2015-05-07T08:44:15-05:00 2014-06-30 420714325 MCGLADREY LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2013-07-01 420698295 MERCY MEDICAL CENTER MERC 3193986107 701 10TH STREET SE CEDAR RAPIDS IA 52403 NATHAN VAN GENDEREN EXECUTIVE VP/CFO 3193986107 2015-05-05 1 JOHN J ROMANO P00227323 5638884000 2013 2016-02-25 16:41:14Z NATHAN VAN GENDEREN 701 10TH STREET SE CEDAR RAPIDS IA 52403 280001530 0 0928 X WWW.MERCYCARE.ORG X 1900 IA TO CARE FOR THE SICK AND ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, GUIDED BY THE SPIRIT OF THE SISTERS OF MERCY. 31 24 2892 993 646352 -389755 5271930 5924084 262410378 266783691 9481560 3505571 -1134135 -973157 276029733 275240189 5288858 5021357 0 0 131460397 127511930 0 0 0 133820411 143299110 270569666 275832397 5460067 -592208 532041098 543266322 210599178 205979268 321441920 337287054 X TO CARE FOR THE SICK AND ENHANCE THE HEALTH OF THE COMMUNITIES WE SERVE, GUIDED BY THE SPIRIT OF THE SISTERS OF MERCY. 0 0 209111625 5021357 265010749 THE MEDICAL CENTER PROVIDES MEDICAL HEALTH CARE, INCLUDING 24 HOURS A DAY, SEVEN DAYS A WEEK TRAUMA CENTER SERVICE, TO ALL PATIENTS ACCESSING THE SYSTEM, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO CERTAIN ESTABILISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO OR NOMINAL PAYMENT IS ANTICIPATED. ADDITIONALLY, EACH HOSPITAL DEPARTMENT ACCEPTS ALL PATIENTS WHO ARE COVERED BY GOVERNMENTAL INDIGENT PROGRAMS. SUCH INDIGENT PROGRAMS TYPICALLY REMIT AMOUNTS SUBSTANTIALLY LESS THAN CHARGES. THE FOLLOWING SUMMARIZES THE HOSPITAL'S CARE OF THE UNINSURED AND UNDERINSURED (DOLLARS IN THOUSANDS):COSTS IN EXCESS OF MEDICARE REIMBURSEMENT (COSTS OF PROVIDING THE SERVICES LESS THE AMOUNTS RECEIVED FROM MEDICARE) - $31,600,000; OTHER COMMUNITY BENEFITS (INCLUDES SUBSIDIZED HEALTH SERVICES, FINANCIAL CONTRIBUTIONS) - $5,238,000; FREE SERVICE (TO PATIENTS WHO MEET MERCY'S FREE-SERVICE GUIDELINES) - $3,489,000; COSTS IN EXCESS OF MEDICAID REIMBURSEMENT (COSTS OF PROVIDING THE SERVICES LESS THE AMOUNTS RECEIVED FROM MEDICAID) - $3,190,000; PHYSICIAN EDUCATION - $473,000.IN ADDITION, CHARITY CARE AND COMMUNITY SERVICE ARE PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR. THESE PROGRAMS PROVIDE A BONA FIDE COMMUNITY HEALTH NEED, INCLUDING: A. A HEALTH NEWS PUBLICATION, THE MERCY TOUCH, DISTRIBUTED TO 68,000 HOUSEHOLDS IN 2014 AT A TOTAL COST OF OVER $75,000. B. PUBLIC AND PROFESSIONAL EDUCATIONAL SEMINARS OFFERED ON TOPICS INCLUDING CHRONIC BACK AND NECK PAIN, PRENATAL EDUCATION, BREAST FEEDING, DIABETES, EATING DISORDERS, OSTEOPOROSIS, CROHNS/COLITIS, CARDIOVASCULAR DISEASE AND WELLNESS, SPECIALIZED CANCER SEMINARS FOR SOCIAL WORKERS, DENTAL HYGIENISTS, NURSES, DENTISTS, AND PHYSICIANS ARE ALSO FREQUENTLY OFFERED. C. HOSPITAL MEETING FACILITIES ARE FREQUENTLY USED WITHOUT CHARGE BY SUCH GROUPS AS THE AMERICAN HEART ASSOCIATION, IOWA BREAST CANCER FOUNDATION, HEALTHY LINN NETWORK ADVISORY COMMITTEE, OVEREATERS ANONYMOUS, CATHOLIC LAYMEN, UNITED WAY, CATHERINE MCAULEY CENTER FOR WOMEN, THE AMERICAN CANCER SOCIETY, M.S. SUPPORT GROUP, AND ARC OF EAST CENTRAL IOWA. D. CONTRIBUTIONS OF 136,682 HOURS TOWARD THE COMMON PURPOSE OF SERVING THE HEALTH CARE OF THE COMMUNITY. THE VALUE OF THESE CONTRIBUTIONS WAS APPROXIMATELY $1,611,000 AND WAS GIVEN BACK THE COMMUNITY THROUGH LOWER COSTS. 