2019-11-14T14:54:41-06:00 2018-12-31 990 2018-01-01 390806367 MERITER HOSPITAL INC MERI 6084176000 202 SOUTH PARK STREET MADISON WI 537151596 BETH ERDMAN CFO 6084176000 2019-11-08 205.167.2.34 2019-11-08 16:16:21 CS P 0BFB9BC94ADA8AF3BF63F4A24AA84C65C722C205 7BA72CF2FC23A5EB6E597A73BA6EA537B1AB5705 2018 2020-04-17 16:48:07Z SUSAN ERICKSON 202 SOUTH PARK STREET MADISON WI 537151596 506379962 0 X WWW.UNITYPOINT.ORG/MADISON X 1898 WI MERITER HOSPITAL, INC. IS A NOT FOR PROFIT, LOCALLY GOVERNED COMMUNITY HOSPITAL. MERITER HOSPITAL PROVIDES A COMPREHENSIVE ARRAY OF PATIENT-FOCUSED INPATIENT AND OUTPATIENT SERVICES TO MEET THE HEALTH-RELATED NEEDS OF OUR COMMUNITY. 16 15 3340 508 616227 0 515034 575677 413840849 447799741 14597939 15686726 23923876 4371880 452877698 468434024 160407 162812 0 0 189397209 229124039 0 0 1192464 228327691 213164086 417885307 442450937 34992391 25983087 767467522 736590555 288553355 268584226 478914167 468006329 X MERITER HOSPITAL, INC. IS DEDICATED TO IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 361508298 162812 449428167 MERITER HOSPITAL, INC. IS A 448-BED COMMUNITY HOSPITAL FOCUSED ON DELIVERING QUALITY CARE AND PATIENT SAFETY. MERITER PROVIDES SOLUTIONS TO MANY COMMUNITY HEALTH CARE NEEDS, AND PROVIDES THE REGION'S ONLY AVAILABLE CHILD AND ADOLESCENT PSYCHIATRY SERVICES, AND SEXUAL ASSAULT NURSE EXAMINER SERVICES. MERITER IS PROUD TO DELIVER MORE BABIES THAN ANY OTHER HOSPITAL IN WISCONSIN AND RECEIVED NUMEROUS AWARDS: - CMS 5 STAR QUALITY AWARD- HEALTHGRADES - TOP 250 HOSPITALS- MADISON'S TOP NURSES- UPH BEST OVERALL HOSPITALIST GROUP- HOMECARE ELITE STATUS- UPH PATIENT EXPERIENCE - COMMUNICATION WITH NURSES- SUCCESSFUL JOINT COMMISSION SURVEY WHICH HAS MERITER REACCREDITED FOR 36 MONTHS- SUCCESSFUL WISCONSIN STATE SURVEY REACCREDITATION FOR 2 YEARS FOR MERITER'S INPATIENT ADULT AND CHILD/ADOLESCENT INPATIENT UNITS AND NEWSTART CONSULTATION AND OUTPATIENT SERVICES- AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S (AHA/ASA) GET WITH THE GUIDELINES STROKE GOLD PLUS ACHIEVEMENT AWARD. THIS AWARD WILL BE RECOGNIZED ON A NATIONAL LEVEL IN THE US NEWS AND WORLD REPORT AND ON THE AH/ASA WEBSITE (WWW.HEART.ORG/QUALITY).- QUALIFIED TO BE RECOGNIZED AS A RECIPIENT OF THE AHA/ASA'S TARGET: STROKE HONOR ROLL ELITE AWARD- THE WISCONSIN MEDICAL SOCIETY AWARDED UNITYPOINT HEALTH - MERITER'S CONTINUING PROFESSIONAL DEVELOPMENT (CPD) PROGRAM "ACCREDITATION WITH COMMENDATION". THIS COMMENDATION STATUS EXTENDS MERITER'S CONTINUING MEDICAL EDUCATION ACCREDITATION PERIOD FROM FOUR YEARS TO SIX YEARS. CRISTIE ROBERSON, CME SUPERVISOR HAS SHAPED THE UNITYPOINT HEALTH - MERITER CONTINUING PROFESSIONAL DEVELOPMENT FUNCTION INTO A PROGRAM THAT WORKS FEROCIOUSLY WITH PHYSICIANS TO IDENTIFY GAPS IN CURRENT MEDICAL PRACTICE AND KNOWLEDGE AND THEN DEVELOP PROGRAMS THAT TRULY CLOSE THE GAPS AND LEAD TO PRACTICE IMPROVEMENTS WITHIN DEPARTMENTS.- NEWSWEEK ANNOUNCED ITS INAUGURAL LIST OF 1,000 BEST HOSPITALS IN THE WORLD. MERITER RANKED 155. HOSPITALS WERE SELECTED BASED ON RECOMMENDATIONS FROM MEDICAL EXPERTS, RESULTS FROM PATIENT SURVEYS AND KEY PERFORMANCE INDICATORS.- THE UPC-MERITER HOSPITALIST PROGRAM WAS RECOGNIZED ON NOVEMBER 6, 2018 AT THE ANNUAL HOSPITALIST SUMMIT HELD IN CEDAR RAPIDS AS THE "BEST OVERALL HOSPITALIST GROUP" IN THE ENTIRE SYSTEM, WHICH INCLUDES 12 DIFFERENT HOSPITALIST GROUPS.- DR. JASON YELK, MEDICAL DIRECTOR OF QUALITY AND PATIENT SAFETY WAS RECOGNIZED WAS RECOGNIZED ON NOVEMBER 6, 2018 AT THE ANNUAL HOSPITALIST SUMMIT HELD IN CEDAR RAPIDS AS A "CHAMPION OF EXCELLENCE" FOR HIS ONGOING WORK ACROSS ALL UNITYPOINT REGIONS TO IMPROVE THE QUALITY AND CONSISTENCY OF CARE FOR OUR PATIENTS.- MADISON MAGAZINE'S TOP NURSES ISSUE FOR 2018. KEVIN FRANCO VALLE, RN, BSN IS A CASE MANAGER AT UNITYPOINT AT HOME.MERITER'S CLINICS OFFERS AMBULATORY HEALTH CARE WITH A FOCUSON PROVIDING EDUCATIONAL, OUTREACH AND REFERRAL PROGRAMS THAT INCLUDE WELLNESS AND DISEASE PREVENTION. THIS OCCURS THROUGH ALL SPECIALTIES FOR INDIVIDUALS AND IN GROUP SETTINGS SUCH AS INDIVIDUAL HEALTH EDUCATION SESSIONS WITH A NURSE PRACTITIONER FOR WOMEN MANAGING THEIR HEART DISEASE, OFFERING GROUP SESSIONS ON THE LATEST ADVANCEMENTS FOR TREATMENTS OF OSTEOARTHRITIS, AND EDUCATIONAL PROGRAMS FOR PREGNANT PARENTS ATTENDING CHILDBIRTH EDUCATION PROGRAMS. MERITER'S PROVIDERS ALSO OFFER VARIOUS EDUCATIONAL TALKS AND SCREENING OPPORTUNITIES AS PART OF COMMUNITY PROGRAMS/EVENTS EACH YEAR. MERITER'S ADULT PRIMARY CARE CLINICS INCLUDE DIABETES MANAGEMENT SERVICES THROUGH A TEAM CONSISTING OF ENDOCRINOLOGISTS, CERTIFIED DIABETES EDUCATORS, A DIETITIAN AND HEALTH PSYCHOLOGIST. HEALTH PSYCHOLOGY SERVICES ARE AVAILABLE TO PATIENTS WHO NEED EMOTIONAL SUPPORT AND GUIDANCE AS THEY WORK THROUGH PERSONAL HEALTH CHANGES. MERITER CHILD & ADOLESCENT PSYCHIATRY STAFF PROVIDE EDUCATIONAL SESSIONS FOR SCHOOL PERSONNEL. MERITER PRIMARILY SERVES PATIENTS FROM DANE COUNTY. 