2015-05-12T09:34:54-05:00 2014-06-30 990 2013-07-01 311373080 MERCY HEALTH SERVICES - IOWA CORP MERC 5156435300 1000 4TH STREET SW MASON CITY IA 50401 RODNEY SCHLADER REGIONAL CFO 7343431000 2015-05-12 2013 2016-02-25 16:41:14Z SEE SCHEDULE O FOR LIST DAVID VELLINGA 1111 6TH AVENUE DES MOINES IA 50314 666859455 0 X WWW.TRINITY-HEALTH.ORG X 1993 DE HEALTH CARE SERVICES 10 7 5804 727 27312422 -277508 1380476 2302651 610555317 611343607 12653174 11910346 44355535 40011591 668944502 665568195 968070 853865 0 0 297014327 295546933 0 21391 21391 368567769 366442363 666550166 662864552 2394336 2703643 661667231 682773995 290097793 287743585 371569438 395030410 HEALTH CARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 605160058 853865 600832792 MERCY HEALTH SERVICES-IOWA, CORP. OPERATED FOUR HOSPITAL DIVISIONS IN THE STATE OF IOWA THAT PROVIDED 145,541 PATIENT DAYS OF HEALTHCARE SERVICES TO THEIR COMMUNITIES. THE MISSION STATEMENT OF MERCY HEALTH SERVICES-IOWA CORP. IS AS FOLLOWS: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. 605160058 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 1013 53 1 5804 1 1 1 0 0 0 0 0 0 0 0 0 X 10 7 1 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 0 X BETH GDOWIK 7343431000 20555 VICTOR PARKWAY LIVONIA MI 481527018 X DAVID VELLINGA DIRECTOR/REG PRES & CEO AS OF 1/14 1.00 3.00 X X 0 0 0 MILTON AVERY CHAIR AS OF 1/14 1.00 1.00 X X 0 0 0 MARY CORITA HEID RSM VICE CHAIR AS OF 1/14 1.00 1.00 X X 0 0 0 RICHARD GILFILLAN MD DIR. 11-12/13;TH PRES/CEO AT 11/13 2.00 53.00 X X 0 139231 6899 JUDITH PERSICHILLI TRINITY INT. PRES & CEO THR 11/13 2.00 53.00 X X 0 4068101 25456 MELANIE DREHER PHD RN CHAIR THROUGH 12/13 1.00 17.00 X X 0 49250 0 BARBARA WHEELEY RSM VICE CHAIR THROUGH 12/13 1.00 17.00 X X 0 0 0 MAURITA SOUKUP RSM DIRECTOR AS OF 1/14 1.00 1.00 X 0 0 0 JAMES CODDINGTON MD DIRECTOR AS OF 1/14;MMC-NI PHYSICIAN 49.00 1.00 X 235764 0 36176 LAMETTA WYNN DIRECTOR AS OF 1/14 1.00 1.00 X 0 0 0 MARK NIEMER MD DIRECTOR AS OF 1/14 1.00 1.00 X 0 0 0 MARTI RODAMAKER DIRECTOR AS OF 1/14 1.00 1.00 X 0 0 0 RICHARD O'CONNELL DIR. AS OF 1/14; EVP & PRES TH DIV 1.00 54.00 X 0 1673574 145485 SUZANNE BRENNAN CSC DIRECTOR THROUGH 12/13 1.00 10.00 X 0 0 0 STANLEY URBAN DIRECTOR THROUGH 12/13 1.00 10.00 X 0 24000 0 RALPH REEDER MD DIRECTOR AS OF 4/14 1.00 1.00 X 0 0 0 PAUL NEUMANN SEC THR 12/13; TH CHIEF LEGAL CNSL 2.00 53.00 X 0 1255551 103026 MARCIA SMITH SECRETARY AS OF 1/14; ASSOCIATE CNSL 44.00 1.00 X 0 219902 31640 AGNES HAGERTY ASST SEC THR 12/13; TH DEP GNL CNSL 2.00 48.00 X 0 402957 47295 RODNEY SCHLADER TREAS AS OF 1/14; REGIONAL CFO 49.00 1.00 X 0 344574 50092 JENNIFER BARNETT TREAS THR 12/13; TH CFO THR 4/14 2.00 53.00 X 0 1219369 30695 BENJAMIN CARTER ASST TREAS THR 12/13; TH TREAS/CFO 2.00 53.00 X 0 1250126 110445 RUSSELL KNIGHT CEO DUBUQUE 49.00 1.00 X 0 715214 71424 ROBERT PEEBLES CEO SIOUX CITY THROUGH 3/14 47.00 3.00 X 0 568262 68733 PAUL MANTERNACH SVP PHYS INTEGRATION MASON CITY 50.00 0.00 X 0 492207 31967 DANIEL VARNUM CEO MASON CITY 49.00 1.00 X 0 489564 61693 JEROME PIERSON MD CMO SIOUX CITY 49.00 1.00 X 0 388355 23343 TERESA MOCK SVP MERCY CLINICS MASON CITY 50.00 0.00 X 0 341451 45145 DIANE FISCHELS VP OPERATIONS MASON CITY 50.00 0.00 X 0 335837 39578 KIMBERLY CHAMBERLIN CNO MASON CITY 49.00 1.00 X 0 253993 21906 KAY TAKES VP PATIENT CARE DUBUQUE 50.00 0.00 X 0 252286 42138 LINDA KREI VP HR AND ORG INTEGRITY SIOUX CITY 49.00 1.00 X 0 246497 30458 GARY GUETZKO VP BUSINESS DEVELOPMENT DUBUQUE 50.00 0.00 X 0 236235 56627 ROBERT SHAFER CFO DUBUQUE 50.00 0.00 X 0 208330 81913 BRIAN MONSMA VP NETWORK DEVELOPMENT SIOUX CITY 48.00 2.00 X 0 204263 33512 TRACY LARSON CNO SIOUX CITY 50.00 0.00 X 0 199700 31181 SUE MEADE VP PROF & SUPP SVCS DUBUQUE 50.00 0.00 X 0 166961 26460 CARL J PLANK PHYSICIAN, DERMATOLOGY (MC) 50.00 0.00 X 927875 0 47681 JAMES R BAER PHYSICIAN, RADIATION ONCOLOGY (MC) 50.00 0.00 X 639744 0 50382 ARVIND PERATHUR PHYSICIAN, INTERNAL MEDICINE (MC) 50.00 0.00 X 616932 0 40586 MARK HAGANMAN PHYSICIAN, FAMILY MEDICINE (MC) 50.00 0.00 X 615543 0 57590 JAMES P KARKOS PHYSICIAN, DERMATOLOGY (MC) 50.00 0.00 X 588737 0 55693 MARIANNE CUNNINGHAM FORMER OFFICER 0.00 50.00 X 0 168430 28979 DANIEL HALE FORMER OFFICER 0.00 55.00 X 0 1302863 50680 MICHAEL SLUBOWSKI FORMER KEY EMPLOYEE 0.00 0.00 X 0 231799 0 JOSEPH SWEDISH FORMER OFFICER 0.00 0.00 X 0 1463995 28888 JAMES BOSSCHER FORMER OFFICER 0.00 55.00 X 0 820344 88666 KEDRICK ADKINS FORMER KEY EMPLOYEE 0.00 0.00 X 0 1808589 1739236 MARILYN KAPTAIN-DAHLEN FORMER KEY EMPLOYEE 0.00 0.00 X 0 308769 134018 STEVEN EAVENSON FORMER KEY EMPLOYEE 0.00 50.00 X 0 389051 35456 KIM PRICE FORMER KEY EMPLOYEE 0.00 0.00 X 140397 0 38163 LARRY WARREN FORMER OFFICER 0.00 9.00 X 0 1635500 0 3764992 23875130 3649305 268 1 1 0 MASON CITY CLINIC PC 250 S CRESCENT DRIVE MASON CITY IA 50401 MEDICAL SERVICES 13245729 UNITED CLINICAL LABORATORIES 205 BLUFF STREET DUBUQUE IA 52001 LABORATORY SERVICES 6446638 MEDICAL ASSOCIATES CLINIC PC 1500 ASSOCIATES DRIVE DUBUQUE IA 52002 MEDICAL SERVICES 2178793 STRATEGIC STAFFING SOLUTIONS 645 GRISWOLD ST SUITE 2900 DETROIT MI 48226 STAFFING SERVICES 1891055 NEUROSURGERY OF NORTH IOWA 1010 4TH ST SW STE 105 MASON CITY IA 50401 MEDICAL SERVICES 1807955 93 2120028 137642 44981 976040 2302651 NET PATIENT SVC REV 622110 563543504 563543504 PHARMACY REVENUE 446110 44782824 22894225 21888599 LABORATORY REVENUE 621500 3017279 3017279 611343607 4159017 4159017 1504570 1050287 454283 454283 454283 7915220 77082 0 240973 7915220 -163891 7751329 7751329 MANAGEMENT REVENUE 541618 3913657 3913657 CAFETERIA REVENUE 722514 3169753 3169753 MEDICARE/MEDICAID HIT 622110 2627502 2627502 29846396 28445478 1400918 39557308 665568195 598530141 27312422 37422981 835899 835899 17966 17966 6572804 271940 6300864 737786 205221 532565 234965040 211813198 23151842 15714066 14183268 1530798 20954347 18662398 2291949 16602890 14590620 2012270 2606269 2290389 315880 558591 558591 6166 6166 21391 21391 448774 394383 54391 48840641 42921155 5919486 1643575 1444374 199201 8753422 7692507 1060915 33277340 29244126 4033214 12679700 12045715 633985 1301433 1143699 157734 135144 118765 16379 7580451 7580451 34733645 32996963 1736682 6239549 5927572 311977 MEDICAL SUPPLIES 124340078 124340078 BAD DEBT 23661369 23661369 INTERCO. PURCHASED SVCS 23441035 20599982 2841053 CONTRACT LABOR 18154575 15954241 2200334 18040606 16223779 1816827 662864552 605160058 57683103 21391 4882422 4946385 471815 247647 76775470 79879367 2273794 2107786 16170896 16110528 1870097 1756619 594005879 393827738 187730323 200178141 152630539 161270308 135207705 132239048 1259569 184005 82394601 83854161 661667231 682773995 63011419 63982947 449476 212210 1870840 3108487 224766058 220439941 290097793 287743585 X 371093894 394797904 450544 207506 25000 25000 371569438 395030410 661667231 682773995 X 2703643 13903346 6853983 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 1 0 0 0 1 128200 1 1800 0 0 130000 0 PART II-B, LINE 1: MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS. THESE ORGANIZATIONS HAVE PROVIDED MHS-IA WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS THAT ARE USED FOR LOBBYING ACTIVITIES. SIMILARLY, THESE HEALTH CARE ORGANIZATIONS WILL ARRANGE CONFERENCES AND SEMINARS FOR MEMBER ORGANIZATIONS AND THEIR EXECUTIVES WHICH INVOLVE LEGISLATORS OR OTHER POLITICAL FIGURES AS GUEST SPEAKERS. AS A CATHOLIC HEALTH MINISTRY, WE ARE CALLED BOTH TO SERVE AND TO TRANSFORM. WE SERVE PEOPLE AND COMMUNITIES IN NEED, ESPECIALLY THE POOR AND UNDERSERVED. WE ALSO SEEK TO TRANSFORM SYSTEMS OF CARE AND POLICIES TO CREATE JUSTICE FOR ALL. ADVOCACY AT OUR SYSTEM SUPPORTS BOTH OF THESE FOUNDATIONAL ELEMENTS OF OUR FAITH-BASED MISSION. WE ADVOCATE FOR POLICIES THAT SUPPORT OUR CAPACITY TO SERVE OTHERS (E.G., MEDICARE PAYMENTS). WE ALSO ADVOCATE FOR FUNDAMENTAL CHANGE, TO TRANSFORM, BY SEEKING ACCESS TO HEALTHCARE FOR ALL. OUR 2014 FEDERAL ADVOCACY GOALS INCLUDED: - SUSTAINABLE MEDICARE PAYMENT AND VALUE-BASED REIMBURSEMENT - REPEAL OF MEDICARE PHYSICIAN PAYMENT SUSTAINABLE GROWTH RATE (SGR) - REFORM OF RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM - PACE FUNDING, ADAPTABILITY, AND AWARENESS OUR 2014 STATE ADVOCACY GOALS INCLUDED: - HEALTH INSURANCE EXCHANGE ENROLLMENT - MEDICAID EXPANSION AND VALUE-BASED ENROLLMENT - WORKFORCE TRANSFORMATION - PACE ACCESS, FUNDING AND AWARENESS - BEHAVIORAL HEALTH ACCESS AND REIMBURSEMENT LOBBYING ACTIVITY PERFORMED BY MHS-IA INCLUDED: - AN "ADVOCACY ACTION" WEBSITE TO ENGAGE ASSOCIATES IN FEDERAL ADVOCACY - DESIGNATE AN ADVOCACY LIAISON - ENGAGEMENT OF A LOBBYIST IN WASHINGTON, D.C. BY TRINITY HEALTH CORPORATION - LEGISLATOR VISITS - COLLABORATION WITH THE CATHOLIC HOSPITAL ASSOCIATION, AND THE AMERICAN HOSPITAL ASSOCIATION - COLLABORATION WITH THE IOWA HOSPITAL ASSOCIATION - ADVOCACY ACTION DAY AT THE STATE LEVEL ATTENDED BY EXECUTIVES REPRESENTING MEMBER HOSPITALS 25000 25000 25000 25000 25000 25000 25000 25000 25000 25000 1.00000 1 1 1 10445234 10445234 341290787 229690883 111599904 215309873 163785692 51524181 26959985 351163 26608822 200178141 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 28135968 F EQUITY METHOD INVESTMENTS 61899129 C HEDGE FUNDS 42203951 F 132239048 OTHER RECEIVABLES 12898752 INTERCOMPANY ACCOUNTS RECEIVABLE 2021783 INVESTMENT IN AFFILIATES 28863358 OTHER ASSETS 2544742 INTERCOMPANY OTHER LT ASSETS 37525526 83854161 INTERCOMPANY ACCOUNTS PAYABLE 5626951 DEFERRED COMPENSATION 11781819 LONG TERM ASSET RETIREMENT OBLIGATION (FIN 47) 3819318 INTERCOMPANY NOTES PAYABLE 197374695 OTHER LIABILITIES 1779724 LEASE OBLIGATION 1770 ANNUITY PAYABLE 55664 220439941 PART V, LINE 4: THE ENDOWMENT FUNDS OF MERCY HEALTH SERVICES - IOWA, CORP. INCLUDE $25,000 KNOWN AS THE VIANNA HOLSCHLAG SCHOLARSHIP FUND. INTEREST INCOME FROM THE FUND IS MADE AVAILABLE FOR NURSING SCHOLARSHIPS. 