2019-05-13T11:03:30-05:00 2018-06-30 990 2017-07-01 420758901 Sartori Memorial Hospital Inc % TIMOTHY HUBER SART 3192683000 515 College Street Cedar Falls IA 50613 DOUG DAVENPORT CFO 3192727300 2019-05-13 170.232.227.236 42509020191335000001 2019-05-13 P 46DDF868077CB02D2C7E1EC7903C40E42556EC24 C72FFBF36B582C0CECDB54FA8D1B1ABE4305271A 2017 2019-02-21 02:37:17Z MercyOne Cedar Falls Medical Center Jack Dusenbery 3421 West Ninth Street Waterloo IA 507025499 37975815 false 0928 X www.wheatoniowa.org X 1954 IA General inpatient and outpatient acute health care services. 6 5 332 155 0 245771 357591 41718895 37344925 14650 21517 382652 141784 42361968 37865817 55530 60500 0 0 14402573 14262510 0 0 0 23040068 23060719 37498171 37383729 4863797 482088 17697472 17970394 2804614 2680232 14892858 15290162 X AS A MEMBER OF WHEATON IOWA, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS. false false 36844246 60500 37258252 WHEATON FRANCISCAN HEALTHCARE IN IOWA Wheaton Franciscan Healthcare - Iowa is a faith-based 511-bed, not-for-profit, comprehensive medical/surgical health care provider offering acute levels of medical care at Covenant Medical Center in Waterloo, Sartori Memorial Hospital in Cedar Falls, and Mercy Hospital in Oelwein. Its services in the region also include Covenant Clinic with more than 100 primary care and specialty providers; Covenant Foundation, Sartori Health Care Foundation and Mercy Hospital Foundation. Areas of excellence include cardiology, orthopedics, neurosurgery, maternity and NICU, cancer treatment, minimally invasive and Bariatric surgery. The Iowa operations have been part of a 140 year system of care sponsored by the Wheaton Franciscan Sisters, formerly incorporated in 1983. In 2016, the Wheaton Franciscan Sisters transferred their Iowa operations to Mercy Health Network, an Iowa-based health care system based out of Des Moines, Iowa. Mercy Health Network (MHN) is an integrated system of member hospitals and other health and patient care facilities united into one operating organization to improve the delivery of healthcare services to the people of Iowa and adjoining states. MHNs sponsors own and operate medical centers and other services in Clinton, Des Moines, Dubuque, Mason City, and Sioux City, and community hospitals in six other locations. In addition, MHN has 27 members who participate through contracts for management and other services. Mercy Health Network (MHN) was founded in 1998 under a joint operating agreement between two of the largest Catholic, not-for-profit health organizations in the United States: Catholic Health Initiatives, based in Englewood, Colorado, and Trinity Health, based in Livonia, Michigan. Covenant Medical Center in Waterloo, Iowa was founded in 1986 when Wheaton Franciscan Services consolidated St. Francis Hospital (founded in 1912) and Schoitz Medical Center (founded in 1904). Covenant Medical Center was located in two locations until 1991 when all acute care services were combined at one site. The other site was transformed into an assisted living center and adult services center. In 1995, Wheaton Franciscan Services Iowa region was renamed Covenant Health System and included Covenant Medical Center in Waterloo, Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, N. E. Iowa Real Estate Investments and Schoitz Health Resources. Sartori Memorial Hospital became a part of Covenant Health System in 1996 when the system entered a long-term lease agreement with the City of Cedar Falls. In 2006, Covenant Health System was renamed Wheaton Franciscan Healthcare-Iowa, to reflect its continued commitment to an integrated health care delivery system for residents of Northeast Iowa. Today Wheaton Franciscan Healthcare Iowa includes Covenant Medical Center (and its unincorporated division, Covenant Clinic) and Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, Sartori Memorial Hospital and Sartori Health Care Foundation in Cedar Falls, and N. E. Iowa Real Estate Investments. WHEATON FRANCISCAN HEALTHCARE IN IOWA LIST OF ENTITIES Hospitals Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic, an unincorporated division of Covenant Medical Center, Inc. Patients have access to more than 100 primary and specialty care physicians, physician assistants, nurse practitioners, and other health care professionals located throughout Northeast Iowa in 24 locations. Regional Service Lines Covenant Cardiology Covenant Cancer Treatment Center Covenant Clinic Orthopedic Services Covenant Home Health Emergency Services Imaging/Radiology Services Iowa Spine and Brain Institute Midwest Institute of Advanced Laparoscopic Surgery Maternal Child Health Occupational Medicine and Wellness Covenant Retail Pharmacies Rehabilitation Services Philanthropic Foundations Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. Other N.E. Iowa Real Estate Investments, Ltd. WHEATON FRANCISCAN HEALTHCARE COMMUNITY IMPACT IN IOWA / 2018 Charity Care: $3,327,650. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on costs, not charges, and does not include bad debt. Unreimbursed Cost of Public Programs: $11,399,588. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $2,091,453. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial Contributions: $1,059,105. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community groups, or nonprofit organizations for charitable purposes. Health Professions Education: $3,165,237. Health professions education is defined as direct costs incurred for accredited training and education programs for physicians, nurses, allied health professionals and technicians (does not include ongoing education for staff). Community Building Activities: $24,611. Community building activities are defined as programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental issues. Costs for these activities include cash and in-kind donations. Community Benefit Operations: $19,886. Community benefit operations are defined as costs associated with dedicated staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations. Subsidized Health Services: $3,039,136. Subsidized health services are defined as the negative margin for clinical services that are provided despite a financial loss because of an identified community need that would need to be met by the government or another not-for-profit if it was not offered. The financial losses are so significant that negative margins remain after removing the effects of charity care, bad debt, and Medicaid shortfalls. TOTAL BENEFIT TO THE COMMUNITY FOR IOWA 2018: $24,126,666. 36844246 true true false true false false false false false false true false false false true true false true false false false false false false true false true true true false true false false false false false false false false false false false false false true true true false false true 0 0 332 true false false false false false true true false false false false X 6 5 false false false false true true true true true false false true true true true true true false true false X TIMOTHY HUBER 3192727607 3421 WEST NINTH STREET WATERLOO IA 507025499 X Jack Dusenbery Director; President 1.0 40.0 X X 0 580880 42654 John Fuller Chair; Director 1.0 1.0 X X 0 0 0 Michael Hager Treasurer - Director 1.0 1.0 X X 0 0 0 James Hartel MD Secretary - Director 1.0 1.0 X X 0 0 0 Sue Roberts Vice Chair - Director 1.0 1.0 X X 0 0 0 Anne Hennessey DDS Director 1.0 1.0 X 0 0 0 Timothy Huber Asst. Treas.; CFO 1.0 40.0 X 0 205960 29717 Mary Jo Kavalier VP Operations 40.0 1.0 X 184873 0 26605 James Lehman MD VP Medical Affairs 1.0 40.0 X 0 399151 33028 Kelly Wolf Pharmacist 40.0 1.0 X 137079 0 9393 Diane Heindl MD Physn Employee; Former Officer 1.0 40.0 X 0 229072 15974 Michele Panicucci FORMER OFFICER 0.0 0.0 X 0 113832 19007 Ryan Meyer Admin Directr; Former Key Empl 1.0 40.0 X 0 138316 32070 321952 1667211 208448 2 true true false Emergency Practice Associates Inc PO Box 1260 WATERLOO IA 507041260 Physician Services 1486314 Xygent Inc 9961 Valley View Road EDEN PRAIRIE MN 55344 Surgical Services 415611 Grapetree Medical Staffing Inc 2501 BOJI BEND DR STE 100 MILFORD IA 51351 Physician Services 261034 3 62897 261256 8555 24883 7649 357591 NET PROGRAM SERVICE REVENUE 622110 15685668 15685668 MEDICARE/MEDICAID PAYMENTS 622110 21215620 21215620 RENT REVENUE 531120 443637 443637 37344925 18618 18618 0 0 170850 75371 95479 0 95479 95479 2899 2899 26469 62897 34627 -8158 -8158 0 0 0 0 0 0 ELECTRONIC HEALTH RECORD 622110 -86673 -86673 GIFT SHOP 453220 49836 49836 CAFETERIA 722514 91175 91175 125 125 54463 37865817 37258252 249974 60500 60500 0 0 0 221479 221479 0 10909694 10709482 200212 510989 501515 9474 1806863 1773789 33074 813485 800871 12614 0 0 0 4617 4617 0 0 1585983 1585983 6329 6329 1295613 1259084 36529 0 0 816391 816391 13677 10754 2923 0 9339 9141 198 22980 22980 0 887802 887802 0 PURCHASED SERVICES 1883558 1883558 MEDICAL SUPPLIES 7119202 7119202 BAD DEBT EXPENSE 1201941 1201941 PARENT COMPANY ALLOCATION 7626043 7626043 587244 587244 37383729 36844246 539483 0 0 0 0 