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MERCY MEDICAL CENTER-CENTERVILLE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MERCY MEDICAL CENTER-CENTERVILLE (EIN 42-0680308)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-13
IRS object ID
201331339349302013
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-13T11:00:37-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN470617373EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CATHOLIC HEALTH INITIATIVESBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1198 INVERNESS DRIVE WESTAddressLine1
CityENGLEWOODCity
StateCOState
ZIP Code80112ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN420680308EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY MEDICAL CENTER - CENTERVILLEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMERCNameControl
Phone5154373413Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 St Josephs DriveAddressLine1
CityCentervilleCity
StateIAState
ZIP Code52544ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSTEVE KUKLAName
TitleSR VP & CFO, MMCTitle
Date Signed2013-05-06DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NamePAMELA KROHNName
PTINP01210500PTIN
Phone3032989100Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1CLINTON CHRISTIANSONBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11 St Josephs DriveAddressLine1
CityCentervilleCity
StateIAState
ZIP Code52544ZIPCode
FieldValueIRS element (for citing)
Gross Receipts27465415GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.MERCYCENTERVILLE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1965YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionMERCY MEDICAL CENTER-CENTERVILLE IS A NOT-FOR-PROFIT CATHOLIC HEALTH ORGANIZATION CREATING HEALTHIER COMMUNITIES BY OPERATING A 25-BED ACUTE CARE HOSPITAL AND A 20-BED SKILLED NURSING FACILITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees289TotalNbrEmployees
Total Nbr Volunteers11TotalNbrVolunteers
Total Gross UBI284TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year916315ContributionsGrantsPriorYear
Contributions Grants Current Year1036074ContributionsGrantsCurrentYear
Program Service Revenue Prior Year25249567ProgramServiceRevenuePriorYear
Program Service Revenue CY25953589ProgramServiceRevenueCY
Investment Income Prior Year545736InvestmentIncomePriorYear
Investment Income Current Year326321InvestmentIncomeCurrentYear
Other Revenue Prior Year120669OtherRevenuePriorYear
Other Revenue Current Year149431OtherRevenueCurrentYear
Total Revenue Prior Year26832287TotalRevenuePriorYear
Total Revenue Current Year27465415TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year13846GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY22693GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12908069SalariesEtcPriorYear
Salaries Etc Current Year12582954SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11439638OtherExpensePriorYear
Other Expenses Current Year12161957OtherExpensesCurrentYear
Total Expenses Prior Year24361553TotalExpensesPriorYear
Total Expenses Current Year24767604TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2470734RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2697811RevenuesLessExpensesCY
Total Assets BOY20619452TotalAssetsBOY
Total Assets EOY22643471TotalAssetsEOY
Total Liabilities BOY2621621TotalLiabilitiesBOY
Total Liabilities EOY2233131TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY17997831NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY20410340NetAssetsOrFundBalancesEOY
Mission DescriptionTHE ORGANIZATION'S MISSION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense22983590Expense
Grants22693Grants
Revenue25953589Revenue
DescriptionSEE SCHEDULE H.Description
Total Program Service Expense22983590TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees289NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledIAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Randall L RubinBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5156437860TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11111 6th AvenueAddressLine1
CityDes MoinesCity
StateIAState
ZIP Code50314ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
CLINTON CHRISTIANSON
PRESIDENT/CEO40.00XX185897028415
LEANNE DROBNICH
Vice Chair1.00XX025835137370
ROBERT PONTIUS
Chairman1.00XX000
BILL BUSS
Director1.00X000
DAVID FRASER
Director/Physician40.00X258965033155
DAVID HOWE
Director1.00X000
DR KATHLEEN LANGE
Director1.00X000
DR PAUL PONCY
Director1.00X000
JOSEPH LEVALLEY
Director/SVP MMC DSM1.00X031605845582
MADELINE CUMMINS
Director1.00X000
MARLENE SPROUSE
Director1.00X000
MIKE CRAVER
Director1.00X000
SR CAMILLA VERRET RSM
Director1.00X000
SR JEANNE CHRISTENSEN RSM
DIRECTOR1.00X000
LORI RATHBUN
VP Operations/Treasurer40.00X104646026362
ERICA COLLINS
Physician40.00223959027863X
JAMES MCCONVILLE
Physician40.00141702016536X
JEFFREY WILLIER
Director of Pharmacy40.00107383026270X
NANCY BARTON
Physician40.00145654336436070X
RICHARD J BURGER
PHYSICIAN40.0012884608450X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1297052TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs577773TotalReportableCompFrmRltdOrgs
Total Other Compensation286073TotalOtherCompensation
Number Individuals GT100 K9NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
EMCARE PHYSICIAN SERVICES
7032 COLLECTION DRIVECHICAGOIL60693PHYSICIAN SERVICES1314796
NUCLEAR SONICS
PO BOX 6NEW RICHMONDWI54017PHYSICIAN SERVICES159599
ALL ABOUT STAFFING
1000 SAWGRASS CORP PARKWAYSUNRISEFL33323MEDICAL SERVICES149966
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Related Organizations971819RelatedOrganizations
Government Grants63755GovernmentGrants
All Other Contributions500AllOtherContributions
Total Contributions1036074TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICES9000992562117325621173
PROGRAM SERVICE REVENUE9000995921659216
INCENTIVE PAYMENTS9000992732002732000

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue25953589TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column241038TotalRevenueColumn
Unrelated Business Revenue284UnrelatedBusinessRevenue
Exclusion$240,754ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities85283Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities85283Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column85283TotalRevenueColumn
Exclusion$85,283ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA72210056178$56,178
REIMBURSEMENT OF EXPENSES90009966085$66,085
MEALS ON WHEELS62421014486$14,486

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column12682TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,682ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue149431TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column27465415TotalRevenueColumn
Related Or Exempt Function Income25953589RelatedOrExemptFunctionIncome
Unrelated Business Revenue284UnrelatedBusinessRevenue
Exclusion$475,468ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total22693Total
Program Services22693ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total557002Total
Program Services238706ProgramServices
Management And General318296ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9332795Total
Program Services9140275ProgramServices
Management And General192520ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total530448Total
Program Services504907ProgramServices
Management And General25541ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1433981Total
Program Services1402661ProgramServices
Management And General31320ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total728728Total
Program Services694574ProgramServices
Management And General34154ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2675210Total
Program Services2643029ProgramServices
Management And General32181ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total70718Total
Program Services17195ProgramServices
Management And General53523ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1448512Total
Program Services1352122ProgramServices
Management And General96390ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total652333Total
Program Services652333ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total86612Total
Program Services65165ProgramServices
Management And General21447ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total5009Total
Program Services837ProgramServices
Management And General4172ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total61182Total
Program Services61182ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total651301Total
Program Services645982ProgramServices
Management And General5319ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total181580Total
Program Services181580ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
CHI IA MBO ASSESSMENT882698882698
MEDICAL SUPPLIES25242142524214
BAD DEBTS20697812069781
REPAIRS AND MAINTENANCE61862327714590909

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total234184Total
Program Services175445ProgramServices
Management And General58739ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total24767604Total
Program Services22983590ProgramServices
Management And General1784014ManagementAndGeneral
Fundraising0Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY783BOY
EOY783EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1706715BOY
EOY2778796EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3104812BOY
EOY4198247EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY367915BOY
EOY354101EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY176419BOY
EOY195268EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16879397LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec12325020LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4724723BOY
EOY4554377EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY10538085BOY
EOY10561899EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20619452BOY
EOY22643471EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1250424BOY
EOY1017247EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1371197BOY
EOY1215884EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2621621BOY
EOY2233131EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17997831BOY
EOY20410340EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17997831BOY
EOY20410340EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20619452BOY
EOY22643471EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2697811ReconcilationRevenueExpenses
Reconcilation Other Changes-285302ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$4,080GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB4080TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDescription of the activities reported on Lines 1a through 1iIdentifier
Return ReferenceSchedule C, Part II-B, Line 1ReturnReference
Explanation$17,817 IN ANNUAL DUES WAS PAID TO THE IOWA HOSPITAL ASSOCIATION AND $4,080 WAS ALLOCATED AS LOBBYING EXPENSES. THE AMOUNT SHOWN IN LINE 1F REPRESENTS THE ENTITY'S SHARE OF ALLOCATED LOBBYING EXPENSES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis160349OtherCostOrOtherBasis
Book Value160349BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10779227OtherCostOrOtherBasis
Depreciation7629276Depreciation
Book Value3149951BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5617434OtherCostOrOtherBasis
Depreciation4402540Depreciation
Book Value1214894BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis322387OtherCostOrOtherBasis
Depreciation293204Depreciation
Book Value29183BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4554377TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value0BookValue

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value0BookValue

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValue
CHI OIP - FIXED INCOME5335791
CHI OIP - EQUITY SECURITIES5226108
FieldValueIRS element (for citing)
Total Of Book Value Securities10561899TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCHI DEBT PROGRAMDescription
Amount$1,215,884Amount
FieldValueIRS element (for citing)
Total Of Amounts1215884TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFIN 48 (ASC 740) footnoteIdentifier
Return ReferenceSchedule D, Part X, Line 2ReturnReference
ExplanationMERCY MEDICAL CENTER - CENTERVILLE'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES - IOWA, CORP DBA MERCY MEDICAL CENTER - DES MOINES (CHI-IOWA CORP). CHI-IOWA CORP'S FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2012 READS AS FOLLOWS: "THE CORPORATION AND ALL SUBSIDIARIES, EXCEPT MPA, AND DMMC ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE. ASC 740, INCOME TAXES, PRESCRIBES CRITERIA FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. MANAGEMENT HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT HAVE NOT BEEN REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION'S FEDERAL INCOME TAX RETURNS ARE OPEN TO EXAMINATION FOR THE YEARS ENDED JUNE 30, 2009 THROUGH JUNE 30, 2012."Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CarefalseFPGReferenceFreeCare
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense155972TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense155972NetCommunityBenefitExpense
Percent Of Total Expense0.00690PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense155972TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense155972NetCommunityBenefitExpense
Percent Of Total Expense0.00690PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served7861PersonsServed
Total Community Benefit Expense41654TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense41654NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served222PersonsServed
Total Community Benefit Expense7256TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense7256NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense621TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense621NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Persons Served140PersonsServed
Total Community Benefit Expense53204TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense53204NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served8223PersonsServed
Total Community Benefit Expense102735TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense102735NetCommunityBenefitExpense
Percent Of Total Expense0.00440PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served8223PersonsServed
Total Community Benefit Expense258707TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense258707NetCommunityBenefitExpense
Percent Of Total Expense0.01130PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served6096PersonsServed
Total Community Building Expense65981TotalCommunityBuildingExpense
Direct Offsetting Revenue15242DirectOffsettingRevenue
Net Community Building Expense50739NetCommunityBuildingExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Total Community Building Expense1861TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense1861NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense340TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense340NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Persons Served6096PersonsServed
Total Community Building Expense68182TotalCommunityBuildingExpense
Direct Offsetting Revenue15242DirectOffsettingRevenue
Net Community Building Expense52940NetCommunityBuildingExpense
Percent Of Total Expense0.00230PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,069,781BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare9951675AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare9756611CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall195064MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY MEDICAL CENTER - CENTERVILLEBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1ONE ST JOSEPHS DRIVEAddressLine1
CityCENTERVILLECity
StateIAState
ZIP Code52544ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY CENTERVILLE LONGTERM CARE FACILITYBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1ONE ST JOSEPHS DRIVEAddressLine1
CityCENTERVILLECity
StateIAState
ZIP Code52544ZIPCode
FieldValueIRS element (for citing)
Facility TypeNURSING HOMEFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Eligibility criteria for free or discounted careSchedule H, Part I, Line 3cWHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO MERCY MEDICAL CENTER - CENTERVILLE ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG THE 69 URBAN AND RURAL COMMUNITIES IN 19 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES ("FPG"), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. MERCY MEDICAL CENTER - CENTERVILLE BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES.