209111625 1 1 0 1 0 0 0 0 0 1 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 307 0 1 2892 1 1 1 0 0 0 0 0 0 0 0 0 X 31 24 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X KAY CRIST 3193986107 701 10TH STREET SE CEDAR RAPIDS IA 52403 TIMOTHY L CHARLES PRESIDENT & CEO 40.00 X X 461581 0 76637 MARY QUASS CHAIRMAN 1.00 X X 0 0 0 EMMETT SCHERRMAN TREASURER 1.00 X X 0 0 0 SISTER SHARON M SUTHERLAND SECRETARY 1.00 X X 0 0 0 GORDON BAUSTIAN MD MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JOHN-PAUL BESONG MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 LYDIA BROWN MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 MICHELE BUSSE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JACK COSGROVE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 CHRIS DEWOLF MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BARRIE ERNST MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 TONY GOLOBIC MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER LUANN HANNASCH MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 NANCY KASPAREK MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JAN KAZIMOUR MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BARB KNAPP MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER TERRY MALTBY MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BRUCE MCGRATH MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 CHERYLE MITVALSKY MEMBER BOARD OF TRUSTEES 1.00 X 0 1232 0 DARREL MORF MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 RUE PATEL MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 FRED PILCHER MD MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 TOM REED MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JOHN RIFE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 CHARLIE ROHDE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 AL RUFFALO MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 KYLE SKOGMAN MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 JOHN SMITH MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER MAURITA SOUKUP MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 BOB VERHILLE MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 SISTER MARGARET WEIGEL MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 DEB WILBUR MD FORMER MEMBER BOARD OF TRUSTEES 1.00 X 0 0 0 PHILIP PETERSON FORMER CHIEF FINANCIAL OFFICER 40.00 X 278472 0 63029 NATHAN VAN GENDEREN EXECUTIVE VP/CFO 40.00 X 0 0 0 JEFFREY CASH CHIEF INFORMATION OFFICER 40.00 X 221345 0 42318 DOUG JONTZ VP - HUMAN RESOURCES 40.00 X 188958 0 45925 TIMOTHY QUINN CHIEF OF CLINICAL OPERATIONS 40.00 X 0 404199 51108 DR MARK VALLIERE CHIEF MEDICAL OFFICER 40.00 X 353323 0 60761 CAM CAMPBELL PHYSICIAN 40.00 X 293984 0 17138 DAVID GLASSMAN PHYSICIAN 40.00 X 286842 0 16176 NICHOLAS HODGMAN PHYSICIAN 40.00 X 284537 0 15711 SUNDARA MUNAGALA PHYSICIAN 40.00 X 255910 0 25372 HOUSAM SOUKIEH PHYSICIAN 40.00 X 286753 0 11126 MICHAEL TRACTA FORMER CHIEF OPERATING OFFICER 40.00 X 355791 0 27412 3267496 405431 452713 40 1 1 0 HMP OF LINN COUNTY PLC PO BOX 645037 CINCINNATI OH 45264 HEALTHCARE PROFESSIONAL SERVICES 3097829 ONCOLOGY ASSOCIATES OF CEDAR RAPIDS 701 10TH STREET CEDAR RAPIDS IA 52403 HEALTHCARE PROFESSIONAL SERVICES 2314722 WELAND CLINICAL LABORATORY 1911 1ST AVE SE CEDAR RAPIDS IA 52406 HEALTHCARE PROFESSIONAL SERVICES 492906 NAVIN HAFFTY & ASSOCIATES LLC 1900 W PARKS DR STE 180 WEST BOROUGH MA 01581 CONSULTING 358875 BE SMITH PO BOX 219241 KANSAS CITY MO 64121 HEALTHCARE PROFESSIONAL SERVICES 248290 23 5628961 295123 5924084 PATIENT REVENUES 900099 216115114 216115114 LABORATORY REVENUE 621500 66526381 65925091 601290 FAMILY COUNSELING REVENUE 624100 278667 278667 FITNESS CENTER REVENUE 900099 154 154 LESS: PROVISION FOR BAD DEBT 900099 -16136625 -16136625 266783691 3732097 3732097 1825865 1607419 218446 218446 218446 270585 497111 -226526 -226526 -226526 2591798 2656811 -65013 -65013 MRI MR ASSOCIATES 621110 2541278 2541278 INVESTMENT PARTNERSHIP INCOME(LOS 561000 1321715 1276653 45062 MRI JOINT VENTURE 621110 -4989583 -4989583 -1126590 275240189 265010749 646352 3659004 5021357 5021357 1874662 1874662 97524565 73035189 24489376 6064959 4570711 1494248 15384493 11594155 3790338 6663251 5021600 1641651 1758 1325 433 326873 246340 80533 122396 92241 30155 1535 1157 378 33211 25029 8182 14155424 10667897 3487527 1959538 1476759 482779 60670087 45722560 14947527 7585903 5716934 1868969 13200 9948 3252 3667589 2763991 903598 343357 258763 84594 51673 38942 12731 4316647 3253138 1063509 24893424 18760334 6133090 1520510 1145896 374614 CONTRACTED SERVICES 9174270 6913969 2260301 REPAIRS 8207625 6185480 2022145 EQUIPMENT RENTAL & MAIN 2485167 1872887 612280 RESIDENCY EXPENSE 1548412 1166924 381488 2220511 1673437 547074 275832397 209111625 66720772 0 917080 6575209 18949670 12510928 40793315 36756061 701174 1407991 6226905 5909990 3983552 3675872 431737162 230327896 211137848 201409266 69366297 86573183 117547241 121366149 62190689 67081673 227327 0 532041098 543266322 34083771 29734675 122122499 119112363 54392908 57132230 210599178 205979268 X 284551909 298517762 12221260 13692779 24668751 25076513 321441920 337287054 532041098 543266322 X -592208 18174294 -1736952 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1535 1535 0 PART II-B, LINE 1: 3.31% OF MEMBERSHIP DUES TO THE CATHOLIC HEALTH ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES, OR $1,535 32934062 53555 2557545 557842 34987320 31300732 514737 1667102 548509 32934062 29795537 1481261 723609 135675 564000 31300732 27886845 151882 4618232 2317922 543500 29795537 26505127 234657 1633447 486386 27886845 0.16070 0.71670 0.12260 0 1 1 19542096 19542096 264318952 145820418 118498534 144901924 82188138 62713786 2974190 2319340 654850 201409266 MONEY MARKET FUNDS 17256 F COMMERCIAL PAPER & CASH 29039877 F MUTUAL FUNDS, INVESTED IN CORP BONDS, LLPS, & REAL ESTATE 92309016 F 121366149 INVESTMENT IN MERCY MEDICAL CENTER FOUNDATION 