361508298 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 139 0 1 3340 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X RON SCHROEDER 6084175832 202 SOUTH PARK STREET MADISON WI 537151596 RAY ALLEN BOARD MEMBER 1.00 1.00 X 0 0 0 KATHY BLUMENFELD BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID BOYER BOARD MEMBER 1.00 1.00 X 0 17971 0 JACK COTTON BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 SARAH DUNN BOARD MEMBER (FR 6/18) 1.00 1.00 X 0 0 0 SUE ERICKSON COOASST TREASTO 118 CEO (FR 2/18) 15.00 35.00 X X 0 612372 100702 MICHAEL GOLDROSEN MD BOARD MEMBER 1.00 1.00 X 0 0 0 VIRGINIA GRAVES BOARD MEMBER 1.00 1.00 X 0 13250 0 PAUL HICK DO BOARD MEMBER (TO 3/18) 1.00 1.00 X 0 0 0 GEORGE KAMPERSCHROER BOARD MEMBER 1.00 1.00 X 0 0 0 BRADLEY MANNING MD BOARD CHAIR 3.00 3.00 X X 12500 25333 0 MARK MOODY BOARD MEMBER 1.00 1.00 X 0 0 0 ART NIZZA DSW BOARD MEMBER/CEO (TO 1/18) 5.00 45.00 X X 0 975404 163052 MARGARET NOREUIL RN PHD BOARD MEMBER 1.00 1.00 X 0 0 0 LISA PEYTON-CAIRE BOARD MEMBER 1.00 1.00 X 0 0 0 JULIE SCHURR MD BOARD MEMBER (TO 6/18) 1.00 1.00 X 0 0 0 JOHN SIMS BOARD MEMBER (TO 6/18) 1.00 1.00 X 0 0 0 MARY STOFFEL MD BOARD MEMBER (FR 2/18) 1.00 1.00 X 0 0 0 DOUG STRUB BOARD MEMBER 1.00 1.00 X 0 0 0 CHERYL WITTKE BOARD MEMBER (FR 6/18) 1.00 1.00 X 0 0 0 BETH ERDMAN CFO/SECRETARY/TREASURER 35.00 15.00 X 0 418752 42005 PAM WETZEL MD CMO/ASST SECRETARY 5.00 45.00 X 0 517202 66718 JAMES ARNETT VP OPERATIONS 15.00 45.00 X 0 363152 56522 TODD BURCHILL VP BUSINESS DEVELOPMENT 5.00 45.00 X 0 363799 68896 SHERRY CASALI CHIEF NURSING OFFICER (FR 2/18) 5.00 45.00 X 27246 254726 45753 PATRICIA GRUNWALD CHIEF NURSING OFFICER (TO 1/18) 45.00 5.00 X 0 160518 1496 MARY J HANSEN VP-CLINIC OPERATIONS 0.00 1.00 X 228003 0 22509 CHRISTINA JACKSON DIR PERIOPERATIVE SVCS 40.00 0.00 X 204805 0 34166 KATHERINE KOSTRIVAS EXEC DIRECTOR JOA 40.00 0.00 X 209258 0 29429 JULIE RICE REGISTERED NURSE 40.00 0.00 X 169721 0 25861 LANA STECKEL DIR MEDICAL IMAGING 40.00 0.00 X 217893 0 29205 GEOFFREY PRIEST MD FORMER CMO/ASST. SEC(TO 3/16) 0.00 1.00 X 0 158080 0 1069426 3880559 686314 117 1 1 0 JP CULLEN AND SONS INC 330 E DELAVAN DRIVE JANESVILLE WI 53546 CONSTRUCTION 9955678 UW MEDICAL FOUNDATION 750 HIGHLAND AVENUE MADISON WI 53792 INTERNS AND RESIDENTS 6735648 UNIVERSITY OF WISCONSIN HOSPITAL AND CLI 750 HIGHLAND AVENUE MADISON WI 53792 INTERNS, RESIDENTS, MED-FLIGHT, AND TEAC 4796640 JH FINDORFF AND SON INC 300 SOUTH BEDFORD ST MADISON WI 53703 CONSTRUCTION 2682894 UNIVERSITY OF WISCONSIN 750 HIGHLAND AVENUE MADISON WI 53792 MEDICAL SERVICES 2154786 39 575677 575677 NET PATIENT REVENUE 900099 433649077 433649077 SUBS & JOINT VENTURES 900099 7432175 7432175 6718489 5888934 41937 787618 447799741 14195957 14195957 4607682 3801962 805720 805720 819 804901 34551848 825637 32699462 1187254 1852386 -361617 1490769 1490769 487992 257260 230732 230732 CAFETERIA/FOOD SVCS 722210 1274052 7000 1267052 CHILDCARE SERVICES 624410 1237433 566471 670962 PARKING REIMBURSEMENT 812930 823404 823404 539 539 3335428 468434024 448024322 616227 19217798 127612 127612 35200 35200 41718 41718 176377147 169738204 6638943 7370431 7091829 278602 33263342 32005988 1257354 12071401 11615102 456299 46251535 161457 46090078 6827116 6827116 21827535 20357637 1469898 1426933 957775 469158 14147799 13105106 1042693 230557 213565 16992 7738083 7738083 1185060 1185060 20233119 18741938 1491181 1063571 985186 78385 MEDICAL SUPPLIES 62397130 57798462 4598668 MISCELLANEOUS EXPENSES 16351837 15421058 923375 7404 STATE REVENUE ASSESSMEN 8984061 8984061 EQUIPMENT RENTAL & MAIN 4499750 4168118 331632 442450937 361508298 79750175 1192464 37955238 32379344 1770319 1823095 53523985 40803530 3968039 4718927 2499501 3199586 1302781 952637 356206167 97358073 257189002 258848094 332522395 318061290 76736262 75804052 767467522 736590555 54638230 59709501 45295 48179 1546546 693883 232323284 208132663 288553355 268584226 X 473909974 463142265 4683666 4539037 320527 325027 478914167 468006329 767467522 736590555 X 25983087 -30863759 -6027166 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 62414818 62414818 188807609 51948332 136859277 3689272 1975371 1713901 81379554 41733688 39645866 19914914 1700682 18214232 258848094 OTHER LONG-TERM ASSETS 309386 INVESTMENT IN JOINT VENTURES 66544135 DEFERRED COMP 457(B) 520762 DUE FROM AFFILIATE 8429769 75804052 1148 RETIREMENT LIABILITY 28579487 HEALTH & WELFARE INS RESERVES 556000 ASSET RETIREMENT OBLIGATION 815234 DUE TO AFFILIATES 177203711 DEFERRED COMP 457(B) 520762 LT PORTION-WORKERS COMPENSATION & OTHER 456321 208132663 X PART X, LINE 2: UNITYPOINT HEALTH AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) AND 501(C)(2) OF THE INTERNAL REVENUE CODE (THE CODE). TAX-EXEMPT ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME AS DESCRIBED UNDER PROVISIONS OF SECTION 511 OF THE CODE. THE SYSTEM FILES FORM 990 FOR SUBSTANTIALLY ALL OF ITS OPERATING ENTITIES IN THE U.S. FEDERAL JURISDICTION AND IS NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES FOR THE YEARS BEFORE 2015. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, DURING THE CARRYFORWARD PERIOD. DEFERRED TAX ASSETS AND LIABILITIES RELATED TO THESE SUBSIDIARIES WERE NOT MATERIAL. 1 1 1 X 1 X 600.000000000000 1 1 0 1 1 3254865 0 3254865 0.00740 66609425 46783596 19825829 0.04480 10763144 5222661 5540483 0.01250 80627434 52006257 28621177 0.06470 310617 10 310607 0.00070 5342 11341419 1180 11340239 0.02560 1769914 0 1769914 0.00400 803814 0 803814 0.00180 5342 14225764 1190 14224574 0.03210 5342 94853198 52007447 42845751 0.09680 1021 1021 0.00000 19877 19877 0.00000 384719 384719 0.00090 38667 38667 0.00010 5600 5600 0.00000 449884 449884 0.00100 0 2714526 0 78311403 87629708 -9318305 X 1 1 1 1 MERITER HOSPITAL INC 202 SOUTH PARK STREET MADISON WI 53715 WWW.UNITYPOINT.ORG/MADISON 316 X X X X X MERITER HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.UNITYPOINT.ORG/MADISON X X 1 18 1 WWW.UNITYPOINT.ORG/MADISON 0 1 X 200.000000000000 600.000000000000 X X X X X X X 1 1 X X X X 1 X WWW.UNITYPOINT.ORG/MADISON/FINANCIAL-ASSISTANCE X WWW.UNITYPOINT.ORG/MADISON/FINANCIAL-ASSISTANCE X WWW.UNITYPOINT.ORG/MADISON/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X 1 X 0 0 MERITER HOSPITAL, INC. PART V, SECTION B, LINE 5: UNITYPOINT HEALTH - MERITER, TOGETHER WITH OUR HEALTHY DANE COLLABORATIVE PARTNERS (SSM/ST. MARY'S, STOUGHTON HOSPITAL, UW HEALTH, GHC OF SOUTH-CENTRAL WI AND PUBLIC HEALTH MADISON DANE COUNTY) USED THE COUNTY HEALTH RANKINGS FRAMEWORK FOR OUR ASSESSMENT. WE KNOW THAT ENVIRONMENTAL AND SOCIAL FACTORS GREATLY IMPACT THE HEALTH OF THE COMMUNITY. WE ASSESSED INPUT FROM THE COMMUNITY AND DATA RELATED TO EACH OF THE HEALTH FACTORS IN THE COUNTY HEALTH RANKINGS MODEL TO BETTER UNDERSTAND WHAT IS IMPACTING THE HEALTH OF OUR COMMUNITY: HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL & ECONOMIC FACTORS AND THE PHYSICAL ENVIRONMENT. WE ALSO USED A HEALTH EQUITY LENS IN OUR ASSESSMENT. WE ARE COMMITTED TO ADDRESSING HEALTH INEQUITIES: "TYPES OF UNFAIR HEALTH DIFFERENCES CLOSELY LINKED WITH SOCIAL, ECONOMIC OR ENVIRONMENTAL DISADVANTAGES THAT ADVERSELY AFFECT A GROUP OF PEOPLE."(ATTAINING HEALTH EQUITY. CDC. RETRIEVED FROM: HTTPS://WWW.CDC.GOV/NCCDPHP/DCH/PROGRAMS/HEALTHYCOMMUNITIESPROGRAM/OVERVIEW/HEALTHEQUITY.HTM )WE USED QUALITATIVE AND QUANTITATIVE DATA TO INFORM OUR ASSESSMENT. WE HELD COMMUNITY-BASED FOCUS GROUPS THROUGHOUT THE SUMMER OF 2018 WITH THE FOLLOWING GROUPS: SSM/ST. MARY'S COMMUNITY PARTNER BREAKFAST, HOUSING AND HEALTHCARE (H2) MEETING, SSM DMG PATIENT ADVISORY GROUP, STOUGHTON BUSINESS HEALTH AND WELLNESS ROUNDTABLE, CENTRO HISPANO KEY INFORMANT INTERVIEW, WISCONSIN FAITH VOICES FOR JUSTICE, HARAMBEE VILLAGE DOULAS, SAVING OUR BABIES PUBLIC ENGAGEMENT SESSIONS AND BLACK MEN'S HEALTH TOWN HALL MEETING. THE MEMBERS OF THE HEALTHY DANE COLLABORATIVE FACILITATED THESE MEETINGS WITH THE FOCUS TOPIC AREAS OF MATERNAL AND CHILD HEALTH, MENTAL HEALTH, SUBSTANCE USE AND CHRONIC DISEASE. WE USED THE FOLLOWING QUESTIONS TO GUIDE THE DISCUSSION: "THINKING ABOUT [INSERT FOCUS TOPIC AREA], WHAT WOULD A HEALTHY COMMUNITY LOOK LIKE TO YOU? AND "IN WHAT WAYS CAN HOSPITALS AND HEALTH SYSTEMS PARTNER WITH THE COMMUNITY TO ADDRESS [INSERT FOCUS TOPIC AREA]?" MERITER HOSPITAL, INC. PART V, SECTION B, LINE 6A: SSM/ST. MARY'S, STOUGHTON HOSPITAL AND UW HEALTH MERITER HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HEALTHY DANE COLLABORATIVE INCLUDES PUBLIC HEALTH MADISON DANE COUNTY AND GHC OF SOUTH-CENTRAL WI AS PRIMARY PARTNERS IN ITS WORK. MERITER HOSPITAL, INC. PART V, SECTION B, LINE 7D: THE COLLABORATIVE'S VENDOR, HEALTHY COMMUNITY INSTITUTE (HCI), DEVELOPS AND MAINTAINS A HIGH-QUALITY DATA AND DECISION-SUPPORT INFORMATION SYSTEM TO AID IN INDICATOR TRACKING, BEST-PRACTICE SHARING AND COMMUNITY DEVELOPMENT. THE SYSTEM PROVIDES ACCESS TO A TEMPLATE, ALONG WITH SUPPORTING SERVICES, TO COMMUNITIES TO HELP IMPROVE QUALITY OF LIFE AND OUTCOMES. IN ADDITION THE CHNA IS POSTED ON THE MERITER HOSPITAL SITE. MERITER HOSPITAL, INC. PART V, SECTION B, LINE 11: WE RECOGNIZE THERE ARE DATA LIMITATIONS: COUNTY AND LOCAL LEVEL DATA BROKEN DOWN BY RACE, ETHNICITY, SOCIOECONOMIC STATUS AND OTHER DEMOGRAPHICS IS NOT ALWAYS AVAILABLE. THESE DATA ARE INCLUDED WHENEVER POSSIBLE. COMMUNITY INPUT SESSIONS REPRESENT VOICES FROM BOTH COMMUNITY LEADERS AND VULNERABLE POPULATIONS. BECAUSE INEQUITIES CONTINUE TO EXIST IN MATERNAL CHILD HEALTH, MENTAL HEALTH, CHRONIC CONDITIONS AND SUBSTANCE ABUSE, WE CHOSE TO FOCUS OUR QUESTIONS IN THOSE SPECIFIC AREAS. IN ADDITION, WE SOUGHT TO BETTER UNDERSTAND HOW HEALTH SYSTEMS AND THE COMMUNITY COULD BETTER PARTNER TOGETHER TO IMPROVE HEALTH OUTCOMES.WE KNOW THAT GENERALLY, DANE COUNTY'S HEALTH OUTCOMES FAIR BETTER THAN MANY STATE AND NATIONAL AVERAGES. HOWEVER, THE STATE AND NATIONAL AVERAGES DO NOT ADEQUATELY CAPTURE THE INEQUITIES BETWEEN POPULATIONS.COMMUNITY MEMBERS VOICED:-- A DESIRE FOR EQUAL OPPORTUNITY, RESOURCES AND RESPECT-- RESILIENCY AND COMMITMENT TO THE COMMUNITY-- A NEED FOR COORDINATED COMMUNITY RESOURCES-- IMPORTANCE OF CONNECTEDNESS