2015-05-12T12:18:03-05:00 2014-06-30 990 2013-07-01 421500277 BAUM HARMON MERCY HOSPITAL BAUM 7122792202 255 N WELCH AVE PRIMGHAR IA 51245 ANGIE SHILLING COO 7122792202 2015-05-12 2013 2016-03-07 17:11:31Z ANGIE SHILLING 255 N WELCH AVE PRIMGHAR IA 51245 7732676 0 X WWW.BAUMHARMON.ORG X 2000 IA ACUTE/AMBULATORY HEALTHCARE SERVICES IN O'BRIEN COUNTY IOWA. 9 2 0 6 0 0 64052 64401 7156232 7410764 -508 -35216 269244 242467 7489020 7682416 12399 6310 0 0 4816403 4864009 0 0 0 2616627 2672739 7445429 7543058 43591 139358 2651617 2644031 899767 1050440 1751850 1593591 ACUTE/AMBULATORY HEALTHCARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 6738061 6310 7437872 BAUM HARMON MERCY HOSPITAL (THE HOSPITAL) WAS FOUNDED IN 1970 TO PROVIDE QUALITY HEALTHCARE TO THE RESIDENTS OF PRIMGHAR, IOWA AND SURROUNDING COMMUNITIES. THE HOSPITAL HAS 14 ACUTE CARE BEDS THAT CAN SWING TO A SKILLED CARE UNIT. THE HOSPITAL HAS BEEN DESIGNATED A CRITICAL ACCESS HOSPITAL BY THE STATE OF IOWA. THE HOSPITAL ALSO OPERATES FOUR PHYSICIAN CLINICS IN PRIMGHAR, PAULLINA, SUTHERLAND, AND HARTLEY, IOWA. TODAY, THE HOSPITAL IS A MEMBER OF TRINITY HEALTH UNDER ITS CORPORATE STRUCTURE. THE MISSION STATEMENT FOR THE HOSPITAL IS AS FOLLOWS: WE, BAUM HARMON MERCY HOSPITAL AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 6738061 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 64 0 1 0 0 0 0 0 0 0 0 0 0 0 X 9 2 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SUE MCCAULEY 7129572303 255 NORTH WELCH AVE PRIMGHAR IA 51245 DON HARSON DIRECTOR 1.00 1.00 X 0 0 0 SHAILESH DESAI DIRECTOR; BHMH CLINIC PHYSICIAN 50.00 0.00 X 0 272966 48925 BRIAN MONSMA DIRECTOR; VP MMC-SC 1.00 49.00 X 0 204263 33512 ROBERT PEEBLES DIRECTOR & CEO MMC-SC THROUGH 3/14 1.00 49.00 X 0 568262 68733 JAMES FITZPATRICK DIRECTOR & CEO MMC-SC AS OF 4/14 1.00 49.00 X 0 0 0 MARTY WEBER PRESIDENT 1.00 0.00 X X 0 0 0 CHARLES KUMMERFELD VICE PRESIDENT 1.00 0.00 X X 0 0 0 LINDA WALVOORD SECRETARY 1.00 0.00 X X 0 0 0 STEPHEN GARY PD BY MGMT CO TREASURER & MMC-SC INT CFO THR 2/14 1.00 49.00 X X 0 0 0 HUGH DEPAULIS TREAS & VP FIN MMC-SC AS OF 3/14 1.00 49.00 X X 0 0 0 DAVID LIEBSACK ADMINISTRATOR CEO THROUGH 4/14 49.00 1.00 X X 0 141880 36921 ROGER LENZ INTERIM CEO AS OF 5/14 49.00 1.00 X X 0 43861 3365 JEANNETT WU PHYSICIAN 50.00 0.00 X 0 242556 35030 SOE NYUNT PHYSICIAN 50.00 0.00 X 0 238050 13716 ANTHONY PETERS PHYSICIAN ASSISTANT 50.00 0.00 X 0 110236 24125 GARY GUETZKO FORMER OFFICER 0.00 50.00 X 0 236235 56627 STEVEN J EAVENSON FORMER OFFICER 0.00 50.00 X 0 389051 35456 0 2447360 356410 0 1 1 0 AMERISOURCE BERGEN 3651 BIRCHWOOD WAUKEGAN IL 60085 PHARMACEUTICAL SERVICES 264989 THERAPEUTIC HEALTH SERVICES 1000 LINCOLN CIRCLE SE ORANGE CITY IA 51041 MEDICAL SERVICES 143864 SANFORD MEDICAL CENTER PO BOX 5074 SIOUX FALLS SD 57117 MEDICAL SERVICES 128558 DR ROBERT THORBROGGER 24376 140TH STREET SPIRIT LAKE IA 51360 MEDICAL SERVICES 118255 4 26879 13893 23629 10208 64401 NET PATIENT SVC REV 622110 7410764 7410764 7410764 162 162 12941 14220 -1279 -1279 -1279 35378 -35378 -35378 -35378 3583 662 2921 2921 CHILD CARE 624410 202747 202747 CAFETERIA REVENUE 722514 10970 10970 COLLECTION REVENUE 900099 9749 9749 17359 17359 240825 7682416 7437872 0 180143 6310 6310 