0 0 0 5345827 4959519 0 0 0 0 0 0 372542 391077 0 0 14941689 2335555 11962257 12606134 0 0 0 0 0 0 0 0 16846 13664 17697472 17970394 1578644 1400480 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1225970 1279752 2804614 2680232 X 14892858 15290162 0 0 0 0 14892858 15290162 17697472 17970394 X 482088 -84784 X false true X true false X false false false false false true 4617 false false false 4617 false Schedule C Disclosures Schedule C Part II-B Line 1f: Sartori Memorial Hospital, Inc. has made grants to other organizations for lobbying purposes. These grants have been in the form of membership dues paid to regional and national health care organizations, where the organizations have provided Sartori Memorial Hospital, Inc. with an estimated percentage of dues payments which are used for lobbying activities. 4300000 4300000 2854162 261233 2592929 6913463 2073966 4839497 874064 356 873708 12606134 0 OTHER LIABILITIES 1279752 1279752 X IRS Form 990 Schedule D, Part X The Company follows the provisions of ASC Subtopic 740-10, Income Taxes - Overall. ASC Subtopic 740-10 clarifies the accounting for uncertainty in tax positions and also provides guidance on when the tax positions are recognized in an entity's financial statements and how the values of these positions are determined. As of June 30, 2018, the Company did not have a liability for unrecognized tax benefits. Fstvl of Trees 78884 57888 20996 5739 10509 350 16321 May Breakfast 10482 5009 5473 500 885 323 0 89366 62897 26469 6239 11394 350 16644 34627 -8158 true true X true X true X true true true false true true 238895 238895 0.00670 4471194 3661231 809963 0.02230 4710089 3661231 1048858 0.02900 248694 248694 0.00690 171348 21704 149644 0.00410 151020 151020 0.00420 23280 23280 0.00070 594342 21704 572638 0.01590 5304431 3682935 1621496 0.04490 true 1201941 11732214 15105161 -3372947 X true true 1 1 Sartori Memorial Hospital Inc 515 College Street Cedar Falls IA 50613 http://www.wheatoniowa.org 070059H (IA) X X X 1 Sartori Memorial Hospital Inc 1 false false true X X X X X X X X X X 15 true true true true X wheatoniowa.org - full url in narrative X true 15 true wheatoniowa.org - full url in narrative false true X 200. 400. X X X X true true X X X true X wheatoniowa.org-full url in narra X wheatoniowa.org-full url in narrativ X wheatoniowa.org-full url in X X X X X X X true X false X X X X true X false false Schedule H Supplemental Information Schedule H Part V Section B Line 3e: Sartori Hospital included in its CHNA written report a prioritized list and description of the community's significant health needs, which were identified through the most recently conducted community health needs assessment. The following community health needs were deemed significant and were prioritized for tax year 2017 through a community-involved selection process: Expand Access Healthy Behaviors and Community Wellness Mental Health Cardiovascular Initiatives Cancer; tobacco cessation Schedule H Part V Section B Line 3j: Iowas Community Health Needs Reports provide additional detailed information in response to many of the Schedule H questions on our Community Health Needs Assessments and Implementation Plans. These reports can be accessed at www.wheatoniowa.org under the About Us page or at this link: https://www.wheatoniowa.org/about-us/community-outreach-benefit. A Community Health Needs Assessment and Implementation Plan for each of the three Wheaton Iowa hospitals are available. Schedule H Part V Section B Line 5: This report was compiled by Wheaton Iowa representing both Covenant Medical Center (CMC) and Sartori Memorial Hospital (SMH) in partnership with Unity Point Health (representing Allen Hospital) and the Black Hawk County Health Department. Wheaton Iowa and Unity Point are both health care systems serving Black Hawk County and surrounding counties with three hospitals and a network of clinics. At the time of the research project, representatives from the listed entities included Amy Hetherton, Director of Marketing and Communications for Wheaton Iowa; Keyah Levy, Community Health Coordinator for Wheaton Iowa; Jim Waterbury, VP of Institutional Advancement for Unity Point Health Allen; and Bruce Meisinger, Director of Public Health for the Black Hawk County Health Department. They worked collaboratively to develop the survey, and made it available to the public online and in paper form. Publicity, websites, and emails invited the public to take the survey anytime before December 20, 2015. Paper surveys