2016-05-13T14:00:28-05:00 2015-06-30 470617373 Catholic Health Initiatives 198 Inverness Drive West Englewood CO 80112 990 2014-07-01 420680308 Mercy Medical Center - Centerville MERC 5154373413 1 St Josephs Drive Centerville IA 52544 RANDALL RUBIN SVP, CFO 2016-05-07 true DONALD NEAL JR P00798244 3032989100 2014 2016-08-17 19:52:53Z Clinton Christianson 1 St Josephs Drive Centerville IA 52544 29188362 false 0928 X www.mercycenterville.org X 1965 IA Mercy 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. 11 8 259 8 -793 -793 569899 967915 24790138 27183829 817147 743855 251863 284433 26429047 29180032 32201 455086 0 0 11621137 12654507 0 0 13830 13428608 13591504 25081946 26701097 1347101 2478935 30514413 33007156 2868343 3004654 27646070 30002502 See schedule O. false false 25145690 455086 27183829 SEE SCHEDULE H. 25145690 true true false true false false false false false false true true false false true true false true false false false false false false false false true true true true true false false false false false false false false false false false false false true false false false true 0 0 259 true false false false false false false false false false X 11 8 false false false false true true true true true false false false true true true true true true true false X Randall L Rubin 5156437860 1111 6th Avenue Des Moines IA 50314 BILL BUSS Board Vice Chair 1.00 0 X X 0 0 0 CLINTON CHRISTIANSON PRESIDENT/CEO 40.00 0 X X 217675 0 40319 MIKE CRAVER Board Chair 1.00 0 X X 0 0 0 SR JEANNE CHRISTENSEN RSM DIRECTOR 1.00 1.00 X 0 0 0 DAVID FRASER Director/Physician 40.00 0 X 258649 0 33660 MICHAEL O'CONNOR DIRECTOR 1.00 0 X 0 0 0 DR PAUL PONCY Director 1.00 0 X 0 0 0 ROBERT PONTIUS Board Member 1.00 0 X 0 0 0 ROBERT RITZ Board Member/President CHI Iowa Corp 1.00 44.00 X 0 795519 107808 LOTTIE WILSON Board Member 1.00 0 X 0 0 0 SR MAURA CLARK Board Member 1.00 0.00 X 0 0 0 MICHAEL WEGNER CFO CHI IA 1.00 46.00 X 0 475714 26940 NANCY BARTON Physician 40.00 0 X 188227 0 43276 RICHARD J BURGER PHYSICIAN 40.00 0 X 124329 0 24616 STEPHEN ECKSTAT CEO-PRIMARY CARE LEADER Mercy Clinics 10.00 30.00 X 26209 146641 34682 JEFFREY WILLIER Director of Pharmacy 40.00 0 X 126378 0 29944 NEAL SOKOL GENERAL SURGEON 40.00 0 X 126185 0 1869 LORI RATHBUN Treasurer/VP Operations 0.00 0.00 X 0 174077 38742 1067652 1591951 381856 9 true true false EMCARE PHYSICIAN SERVICES 7032 COLLECTION DRIVE CHICAGO IL 60693 PHYSICIAN SERVICES 1304724 COMPHEALTH 6440 South Millrock Drive Suite 175 Salt Lake City UT 84121 locum tenens staffing 507322 BLOOMFIELD ANESTHETISTS 105 E LOCUST ST BLOOMFIELD IA 52537 PHYSICIAN SERVICES 339527 ALL ABOUT STAFFING 1000 SAWGRASS CORP PARKWAY SUNRISE FL 33323 MEDICAL SERVICES 313748 NUCLEAR SONICS PO BOX 6 NEW RICHMOND WI 54017 PHYSICIAN SERVICES 130252 14 X 0 0 0 897869 69608 438 0 967915 Net patient services 900099 25780436 25780436 0 0 Medicare/Medicaid 900099 1403393 1403393 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27183829 436465 0 -793 437258 0 0 0 0 0 0 0 0 68816 0 0 0 68816 0 68816 0 0 68816 285720 30000 0 8330 285720 21670 307390 0 0 307390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria 722100 50060 0 0 50060 Intercompany Transactions 900099 62593 0 0 62593 Other Program Service Revenue 900099 54486 0 0 54486 48478 0 0 48478 215617 29180032 27183829 -793 1029081 X 38656 38656 416430 416430 559040 296271 248939 13830 9448032 9210447 237585 496824 471983 24841 1428599 1357169 71430 722012 685911 36101 390 390 4181 4181 5397899 5319453 78446 0 71150 7115 64035 1359627 1264453 95174 695061 695061 59763 43029 16734 4577 2517 2060 37243 37243 566752 566752 600525 594520 6005 110103 110103 Bad debts 1251196 1251196 Medical Supplies 2204759 2204759 Repairs and maintenance 385239 377534 7705 Dues & subscriptions 49336 49336 793703 190907 602796 0 26701097 25145690 1541577 13830 802 1307 1077576 1696418 0 4787192 4414351 0 0 0 199081 392661 397899 167171 55146 19280158 13762602 3938059 5517556 0 20150952 20725398 0 0 0 0 30514413 33007156 1936663 1818802 0 0 0 0 0 0 0 0 931680 1185852 2868343 3004654 X 27646070 30002502 0 0 27646070 30002502 30514413 33007156 2478935 -122503 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 4181 false false false 4181 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The portion of organization dues that are related to lobbying are as follows: American Hospital Association - $757 Catholic Health Association - $237 $15,175 IN ANNUAL DUES WAS PAID TO THE IOWA HOSPITAL ASSOCIATION AND $3,187 WAS ALLOCATED AS LOBBYING EXPENSES 160349 160349 10834397 8275202 2559195 0 0 0 7662566 5169840 2492726 622846 317560 305286 5517556 CHI OIP - Fixed Income CHI OIP - Equity Securities CHI Operating Investment Program, LP 20725398 F 20725398 CHI Debt Program accrued expenses 459274 intercompany payables 726578 1185852 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Mercy Medical Center - Centerville's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2015, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements." true true X false false true true false true true 178060 178060 0.0070 0 0.0 0 0.0 0 0 178060 0 178060 0.0070 12 6586 326371 326371 0.0128 6 311 10037 10037 