Costing Methodology used to calculate financial assistanceSchedule H, Part I, Line 7PROVIDE AN EXPLANATION OF THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. IF A COST ACCOUNTING SYSTEM WAS USED, INDICATE WHETHER THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED OR SELF PAY). A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. ALSO INDICATE WHETHER A COST-TO-CHARGE RATIO WAS USED FOR ANY OF THE FIGURES REPORTED IN THE TABLE. DESCRIBE WHETHER THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, AND, IF NOT, WHAT KIND OF COST-TO-CHARGE RATIO WAS USED AND HOW IT WAS DERIVED. IF SOME OTHER COSTING METHODOLOGY WAS USED BESIDES A COST ACCOUNTING SYSTEM, COST-TO-CHARGE RATIO, OR A COMBINATION OF THE TWO, DESCRIBE THE METHOD USED. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/12 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. BASED ON THAT FORMULA, A 43.17% COST-TO-CHARGE RATIO RESULTS. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO.
Bad Debt Expense excluded from financial assistance calculationSchedule H, Part I, Line 7, column(f)2,069,781
Bad debt expense - financial statement footnoteSchedule H, Part III, Line 4THE COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS BASED ON THE SAME METHODOLOGY USED TO REPORT BAD DEBT EXPENSE IN THE ORGANIZATION'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. MERCY MEDICAL CENTER - CENTERVILLE DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. "THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE CORPORATION."
Community benefit & methodology for determining medicare costsSchedule H, Part III, Line 8MERCY MEDICAL CENTER - CENTERVILLE IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL ("CAH"). CAHS ARE RURAL COMMUNITY HOSPITALS THAT ARE CERTIFIED TO RECEIVE COST-BASED REIMBURSEMENT FROM MEDICARE. THE REIMBURSEMENT THAT CAHS RECEIVE IS INTENDED TO IMPROVE THEIR FINANCIAL PERFORMANCE AND THEREBY REDUCE HOSPITAL CLOSURES. CAHS ARE CERTIFIED UNDER A DIFFERENT SET OF MEDICARE CONDITIONS OF PARTICIPATION (COP). SHORTFALLS ARE CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COSTS OF CARING FOR PROGRAM BENEFICIARIES. BECAUSE SHORTFALLS ARE BASED ON COSTS, NOT CHARGES, MERCY MEDICAL CENTER - CENTERVILLE, DUE TO THEIR DESIGNATION AS A CAH, RECEIVED COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES, MERCY MEDICAL CENTER - CENTERVILLE WILL NOT EXPERIENCE MEDICARE RELATED SHORTFALLS. ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE-SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT). TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY: TOTAL MEDICARE REVENUE: $9,968,897 TOTAL MEDICARE COSTS: $9,789,834 SURPLUS: $179,063 MERCY MEDICAL CENTER - CENTERVILLE BELIEVES THAT EXCLUDING MEDICARE LOSSES FROM COMMUNITY BENEFIT MAKES THE OVERALL COMMUNITY BENEFIT REPORT MORE CREDIBLE FOR THESE REASONS: UNLIKE SUBSIDIZED AREAS SUCH AS BURN UNITS OR BEHAVIORAL-HEALTH SERVICES, MEDICARE IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS. IN FACT, FOR-PROFIT HOSPITALS FOCUS ON ATTRACTING PATIENTS WITH MEDICARE COVERAGE, ESPECIALLY IN THE CASE OF WELL-PAID SERVICES THAT INCLUDE CARDIAC AND ORTHOPEDICS. SIGNIFICANT EFFORT AND RESOURCES ARE DEVOTED TO ENSURING THAT HOSPITALS ARE REIMBURSED APPROPRIATELY BY THE MEDICARE PROGRAM. THE MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC), AN INDEPENDENT CONGRESSIONAL AGENCY, CAREFULLY STUDIES MEDICARE PAYMENT AND THE ACCESS TO CARE THAT MEDICARE BENEFICIARIES RECEIVE. THE COMMISSION RECOMMENDS PAYMENT ADJUSTMENTS TO CONGRESS ACCORDINGLY. THOUGH MEDICARE LOSSES ARE NOT INCLUDED BY CATHOLIC HOSPITALS AS COMMUNITY BENEFIT, THE CATHOLIC HEALTH ASSOCIATION GUIDELINES ALLOW HOSPITALS TO COUNT AS COMMUNITY BENEFIT SOME PROGRAMS THAT SPECIFICALLY SERVE THE MEDICARE POPULATION. FOR INSTANCE, IF HOSPITALS OPERATE PROGRAMS FOR PATIENTS WITH MEDICARE BENEFITS THAT RESPOND TO IDENTIFIED COMMUNITY NEEDS, GENERATE LOSSES FOR THE HOSPITAL, AND MEET OTHER CRITERIA, THESE PROGRAMS CAN BE INCLUDED IN THE CHA FRAMEWORK IN CATEGORY C AS "SUBSIDIZED HEALTH SERVICES." MEDICARE LOSSES ARE DIFFERENT FROM MEDICAID LOSSES, WHICH ARE COUNTED IN THE CHA COMMUNITY BENEFIT FRAMEWORK, BECAUSE MEDICAID REIMBURSEMENTS GENERALLY DO NOT RECEIVE THE LEVEL OF ATTENTION PAID TO MEDICARE REIMBURSEMENT. MEDICAID PAYMENT IS LARGELY DRIVEN BY WHAT STATES CAN AFFORD TO PAY, AND IS TYPICALLY SUBSTANTIALLY LESS THAN WHAT MEDICARE PAYS.
Collection practices for patients eligible for financial assistanceSchedule H, Part III, Line 9bMERCY MEDICAL CENTER - CENTERVILLE ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE PART OF CATHOLIC HEALTH INITIATIVES "CHI". CHI HAS A WRITTEN POLICY (STEWARDSHIP POLICY NO. 16) GOVERNING THE PROCEDURES FOR COLLECTIONS OF PAST DUE ACCOUNTS. ALL HOSPITAL FACILITIES INCLUDED IN THE FILING ORGANIZATION HAVE ADOPTED THIS POLICY AND FOLLOW THESE PRACTICES WITH REGARDS TO COLLECTIONS: PROCEDURES CHI ENTITIES WILL FOLLOW STANDARD PROCEDURES IN COLLECTING SELF-PAY BALANCES AS FOLLOWS: PERMISSIBLE COLLECTIONS ACTIVITY EACH FACILITY MUST ADHERE TO THE FOLLOWING REQUIREMENTS IN RELATION TO THE PURSUIT OF SELF-PAY BALANCES: * FAIR PURSUIT. EACH FACILITY SHALL ENSURE THAT ALL PATIENT AND PATIENT GUARANTOR ACCOUNTS ARE PURSUED FAIRLY. * ETHICS AND INTEGRITY. EACH FACILITY SHALL ENSURE THAT ALL COLLECTION ACTIVITIES CONSISTENTLY REFLECT THE HIGHEST STANDARDS OF ETHICS AND INTEGRITY. * REASONABLE PAYMENT TERMS. EACH FACILITY SHALL OFFER REASONABLE PAYMENT SCHEDULES AND TERMS TO EACH PATIENT AND PATIENT GUARANTOR WITH SELF-PAY BALANCES. ALL COLLECTION ACTIVITIES CONDUCTED BY THE FACILITY OR ITS THIRD-PARTY COLLECTION AGENTS WILL BE IN CONFORMANCE WITH ALL FEDERAL AND STATE LAWS GOVERNING DEBT COLLECTION PRACTICES. COLLECTION ACTIVITY MAY BE IN THE FORM OF LETTERS, EMAILS, PHONE CALLS, AND/OR CREDIT REPORTING AND MAY ALSO INCLUDE WAGE GARNISHMENTS, PLACING OF LIENS ON BUILDINGS OR RESIDENCES OTHER THAN PERSONAL RESIDENCES, INITIATION OF LAWSUIT, AND/OR OTHER ACTIONS AS REQUIRED, EXCEPT AS PROHIBITED BY IMPERMISSIBLE COLLECTIONS ACTIONS BELOW. PRE-COLLECTIONS ACTIVITY * TIMING. GENERALLY, ACCOUNTS WILL NOT BE REFERRED TO COLLECTIONS UNTIL THEY ARE 120 DAYS OLD. HOWEVER, IN CIRCUMSTANCES WHERE INVOICES TO NON-MEDICARE PATIENTS ARE RETURNED UNDELIVERED WITH NO KNOWN ADDRESS, THOSE SELF-PAY BALANCES MAY BE REFERRED TO COLLECTIONS PRIOR TO EXPIRATION OF 120 DAYS. * LIMITATIONS - FINANCIAL ASSISTANCE ELIGIBILITY. THE FACILITY SHALL PERFORM A REASONABLE REVIEW OF EACH PATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT (INCLUDING, BUT NOT LIMITED TO, REPORTING THE ACCOUNT TO A COLLECTION AGENCY) TO ENSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G., MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE FACILITY'S FINANCIAL ASSISTANCE POLICY. THAT REASONABLE REVIEW WILL INCLUDE ONE OR MORE OF THE FOLLOWING: * NOTIFICATION TO PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ON ADMISSION, PRIOR TO DISCHARGE, AND/OR IN THE BILLING PROCESS; * REVIEW OF FINANCIAL ASSISTANCE APPLICATION SUBMITTED BY OR ON BEHALF OF THE PATIENT; OR * REVIEW OF THE PATIENT'S ELIGIBILITY USING PATIENT ACCOUNT STATISTICAL SCORING SOFTWARE. * COOPERATING EFFORTS. NO FACILITY SHALL SEND ANY UNPAID SELF-PAY ACCOUNT TO A THIRD-PARTY COLLECTION AGENT AS LONG AS THE PATIENT AND PATIENT GUARANTOR ARE COOPERATING WITH THE FACILITY IN EFFORTS TO SETTLE THE ACCOUNT BALANCE WITHIN A REASONABLE TIME FRAME (GENERALLY 18 MONTHS). * SUBSEQUENT ASSESSMENT. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO THE FACILITY FOR APPROPRIATE FOLLOW-UP. CHI SHALL DIRECT ITS STAFF AND THIRD-PARTY COLLECTION AGENTS TO CONTINUALLY ASSESS EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY OR TO BE DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE. COLLECTIONS THE FACILITY MAY USE A THIRD-PARTY COLLECTION AGENT AS A REPRESENTATIVE, ACTING IN THE NAME OF THE FACILITY AND ENGAGED ON A CONTRACTUAL BASIS, FOR THE EXPRESS PURPOSES OF FOLLOWING-UP ON AND POTENTIALLY COLLECTING ANY PATIENT ACCOUNTS RECEIVABLE BALANCES. THE FACILITY SHALL CONTRACTUALLY DEFINE THE STANDARDS AND SCOPE OF PRACTICES TO BE USED BY THIRD-PARTY COLLECTION AGENTS. THOSE STANDARDS AND SCOPE OF PRACTICES SHALL BE CONSISTENT WITH THIS POLICY AND SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING: * STATEMENT MESSAGE. THE FACILITY SHALL REQUIRE ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FACILITY OR OTHER FINANCIAL ASSISTANCE PROGRAMS. * ADVANCE SETTLEMENT APPROVALS. THE FACILITY SHALL INSTRUCT ITS THIRD-PARTY COLLECTION AGENTS TO SEEK APPROVAL FROM THE AUTHORIZED AND DESIGNATED FACILITY STAFF MEMBER BEFORE ANY SETTLEMENT, AS A RESULT OF BANKRUPTCY PROCEEDINGS, SHALL BE ACCEPTED. * STANDARDS OF CONDUCT. THE FACILITY SHALL REQUIRE THAT THE THIRD-PARTY COLLECTION AGENTS CONDUCT THEMSELVES IN COMPLIANCE WITH THE HIGHEST STANDARDS OF BUSINESS ETHICS AND INTEGRITY AND APPLICABLE LEGAL REQUIREMENTS, AS REFLECTED IN THE CHI STANDARDS OF CONDUCT, AS MAY BE AMENDED BY CHI, AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.CATHOLICHEALTHINITIATIVES.ORG/CORPORATERESPONSIBILITY. * PROHIBITED COLLECTIONS ACTIONS. THE FACILITY SHALL PROHIBIT THE THIRD-PARTY COLLECTION AGENTS FROM ENGAGING IN PROHIBITED COLLECTIONS ACTIONS AS DEFINED IN IMPERMISSIBLE COLLECTIONS ACTIONS BELOW. * ANNUAL ADHERENCE AUDIT. THE FACILITY OR ITS DESIGNEE SHALL BE PERMITTED TO AUDIT ITS THIRD-PARTY COLLECTION AGENTS AT LEAST ANNUALLY FOR ADHERENCE TO THESE STANDARDS. IMPERMISSIBLE COLLECTIONS ACTIONS CHI ENTITIES SHALL DIRECT THEIR STAFF AND THIRD-PARTY COLLECTION AGENTS THAT THE FOLLOWING ACTIONS ARE ALWAYS PROHIBITED IN RELATION TO THE PURSUIT OF SELF-PAY BALANCES. * UNEMPLOYED WITHOUT SIGNIFICANT INCOME/ASSETS. NO FACILITY SHALL PURSUE ANY LEGAL ACTION FOR NON-PAYMENT OF ANY BILLS AGAINST ANY PATIENT OR PATIENT GUARANTOR WHO IS KNOWN TO BE UNEMPLOYED AND WHO HAS BEEN DETERMINED IN ACCORDANCE WITH CHI STEWARDSHIP POLICY NO. 15, HOSPITAL FINANCIAL ASSISTANCE, ON THE BASIS OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION, TO BE WITHOUT SIGNIFICANT INCOME OR ASSETS. * PRINCIPAL RESIDENCE. NO FACILITY SHALL PURSUE ANY LEGAL ACTION AGAINST ANY PATIENT OR PATIENT GUARANTOR BY SEEKING A REMEDY THAT WOULD INVOLVE FORECLOSING UPON THE PRINCIPLE RESIDENCE OF A PATIENT OR PATIENT GUARANTOR, PLACING A LIEN ON THE PRINCIPAL RESIDENCE, TAKING ANY OTHER ACTION THAT COULD RESULT IN THE INVOLUNTARY SALE OR TRANSFER OF SUCH RESIDENCE, OR INFORMING ANY PATIENT OR PATIENT GUARANTOR THAT HE/SHE MAY BE SUBJECT TO ANY SUCH ACTION. * OTHER IMPERMISSIBLE COLLECTION TACTICS. O NO FACILITY SHALL CHARGE INTEREST ON OUTSTANDING BALANCES; O NO FACILITY SHALL REQUIRE PATIENTS OR PATIENT GUARANTORS TO INCUR DEBT OR LOANS WITH RECOURSE TO THE PATIENT'S OR GUARANTOR'S PERSONAL OR REAL PROPERTY ASSETS ("RECOURSE INDEBTEDNESS"); AND O NO FACILITY SHALL INVOKE SO-CALLED "BODY ATTACHMENTS" (I.E., THE ARREST OR JAILING OF PATIENTS IN DEFAULT ON THEIR ACCOUNTS, SUCH AS FOR MISSED COURT APPEARANCES). IN ADDITION TO THE WRITTEN POLICY ALL OF CATHOLIC HEALTH INITIATIVES' HOSPITALS' CONTRACTS WITH THIRD PARTY COLLECTION AGENCIES INCLUDE THE FOLLOWING STANDARDS: * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL REQUEST BENCH OR ARREST WARRANTS AS A RESULT OF NON-PAYMENT; * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL SEEK LIENS THAT WOULD REQUIRE THE SALE OR FORECLOSURE OF A PRIMARY RESIDENCE; AND * NO CATHOLIC HEALTH INITIATIVES' COLLECTION AGENCY MAY SEEK COURT ACTION WITHOUT HOSPITAL APPROVAL. FINALLY, COLLECTION AGENCIES ARE TRAINED ON THE CATHOLIC HEALTH INITIATIVES MISSION, CORE VALUES AND STANDARD OF CONDUCT TO MAKE SURE ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT.
Used federal poverty guidelines (FPG) to determine eligibilitySchedule H, Part V Section B, Line 9(1) MERCY MEDICAL CENTER - CENTERVILLE - HUD LOW INCOME GUIDELINES USED;
Used FPG to determine eligibility for providing discounted care criteriaSchedule H, Part V Section B, Line 10(1) MERCY MEDICAL CENTER - CENTERVILLE - HUD LOW INCOME GUIDELINES USED;
Means used to determine amounts billedSchedule H, Part V Section B, Line 19d(1) MERCY MEDICAL CENTER - CENTERVILLE - THE HOSPITAL FACILITY USED THE AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE SERVICES AT THE HOSPITAL FACILITY.;
Charges for Medical CareSchedule H, Part V Section B, Line 20(1) MERCY MEDICAL CENTER - CENTERVILLE - BECAUSE THE HOSPITAL FACILITY GIVES THE AVERAGE DISCOUNTED RATE, SOME PATIENTS PAY LOWER OR HIGHER RATES THAN THE INDIVIDUAL COMMERCIAL INSURANCE RATES.;
Gross Charges for Medical CareSchedule H, Part V Section B, Line 21(1) MERCY MEDICAL CENTER - CENTERVILLE - WE INITIALLY CHARGE PATIENTS THE FULL CHARGE FOR CARE AND THEN IF THEY FILL OUT AN APPLICATION WE DETERMINE WHETHER PATIENT QUALIFIES FOR CHARITY CARE, SELF PAY, OR A COMBINATION OF BOTH. AT A MINIMUM, WE WRITE OFF THE AMOUNT OF CHARGES DOWN TO THE LEVEL OF THE AVERAGE INSURANCE ALLOWED AMOUNT.;
LINES 2, 4, 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATIONSCHEDULE H, PART VIORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE: MERCY MEDICAL CENTER-CENTERVILLE IS A 25-BED CRITICAL ACCESS NOT-FOR-PROFIT CATHOLIC HOSPITAL LOCATED IN CENTERVILLE, IA. THE HOSPITAL IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. THE MISSION OF THE HOSPITAL IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY, AND VIABILITY IN THE 21ST CENTURY. THE MEDICAL FRATERNITY IN CENTERVILLE FOUNDED THE HOSPITAL AS THE CENTERVILLE HOSPITAL IN 1902. AT THE COMMUNITY'S REQUEST, MANAGEMENT AND OPERATIONS OF THE HOSPITAL WERE TAKEN OVER BY THE SISTERS OF MERCY IN 1910. SINCE THAT TIME, MERCY HAS CONTINUED TO REACH OUT TO PROVIDE EDUCATION, HEALTH CARE AND SERVICES IN OUR COMMUNITY. GUIDED BY OUR VALUES OF REVERENCE, INTEGRITY, COMPASSION, AND EXCELLENCE, WE HOLD OURSELVES TO A HIGH STANDARD OF GIVING TO THE POOR AND BROADER COMMUNITY. MERCY CENTERVILLE EMPLOYS 230 PEOPLE WITH A MEDICAL STAFF OF 9 FAMILY PRACTICE PHYSICIANS, 2 GENERAL SURGEONS, 1 OB-GYN, 1 INTERNAL MEDICINE, AND 1 PEDIATRICIAN. CONSULTING SPECIALTY CLINICS AT THE HOSPITAL ARE ALSO AVAILABLE IN THE AREAS OF PATHOLOGY, ALLERGY, UROLOGY, ORTHOPEDICS, NEUROLOGY, OTOLARYNGOLOGY, CARDIOLOGY, ONCOLOGY, PODIATRY, OPHTHALMOLOGY, VASCULAR SURGERY, PLASTIC SURGERY, DERMATOLOGY, NEPHROLOGY AND ORTHOPEDICS. JUST LIKE FIRE AND POLICE PROTECTION, THE HOSPITAL PROVIDES 24-HOUR EMERGENCY ROOM PHYSICIANS AND THE COUNTY'S ONLY AMBULANCE SERVICE. DIAGNOSTIC CAPABILITY INCLUDES X-RAY, ULTRASOUND, VASCULAR ULTRASOUND, CT SCAN, PET-CT SCAN, NUCLEAR MEDICINE, MRI, DIGITAL MAMMOGRAPHY AND BONE DENSITOMETRY. OTHER SERVICES INCLUDE PHYSICAL & OCCUPATIONAL THERAPY, RESPIRATORY THERAPY, OBSTETRICS, SURGERY, HOME CARE, HOSPICE, AMBULANCE, CARDIAC REHABILITATION, AND SOCIAL AND PASTORAL CARE PROGRAMS. THE HOSPITAL ALSO OPERATES A 20-BED LONG-TERM CARE FACILITY, DIALYSIS CENTER AND SLEEP LAB. THE HOSPITAL'S SERVICES ARE PROVIDED TO THE COMMUNITY ON A NON-DISCRIMINATORY BASIS AND INCLUDE AN EMERGENCY ROOM STAFFED 24/7 WITH EMERGENCY ROOM PHYSICIANS THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL IS GOVERNED BY A BOARD IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE THE MAJORITY. THE HOSPITAL PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS LIKE MEDICAID AND MEDICARE. COMMUNITY BENEFIT APPROACH: MERCY MEDICAL CENTER HAS PROVIDED CENTERVILLE AND THE PEOPLE OF APPANOOSE COUNTY WITH MANY ONGOING COMMUNITY BENEFITS SINCE ITS BEGINNING. FOREMOST, AS A PRIVATE HOSPITAL, IT HAS SAVED THE COMMUNITY NEARLY ONE MILLION DOLLARS ANNUALLY IN PROPERTY TAXES COMPARED TO SURROUNDING COUNTIES WHO SUPPORT PUBLIC HOSPITALS. TRUE TO ITS MISSION, MERCY-CENTERVILLE HAS MADE A COMMITMENT TO IMPROVING THE HEALTH OF THE COMMUNITY BEFORE THEY BECOME ILL. THE HOSPITAL HAS FINANCIAL ASSISTANCE POLICIES AND PROGRAMS FOR LOW-INCOME PERSONS LIKE THE UNINSURED/UNDERINSURED PATIENT DISCOUNT POLICY AND THE SELF-PAY AND THIRD-PARTY DISCOUNTS POLICY.