500692 321891 178801 67288 67288 3273574 2972228 301346 184546 171567 12979 593956 541099 52857 243953 214438 29515 728561 691976 36585 14953 8217 6736 191708 158316 33392 379 379 214138 200252 13886 31313 17583 13730 20962 19113 1849 236116 176528 59588 16724 16724 MEDICAL SUPPLIES 578346 578346 BAD DEBT 212195 212195 INTERCO. PURCHASED SVCS 192481 191475 1006 EQUIPMENT MAINTENANCE 183877 132955 50922 50986 39560 11426 7543058 6738061 804997 0 79374 118245 1576689 976536 170818 195049 66320 50288 3314037 2348937 743073 965100 15343 338813 2651617 2644031 848019 1002598 51748 47842 899767 1050440 X 1751750 1593491 100 100 1751850 1593591 2651617 2644031 X 139358 -297617 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1557 0 0 0 1557 0 PART II-B, LINE 1: BAUM HARMON MERCY HOSPITAL HAS MADE GRANTS TO OTHER ORGANIZATIONS IN THE FORM OF MEMBERSHIP DUES PAID TO NATIONAL AND REGIONAL HEALTH CARE ORGANIZATIONS. THESE ORGANIZATIONS HAVE PROVIDED BAUM HARMON MERCY HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. BAUM HARMON MERCY HOSPITAL MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 62525 62525 1255243 1085611 169632 1727039 1065563 661476 269230 197763 71467 965100 OTHER LONG-TERM ASSETS 5500 INTERCOMPANY OTHER LT ASSETS 333313 338813 INTERCOMPANY ACCOUNTS PAYABLES 9749 ASSET RETIREMENT OBLIGATION (FIN 47) 38093 47842 1 1 X 1 X 1 X 1 1 1 0 1 1 1 29 16462 16462 0.00220 1 842 258642 439017 -180375 0.00000 2 871 275104 439017 -163913 0.00220 11 596 2290 885 1405 0.00020 11 596 2290 885 1405 0.00020 13 1467 277394 439902 -162508 0.00240 0 163874 83576 3000819 3165339 -164520 X 1 1 1 1 BAUM HARMON MERCY HOSPITAL 255 N WELCH AVE PRIMGHAR IA 51245 WWW.BAUMHARMON.ORG 710106H X X X X REHAB, SKILLED NURSING CARE, CLINICS BAUM HARMON MERCY HOSPITAL 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 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 BAUM HARMON MERCY HOSPITAL PART V, SECTION B, LINE 3: IN CONDUCTING THIS CHNA THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.BAUM HARMON MERCY HOSPITAL FACILITATED A FOCUS GROUP THAT REVIEWED INTERNAL AND EXTERNAL TRENDS IN HEALTHCARE, LOCAL DEMOGRAPHICS AND COUNTY HEALTH RANKINGS FOR O'BRIEN COUNTY. THE GROUP DISCUSSION IDENTIFIED HEALTH NEEDS IN THE COMMUNITIES AND FOCUSED ON THE PRIORITY NEEDS TO BE ADDRESSED BY BAUM HARMON MERCY HOSPITAL AND CLINICS INDEPENDENTLY AND/OR IN COLLABORATION WITH OTHER COMMUNITY GROUPS AND ORGANIZATIONS. MEMBERS OF THE FOCUS GROUP INCLUDED BAUM HARMON AND MERCY MEDICAL CENTER REPRESENTATIVES, SEVERAL BANKERS, SEVERAL COMMUNITY ACTIVISTS, PHYSICIANS, SEVERAL RETIRED PERSONS AND THE FACILITATORS. AS PART OF THE COMMUNITY NEEDS ASSESSMENT PROCESS, THE HOSPITAL'S STAFF HAS CONSULTED WITH REPRESENTATIVES OF THE O'BRIEN COUNTY HEALTHCARE COALITION, O'BRIEN COUNTY OFFICE OF THE DEPARTMENT OF HUMAN SERVICES, NORTHWEST IOWA PLANNING AND DEVELOPMENT COMMISSION AND O'BRIEN COUNTY EMERGENCY SERVICES ASSOCIATION. EACH OF THESE ORGANIZATIONS PLAYS A PARTICULAR ROLE IN THE COMMUNITIES AND THEIR INPUT IS MORE SPECIFICALLY DEFINED IN THE CHNA REPORT. BAUM HARMON MERCY HOSPITAL PART V, SECTION B, LINE 7: THE HOSPITAL FACILITY DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. BAUM HARMON MERCY HOSPITAL RECOGNIZES