62932105 C DEFERRED FINANCING COSTS 986441 C INVESTMENT IN CEDAR RAPIDS PHO 853000 C SLEEP LAB JOINT VENTURE 1142000 C INVESTMENT IN MR ASSOCIATES 503000 C INVESTMENT IN MEDICAL MALL 665127 C 67081673 INTEREST RATE SWAP AGREEMENTS 9825341 PENSION LIABILITY 39452186 SELF INSURANCE RESERVES 7208715 THIRD PARTY SETTLEMENTS 645988 57132230 X 290796954 18174294 -2894583 15279711 275517243 -277054 -277054 275240189 274951820 2010359 2010359 272941461 2890936 2890936 275832397 PART V, LINE 4: MERCY HOSPITAL, CEDAR RAPIDS, IA ENDOWMENT FOUNDATION, INC., A RELATED ORGANIZATION, HOLDS THE ENDOWMENT FUNDS. THE FOUNDATION'S ENDOWMENT FUNDS ARE USED FOR THE HALL-PERRINE CANCER CENTER & CANCER PROGRAMS, HALL RADIATION CENTER, NEUROSCIENCES, HOSPICE OF MERCY, HOSPICE HOUSE, PATIENT CARE SERVICES, HALL-PERRINE FAMILY RESOURCE CENTER, HALLMAR, WATTS LIBRARY, MERCY MEDICAL CENTER CAPITAL PROJECTS, AND GENERAL ENDOWMENT FUNDS TO BE USED AT THE BOARD OF DIRECTOR'S DISCRETION. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HOSPITALS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE CONTINUED TAX EXEMPT STATUS OF BONDS ISSUED BY THE OBLIGATED GROUP, THE NATURE, THE CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2014 AND 2013, THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY. FORMS 990 AND 990T FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -75,504. CHANGE IN UNRECOGNIZED FUNDED STATUS OF RETIREMENT PLAN -5,375,970. CHANGE IN INTEREST IN NET ASSETS OF MERCY MEDICAL CENTER FOUNDATION 5,056,891. GRANT TO MERCYARE SERVICE CORPORATION INCLUDED WITH REVENUES -2,500,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES -1,825,204. LOSS ON SALE OF ASSETS -226,526. AUXILIARY AND GIFT SHOP REVENUE NOT INCLUDED IN AUDIT REPORT 38,533. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) 1,066,558. CHARITABLE CONTRIBUTION REVENUE INCLUDED WITH EXPENSES IN REPORT 41,371. EXPENSES INCLUDED WITH REVENUES IN REPORT -18,047. TRANSFER OF LAND TO AFFILIATE 191,107. CONTRIBUTION REVENUE NOT REPORTED FOR BOOKS 46,171. ADDITIONAL CONTRIBUTION REVENUE NOT INCLUDED FOR BOOKS 408,983. PART XII, LINE 2D - OTHER ADJUSTMENTS: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES 1,825,204. LOSS ON SALE OF FIXED ASSETS 226,526. CHARITABLE CONTRIBUTION REVENUE INCLUDED WITH EXPENSES IN REPORT -41,371. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT TO MERCYCARE SERVICE CORPORATION INCLUDED WITH REVENUES 2,500,000. EXPENSES INCLUDED WITH REVENUES IN REPORT -18,047. ADDITIONAL CONTRIBUTION EXPENSE NOT INCLUDED FOR BOOKS 408,983. 1 1 1 X 0 1 1 1 0 1 1 4163387 4163387 0.01510 26464421 21603000 4861421 0.01760 30627808 21603000 9024808 0.03270 1039050 1039050 0.00380 1858543 1222488 636055 0.00230 12232000 8695000 3537000 0.01280 393193 393193 0.00140 15522786 9917488 5605298 0.02030 46150594 31520488 14630106 0.05300 712 712 0.00000 1579 1579 0.00000 122 122 0.00000 374266 374266 0.00140 376679 376679 0.00140 1 16136612 0 91381405 122977615 -31596210 X 1 1 1 MR ASSOCIATES LLP MRI SERVICES 0.33000 0.00000 0.33000 2 EASTERN IOWA SLEEP CENTER LLC SLEEP