LINES 2, 4, 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION (CONTINUED)SCHEDULE H, PART VI(CONTINUED) QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT: I. COMMUNITY OUTREACH FOR THE POOR SENIOR TRANSPORTATION: THE HOSPITAL SPONSORS A COMMUNITY BUS WHICH PROVIDES TRANSPORTATION TO MEDICAL APPOINTMENTS FOR THE ELDERLY AND THOSE WITH LOW INCOME WHO ARE UNABLE TO DRIVE OR HAVE NO ONE TO TRANSPORT THEM. THE BUS SERVED 880 RIDERS LAST YEAR. MEALS ON WHEELS: THE HOSPITAL PROVIDES MEAL PREPARATION AND DIETICIAN CONSULTANT SERVICE FOR THE COUNTY MEALS OF WHEELS PROGRAM. THIS PROGRAM SERVED 6,096 MEALS ON WHEELS TO THE POOR AND ELDERLY IN THE COMMUNITY. II. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY DIABETES EDUCATION & SUPPORT GROUP: MERCY OFFERS A CERTIFIED DIABETES EDUCATION AND SUPPORT GROUP FROM PATIENTS WITH DIABETES AND THEIR SPOUSES. THIS PROGRAM OFFERS BOTH PRESENTATIONS FROM VARIOUS DISCIPLINES INVOLVED IN MANAGING DIABETES AS WELL AS DISCUSSION. 33 INDIVIDUALS TOOK PART IN THIS EDUCATION TO ASSIST THEM IN MANAGING THEIR DIABETES. DIABETES SCREENING: MERCY OFFERS DIABETES SCREENINGS TO THE COMMUNITY IN AN EFFORT TO IDENTIFY POTENTIAL DIABETICS OR THOSE WITH THE DISEASE WHO ARE UNAWARE THEY HAVE THE DISEASE TO PROVIDE INTERVENTIONS WITH THEIR PHYSICIAN. 57 PEOPLE WERE ASSISTED THROUGH THIS EFFORT. ALZHEIMER'S SUPPORT GROUP: MERCY HOLDS A MONTHLY ALZHEIMER'S SUPPORT GROUP TO MEET THE GROWING NEEDS OF THE ELDERLY FACING ALZHEIMER'S AND THOSE WHO ARE PROVIDING CARE TO THEM IN THE HOME. THE GROUP HAS BOTH A MORNING AND EVENING SESSION FOR THE CONVENIENCE OF CAREGIVERS. 96 PEOPLE BENEFITED FROM THE SERVICES OF THIS PROGRAM LAST YEAR. FALL ASSESSMENT SCREENING: THE PHYSICAL THERAPY DEPARTMENT OFFERED FREE FALL ASSESSMENTS FOR SENIOR CITIZENS. THE PURPOSE IS TO HELP COMMUNITY MEMBERS IDENTIFY THEIR RISK FOR FALLING AND TO PROVIDE THE RESOURCES AND EDUCATION TO HELP PREVENT FALLS/INJURIES. 25 PEOPLE PARTICIPATED IN THE ASSESSMENT. BLOOD PRESSURE CLINICS & HEALTH PROMOTION EDUCATION: THE HOSPITAL PROVIDED BLOOD PRESSURE AND GLUCOSE SCREENINGS TO THE COMMUNITY THROUGHOUT THE YEAR AND PROVIDED COMMUNITY EDUCATION ON HEART DISEASE AND DIABETES. 451 PEOPLE BENEFITTED FROM THESE HEALTH/WELLNESS PROGRAMS. INFECTION CONTROL TRAINING FOR COMMUNITY: THE HOSPITAL PROVIDED INFECTION CONTROL TRAINING FOR AREA BUSINESSES. THE UPDATE INCLUDED BASIC BLOODBORNE PATHOGENS AND EXPOSURE REPORTING FOR COMMUNITY BUSINESSES. PARTICIPANTS WERE ENGAGED TO UNDERSTAND HOW BLOOD BORNE PATHOGENS RELATE TO THEIR DUTIES IN EMERGENCIES THEY MAY ENCOUNTER. 81 PEOPLE PARTICIPATED IN THIS PROGRAM. INFECTION PREVENTION: THE HOSPITAL PROVIDED EDUCATION FOR ELEMENTARY STUDENTS ABOUT PREVENTING THE SPREAD OF GERMS. 75 CHILDREN BENEFITTED FROM THIS ACTIVITY. NARCOTICS ANONYMOUS: THE HOSPITAL PROVIDES FACILITIES ONCE A WEEK THROUGHOUT THE YEAR TO NARCOTICS ANONYMOUS, ALLOWING THE GROUP A SAFE AND CONFIDENTIAL ENVIRONMENT TO ASSIST AND SUPPORT THEIR RECOVERY.
Patient education of eligibility for assistance.Schedule H, Part VI, Line 3MERCY MEDICAL CENTER - CENTERVILLE INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, MERCY MEDICAL CENTER - CENTERVILLE PROMINENTLY DISPLAYS ITS FINANCIAL ASSISTANCE POLICY IN BOTH ENGLISH AND SPANISH IN OBVIOUS LOCATIONS THROUGHOUT THE HOSPITALS, INCLUDING THE EMERGENCY ROOMS AND OTHER PATIENT INTAKE AREAS, AS WELL AS IN MERCY MEDICAL CENTER - CENTERVILLE OUTPATIENT FACILITIES. IN ADDITION, MERCY MEDICAL CENTER - CENTERVILLE REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR FINANCIAL ASSISTANCE UNDER MERCY MEDICAL CENTER - CENTERVILLE'S FINANCIAL ASSISTANCE POLICY. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY AND PROCEDURES INCLUDING AN APPLICATION FOR ASSISTANCE.MERCY MEDICAL CENTER - CENTERVILLE REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON ENGLISH-SPEAKING INDIVIDUALS. MERCY MEDICAL CENTER - CENTERVILLE'S STAFF WILL ALSO ASSIST THE PATIENT/GUARANTOR WITH APPLYING FOR OTHER AVAILABLE COVERAGE (SUCH AS MEDICAID), IF NECESSARY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES.
Affiliated health care systemSchedule H, Part VI, Line 6MERCY MEDICAL CENTER - CENTERVILLE, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE PART OF CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES (CHI) IS A NATIONAL FAITH-BASED NONPROFIT HEALTH CARE ORGANIZATION WITH HEADQUARTERS IN ENGLEWOOD, COLORADO. CHI'S EXEMPT PURPOSE IS TO SERVE AS AN INTEGRAL PART OF ITS NATIONAL SYSTEM OF HOSPITALS AND OTHER CHARITABLE ENTITIES, WHICH ARE DESCRIBED AS MARKET-BASED ORGANIZATIONS, OR MBOS. AN MBO IS A DIRECT PROVIDER OF CARE OR SERVICES WITHIN A DEFINED MARKET AREA THAT MAY BE AN INTEGRATED HEALTH SYSTEM AND/OR A STAND-ALONE HOSPITAL OR OTHER FACILITY OR SERVICE PROVIDER. CHI SERVES AS THE PARENT CORPORATION OF ITS MBOS WHICH ARE COMPRISED OF 73 HOSPITALS; 40 LONG-TERM CARE, ASSISTED- AND RESIDENTIAL-LIVING FACILITIES; TWO COMMUNITY HEALTH-SERVICES ORGANIZATIONS; TWO ACCREDITED NURSING COLLEGES; AND HOME HEALTH AGENCIES. TOGETHER, THESE FACILITIES PROVIDED $612 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2011 FISCAL YEAR, INCLUDING SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. CHI PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARED SERVICES" FOR THE MBOS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES - INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN -- PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE MBOS. THE COST SAVINGS ACHIEVED THROUGH CHI'S CENTRALIZATION ENABLE MBOS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. MERCY MEDICAL CENTER - CENTERVILLE OPERATES TO SERVE THE HEALTH CARE NEEDS OF THE CENTERVILLE, IA AND SURROUNDING APPANOOSE COUNTY COMMUNITIES.