0.0004 1 100 12 12 0.0000 0 0.0 17 489 74327 74327 0.0029 36 7486 410747 0 410747 0.0161 36 7486 588807 0 588807 0.0231 1 29 1101 1101 0.0000 0 0.0 2 3515 48473 7541 40932 0.0016 0 0.0 0 0.0 1 33 100 100 0.0000 2 30 2741 2741 0.0001 0 0.0 2 675 8431 8431 0.0003 8 4282 60846 7541 53305 0.0021 true 1251196 0 8771597 8817444 -45847 X true true 1 1 Mercy Medical Center - Centerville www.MercyCenterville.org 040050H X X X A A 1 false false true X X X X X X X X X 12 true false true true X www.mercycenterville.org X true 12 true http://www.mercycenterville.org/webres/File/Documents/CHNA%20Implementation%20Strategy%202013-2015.p false false true X X X X X true true X true X (SEE PART VI) X http://www.mercycenterville.org/patient-visitor-info/patients/financial-assistance-policy.aspx X X true X false X true X true true Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - Mercy Medical Center - Centerville. Mercy Medical Center - Centerville along with Appanoose County Public Health Nursing Office and VVV Research & Development, Inc. worked together to research and develop the CHNA. As part of this process a comprehensive healthcare survey was sent to approximately 1,000 service area families and a public town hall meeting was held in April to identify and prioritize service area health needs. Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - Mercy Medical Center - Centerville. Appanoose County Public Health Nursing Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - Mercy Medical Center - Centerville. Mercy Medical Center - Centerville completed a community health needs assessment in 2013 and adopted an implementation plan for 2013-2015. Progress towards the goals outlined in the implementation plan is as follows: 1. To Improve the availability & quality of crisis mental health services - Working in collaboration with the Appanoose County Mental Health Coalition, made up of the hospital, county central point services coordinator, Centerville Community Betterment, Appanoose County Law Enforcement, County Attorney, Magistrate, 8th Judicial Court and Community Health Centers of Southern Iowa, we established a crisis mental health initiative with the goal of reducing inpatient mental health admissions from our county. This began with identifying and placing licensed mental health counselors on call for the ER and available to emergency room physicians to complete a mental health screening. Additionally we renewed a contract with Mercy-Des Moines to provide tele-heath mental health assessments if needed. Mental health counselors at several different agencies in the community began meeting and working together and they all opened up an appointment each day to provide emergency outpatient counseling if needed or referred to from the ER. Working with Centerville Community Betterment, the hospital applied and received a grant from the Catholic Health Initiatives Mission and Ministry fund and administered the grant for the purpose of starting a crisis stabilization house to provide a short term housing and outpatient intervention for the majority of crisis mental health patients who would be better served by receiving outpatient care in the community rather than being sent to an inpatient mental health unit. This initiative has decreased crisis emergency mental health admissions from our county to an inpatient unit by 61% with only 19% of those screened going to an inpatient unit compared to 80% when we started in 2013. 81% of those screened have received appropriate outpatient care in the community. The initiative is viewed as rural model for the state of Iowa and is proving that by working together with all agencies involved with crisis mental health that investment in intervention is more effective, less costly and a less restrictive alternative when patients receive care in the appropriate setting instead of passing them on to an inpatient unit where they are released within 24-48 hours and returned to the community without support. In the latest CHNA needs assessment, conducted in March 2016, emergency mental health services was no longer in the top community health needs as identified by the community, which correlates to the remarkable success of the program established and steps taken. 2. Improve the access of area citizens to primary care services - We completed a physician needs assessment for the community and from that assessment determined a need for 3 additional primary care physicians over three years. We successfully recruited 3 primary physicians including 1 family medicine, 1 family medicine with OB and 1 general surgeon. 3. Explore development of an urgent care after hour's option. We researched the development of an urgent care/walk-in clinic to provide after hours and weekend options for non-emergent care so community members don't have to rely on the emergency room where 60% of the patients seen are for non-emergent issues. We consulted Mercy-Des Moines about models of urgent care and researched an opportunity to partner with a local grocery store in town who was considering a new building project to include an urgent care run by the hospital. They eventually delayed those plans. We are moving forward with plans to create an urgent care in a section of our existing clinic and have begun recruiting mid-level practitioners to staff it. If successful, we will be in a position to begin that service in the first quarter of calendar year 2017. 