1 ME&V 6711 CHANCELLOR DRIVE CEDAR FALLS IA 50613 FUNDRAISING ANALYSIS 0 0 21391 0 21391 1 1 X 1 X 1 X 1 1 0 1 1 5 11320 10864879 10864879 0.01700 66 63090 53186765 46164567 7022198 0.01100 71 74410 64051644 46164567 17887077 0.02800 75 165644 3359712 119298 3240414 0.00510 14 19589 7870194 3266727 4603467 0.00720 39 46848 18087494 8735660 9351834 0.01460 3 1097 189662 95264 94398 0.00010 32 74697 946994 59116 887878 0.00140 163 307875 30454056 12276065 18177991 0.02840 234 382285 94505700 58440632 36065068 0.05640 1 30 350 350 0.00000 1 70 38 38 0.00000 2 243 4216 4216 0.00000 1 60 700 700 0.00000 5 25031 121094 121094 0.00020 10 25434 126398 126398 0.00020 0 7851191 0 210190102 222169824 -11979722 X 1 1 1 FOREST PARK IMAGING LLC IMAGING SERVICES 0.52890 0.47110 2 MAGNETIC RESONANCE SERVICES PARTNERSHIP MRI SERVICES 0.49000 0.51000 3 MASON CITY AMBULATORY SURGERY CENTER LLC AMBULATORY SURGICAL SERVICES 0.51000 0.49000 4 MERCY HEART CENTER OUTPATIENT SERVICES LLC OUTPATIENT ECHOCARDIOGRAPHY AND NUCLEAR MEDICINE SERVICES 0.51000 0.49000 5 SURGICAL CENTER BUILDING ASSOCIATES LLC OWNS AND LEASES SURGICAL CENTER BUILDING 0.35000 0.65000 6 SIOUXLAND SURGERY CENTER LLP AMBULATORY SURGICAL SERVICES 0.30940 0.69060 7 HEALTH MANAGEMENT SERVICES LLC AMBULATORY SURGICAL SVCS, OCCUPATIONAL HLTH SVCS AND PRIMARY CARE PHYS SVCS 0.50000 0.50000 8 NORTH IOWA COMMUNITY HEALTHCARE LLC HEALTHCARE PROVIDERS AND MANAGEMENT SERVICES 0.20450 0.45450 9 PREFERRED HEALTH CHOICES LLC MANAGEMENT SERVICES 0.50000 0.50000 6 1 MERCY MEDICAL CENTER-NORTH IOWA 1000 FOURTH STREET SW MASON CITY IA 50401 WWW.MERCYNORTHIOWA.COM 170023H X X X X X 2 MERCY MEDICAL CENTER-SIOUX CITY 801 FIFTH STREET SIOUX CITY IA 51102 WWW.MERCYSIOUXCITY.COM 970112H X X X EMPLOYED PHYSICIANS, SKILLED CARE UNIT 3 MERCY MEDICAL CENTER - DUBUQUE 250 MERCY DRIVE DUBUQUE IA 52001 WWW.MERCYDUBUQUE.COM 310003H X X X REHAB,LAB,PHARM, X-RAY,HOME CARE 4 SIOUXLAND SURGERY CENTER 600 SIOUX POINT ROAD DAKOTA DUNES SD 57049 WWW.SIOUXLANDSURG.COM 10580 X X 5 MERCY MEDICAL CENTER-NEW HAMPTON 308 NORTH MAPLE AVE NEW HAMPTON IA 50659 WWW.MERCYNEWHAMPTON.COM 190022H X X X EMPLOYED PHYSICIANS 6 MERCY MEDICAL CENTER - DYERSVILLE 1111 THIRD STREET SW DYERSVILLE IA 52040 WWW.MERCYDUBUQUE.COM/MERCY-DYERSVILLE 310181H X X X X REHAB,LAB,PHARM, X-RAY,HOME CARE MERCY MEDICAL CENTER-NORTH IOWA 1 1 X X X X X X X X X 13 1 0 1 X SEE SCHEDULE H, PART V, SECTION C X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 MERCY MEDICAL CENTER-SIOUX CITY 2 1 X X X X X X X X 12 1 1 1 X WWW.MERCYSIOUXCITY.COM/COMMUNITY-BENEFIT X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 MERCY MEDICAL CENTER-DUBUQUE 3 1 X X X X X X X X X 11 1 1 1 X WWW.MERCYDUBUQUE.COM/COMMUNITY-BENEFIT X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 SIOUXLAND SURGERY CENTER 4 1 X X X X X X X X X 12 1 1 1 X WWW.MERCYSIOUXCITY.COM/COMMUNITY-BENEFIT X X X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X X 1 1 X 0 0 X X X X 0 X X 0 0 MERCY MEDICAL CENTER-NEW HAMPTON 5 1 X X X X X X X X 12 1 0 1 X SEE SCHEDULE H, PART V, SECTION C X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 MERCY MEDICAL CENTER-DYERSVILLE 6 1 X X X X X X X X X 13 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 MERCY MEDICAL CENTER-NORTH IOWA PART V, SECTION B, LINE 3: TRAINED FACILITATORS LED THESE FOCUS GROUPS: HISPANIC COMMUNITY GROUP, COMMUNITY KITCHEN GROUP, AND SENIOR CITIZENS GROUP. A UNIVERSITY OF DES MOINES PUBLIC HEALTH CONSULTANT-LED SURVEY WAS USED FOR FIVE PUBLICIZED COMMUNITY LISTENING GROUPS. A QUESTIONNAIRE SURVEY WAS EMAILED TO THE STAFF OF THE LARGEST EMPLOYER IN NORTH IOWA AS WELL AS TO SOCIAL SERVICE AGENCIES IN THE AREA AND TO THE MINISTERIAL GROUP AT THE COUNTY SEAT. INPUT FROM THE COMMUNITY BENEFIT TASK FORCE REPRESENTS HOSPITAL STAFF WHO DIRECTLY TOUCH THE UNINSURED AND UNDERINSURED POPULATION (FINANCIAL AND MEDICATION ASSISTANCE, PHARMACISTS, CASE MANAGEMENT, HISPANIC CLINIC, BEHAVIORAL HEALTH, COMMUNITY CARE COORDINATION PROJECT (IOWA SAFETY NET FUNDED) ETC.), AS WELL AS REPRESENTATIVES OF COMMUNITY HUMAN SERVICE AGENCIES (PUBLIC HEALTH, COMMUNITY ACTION, SALVATION ARMY, HOMELESS SHELTERS, CRISIS INTERVENTION, CERRO GORDO COUNTY FREE CLINIC (NON-MERCY), ETC.), SCHOOL SYSTEMS, MINISTERIAL, RETIRED MILITARY, AND RETIRED HOSPITAL ADMINISTRATION. MERCY MEDICAL CENTER-SIOUX CITY PART V, SECTION B, LINE 3: MERCY MEDICAL CENTER-SIOUX CITY'S (SC) STAFF CONSULTED AGENCIES PROVIDING SOCIAL SERVICE DIRECTLY TO THE POOR AND THE MARGINALIZED. MERCY MEDICAL CENTER-SC NETWORKED WITH LOCAL CHURCHES AND HOSTED COMMUNITY EVENTS ON SITE AT THE HOSPITAL AND IN THE COMMUNITY. COMMUNITY MEMBERS WHO WOULD BE DIRECT RECIPIENTS OF THE SERVICES PARTICIPATED AT THESE EVENTS ALONG WITH PROVIDERS. THIS INFORMATION WAS SUPPLEMENTED WITH RESEARCH FROM THE SIOUXLAND SOCIAL SCIENCE RESEARCH CENTER. IN EARLY 2013, BRIAR CLIFF UNIVERSITY'S SIOUXLAND RESEARCH CENTER (SRC) WAS CONTACTED BY THE COMPREHENSIVE STRATEGY COUNCIL ABOUT CONDUCTING A STUDY OF WOODBURY COUNTY RESIDENTS WHOSE INCOME LEVELS FELL AT OR BELOW THE POVERTY LEVEL. THE PRIMARY PURPOSE OF THE STUDY WAS TO HELP DETERMINE WHAT BARRIERS, IF ANY, PREVENTED RESIDENTS FROM UTILIZING SOCIAL SERVICE AGENCIES IN THE SIOUXLAND AREA. TO HELP ANSWER THIS QUESTION, THE SRC FIRST CONDUCTED FOCUS GROUPS WITH MEMBERS OF THE TARGET POPULATION, AND THEN MAILED SURVEYS TO APPROXIMATELY 1500 WOODBURY COUNTRY RESIDENTS WHO MET STUDY CRITERIA. MERCY MEDICAL CENTER-SC PARTICIPATES IN MONTHLY COLLABORATIVE SESSIONS AS PART OF THE HEALTHY SIOUXLAND INITIATIVE. THIS GROUP HOLDS QUARTERLY JOINT MEETINGS WITH THE SIOUXLAND COMPREHENSIVE COLLABORATIVE.MERCY MEDICAL CENTER-SC MET WITH THE BOARD OF DIRECTORS, ADMINISTRATORS, AND KEY PHYSICIANS FROM THE SIOUXLAND SURGERY CENTER TO SOLICIT INPUT AND PARTICIPATION IN THE COMMUNITY BENEFIT PLANS FOR THE TRI-STATE AREA. MERCY MEDICAL CENTER-SC PARTICIPATED IN THE CONVOY OF HOPE AND PROVIDED DIRECT EDUCATION AND RECEIVED DIRECT INPUT REGARDING NEEDS FROM 4,000 POOR AND/OR MARGINALIZED IN OUR COMMUNITY. MERCY MEDICAL CENTER-DUBUQUE PART V, SECTION B, LINE 3: THE PROCESS INVOLVED GATHERING COMMUNITY STAKEHOLDERS WHO HAVE A ROLE IN THE DELIVERY AND PARTNERSHIP OF PUBLIC HEALTH SERVICES. A STEERING COMMITTEE WAS FORMED TO OVERSEE THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT -HEALTH IMPROVEMENT PLAN PROCESS. THE STEERING COMMITTEE CONSISTED OF STAFF FROM THE COUNTY BOARD OF HEALTH, COUNTY HEALTH DEPARTMENT, DUBUQUE VISITING NURSE ASSOCIATION, THE CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT, AND MERCY MEDICAL CENTER. AS DESCRIBED IN THE CHNA DOCUMENT, FOUR COMMUNITY FORUMS WERE HELD ON DIFFERENT DAYS OF THE WEEK, TIMES OF THE DAY, AND LOCATIONS AROUND THE COUNTY TO PROVIDE OPPORTUNITIES FOR COMMUNITY MEMBERS TO PROVIDE INPUT TO THE PLANNING PROCESS. THE MEETINGS WERE WIDELY PUBLICIZED IN THE LOCAL NEWSPAPER, HOSPITAL NEWSLETTERS, AND THE NEWSLETTERS AND WEBSITES OF OTHER COMMUNITY ORGANIZATIONS. SIOUXLAND SURGERY CENTER PART V, SECTION B, LINE 3: SIOUXLAND SURGERY CENTER COLLABORATED WITH MERCY MEDICAL CENTER - SIOUX CITY AND UNITY POINT-ST. LUKE'S REGIONAL MEDICAL CENTER IN CONDUCTING THE CHNA. PLEASE SEE EXPLANATION UNDER MERCY MEDICAL CENTER - SIOUX CITY FOR MORE INFORMATION. MERCY MEDICAL CENTER-NEW HAMPTON PART V, SECTION B, LINE 3: THE ASSESSMENT PROCESS WAS INITIATED BY MERCY MEDICAL CENTER - NEW HAMPTON (MMC-NH). A PLANNING TEAM WAS FORMED CONSISTING OF REPRESENTATIVES FROM HOSPITAL GOVERNANCE, LEADERSHIP AND MEDICAL STAFF, AREA EMPLOYERS, SCHOOL DISTRICTS AND AREA HEALTH PROFESSIONALS. FACILITATED BY AN OUTSIDE CONSULTANT, FOUR SEPARATE DISCUSSION GROUPS WERE HELD LOCALLY. THE GROUPS REPRESENTED VARYING SECTORS IN THE COMMUNITY: (1) SOCIAL SERVICE PARTNERS, (2) PATIENTS, (3) COMMUNITY/BUSINESS REPRESENTATIVES, AND (4) INDUSTRIAL WORKERS. THERE WAS A 63% RESPONSE TO INVITATIONS TO PARTICIPATE. THE PATIENT GROUP WAS PULLED RANDOMLY FROM A PATIENT LISTING OVER THE PRECEDING 6 MONTHS, SOCIAL SERVICE PARTNERS WERE A CROSS-SECTION OF THE AGENCIES MMH-NH WORKS CLOSELY WITH, AND COMMUNITY LEADERS/BUSINESS OWNERS WERE SELECTED FOR THEIR KNOWLEDGE OF THE COMMUNITY. INDUSTRIAL WORKERS ON GROUP 4 WERE IDENTIFIED BY THEIR EMPLOYER.FOUR PARTICIPANTS WERE FROM OUTSIDE NEW HAMPTON (FREDERICKSBURG, LAWLER AND ALTA VISTA); ALL OTHERS WERE FROM NEW HAMPTON. THE OUTSIDE CONSULTANT COLLATED AND ANALYZED THE FOCUS GROUP RESULTS WITH SUPPORT FROM MERCY MEDICAL CENTER - NORTH IOWA'S PLANNING & MARKETING TEAM IN MASON CITY. MERCY MEDICAL CENTER-DYERSVILLE PART V, SECTION B, LINE 3: THE PROCESS INVOLVED GATHERING COMMUNITY STAKEHOLDERS WHO HAVE A ROLE IN THE DELIVERY AND PARTNERSHIP OF PUBLIC HEALTH SERVICES. A STEERING COMMITTEE WAS FORMED TO OVERSEE THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT -HEALTH IMPROVEMENT PLAN PROCESS. THE STEERING COMMITTEE CONSISTED OF STAFF FROM THE COUNTY BOARD OF HEALTH, COUNTY HEALTH DEPARTMENT, DUBUQUE VISITING NURSE ASSOCIATION, THE CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT, AND MERCY MEDICAL CENTER. AS DESCRIBED IN THE CHNA DOCUMENT, FOUR COMMUNITY FORUMS WERE HELD ON DIFFERENT DAYS OF THE WEEK, TIMES OF THE DAY, AND LOCATIONS AROUND THE COUNTY TO PROVIDE OPPORTUNITIES FOR COMMUNITY MEMBERS TO PROVIDE INPUT TO THE PLANNING PROCESS. THE MEETINGS WERE WIDELY PUBLICIZED IN THE LOCAL NEWSPAPER, HOSPITAL NEWSLETTERS, AND THE NEWSLETTERS AND WEBSITES OF OTHER COMMUNITY ORGANIZATIONS. MERCY MEDICAL CENTER-SIOUX CITY PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - SIOUX CITY'S CHNA WAS CONDUCTED WITH ST. LUKE'S REGIONAL MEDICAL CENTER AND SIOUXLAND SURGERY CENTER. MERCY MEDICAL CENTER-DUBUQUE PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - DUBUQUE CONDUCTED ITS CHNA WITH MERCY MEDICAL CENTER - DYERSVILLE. SIOUXLAND SURGERY CENTER PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - SIOUX CITY AND ST. LUKE'S REGIONAL MEDICAL CENTER MERCY MEDICAL CENTER-DYERSVILLE PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - DYERSVILLE CONDUCTED ITS CHNA WITH MERCY MEDICAL CENTER - DUBUQUE. MERCY MEDICAL CENTER-SIOUX CITY PART V, SECTION B, LINE 5D: THE CHNA WAS DISTRIBUTED TO SOCIAL AGENCIES AND THE PLAN TO ADDRESS UNMET NEEDS WAS EXPLAINED. MERCY MEDICAL CENTER-NORTH IOWA PART V, SECTION B, LINE 7: AS THE TASK FORCE PRIORITIES WERE STUDIED MORE CLOSELY IN LIGHT OF LIMITED CAPACITY AND ACTIVITY ALREADY IN PLACE, THE FOLLOWING IDENTIFIED NEEDS WERE SELECTED TO NOT BE DIRECTLY ADDRESSED:1. COMMUNITY CONSCIOUSNESS OF COMMUNITY WELLNESS IS REFLECTED IN ITS HIGH RANK. HOWEVER, THE COMMUNITY IS ALREADY ADDRESSING THIS NEED IN A VARIETY OF COLLABORATIVE WAYS.2. THE NEED FOR IMPROVED PARENTING SKILLS/SELF-RESPONSIBILITY IS CAUSAL TO MANY OTHER NEEDS AND IS BEING ADDRESSED THROUGH INTRODUCTION OF THE NURTURED HEART APPROACH FOR COMMUNICATION STYLE ACROSS HUMAN SERVICE AGENCIES AND HOSPITAL HEALTH COACHES. 