AND SOCIAL COHESION-- A NEED FOR CULTURALLY RESPONSIVE CAREBOTH COMMUNITY INPUT AND QUANTITATIVE DATA WERE USED TO ASSESS THE NEEDS AND ASSETS OF DANE COUNTY. AREAS OF HIGH COMMUNITY NEED AND PRIORITY FOCUS WERE IDENTIFIED USING THE FOLLOWING CRITERIA:-- DATA INDICATED AN INEQUITY, DISPARITY OR NOTABLE DIFFERENCES IN OUTCOMES WITHIN THE POPULATION-- COMMUNITY VOICED NEED-- DATA INDICATED THAT DANE COUNTY OUTCOMES ARE WORSE THAN STATE OR NATIONAL OUTCOMES-- ESTABLISHED COLLABORATION AND CONTINUING MOMENTUM OF EXISTING WORK-- AREAS OF IDENTIFIED INEQUITIES WERE WEIGHTED THE MOST HIGHLY WHEN PRIORITIZING HEALTH NEEDS.AFTER CAREFUL AND THOROUGH REVIEW OF AVAILABLE DATA, BOTH QUANTITATIVE AND QUALITATIVE, THE HEALTHY DANE COLLABORATIVE IDENTIFIED FOUR PRIORITY HEALTH OUTCOMES: MATERNAL AND CHILD HEALTH, CHRONIC CONDITIONS, MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDERS. MERITER HOSPITAL, INC. PART V, SECTION B, LINE 13H: PATIENTS WHO QUALIFY AND ARE RECEIVING BENEFITS FROM THE FOLLOWING PROGRAMS MAY BE PRESUMED ELIGIBLE FOR 100% FINANCIAL ASSISTANCE: THE US. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE FOOD STAMP PROGRAM; WOMEN, INFANTS & CHILDREN (WIC); AND VARIOUS COUNTY AND STATE RELIEF PROGRAMS. THIRD PARTY AGENCIES ARE USED TO ASSIST WITH COLLECTIONS AND, IF THOSE AGENCIES PROVIDE A STATEMENT REGARDING A PATIENT'S LIKELY INCOME LEVEL, THAT INFORMATION IS USED IN DETERMINING THE ELIGIBILITY STATUS AND THE LEVEL OF DISCOUNT AVAILABLE. 4 3 - CHILD & ADOLESCENT PSYCHIATRY 8001 RAYMOND ROAD MADISON WI 53719 INPATIENT PSYCHIATRY SERVICES 4 - MERITER NEWSTART 1015 GAMMON LANE MADISON WI 53719 SUBSTANCE ABUSE TREATMENT PROGRAM 5 - MERITER WELLNESS CENTER 501 W BELTLINE HWY SUITE 207 MADISON WI 53713 CARDIOVASCULAR & PULMONARY REHAB & NUTRITION 6 - CENTER FOR PERINATAL CARE 202 S PARK ST MADISON WI 53715 PREGNANCY CARE PART I, LINE 6A: A COMMUNITY BENEFIT REPORT IS FILED ON BEHALF OF MERITER HEALTH SERVICES; MERITER HOSPITAL IS A SUBSIDIARY. THE COMMUNITY BENEFIT TEXT IN THIS RETURN REPRESENTS THE HOSPITAL. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A. THE AMOUNTS ON LINES 7B-7C (UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) ARE OBTAINED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO COST ACCOUNTING SYSTEM USE SEGMENT SPECIFIC COST-TO-CHARGE RATIO. THE AMOUNTS FOR LINES 7E, F, H, AND I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED FROM A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS. SEGMENTS NOT PASSED TO A COST ACCOUNTING SYSTEM USE THE COST-TO-CHARGE RATIO. PART II, COMMUNITY BUILDING ACTIVITIES: MERITER STRIVES TO HELP CREATE A HEALTHY COMMUNITY INCLUDING STRONG SCHOOLS, SAFE NEIGHBORHOODS AND DIVERSE WORKFORCE. THROUGH PARTNERSHIPS WITH LOCAL NON-PROFIT ORGANIZATIONS AND COMMUNITY GROUPS, MERITER IS WORKING TO STRENGTHEN THE COMMUNITY THROUGH CHARITABLE GIVING AND COMMUNITY ENGAGEMENT. WITH THE SUPPORT OF THE FOUNDATION FOR MADISON PUBLIC SCHOOLS, MERITER ADOPTED JAMES MADISON MEMORIAL HIGH SCHOOL AND ENGAGES IN SEVERAL PARTNERSHIP ACTIVITIES TO ENHANCE EDUCATIONAL ATTAINMENT. THE BAYVIEW COMMUNITY, LOCATED ACROSS THE STREET FROM MERITER, IS A CDA HOUSING COMMUNITY, HOME TO A DIVERSE COMMUNITY OF RESIDENTS AND IMMIGRANTS; OVER 80% OF WHOM IDENTIFY AS HMONG. MERITER SUPPORTS BAYVIEW'S GIVING GARDEN, LOCATED ON THE MERITER HOSPITAL GROUNDS. THE GIVING GARDEN INCREASED THE BAYVIEW COMMUNITY'S ACCESS TO HEALTHY AND FRESH, CULTURALLY APPROPRIATE FOOD CHOICES. AS OF SEPTEMBER 2018, YOUTH HARVESTED APPROXIMATELY 450 POUNDS OF ORGANIC PRODUCE! THE HIGHLIGHT OF THE PROGRAM ACCORDING TO THE YOUTH PARTICIPANTS WAS WORK IN THE GARDEN. YOUTH PREPARED THE SOIL, MULCHED, WEEDED, PLANTED, TRIMMED, WATERED, BUILT STRUCTURAL SUPPORT FOR PLANTS, INSTALLED FENCING, LABELED PLANTS, CREATED A GARDEN MAP, PERFORMED SOIL TESTS, REMOVED PESTS, AND HARVESTED PRODUCE. YOUTH WORKED TOGETHER TOWARD A COMMON GOAL: TO PROVIDE FRESH, ORGANIC PRODUCE TO THE BAYVIEW COMMUNITY. THEY SPENT STRUCTURED TIME OUTSIDE AND AWAY FROM DIGITAL DEVICES AND, INSTEAD, WATCHED THE GARDEN CHANGE THROUGHOUT THE SEASON AND TOOK OWNERSHIP OF THE HEALTH OF THE PLANTS. PARTICIPANTS GAINED FAMILIARITY WITH HANDLING VEGETABLES FOR FOOD PREPARATION. YOUTH CHOPPED, TRIMMED, AND PEELED VEGETABLES AND HERBS, AND LEARNED TO FOLLOW RECIPES. YOUTH EXPERIMENTED WITH RECIPES AND TASTE-TESTED A VARIETY OF HEALTHY SNACK ALTERNATIVES. YOUTH LEARNED ABOUT MINDFUL EATING AND HOW TO BETTER UNDERSTAND HUNGER CUES.MERITER IS ALSO WORKING WITH SEVERAL COMMUNITY GROUPS TO FUND TRAINING PROGRAMS, SCHOLARSHIPS AND TUTORING PROGRAMS. EXAMPLES INCLUDE THE URBAN LEAGUE OF GREATER MADISON, AVID/TOPS (PARTNERSHIP WITH MADISON METROPOLITAN SCHOOL DISTRICT AND THE BOYS AND GIRLS CLUB OF DANE COUNTY), OPERATION FRESH START AND MADISON COLLEGE HEALTH PROFESSIONS PROGRAM. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR ST. LUKE'S HOSPITAL. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. PART III, LINE 8: AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORTS AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE.THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. HOWEVER THE MEDICARE COST REPORT DISALLOWS CERTAIN ITEMS THAT WE BELIEVE ARE LEGITIMATE EXPENSES INCURRED IN THE PROCESS OF CARING FOR OUR MEDICARE PATIENTS. EXAMPLES OF THESE ITEMS INCLUDE PROVIDER BASED PHYSICIAN EXPENSE, SELF INSURANCE EXPENSE, HOME OFFICE EXPENSE AND THE SHORTFALL FROM FEE SCHEDULE PAYMENTS. IN ADDITION TO THESE ITEMS THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM DO NOT INCLUDE MEDICARE PHYSICIAN FEE SCHEDULE EXPENSE AND OFFSETTING REVENUE.THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM, MEDICAID OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS ABSENT THE MEDICARE PROGRAM. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. ADDITIONALLY, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS. FINALLY, THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: WE NOTIFY PATIENTS OF THEIR FINANCIAL RESPONSIBILITY AS WELL AS OUR CHARITY CARE POLICY. OUR COLLECTION AGENCIES ARE EDUCATED ON OUR FAHCP (FINANCIAL ASSISTANCE FOR HEALTH CARE PROGRAM) AND WE FOLLOW WHA (WISCONSIN HOSPITAL ASSOCIATION) GUIDELINES. OUR POLICY STATES "PATIENT ACCOUNTS IN THE PROCESS OF FINANCIAL AID REVIEW WILL NOT KNOWINGLY BE SENT TO COLLECTIONS." PART VI, LINE 2: UNITYPOINT HEALTH - MERITER, TOGETHER WITH OUR HEALTHY DANE COLLABORATIVE PARTNERS (SSM/ST. MARY'S, STOUGHTON HOSPITAL, UW HEALTH, GHC OF SOUTH-CENTRAL WI AND PUBLIC HEALTH MADISON DANE COUNTY) COLLABORATIVE COMPLETED THE HEALTH ASSESSMENT OF DANE COUNTY. WE ENDORSED ONE SINGLE COMMUNITY HEALTH NEEDS ASSESSMENT FOR OUR COMMUNITY, THE FIRST FOR DANE COUNTY. SECONDARY DATA WAS COMPLIED BY THE HEALTHY COMMUNITY INSTITUTE/CONDUENT. THE DATA WAS VALIDATED BY OUR COMMUNITY ENGAGEMENT SESSIONS/FOCUS GROUPS. PART VI, LINE 3: THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE TO ALL PATIENTS AND WITHIN THE COMMUNITY. COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. THE CENTRAL BILLING OFFICE IS AVAILABLE BY PHONE TO ANSWER QUESTIONS ABOUT THE POLICY, OR PATIENTS SHOULD GO TO THE CASHIER'S OFFICE AT THE HOSPITAL TO OBTAIN THIS INFORMATION. THE PLAIN LANGUAGE SUMMARY IS OFFERED AS PART OF THE PATIENT INTAKE AND/OR DISCHARGE PROCESS AND INCLUDED WHEN A PATIENT IS SENT WRITTEN NOTICE THAT EXTRAORDINARY COLLECTION ACTIONS MAY BE TAKEN AGAINST HIM/HER. THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND ALL FINANCIAL ASSISTANCE FORMS ARE AVAILABLE IN ENGLISH AND IN ANY OTHER LANGUAGE IN WHICH LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS CONSTITUTE THE LESSER OF 1,000 PERSONS OR MORE THAN 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. THESE TRANSLATED DOCUMENTS WILL BE AVAILABLE BY MAIL, ON EACH HOSPITAL'S WEBSITE, AND IN PERSON AT EACH HOSPITAL. PART VI, LINE 4: DANE COUNTY IS IN SOUTH-CENTRAL WISCONSIN AND IS HOME TO MADISON, WISCONSIN'S CAPITAL AND THE COUNTY SEAT. DANE COUNTY IS THE SECOND MOST DENSELY POPULATED COUNTY IN WI, AND MADISON IS THE SECOND LARGEST CITY IN THE STATE. THE POPULATION GREW 5.5% BETWEEN 2012 AND 2016, BRINGING THE TOTAL POPULATION TO 531,273. MADISON HAS 245,691 RESIDENTS, ALMOST HALF OF THE COUNTY'S POPULATION. AND, AMONG ITS RESIDENTS ARE MORE THAN 43,000 UW STUDENTS. THE RACIAL DEMOGRAPHICS IN DANE COUNTY ARE CHANGING. IN 2017, BLACK/AFRICAN AMERICANS MADE UP 5.4% OF THE DANE COUNTY POPULATION; ASIANS MADE UP 6.2%; WHITE/CAUCASIANS 85.2%; AMERICAN INDIAN OR ALASKA NATIVE 0.1%; NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 0.5%; AND TWO OR MORE RACES 2.7%. IN ADDITION, 6.5% OF DANE COUNTY'S POPULATION ARE OF HISPANIC OR LATINO ETHNICITY. AN OPPORTUNITY GAP EXISTS BETWEEN WHITE STUDENTS AND STUDENTS OF COLOR IN DANE COUNTY EVIDENCED BY DISPARITIES IN EDUCATIONAL OUTCOMES. DANE COUNTY'S 87.1% HIGH SCHOOL GRADUATION RATE IS AMONG THE LOWEST IN THE STATE. THE PERCENT OF THE POPULATION THAT HAS AT LEAST A BACHELOR'S DEGREE IS MUCH HIGHER IN DANE COUNTY COMPARED WITH WISCONSIN AND THE US OVERALL (DANE COUNTY 49%, WI 28.4%, US 30.3%). THE MEDIAN HOUSEHOLD INCOME IS ALSO HIGHER IN DANE COUNTY ($64,773) THAN IN WI ($54,610). THERE IS CONSIDERABLE VARIABILITY WHEN YOU DISAGGREGATE MEDIAN HOUSEHOLD INCOME BY RACE AND ETHNICITY; THE MEDIAN INCOME FOR BLACK HOUSEHOLDS IS CLOSER TO $30,000 AND FOR HISPANIC OR LATINO HOUSEHOLDS IS JUST UNDER $40,000.DESPITE DANE COUNTY'S HIGH MEDIAN HOUSEHOLD INCOME AND LOW UNEMPLOYMENT RATE (2.8%), DANE COUNTY IS FACED WITH AN INCREASING NUMBER OF PEOPLE LIVING IN POVERTY. 