4. Engage the community about the importance of a healthy lifestyle - Working with local partners, the YMCA and the Appanoose County Wellness Coalition (a broad based organization made up of business, schools, local government and citizens) we are educating the community about risk factors for disease, healthy food options and providing exercise initiatives for individuals and families to get moving and promote the importance of regular exercise. We offer free community blood pressure and reduced rate cholesterol screenings at the YMCA during the year and also offer reduced rate wellness screenings at the hospital for anyone who is seeking basic metabolic health screens. We provide a free monthly diabetes support group, led by an RN and Dietician to help people understand how to better manage diabetes and improve the quality of their lives. Working with the local Hy-Vee Store, we sponsored a community wide Step into Spring. This was an 8 week program designed to get people moving and promote the importance of incorporating exercise into the daily of lives of those of all ages. 1000 people including 320 adults and 680 children, aged K-6 from the Centerville and Moulton school districts participated in the program. The goal of exercising a combined total of 1,000,000 minutes was exceeded. 5. Community Healthcare Directory - The goal was to provide a comprehensive resource of community health and welfare services/resources. Our social services director, working with a community committee made up of Public Health, Appanoose Community Care Services and the school nurses researched and compiled a list of resources and contact information for health referral sources. The committee will review and update the directory annually. Access to this directory is available on the Mercy-Centerville website, the City of Centerville website. 6. Renovate Mercy Emergency Room - Master facility planning that includes a new emergency room was completed and a business plan has been submitted to our corporate headquarters for approval. The areas identified in the CHNA not addressed were community wide issues that the hospital is unable to impact including: Furthering Economic Development, Funding for the YMCA and integrating/Expanding Veterans Care. Those concerns were communicated to the appropriate community officials. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - MERCY MEDICAL CENTER - CENTERVILLE. HUD LOW INCOME GUIDELINES USED Schedule H, Part V, Section B, Line 22 Facility A, 1 Facility A, 1 - Mercy Medical Center - Centerville. The hospital facility used the average of the negotiated commercial insurance rates for those services at the hospital facility. Schedule H, Part V, Section B, Line 23 Facility A, 1 Facility A, 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. Schedule H, Part V, Section B, Line 24 Facility A, 1 Facility A, 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. 1 Mercy Centerville Longterm Care Facility One St Josephs Drive Centerville IA 52544 nursing home Schedule H, Part VI LINES 2, 4, 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION I. Organization'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 209 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, otolaryngology, cardiology, oncology, podiatry, vascular surgery, dermatology and nephrology 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, 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. Mercy Medical Center - Centerville is a regional hospital, with a primary service area of Appanoose county and a secondary reach to the surrounding counties. The population served includes both urban and rural communities. Many services provided by Mercy continue to service are areas of greatest need. Access to a medical home, need for coordinated specialty care and financial assistance for the uninsured and underserved were identified by the participants. These barriers, combined with needed access to healthy food, safe housing and public transportation, have guided the community-based activities for Mercy. Schedule H, Part VI LINES 2, 4, 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION (CONTINUED) (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. Meals on Wheels The hospital provides meal preparation and dietician consultant service for the county meals on wheels program. 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. 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. 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. 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. Infection Control Training for Community The hospital provided infection control training for area businesses. The update included basic blood borne pathogens and exposure reporting for community businesses. Participants were engaged to understand how blood borne pathogens relates to their duties in emergencies they may encounter. Influenza Vaccinations The hospital provided flu vaccines to the mentally handicapped in the community's three group homes. 