THAT WHEN BLENDING TOGETHER ALL OF THE DATA SOURCES UTILIZED IN THE CHNA REPORT, THERE CAN BE DEVELOPED AN EXHAUSTIVE LIST OF HEALTHCARE NEEDS FOR THE SERVICE AREA OF BAUM HARMON MERCY HOSPITAL. OUR LIST WOULD BE CONSISTENT WITH THE LIST OF FINDINGS FOR ALMOST EVERY OTHER RURAL COMMUNITY IN IOWA AND THE STATE AS A WHOLE. COMMUNITY NEEDS INCLUDE:- PREVENTION, TREATMENT AND MANAGEMENT OF CHRONIC ILLNESSES SUCH AS CANCER, DIABETES, DEMENTIA, CARDIOVASCULAR, PULMONARY, AND RENAL DISEASES- PREVENTION, TREATMENT AND MANAGEMENT OF OBESITY IN CITIZENS OF ALL AGES- PROMOTION OF HEALTHY LIFESTYLES AND INCREASED ACCEPTANCE OF PERSONAL RESPONSIBILITY FOR HEALTH OUTCOMES- PROVISION OF MENTAL HEALTH SERVICES FOR BOTH ACUTE AND CHRONIC CARE- EMERGENCY PREPAREDNESS AND PROVISION OF EMERGENCY RESPONSE SERVICES- HIGH QUALITY AND LOW COST ESSENTIAL HEALTHCARE SERVICES AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY FOR SERVICES OR LEVEL OF INSURANCE COVERAGE- ENVIRONMENTAL HEALTH-SAFE WATER, SAFE COMMUNITIES- VIBRANT AND SAFE COMMUNITIES WITH GOOD SCHOOLS, JOB OPPORTUNITIES, AFFORDABLE HOUSING, AND HIGH QUALITY CHILD AND SENIOR CARE OPTIONS- INCREASED EMPHASIS ON THE CONTINUITY OF CARE WITH HIGH QUALITY, PLEASANT AND SAFE OPTIONS FOR PERSONS UNABLE TO LIVE INDEPENDENTLY IN THEIR OWN HOMES- PROVISION OF ESSENTIAL HEALTHCARE CARE SERVICES CLOSE TO HOME-PRIMARY CARE CLINICS AND PHARMACY SERVICES- HEALTH-RELATED EDUCATION ON A VARIETY OF TOPICSWITH SUCH AN EXHAUSTIVE LIST AND THE FINITE RESOURCES OF A CRITICAL ACCESS HOSPITAL LIKE BAUM HARMON MERCY, WE NEEDED TO DEVELOP A PROCESS FOR IDENTIFYING AND PRIORITIZING COMMUNITY HEALTH NEEDS-WHAT DOES THE HOSPITAL HAVE THE RESOURCES TO ADDRESS EITHER ALONE OR IN COLLABORATION WITH COMMUNITY PARTNERS AND NEEDS THAT ARE BEYOND OUR CAPACITY TO ADDRESS. IN MANY CASES, BAUM HARMON MAY BE ABLE TO FACILITATE ACTIONS TOWARD A COMMUNITY NEED BUT WILL BE UNABLE TO FULLY ADDRESS THE NEED. IN THE CHNA REPORT, BAUM HARMON MERCY DESCRIBES SPECIFIC ACTIONS PLANNED TO ADDRESS THE NEEDS OF THE SERVICE AREA COMMUNITY. BAUM HARMON MERCY HOSPITAL 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. BAUM HARMON MERCY HOSPITAL 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 WRITE OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE COMMERCIAL CONTRACTUAL ADJUSTMENT FOR ALL COMMERCIAL PAYERS. BAUM HARMON MERCY HOSPITAL - PART V, SECTION B, LINE 5A: HTTP://WWW.BAUMHARMON.ORG/WORKFILES/CHNA_REPORT_BAUM.PDF 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: BAUM HARMON MERCY HOSPITAL 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, BAUM HARMON MERCY HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE:(WWW.TRINITY-HEALTH.ORG/DOCUMENTS/990/BHMH%20SCH%20H.PDF). PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $212,195, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - 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: THIS CRITICAL ACCESS HOSPITAL DOES NOT HAVE PRESUMPTIVE CHARITY. THE 51% IS BASED ON OAKLAND MERCY HOSPITAL THAT IS SIMILAR IN SIZE TO BAUM HARMON MERCY HOSPITAL DUE TO NO OTHER METHOD TO ACCESS THIS PERCENT. THIS PERCENT OF BAD DEBT WAS ESTIMATED AT THIS AMOUNT BASED ON A REVIEW OF PATIENT RECORDS REPORTED AS BAD DEBT. AN ASSESSMENT