12.7% OF DANE COUNTY RESIDENTS LIVE IN POVERTY, COMPARABLE TO THE STATE POVERTY RATE BUT TRENDING IN A WORSENING DIRECTION. THE DISPROPORTIONATE IMPACT OF POVERTY ON COMMUNITY'S COLOR IS EVEN MORE PROFOUND WHEN LOOKING AT RATES OF CHILDREN LIVING IN POVERTY. OVERALL, 31% OF CHILDREN IN DANE COUNTY ARE ELIGIBLE FOR FREE OR REDUCED-PRICE LUNCH. PART VI, LINE 5: MERITER IS A LOCALLY MANAGED AND A LOCALLY GOVERNED HOSPITAL. THE COMMUNITY-BASED BOARD OF DIRECTORS IS COMMITTED TO PROTECTING THE HEALTH OF THE COMMUNITY THROUGH SUSTAINING SEVERAL OF MERITER'S PROGRAMS AND SERVICES THAT ONLY MERITER PROVIDES. SEVERAL YEARS AGO, THE BOARD MADE A PLEDGE TO CONTINUE TO PROVIDE CHILD AND ADOLESCENT PSYCHIATRIC SERVICES EVEN WHEN OTHER PROVIDERS CHOSE NOT TO PROVIDE SUPPORT. PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM (D/B/A UNITYPOINT HEALTH). THROUGH RELATIONSHIPS WITH 36 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 280 PHYSICIAN CLINICS, UNITYPOINT HEALTH PROVIDES CARE THROUGHOUT IOWA, WESTERN ILLINOIS, AND SOUTHERN WISCONSIN.UNITYPOINT HEALTH ENTITIES EMPLOY A LARGE NONPROFIT WORKFORCE, WITH MORE THAN 30,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 6.5 MILLION PATIENT VISITS, UNITYPOINT HEALTH HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $4.4 BILLION, UNITYPOINT HEALTH IS THE FIFTH LARGEST NONDENOMINATIONAL HEALTH SYSTEM IN AMERICA AND PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES TO IMPROVE THE HEALTH OF PEOPLE IN ITS COMMUNITIES. UNITYPOINT HEALTH AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES THROUGHOUT IOWA, AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THE STATE. IN 2018, UNITYPOINT HEALTH AND ITS AFFILIATES PROVIDED MORE THAN $559 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY UNITYPOINT HEALTH AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 MERITER FOUNDATION 202 S PARK STREET MADISON WI 537151596 237098688 501(C)(3) 96228 HOSPITAL PROGRAMS MERITER HEALTH SERVICES INC 202 S PARK STREET MADISON WI 537151596 391412318 501(C)(3) 6412 MERITER HEALTH SERVICES PROGRAMS 2 0 HOSPITAL SCHOLARSHIPS 35 35200 PART I, LINE 2: GRANTS ARE MADE UPON A SPECIFIC PROJECT REQUEST AND ONLY MADE TO ORGANIZATIONS THAT WE HAVE A WORKING RELATIONSHIP WITH AND SHARE A COMMON GOAL OF COMMUNITY BENEFIT. GRANTS ARE ONLY MADE TO 501 (C)(3) ORGANIZATIONS WHICH MUST COMPLETE FORM 990S AND ANNUAL REPORTS. PART III - SCHOLARSHIPS ARE AWARDED TO INDIVIDUALS WHO HAVE SUBMITTED REQUIRED APPLICATION AND SUPPORTING DOCUMENTATION. A SELECTION COMMITTEE REVIEWS THE REQUESTS, EVALUATES EACH APPLICATION BASED UPON FINANCIAL NEED, ACADEMIC RECORD, EXTRA CURRICULAR WORK/VOLUNTEERING, RECOMMENDATION AND ESSAY. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 SUE ERICKSON COOASST TREASTO 118 CEO (FR 2/18) 0 447307 0 92330 0 72735 0 79445 0 21257 0 713074 0 0 ART NIZZA DSW BOARD MEMBER/CEO (TO 1/18) 0 755265 0 114647 0 105492 0 138601 0 24451 0 1138456 0 0 BETH ERDMAN CFO/SECRETARY/TREASURER 0 294809 0 106512 0 17431 0 36151 0 5854 0 460757 0 0 PAM WETZEL MD CMO/ASST SECRETARY 0 406169 0 93170 0 17863 0 47304 0 19414 0 583920 0 0 JAMES ARNETT VP OPERATIONS 0 266041 0 76005 0 21106 0 33311 0 23211 0 419674 0 0 TODD BURCHILL VP BUSINESS DEVELOPMENT 0 269232 0 78318 0 16249 0 41528 0 27368 0 432695 0 0 SHERRY CASALI CHIEF NURSING OFFICER (FR 2/18) 8989 214489 0 23788 18257 16449 1097 34677 875 9104 29218 298507 0 0 PATRICIA GRUNWALD CHIEF NURSING OFFICER (TO 1/18) 0 15494 0 79431 0 65593 0 0 0 1496 0 162014 0 0 MARY J HANSEN VP-CLINIC OPERATIONS -3917 0 16120 0 215800 0 645 0 21864 0 250512 0 0 0 CHRISTINA JACKSON DIR PERIOPERATIVE SVCS 171906 0 31739 0 1160 0 8425 0 25741 0 238971 0 0 0 KATHERINE KOSTRIVAS EXEC DIRECTOR JOA 174948 0 32734 0 1576 0 8549 0 20880 0 238687 0 0 0 JULIE RICE REGISTERED NURSE 166769 0 2540 0 412 0 6925 0 18936 0 195582 0 0 0 LANA STECKEL DIR MEDICAL IMAGING 179661 0 35933 0 2299 0 8839 0 20366 0 247098 0 0 0 GEOFFREY PRIEST MD FORMER CMO/ASST. SEC(TO 3/16) 0 0 0 0 0 158080 0 0 0 0 0 158080 0 0 PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: BUSINESS CLUB DUES WERE PAID FOR ONE PERSON. THE BUSINESS CLUB IS AN IRS SECTION 501(C)(7). PART I, LINES 4A-B SEVERANCE PAYMENTS: THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS DURING THE YEAR THAT WERE INCLUDED IN THEIR TAXABLE INCOME: MARY HANSEN $215,800. THE FOLLOWING INDIVIDUAL PARTICIPATED IN A NON-QUALIFIED RETIREMENT PLAN WITH THE FOLLOWING CHANGE TO THEIR ACCOUNT: JAMES ARNETT $22,311, TODD BURCHILL $30,528, SHERRY CASALI $25,036, BETH ERDMAN $28,133, SUSAN ERICKSON $72,401, ART NIZZA $112,209, AND PAM WETZEL $40,881. FORM 990, PART VI, SECTION A, LINE 6 MERITER HEALTH SERVICES, INC., A TAX-EXEMPT, WISCONSIN NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MERITER HEALTH SERVICES, INC., AS SOLE MEMBER, SHALL APPOINT ALL MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B MERITER HEALTH SERVICES, INC., AS SOLE MEMBER, SHALL AUTHORIZE OR APPROVE THE FOLLOWING ACTIONS: (A) MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; (B) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OF THE CORPORATION; (C) A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION; (D) THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY CORPORATION OF THE CORPORATION; (E) THE ADOPTION OF THE AGGREGATE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (F) AGGREGATE BORROWING FOR PERIODS OF ONE (1) YEAR OR LESS FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE VOTING