3. CHRONIC DISEASE MANAGEMENT FOR DIABETES AND HEART DISEASE ARE COMPONENTS OF SEVERAL CURRENT COMMUNITY-WIDE INITIATIVES.4. TRANSPORTATION WILL ALWAYS BE A BARRIER IN RURAL AREAS. THIS ASPECT OF "ACCESS TO CARE" IS A SHARED RESPONSIBILITY WITHIN THE BROADER COMMUNITY AND THERE ARE GROUPS ALREADY LOOKING AT THIS AND SEEKING ADVOCACY AT THE STATE LEVEL.5. THE ISSUE OF SAFETY HAS A SCOPE OR SERVICE THAT IS VERY BROAD, ENCOMPASSING FARM ACCIDENTS, MOTORCYCLE ACCIDENTS, HOME FALLS, ETC. CAPACITY DOES NOT ALLOW A TARGETED FOCUS AT THIS TIME. MERCY MEDICAL CENTER-DUBUQUE PART V, SECTION B, LINE 7: THE FOLLOWING PROBLEMS OR NEEDS WERE IDENTIFIED, BUT NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY OR OTHER REASONS LISTED. 1. CANCER PREVENTION/EARLY DETECTION: TOBACCO USE (SMOKING 16%) 44% RATE (STATE 39.5%/100,000). 2. SUBSTANCE ABUSE (BINGE DRINKING, MARIJUANA USE, PRESCRIPTION DRUGS, TOBACCO, ALCOHOL); INCLUDES HIGH RISK BEHAVIOR BY YOUTH USING ALCOHOL AND DRUG USE. 3. MENTAL HEALTH ACCESS IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF HUMAN RESOURCES OR STAFF. 4. HIGH RISK SEXUAL BEHAVIORS INCLUDING YOUTH INITIATING SEXUAL ACTIVITY AT YOUNGER AGE IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF FINANCIAL RESOURCES. 5. PREVENTION/SCREENING FOR CHRONIC DISEASE. 6. ACCESS TO PRENATAL CARE IN 1ST TRIMESTER OF PREGNANCY. 7. NEED FOR INCREASED EDUCATION ON HEALTHY LIFESTYLE BEHAVIORS (INCLUDING REGULAR EXERCISE AND HEALTHY DIET/NUTRITION HABITS) AMONG YOUNG (PRE-SCHOOL TO GRADE SCHOOL) CHILDREN IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND COMMUNITY PARTNERS DO NOT EXIST. 8. ACCESS TO MEDICAL AND DENTAL CARE FOR ALL AGES AND ACCESS TO VACCINES FOR ADULTS IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF FINANCIAL RESOURCES.9. RESPITE CARE SERVICES FOR CAREGIVERS IN THE HOME SETTING IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF ACCESS TO TECHNICAL ASSISTANCE AND SERVICES. 10. COMMUNITY AWARENESS TO ACCESS SERVICES FOR RESIDENTS/FAMILIES DISCHARGED FROM THE MILITARY AND VETERANS REGARDLESS OF AGE IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY, LACK OF ACCESS TO TECHNICAL ASSISTANCE AND SERVICES, AND LEAD ORGANIZATION DOES NOT EXIST. SIOUXLAND SURGERY CENTER PART V, SECTION B, LINE 7: SIOUXLAND SURGERY CENTER ADDRESSED COMMUNITY HEALTH NEEDS WITHIN THE SCOPE OF THE HOSPITAL'S EXPERTISE (EXERCISE AND NUTRITION FOR YOUTH, POVERTY, AND SOCIAL DETERMINANTS IMPACTING HEALTH). MENTAL HEALTH SERVICES AND PRIMARY CARE ARE NOT WITHIN THE SCOPE OF THE ORGANIZATION, AND OTHERS IN THE COMMUNITY ARE BETTER SKILLED TO ADDRESS THESE NEEDS. MERCY MEDICAL CENTER-NEW HAMPTON PART V, SECTION B, LINE 7: MMC-NH HAS CHOSEN NOT TO DIRECTLY ADDRESS THESE COMMUNITY NEEDS: PHYSICAL INACTIVITY AND ACCESS TO RECREATION AND FITNESS FACILITIES. THOUGH THE 8.04 ESTABLISHMENT RATE PER 100,000 POPULATION IS WELL BELOW BOTH IOWA'S AND THE COUNTRY'S AVERAGES, MMC-NH BELIEVES THAT WORKING WITH AND THROUGH THE CHICKASAW WELLNESS CENTER TO MAXIMIZE ITS ALREADY-EXCELLENT ROSTER OF PROGRAMS AND SERVICES IS A MORE EFFECTIVE USE OF SCARCE COMMUNITY RESOURCES.CHICKASAW COUNTY'S PERCENT OF MEDICARE ENROLLEES WITH DIABETES HAVING AN ANNUAL EXAM (87.21%) IS AGAIN BELOW IOWA'S BENCHMARK, AS A MEMBER OF THE MERCY HEALTH NETWORK, MMC-NH BELIEVES THAT WORKING WITHIN THE NETWORK'S OVERALL STRATEGY FOR MANAGING DIABETES AND OTHER CHRONIC DISEASES IS, AGAIN, A MORE EFFECTIVE USE OF SCARCE INSTITUTIONAL RESOURCES. MMC-NH'S CLINICAL TEAM, INCLUDING PHYSICIANS, IS PLAYING AN ACTIVE ROLE IN BRINGING THE NETWORK'S METHODOLOGIES TO NEW HAMPTON AND CHICKASAW COUNTY. MERCY MEDICAL CENTER-DYERSVILLE PART V, SECTION B, LINE 7: THE FOLLOWING PROBLEMS OR NEEDS WERE IDENTIFIED, BUT NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY OR OTHER REASONS LISTED. 1. CANCER PREVENTION/EARLY DETECTION: TOBACCO USE (SMOKING 16%) 44% RATE (STATE 39.5%/100,000). 2. SUBSTANCE ABUSE (BINGE DRINKING, MARIJUANA USE, PRESCRIPTION DRUGS, TOBACCO, ALCOHOL); INCLUDES HIGH RISK BEHAVIOR BY YOUTH USING ALCOHOL AND DRUG USE. 3. MENTAL HEALTH ACCESS IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF HUMAN RESOURCES OR STAFF. 4. HIGH RISK SEXUAL BEHAVIORS INCLUDING YOUTH INITIATING SEXUAL ACTIVITY AT YOUNGER AGE IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF FINANCIAL RESOURCES. 5. PREVENTION/SCREENING FOR CHRONIC DISEASE. 6. ACCESS TO PRENATAL CARE IN 1ST TRIMESTER OF PREGNANCY. 7. NEED FOR INCREASED EDUCATION ON HEALTHY LIFESTYLE BEHAVIORS (INCLUDING REGULAR EXERCISE AND HEALTHY DIET/NUTRITION HABITS) AMONG YOUNG (PRE-SCHOOL TO GRADE SCHOOL) CHILDREN IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND COMMUNITY PARTNERS DO NOT EXIST. 8. ACCESS TO MEDICAL AND DENTAL CARE FOR ALL AGES AND ACCESS TO VACCINES FOR ADULTS IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF FINANCIAL RESOURCES.9. RESPITE CARE SERVICES FOR CAREGIVERS IN THE HOME SETTING IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF ACCESS TO TECHNICAL ASSISTANCE AND SERVICES. 10. COMMUNITY AWARENESS TO ACCESS SERVICES FOR RESIDENTS/FAMILIES DISCHARGED FROM THE MILITARY AND VETERANS REGARDLESS OF AGE IS NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY, LACK OF ACCESS TO TECHNICAL ASSISTANCE AND SERVICES, AND LEAD ORGANIZATION DOES NOT EXIST. MERCY MEDICAL CENTER-NORTH IOWA PART V, SECTION B, LINE 12I: 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 HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY MEDICAL CENTER-SIOUX CITY PART V, SECTION B, LINE 12I: 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 HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY MEDICAL CENTER-DUBUQUE PART V, SECTION B, LINE 12I: 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 HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY MEDICAL CENTER-NEW HAMPTON PART V, SECTION B, LINE 12I: 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 HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY MEDICAL CENTER-DYERSVILLE PART V, SECTION B, LINE 12I: 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 HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY MEDICAL CENTER-NORTH IOWA PART V, SECTION B, LINE 14G: SIGNS ARE POSTED AND BROCHURES ARE AVAILABLE IN PATIENT REGISTRATION AREAS (INCLUDING CENTRAL ADMISSIONS, EMERGENCY DEPARTMENT AND MERCY CLINIC RECEPTION AREAS) EXPLAINING THAT ASSISTANCE IS AVAILABLE AND THE CONTACT INFORMATION FOR THE FINANCIAL COUNSELORS. COUNSELORS ALSO PROVIDE THE POLICY TO PATIENTS WHEN REQUESTED.ASSISTANCE AVAILABILITY AND CONTACT INFORMATION FOR THE FINANCIAL COUNSELORS IS PRINTED ON PATIENT BILLING STATEMENTS. MERCY MEDICAL CENTER-SIOUX CITY PART V, SECTION B, LINE 14G: SUMMARY INFORMATION IS PROVIDED TO PATIENTS IN THEIR ADMISSION PACKETS RELATED TO FINANCIAL ASSISTANCE AND PATIENT BALANCE RESOLUTION. BROUCHURES ARE AVAILABLE IN CENTRAL REGISTRATION AND THE EMERGENCY DEPARTMENT THAT SUMMARIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS. SUMMARY STATEMENTS ARE PRESENT ON THE PATIENTS BILL STATING THAT ASSISTANCE MAY BE AVAILABLE. FINANCIAL COUNSELORS DO VISIT WITH ALL UNINSURED INPATIENTS AND OFFER ASSISTANCE THROUGH THE FINANCIAL ASSISTANCE PROGRAM. THE DETAILED POLICY IS AVAILABLE TO PATIENTS UPON REQUEST FROM ON-SITE FINANCIAL COUNSELORS NEAR CENTRAL REGISTRATION AND THE EMERGENCY DEPARTMENT. INFORMATION ON THE FINANCIAL ASSISTANCE PROGRAM CAN ALSO BE OBTAINED BY CALLING THE SHARED SERVICE CENTER CUSTOMER SERVICE LINE. A COMPREHENSIVE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE. MERCY MEDICAL CENTER-NEW HAMPTON PART V, SECTION B, LINE 14G: BROCHURES ARE AVAILABLE IN PATIENT REGISTRATION AREAS (INCLUDING HOSPITAL REGISTRATION, EMERGENCY DEPARTMENT AND MERCY CLINIC RECEPTION AREAS) EXPLAINING THAT ASSISTANCE IS AVAILABLE AND THE CONTACT INFORMATION FOR THE FINANCIAL COUNSELORS. COUNSELORS ALSO PROVIDE THE POLICY TO PATIENTS WHEN REQUESTED.ASSISTANCE AVAILABILITY AND CONTACT INFORMATION FOR THE FINANCIAL COUNSELORS IS PRINTED ON PATIENT BILLING STATEMENTS. A COMPREHENSIVE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE. MERCY MEDICAL CENTER-NORTH IOWA PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. MERCY MEDICAL CENTER-SIOUX CITY PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. MERCY MEDICAL CENTER-DUBUQUE PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. SIOUXLAND SURGERY CENTER PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. MERCY MEDICAL CENTER-NEW HAMPTON PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. MERCY MEDICAL CENTER-DYERSVILLE PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. MERCY MEDICAL CENTER - NORTH IOWA - PART V, SECTION B, LINE 5A HTTP://WWW.MERCYNORTHIOWA.