State filing of community benefit reportSchedule H, Part VI, Line 7IA

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RATHBUN LAKE AREA YMCABusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1708 S MAIN STAddressLine1
CityCENTERVILLECity
StateIAState
ZIP Code52544ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient262927214EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant10500AmountOfCashGrant
Purpose Of GrantCOMMUNITY SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedures for monitoring use of grant fundsIdentifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationALL OF OUR GRANTS ARE MADE TO 501(C)(3) ORGANIZATIONS TO ENSURE THE GRANTS ARE USED FOR CHARITABLE PURPOSES.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CLINTON CHRISTIANSON
166116000197810160150124000214312000
DAVID FRASER
229899026921021450202280129270292120000
ERICA COLLINS
22280205001107020483073800251822000
JAMES MCCONVILLE
135258045350190909836067000158238000
JOSEPH LEVALLEY
028434900031709025128020454036164000
LEANNE DROBNICH
02262150003213602999007380029572100
NANCY BARTON
13861603381193936571425174870185830181724336400

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SEVERANCE PAYMENTSSCHEDULE J, PART I, LINE 4APOST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2011 CALENDAR YEAR.
SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANSCHEDULE J, PART I, LINE 4BDURING THE 2011 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. NO INDIVIDUALS WERE ELGIBLE TO PARTICIPATE FOR 2011.
Non-fixed paymentsSchedule J, Part I, Line 7THE ORGANIZATION MAINTAINS A VARIABLE PAY PROGRAM FOR CERTAIN ELIGIBLE EMPLOYEES THAT PUTS A PORTION OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION ARE MADE BASED UPON THE ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Delegate broad authority to a committeeForm 990, Part VI, Section A, Line 1aTHE EXECUTIVE COMMITTEE CONSISTS ONLY OF DIRECTORS OF THE ORGANIZATION AND IS COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, EACH OF WHOM SERVE AS EX OFFICIO VOTING MEMBERS OF THE EXECUTIVE COMMITTEE, AND ANY ADDITIONAL VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT THE ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIODS BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT THEIR ACTIONS ARE CONSISTENT WITH ANY ACTIONS OR POLICIES OF THE BOARD OR THE CORPORATE MEMBER. ALL ACTIONS TAKEN ARE CONTEMPORANEOUSLY DOCUMENTED AND REPORTED TO THE BOARD AT THE EARLIEST MEETING.
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6THE ENTITY'S SOLE CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA, CORP D/B/A MERCY MEDICAL CENTER - DES MOINES, AN IOWA NONPROFIT CORPORATION.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aTHE SOLE CORPORATE MEMBER HAS THE RIGHT TO APPROVE AND REMOVE WITH OR WITHOUT CAUSE THE MEMBERS OF THE GOVERNING BOARD.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bTHE ORGANIZATION'S CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA, CORP D/B/A MERCY MEDICAL CENTER - DES MOINES, AN IOWA NONPROFIT CORPORATION. PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, BOTH CATHOLIC HEALTH INITIATIVES - IOWA, CORP AND CATHOLIC HEALTH INITIATIVES ("CHI") (CATHOLIC HEALTH INITIATIVES - IOWA, CORP'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY CATHOLIC HEALTH INITIATIVES - IOWA, CORP: *APPROVE MEMBERS OF THE MERCY MEDICAL CENTER - CENTERVILLE BOARD; *AMENDMENT OF THE CORPORATE DOCUMENTS OF MERCY MEDICAL CENTER - CENTERVILLE; *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY MEDICAL CENTER - CENTERVILLE; *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MERCY MEDICAL CENTER - CENTERVILLE; THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF MERCY MEDICAL CENTER - CENTERVILLE; *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY MEDICAL CENTER - CENTERVILLE; *APPROVAL OF ISSUANCE OF DEBT BY MERCY MEDICAL CENTER - CENTERVILLE; *APPROVAL OF PARTICIPATION OF MERCY MEDICAL CENTER - CENTERVILLE IN A JOINT VENTURE; *APPROVAL OF FORMATION OF A NEW CORPORATION BY MERCY MEDICAL CENTER - CENTERVILLE; *APPROVAL OF A MERGER INVOLVING MERCY MEDICAL CENTER - CENTERVILLE; *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MERCY MEDICAL CENTER - CENTERVILLE; *TO REQUIRE THE TRANSFER OF ASSETS BY MERCY MEDICAL CENTER - CENTERVILLE TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.5 OF THE ORGANIZATION'S BYLAWS, CATHOLIC HEALTH INITIATIVES - IOWA, CORP OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bTHE ORGANIZATION'S ACCOUNTING PERSONNEL WORK WITH THE CHI TAX DEPARTMENT PERSONNEL TO PREPARE THE FORM 990. WHEN AVAILABLE, THE CFO REVIEWS THE RETURN AND ANY NECESSARY REVISIONS ARE INCLUDED IN THE FINAL VERSION WHICH IS APPROVED FOR FILING WITH THE IRS. SUBSEQUENT TO REVIEW BY THE CHIEF FINANCIAL OFFICER, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. SUBSEQUENT TO E-FILING, THE FINAL E-FILED FORM 990 IS PRESENTED TO THE BOARD AT A REGULARLY SCHEDULED BOARD MEETING.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. IN ADDITION, ANY BOARD MEMBER WITH A CONFLICT IS REQUIRED TO DECLARE THE CONFLICT BEFORE THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING. THE ENTIRE BOARD OR COMMITTEE DETERMINES WHETHER THE AFFECTED BOARD MEMBER SHOULD BE EXCLUDED FROM THE MEETING DUE TO THE DISCLOSED CONFLICT.
Process used to establish compensation of top management officialForm 990, Part VI, Section B, Line 15aTHE ORGANIZATION USES A THIRD-PARTY CONSULTANT TO SURVEY COMPENSATION TRENDS ANNUALLY AND TO RECOMMEND A COMPENSATION RANGE FOR THE CEO. THIS RECOMMENDATION IS PRESENTED TO THE BOARD FOR FINAL DETERMINATION AND APPROVAL. THE SALARIES ARE COMPARED TO INDUSTRY STANDARDS AND GUIDELINES FOR APPROPRIATENESS. THIS PROCESS WAS LAST UNDERTAKEN IN THE FISCAL YEAR ENDED JUNE 30, 2012.
Process used to establish compensation of other officers/key employeesForm 990, Part VI, Section B, Line 15bTHE ORGANIZATION USES A THIRD-PARTY CONSULTANT TO SURVEY COMPENSATION TRENDS ANNUALLY AND TO RECOMMEND COMPENSATION RANGES FOR THE OTHER OFFICERS AND KEY EMPLOYEES. THESE RECOMMENDATIONS ARE PRESENTED TO THE BOARD FOR FINAL DETERMINATION AND APPROVAL. THE SALARIES ARE COMPARED TO INDUSTRY STANDARDS AND GUIDELINES FOR APPROPRIATENESS. THIS PROCESS WAS LAST UNDERTAKEN IN THE FISCAL YEAR ENDED JUNE 30, 2012.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.COM. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON THE IOWA SECRETARY OF STATE'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE.
HOURS DEVOTED TO RELATED ORGANIZATIONSFORM 990, PART VII, SECTION ACOMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 40 HOUR-PER-WEEK EMPLOYEES.
Other changes in net assets or fund balancesForm 990, Part XI, Line 5NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -285302;

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (127 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
ALEGENT HEALTH - BERGAN MERCY HEALTH SYS
7500 MERCY ROADOMAHANE68124470484764HEALTHCARENE501(C)(3)3CHItrue
ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA
PO BOX 368CORNINGIA50841420782518HEALTHCAREIA501(C)(3)3AHBMHStrue
ALVERNA APARTMENTS
300 SE 8TH AVENUELITTLE FALLSMN56345411351177LTERM CAREMN501(C)(3)9CHItrue
APPLETREE COURT
601 OAK STREETBRECKENRIDGEMN56520411850500SENIOR HOMESMN501(C)(3)9SFHtrue
BISHOP DRUMM RETIREMENT CENTER