MEMBER FROM TIME TO TIME; AND AGGREGATE BORROWING FOR PERIODS OF MORE THAN ONE (1) YEAR FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE VOTING MEMBER FROM TIME TO TIME. FOR THE PURPOSE OF THIS SUBPARAGRAPH, THE TERM AGGREGATE BORROWING MEANS BORROWINGS NOT PREVIOUSLY INCLUDED IN THE OPERATING AND/OR CAPITAL BUDGETS, AND INCLUDES BUT IS NOT LIMITED TO LEASE AGREEMENTS AND CONTRACTS FOR SALE; (G) THE PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, AND ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE VOTING MEMBER FROM TIME TO TIME, NOT PREVIOUSLY INCLUDED IN THE CAPITAL BUDGET; (H) THE APPOINTMENT OF THE INDEPENDENT AUDITOR AND CORPORATE COUNSEL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARDS OF DIRECTORS CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ON A PROACTIVE BASIS, DECLARATIONS OF POTENTIAL CONFLICTS OF INTEREST ARE SIGNED WHEN EACH DIRECTOR JOINS THE BOARD AND ANNUALLY THEREAFTER. THE CEO AND BOARD CHAIR MONITOR THE POTENTIAL CONFLICTS DISCLOSED BY BOARD MEMBERS AND MANAGE ATTENDANCE AT MEETINGS AND PARTICIPATION IN VOTES ACCORDING TO THE ISSUE ON THE AGENDA. INDIVIDUAL DIRECTORS ALSO MONITOR THEIR POTENTIAL CONFLICTS AND RECUSE THEMSELVES FROM BOARD DISCUSSION AND/OR VOTES AS REQUIRED BY THE CIRCUMSTANCES. THE PROCESS OF MANAGING CONFLICTS OF INTEREST IS RECORDED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS ("COMMITTEE") CONDUCTS A COMPREHENSIVE REVIEW OF ALL COMPENSATION AND BENEFITS PROVIDED TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, INCLUDING THE IHS CHIEF EXECUTIVE OFFICER (THE "CEO"). THIS REVIEW COMPARES THE TOTAL COMPENSATION AND VALUE OF BENEFITS PROVIDED TO EACH EXECUTIVE, ON A POSITION BY POSITION BASIS, TO THAT PROVIDED TO FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED ORGANIZATIONS. THIS REVIEW IS CONDUCTED BY THE COMMITTEE WITH THE ASSISTANCE OF A NATIONAL, INDEPENDENT COMPENSATION CONSULTANT REPORTING DIRECTLY TO THE COMMITTEE. THE COMMITTEE HAS BEEN DELEGATED THE RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION AND IS MADE UP ENTIRELY OF INDEPENDENT DIRECTORS WITHIN THE MEANING OF THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE FEDERAL INCOME TAX INTERMEDIATE SANCTIONS RULES. THE COMPENSATION CONSULTANT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT, PERFORMS THESE VALUATIONS ON A REGULAR BASIS, IS QUALIFIED TO MAKE THE VALUATIONS OF THE SERVICES INVOLVED, AND HAS SO INDICATED IN A WRITTEN CERTIFICATION TO THE COMMITTEE. BASED UPON THE ADVICE OF THE COMPENSATION CONSULTANT, AND APPLYING THE BOARD'S COMPENSATION PHILOSOPHY, THE COMMITTEE ESTABLISHES THE OVERALL ADJUSTMENT IN COMPENSATION AND BENEFITS FOR THE CEO FORUM GROUP AND SVP POSITIONS FOR THE ENTIRE HEALTH SYSTEM (SEVERAL OF WHICH ARE EMPLOYEES OF THE FILING ORGANIZATION) AND DELEGATES TO THE CEO THE AUTHORITY TO MAKE ADJUSTMENTS, CONSISTENT WITH THE COMMITTEE'S DIRECTION, FOR THE OTHER EXECUTIVES. THE COMMITTEE DETERMINES ALL ASPECTS OF THE COMPENSATION AND BENEFITS OF THE CEO. THE COMMITTEE INTENTIONALLY TAKES ALL THE STEPS NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES, INCLUDING CONTEMPORANEOUS SUBSTANTIATION OF ALL COMMITTEE MEETINGS AND ACTIONS. THE ORGANIZATION BELIEVES IT IS IN FULL COMPLIANCE WITH SECTION 4958 OF THE IRC, PROVIDES NO MORE THAN REASONABLE AND FAIR MARKET VALUE COMPENSATION AND BENEFITS FOR ITS EMPLOYEES AND DOES NOT PROVIDE ANY EXCESS COMPENSATION OR BENEFITS AS PROHIBITED BY SECTION 4958. THE REVIEW OF COMPENSATION AND BENEFITS WAS LAST PERFORMED IN DECEMBER 2018 FOR THE FOLLOWING INDIVIDUALS: SUE ERICKSON ART NIZZA THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 18 BECAUSE THE ORGANIZATION FILED ITS FORM 1023 BEFORE JULY 1987 AND DID NOT HAVE A COPY OF FORM 1023 ON THAT DATE, IT IS NOT REQUIRED TO MAKE ITS FORM 1023 AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, LEGAL DEPARTMENT. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE ON THE IOWA HEALTH SYSTEM WEBSITE, WWW.UNITYPOINT.ORG. FORM 990, PART XI, LINE 9: CHANGES IN PENSION LIABILITY -8,465,159. ASSETS RELEASED FROM RESTRICTION -334,361. RELEASED FOR CAPITAL AND OTHER 197,005. TEMPORARY & PERMANENTLY RESTRICTED TRANSFER FOUNDATION 244,231. UPH TRANSFERS 2,696,831. OTHER -365,713. ABBE CENTER FOR COMMUNITY MENTAL HEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421045257 MENTAL HEALTH CARE IA 501(C)(3) 509(A)(2) ABBEHEALTH INC 0 ABBEHEALTH INC 740 N 15TH AVE NO A HIAWATHA IA 52233 421373123 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III ST LUKE'S HEALTHCARE 0 AGING SERVICES INC 740 N 15TH AVE NO A HIAWATHA IA 52233 237085316 SENIOR SERVICES IA 501(C)(3) 170(B)(1) (A)(VI) ABBEHEALTH INC 0 ALLEN COLLEGE 1825 LOGAN AVENUE WATERLOO IA 50703 421351526 EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS IA 501(C)(3) 170(B)(1) (A)(II) ALLEN HEALTH SYSTEMS INC 0 ALLEN HEALTH SYSTEMS INC 1825 LOGAN AVENUE WATERLOO IA 50703 421201924 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM 0 ALLEN MEMORIAL HOSPITAL CORPORATION 1825 LOGAN