2016-05-12T13:11:47-05:00 2015-06-30 990 2014-07-01 421478417 MERCY HEALTH NETWORK INC MERC 5156435300 1111 6TH AVENUE DES MOINES IA 50314 DAVID VELLINGA CEO 5156435300 2016-05-12 2014 2016-08-17 19:52:53Z DAVID VELLINGA 1111 6TH AVENUE DES MOINES IA 50314 14726121 0 X MERCYHEALTHNETWORK.COM X 1998 DE TO PROVIDE HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT 3 0 0 0 0 0 0 0 14063161 14403448 370280 322673 0 0 14433441 14726121 103638 91005 0 0 0 1309155 0 0 0 14562178 13113066 14665816 14513226 -232375 212895 12278699 14502032 1920018 4114940 10358681 10387092 X TO WORK TOGETHER AND WITH OTHERS TO CONTINUE THE HEALING MINISTRY AND PROMOTE THE WELL-BEING OF PEOPLE WE SERVE BY LIVING THE VALUES OF COMPASSION, RESPECT, CONCERN FOR THOSE WHO ARE POOR, EXCELLENCE AND STEWARDSHIP. 0 0 13174694 91005 14403448 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 HEALTH CARE SERVICES TO THE PEOPLE OF IOWA AND SURROUNDING COMMUNITIES. MHN IS SPONSORED BY CATHOLIC HEALTH INITIATIVES (CHI) AND TRINITY HEALTH CORPORATION (THC). MHN PROVIDES SIGNIFICANT ADMINISTRATIVE, MANAGEMENT, GOVERNANCE AND OVERSIGHT RESPONSIBILITIES FOR THE OVERALL ACTIVITIES AND OPERATIONS OF MANY ACUTE CARE HOSPITALS, AMBULATORY CARE FACILITIES, HOME CARE AND HOSPICE PROGRAMS PRESENTLY OWNED AND OPERATED BY CHI OR THC.THE MHN SYSTEM FUNCTIONS AS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM (IN THE BROAD SENSE) BY ESTABLISHING A SINGLE SYSTEM THAT PROVIDES A CONTINUUM OF HEALTH CARE SERVICES PREVIOUSLY PROVIDED THROUGH SEPARATE PROVIDERS. THROUGH THIS SINGLE SYSTEM, THE RESPECTIVE MISSIONS OF CHI AND THC ARE UNIFIED AND THE ABILITY TO EFFECTIVELY AND EFFICIENTLY MEET THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED BY THE MHN SYSTEM ARE ENHANCED.PLEASE VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION: WWW.MERCYHEALTHNETWORK.COM 13174694 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 9 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 0 0 1 0 X KIMBERLY SAXTON DIR FINANCE & PAYROLL 7343430844 20555 VICTOR PARKWAY LIVONIA MI 481527018 DAVID VELLINGA PRESIDENT AND CEO 59.00 1.00 X X 0 1261019 48046 J RICHARD O'CONNELL SECR/TREAS THROUGH 7/14; TRINITY EVP 2.00 53.00 X X 0 1748402 54577 MICHAEL ROWAN CHAIR; CHI PRESIDENT & COO 2.00 58.00 X X 0 2500443 53656 SALLY JEFFCOAT SEC/TREAS AS OF 8/14; TRINITY EVP 2.00 53.00 X X 0 1069085 45673 0 6578949 201952 0 0 1 0 KAUFMAN HALL ASSOCIATES 8610 SOLUTION CENTER CHICAGO IL 606778006 VALUATION SERVICES 202100 DAVIS BROWN KOEHN SHORS & ROBERTS 215 10TH STREET STE 1300 DES MOINES IA 50309 PROFESSIONAL SERVICES 153800 2 MANAGEMENT REVENUE 541610 14403448 14403448 14403448 144674 144674 177999 0 177999 177999 177999 14726121 14403448 0 322673 91005 91005 1309155 1309155 1900 1900 689498 689498 27568 91 27477 20000 20000 19687 19687 59961 59961 25477 25477 SHARED SERVICES EXPENSE 10098911 10098911 CONTRACT LABOR 2152564 2152564 SUBSCRIPTIONS AND DUES 17500 17500 14513226 13174694 1338532 0 213 213 669618 3950811 4472358 3503549 4472358 4154508 5557103 12278699 14502032 665996 2590111 1254022 1524829 1920018 4114940 X 10358681 10387092 10358681 10387092 12278699 14502032 212895 -184484 0 X 0 0 0 X X 2 MERCY HEALTH SERVICES - IOWA 311373080 3 1 0 0 CATHOLIC HEALTH INITIATIVES - IOWA 420680448 3 1 15000 0 2 15000 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART 1, LINE 11G, COLUMN (VI): MERCY HEALTH NETWORK PROVIDES HEALTH CARE DELIVERY SYSTEM SERVICES TO ITS SUPPORTED ORGANIZATIONS. PART IV, SECTION A, LINE 2: CATHOLIC HEALTH INITIATIVES - IOWA, CORP. DOES NOT HAVE AN IRS DETERMINATION OF STATUS UNDER SECTION 509(A)(1); IT HAS BEEN RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) UNDER GROUP EXEMPTION NO. 0928 AND IS LISTED IN THE OFFICIAL CATHOLIC DIRECTORY AS A HOSPITAL. IT HAS BEEN DETERMINED THAT CATHOLIC HEALTH INITIATIVES - IOWA, CORP. IS A PUBLIC CHARITY AS DESCRIBED IN SECTION 509(A)(1) BECAUSE IT IS A HOSPITAL AS DESCRIBED UNDER SECTION 170(B)(1)(A)(III). PART IV, SECTION C, LINE 1: THE BOARD OF MERCY HEALTH NETWORK IS APPOINTED BY THE SAME BODIES THAT APPOINT THE BOARDS OF MERCY HEALTH NETWORK'S SUPPORTED ORGANIZATIONS. MERCY HEALTH SERVICES - IOWA, CORP. IS CONTROLLED BY TRINITY HEALTH CORPORATION AND CATHOLIC HEALTH INITIATIVES - IOWA, CORP. IS CONTROLLED BY CATHOLIC HEALTH INITIATIVES. TRINITY HEALTH CORPORATION AND CATHOLIC HEALTH INITIATIVES EACH HAVE THE RIGHT TO APPOINT ONE-HALF OF THE BOARD OF DIRECTORS OF MERCY HEALTH NETWORK. TRINITY HEALTH CORPORATION AND CATHOLIC HEALTH INITIATIVES HAVE THE POWER TO APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS A MERGER, DISSOLUTION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. 0 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 1252260 F EQUITY METHOD INVESTMENTS 1699496 C HEDGE FUNDS 1520602 F 4472358 MISCELLANEOUS RECEIVABLES 2476335 RELATED PARTY RECEIVABLES 3080768 5557103 RELATED PARTY PAYABLES 1524829 1524829 1 IOWA HEALTHCARE COLLABORATIVE 100 EAST GRAND AVE STE 360 DES MOINES IA 50309 203869767 501(C)(3) 50000 COMMUNITY WELFARE IOWA HOSPITAL ASSOCIATION 100 EAST GRAND AVENUE DES MOINES IA 50309 420706508 501(C)(6) 7505 COMMUNITY WELFARE UNIVERSITY OF IOWA FOUNDATION PO BOX 4550 IOWA CITY IA 52244 420796760 501(C)(3) 10000 COMMUNITY WELFARE CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 501(C)(3) 15000 COMMUNITY WELFARE 3 1 PART I, LINE 2: DONATIONS MADE BY MERCY HEALTH NETWORK, INC. TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS. 0 1 0 0 0 0 0 0 0 DAVID VELLINGA PRESIDENT AND CEO 0 671240 0 404174 0 185605 0 33702 0 14344 0 1309065 0 53428 J RICHARD O'CONNELL SECR/TREAS THROUGH 7/14; TRINITY EVP 0 791024 0 532372 0 425006 0 18200 0 36377 0 1802979 0 174337 MICHAEL ROWAN CHAIR; CHI PRESIDENT & COO 0 1195620 0 788897 0 515926 0 32602 0 21054 0 2554099 0 224413 SALLY JEFFCOAT SEC/TREAS AS OF 8/14; TRINITY EVP 0 603463 0 201629 0 263993 0 18200 0 27473 0 1114758 0 118422 PART I, LINE 3 MERCY HEALTH NETWORK'S CEO IS PAID DIRECTLY BY CATHOLIC HEALTH INITIATIVES (CHI). CHI USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION FOR MERCY HEALTH NETWORK'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN THE NEW TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) EFFECTIVE JANUARY 1, 2014. THE PLAN WILL PROVIDE RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. THERE WERE NO PAYOUTS IN 2014. SALLY JEFFCOAT J. RICHARD O'CONNELL THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($260,000 FOR 2014). THE PLAN WAS FROZEN DECEMBER 31, 2013. THE FOLLOWING PAYOUTS FOR 2014 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: SALLY JEFFCOAT - $126,988 J. RICHARD O'CONNELL - $ 185,824 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. DURING THE 2014 CALENDAR YEAR, CHI MAINTAINED A SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLAN FOR SENIOR VICE PRESIDENTS AND ABOVE. MICHAEL ROWAN AND DAVID VELLINGA ARE PARTICIPANTS IN THIS PLAN. THE FOLLOWING CONTRIBUTIONS MADE BY CHI TO THE DEFERRED COMPENSATION PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: MICHAEL ROWAN - $224,413 DAVID VELLINGA - $53,428 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF MERCY HEALTH NETWORK, INC. ARE TRINITY HEALTH CORPORATION AND CATHOLIC HEALTH INITIATIVES. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF MERCY HEALTH NETWORK, INC. HAS THE RIGHT TO APPOINT ONE-HALF OF THE BOARD OF DIRECTORS OF MERCY HEALTH NETWORK, INC. FORM 990, PART VI, SECTION A, LINE 7B THE TWO MEMBERS MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. BOTH MEMBERS MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 MERCY HEALTH NETWORK, INC.'S FORM 990 WAS REVIEWED BY MANAGEMENT. THE MEMBERS OF THE BOARD OF DIRECTORS RECEIVE A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION C, LINE 19 MERCY HEALTH NETWORK, INC. DOES NOT CURRENTLY MAKE ITS DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 SPONSOR AND SUPPORT HEALTHCARE PROVIDERS CO 501(C)(3) LINE 9 N/A 1 CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVENUE DES MOINES IA 50314 420680448 HEALTHCARE SERVICES IA 501(C)(3) LINE 3 CATHOLIC HEALTH INITIATIVES 1 MERCY HEALTH SERVICES - IOWA CORP 1000 4TH STREET SW MASON CITY IA 50401 311373080 HEALTHCARE SERVICES DE 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 TRINITY HEALTH CORPORATION 20555 VICTOR PARKWAY LIVONIA MI 48152 351443425 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) LINE 11B, II CATHOLIC HEALTH MINISTRIES 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0