OF THE FINANCIAL ASSISTANCE PACKETS WAS DONE TO FIND OUT HOW MANY WERE DENIED DUE TO MISSING OR INCOMPLETE DOCUMENTATION. PART III, LINE 4: BAUM HARMON MERCY HOSPITAL 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: BAUM HARMON MERCY HOSPITAL 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: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - BAUM HARMON MERCY HOSPITAL ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - BAUM HARMON MERCY IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTH CARE 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 COMMUNITY.IN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, BAUM HARMON MERCY 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 OBLIGATIONSBAUM HARMON MERCY COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL- BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. OUR BUSINESS OFFICE STAFF ANSWERS QUESTIONS REGARDING PATIENT BILLS AND HOSPITAL PROGRAMS FIVE DAYS A WEEK AT THE HOSPITAL BUSINESS OFFICE OR BY PHONE.EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.BAUM HARMON MERCY OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH CONTACT WITH BUSINESS OFFICE AND ADMINISTRATIVE STAFF. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE AS NEEDED FOR NON-ENGLISH SPEAKING PATIENTS. BAUM HARMON MERCY HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. BAUM HARMON MERCY MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. BAUM HARMON MERCY EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) 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. PART VI, LINE 4: COMMUNITY INFORMATION - THE 2010 CENSUS POPULATION FOR O'BRIEN COUNTY IS 14,398 PEOPLE, A DECREASE OF 4.7% FROM THE 2000 CENSUS. OF THESE, 6.4% ARE UNDER AGE 5 YEARS, 23.6% ARE UNDER AGE 18 YEARS AND 20.4% ARE AGE 65 YEARS AND OLDER. PERSONS 65 YEARS AND OLDER ARE 20.4% OF THE CITIZENS OF O'BRIEN COUNTY AND ARE ONLY 14.9% OF THE POPULATION OF THE ENTIRE STATE OF IOWA. THE ECONOMIC IMPACT OF THE HEALTH SECTOR UPON THE ECONOMY OF O'BRIEN COUNTY IS TREMENDOUS IN DATA PUBLISHED BY THE IOWA HOSPITAL ASSOCIATION IN JANUARY 2014 FOR THE PREVIOUS YEAR, BAUM HARMON'S ECONOMIC IMPACT WAS CLOSE TO 5.7 MILLION DOLLARS WITH NEARLY AN ADDITIONAL MILLION IN RETAIL SALES. THE HEALTH SECTOR EMPLOYS A LARGE NUMBER OF RESIDENTS, SIMILAR TO A LARGE INDUSTRIAL FIRM. IF THE HEALTH SECTOR INCREASES OR DECREASES IN SIZE, THE MEDICAL HEALTH OF THE COMMUNITY AS WELL AS THE ECONOMIC HEALTH OF THE COMMUNITY IS GREATLY AFFECTED. FOR THE ATTRACTION OF INDUSTRIAL FIRMS, BUSINESSES, AND RETIREES, IT IS CRUCIAL THAT THE AREA HAVE A QUALITY HEALTH SECTOR. OFTEN OVERLOOKED IS THE FACT THAT A PROSPEROUS HEALTH SECTOR ALSO CONTRIBUTES TO THE ECONOMIC HEALTH OF THE COMMUNITY. PART VI, LINE 5: OTHER INFORMATION - AS A CRITICAL ACCESS HOSPITAL, IT IS VERY IMPORTANT FOR US TO WORK COLLABORATIVELY TO ASSURE THAT WE ARE OFFERING WHAT OUR COMMUNITY NEEDS. OUR HOSPITAL BOARD IS MADE UP OF INDIVIDUALS FROM EACH ONE OF THE PRIMARY COMMUNITIES IN OUR SERVICE AREA AND FROM OUR NETWORK HOSPITAL, MERCY MEDICAL CENTER-SIOUX CITY.OUR OPEN MEDICAL STAFF PROVIDES SEVERAL DIFFERENT STYLES OF CARE, FROM INTERNISTS TO FAMILY PRACTICE PHYSICIANS AND A WIDE ARRAY OF SPECIALTY PHYSICIANS. BAUM HARMON