1111 6TH AVENUEDES MOINESIA50314420725196LTERM CAREIA501(C)(3)9CHI-IA CORPtrue
BORNEMANN HEALTHCARE CORPORATION
2500 BERNVILLE RD PO BOX 316READINGPA19603232187242HEALTHCAREPA501(C)(3)11 - Type ICHItrue
CARRINGTON HEALTH CENTER
800 NORTH 4TH STREETCARRINGTONND58421450227311HEALTHCAREND501(C)(3)3CHItrue
CATHOLIC HEALTH INITIATIVES
198 INVERNESS DRIVE WESTENGLEWOODCO80112470617373HEALTHCARECO501(C)(3)9NAtrue
CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION
6385 CORPORATE DRIVECOLORADO SPRINGSCO80919840902211FUNDRAISINGCO501(C)(3)7CHICtrue
CATHOLIC HEALTH INITIATIVES INSTITUTE FOR RESEARCH AND INNOVATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112271050565HEALTHCARECO501(C)(3)11 - Type ICHItrue
CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION
6385 CORPORATE DRIVECOLORADO SPRINGSCO80919270930004FUNDRAISINGCO501(C)(3)9CHItrue
CATHOLIC HEALTH INITIATIVES-COLORADO
188 INVERNESS DRIVE WESTENGLEWOODCO80112840405257HEALTHCARECO501(C)(3)3CHItrue
CENTENNIAL MEDICAL GROUP INC
2700 STEWART PARKWAYROSEBURGOR97470263946191PHYSICIANSOR501(C)(3)9MMCtrue
CENTRAL KANSAS MEDICAL CENTER
3515 BROADWAYGREAT BENDKS67530480543724SURGERY CNTRKS501(C)(3)3CHItrue
CHI HEALTH CONNECT AT HOME - FARGO
4816 AMBER VALLEY PARKWAYFARGOND58104271966847HEALTHCAREND501(C)(3)3CHItrue
CHI KENTUCKY INC
3900 OLYMPIC BLVD SUITE 400ERLANGERKY41018202741651HEALTHCAREKY501(C)(3)11 - Type ICHItrue
CHI NATIONAL HOME CARE
198 INVERNESS DRIVE WESTENGLEWOODCO80112451261716HEALTHCARECO501(C)(3)11 - Type ICHI NStrue
CHI NATIONAL SERVICES
198 INVERNESS DRIVE WESTENGLEWOODCO80112452532084HEALTHCARECO501(C)(3)9CHItrue
CHI NEBRASKA
6940 O STREET SUITE 200LINCOLNNE68510363233121HEALTHCARENE501(C)(3)11 - Type ICHItrue
CONTINUING CARE HOSPITAL
150 NORTH EAGLE CREEK DRIVELEXINGTONKY40509611400619LTACHKY501(C)(3)3SJHStrue
COVENANT HOME CARE
1223 POTTSVILLE PIKESHOEMAKERSVILLEPA19555232018429HOME HEALTHPA501(C)(3)11 - Type IINAtrue
ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
1450 BATTERSBY AVENUEENUMCLAWWA98022910715805HEALTHCAREWA501(C)(3)3FHStrue
FLAGET HEALTHCARE DBA FLAGET MEMORIAL HOSPITAL
4305 NEW SHEPHERDSVILLE ROADBARDSTOWNKY40004611345363HEALTHCAREKY501(C)(3)3KOHtrue
FLAGET MEMORIAL HOSPITAL FOUNDATION INC
4305 NEW SHEPHERDSVILLE ROADBARDSTOWNKY40004562351341FUNDRAISINGKY501(C)(3)11 - Type IFHtrue
FRANCISCAN FOUNDATION
1717 SOUTH J STREETTACOMAWA98405911145592FUNDRAISINGWA501(C)(3)9FHStrue
FRANCISCAN HEALTH SYSTEM FKA FRANCISCAN HEALTH SYSTEM WEST
1717 SOUTH J STREETTACOMAWA98405910564491HEALTHCAREWA501(C)(3)3CHItrue
FRANCISCAN MEDICAL GROUP
1708 SOUTH YAKIMA AVENUETACOMAWA98405911939739HEALTHCAREWA501(C)(3)9FHStrue
FRANCISCAN VILLA OF SOUTH MILWAUKEE INC
3601 SOUTH CHICAGO AVENUESOUTH MILWAUKEEWI53172391093829HEALTHCAREWI501(C)(3)9CHItrue
GETTYSBURG MEDICAL CENTER
606 EAST GARFIELD AVENUEGETTYSBURGSD57442460234354HEALTHCARESD501(C)(3)3SMHCtrue
GLOBAL HEALTH INITIATIVES
198 INVERNESS DRIVE WESTENGLEWOODCO80112201536108MINISTRIESCO501(C)(3)11 - Type ICHItrue
GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE
375 DIXMYTH AVECINCINNATIOH45220311778403EDUCATIONOH501(C)(3)2GSHtrue
GOOD SAMARITAN FOUNDATION OF CINCINNATI INC
619 OAK STREET ACCOUNTING-3 WCINCINNATIOH45206311206047FUNDRAISINGOH501(C)(3)11 - Type IGSHtrue
GOOD SAMARITAN HOSPITAL
PO BOX 1990KEARNEYNE68848470379755HEALTHCARENE501(C)(3)3CHI NEBRASKAtrue
GOOD SAMARITAN HOSPITAL FOUNDATION
111 W 31ST STREETKEARNEYNE68847470659443FUNDRAISINGNE501(C)(3)7GSHtrue
HEALTH SET
4200 WEST CONEJOS PLACE 436DENVERCO80204841102943LOW INC.CARECO501(C)(3)7CHICtrue
HEALTHCARE AND WELLNESS FOUNDATION
2400 ST FRANCIS DRIVEBRECKENRIDGEMN56520760761782FUNDRAISINGMN501(C)(3)11 - Type ISFMCtrue
HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL
7601 OSLER DRIVETOWSONMD21204526050777HEALTHCAREMD501(C)(3)9SJMCtrue
HOUSE OF MERCY
1111 6TH AVENUEDES MOINESIA50314421323808SHELTERIA501(C)(3)7CHI-IA CORPtrue
JEWISH HOSPITAL AND ST MARY'S HEALTHCARE
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202611029768HEALTHCAREKY501(C)(3)3KOHtrue
JEWISH PHYSICIAN GROUP INC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40215611352729HEALTHCAREKY501(C)(3)9JHSMHtrue
KENTUCKYONE HEALTH INC FKA JH PROPERTIES INC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202611029769HEALTHCAREKY501(C)(3)9CHItrue
LAKEWOOD HEALTH CENTER
600 MAIN AVENUE SOUTHBAUDETTEMN56623410758434HEALTHCAREMN501(C)(3)3CHItrue
LINUS OAKES INC
2700 STEWART PARKWAYROSEBURGOR97470930821381SENIOR LIVINGOR501(C)(3)9MMCtrue
LISBON AREA HEALTH SERVICES
905 MAIN STREETLISBONND58054820558836HEALTHCAREND501(C)(3)3CHItrue
MEMORIAL HEALTH CARE SYSTEM FOUNDATION
2525 DE SALES AVENUECHATTANOOGATN37404621839548FUNDRAISINGTN501(C)(3)7MHCStrue
MEMORIAL HEALTH CARE SYSTEM INC
2525 DE SALES AVENUECHATTANOOGATN37404620532345HEALTHCARETN501(C)(3)3CHItrue
MEMORIAL HEALTH PARTNERS FOUNDATION INC
6028 SHALLOWFORD ROADCHATTANOOGATN37421030417049HEALTHCARETN501(C)(3)9MHCStrue
MERCY AUXILIARY OF CENTRAL IOWA
1111 6TH AVENUEDES MOINESIA50314426076069AUXILIARYIA501(C)(3)11 - Type ICHI-IA CORPtrue
MERCY CLINICS INC
1111 6TH AVENUEDES MOINESIA50314421193699PHYSICIANIA501(C)(3)9CHI-IA CORPtrue
MERCY COLLEGE OF HEALTH SCIENCES
1111 6TH AVENUEDES MOINESIA50314421511682EDUCATIONIA501(C)(3)2CHI-IA CORPtrue
MERCY FOUNDATION OF DES MOINES IA
1111 6TH AVENUEDES MOINESIA50314237358794FUNDRAISINGIA501(C)(3)7CHI-IA CORPtrue
MERCY FOUNDATION INC
2700 STEWART PARKWAYROSEBURGOR97470936088946FUNDRAISINGOR501(C)(3)7MMCtrue
MERCY HEALTH CARE FOUNDATION
PO BOX 368CORNINGIA50841421461064FUNDRAISINGNE501(C)(3)11 - Type IAHMHtrue
MERCY HEALTHCARE FOUNDATION
570 CHAUTAUQUA BOULEVARDVALLEY CITYND58072450226553FUNDRAISINGND501(C)(3)11 - Type IMHVCtrue
MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS
800 MERCY DRIVECOUNCIL BLUFFSIA51503421178204FUNDRAISINGIA501(C)(3)11 - Type IAHBMHStrue
MERCY HOSPITAL OF DEVILS LAKE
1031 SEVENTH STREET NEDEVILS LAKEND58301450227012HEALTHCAREND501(C)(3)3CHItrue
MERCY HOSPITAL OF VALLEY CITY
570 CHAUTAUQUA BOULEVARDVALLEY CITYND58072450226553HEALTHCAREND501(C)(3)3CHItrue
MERCY MEDICAL CENTER
2700 STEWART PARKWAYROSEBURGOR97470930386868HEALTHCAREOR501(C)(3)3CHItrue
MERCY MEDICAL CENTER
1301 15TH AVENUE WESTWILLISTONND58801450231183HEALTHCAREND501(C)(3)3CHItrue
CATHOLIC HEALTH INITIATIVES-IOWA CORP DBA MERCY MEDICAL CENTER-DES MOINES
1111 6TH AVENUEDES MOINESIA50314420680448HEALTHCAREIA501(C)(3)3CHItrue
MERCY MEDICAL FOUNDATION
1301 15TH AVENUE WESTWILLISTONND58801450381803FUNDRAISINGND501(C)(3)11 - Type IMMCtrue
MERCY PROFESSIONAL PRACTICE ASSOCIATES INC
1111 6TH AVENUEDES MOINESIA50314421470935PHYSICIANIA501(C)(3)9CHI-IA CORPtrue
MLIFECARES
2727 MCCLELLAND BLVDJOPLINMO64804431305163PROPERTY MGMTMO501(C)(3)11 - Type ISJRMCtrue
MNMCH INC
220 NORTH PENNSYLVANIACOLUMBUSKS66725481216238HEALTHCAREKS501(C)(3)3SJRMCtrue
MT ST JOSEPH INC
3060 SE STARK STREETPORTLANDOR97214930386870NURSING CAREOR501(C)(3)9CHItrue
NEBRASKA HEART HOSPITAL
7500 SOUTH 91ST STREETLINCOLNNE68526392031968HEALTHCARENE501(C)(3)3CHI NEBRASKAtrue
OAKES COMMUNITY HOSPITAL
314 SOUTH 8TH STREETOAKESND58474450231675HEALTHCAREND501(C)(3)3CHItrue
OAKES COMMUNITY HOSPITAL FOUNDATION
1200 N 7TH STREETOAKESND58474710966606FUNDRAISINGND501(C)(3)11 - Type IOCHtrue
PUEBLO STEPUP
1925 EAST ORMAN AVE SUITE G52PUEBLOCO81004841234295COMMUNITYCO501(C)(3)7CHICtrue
SET OF COLORADO SPRINGS INC
825 E PIKES PEAK AVENUE BLDG 29COLORADO SPRINGSCO80903841183335LTERM CARECO501(C)(3)7CHICtrue