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. Amish Hemophilia Clinic In collaboration with the University of Iowa Hospitals and Clinics, Mercy provided clinical space and a support nurse for area Amish community diagnosed with various blood disorders. Patients received a physical, hemophilia education, dental exam, physical therapy exam and phlebotomy services. Appanoose County Mental Health In partnership with Appanoose County, Centerville Community Betterment, Law Enforcement and the 8th district court, Mercy has helped to develop and execute a mental health crisis stabilization program. Utilizing on call therapists in the emergency room for mental health assessment and appropriate follow up care utilizing local resources instead of inpatient mental health units. The group has also developed a short term crisis stabilization house assisted by the hospital's effort to receive a 2 year grant. The results of the initiative has reduced inpatient mental health admissions from the county by almost 80%. Kids Health Fair Mercy was a lead sponsor and participant in the Appanoose County Healthy Kids Fair. The kids fair targeted youth and families promoting good health habits, hygiene, nutrition and exercise for kids. Mamm & Glam Mercy hosted the Mamm and Glam event for women to promote breast cancer screenings. Appanoose County women have a lower rate of mammogram screenings compared to the state and national averages. The event allowed women to schedule their mammogram, provided screening education and grab bags, and tours of the mammography suite in an effort to boost awareness and screenings by local women. Parkinson's Support Group Mercy holds a monthly support group for area residents suffering from Parkinson's. Led by a hospital physical therapist, the program helps to educate those with Parkinson's and their caregivers about living with Parkinson's and the resources available to assist them in their everyday life living with the disease. Schedule H, Part V, Section B, Line 16a FAP AVAILABLE WEBSITE http://www.mercycenterville.org/webres/File/Documents/No_%2015%20Hospital%20Financial%20Assistance%2003-14-12.pdf Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care When 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 urban and rural communities in 18 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. Schedule H, Part I, Line 7g Subsidized Health Services There are no physician clinics included in subsidized health services. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 1251196 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost-to-charge ratio for the year ended 6/30/15 was computed using the following formula: Operating expense (before restructuring, impairment and other losses) divided by gross patient revenue. Based on that formula, $22,732,558/$53,164,857 results in a 42.76% cost-to-charge ratio. Worksheet 2 was not used to derive the cost-to-charge ratio. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 42.76%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology 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. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Mercy Medical Center - Centerville does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives. The consolidated footnote reads as follows: "The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration 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, CHI follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented on the consolidated statements of operatings as a deduction from patient services revenuew (net of contractual allowances and discounts) since CHI accepts and treats substantially all patients without regard to the ability to pay." Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Mercy 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: $8,771,597 Total Medicare costs: $8,817,444 Shortfall: ($45,847) 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. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Mercy 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. - No Facility shall charge interest on outstanding balances; - 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 - 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. Schedule H, Part V, Section B, Line 16a FAP website A - Mercy Medical Center - Centerville: Line 16a URL: (SEE PART VI); Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - Mercy Medical Center - Centerville: Line 16c URL: http://www.mercycenterville.org/patient-visitor-info/patients/financial-assistance-policy.aspx; Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Mercy Medical Center - Centerville, along with its affiliated outpatient facilities are part of Catholic Health Initiatives "CHI". CHI has a written policy (Stewardship policy No. 15) governing the procedures for determining and informing patients about the entity's financial assistance policy. All hospital facilities included in the filing organization have adopted the policy. The policy states the organization will include 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. Schedule H, Part VI, Line 6 Affiliated health care system Mercy 