were available at the hospitals and clinics, the local food bank and other non-profit agencies. Information on how to access the link for the online survey was promoted heavily and emailed to internal and external audiences. The partners received nearly 600 electronic and paper surveys with additional efforts made to ensure a cross-section of residents completed the survey. Additionally, one-on-one interviews were conducted with local organizations and businesses (listed below) to better understand the populations they serve, and the health needs of their clients and/or employees. This information was compared to existing secondary data, including a 2015 health assessment completed by Black Hawk County Health Department. Allen Child Protection Center Allens Womens Health Big Brothers Big Sisters of NE Iowa Black Hawk County Gaming Association Black Hawk County Health Department Black Hawk Grundy Mental Health Care Initiatives Hospice Cedar Valley Friends of the Family Cedar Valley Promise Cedar Valley United Way Covenant Prenatal & Womens Health Clinic Family & Childrens Council Guernsey Charitable Foundation Hawkeye Community College Healthy Cedar Valley Coalition I-HOPE Free Clinic KWWL Martin Luther King, Jr. Center McElroy Trust Northeast Iowa Food Bank Salvation Army Success Street Inc. Together 4 Families University of Northern Iowa Waterloo Community Schools Waterloo Human Rights Commission YWCA Schedule H Part V Section B Line 6a: Our community health needs assessment was conducted in partnership with Covenant Medical Center, Allen Hospital, and the Black County Health Department. Schedule H Part V Section B Line 6b: Sartori Memorial Hospital and Covenant Medical Center, as part of Wheaton Iowa, worked with Allen Hospital, part of Unity Point, and the Black Hawk County Health Department. Schedule H Part V Section B Line 7a: https://www.wheatoniowa.org/about-us/community-outreach-benefit/community- health-needs-assessment.aspx Schedule H Part V Section B Line 10a: https://www.wheatoniowa.org/about-us/community-outreach-benefit/community- health-needs-assessment.aspx Schedule H Part V Section B Line 11: Using the CHNA completed in June 2013, the hospital developed, adopted, and worked on executing a three-year Implementation Strategy to address priority community health needs. The following summarizes how the hospital addressed priority health needs in the community. Access and Education o Coordinated a Medical Leaders Program for Hansen Elementary to provide a learning forum to generate interest in health care careers. o A Healthcare 101 video promoting the benefits of weight loss surgery in reducing comorbidities. o Care-A-Van is a free service providing safe and efficient transportation for clients who may have no other means of getting to and from medical services provided by Wheaton Iowa. Care-A-Van has operated in Cedar Falls since July of 2014 transporting patients to and from the Waterloo and Cedar Falls area to SMH and Covenant Clinic offices in Cedar Falls. Health Behaviors & Community Wellness (Obesity & Physical Inactivity) o SMH partners with the Northeast Iowa Food Bank to provide nutritious meals during the summer programs at Hansen Elementary. o A Healthcare 101 video promoting the benefits of exercising in reducing health issues. o SMH expanded its Fruit and Vegetable Voucher Program (FVVP) to provide fresh fruits and vegetables to bariatric patients who then discussed healthy eating with a dietician to receive vouchers to redeem at local farmers' markets. Mental Health Services & Education o SMH collaborated with several community agencies including Cedar Valley United Way to address the critical issues surrounding mental health, working together to advance mental health programs and services. Multiple strategies and tactics are identified, defined and will be implemented in the coming years. Cardiovascular Disease o Sponsored the American Heart Associations' Heart Walk in May 2018 providing heart education, interactive activities, etc. Cancer o SMH continued to collaborate with the Black Hawk County Tobacco and Clean Air Coalition and financially supported the creation and dissemination of Quit Kits to promote online counseling and free nicotine replacement therapy through Quit Line Iowa. The partnership provided "Ask, Assess, Refer" (2As/R) training to more than 250 health care professionals at CMC and Sartori. Although much progress has been made, SMH remains focused on the same key findings with its partners. These include: Access and Education; Healthy Behaviors and Community Wellness; Mental Health Services and Education, Cardiovascular Disease and Cancer. Based on the CHNA completed in June 2016, the hospital developed and adopted, a three-year Implementation Strategy to address the same priority community health needs. The following summarizes how the hospital will address the priority health needs in the June 2016 Implementation Strategy: Expand Access o Continue to recruit primary care providers o Expand clinic access Healthy Behaviors and Community Wellness o Improve access to healthy food, diabetes education, etc. o Provide screenings and education at community events o Partner with local government, organizations and the school system to create awareness and impact change. o Participate in educational programs centered on the effects of alcohol/drug abuse Mental Health o Continue our partnership with community leaders to develop strategies to improve local care o Promote and educate residents on the benefits of a nutritious diet and exercise to improve mental health Cardiovascular o Maximize the American Heart Association Mission: Lifeline program to ensure all emergency medical services that can transmit vital patient information from the field o Participate in the American Heart Associations ACTION Registry program to share data for high effectiveness o Continue to invest in life saving measures, as well as collaborate with various area organizations to educate and promote signs and symptoms of heart disease. Cancer o Partner with area agencies to reduce tobacco use, and promote tobacco cessation and prevention programs While our organization understands the importance of meeting all of the needs of the community, an in depth assessment was completed in which key leaders identified/confirmed the prominent needs that would be most impacted by the site. The top community health needs assessed, but will not be part of the current implementation plan are as follows: Transportation: CMC currently provides a Care-A-Van service for patients, and recently donated funds to DaVita Dialysis to help fund transportation for our patients who need daily rides to appointments. We were able to expand the Care-A-Van service in Cedar Falls during the last assessment, but are limited by the number of volunteer drivers. The organization remains engaged with l Schedule H Supplemental Information Schedule H Part 1 Line 6a: For Fiscal Years prior to 2017, the Annual Report that included the Hospitals community benefit information was contained in a report prepared by the former parent organization, Wheaton Franciscan Services, Inc. However, effective May 1, 2016, the Iowa region of Wheaton Franciscan Healthcare was transferred to Mercy Health Network. As a result of this transfer, the Iowa region has conducted their own audit, and prepared their own Community Benefit Reports for Fiscal 2016 and subsequent years. This is available upon request. Schedule H Part 1 Line 7: Community Benefit amounts are reported using total actual costs per the hospitals managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information is published. Amounts are summarized using a software application recommended by the Catholic Health Association in conjunction with the Iowa Hospital Association, because it has the ability to provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the Iowa organization. After amounts are verified and approved, community benefit amounts become finalized. Finally, the information is compiled with the assistance of CBISA software for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. The Iowa hospital facilities are not required to report community benefit information to the State of Iowa, but do make the information readily available on certain websites, and report the information to the Iowa Hospital Association. Schedule H Part 1 Line 7 Column f: Iowa Hospitals follow guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommend that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $1,201,941 has not been included in the denominator of the calculation that determines the percentages reported on Schedule H Line 7 Column f. Schedule H Part 1 Line 7g: In the Iowa region, clinic operations are included as a department of the hospital, Covenant Medical Center, Inc. Clinic operations for the Iowa clinics are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, costs related to physician clinics are not included in subsidized health services reported on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-3: In determining bad debt amounts, the Iowa organizations use a two-level scoring process as follows: First, for any patient account that is categorized as having no insurance, when the amount becomes 60 days overdue or greater, the patients account is reviewed for financial assistance qualification. If the patient is found to qualify for financial assistance, the necessary steps are taken to apply, and the needed adjustments are made so as to treat as charity care and not as bad debt. A similar scoring process is completed for those patients who do have insurance, but after 120 days or greater, still have not paid the patient responsibility portion. Again, these patient accounts are reviewed for financial assistance, and if they qualify, similar steps are taken to remove from bad debt. As a result of these scoring procedures, Iowas position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, or later with the timing of the scoring procedures mentioned above. Bad debt is therefore only determined for each organization at the time the amount due is truly determined to be uncollectible, after financial assistance has been determined, and after many months of collection efforts. Additionally, the organization followed guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommends that no bad debt amounts be included in community benefit amounts. For these reasons, Part III Section A Line 3 is reported at zero. Schedule H Part III Section A Line 4 Sartori Memorial Hospital, Inc. is included in the consolidated financial statements of Wheaton Franciscan Healthcare - Iowa, Inc. The following is the text of the footnote from the financial statements which addresses the allowance for doubtful accounts. This footnote can be found on page 14 of the attached consolidated financial statements. The Hospitals recognize patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospitals recognize revenue for services provided (on the basis of discounted rates, as provided by policy). On the basis of historical experience, a portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospitals record a provision for bad debts related to uninsured patients in the period the services are provided. Schedule H Part III Section B Line 6-8 Schedule H Part III Section B Line 6 reports allowable costs of care as taken from the most recently filed Medicare cost report available at the time the Community Benefit Report is published. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid cost is determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Iowa Hospital Association, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b: Iowa organizations follow a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Please also see Schedule H Part III Section A Lines 1-3 narrative response. Schedule H Part V Section A and Section C: Affiliates of the Iowa region have defined and reported hospital facilities to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Iowa state law required for hospital licensing. Although there may be other facilities within our system built to hospital specifications, performing hospital-based billing, and conforming to other hospital standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part VI Line 2: Iowa assesses the needs of the communities it serves by reviewing admission and discharge data, analyzing information from the community health departments and other community leaders, and by aligning our services with the Healthy People 2020 and other current year initiatives. The Iowa hospital organizations complete a Community Health Needs Assessment and Implementation Plan every three years. Please reference Schedule H Part V Section B Lines 1-12 for additional information. Schedule H Part VI Line 3: Iowa provides its patients with several opportunities to gain knowledge and awareness of its Community Care (Charity Care/Financial Assistance) program. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as: patient admitting and registration areas in both inpatient and outpatient settings, physician offices, and emergency departments. Additionally, brochures describing the policy are available upon request in the same locations and on Iowas website. The policy is al true Sartori Healthcare Foundation Inc 3421 West 9th St Waterloo IA 507025499 421240996 501(c)(3) 60500 Book Support 1 0 Schedule I Disclosures Donations made by Sartori Memorial Hospital, Inc. to charitable organizations are made in furtherance of the recipient organization's exempt purpose. Donations are included in community benefits in schedule H if the contribution has been formally restricted to a community benefit activity that meets the criteria to be reported on schedule H. false false false false false false false false false Jack Dusenbery Director; President 0 439742 0 128910 0 12228 0 16200 0 26454 0 623534 0 0 Diane Heindl MD Physn Employee; Former Officer 228259 0 813 13362 2612 245046 0 Mary Jo Kavalier VP Operations 154744 0 27332 0 2797 0 3922 0 22683 0 211478 0 0 0 James Lehman MD VP Medical Affairs 336455 57133 5563 12150 20878 432179 0 Ryan Meyer Admin Directr; Former Key Empl 137589 0 727 6150 25920 170386 0 Michele Panicucci FORMER OFFICER 75292 0 38540 5190 13817 132839 0 Timothy Huber Asst. Treas.; CFO 205380 0 580 15589 14128 235677 0 Schedule J Disclosures Schedule J Part I Line 3 Sartori Memorial Hospital, Inc. is a subsidiary in the Wheaton Iowa system. Sartori Memorial Hospital, Inc.'s President/CEO is paid directly by a related entity, Covenant Medical Center, Inc. Covenant Medical Center, Inc. used the following methods to establish the compensation of Sartori Memorial Hospital, Inc.'s President/CEO: -independent compensation consultant -written employment contract -compensation survey or study, and -approval by Mercy Health Network board of directors Schedule O Disclosures IRS Form 990 Part I Line 6 Sartori Memorial Hospital, Inc. received donated services through volunteers assisting in such areas as surgical waiting area, information desk, ambulatory surgery, medical records, engineering, occupational health, dietary, community screenings, materials, laundry, surgery, administration, human resources, public relations, wellness, and medical runner. Part V Line 1a and Part VII Section B Line 1-2 Wheaton Iowa streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC are now reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. IRS Form 990 Part VI Section A Lines 6-7b Sartori Memorial Hospital, Inc. has one member which holds several reserved powers over Sartori Memorial Hospital, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Lines 11a and 11b Affiliates of Wheaton Iowa during the fiscal year ending June 30, 2018 used a multiple-level review process on all IRS Forms 990 to ensure accurate and timely filing for all organizations. Under the direction of the Chief Financial Officer, the Accounting Department prepares Forms 990 and any applicable 990-T and associated state filings. When complete, the return is first reviewed by a Senior-Level (or higher) associate in the Finance Department, who focuses on the income statement and balance sheet items, and schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Finance, the return is provided to the Tax Department of the Wheaton Iowa sponsor organization, where the Tax Director concentrates primarily on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule H or Schedule J may be reviewed by committees, such as the Community Benefit Team or the Compensation Committee in selected years. The board has asked for formal presentations on various 990 topics over the years. This decision will vary from year to year, again based on many factors. Once all levels of review have been completed, a designated finance and accounting employee will schedule an appointment with the signer of the 990. The signer, the Vice President-Finance and CFO, will perform an additional, normally high level review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors, who at a later date but prior to efiling, are provided access to all 990's throughout their assigned region. IRS Form 990 Part VI Section B Lines 12a - 12c: Sartori Memorial Hospital, Inc. has adopted a Conflict of Interest policy which applies to all "interested persons" of Sartori Memorial Hospital, Inc. including directors, principal officers, key employees, and members of committees with Board-delegated powers. Interested persons are expected to discharge their duties in a manner the person reasonably believes to be in the best interests of Sartori Memorial Hospital, Inc. and to avoid situations involving a conflict of interest. On an annual basis, interested persons are required to complete a conflict of interest disclosure statement and to affirm their receipt of the conflict of interest policy, compliance with its requirements, and agree to notify the organization of changes impacting their annual disclosure in accordance with the policy. The annual disclosures are provided to internal Legal Counsel and the Integrity and Compliance Officer, from which Legal Counsel prepares a report for the Board Chair and CEO. A summary of potential conflicts is reviewed with the Board of Directors of Sartori Memorial Hospital, Inc. (or a delegated committee of the Board) on a yearly basis. Interested persons are required to make full disclosure to Sartori Memorial Hospital, Inc. of any financial or business interests that might result in or have the appearance of a conflict of interest. The Board of Directors of Sartori Memorial Hospital, Inc. (or a delegated committee of the Board) is responsible for the review of transactions to determine whether an actual conflict of interest exists. In the event of an actual conflict, the Board (or a delegated committee of the Board) will either avoid the conflict or appropriately scrutinize the transaction to ensure it is in the best interests of Sartori Memorial Hospital, Inc. Interested persons are required to recuse themselves from discussion and voting on matters involving a conflict of interest. The policy further addresses the proper documentation of the proceedings and potential disciplinary and corrective action for violations of the policy. The policy is available to the public upon request. Schedule O Disclosures (cont'd) IRS Form 990 Part VI Section B Line 15a Question 15a is answered "No" because the compensation for the CEO of Sartori Memorial Hospital, Inc. is established and paid by a related entity, Covenant Medical Center, Inc. In establishing CEO compensation, Covenant Medical Center, Inc. follows a process which includes the following: Use of an independent compensation consultant and compensation study, use of a written employment contract, and review and approval by the Mercy Health Network board of directors. This process is performed annually. IRS Form 990 Part VI Section B Line 15b In establishing other officer and key employee compensation, Sartori Memorial Hospital, Inc. follows a process which includes the following: Use of an independent compensation consultant and compensation study, use of a written employment contract, and review and approval by the Covenant Medical Center, Inc. and Wheaton Franciscan Healthcare - Iowa, Inc. CEO, authorized to act on behalf of the Board with respect to certain compensation matters. This process is performed annually. IRS Form 990 Part VI Section C Line 19 Affliates of Wheaton Iowa, during the fiscal year ending June 30, 2018, provided upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. IRS Form 990 Part VII Column B Affiliates of Wheaton Iowa during the fiscal year ending June 30, 2018 operated as a controlled group of related healthcare organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where Wheaton has common boards and other overlaps in committee representations, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. IRS Form 990 Part XI Line 9 Certain related organizations utilize receivable/payable accounts throughout the year. These intercompany balances were settled through the equity account at the end of the fiscal year to bring the receivable/payable balance to zero. For the fiscal year ended June 30, 2018 this resulted in a decrease in net assets or fund balances of $84,784. WF Healthcare - Iowa Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421177001 HOLDING CO IA 501(c)(3) 12 - III-FI MHN true Covenant Foundation Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421295784 FOUNDATION IA 501(c)(3) 10 COV MED CTR true Covenant Medical Center Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421264647 HOSPITAL IA 501(c)(3) 3 WFH-IOWA true Mercy Hospital of Fran Sisters Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421178403 HOSPITAL IA 501(c)(3) 3 WFH-IOWA true NE Iowa Real Estate Invsts 3421 WEST NINTH STREET WATERLOO IA 50702 421207432 HOLDING CO IA 501(c)(2) N/A WFH-IOWA true Sartori Health Care Foundation Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421240996 FOUNDATION IA 501(c)(3) 12 - I SARTORI HOSP true Mercy Health Network 1111 6th Avenue Des Moines IA 50314 421478417 PARENT DE 501(C)(3) 12 - III-FI NA true false true true false false false false false true true true true true true true true false false Sartori Health Care Foundation Inc B 60500 Book value Sartori Health Care Foundation Inc C 261256 Book value Wheaton Franciscan Healthcare - Iowa Inc m 7626043 Book value Covenant Medical Center Inc o 1087276 Book value Mercy Hospital of Franciscan Sisters Inc o 152593 Book value