SAINT CLARE'S COMMUNITY CARE
25 POCONO ROADDENVILLENJ07834222876836HEALTHCARENJ501(C)(3)11 - Type IISCHStrue
SAINT CLARE'S FOUNDATION INC
25 POCONO ROADDENVILLENJ07834222502997FUNDRAISINGNJ501(C)(3)7SCHStrue
SAINT CLARE'S HEALTH SERVICES INC
25 POCONO ROADDENVILLENJ07834223639733MANAGEMENTNJ501(C)(3)7CHItrue
SAINT CLARE'S HOSPITAL
25 POCONO ROADDENVILLENJ07834223319886HEALTHCARENJ501(C)(3)3SCHStrue
SAINT ELIZABETH FOUNDATION
555 SOUTH 70TH STREETLINCOLNNE68510470625523FUNDRAISINGNE501(C)(3)7SERMCtrue
SAINT ELIZABETH HEALTH SERVICES
555 SOUTH 70TH STREETLINCOLNNE68510363233120HEALTHCARENE501(C)(3)3SERMCtrue
SAINT ELIZABETH REGIONAL MEDICAL CENTER
555 SOUTH 70TH STREETLINCOLNNE68510470379836HEALTHCARENE501(C)(3)3CHI NEBRASKAtrue
SAINT FRANCIS MEDICAL CENTER
2620 WEST FAIDLEYGRAND ISLANDNE68803470376601HEALTHCARENE501(C)(3)3CHI NEBRASKAtrue
SAINT FRANCIS MEDICAL CENTER FOUNDATION
PO BOX 9804GRAND ISLANDNE68802470630267FUNDRAISINGNE501(C)(3)7SFMCtrue
SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC
305 ESTILL STREETBEREAKY40403260152877FUNDRAISINGKY501(C)(3)7SJHStrue
SAINT JOSEPH HEALTH SYSTEM INC
424 LEWIS HARGETT CIRCLE 160LEXINGTONKY40509611334601HEALTHCAREKY501(C)(3)3CHItrue
SAINT JOSEPH LONDON FOUNDATION INC
310 EAST NINTH STREETLONDONKY40741260438748FUNDRAISINGKY501(C)(3)11 - Type ISJHStrue
SAINT JOSEPH MEDICAL FOUNDATION INC
ONE ST JOSEPH DRIVELEXINGTONKY40504311539059PHY PRACTICESKY501(C)(3)3SJHStrue
SAINT JOSEPH MOUNT STERLING FOUNDATION INC
50 STERLING AVENUEMOUNT STERLINGKY40353272884584FUNDRAISINGKY501(C)(3)7SJHStrue
SAINT JOSEPH'S HOSPITAL FOUNDATION
30 WEST 7TH STREETDICKINSONND58601363418207FUNDRAISINGND501(C)(3)11 - Type ISJHHCtrue
SAMARITAN BEHAVIORAL HEALTH
601 S EDWIN C MOSES BLVDDAYTONOH45408020633634HEALTHCAREOH501(C)(3)3SHPtrue
SAMARITAN HEALTH FOUNDATION
2222 PHILADELPHIA DRIVEDAYTONOH45406237296923FUNDRAISINGOH501(C)(3)7SHPtrue
SAMARITAN HEALTH PARTNERS
2222 PHILADELPHIA DRIVEDAYTONOH45406311107411HEALTHCAREOH501(C)(3)11 - Type ICHItrue
SJMGROUP
2727 MCCLELLAND BLVDJOPLINMO64804431882377PHYS PRACTICEMO501(C)(3)9SJRMCtrue
SJRMC JOPLIN MISSOURI
2727 MCCLELLAND BLVDJOPLINMO64804440545809HEALTHCAREMO501(C)(3)3CHItrue
ST JOSEPH HEALTH MINISTRIES
1929 LINCOLN HWY E STE 150LANCASTERPA17602232342997HEALTHPA501(C)(3)11 - Type ICHItrue
ST ANTHONY HOSPITAL
1601 SE COURT AVENUEPENDLETONOR97801930391614HEALTHCAREOR501(C)(3)3CHItrue
ST ANTHONY HOSPITAL FOUNDATION
1601 SE COURT AVENUEPENDLETONOR97801930992727FUNDRAISINGOR501(C)(3)11 - Type ISA HOSPITALtrue
ST ANTHONY'S HOSPITAL ASSOCIATION
FOUR HOSPITAL DRIVEMORRILTONAR72110710245507HEALTHCAREAR501(C)(3)3SVIMCtrue
ST CATHERINE HOSPITAL
401 EAST SPRUCE STREETGARDEN CITYKS67846480543721HEALTHCAREKS501(C)(3)3CHItrue
ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION
401 EAST SPRUCE STREETGARDEN CITYKS67846200598702FUNDRAISINGKS501(C)(3)11 - Type ISCHtrue
ST DOMINIC OF ONTARIO OREGON
351 SW 9TH STREETONTARIOOR97914930433692HEALTHCAREOR501(C)(3)3CHItrue
ST FRANCIS HOME
2400 ST FRANCIS DRIVEBRECKENRIDGEMN56520410729978LTERM CAREMN501(C)(3)9CHItrue
ST FRANCIS LIFE CARE CORPORATION
19 POCONO ROADDENVILLENJ07834222536017ELDERLY CARENJ501(C)(3)9SCHStrue
ST FRANCIS MEDICAL CENTER
2400 ST FRANCIS DRIVEBRECKENRIDGEMN56520410695598HEALTHCAREMN501(C)(3)3CHItrue
ST FRANCIS OF BAKER CITY
3325 POCAHONTAS ROADBAKER CITYOR97814930412495HEALTHCAREOR501(C)(3)3CHItrue
ST JOHN'S MERCY REGIONAL FOUNDATION
2727 MCCLELLAND BLVDJOPLINMO64804431308084FUNDRAISINGMO501(C)(3)7SJRMCtrue
ST JOSEPH COMMUNITY HEALTH
300 CENTRAL AVE SW SUITE 3000ALBUQUERQUENM87102710897107COMMUNITYNM501(C)(3)11 - Type ICHItrue
ST JOSEPH HOSPITAL FOUNDATION INC
305 ESTILL STREETLEXINGTONKY40504611159649FUNDRAISINGKY501(C)(3)11 - Type ISJHStrue
ST JOSEPH MEDICAL CENTER FOUNDATION
2500 BERNVILLE ROAD PO BOX 316READINGPA19603232649362FUNDRAISINGPA501(C)(3)11 - Type ISJRHNtrue
ST JOSEPH MEDICAL CENTER FOUNDATION INC
7601 OSLER DRIVETOWSONMD21204521681044FUNDRAISINGMD501(C)(3)7SJMCtrue
ST JOSEPH MEDICAL CENTER INC
7601 OSLER DRIVETOWSONMD21204520591461HEALTHCAREMD501(C)(3)3CHItrue
ST JOSEPH MEDICAL GROUP
2500 BERNVILLE ROAD PO BOX 316READINGPA19603208544021HEALTHCAREPA501(C)(3)9BHCtrue
ST JOSEPH PHYSICIAN ENTERPRISES
7601 OSLER DRIVETOWSONMD21204521311775PHYSICIANSMD501(C)(3)11 - Type ISJMCtrue
ST JOSEPH REGIONAL HEALTH NETWORK
2500 BERNVILLE ROAD PO BOX 316READINGPA19603231352211HEALTHCAREPA501(C)(3)3CHItrue
ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVENUEPARK RAPIDSMN56470410695603HEALTHCAREMN501(C)(3)3CHItrue
ST JOSEPH'S HOSPITAL AND HEALTH CENTER
30 WEST 7TH STREETDICKINSONND58601450226429HEALTHCAREND501(C)(3)3CHItrue
MERCY MEDICAL CENTER - CENTERVILLE
ONE ST JOSEPHS DRIVECENTERVILLEIA52544420680308HEALTHCAREIA501(C)(3)3CHI-IA CORPtrue
ST MARY'S COMMUNITY HOSPITAL
1314 3RD AVENUENEBRASKA CITYNE68410470443636HEALTHCARENE501(C)(3)3CHI NEBRASKAtrue
ST MARY'S HEALTHCARE CENTER
801 EAST SIOUX AVENUEPIERRESD57501460230199HEALTHCARESD501(C)(3)3CHItrue
ST MARY'S HOSPITAL FOUNDATION
1314 3RD AVENUENEBRASKA CITYNE68410470707604FUNDRAISINGNE501(C)(3)7SMHtrue
ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLELITTLE ROCKAR72205510169537FUNDRAISINGAR501(C)(3)11 - Type ISVIMCtrue
ST VINCENT INFIRMARY MEDICAL CENTER
TWO ST VINCENT CIRCLELITTLE ROCKAR72205710236917HEALTHCAREAR501(C)(3)3CHItrue
ST VINCENT MEDICAL GROUP
TWO ST VINCENT CIRCLELITTLE ROCKAR72205710830696HEALTHCAREAR501(C)(3)9SVIMCtrue
THE COMMUNITY LIMITED CARE DIALYSIS CENTER
619 OAK STREET ACCOUNTING-3 WCINCINNATIOH45206237419853DIALYSISOH501(C)(2)N/AGSHtrue
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH
619 OAK STREET ACCOUNTING-3 WCINCINNATIOH45206310537486HEALTHCAREOH501(C)(3)3CHItrue
THE MERCY HOSPITAL OF DEVILS LAKE FDN
1031 SEVENTH STREET NEDEVILS LAKEND58301352367360FUNDRAISINGND501(C)(3)7MHDLtrue
THE PHYSICIAN NETWORK
2000 Q STREET SUITE 500LINCOLNNE68503470780857PHYS PRACTICENE501(C)(3)11 - Type ICHI NEBRASKAtrue
TOTAL HEALTHCARE
188 INVERNESS DRIVE WEST SUITE 500ENGLEWOODCO80112840927232HEALTHCARECO501(C)(3)3CHICtrue
UNITY FAMILY HEALTHCARE
815 2ND STREET SELITTLE FALLSMN56345410721642HEALTHCAREMN501(C)(3)3CHItrue
VILLA NAZARETH INC
801 PAGE DRIVEFARGOND58103450226714LT CAREND501(C)(3)9CHItrue
VISITING NURSE ASSOCIATION OF SAINT CLARE'S
191 WOODPORT ROADSPARTANJ07871221768334HOME HEALTHNJ501(C)(3)9SCHStrue

Form990 Schedule R Part III Form990ScheduleRPartIII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnershipCode VCodeVAmount
AUDUBON LAND COMPANY LLC
5390 N ACADEMY BLVD SUITE 300COLORADO SPRINGSCO80918841513085REAL ESTATECOCHICRELATED34991-694032falsefalse0.501
AVANTAS LLC
11128 JOHN GALT BLVD SUITE 400OMAHANE68137392045003HEALTHCARENEAHBMHSRELATED-2862040-2537888falsefalse0.95
BERYWOOD OFFICE PROPERTIES LLC
400 BERYWOOD TRAILCLEVELANDTN37312621875199PHYS OFFICETNMHCSRELATED575451013237falsetrue0.63
BLUEGRASS REGIONAL IMAGING CENTER
1218 SOUTH BROADWAY SUITE 310LEXINGTONKY40504611386736DIAGNOSTICKYSJHSRELATEDfalsefalse0.65
CENTRAL NEBRASKA HOME CARE SERVICES
PO BOX 1146-4510 SECOND AVENUEKEARNEYNE68848470692112HEALTHCARE SRVCNENARELATED-92336745068falsetrue1
CENTRAL NEBRASKA REHAB SERVICE
3004 W FAIDLEY AVEGRAND ISLANDNE68802810653461PHYSICAL THERAPYNESFMCRELATED18358122199571falsefalse0.51
CHI OPERATING INVESTMENT PROGRAM LP
198 INVERNESS DRIVE WESTENGLEWOODCO80112470727942INVESTMENTSCOCHIUNRELATED3972412716272650880falsetrue1