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 92 hospitals, including four academic medical centers, and 24 critical access facilities; community health service organizations; accredited nursing colleges; home health agencies; and other facilities that span the inpatient and outpatient continuum of care. Together, these facilities provided $910 million in charity care and community benefit in the 2014 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 with its wholly owned affiliates and community partners, along with its fundraising arm, the Mercy Foundation of Des Moines, IA, to serve the health care needs of the Appanoose county, Iowa communities. Schedule H, Part VI, Line 7 State filing of community benefit report IA true Rathbun Lake Area YMCA 708 Main Street Centerville IA 52544 262927214 501(c)(3) 14200 Program Support 1 0 charity care and financial assistance 186 0 416430 book reduction or write-off of patient services Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds All of our grants are made to 501(c)(3) organizations to ensure the grants are used for charitable purposes. Schedule I, Part III assistance to individuals Mercy Medical Center - Centerville RECOGNIZES THE RIGHT TO QUALITY HEALTHCARE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, OR ABILITY TO PAY. BUSINESS OFFICE STAFF HELPS PATIENTS SEEK LOCAL, STATE, AND FEDERAL REIMBURSEMENT AT NO CHARGE WHEN NO OTHER SOURCE OF PAYMENT IS AVAILABLE. FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS WITH DEMONSTRATED INABILITY TO PAY FOR MEDICALLY NECESSARY SERVICES. THESE FUNDS ARE DIRECTLY USED TO OFFSET THE PATIENTS ACCOUNTS RECEIVABLE. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. All of our grants are made to 501(c)(3) organizations to ensure the grants are used for charitable purposes. X X X true true false false false false false true false CLINTON CHRISTIANSON PRESIDENT/CEO 191270 0 15672 0 10733 0 26967 0 13352 0 257994 0 0 0 DAVID FRASER Director/Physician 248274 0 8077 0 2298 0 20952 0 12708 0 292309 0 0 0 ROBERT RITZ Board Member/President CHI Iowa Corp 0 627645 0 140570 0 27304 0 87202 0 20606 0 903327 0 0 LORI RATHBUN Treasurer/VP Operations 0 152674 0 10000 0 11403 0 20061 0 18681 0 212819 0 0 MICHAEL WEGNER CFO CHI IA 0 399840 0 55594 0 20280 0 9100 0 17840 0 502654 0 0 NANCY BARTON Physician 164606 0 21232 0 2389 0 24342 0 18934 0 231503 0 0 0 STEPHEN ECKSTAT CEO-PRIMARY CARE LEADER Mercy Clinics 26209 18736 0 0 0 127905 0 28602 0 6080 26209 181323 0 0 JEFFREY WILLIER Director of Pharmacy 125856 0 0 0 522 0 12662 0 17282 0 156322 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment Post-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. The following reportable individuals received severance payments from Catholic Health Initiatives (a Related Organization) during the 2014 calendar year, and these severance payments were included in the individual's W-2 income and reportable compensation on Schedule J: STEPHEN ECKSTAT - $124,383 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan During the 2014 calendar year Catholic Health Initiatives (CHI), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs/Presidents and other CHI employees at the level of Senior Vice President and above. The following reportable individuals were eligible to participate in that plan: ROBERT RITZ During 2014 the following contributions were made by CHI to the deferred compensation plan: ROBERT RITZ - $57,150 Schedule J, Part I, Line 7 Non-fixed payments The 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. Form 990, Part III, Line 1 MISSION STATEMENT THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION. Form 990, Part VI, Line 1a Delegate broad authority to a committee THE 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. Form 990, Part VI, Line 6 Classes of members or stockholders The entity's sole corporate member is Catholic Health Initiatives - Iowa, Corp d/b/a Mercy Medical Center - Des Moines, an Iowa nonprofit corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The sole corporate member has the right to approve and remove with or without cause the members of the governing board. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The 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. Form 990, Part VI, Line 11b Review of form 990 by governing body The 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. Form 990, Part VI, Line 12c Conflict of interest policy Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy in place to maintain the integrity of all of its activities. The policy applies to CHI Board of Stewardship Trustees and members of its committees; all board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each person has a general ongoing obligation to promptly and fully report to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must report the actual or potential conflict as soon as she/he becomes aware of it. In any situation where the person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI Entity may reject a Person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential COI. If the C-CIRC determines that there is a potential or actual conflict of interest