STUDIES 0.33000 0.00000 0.33000 3 CEDAR RAPIDS PHYSICIAN HOSPITAL ORGANIZATION PAYOR CONTRACTING 0.39000 0.00000 0.61000 4 PCI REGIONAL MED MALL LLC MEDICAL SERVICES 0.10000 0.00000 0.80000 5 PCI LENDER LLC FINANCIAL SERVICES 0.07500 0.00000 0.85000 1 1 MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 WWW.MERCYCARE.ORG 570036H X X X X MERCY MEDICAL CENTER 1 1 X X X X X X X X X 12 1 1 1 X WWW.MERCYCARE.ORG X X X X X X X X X 0 0 1 1 200.000000000000 0 1 X X X X X X X X 1 1 X X X 0 0 X X X 1 X 0 0 MERCY MEDICAL CENTER PART V, SECTION B, LINE 3: LINN COUNTY PUBLIC HEALTH FACILITATED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THROUGH THE USE OF THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). THIS PROCESS INCLUDED THE FOLLOWING: A COMMUNITY HEALTH STATUS ASSESSMENT (COLLECTION OF STATISTICAL DATA FROM MAJOR LEADING HEALTH INDICATORS); COMMUNITY THEMES AND STRENGTHS ASSESSMENT (FACILITATED DIALOGUES/FOCUS GROUPS THAT ARE CONDUCTED AMONG DIVERSE POPULATIONS); A LOCAL PUBLIC HEALTH SYSTEMS ASSESSMENT (AN EVENT THAT BRINGS TOGETHER COMMUNITY MEMBERS, AGENCIES, AND LEADERS TO IDENTIFY THE PUBLIC HEALTH SYSTEM'S STRENGTHS AND WEAKNESSES); AND A FORCE OF CHANGE ASSESSMENT (AN IMPORTANT BRAINSTORMING ACTIVITY THAT IDENTIFIED FORCES THAT HAVE THE POTENTIAL TO AFFECT HEALTH OUTCOMES). SPECIFICALLY, LINN COUNTY PUBLIC HEALTH CONDUCTED A TOTAL OF 12 COMMUNITY DIALOGUES WITH VARIOUS GROUPS, INCLUDING: MENTAL HEALTH SERVICES PLANNING COMMITTEE, WOMEN'S HEALTH NETWORK, FAMILY VIOLENCE PREVENTION COALITION, PARTNERSHIP FOR A DRUG FREE COMMUNITY, LAW ENFORCEMENT INTELLIGENCE NETWORK (HOUSED IN BENTON COUNTY), RESIDENTS IN TREATMENT AT THE HEART OF IOWA, SAFE KIDS COALITION, HEALTH LIVING COALITION/BLUE ZONES PROJECT SUBCOMMITTEES, SEXUAL HEALTH ALLIANCE OF LINN AND JOHNSON COUNTIES, PROVIDERS WITH THE LINN COUNTY MEDICAL SOCIETY AND ENVIRONMENTAL PUBLIC HEALTH WORK GROUP. BENTON COUNTY PUBLIC HEALTH CONDUCTED TWO ADDITIONAL COMMUNITY DIALOGUES WITHIN BENTON COUNTY. IN ADDITION, THE COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE INCLUDED INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS: BENTON COUNTY PUBLIC HEALTH/VIRGINIA GAY HOSPITAL, CEDAR COUNTY, COMMUNITY HEALTH FREE CLINIC, HACAP, HIS HANDS FREE MEDICAL CLINIC, JOHNSON COUNTY PUBLIC HEALTH, JONES REGIONAL MEDICAL CENTER, LINN COMMUNITY CARE, LINN COUNTY PUBLIC HEALTH, MERCY MEDICAL CENTER, UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL AND UNITED WAY OF EAST CENTRAL IOWA. MERCY MEDICAL CENTER VALIDATED THE IDENTIFIED NEEDS WITH MERCY'S PRIMARY CARE NETWORK OF PHYSICIANS AND THE HOSPITAL'S QUALITY STEERING COMMITTEE. MERCY MEDICAL CENTER PART V, SECTION B, LINE 4: LINN COUNTY PUBLIC HEALTH FACILITATED A CHNA FOR UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL AND MERCY MEDICAL CENTER. BOTH HOSPITALS ARE LOCATED IN CEDAR RAPIDS, IA. MERCY MEDICAL CENTER PART V, SECTION B, LINE 7: SEXUAL HEALTH WAS IDENTIFIED AS A HIGH PRIORITY FOR LINN AND JOHNSON COUNTIES. TO ADDRESS THIS NEED, MERCY MEDICAL CENTER HAS SEXUAL ASSAULT NURSE EXAMINERS LOCATED IN THE ED AND THEY PARTICIPATE ON THE LINN COUNTY SEXUAL ASSAULT RESPONSE TEAM. MERCY WILL NOT BE FURTHER ADDRESSING THIS NEED BECAUSE THE LINN COUNTY PUBLIC HEALTH DEPARTMENT CURRENTLY OFFERS EXTENSIVE SERVICES IN THIS AREA. THESE SERVICES INCLUDE: COORDINATING THE SEXUAL HEALTH ALLIANCE OF LINN AND JOHNSON COUNTIES COALITION (A MERCY PHYSICIAN SERVES ON THIS COALITION); OFFERING HIV TESTS AND FREE STD EXAMINATIONS AND TREATMENT; CONDUCTING STD PARTNER TRACKING FOLLOW-UP SERVICES; OFFERING FREE CONDOMS, DENTAL DAMS AND LUBRICANT; PROVIDING OFFSITE STD/HIV TESTING TO HIGH-RISK COMMUNITY AGENCIES AND EVENTS WITH HIGH-RISK POPULATIONS; AND MONITORING POPULATION HEALTH CHANGES THROUGH PUBLIC HEALTH SURVEILLANCE. VIOLENCE, INJURY PREVENTION, ENVIRONMENTAL HEALTH AND PRENATAL/EARLY CHILDHOOD HEALTH WERE OTHER KEY HEALTH PRIORITIES ANALYZED IN THE CHNA. HOWEVER, THEY WERE NOT IDENTIFIED AS HIGH PRIORITY AREAS DUE TO LIMITED DATA AND/OR THE LOWER INCIDENCE OR PREVALENCE RATES WHEN COMPARED TO STATE AND NATIONAL RATES. FOR THIS REASON, MERCY WILL NOT BE ADDRESSING THESE NEEDS BEYOND CURRENT PROGRAMMING. MERCY MEDICAL CENTER PART V, SECTION B, LINE 11: DISCOUNTED CARE IS AVAILABLE TO ALL MERCY MEDICAL CENTER PATIENTS WHO DO NOT HAVE ACTIVE MEDICAL INSURANCE COVERAGE, NOT JUST THOSE WITHIN A FPG FAMILY INCOME LIMIT. IF PATIENTS STILL FIND THEMSELVES UNABLE TO PAY, THEY MAY APPLY FOR ADDITIONAL FINANCIAL ASSISTANCE. PART I, LINE 3C: DISCOUNTED CARE IS AVAILABLE TO ALL MERCY MEDICAL CENTER PATIENTS WHO DO NOT HAVE ACTIVE MEDICAL INSURANCE COVERAGE, NOT JUST THOSE WITHIN A FPG FAMILY INCOME LIMIT. IF PATIENTS STILL FIND THEMSELVES UNABLE TO PAY, THEY MAY APPLY FOR ADDITIONAL FINANCIAL ASSISTANCE. PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: MERCY MEDICAL CENTER UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO, AND THIS RATIO WAS USED IN COMPUTING THE INFORMATION REPORTED IN PART I, LINE 7. PART I, LINE 7G: NO COSTS ASSOCIATED WITH A PHYSICIAN CLINIC WERE REPORTED IN SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): BAD DEBT EXPENSE WAS NOT INCLUDED IN THE DENOMINATOR BECAUSE IT WAS REPORTED ON LINE 2E OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 16.73%. THIS PERCENTAGE INCREASES TO 61.32% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN THE TOTAL COMMUNTY BENEFIT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: MERCY MEDICAL CENTER (MERCY) PARTICIPATED IN A NUMBER OF COMMUNITY BUILDING ACTIVITIES THAT PROMOTED THE HEALTH OF THE COMMUNITIES IT SERVES. THIS WAS DONE THROUGH MERCY REPRESENTATION ON A NUMBER OF COALITIONS, COMMITTEES AND BOARDS. MERCY MADE FINANCIAL CONTRIBUTIONS TO NON-PROFIT ORGANIZATIONS THAT SUPPORT COMMUNITY-BUILDING EFFORTS, INCLUDING PHYSICAL IMPROVEMENTS AND COMMUNITY SUPPORT. A TEAM OF MERCY STAFF SPENT TIME PLANTING A COMMUNITY GARDEN IN AN UNDERSERVED AREA.MERCY PROVIDES REPRESENTATION ON THE FOLLOWING COMMUNITY-BUILDING COALITIONS, BOARDS, AND COMMITTEES: - BIG BROTHERS BIG SISTERS - CATHERINE MCAULEY CENTER BOARD - DAYBREAK ROTARY - DIVERSITY FOCUS BOARD - EARLY CHILDHOOD IOWA - FOUR OAKS