HEALTHCARE SUPPORT SERVICES
PO BOX 9804GRAND ISLANDNE68802721546196LAUNDRYNENARELATED-111793069835falsefalse1
MRI AT ST JOESPH MEDICAL CENTER LLC
7253 AMBASSADOR ROADBALTIMOREMD21244521958002MEDICAL IMAGINGMDSJMCRELATED4231672174155falsetrue0.51
NORTH RIVER SURGERY CENTER LLC
2209 WILDWOOD AVENUESHERWOODAR72120710799771AMBUL SURG CTRARSVIMCRELATED810711077536falsefalse0.5744
O'DEA MEDICAL ARTS LIMITED PARTNERSHIP
7601 OSLER DRIVETOWSONMD21204521682964REAL ESTATEMDTOWSON MANAGEMENT INCRELATED1119335418117falsefalse0.65122
ORTHOCOLORADO LLC
11650 WEST 2ND PLACELAKEWOODCO80255371577105ORTHO HOSPITALCOCHICRELATED-3249434-2760206falsefalse0.6
PENINSULA RADIATION ONCOLOGY
315 MARTIN LUTHER KING JR WAY 111TACOMAWA98405710799771HEALTHCARE SRVCWAFHSRELATED13501485985falsefalse0.6
PENRAD IMAGING
1390 KELLY JOHNSON BLVDCOLORADO SPRINGSCO80920841072619MEDICAL IMAGINGCOCHICRELATED7150942397488falsefalse0.7
RUXTON SURGICENTER LLC
8322 BELLONA AVENUE SUITE 201BALTIMOREMD21204522095835SURGERY CENTERMDSJMCRELATED-693452802932falsetrue0.51
SAINT JOSEPH - SCA HOLDINGS LLC
424 LEWIS HARGETT CIRCLE STE 160LEXINGTONKY40503453801157OP SURGERYDESJHSRELATEDfalsetrue0.51
SCA PREMIER SURGERY CENTER OF LOUISVILLE LLC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202721386840SURGERY CENTERKYJHRELATED68676446063falsetrue0.51
ST FRANCIS LAND COMPANY
5390 N ACADEMY BLVD SUITE 300COLORADO SPRINGSCO80918263134100REAL ESTATECOCHICRELATED-130967408090falsefalse0.51
ST FRANCIS MEDICAL CENTER ASSOCIATES
1717 SOUTH J STREETTACOMAWA98405911352698MED. OFFICEWAFHSRELATED1109861672098falsefalse0.5421
ST JOSEPH-PAML LLC
424 LEWIS HARGETT CIRCLE STE 160LEXINGTONKY40503452116736MGMT SVCSKYSJHSRELATEDfalsetrue0.625
SUPERIOR MEDICAL IMAGING LLC
5000 NORTH 26TH STREETLINCOLNNE68521262884555OP DIAGNOSTICSNESERMCRELATED-254775796941falsefalse0.51$0
SURGERY CENTER OF LEXINGTON LLC
424 LEWIS HARGETT CIRCLE STE 160LEXINGTONKY40503621179539SURGERY CENTERDESJHSRELATED3935192214599falsetrue0.51
SURGERY CENTER OF LOUISVILLE LLC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202621179537SURGERY CENTERKYJHRELATED-3676395845falsetrue0.51

Form990 Schedule R Part IV Form990ScheduleRPartIV (45 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
ALTERNATIVE INSURANCE MANAGEMENT SERVICE
3900 OLYMPIC BOULEVARD SUITE 400ERLANGERKY41018841112049MANAGEMENT SERVICESCOCHIC CORPORATION032674411
AMERICAN NURSING CARE
1700 EDISON DRIVEMILFORDOH45150311085414HOME HEALTHOHCHSC CORPORATION4648726446541991
AMERIMED INC
1700 EDISON DRIVEMILFORDOH45150311158699HOME HEALTHOHANCC CORPORATION662062116668741
BC HOLDING COMPANY INC
1850 BLUEGRASS AVELOUISVILLEKY40215311542851FITNESS CLUBKYJHC CORPORATION001
CADUCEUS MEDICAL ASSOCIATES INC
5600 BRAINERD ROAD SUITE 500CHATTANOOGATN37411621570736HEALTHCARETNMHCSC CORPORATION010081
CAPTIVE MANAGEMENT INITIATIVES
980663022CAPTIVE MANAGEMENTCHIC CORPORATION001PO BOX 10073 APOGEORGETOWNGRAND CAYMANCJKY1-1001CJ
CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH
198 INVERNESS DRIVE WESTENGLEWOODCO80112272269511RESEARCHCOCIRITRUST-286460528097071
CGH REALTY COMPANY INC
215 N 12TH STREADINGPA19603232326801REAL ESTATEPASJHMC CORPORATION1
COMCARE SERVICES
4231 W 16TH AVENUEDENVERCO80204840904813INACTIVECOCHICC CORPORATION001
CONSOLIDATED HEALTH SERVICES
1700 EDISON DRIVEMILFORDOH45150311378212HOME HEALTHOHCHIC CORPORATION-1525246658448621
DAVID DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476192395INVESTMENTSNEGSHFTRUST1
DES MOINES MEDICAL CENTER INC
1111 6TH AVENUEDES MOINESIA50314420837382REAL ESTATEIACHI-IA CORPC CORPORATION7149712216670.9298
FIRST INITIATIVES INSURANCE LTD
980203038INSURANCECHIC CORPORATION001PO BOX 10073 APOGEORGETOWNGRAND CAYMANCJKY1-1001CJ
FRANCISCAN SERVICES INC
198 INVERNESS DRIVE WESTENGLEWOODCO80112232487967HEALTHCARECOCHIC CORPORATION-571958371421
GOOD SAMARITAN OUTREACH SERVICES
PO BOX 1990KEARNEYNE68848470659440MEDICAL CLINICNECHI NEBRASKAC CORPORATION-1656663551101
HAROLD W RASE 1995 CHARITABLE UNITRUST
30 WEST 7TH STREETDICKINSONND58601456090420INVESTMENTSNDSJHHCTRUST1240221481
HAROLD W RASE 1996 CHARITABLE UNITRUST
30 WEST 7TH STREETDICKINSONND58601206037112INVESTMENTSNDSJHHCTRUST1057154621
HAROLD W RASE 1997 CHARITABLE UNITRUST
30 WEST 7TH STREETDICKINSONND58601206037104INVESTMENTSNDSJHHCTRUST0205201
HAROLD W RASE 1999 CHARITABLE UNITRUST
30 WEST 7TH STREETDICKINSONND58601206037099INVESTMENTSNDSJHHCTRUST0250361
HEALTH SYSTEMS ENTERPRISES INC
PO BOX 1990KEARNEYNE68848470664558MANAGEMENTNEGSHC CORPORATION10213614430491
HEALTHCARE MGMT SERVICES ORG INC
1149 MARKET STTACOMAWA98402911865474HEALTH ORG.WAFHSC CORPORATION001
JAMES & HENRIETTA NISTLER UNITRUST
30 WEST 7TH STREETDICKINSONND58601206021899INVESTMENTSNDSJHHCTRUST692390751
JEANNE DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476192398INVESTMENTSNEGSHFTRUST1
JOSEPH A SCHUSTER ANNUITY TRUST #1
400 UNIVERSITY AVENUEDES MOINESIA50314421195122INVESTMENTSIAMFDMTRUST78344163491
LODESCA MILLER CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476186933INVESTMENTSNEGSHFTRUST1
MEDQUEST
1301 15TH AVENUE WESTWILLISTONND58801450392137SALE OF DMENDMMC WILLISTONC CORPORATION1514989625541
MERCY PARK APARTMENTS LTD
1111 6TH AVENUEDES MOINESIA50314421202422HOUSINGIACHI-IA CORPC CORPORATION36990519372201
MERCY SERVICES CORP
2700 STEWART PARKWAYROSEBURGOR97470930824308RETAIL SALESORMMCC CORPORATION09560031
MHSERVICES CORPORATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112431457881DMEMOSJRMCC CORPORATION-406101
MOUNTAIN MANAGEMENT SERVICES INC
5600 BRAINERD ROAD SUITE 500CHATTANOOGATN37411621570739MGMT SVC ORGTNMHCSC CORPORATION-3315246794351
NAZARETH ASSURANCE COMPANY
030304831INSURANCECHIC CORPORATION001PO BOX 10073 APOGEORGETOWNGRAND CAYMANCJKY1-1001CJ
PATIENT TRANSPORT SERVICES INC
1700 EDISON DRIVEMILFORDOH45150311100798HOME HEALTHOHANCC CORPORATION4799401
PHYSICIAN HEALTH SYSTEM NETWORK
1149 MARKET STTACOMAWA98402911746721HEALTH ORG.WAFHSC CORPORATION001
RAY & SHIRLEY DAVID 1999 UNITRUST
30 WEST 7TH STREETDICKINSONND58601206037077INVESTMENTSNDSJHHCTRUST0261101
ROBERT & WANDA CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848266191916INVESTMENTSNEGSHFTRUST1
SAINT CLARE''S PRIMARY CARE INC
66 FORD ROADDENVILLENJ07834222441202BILLING SERVICESNJSCCCC CORPORATION-46996217720161
SAMARITAN FAMILY CARE INC
40 W FOURTH ST 1700DAYTONOH45402311299450HEALTHCAREOHSHPC CORPORATION1
SJH SERVICES CORPORATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112232307408HEALTHCARECOFSIC CORPORATION-19277729738581
SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR 160LEXINGTONKY40503270164198MANAGEMENTKYSJHSC CORPORATION001
ST ANTHONY DEVELOPMENT COMPANY
1415 SOUTHGATEPENDLETONOR97801931216943ATHLETIC CLUBORSAHC CORPORATION9213930075501
ST VINCENT COMMUNITY HEALTH SERVICES INC
TWO ST VINCENT CIRCLELITTLE ROCKAR72205710710785HEALTHCAREARSVIMCC CORPORATION2804485140493741
ST JOSEPH DEVELOPMENT COMPANY INC
1717 SOUTH J STREETTACOMAWA98405911480569RENTALWAFSIC CORPORATION63164118454391
ST JOSEPH OFFICE PARK ASSOCIATION
1401 HARRODSBURG ROAD BLDG B70LEXINGTONKY40504611079899MANAGEMENTKYSJHSC CORPORATION8821390.85
TOM DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476192393INVESTMENTSNEGSHFTRUST1
TOWSON MANAGEMENT INC
7601 OSLER DRIVETOWSONMD21204521710750MANAGEMENT SERVICESMDFSIC CORPORATION2669601
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg