenses: ; Medical Prof Fees - Svcs From Medical Group - Total Expense: 10504076, Program Service Expense: , Management and General Expenses: 10504076, Fundraising Expenses: ; Contract Services - Total Expense: 30867791, Program Service Expense: 30867791, Management and General Expenses: , Fundraising Expenses: ; Purchased Serices - Total Expense: 23089430, Program Service Expense: 18240651, Management and General Expenses: 4848779, Fundraising Expenses: ; Consulting - Total Expense: 1196124, Program Service Expense: 1196124, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Capital Resource Pool - -5573034; PET SCANNER LLC 1111 SIXTH AVENUE DES MOINES IA 50314 INACTIVE IA CHI-IA CORP MERCY THERAPEUTIC RADIOLOGY ASSOCIATES LLC 1111 SIXTH AVENUE DES MOINES IA 50314 PHYSICIAN SERVICES IA CHI-IA CORP PERINATAL CENTER OF IOWA LLC 1111 SIXTH AVENUE DES MOINES IA 50314 PHYSICIAN SERVICES IA CHI-IA CORP MERCY NORTH ASC LLC 1111 SIXTH AVENUE DES MOINES IA 50314 AMBULATORY SURGERY CENTER IA CHI-IA CORP CENTRAL IOWA CYBERKNIFE LLC 1111 SIXTH AVENUE DES MOINES IA 50314 PHYSICIAN SERVICES IA CHI-IA CORP MERCY WEST ENDOSCOPY LLC 1111 SIXTH AVENUE DES MOINES IA 50314 AMBULATORY SURGERY CENTER IA CHI-IA CORP HEART PARTNERS LLC 1111 SIXTH AVENUE DES MOINES IA 50314 PHYSICIAN SERVICES IA CHI-IA CORP ONECARE LLC DBA MERCY ACO 1111 6TH AVE DES MOINES IA 50314 454498644 ACCOUNTABLE CARE ORGANIZATION BUSINESS IA CHI-IA CORP ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HEALTHCARE NE 501(c)(3 3 ACH true ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING NE 501(c)(3 7 ACH true ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HEALTHCARE IA 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - IMMANUEL MEDICAL 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