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT MERCY MEDICAL CENTER - NEW HAMPTON - PART V, SECTION B, LINE 5A HTTP://WWW.MERCYNEWHAMPTON.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT MERCY MEDICAL CENTER - DYERSVILLE - PART V, SECTION B, LINE 5A HTTP://WWW.MERCYDUBUQUE.COM/DYERSVILLE-COMMUNITY-BENEFIT 15 MEDICAL ASSOCIATES WEST CAMPUS 1500 ASSOCIATES DRIVE DUBUQUE IA 52001 OCC. HEALTH, PHYS THER, AMBULATORY SURGERY MEDICAL ASSOCIATES CLINIC 1240 BIG JACK ROAD PLATTEVILLE WI 53818 X-RAY, LAB, EMPLOYED PHYSICIANS TRI-STATE OCCUPATIONAL HEALTH 1920 ELM STREET DUBUQUE IA 52001 PHYS THERAPY,EMPLOYED PHYSICIANS MEDICAL ASSOCIATES CLINIC 10988 BARTELL BLVD GALENA IL 61036 HOME CARE,LAB, EMPLOYED PHYSICIANS MERCY MEDICAL CENTER - DYERSVILLE 1121 THIRD STREET SW DYERSVILLE IA 52040 EMPLOYED PHYSICIANS MEDICAL ASSOCIATES CLINIC 208 N 12TH STREET BELLEVUE IA 52031 EMPLOYED PHYSICIANS MEDICAL ASSOCIATES CLINIC 911 NW CARTER ELKADER IA 52043 EMPLOYED PHYSICIANS CASCADE FAMILY HEALTH CENTER 805 JOHNSON STREET SW CASCADE IA 52033 EMPLOYED PHYSICIANS, LAB, X-RAY, PT MEDICAL ASSOCIATES CLINIC 117 SOUTH MADISON CUBA CITY WI 53807 X-RAY, LAB, EMPLOYED PHYSICIANS MEDICAL ASSOCIATES CLINIC 560 PLEASANT ST ELIZABETH IL 61028 EMPLOYED PHYSICIANS MEDICAL ASSOCIATES CLINIC 107 S PAGE MONONA IA 52159 EMPLOYED PHYSICIANS MEDICAL ASSOCIATES EAST CAMPUS 1000 LANGWORTHY DUBUQUE IA 52001 OCC. HEALTH, PHYSICAL THERAPY MERCY DAKOTA DUNES 705 SIOUX POINT ROAD DAKOTA DUNES SD 57049 WEIGHT LOSS CENTER MASON CITY SURGERY CENTER 990 4TH STREET MASON CITY IA 50401 AMBULATORY SURGERY MERCY FAMILY PRACTICE - BUFFALO CENTER 115 NORTH MAIN BUFFALO CENTER IA 50424 X-RAY, LAB, EMPLOYED PHYSICIANS PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: MERCY HEALTH SERVICES-IOWA (MHS-IA) 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, THE HOSPITAL DIVISIONS OF MERCY HEALTH SERVICES-IOWA INCLUDE A COPY OF THEIR MOST RECENT SCHEDULE H ON THEIR RESPECTIVE WEBSITES. TRINITY HEALTH ALSO INCLUDES MHS-IA'S MOST RECENTLY FILED SCHEDULE H ON ITS WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITALS' COST ACCOUNTING SYSTEMS. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $23,661,369, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: MERCY MEDICAL CENTER - NORTH IOWA (MMC-NI):AS THE LARGEST EMPLOYER IN OUR 14-COUNTY AREA, MHS-IA, DOING BUSINESS AS MERCY MEDICAL CENTER - NORTH IOWA TAKES CIVIC RESPONSIBILITY VERY SERIOUSLY. WORKFORCE DEVELOPMENT: NORTH IOWA IS NOT ALWAYS THE PREFERRED LOCATION OF CHOICE FOR MEDICAL PROFESSIONALS. FOR THIS REASON, MERCY MEDICAL CENTER - NORTH IOWA ACTIVELY RECRUITS PHYSICIANS IN AN EFFORT TO PROMOTE ACCESSIBLE HEALTH CARE TO THE RESIDENTS OF THE COMMUNITIES WE SERVE THAT HAVE BEEN DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND/OR MEDICALLY UNDERSERVED AREA (MUA). THESE EFFORTS SUPPORT THE COMMUNITIES BY PROVIDING EXPERTISE AND HEALTHCARE SERVICES, AND, AS A CLAUSE IN THEIR CONTRACT STATES, SPECIAL CARE FOR INDIGENT AND UNDERSERVED POPULATIONS. MERCY MEDICAL CENTER - SIOUX CITY:THE CHANGING DEMOGRAPHICS OF THE SIOUXLAND AREA REQUIRE AN UNDERSTANDING OF AND COMMITMENT TO DIVERSITY AND INCLUSION. MERCY MEDICAL CENTER-SIOUX CITY IS ENGAGED IN A COMPREHENSIVE PHYSICIAN RECRUITING EFFORT TO BRING NEEDED PHYSICIANS TO HEALTH PROFESSIONAL SHORTAGE AREAS. PHYSICIANS ARE RECRUITED BASED ON COMMUNITY NEED/SHORTAGE. WE ADVOCATE FOR AND SPEND RESOURCES TO BRING PHYSICIANS TO OUR COMMUNITY. THE PHYSICIANS USUALLY HAVE PRIVILEGES AT BOTH LOCAL HOSPITALS. AREAS OF CONCERN/NEED ARE RADIATION ONCOLOGY, PSYCHIATRY, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, ANESTHESIOLOGY, CARDIOLOGY, AND NEUROLOGY. WE WERE SUCCESSFUL (IN COLLABORATION WITH UNITY POINT & THE SIOUXLAND MENTAL HEALTH CENTER) TO BRING A MUCH NEEDED PSYCHIATRIST TO THE AREA.MERCY MEDICAL CENTER - SIOUX CITY HAS PLEDGED FUNDS (DONATION) TO SUPPORT THE MAINTENANCE OF THE SHEPHERD'S GARDEN THAT WILL BE COMPLETED IN 2015.MERCY MEDICAL CENTER - SIOUX CITY (HUMAN RESOURCES) PARTNERED WITH NATIVE AMERICAN SCHOOLS IN WINNEBAGO, NEBRASKA ON PROJECT SEARCH. THIS JOINT EFFORT ENABLED NATIVE AMERICANS TO PARTICIPATE IN A 5TH YEAR SENIOR JOB TRAINING PROGRAM, WITH GRADUATION. THE PROGRAM IS WELL RECEIVED AND PRODUCED GREAT RESULTS FOR TRAINING AND HELPING YOUNG ADULTS BECOME EMPLOYABLE.MERCY MEDICAL CENTER - NEW HAMPTON (MMC-NH):AS ONE OF THE LARGEST EMPLOYERS IN THE AREA, MMC-NH TAKES ITS CIVIC RESPONSIBILITY VERY SERIOUSLY. SUPPORT OF AND CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS, EVENTS, AND PROGRAMS, SUCH AS THE CHAMBER, NEW HORIZONS, AND THE INDUSTRIAL DEVELOPMENT CORPORATION HELP IMPROVE THE ECONOMY OF MMC-NH'S CATCHMENT COUNTIES. BY PROMOTING ECONOMIC DEVELOPMENT, MMC-NH HELPS CREATE A COMMUNITY THAT CONTINUES TO BUILD ITSELF THROUGH THE LEADERS WHO WORK AND VOLUNTEER AT THE HOSPITAL. ECONOMIC STABILITY IS INTRINSICALLY LINKED TO THE PREVENTION OF HEALTH PROBLEMS ASSOCIATED WITH POVERTY, HOMELESSNESS, AND ENVIRONMENTAL CHALLENGES, AND IS CRUCIAL IF THE COMMUNITY HOPES TO MAINTAIN A VIABLE HOSPITAL COMPLEX WITH A BROAD SPECTRUM OF ESSENTIAL SERVICES. IN ADDITION TO SUPPORTING ECONOMIC DEVELOPMENT IN OUR REGION, MMC-NH ENCOURAGES ITS LEADERSHIP STAFF TO SUPPORT AND PROVIDE LEADERSHIP TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE AREA. IN ORDER TO CREATE AWARENESS OF THE OPPORTUNITIES IN HEALTHCARE IN RURAL IOWA, MMC-NH COLLABORATES WITH THE HIGH SCHOOL TO PROVIDE THE SERVICE TO BRING IN STUDENTS TO SHADOW A VARIETY OF HEALTH-RELATED OCCUPATIONS IN ORDER TO SPARK INTEREST IN CONSIDERING A HEALTHCARE CAREER. MMC-NH ALSO IDENTIFIED A NEED FOR MEMBERS OF THE COMMUNITY TO MORE SAFELY DISPOSE OF THEIR SHARPS AND CONTAINERS. THE HOSPITAL NOW COLLABORATES WITH PHARMACIES IN NEW HAMPTON TO COLLECT THE CONTAINERS.MMC-NH PROVIDES SUPPORT AND EXPERTISE TO THE CHICKASAW CONNECTIONS. THIS PARTNERSHIP INCLUDES ACTIVE INVOLVEMENT FROM ALL OF OUR FAMILY MEDICINE PHYSICIANS AND THE MARKETING DEPARTMENT IN THIS UNDERAGE DRINKING COALITION.MMC-NH PARTICIPATES IN THE PARTNERS IN EDUCATION WITH OUR AREA SCHOOL TO EDUCATE THEM ON A VARIETY OF HEALTH TOPICS, FROM HAND WASHING AND HUMAN DEVELOPMENT, TO HEALTHCARE CAREERS AND HOSPITAL TOURS. WE PLAY AN ACTIVE ROLE IN THE EDUCATION SYSTEM.MMC-NH ALSO PROMOTES ECONOMIC DEVELOPMENT BY PARTICIPATING ON THE NORTHEAST IOWA COMMUNITY COLLEGE ADVISORY BOARD (NICC). NICC IS A PUBLIC, TAX-SUPPORTED, EDUCATIONAL INSTITUTION SERVING EIGHT COUNTIES IN NORTHEAST IOWA AND THE ADVISORY BOARD AIDS IN CONNECTING STUDENTS AND EMPLOYERS IN THE AREA TO PROMOTE THE GROWTH AND VITALITY OF OUR COMMUNITY. PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY.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: MERCY HEALTH SERVICES - IOWA, CORP. USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (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. FY13 WAS THE FIRST YEAR MERCY HEALTH SERVICES - IOWA, CORP. UTILIZED THE PREDICTIVE MODEL WITH RESULTS USED FOR ANALYSIS ONLY. STARTING IN FY14, MERCY HEALTH SERVICES - IOWA, CORP. IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, MERCY HEALTH SERVICES - IOWA, CORP. IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: MERCY HEALTH SERVICES - IOWA, CORP. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY REGIONAL HEALTH MINISTRY AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE." PART III, LINE 8: MERCY HEALTH SERVICES - IOWA, CORP. DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE 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: MERCY HEALTH SERVICES - IOWA, CORP'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 EACH ORGANIZATION'S COLLECTION POLICY. THE HOSPITALS HAVE 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 - MERCY HEALTH SERVICES - IOWA HOSPITALS ASSESS THE HEALTH STATUS OF THE COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. OUR HOSPITALS 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, IN THE ASSESSMENT OF THE COMMUNITY.MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON EACH HAVE A LOCAL BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS, EMPLOYERS AND DEMOGRAPHIC GROUPS. THESE HOSPITALS ALSO COMMUNICATE WITH OTHER VARIOUS AGENCIES ABOUT WHAT SERVICES ARE NEEDED LOCALLY. IN PARTICULAR, OUR PRIMARY CARE PHYSICIANS HAVE A STRONG AWARENESS OF PATIENT NEEDS. TASK FORCES ARE CREATED WHEN SPECIAL CONCERNS ARISE. A RECENT EXAMPLE WAS DENTAL ACCESS. A COMMITTEE MEETS QUARTERLY THAT IS COMPRISED OF COMMUNITY MEMBERS AND HOSPITAL PERSONNEL THAT WORK DIRECTLY WITH THE UNINSURED, UNDERINSUED AND UNDERSERVED. THE COMMUNITY BENEFIT MINISTRY OFFICER INTERFACES REGUARLY WITH COMMUNITY SOCIAL SERVICE AGENCIES AND COMMITTEES.MERCY MEDICAL CENTER-SIOUX CITY STAFF ROUTINELY (WEEKLY) MEETS WITH VARIOUS COMMUNITY AGENCIES, CHURCHES, AND SCHOOLS IN SEARCH OF OPPORTUNITIES TO PARTNER TO ADDRESS (1) ACCESS TO PRIMARY CARE, (2) EXERCISE AND NUTRITION FOR YOUTH, (3) ACCESS TO MENTAL HEALTH SERVICES, AND (4) SOCIAL DETERMINANTS OF HEALTH GENERAL POVERTY, HOMELESSNESS , EDUCATION, AND HUNGER. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCY HEALTH SERVICES-IOWA IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE - BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AHA RECOMMENDATIONS, MHS-IA HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSMHS-IA COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES IS MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED IN VARIOUS ADMISSION AREAS THROUGHOUT THE HOSPITALS AND CLINICS. A "PATIENT FINANCIAL GUIDELINES" BROCHURE IS ALSO AVAILABLE AT EACH ADMISSION AREA. THIS BROCHURE PROVIDES INFORMATION REGARDING PAYMENT OPTIONS, FINANCIAL ASSISTANCE AND BILLING QUESTIONS. FINANCIAL COUNSELING IS ALSO PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. AT TIME OF ADMISSION, THE NAMES OF UNINSURED AND UNDERINSURED PATIENTS ARE GIVEN TO FINANCIAL COUNSELORS WHO 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 HEALTHCARE SERVICES. THE FINANCIAL COUNSELORS HAVE A GOOD WORKING RELATIONSHIP WITH THE DEPARTMENT OF HUMAN SERVICES AND VARIOUS COUNTY AND COMMUNITY PROGRAMS. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION FOR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.THE HOSPITALS OFFER 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. OUTPATIENTS, REFERRALS, OR SELF-REFERRALS RECEIVE THE SAME ATTENTION AND ASSISTANCE FROM FINANCIAL COUNSELORS. CONTACT MAY BE BY PHONE AND/OR LETTER PROCESS IF FACE-TO-FACE CONTACT IS NOT POSSIBLE.INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON THE HOSPITALS' WEBSITES, IN THE ADMISSION PACKAGE DURING INTAKE, AND "PATIENT ASSISTANCE" BROCHURES.ALL HOSPITALS HAVE ESTABLISHED WRITTEN POLICIES FOR BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS.MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON:IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. PATIENT FINANCIAL SERVICES IS ABLE TO ASSIST SPANISH-SPEAKING PATIENTS WITH THE FINANCIAL APPLICATION PROCESS. A LANGUAGE LINE CONNECTION IS ALSO AVAILABLE FOR MORE THAN 170 OTHER LANGUAGES.MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON EDUCATE STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS ABOUT THESE POLICIES, WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. THE PATIENT FINANCIAL SERVICES DEPARTMENT HAS ITS OWN TRAINING DEPARTMENT AND TRAINERS. THE PATIENT REGISTRATION, FINANCIAL ASSISTANCE, PATIENT FINANCIAL SERVICES, CUSTOMER SERVICE, AND BILLING DEPARTMENTS RECEIVE TRAINING REGARDING THE POLICIES THAT ARE RELEVANT TO THEIR POSITIONS AND OUR MISSION VALUES. SCRIPTING IS USED AND FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE IN ENGLISH AND SPANISH. MERCY MEDICAL CENTER - NORTH IOWA ALSO PROVIDES FINANCIAL ASSISTANCE FOR PRESCRIBED MEDICATIONS. THERE ARE SEVERAL SHORT-TERM ASSISTANCE PROGRAMS, AS WELL AS A SOCIAL WORKER FACILITATING THE APPLICATION PROCESS FOR LONG-TERM ASSISTANCE FROM PHARMACEUTICAL PROGRAMS.MERCY MEDICAL CENTER - SIOUX CITY:MERCY MEDICAL CENTER-SIOUX CITY NOT ONLY COMMUNICATES FINANCIAL ASSISTANCE POLICIES VIA TRADITIONAL CHANNELS (REGISTRATION, AND BILLING); THE ORGANIZATION SHARES ITS FINANCIAL ASSISTANCE POLICY WITH OTHER SERVICE AGENCIES AND NOT-FOR-PROFIT ORGANIZATIONS. FOR EXAMPLE, THROUGH THE MISSION HEALTH PROGRAM, A COLLABORATION BETWEEN THE SIOUXLAND COMMUNITY HEALTH CENTER, MMC-SIOUX CITY AND UNITY POINT - ST. LUKE'S HOSPITAL, MERCY MEDICAL CENTER-SIOUX CITY REACHES OUT TO CHURCHES AND SCHOOLS TO FIND THOSE WHO MAY BE IN NEED OF FINANCIAL ASSISTANCE. PARTICIPANTS ARE PRE-QUALIFIED FOR FINANCIAL ASSISTANCE AT BOTH LOCAL HOSPITALS, AND ARE INVITED TO CHOOSE A MEDICAL HOME. THE MISSION HEALTH PROGRAM HAS OVER 1,400 ENROLLED PATIENTS, ALL OF WHOM HAVE A BETTER UNDERSTANDING AND REDUCED ANXIETY CONCERNING FINANCIAL OBLIGATIONS AND ASSISTANCE IF HOSPITALIZATION IS NEEDED. AS THE AFFORDABLE CARE ACT IS IMPLEMENTED MERCY WILL INCREASE EFFORTS TO EDUCATE PATIENTS REGARDING MEDICAID EXPANSION AND ASSIST WITH ENROLLMENT OF PATIENTS.FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTHCARE SERVICES. MERCY MEDICAL CENTER-SIOUX CITY SOCIAL WORKERS PROVIDE ASSISTANCE AND COUNSELING REGARDING FINANCIAL ASSISTANCE OPPORTUNITIES WITHIN THE ORGANIZATION, AND REFER PATIENTS AND FAMILIES TO APPROPRIATE AGENCIES FOR COVERAGE. MERCY MEDICAL CENTER-SIOUX CITY ALSO WORKS WITH THE MIDLANDS GROUP TO ENLIST PATIENTS IN QUALIFYING PROGRAMS. MERCY MEDICAL CENTER-SIOUX CITY UTILIZES A COMMUNITY NEEDS INDEX (CNI) TO TARGET SPECIFIC ZIP CODES WHERE PATIENTS IN NEED OF FINANCIAL ASSISTANCE OFTEN RESIDE. THE HOSPITAL HIRED A MINORITY OUTREACH COORDINATOR TO SOLICIT INPUT REGARDING MINORITY HEALTH AND SOCIAL NEEDS. THIS BI-LINGUAL PERSON ALSO ASSISTS IN EDUCATION REGARDING ACA AND MEDICAID EXPANSION OPPORTUNITIES.MERCY MEDICAL CENTER - DUBUQUE AND MERCY MEDICAL CENTER - DYERSVILLE:FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTH CARE SERVICES. MERCY MEDICAL CENTER-DUBUQUE CONTRACTS WITH A FIRM WITH A LONG TRACK RECORD OF COMPASSIONATE SERVICE TO PROVIDE COUNSELING, REFERRALS, AND ASSISTANCE TO PATIENTS IN DETERMINING ELIGIBILITY AND ENROLLING IN A WIDE VARIETY OF PUBLIC AND PRIVATE ASSISTANCE PROGRAMS, SUCH AS MEDICARE, MEDICAID, HAWK-I (AND THE CORRESPONDING SCHIPS PROGRAMS FOR ILLINOIS AND WISCONSIN) AND IOWA CARE, IOWA'S STATE ASSISTANCE PROGRAM FOR INDIGENT PERSONS.PATIENT ACCOUNTS COUNSELORS ARE AVAILABLE TO HELP PATIENTS UNDERSTAND THEIR BILLS AND FIND RESOURCES TO ASSIST IN PAYING THEM. MERCY MEDICAL CENTER-DUBUQUE ALSO 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 IN BROCHURES AT EVERY SITE WHERE PATIENTS ARE ADMITTED, AND AT THE BILLING OFFICE, DESCRIBING MERCY'S CHARITY CARE POLICIES, THRESHOLDS, LIMITATIONS, AND PROCESS. AN APPLICATION FOR FINANCIAL ASSISTANCE IS PROVIDED WITH BILLING STATEMENTS. INFORMATION ABOUT MERCY'S CHARITY CARE POLICY IS ALSO INCLUDED IN THE "PATIENT AND VISITOR INFORMATION" GUIDEBOOK, WHICH IS AVAILABLE IN ENGLISH AND SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY THE HOSPITAL. BROCHURES ARE AVAILABLE IN ALL ADMISSION AREAS.SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO ALL HUMAN SERVICE AGENCIES WITHIN THE MERCY MEDICAL CENTER-DUBUQUE AND DYERSVILLE SERVICE AREAS. MERCY MEDICAL CENTER-DUBUQUE AND DYERSVILLE EDUCATE ALL STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS ABOUT THESE POLICIES, WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT. THIS TRAINING OCCURS AT THE TIME OF HIRE AND ALSO THROUGH IN-SERVICE TRAINING. PART VI, LINE 4: COMMUNITY INFORMATION - MERCY MEDICAL CENTER - NORTH IOWA SERVES A 14-COUNTY SERVICE AREA WITHIN A 70-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM MASON CITY. THE PRIMARY SERVICE AREA CONSISTS OF CERRO GORDO AND WORTH COUNTIES IN IOWA, WHILE THE SECONDARY SERVICE AREA IS COMPRISED OF AN ADDITIONAL 12 CONTIGUOUS COUNTIES IN IOWA (BUTLER, CHICKASAW, FLOYD, FRANKLIN, HANCOCK, HARDIN, HOWARD, KOSSUTH, MITCHELL, PALO ALTO, WINNEBAGO, AND WRIGHT). IN 2012 THE 14-COUNTY SERVICE AREA HAD AN ESTIMATED POPULATION OF 204,551 ACCORDING TO NEILSEN COUNTY AND 2013 TRUVEN HEALTH ANALYTICS, INC. 94.1 PERCENT OF RESIDENTS ARE CAUCASIAN. HISPANICS, AT LESS THAN 3.7%, REPRESENT THE AREA'S LARGEST MINORITY GROUP. THE AVERAGE HOUSEHOLD INCOME IS $52,972. HOUSEHOLDS MAKING $25,000 OR LESS COMPRISE 25.4 PERCENT; THOSE MAKING FROM $25,000-$50,000 ARE 32.3 PERCENT; $50,000-$75,000 IS 22.8 PERCENT AND THOSE MAKING $75,000 OR MORE REPRESENT 19.4 PERCENT. UNEMPLOYMENT WENT DOWN IN MERCY - NORTH IOWA'S SERVICE AREA. IN OCTOBER 2011, THE UNEMPLOYMENT RATE WAS 4.9 PERCENT AND IN OCTOBER 2012, IT WAS 4.3 PERCENT, ACCORDING TO IOWA WORKFORCE DEVELOPMENT. THERE ARE 11 CRITICAL ACCESS HOSPITALS WITHIN MERCY - NORTH IOWA'S SERVICE AREA PROVIDING PRIMARY HEALTH CARE SERVICES, EIGHT OF WHICH ARE AFFILIATES. PATIENTS FROM THE REMAINING IOWA COUNTIES UTILIZE MERCY - NORTH IOWA FOR TERTIARY LEVEL CARE. THE UNIVERSITY OF IOWA HOSPITALS IN IOWA CITY AND MAYO CLINIC IN ROCHESTER, MINNESOTA ALSO PROVIDE TERTIARY CARE FOR THIS AREA.MERCY - NORTH IOWA'S MARKET SHARE FOR THE 14-COUNTY SERVICE AREA IN CALENDAR YEAR 2012 IS 52 PERCENT, AS REPORTED BY IOWA HOSPITAL ASSOCIATION DATA.MERCY MEDICAL CENTER - NEW HAMPTON SERVES THE CHICKASAW AREA AND SURROUNDING COUNTIES WITHIN A 20-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM NEW HAMPTON. THE PRIMARY SERVICE AREA CONSISTS OF THE TOWNS OF NEW HAMPTON, FREDERICKSBURG, ALTA VISTA, IONIA, ELMA, WAUCOMA, LAWLER AND NASHUA. THE ESTIMATED POPULATION OF THIS AREA IS 13,500. ACCORDING TO THE U.S. CENSUS BUREAU, CHICKASAW COUNTY HAD AN ESTIMATED POPULATION OF 12,321 IN 2013. CHICKASAW COUNTY EXPERIENCED AN ESTIMATED .9% PERCENT DECLINE IN POPULATION FROM 2010-2013. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. NINETEEN PERCENT OF THE POPULATION IN THE CHICKASAW AREA WAS OVER AGE 65 IN 2013, COMPARED TO 15 PERCENT FOR THE STATE AND 13 PERCENT FOR THE NATION. IOWA RANKS FIFTH IN PERCENTAGE OF POPULATION OVER THE AGE OF 65. THIS LARGE PERCENTAGE OF ELDERLY PRESENTS SPECIAL CHALLENGES TO HEALTH CARE PROVIDERS BECAUSE THE ELDERLY HAVE THE HIGHEST INCIDENCE OF DISEASE AND MORTALITY IN MOST CATEGORIES AND, CORRESPONDINGLY, ARE THE BIGGEST USERS OF HEALTH CARE SERVICES. IN ADDITION, MEDICARE PAYMENT SHORTFALLS PRESENT AN ADDITIONAL BURDEN FOR RURAL HEALTH PROVIDERS. FOR FISCAL YEAR 2014, 48.8 PERCENT OF MMC-NH'S REVENUES (HOSPITAL INPATIENT AND OUTPATIENT) WERE GENERATED FROM MEDICARE PATIENTS. THE MEDIAN HOUSEHOLD INCOME IN CHICKASAW COUNTY WAS ESTIMATED AT $43,741 IN 2013. INDIVIDUALS BELOW THE POVERTY LEVEL COMPRISE 10.1% OF THE POPULATION. THE FISCAL YEAR 2014 PAYER MIX AT POINT OF REGISTRATION INCLUDES 49% COVERED BY MEDICARE, 8% COVERED BY MEDICAID AND 5% SELF-PAY.MERCY MEDICAL CENTER-SIOUX CITY SERVES A 33-COUNTY AREA OF WESTERN IOWA, EASTERN NEBRASKA AND SOUTHEASTERN SOUTH DAKOTA, AN AREA THAT INCLUDES MANY ZIP CODES WITH A HIGH COMMUNITY NEED. IN ADDITION TO THE MAIN HOSPITAL IN SIOUX CITY, MERCY MEDICAL CENTER-SIOUX CITY OWNS RURAL HOSPITALS IN PRIMGHAR, IOWA, AND OAKLAND, NEBRASKA; MANAGES HOSPITALS IN PENDER, NEBRASKA AND HAWARDEN, IOWA; AND OPERATES A PRIMARY CARE CLINIC NETWORK, SPECIALTY CARE CLINICS AND HOME HEALTH SERVICES. MMC-SC ALSO PARTNERS WITH OTHER COMMUNITY HEALTHCARE PROVIDERS TO SPONSOR A REGIONAL CANCER CENTER, PARAMEDIC SERVICES, HOSPICE SERVICES, A FREESTANDING SURGERY CENTER AND A VARIETY OF OTHER HEALTH SERVICES.THE PRIMARY SERVICE AREA IS CONSIDERED URBAN (WITHIN SIOUX CITY). HOWEVER, MMC-SC SERVES MANY RURAL COMMUNITIES THROUGHOUT THE 33 COUNTY AREA, AND MANY DISTINCT ETHNIC AND CULTURAL GROUPS, INCLUDING HISPANIC, VIETNAMESE, SOMALI, AND NATIVE AMERICAN (WINNEBAGO, OMAHA, LAKOTA, AND PONCA TRIBES). THE AVERAGE HOUSEHOLD INCOME FOR THE 14-COUNTY SIOUX CITY AREA IS $55,562. ACCORDING TO THE STATE HEALTH ACCESS DATA ASSISTANCE CENTER, IN 2007, 27.9% PERCENT OF RESIDENTS WERE BELOW THE FEDERAL POVERTY GUIDELINES. MORE THAN 8.7% OF THE COMMUNITY IS UNINSURED, AND APPROXIMATELY 35.1% OF FAMILIES ARE ON MEDICAID OR OTHER ASSISTANCE PROGRAMS.ACCORDING TO 2012 NIELSEN COMPANY DATA, THE 14-COUNTY COMMUNITY HAS A POPULATION OF 301,832. EIGHT-TWO PERCENT OF THE POPULATION IS WHITE, 12% HISPANIC, 2% ASIAN & PACIFIC ISLANDER AND 1% BLACK. MEDICAID ENROLLMENT IS 34% IN NEBRASKA AND 37.5% IN SOUTH DAKOTA. THE PERCENT OF POPULATIONS IN EACH STATE BELOW 200% OF THE FEDERAL POVERTY LEVEL IS 28.8% IN NEBRASKA AND 30.9% IN SOUTH DAKOTA. SOUTH SIOUX CITY, NEBRASKA IS NOW A MINORITY MAJORITY COMMUNITY WITH LATINO AT 46% OF THE POPULATION. THE STUDENT POPULATION IN SOUTH SIOUX CITY SCHOOLS IS 70% LATINO.MERCY MEDICAL CENTER - DUBUQUE AND MERCY MEDICAL CENTER - DYERSVILLE: FOR PURPOSES OF THEIR COMMUNITY HEALTH NEEDS ASSESSMENTS, MERCY MEDICAL CENTER DUBUQUE AND MERCY MEDICAL CENTER - DYERSVILLE'S PRIMARY SERVICE AREA IS DUBUQUE COUNTY, IOWA. ABOUT 60% OF OUR INPATIENT CASES AND MORE THAN 75% OF OUR EMERGENCY DEPARTMENT CASES WERE FOR DUBUQUE COUNTY RESIDENTS.DUBUQUE COUNTY'S POPULATION IS 89,143. IT INCLUDES ONE URBAN COMMUNITY, THE CITY OF DUBUQUE. ITS 65 AND OVER POPULATION IS ALMOST AS HIGH AS IOWA'S, AND SIGNIFICANTLY HIGHER THAN THE U.S. AVERAGE FOR THIS AGE RANGE. CONVERSELY, THE 16-24 POPULATION IS NOTICEABLY LOWER THAN THE U.S. AVERAGE. ALTHOUGH MINORITY POPULATIONS IN DUBUQUE COUNTY HAVE INCREASED DURING THE LAST DECADE, THE POPULATION IS STILL 97.1% WHITE, WITH NO OTHER SINGLE RACIAL GROUP ACCOUNTING FOR MORE THAN 1%. THE COUNTY'S HISPANIC OR LATINO POPULATION IS 1.2%CONSIDERING ONLY THE POPULATION OF DUBUQUE COUNTY RESIDENTS WHO ARE 25 OR OLDER, DUBUQUE COUNTY HAS A HIGHER PERCENTAGE OF RESIDENTS WITH ONLY A HIGH SCHOOL DIPLOMA OR EQUIVALENT THAN IOWA AND THE U.S. THERE IS A SMALLER PERCENTAGE OF DUBUQUE COUNTY RESIDENTS WITH SOME COLLEGE THAN IOWA OR THE U.S.MEDIAN INCOME IN DUBUQUE COUNTY IS $39,582, SLIGHTLY HIGHER THAN IOWA, BUT LOWER THAN THE U.S. MEDIAN. IN THE COUNTY, HOUSEHOLDERS UNDER 25 AND OLDER THAN 65 ARE BELOW THAT MEDIAN, WHICH IS ALSO TRUE FOR IOWA AND THE U.S. PER CAPITA INCOME IN DUBUQUE COUNTY IS $19,600, EQUAL TO IOWA AND SOMEWHAT LOWER THAN THE U.S. DUBUQUE COUNTY BLACK PER CAPITA INCOME IS 51% OF WHITE PER CAPITA INCOME, COMPARED TO 61% IN IOWA AND 60% NATIONALLY. DUBUQUE COUNTY HISPANIC PER CAPITA INCOME IS 58% OF WHITE PER CAPITA INCOME, COMPARED TO 54% IN IOWA AND 51% NATIONALLY. THE GROWING ELDERLY POPULATION IS OF CONCERN TO THE COMMUNITY. WE ANTICIPATE A SHORTAGE OF HEALTH CARE WORKERS TO CARE FOR THE ELDERLY, LIMITED TRANSPORTATION OPTIONS, LIMITED ADULT DAY CARE OPTIONS AND LIMITED FUNDING FOR SERVICES FOR THE ELDERLY. THE HIGH COST OF PRESCRIPTION MEDICATIONS AND CHRONIC ILLNESSES CAUSING LONG-TERM DISABILITY PRESENT FINANCIAL CONCERNS AS WELL.SEVERAL HEALTH CONCERNS HAVE BEEN IDENTIFIED IN THE SERVICE AREA, INCLUDING WOMEN NOT RECEIVING PRENATAL CARE DURING THE FIRST TRIMESTER; A HIGHER THAN AVERAGE RATE OF PROSTATE, LUNG, BREAST AND COLORECTAL CANCER; OBESITY AND ITS CONTRIBUTION TO HEART DISEASE, DIABETES, ARTHRITIS, AND HIGH BLOOD PRESSURE; AN INCREASING INCIDENCE OF DIABETES IN BOTH CHILDREN AND ADULTS; HEART DISEASE; AND ASTHMA. THE RECENT COMMUNITY HEALTH ASSESSMENT ADDS OBESITY AND SPECIFICALLY CHILDHOOD OBESITY TO THESE CONCERNS. PART VI, LINE 5: OTHER INFORMATION - MERCY MEDICAL CENTER - NORTH IOWA (MMC-NI) HAS BEEN PROVIDING MANAGEMENT SERVICES FOR RURAL HOSPITALS SINCE 1978. THESE COMMUNITY HOSPITALS OFFER QUALITY HEALTH CARE AND YET ARE STILL ABLE TO TAKE ADVANTAGE OF ALL THE RESOURCES MERCY MEDICAL CENTER - NORTH IOWA HAS TO OFFER AS A MAJOR REFERRAL CENTER. MMC-NI EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTHCARE PROVIDERS IN ORDER TO BEST MEET THE NEEDS OF THOSE WHO LIVE IN NORTH IOWA COMMUNITIES. MERCY MEDICAL CENTER - NORTH IOWA IS INTENTIONAL IN DEVELOPING TRIPLE AIM ACCOUNTABLE CARE ORGANIZATION (ACO) RELATIONSHIPS, COLLABORATING WITH COMMUNITY HEALTH PROVIDERS AND SOCIAL SERVICE AGENCIES IN CREATING SYSTEM OF CARE COORDINATION PROCESSES. THERE ARE NEARLY 100 PROFESSIONS REPRESENTING ALL ASPECTS OF HEALTHCARE IN OUR 14-COUNTY SERVICE AREA PARTICIPATING IN TRANSITIONS OF CARE, TO IMPROVE COMMUNICATION AND PROCESSES TO IMPROVE QUALITY AND SAFETY OF TRANSITIONS BETWEEN FACILITIES. THE TRIAD PROJECT, FOR PERSONS WITH THE CO-OCCURRING MORBIDITIES OF SUBSTANCE USE DISORDER, CHRONIC DISEASE AND POSSIBLY MENTAL HEALTH DISORDER, IS A COLLABORATIVE QUALITY IMPROVEMENT PROJECT. AN IOWA SAFETY NET GRANT WAS RECEIVED THROUGH THE IOWA PRIMARY CARE ASSOCIATION TO CREATE A COMMUNITY CARE COLLABORATION PROGRAM TO NOT ONLY ADDRESS ACCESS TO HEALTH INSURANCE AND QUALITY OF CARE, BUT TO ALSO COORDINATE REFERRALS FOR HUMAN SERVICE RESOURCES.AS A TEACHING HOSPITAL, MERCY MEDICAL CENTER - NORTH IOWA HOSTS A FAMILY PRACTICE RESIDENCY PROGRAM, PHARMACY RESIDENCY, CARDIOLOGY FELLOWSHIP, AND A SCHOOL OF RADIOLOGIC TECHNOLOGY. MERCY MEDICAL CENTER - NORTH IOWA IS A CLINICAL SITE FOR STUDENTS STUDYING TO BECOME PHYSICIANS, NURSES, PARAMEDICS, PHARMACISTS, MEDICAL ASSISTANTS AND OTHER ALLIED HEALTH PROFESSIONALS. IN ADDITION, THE MEDICAL CENTER MANAGES AN ADULT DAY CARE CENTER AND SUPPORTS HOMELESS SHELTERS FOR MEN AND WOMEN IN COLLABORATION WITH OTHER NON-PROFITS.AS A SOLE COMMUNITY PROVIDER, SPECIALIZED SERVICES INCLUDE A HEART CENTER, CANCER CENTER, DIABETES CENTER, STROKE CENTER, BARIATRIC CENTER, LEVEL II BIRTH CENTER AND A LEVEL II EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. BECAUSE OF THE NEED BY INDIGENT ADULTS FOR DENTAL CARE, MERCY - NORTH IOWA PROVIDES A SUITE WITH TWO FULLY FURNISHED OPERATORIES TO ACCOMMODATE EMERGENT DENTAL NEEDS. HALF-DAY CLINICS ARE MANNED BY AREA DENTISTS AND DENTAL ASSISTANTS WHO VOLUNTEER THEIR TIME AND GUIDANCE. MERCY - NORTH IOWA INVESTS IN THE COMMUNITY TO ENHANCE THE HEALTH OF RESIDENTS BY PROVIDING:- SERVICES SUCH AS, FREE HEALTH SCREENINGS- SUBSIDIZED TRANSPORTATION TO ELIMINATE BARRIERS TO HEALTHCARE- MERCY FAMILY HEALTH LINE A 24-HOUR/7-DAY A WEEK TELEPHONE INFORMATION SERVICE- PARTICIPATION OF THE HOSPITAL KITCHEN IN PREPARATION OF MEALS ON WHEELS- MEDICAL SERVICES FOR RESIDENTS OF THE NORTHERN LIGHTS HOMELESS SHELTERS- VOLUNTEER SERVICES AS PROVIDED BY THE MERCY AMBASSADORS, THE HOSPITAL VOLUNTEER AUXILIARY, INCLUDING SCHOLARSHIPS, INFANT SEAT RENTALS, AND FACILITATION OF HEALTHCARE SCREENINGSMERCY MEDICAL CENTER-SIOUX CITY HAS EARNED MORE NATIONAL RECOGNITION FOR QUALITY PATIENT OUTCOMES THAN ANY OTHER HOSPITAL IN THE REGION. THE MEDICAL CENTER HAS EARNED MULTIPLE HONORS FOR ITS LEADERSHIP AND EXCELLENCE IN SEVERAL CLINICAL AREAS, INCLUDING CARDIAC CARE, ORTHOPEDIC SERVICES, VASCULAR SURGERY, STROKE CARE AND CANCER CARE.MERCY MEDICAL CENTER-SIOUX CITY IS HOME TO THE ONLY LEVEL II TRAUMA CENTER IN WESTERN IOWA, AND PROVIDES A VITAL, LIFESAVING LINK TO RURAL AREAS VIA MERCY AIR CARE, THE HOSPITAL'S HELICOPTER AMBULANCE SERVICE.MERCY MEDICAL CENTER-SIOUX CITY IS INVOLVED IN A NUMBER OF COMMUNITY VENTURES, AND SUPPORTS THE SIOUXLAND MEDICAL EDUCATION FOUNDATION (FAMILY PRACTICE RESIDENCY). WE ALSO WORK CLOSELY WITH WINNEBAGO INDIAN HEALTH SERVICES TO CLOSE HEALTH OUTCOMES DISPARITIES. IN ADDITION, THE MEDICAL CENTER COLLABORATES WITH ST. LUKE'S COLLEGE OF NURSING, WITCC SCHOOL OF NURSING AND BRIAR CLIFF UNIVERSITY SCHOOL OF NURSING.MERCY MEDICAL CENTER IS SHIFTING FOCUS AND COMMITTING RESOURCES TO PEOPLE-CENTERED HEALTH CARE. MERCY MEDICAL CENTER HAS RECEIVED BLUE ZONE DISTINCTION AS AN EMPLOYER AND IS WORKING TO ASSIST OTHERS TO RECEIVE THIS. RIVERSIDE ELEMENTARY IS ON SCHEDULE TO RECEIVE THIS DISTINCTION, IN PART DUE TO MERCY'S SUPPORT OF EXERCISE EQUIPMENT FOR STUDENTS AND PLUMBING TO SUPPORT A COMMUNITY GARDEN. MERCY MEDICAL CENTER-DUBUQUE PROVIDES SEVERAL SERVICES THAT ARE UNIQUE TO THE COMMUNITY, INCLUDING OPEN HEART SURGERY, NEONATAL INTENSIVE CARE AND INPATIENT COMMUNITY PSYCHIATRIC SERVICES. IN ADDITION, THE HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.MERCY MEDICAL CENTER - NEW HAMPTON:AS A SOLE COMMUNITY PROVIDER, MERCY MEDICAL CENTER - NEW HAMPTON PROVIDES A RANGE OF SPECIALIZED SERVICES, DIABETES EDUCATION AND NUTRITION AND AN EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. EMERGENCY SERVICES ARE PROVIDED AT A FINANCIAL LOSS, BUT ARE A CRITICALLY-NEEDED SERVICE. MERCY COOPERATES WITH OTHER AGENCIES TO IMPROVE OVERALL COMMUNITY HEALTH AND WELL-BEING. FOR EXAMPLE, WE SPONSOR A COMMUNITY GARDEN, AND PRODUCE IS PROVIDED TO THE COMMUNITY'S FOOD PANTRY (WHICH UTILIZES HOSPITAL SPACE, AT NO