COMMITTEE - JUNIOR ACHIEVEMENT - KINGSTON HILL - MARION CHAMBER OF COMMERCE - MISSION OF HOPE - PARENT EDUCATION CONSORTIUM - REGIONAL FOOD SYSTEM - UNITED WAY DAY OF CARING - UNITED WAY TEAMS AND BOARD - YOUNG PARENTS NETWORK BOARD PART III, LINE 2: BAD DEBT RECORDED IS THE UNPAID AMOUNT OF THE PATIENT'S ACCOUNT; IT DOES NOT REFLECT GROSS ESTABLISHED CHARGES. FOR PATIENTS WITH INSURANCE COVERAGE, THIS IS THE RESULTING PATIENT LIABILITY AFTER INSURANCE PAYMENTS AND CONTRACTUAL ALLOWANCES HAVE BEEN APPLIED TO THE ACCOUNT. FOR PATIENTS WITHOUT INSURANCE COVERAGE, A DISCOUNT PERCENTAGE BASED ON CURRENT ORGANIZATION POLICY IS APPLIED TO GROSS ESTABLISHED CHARGES BEFORE THE PATIENT IS BILLED. IF THEY DO NOT PAY THIS REMAINING AMOUNT AND DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THIS AMOUNT WOULD BE APPLIED TO BAD DEBT. PAYMENTS RECEIVED AFTER AN ACCOUNT HAS BEEN WRITTEN OFF TO BAD DEBT ARE CREDITED TO A BAD DEBT RECOVERY ACCOUNT. DISCOUNTS FROM INSURANCE OR SELF-PAY ACCOUNTS ARE WRITTEN OFF TO CONTRACTUAL ALLOWANCE ACCOUNTS. PART III, LINE 4: SEE PAGES 7 AND 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 8: THE COSTS SHOWN FOR THE MEDICARE SHORTFALL ARE BASED ON TOTAL CHARGES OF ALL MEDICARE AND MEDICARE REPLACEMENT (PART C) PATIENTS. THE SHORTFALL IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES BY THE COST TO CHARGE RATIO CALCULATED ON WORKSHEET 2, LESS PAYMENTS WE RECEIVED FOR THESE SERVICES.THE MEDICARE COST REPORT IS NOT AN APPROPRIATE SOURCE TO DETERMINE THE COSTS FOR THESE PATIENTS. MANY ITEMS, INCLUDING ALL OUTPATIENT SERVICES FOR PATIENTS WHO ARE COVERED BY A MEDICARE REPLACEMENT PLAN (PART C) AND MANY SERVICES SUCH AS LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND OTHERS PAID ON A FEE FOR SERVICE BASIS, ARE NOT INCLUDED ON THE MEDICARE COST REPORT. IN ADDITION, HOSPICE, HOME HEALTH, AND DIALYSIS SERVICES, ALTHOUGH INCLUDED IN MEDICARE COST REPORT, DO NOT SHOW THE COSTS AND PAYMENTS ASSOCIATED WITH THESE SERVICES FOR MEDICARE BENEFICIARIES. FOR MERCY MEDICAL CENTER, 46% OF OUR GROSS CHARGES ARE GENERATED BY PATIENTS WITH MEDICARE AND MEDICARE REPLACEMENT (PART C) COVERAGE. ANOTHER 9% OF OUR GROSS CHARGES ARE GENERATED BY PATIENTS WITH MEDICAID COVERAGE. NEITHER GOVERNMENT PROGRAM HAS HISTORICALLY REIMBURSED ENOUGH TO COVER THE COSTS OF THE SERVICES PROVIDED TO THESE PATIENTS. IF WE DID NOT SERVE THESE PATIENT POPULATIONS, ANOTHER FACILITY WOULD HAVE TO PROVIDE THE SERVICE. OF THE 74,530 MEDICARE PATIENTS DISCHARGED IN THE 2014 FISCAL YEAR, 16.1% OF THEM HAD MEDICAID SECONDARY COVERAGE. THIS DOES NOT REFLECT ANY OF THE PATIENTS WHOSE PRIMARY COVERAGE IS MEDICARE REPLACEMENT (PART C) POLICY. BASED ON INFORMATION FROM THE AMERICAN HOSPITAL ASSOCIATION, APPROXIMATELY 20% OF MEDICARE BENEFICIARIES ARE DUALLY-ELIGIBLE AND ACCOUNT FOR APPROXIMATELY 55% OF A HOSPITAL'S MEDICARE BAD DEBT. PART III, LINE 9B: MERCY MEDICAL CENTER UNDERSTANDS PATIENTS MAY NOT HAVE THE ABILITY TO PAY FOR SERVICES NOR RECOGNIZE THE OPPORTUNITY THEY MAY HAVE TO RECEIVE FINANCIAL ASSISTANCE. TO AID IN THIS PROCESS, MERCY MEDICAL CENTER