AVENUE WATERLOO IA 50703 420698265 HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ALLEN HEALTH SYSTEMS INC 0 ANAMOSA AREA AMBULANCE SERVICE 101 GRANT WOOD DRIVE ANAMOSA 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IA IOWA HEALTH SYSTEM C 6092131 11401133 1.00000 0 DELHI POINT CONDO ASSOCIATION 350 N GRANDVIEW DUBUQUE IA 52001 421467002 REAL ESTATE MANAGEMENT IA THE FINLEY HOSPITAL C 5208 400 0.58770 0 HCP CORPORATION 202 SOUTH PARK STREET MADISON WI 53715 391177562 REAL ESTATE RENTAL WI MERITER HOSPITAL INC C 280942 1385135 1.00000 0 HANCOCK AREA MEDICAL SUPPLY INC 1204 BUCHANAN ST CARTHAGE IL 62321 371180373 RETAIL HOME HEALTH MEDICAL EQUIPMENT IL MEMORIAL HOSPITAL ASSOCIATION C 597051 502177 1.00000 0 HANSEN CHARITABLE REMAINDER ANNUITY TRUST 210 FOURTH AVENUE GRINNELL IA 50112 396770806 INVESTMENT IA GRINNELL REGIONAL MEDICAL CENTER FOUNDATION T 0.94000 0 HANSEN CHARITABLE REMAINDER UNITRUST 210 FOURTH AVENUE GRINNELL IA 50112 396770807 INVESTMENT IA GRINNELL REGIONAL MEDICAL CENTER FOUNDATION T 0.93000 0 HEALTH ADVANTAGE PLUS INC 210 4TH AVENUE GRINNELL IA 50112 421436490 PHYSICAL THERAPY IA GRINNELL REGIONAL MEDICAL CENTER C 557678 339208 1.00000 0 HEALTH PLUS INC 5409 N KNOXVILLE AVE PEORIA IL 61614 371295532 MANAGED CARE ADMINISTRATION IL PROCTOR HEALTH CARE INCORPORATED C 213 10411 1.00000 0 HNC SERVICES 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 270987243 FIBER OPTIC NETWORK SERVICES IA IOWA HEALTH SYSTEM C 2126071 1141481 1.00000 0 HOME HEALTH PLUS SERVICES INC PO BOX 87 PEORIA IL 61650 364053068 HOME HEALTH SERVICES IL METHODIST HEALTH VENTURES INC C 761492 218530 1.00000 0 KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY INC 420 NORTH 17TH STREET KEOKUK IA 52632 421237312 RETAIL DURABLE MEDICAL EQUIPMENT IA KEOKUK HEALTH SYSTEMS INC C 2958672 1353300 1.00000 0 MARIGOLD CITY LAND TRUST NO ONE 2956 COURT STREET PEKIN IL 61554 272750273 PROPERTY MANAGEMENT IL PARK COURT LIMITED T 12118 156946 1.00000 0 MEDIMORE INC 1776 WEST LAKES PKWY 400 WEST DES MOINES IA 50266 421414390 MANAGED CARE IA IOWA HEALTH SYSTEM C 1093243 15268087 1.00000 0 MERITER HEALTH ENTERPRISES INC 202 SOUTH PARK STREET MADISON WI 53715 391293620 MANAGEMENT SERVICES WI MERITER MANAGEMENT SERVICES INC C 1.00000 0 MERITER MANAGEMENT SERVICES INC 202 SOUTH PARK STREET MADISON WI 53715 391458235 ADMINISTRATIVE SERVICES WI MERITER HEALTH SERVICES INC C 25655976 13865587 1.00000 0 METHODIST HEALTH VENTURES INC PO BOX 87 PEORIA IL 61650 371140939 PHARMACY/OFFICE STAFFING IL METHODIST HEALTH SERVICES CORPORATION C 42739 2198286 1.00000 0 METHODIST PHYSICIAN SERVICES INC PO BOX 87 PEORIA IL 61650 363858550 MEDICAL SERVICES IL METHODIST HEALTH VENTURES INC C 48658 1.00000 0 OPTIMUM HEALTH SOLUTIONS INC 221 NORTHEAST GLEN OAK AVE PEORIA IL 61636 205430137 HEALTH & WELLNESS CONSULTING IA METHODIST HEALTH VENTURES INC C 1076662 1785651 1.00000 0 PEKIN PROHEALTH INC 600 SOUTH 13TH STREET PEKIN IL 61554 371117052 CLINIC IL PROGRESSIVE HEALTH SYSTEMS C 9536558 3923033 1.00000 0 PRECEDENCE INC 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 371288604 MANAGED MENTAL CARE IA THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH C 1625713 565007 1.00000 0 PROVIDER RESOURCE MANAGEMENT INC PO BOX 87 PEORIA IL 61650 371223550 RESOURCE MANAGEMENT IL METHODIST HEALTH SERVICES CORPORATION C 561 34360 1.00000 0 STL HEALTH RESOURCES CO 1026 A AVE NE CEDAR RAPIDS IA 52402 421193499 PHYSICIAN OFFICE RENTAL IA ST LUKE'S METHODIST HOSPITAL C 41484 4485551 1.00000 0 TRINITY HEALTH ENTERPRISES INC 2701 17TH ST ROCK ISLAND IL 61201 363320141 RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY IL TRINITY REGIONAL HEALTH SYSTEM C -85481 1960393 1.00000 0 TRINITY PHYSICIAN HOSPITAL ORGANIZATION LTD 4622 PROGRESS DRIVE STE A DAVENPORT IA 52807 363924720 MANAGED HEALTH CARE IA TRINITY MEDICAL CENTER C 1.00000 0 1 1 1 1 1 0 0 0 0 1 0 1 1 0 0 1 0 1 0 MERITER MANAGEMENT SERVICES INC A 1153 BASED ON GAAP, CASH, AND/OR FMV. SCHEDULE R, PARTS I - IV: IOWA HEALTH SYSTEM AND SUBSIDIARIES (D/B/A UNITYPOINT HEALTH) IOWA HEALTH SYSTEM IS AN IOWA NONPROFIT CORPORATION FORMED IN DECEMBER 1994. IOWA HEALTH SYSTEM AND ITS SUBSIDIARIES PROVIDE INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES FROM 36 HOSPITAL FACILITIES AND OVER 400 OUTPATIENT SITES IN IOWA, ILLINOIS AND WISCONSIN. PRIMARY, SECONDARY AND TERTIARY CARE SERVICES ARE PROVIDED TO RESIDENTS OF IOWA, ILLINOIS, WISCONSIN AND ADJACENT STATES. ON APRIL 16, 2013, IOWA HEALTH SYSTEM BEGAN BEING PUBLICLY KNOWN AS UNITYPOINT HEALTH (THE SYSTEM). THIS NAME CHANGE REFLECTS THE TRANSFORMATION OF CLINICAL PROCESSES UNDERWAY WITHIN THE SYSTEM AND THE ADAPTATION TO BETTER ADDRESS THE HEALTH CARE NEEDS OF COMMUNITIES, INCLUDING BUILDING A MODEL OF DELIVERING HEALTH CARE THAT COORDINATES CARE AROUND THE PATIENT WHILE FOCUSING ON IMPROVING THE QUALITY OF CARE AND REDUCING COSTS. THE LEGAL NAME OF THE PARENT REMAINS IOWA HEALTH SYSTEM, WITH THE UNITYPOINT HEALTH NAME REFLECTING A DOING BUSINESS AS (D/B/A).