HAS FOUR PROVIDER-BASED RURAL HEALTH CLINICS SERVING PRIMGHAR, SUTHERLAND, PAULLINA, HARTLEY AND THE SURROUNDING RURAL AREAS. BAUM HARMON MERCY HAS EMPLOYEES WHO SERVE ON THE O'BRIEN COUNTY BOARD OF HEALTH, THE O'BRIEN COUNTY EMS ASSOCIATION, THE REGION 3 HOSPITAL PREPAREDNESS PROGRAM STEERING COMMITTEE, AND THE IOWA PREPAREDNESS ADVISORY COMMITTEE AS A RESPONSIBILITY RELATED TO THEIR EMPLOYMENT. EMPLOYEES VOLUNTEER WITH A WIDE VARIETY OF ORGANIZATIONS INCLUDING THEIR CHURCHES, CHAMBERS OF COMMERCE, SCHOOL BOARDS, AND NUMEROUS SERVICE CLUBS.BAUM HARMON MERCY STAFF PROVIDES SUBSIDIZED COMMUNITY SCREENING EVENTS OFFERING DIABETES AND LIPID SCREENINGS IN FOUR COMMUNITIES, VASCULAR SCREENINGS TWICE ANNUALLY AT THE HOSPITAL AND PROSTATE SCREENINGS IN TWO OF OUR CLINIC SITES. THESE SCREENING EVENTS ARE OPEN TO THE PUBLIC.BAUM HARMON MERCY PROVIDES WORKSITE HEALTH SCREENINGS FOR A SCHOOL DISTRICT IN OUR SERVICE AREA AND ALSO COUNTY GOVERNMENT-BOTH ORGANIZATIONS REQUESTING THIS ASSISTANCE.FROM TIME-TO-TIME, BAUM HARMON MERCY HOSPITAL DONATES UNOPENED BUT OUTDATED MEDICAL SUPPLIES AND EQUIPMENT REMOVED FROM SERVICE TO CHARITABLE CAUSES INCLUDING: DR. WESTER'S MISSION IN AFRICA, GLOBAL HEALTH MINISTRIES THROUGH THE LUTHERAN CHURCH AND WHEN THE OPPORTUNITY PRESENTS SOME SUPPLIES ARE SENT WITH STAFF GOING ON MEDICAL/SURGICAL MISSION TRIPS TO BANGLADESH AND TANZANIA.BAUM HARMON MERCY HOSPITAL REACHES OUT TO THE COMMUNITIES AND PUBLIC BY OPERATING AND SUBSIDIZING A DAY CARE CENTER AND FITNESS CENTER. THE DAY CARE CENTER PROVIDES CHILD CARE FOR MANY FAMILIES IN THE COMMUNITY INCLUDING TRADITIONAL DAY CARE, A BEFORE AND AFTER SCHOOL PROGRAM AND EMERGENCY RESPITE CARE. THE FITNESS CENTER PROVIDES AN AFFORDABLE PLACE TO EXERCISE AND REHABILITATE AFTER INJURIES/ILLNESSES.BAUM HARMON MERCY STAFF WORK CLOSELY WITH O'BRIEN COUNTY EMERGENCY MANAGEMENT AND O'BRIEN COUNTY PUBLIC HEALTH AND OTHER COMMUNITY PARTNERS IN DEVELOPING AND TESTING EMERGENCY RESPONSE PLANS FOR A VARIETY OF POTENTIAL THREATS TO INDIVIDUALS AND COMMUNITIES. THE HOSPITAL PROVIDES CPR AND FIRST AID TRAINING FOR SEVERAL OTHER ORGANIZATIONS AND BUSINESSES OUTSIDE OF THE HOSPITAL. THE HOSPITAL DOES CHARGE A FEE FOR THESE CLASSES BUT IT DOES NOT COVER ALL OF THE ASSOCIATED COSTS. PART VI, LINE 6: BAUM HARMON MERCY HOSPITAL 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. 0 1 0 0 0 0 0 0 0 SHAILESH DESAI DIRECTOR; BHMH CLINIC PHYSICIAN 0 270399 0 0 0 2567 0 25434 0 23491 0 321891 0 0 BRIAN MONSMA DIRECTOR; VP MMC-SC 0 164131 0 39625 0 507 0 12968 0 20544 0 237775 0 0 ROBERT PEEBLES DIRECTOR & CEO MMC-SC THROUGH 3/14 0 381701 0 129132 0 57429 0 51809 0 16924 0 636995 0 0 DAVID LIEBSACK ADMINISTRATOR CEO THROUGH 4/14 0 132617 0 8559 0 704 0 13964 0 22957 0 178801 0 0 JEANNETT WU PHYSICIAN 0 241505 0 0 0 1051 0 12376 0 22654 0 277586 0 0 SOE NYUNT PHYSICIAN 0 234906 0 0 0 3144 0 11802 0 1914 0 251766 0 0 GARY GUETZKO FORMER OFFICER 0 186807 0 47679 0 1749 0 37463 0 19164 0 292862 0 0 STEVEN J EAVENSON FORMER OFFICER 0 285014 0 74922 0 29115 0 19540 0 15916 0 424507 0 0 PART I, LINE 3 BAUM HARMON MERCY HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. BAUM HARMON MERCY HOSPITAL'S CEO IS PAID DIRECTLY BY MERCY MEDICAL CENTER - SIOUX CITY, A SUBSIDIARY OF TRINITY HEALTH CORPORATION. MERCY MEDICAL CENTER - SIOUX CITY USED THE FOLLOWING METHOD TO ESTABLISH THE COMPENSATION OF BAUM HARMON MERCY HOSPITAL'S CEO: - COMPENSATION SURVEY OR STUDY PART I, LINE 4B THE FOLLOWING IS A PARTICIPANT 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 ACCRUAL FOR 2013 FOR THIS PLAN IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: ROBERT PEEBLES - $39,059 PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER SECTION 451. THE FOLLOWING ARE THE 451 DEFERRALS FOR CALENDAR 2013: SHAILESH DESAI - $12,000 SOE NYUNT - $60,000 JEANNETT WU - $60,000 NORMA WEBER FAMILY MEMBER OF MARTY WEBER, BOARD PRESIDENT 23673 EMPLOYMENT ARRANGEMENT. 0 GINA WIEKAMP FAMILY MEMBER OF DON HARSON, BOARD DIRECTOR 43615 EMPLOYMENT ARRANGEMENT. 0 FORM 990, PART VI, SECTION A, LINE 3 MERCY MEDICAL CENTER - SIOUX CITY (MMC-SC) HAS CONTRACTED WITH TATUM, LLC FOR THE PROVISION OF INTERIM CFO SERVICES. IN CALENDAR YEAR 2013 MMC-SC PAID $450,636 TO TATUM, LLC FOR STEPHEN GARY'S SERVICES AS INTERIM CFO OF MMC-SC. MMC-SC DOES NOT KNOW HOW MUCH STEPHEN GARY RECEIVED AS WAGES FROM TATUM, LLC IN CALENDAR 2013. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF BAUM HARMON MERCY HOSPITAL IS MERCY HEALTH SERVICES - IOWA, CORP. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH SERVICES - IOWA, CORP. IS THE SOLE MEMBER OF BAUM HARMON MERCY HOSPITAL. MERCY HEALTH SERVICES - IOWA, CORP. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF BAUM HARMON MERCY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, MERCY HEALTH SERVICES - IOWA, CORP. MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. MERCY HEALTH SERVICES - IOWA, CORP. 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 BAUM HARMON MERCY HOSPITAL IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C BAUM HARMON MERCY HOSPITAL 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 BAUM HARMON MERCY HOSPITAL, 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 BAUM HARMON MERCY HOSPITAL'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO BAUM HARMON MERCY HOSPITAL 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 BAUM HARMON MERCY HOSPITAL IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO BAUM HARMON MERCY HOSPITAL. 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 BAUM HARMON MERCY HOSPITAL ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED NO BECAUSE THE TOP MANAGEMENT OFFICIAL IS ON MERCY MEDICAL CENTER - SIOUX CITY'S PAYROLL. 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 DIRECTORS OF BAUM HARMON MERCY HOSPITAL 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 BAUM HARMON MERCY HOSPITAL 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 ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, BAUM HARMON MERCY HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE. BAUM HARMON MERCY HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO/FROM AFFILIATES -297,617. FORM 990, PART XII, LINE 2: BAUM HARMON MERCY HOSPITAL'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY14 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 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 SERVICES-IOWA CORP 0 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 11A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 REAL ESTATE HOLDING NY 501(C)(2) N/A LTC (EDDY) INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 INDEPENDENT/ASSISTED LIVING RETIREMENT COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 BRIGHTSIDE INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042182395 BEHAVIORAL CARE MA 501(C)(3) LINE 9 SISTERS OF PROVIDENCE HEALTH SYSTEM INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES NY 12047 141701597 NURSING HOME NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES MI 501(C)(3) LINE 11B, II TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH EAST 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 232929748 MANAGEMENT SERVICES PA 501(C)(3) LINE 11C, III-FI CHE TRINITY INC 1 CHE TRINITY INC 20555 VICTOR PARKWAY LIVONIA MI 48152 900931907 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) LINE 11B, II N/A 0 COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK NJ 07102 262616342 INACTIVE ENTITY NJ 501(C)(3) LINE 9 SAINT MICHAELS MEDICAL CENTER 1 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 1 CONTINUING CARE MANAGEMENT SERVICES NETWORK 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 352336834 MANAGEMENT & SUPPORT SERVICES PA 501(C)(3) LINE 11B, II CATHOLIC HEALTH EAST 1 CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY MI 48098 383320699 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) LINE 11A, I TRINITY HOME HEALTH SERVICES INC 1 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 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 TERM CARE MA 501(C)(3) LINE 3 SISTERS OF PROVIDENCE HEALTH SYSTEM INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 ELDERCARE DE 501(C)(3) LINE 9 ST FRANCIS HOSPITAL 1 GLEN EDDY INC ONE GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 INDEPENDENT/ASSISTED LIVING COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 233068656 HEALTH CARE PA 501(C)(3) LINE 7 CATHOLIC HEALTH EAST 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HOSPITAL GA 501(C)(3) LINE 3 SAINT JOSEPH'S HEALTH SYSTEM INC 1 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 SUPPORT THE SERVICES OF RELATED HOSPITAL IL 501(C)(3) LINE 9 GOTTLIEB MEMORIAL HOSPITAL 1 GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK IL 60160 743260011 SUPPORT THE SERVICES OF RELATED HOSPITAL IL 501(C)(3) LINE 11C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W 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 TROY NY 12180 141725101 NURSING HOME NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48333 521945054 LONG-TERM CARE AND REHABILITATION FOR THE ELDERLY MD 501(C)(3) LINE 9 TRINITY CONTINUING CARE SERVICES 1 HOLY CROSS HEALTH FOUNDATION INC 11801 TECH ROAD SILVER SPRING MD 20904 208428450 CHARITABLE FUNDRAISING MD 501(C)(3) LINE 11A, I HOLY CROSS HEALTH INC 1 HOLY CROSS HEALTH INC 1500 FOREST GLEN RD SILVER SPRING MD 20910 520738041 HEALTHCARE SERVICES MD 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 590791028 HOSPITAL-HEALTHCARE PROVIDER FL 501(C)(3) LINE 3 CATHOLIC HEALTH EAST 1 HOLY CROSS LONG TERM CARE INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 650787320 MEDICAL SERVICES FL 501(C)(3) LINE 3 HOLY CROSS HOSPITAL INC 1 HOLY CROSS MEDICAL CENTER 20555 VICTOR PARKWAY LIVONIA MI 48152 951985442 HEALTHCARE SERVICES (FORMERLY) CA 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS MEDICAL PROPERTIES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 650666283 MEDICAL BUILDING REAL ESTATE MANAGEMENT FL 501(C)(2) N/A HOLY CROSS HOSPITAL INC 1 HOME AIDE SERVICE OF EASTERN NEW YORK 433 RIVER ST SUITE 3000 TROY NY 12180 141514867 HOME CARE NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY IA 50401 421173708 HOSPICE HEALTH CARE SERVICES IA 501(C)(3) LINE 7 MERCY HEALTH SERVICES-IOWA CORP 1 HOSPICE OF SIOUXLAND 4300 HAMILTON BLVD SIOUX CITY IA 51104 383320710 HOSPICE SERVICES IA 501(C)(3) LINE 11A, I N/A 0 HOSPICE OF WASHTENAW II 806 AIRPORT BLVD ANN ARBOR MI 48108 383320707 HOSPICE HEALTH CARE SERVICES MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR MI 48106 383316559 PROVIDES OFFICE-BASED MEDICAL CARE MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 INTRACOASTAL HEALTH SYSTEMS INC 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 650556413 MANAGEMENT & SUPPORT SERVICES PA 501(C)(3) LINE 11A, I CATHOLIC HEALTH EAST 1 JAMES A EDDY MEMORIAL GERIATRIC CENTER INC 2256 BURDETT AVE TROY NY 12180 222570478 NURSING HOME NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 LAKESHORE COMMUNITY HOSPITAL INC 72 S STATE STREET SHELBY MI 49455 382549295 ACUTE HEALTHCARE SERVICES MI 501(C)(3) LINE 3 MERCY HEALTH PARTNERS 1 LANGHORNE MRI INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232519529 INACTIVE ENTITY PA 501(C)(3) LINE 9 ST MARY MEDICAL CENTER 1 LANGHORNE PHYSICIAN SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232571699 PHYSICIAN SERVICES PA 501(C)(3) LINE 9 ST MARY MEDICAL CENTER 1 LIFE AT LOURDES INC 2475 MCCLELLAN AVENUE PENNSAUKEN NJ 08109 261854750 ELDERLY CARE NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LIFE AT ST FRANCIS HEALTHCARE INC 7TH CLAYTON STREETS WILMINGTON DE 19805 452569214 ELDERLY CARE DE 501(C)(3) LINE 9 ST FRANCIS HOSPITAL 1 LIFE ST FRANCIS CORPORATION 601 HAMILTON AVENUE TRENTON NJ 08629 222797282 HEALTH SERVICES NJ 501(C)(3) LINE 11A, I ST FRANCIS MEDICAL CENTER TRENTON NJ 1 LIFE ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SUITE B SOUTHERN PINES NC 28387 272159847 HEALTHCARE SERVICES NC 501(C)(3) LINE 3 ST JOSEPH'S OF THE PINES INC 1 LIFE ST MARY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 262976184 ELDERLY CARE PA 501(C)(3) LINE 9 ST MARY MEDICAL CENTER 1 LOURDES ANCILLARY SERVICES 1600 HADDON AVENUE CAMDEN NJ 08103 222568525 SUPPORTING ORGANIZATION NJ 501(C)(3) LINE 11B, II OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES CARDIOLOGY SERVICES PC 1600 HADDON AVENUE CAMDEN NJ 08103 274357794 CARDIOLOGY SERVICES NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES DIALYSIS AT INNOVA INC 3716 CHURCH ROAD MT LAUREL NJ 08054 263237625 HOSPITAL NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES MEDICAL CENTER OF BURLINGTON COUNTY 218 SUNSET ROAD WILLINGBORO NJ 08046 223612265 HOSPITAL NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOYOLA UNIVERSITY HEALTH SYSTEM 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 363342448 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT 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