COST).THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTHCARE PROVIDERS, IN ORDER TO BEST MEET THE NEEDS OF OUR NORTHEAST IOWA COMMUNITIES.MMC-NH HAS ABOUT 200 VOLUNTEERS, WHO SERVE IN NEARLY EVERY DEPARTMENT OF THE MEDICAL CENTER. FROM CLERICAL WORK TO PROVIDING PATIENT AND VISITOR SERVICES, MERCY VOLUNTEERS TRULY DO MAKE A DIFFERENCE. THROUGH FUNDRAISERS, THE VOLUNTEERS ALSO PROVIDE FINANCIAL SUPPORT TO A VARIETY OF AREAS WITHIN THE HOSPITAL. MERCY AUXILIARY AWARDS SCHOLARSHIPS TO HIGH SCHOOL AND NON-TRADITIONAL STUDENTS PURSUING EDUCATION IN THE HEALTHCARE FIELD. THE AUXILIARY ALSO SPONSORS NUMEROUS BLOOD DRIVES AND LUNCH-AND-LEARN EVENTS ON HEALTHCARE SUBJECTS. THEY ALSO PROVIDE WIGS AND TURBANS TO THOSE INDIVIDUALS WHO HAVE LOST THEIR HAIR DUE TO ILLNESS. PART VI, LINE 6: MERCY HEALTH SERVICES-IOWA 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 ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 1 DUBUQUE COMMUNITY SCHOOLS 2500 CHANEY RD DUBUQUE IA 52001 426001531 PUBLIC SCHOOL 15000 SUPPORT OF ATHLETIC TRAINER PROGRAM FOR 2 HIGH SCHOOLS WAHLERT CATHOLIC HIGH SCHOOL 2005 KANE ST DUBUQUE IA 52001 420792429 RELIGIOUS SCHOOL 7500 SUPPORT OF ATHLETIC TRAINER PROGRAM FOR HIGH SCHOOL CRESCENT COMMUNITY HEALTH CENTER 1789 ELM ST SUITE A DUBUQUE IA 52001 481302204 501(C)3 12000 SUPPORT FOR COMMUNITY GARDENING PROGRAM ST JOHN'S GUESTHOUSE 1296 WHITE ST DUBUQUE IA 52001 237421408 CHURCH 10000 SUPPORT FOR ST. JOHN'S EVANGELICAL LUTHERAN GUESTHOUSE FOR THE HOMELESS STONEHILL BENEVOLENT FOUNDATION 3485 WINDSOR AVE DUBUQUE IA 52001 421337556 501(C)3 10000 CONTRIBUTION FOR THEIR CAPITAL CAMPAIGN NORTH IOWA CORRIDOR ECONOMIC DEVELOPMENT CORPORATION 9 NORTH FEDERAL AVE MASON CITY IA 50401 753190471 501(C)6 20000 ANNUAL INVESTOR CAMPAIGN PLEDGE NORTH IOWA COMMUNITY ACTION ORGANIZATION 218 5TH ST SW MASON CITY IA 50402 420921505 501(C)3 58300 COMMUNITY PARTNERS CONTRACT FRANKLIN GENERAL HOSPITAL FOUNDATION 1720 CENTRAL AVE E HAMPTON IA 50441 421412025 501(C)3 10000 HEALING RENEWING EXPANDING CAMPAIGN CITY OF MASON CITY 10 1ST ST NW MASON CITY IA 50401 426004948 501(C)6 25000 BLUE ZONES PROJECT PLEDGE NORTHERN LIGHTS ALLIANCE FOR THE HOMELESS INC 307 NORTH MONROE MASON CITY IA 50401 421501295 501(C)3 61141 SUPPORT OF EXECUTIVE SALARIES & BENEFITS MASON CITY DOWNTOWN ASSOCIATION 9 NORTH FEDERAL MASON CITY IA 50401 481256121 501(C)3 30000 RAGBRAI SPONSORSHIP NORTHEAST IOWA COMMUNITY ACTION CORP 305 MONTGOMERY ST DECORAH IA 52101 426092713 501(C)3 6000 0 COMMUNITY SUPPORT BOYS AND GIRLS HOME AND FAMILY SERVICES PO BOX 1197 SIOUX CITY IA 51102 930991860 501(C)3 5000 COMMUNITY SUPPORT BOYS CLUB OF SIOUX CITY INC 823 PEARL STREET SIOUX CITY IA 51101 420940032 501(C)3 16000 COMMUNITY SUPPORT BRIAR CLIFF UNIVERSITY 3302 REBBECA ST SIOUX CITY IA 51104 420707124 501(C)3 7500 COMMUNITY SUPPORT GIRL SCOUTS OF GREATER IOWA 10715 HICKMAN RD URBANDALE IA 50322 420698218 501(C)3 5000 COMMUNITY SUPPORT MARY J TREGLIA COMMUNITY HOUSE 900 JENNINGS ST SIOUX CITY IA 51105 420681107 501(C)3 15000 COMMUNITY SUPPORT BOY SCOUTS OF AMERICA 326 MID-AMERICA COUNCIL 12401 WEST MAPLE RD OMAHA NE 68164 470376545 501(C)3 5575 COMMUNITY SUPPORT THE SHEPHERD'S GARDEN 608 NEBRASKA ST SIOUX CITY IA 51101 272258821 501(C)3 10000 COMMUNITY SUPPORT SIOUXLAND COMMUNITY HEALTH CENTER 1021 NEBRASKA STREET SIOUX CITY IA 51102 421374894 501(C)3 80607 COMMUNITY SUPPORT SIOUXLAND MENTAL HEALTH SERVICES PO BOX 1917 SIOUX CITY IA 51102 426122297 501(C)3 10000 COMMUNITY SUPPORT THE SIOUXLAND Y 601 RIVERVIEW DRIVE SOUTH SIOUX CITY NE 68776 420738980 501(C)3 10000 COMMUNITY SUPPORT SISTERS OF MERCY REGIONAL COMMUNITY OF DETROIT INC 29000 W 11 MILE RD FARMINGTON HILLS MI 48336 381360937 RELIGIOUS 7000 COMMUNITY SUPPORT ST MICHAEL'S SCHOOL 1315 1ST AVENUE SOUTH SIOUX CITY NE 68776 470457873 501(C)3 10000 COMMUNITY SUPPORT IOWA STATE UNIVERSITY FOUNDATION 2505 UNIVERSITY BLVD AMES IA 50010 421143702 501(C)3 5460 SUPPORT IOWA STATE UNIVERSITY EXTENSION AND OUTREACH 24 1 HOUSING, UTILITIES AND AUTO SUPPORT 9962 FOOD, CLOTHING AND TRANSPORTATION ASSISTANCE 3347 MEDICAL BILLS 4657 PART I, LINE 2: DONATIONS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 1 1 0 0 0 0 0 0 0 JUDITH PERSICHILLI TRINITY INT. PRES & CEO THR 11/13 0 1311163 0 1102307 0 1654631 0 18975 0 6481 0 4093557 0 0 JAMES CODDINGTON MD DIRECTOR AS OF 1/14;MMC-NI PHYSICIAN 167398 0 37556 0 30810 0 16630 0 19546 0 271940 0 0 0 RICHARD O'CONNELL DIR. AS OF 1/14; EVP & PRES TH DIV 0 731422 0 769386 0 172766 0 111806 0 33679 0 1819059 0 0 PAUL NEUMANN SEC THR 12/13; TH CHIEF LEGAL CNSL 0 511279 0 626797 0 117475 0 74894 0 28132 0 1358577 0 0 MARCIA SMITH SECRETARY AS OF 1/14; ASSOCIATE CNSL 0 218796 0 0 0 1106 0 13078 0 18562 0 251542 0 0 AGNES HAGERTY ASST SEC THR 12/13; TH DEP GNL CNSL 0 355901 0 23243 0 23813 0 32268 0 15027 0 450252 0 0 RODNEY SCHLADER TREAS AS OF 1/14; REGIONAL CFO 0 276450 0 66685 0 1439 0 28291 0 21801 0 394666 0 0 JENNIFER BARNETT TREAS THR 12/13; TH CFO THR 4/14 0 631567 0 425195 0 162607 0 18975 0 11720 0 1250064 0 0 BENJAMIN CARTER ASST TREAS THR 12/13; TH TREAS/CFO 0 581124 0 586500 0 82502 0 84996 0 25449 0 1360571 0 0 RUSSELL KNIGHT CEO DUBUQUE 0 318264 0 262517 0 134433 0 66469 0 4955 0 786638 0 9775 ROBERT PEEBLES CEO SIOUX CITY THROUGH 3/14 0 381701 0 129132 0 57429 0 51809 0 16924 0 636995 0 0 PAUL MANTERNACH SVP PHYS INTEGRATION MASON CITY 0 337165 0 153898 0 1144 0 12892 0 19075 0 524174 0 0 DANIEL VARNUM CEO MASON CITY 0 352913 0 81111 0 55540 0 41947 0 19746 0 551257 0 0 JEROME PIERSON MD CMO SIOUX CITY 0 313552 0 71843 0 2960 0 12750 0 10593 0 411698 0 0 TERESA MOCK SVP MERCY CLINICS MASON CITY 0 273723 0 65086 0 2642 0 25744 0 19401 0 386596 0 0 DIANE FISCHELS VP OPERATIONS MASON CITY 0 271229 0 63239 0 1369 0 30824 0 8754 0 375415 0 0 KIMBERLY CHAMBERLIN CNO MASON CITY 0 172983 0 79441 0 1569 0 10883 0 11023 0 275899 0 0 KAY TAKES VP PATIENT CARE DUBUQUE 0 170138 0 81318 0 830 0 24946 0 17192 0 294424 0 0 LINDA KREI VP HR AND ORG INTEGRITY SIOUX CITY 0 199290 0 45450 0 1757 0 26358 0 4100 0 276955 0 0 GARY GUETZKO VP BUSINESS DEVELOPMENT DUBUQUE 0 186807 0 47679 0 1749 0 37463 0 19164 0 292862 0 0 ROBERT SHAFER CFO DUBUQUE 0 165037 0 41040 0 2253 0 77063 0 4850 0 290243 0 0 BRIAN MONSMA VP NETWORK DEVELOPMENT SIOUX CITY 0 164131 0 39625 0 507 0 12968 0 20544 0 237775 0 0 TRACY LARSON CNO SIOUX CITY 0 160523 0 38848 0 329 0 10443 0 20738 0 230881 0 0 SUE MEADE VP PROF & SUPP SVCS DUBUQUE 0 132537 0 33805 0 619 0 9655 0 16805 0 193421 0 0 CARL J PLANK PHYSICIAN, DERMATOLOGY (MC) 536127 0 24295 0 367453 0 28116 0 19565 0 975556 0 0 0 JAMES R BAER PHYSICIAN, RADIATION ONCOLOGY (MC) 595968 0 0 0 43776 0 12750 0 37632 0 690126 0 0 0 ARVIND PERATHUR PHYSICIAN, INTERNAL MEDICINE (MC) 459039 0 120529 0 37364 0 12750 0 27836 0 657518 0 0 0 MARK HAGANMAN PHYSICIAN, FAMILY MEDICINE (MC) 395725 0 185227 0 34591 0 26693 0 30897 0 673133 0 0 0 JAMES P KARKOS PHYSICIAN, DERMATOLOGY (MC) 389111 0 89005 0 110621 0 24743 0 30950 0 644430 0 0 0 MARIANNE CUNNINGHAM FORMER OFFICER 0 167604 0 0 0 826 0 10136 0 18843 0 197409 0 0 DANIEL HALE FORMER OFFICER 0 515065 0 692503 0 95295 0 29355 0 21325 0 1353543 0 0 MICHAEL SLUBOWSKI FORMER KEY EMPLOYEE 0 0 0 0 0 231799 0 0 0 0 0 231799 0 231799 JOSEPH SWEDISH FORMER OFFICER 0 344758 0 0 0 1119237 0 21706 0 7182 0 1492883 0 0 JAMES BOSSCHER FORMER OFFICER 0 351725 0 348218 0 120401 0 75455 0 13211 0 909010 0 15518 KEDRICK ADKINS FORMER KEY EMPLOYEE 0 504488 0 873685 0 430416 0 1730702 0 8534 0 3547825 0 45090 MARILYN KAPTAIN-DAHLEN FORMER KEY EMPLOYEE 0 85475 0 45083 0 178211 0 121809 0 12209 0 442787 0 0 STEVEN EAVENSON FORMER KEY EMPLOYEE 0 285014 0 74922 0 29115 0 19540 0 15916 0 424507 0 0 KIM PRICE FORMER KEY EMPLOYEE 134666 0 0 0 5731 0 15309 0 22854 0 178560 0 0 0 LARRY WARREN FORMER OFFICER 0 1635500 0 0 0 0 0 0 0 0 0 1635500 0 0 PART I, LINE 3 MERCY HEALTH SERVICES - IOWA, CORP. IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MERCY HEALTH SERVICES - IOWA, CORP. HOSPITAL CEOS ARE PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MERCY HEALTH SERVICES - IOWA, CORP. CEOS: - 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 INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2013. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): KEDRICK ADKINS - $ 310,298 MARILYN KAPTAIN-DAHLEN - $151,670 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERENCE AMOUNTS, WHICH WERE UNPAID AS OF 12/31/13: KEDRICK ADKINS - $1,347,759 ($814,924 PAID IN 2014 AND $532,835 TO BE PAID IN 2015) MARILYN KAPTAIN-DAHLEN - $88,782 PAID IN 2014 THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($255,000 FOR 2013). THE FOLLOWING ACCRUALS FOR 2013 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $106,281 JAMES BOSSCHER - $50,952 BENJAMIN CARTER - $72,246 RUSSELL KNIGHT - $42,321 PAUL NEUMANN - $62,144 RICHARD O'CONNELL - $99,056 ROBERT PEEBLES - $39,059 DANIEL VARNUM - $29,197 PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A MERCY HEALTH SERVICES - IOWA CORP. NON-QUALIFIED ELECTIVE DEFERRED COMPENSATION PLAN. THE FOLLOWING DEFERRALS FOR 2013 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JAMES R. BAER- $34,752 JAMES CODDINGTON, MD - $23,400 MARK HAGANMAN - $33,467 JAMES P. KARKOS- $107,106 ARVIND PERATHUR - $28,147 CARL J. PLANK- $43,072 THE FOLLOWING IS A PARTICIPANT IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUAL FOR 2013 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $258,812 PART II: THE FOLLOWING INDIVIDUALS ARE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JENNIFER BARNETT - $139,649 JUDITH PERSICHILLI - $1,601,362 JOSEPH SWEDISH - $543,977 MICHAEL SLUBOWSKI - $231,799 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. PART II, COLUMN B (II): THE FOLLOWING INDIVIDUALS RECEIVED AMOUNTS IN 2013 FROM A LONG-TERM INCENTIVE PLAN (LTIP). PARTICIPANTS IN THE LTIP (CEO'S AND CERTAIN TRINITY EXECUTIVES) WERE ELIGIBLE TO RECEIVE A PAYMENT UNDER THE PLAN ONLY IF CERTAIN CULTURE OF SAFETY SURVEY SCORE TARGETS WERE ACHIEVED AT THE END OF A THREE-YEAR PERIOD (FY11 THROUGH FY13). THE FOLLOWING LTIP AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(II): KEDRICK ADKINS - $372,833 JAMES BOSSCHER - $160,406 BENJAMIN CARTER - $253,562 KIMBERLY CHAMBERLIN - $38,496 DANIEL HALE - $242,723 RUSSELL KNIGHT - $147,289 PAUL MANTERNACH - $74,577 PAUL NEUMANN - $237,224 RICHARD O'CONNELL - $294,870 KAY TAKES - $38,232 UNITED CLINICAL LABORATORIES (UCL) R. SHAFER & K. TAKES, KEY EMPLOYEES, ARE ON UCL BD 6446638 PAYMENTS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO UNITED CLINICAL LABORATORIES FOR LABORATORY SERVICES. 