that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing person be allowed to participate in the activity or transaction subject to restrictions as outlined in the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and the manager do not agree with the review decision, interpretation of the Policy, or seek exemption or exception, the manager shall consult with the manager's Vice President (or higher if the manager is a Vice President) to reach a determination. If the matter remains unresolved, it shall be referred to the CHI Vice President of Human Resources and the CHI Corporate Responsibility Officer. If they are unable to reach agreement, the matter shall be referred to the CHI General Counsel, whose decision shall be final. Reviews and determinations involving board and board committee members and corporate officers will be the responsibility of the board, board executive committee, or board chair, with guidance from the Legal Services Group (LSG). Annual COI disclosures of all trustee and corporate officers will be reviewed by the CHI Senior Vice President, Legal Services, and General Counsel or his or her designee who will report potential conflicts to the applicable Board Chair. The Board Chair or designee shall make such further investigation of any conflict of interest disclosures as he or she may deem appropriate. If the conflict involves the Board Chair, the Vice Chair will assume the Chair's role. Based on review and evaluation of the relevant facts and circumstances, the Board Chair will make an initial determination as to whether a conflict of interest exists and whether, pursuant to the COI Policy, review and approval or other action by the Board is required. A written record of the Board Chair's determination, including relevant facts and circumstances, will be made. The Board Chair shall then make an appropriate report to the Executive Committee of the Board concerning such review, evaluation and determination. If a difference of opinion exists between the Board Chair and another Trustee as to whether the facts and circumstances of a given situation constitute a conflict of interest or whether Board review and approval or other action is required within the COI Policy, the matter shall be submitted to the Board's Executive Committee, which shall make a final determination as to the matter presented. Such determination, including relevant facts and circumstances, will be reflected in the Executive Committee minutes and will be reported to the Board. When any conflict of interest is considered by the board, the trustee or corporate officer, as appropriate, must disclose all of the material facts to the Board. The trustee shall not vote and the trustee or corporate officer shall not use his or her personal influence on the matter. The trustee or corporate officer shall be excused from the meeting during discussion and vote on the conflict of interest. In reviewing such transactions between CHI or CHI Entities and vendors or other contractors who are, or are affiliated with, Trustees or Corporate Officers, the Board will act as it would in reviewing transactions with unrelated third parties. The transaction is not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. The Board must approve the transaction by a majority of the Trustees on the Board, without counting the vote of any individual who has an interest in the transaction. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy. Form 990, Part VI, Line 15a Process to establish compensation of top management official The 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, 2014. Form 990, Part VI, Line 15b Process to establish compensation of other employees The 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, 2014. Form 990, Part VI, Line 19 Required documents available to the public The 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. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 48478, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 48478; Form 990, Part IX, Line 11g Other Fees Medical Professional - Total Expense: 2010252, Program Service Expense: 1981060, Management and General Expenses: 29192, Fundraising Expenses: ; Clinical Engineering - Total Expense: 263995, Program Service Expense: 260161, Management and General Expenses: 3834, Fundraising Expenses: ; Laboratory - Total Expense: 85167, Program Service Expense: 83930, Management and General Expenses: 1237, Fundraising Expenses: ; Contracted Services - Total Expense: 1774428, Program Service Expense: 1748600, Management and General Expenses: 25828, Fundraising Expenses: ; Revenue Recovery Center - Total Expense: 1233725, Program Service Expense: 1215810, Management and General Expenses: 17915, Fundraising Expenses: ; Consulting - Total Expense: 30332, Program Service Expense: 29892, Management and General Expenses: 440, Fundraising Expenses: ; ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HEALTHCARE NE 501(c)(3 3 ACH true ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING NE 501(c)(3 7 ACH true ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HEALTHCARE IA 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT 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