0 BARBARA SHAFER FAMILY MEMBER OF ROBERT SHAFER, KEY EMPLOYEE 65516 EMPLOYMENT ARRANGEMENT 0 NANCY ROLING FAMILY MEMBER OF ROBERT SHAFER, KEY EMPLOYEE 128204 EMPLOYMENT ARRANGEMENT 0 PREFERRED HEALTH CHOICES LLC (PHC) RUSSELL KNIGHT, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF PHC 14040342 PAYMENTS MADE BY PREFERRED HEALTH CHOICES TO MERCY HEALTH SERVICES - IOWA, CORP. FOR MEDICAL SERVICES PROVIDED. 0 PREFERRED HEALTH CHOICES LLC (PHC) RUSSELL KNIGHT, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF PHC 15108470 PAYMENTS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO PREFERRED HEALTH CHOICES FOR REIMBURSEMENT OF THIRD PARTY ADMINISTRATOR PAYMENTS. 0 WELLMARK BLUE CROSS BLUE SHIELD OF IOWA AND SOUTH DAKOTA MELANIE DREHER, BOARD MEMBER, ALSO SERVES ON THE BOARD OF WELLMARK BCBS 103080195 PAYMENTS MADE BY WELLMARK BCBS TO MERCY HEALTH SERVICES - IOWA, CORP FOR MEDICAL SERVICES PROVIDED. 0 0 0 0 SIOUXLAND SURGERY CENTER ROBERT PEEBLES, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF SIOUXLAND SURGERY 8051400 PARTNERSHIP DISTRIBUTION MADE BY SIOUXLAND SURGERY CENTER TO MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA IS A 31% PARTNER IN SIOUXLAND SURGERY CENTER) 0 HEALTH MANAGEMENT SERVICES LLC (HMS) R. KNIGHT, R. SHAFER & G. GUETZKO, KEY EMPLOYEES, ARE ALSO HMS BD MEMBERS 3067591 PARTNERSHIP DISTRIBUTION MADE BY HEALTH MANAGEMENT SERVICES, LLC TO MHS-IA (MHS-IA IS A 50% PARTNER IN HEALTH MGMT SVCS) 0 HEALTH MANAGEMENT SERVICES LLC (HMS) R. KNIGHT, R. SHAFER & G. GUETZKO, KEY EMPLOYEES, ARE ALSO HMS BD MEMBERS 1596097 PARTNERSHIP CAPITAL CONTRIBUTION MADE TO HEALTH MANAGEMENT SERVICES, LLC BY MHS-IA (MHS-IA IS A 50% PARTNER IN HEALTH MGMT SVCS) 0 MC AMBULATORY SURGERY CENTER LLC (MCASC) DANIEL VARNUM, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF MCASC 3383629 PARTNERSHIP DISTRIBUTION MADE BY MCASC TO MHS-IA (MHS-IA IS A 51% PARTNER IN MCASC) 0 AVERY OUTDOOR MILTON AVERY, BOARD OFFICER, IS AN OWNER OF AVERY OUTDOOR 147815 PAYMENTS MADE FOR SIGNS AND BILLBOARDS 0 X 1 975000 EXPERT OPINION X MISCELLANEOUS 1 1040 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 RODNEY SCHLADER, IOWA REGIONAL CFO, DANIEL VARNUM, MERCY MEDICAL CENTER - NORTH IOWA CEO, AND MARTI RODAMAKER, MERCY HEALTH SERVICES - IOWA BOARD DIRECTOR, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA) HAS CONTRACTED WITH TATUM, LLC FOR THE PROVISION OF INTERIM CFO SERVICES. IN CALENDAR YEAR 2013 MHS-IA PAID $450,636 TO TATUM, LLC FOR STEPHEN GARY'S SERVICES AS INTERIM CFO AT ITS SIOUX CITY HOSPITAL . MHS-IA DOES NOT KNOW HOW MUCH STEPHEN GARY RECEIVED AS WAGES FROM TATUM, LLC IN CALENDAR 2013. FORM 990, PART VI, SECTION A, LINE 4 THE CERTIFICATE OF INCORPORATION AND BYLAWS OF MERCY HEALTH SERVICES - IOWA WERE AMENDED TO CHANGE THE SOLE MEMBER OF THE CORPORATION. EFFECTIVE JULY 1, 2013 THE SOLE MEMBER IS TRINITY HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE JULY 1, 2013 THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA, CORP. IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A EFFECTIVE JULY 1, 2013 TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA, CORP. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MERCY HEALTH SERVICES - IOWA, CORP. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR MERCY HEALTH SERVICES - IOWA, CORP. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS ARE REVIEWED BY THE MHS-IA BOARD, WHICH IS THE IOWA REGIONAL BOARD OF THE TRINITY HEALTH SYSTEM. THE MHS-IA 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 MERCY HEALTH SERVICES - IOWA, CORP. HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF MERCY HEALTH SERVICES - IOWA, CORP., WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH MERCY HEALTH SERVICES - IOWA, CORP.'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCY HEALTH SERVICES - IOWA, CORP. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MERCY HEALTH SERVICES - IOWA, CORP. IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO MERCY HEALTH SERVICES - IOWA, CORP. 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 REVIEWED WITH THE BOARD OF DIRECTORS OF MERCY HEALTH SERVICES - IOWA, CORP. ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR MERCY HEALTH SERVICES - IOWA'S HOSPITAL CEO'S, OFFICERS AND KEY MANAGEMENT OFFICIALS ARE ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. 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 CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MERCY HEALTH SERVICES - IOWA, CORP. 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 HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 MERCY HEALTH SERVICES - IOWA, CORP. 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, MERCY HEALTH SERVICES - IOWA, CORP. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. MERCY HEALTH SERVICES - IOWA, CORP'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1: SR. SUZANNE BRENNAN, CSC, IS A MEMBER OF THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS. HAVING TAKEN A VOW OF POVERTY, SR. SUZANNE BRENNAN DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HEALTH SERVICES - IOWA, CORP. INSTEAD, A TOTAL OF $25,000 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS FOR SR. SUZANNE BRENNAN'S SERVICES AS A DIRECTOR FOR TRINITY HEALTH CORPORATION, MERCY HEALTH SERVICES - IOWA, CORP. AND TRINITY HEALTH - MICHIGAN. SR. BARBARA WHEELEY, RSM, IS A MEMBER OF THE RELIGOUS SISTERS OF MERCY. HAVING TAKEN A VOW OF POVERTY, SR. BARBARA WHEELEY DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HEALTH SERVICES - IOWA, CORP. INSTEAD, A TOTAL OF $21,000 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE RELIGOUS SISTERS OF MERCY FOR SR. BARBARA WHEELEY'S SERVICES AS VICE CHAIR FOR MERCY HEALTH SERVICES - IOWA CORP., TRINITY HEALTH - MICHIGAN AND TRINITY HEALTH CORPORATION. FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS TO AFFILIATES -6,174,369. OTHER TRANSACTIONS 13,028,352. FORM 990, PART XII, LINE 2: MERCY HEALTH SERVICES -IOWA, CORP.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY14 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE 1, DOING BUSINESS AS NAMES: DUNES MEDICAL LABORATORIES,FOREST PARK PHARMACY, HEALTHWORKS, MARIAN HEALTH CENTER, MERCY FAMILY PHARMACY, MERCY HEALTH CENTER-DUBUQUE (ST. JOSEPH'S), MERCY HEALTH CENTER-DYERSVILLE (ST. MARY'S), MERCY HOME CARE-NORTH IOWA, MERCY HOME HEALTHCARE DUBUQUE, MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER-DYERSVILLE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA, MERCY MEDICAL CENTER-SIOUX CITY, NORTH IOWA MERCY CLINICS, NORTH IOWA MERCY HEALTH CENTER, NORTH IOWA MERCY HOME HEALTHCARE, SHEFFIELD PHARMACY, SIOUXLAND PATHOLOGY GROUP-SMHC, SIOUXLAND RADIOLOGY-SMHC, ST. JOSEPH COMMUNITY HOSPITAL MERCY CARE CONNECTIONS LLC 1000 4TH STREET SW MASON CITY IA 50401 352473948 ACCOUNTABLE CARE ORGANIZATION IA 0 0 MERCY HEALTH SERVICES - IOWA CORP ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 MANAGEMENT & SUPPORT SERVICES FL 501(C)(3) LINE 11A, I CATHOLIC HEALTH EAST 1 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH 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HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE IA 52001 262227941 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIAN SERVICES C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 232515999 PHYSICIAN SERVICES PA 501(C)(3) LINE 3 MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH NY 501(C)(3) LINE 3 LTC(EDDY) INC 1 EMPIRE HOME INFUSION SERVICES INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME CARE NY 501(C)(3) LINE 9 HOME AIDE SERVICE OF EASTERN NEW YORK INC 1 FARREN CARE CENTER INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042501711 LONG 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NORTH AVE MELROSE PARK IL 60160 362379649 HEALTHCARE SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 GRAND RAPIDS MEDICAL EDUCATION PARTNERS INC 1000 MONROE AVENUE NW GRAND RAPIDS MI 49503 237270669 MEDICAL EDUCATION TRAINING PROGRAMS MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 HACKLEY HOSPITAL 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 49443 381358196 HEALTHCARE SERVICES MI 501(C)(3) LINE 3 MERCY HEALTH PARTNERS 1 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON MI 49443 382299878 SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY MI 501(C)(3) LINE 11C, III-FI MERCY HEALTH PARTNERS 1 HACKLEY LIFE COUNSELING 1352 TERRACE ST MUSKEGON MI 49442 381386362 COUNSELING, EDUCATION, AND SUPPORT MI 501(C)(3) LINE 9 MERCY HEALTH PARTNERS 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 INDEPENDENT/ASSISTED LIVING RETIREMENT COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE 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