HAS IMPLEMENTED A PRESUMPTIVE CHARITY ELIGIBILITY PROGRAM (PCEP). PATIENTS WHO QUALIFY FOR THIS PROGRAM DO NOT COMPLETE PAPERWORK. MERCY MEDICAL CENTER UTILIZES AN OUTSIDE VENDOR TO ASSIST IN DETERMINING A PATIENT'S FINANCIAL RISK. MERCY MEDICAL CENTER USES BILLING AND COLLECTION RECOMMENDATIONS FROM THE IOWA HOSPITAL ASSOCIATION. THESE RECOMMENDATIONS INCLUDE: - MERCY MEDICAL CENTER WILL PROVIDE THE SAME INFORMATION CONCERNING SERVICES AND CHARGES TO ALL PATIENTS. - MERCY MEDICAL CENTER WILL NOT KNOWINGLY SEND A PATIENT'S BILL TO A COLLECTION AGENCY BEFORE INITIAL FINANCIAL ELIGIBILITY ASSISTANCE DETERMINATION HAS BEEN MADE. - MERCY MEDICAL CENTER WILL REVIEW THE PATIENT'S RECORD TO DETERMINE IF REASONABLE EFFORTS WERE UNDERTAKEN TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED AND/OR IF FINANCIAL ASSISTANCE IS APPROPRIATE BEFORE ANY COLLECTION AGENCY ASSIGNMENT. PART III, LINE 3: NOT APPLICABLE PART VI, LINE 2: MERCY MEDICAL CENTER UNDERSTANDS THE NEED FOR ONGOING ASSESSMENT AND USES DATA AND INFORMATION OBTAINED FROM HOSPITAL CHARITY CARE CASES, COMMUNITY FREE CLINICS, UNITED WAY AND COUNTY HEALTH RANKING REPORTS TO MODIFY CURRENT ACTIVITIES AND CREATE NEW PROGRAMS TO ADDRESS HEALTH NEEDS. ADDITIONALLY, MERCY MEDICAL CENTER RECEIVES REQUESTS FROM LOCAL NON-PROFIT ORGANIZATIONS FOR FINANCIAL AND IN-KIND SUPPORT TO ADDRESS COMMUNITY NEEDS FOR WHICH THEY PROVIDE PROGRAMS AND SERVICES. MERCY MEDICAL CENTER UTILIZES ALL OF THIS INFORMATION, IN ADDITION TO THE CHNA TO COMPLETE A COMMUNITY BENEFIT PLAN FOR THE HOSPITAL EACH YEAR. PART VI, LINE 3: MERCY MEDICAL CENTER IS COMMITTED TO PROVIDING ACCESS TO QUALITY HEALTHCARE WITH COMPASSION, DIGNITY AND RESPECT FOR ALL THOSE WE SERVE, PARTICULARLY THE POOR AND UNDERSERVED; CARING FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES; ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE AND COMMUNICATING INFORMATION ABOUT FINANCIAL ASSISTANCE IN A CLEAR AND CONSISTENT MANNER.MERCY MEDICAL CENTER INFORMS PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE IN THE FOLLOWING WAYS. MERCY MEDICAL CENTER'S BILLING AND COLLECTION POLICIES ALONG WITH THE LIST OF ALL FINANCIAL RESOURCES ARE PROVIDED IN BROCHURES, ARE INCLUDED IN PATIENT REGISTRATION PACKETS, INCLUDED IN HOSPITAL BILLING STATEMENTS AND POSTED IN KEY PUBLIC AREAS.PATIENTS ARE EDUCATED ABOUT THEIR RESPONSIBILITIES, THE POTENTIAL FINANCIAL OBLIGATION THEY MAY INCUR, THEIR OBLIGATIONS FOR COMPLETING ELIGIBILITY DOCUMENTATIONS AND THE HOSPITAL'S BILLING AND COLLECTION POLICIES. PATIENTS ARE REFERRED TO AND/OR PROVIDED WITH ASSISTANCE TO COMPLETE MEDICAID, STATE INSURANCE EXCHANGE PRODUCTS OR OTHER LOCAL FUNDING APPLICATIONS. MERCY MEDICAL CENTER PROVIDES THESE SERVICES UTILIZING INTERPRETER SERVICES IF NECESSARY. PART VI, LINE 4: MERCY MEDICAL CENTER SERVES A PRIMARY SERVICE AREA (PSA) OF LINN COUNTY AND A SECONDARY SERVICE AREA (SSA) OF EIGHT CONTIGUOUS COUNTIES (BENTON, BUCHANAN, CEDAR, DELAWARE, IOWA, JOHNSON, JONES AND TAMA). 17% OF MERCY'S INPATIENT DISCHARGES AND 16% OF MERCY'S OUTPATIENT VISITS COME FROM THE SECONDARY SERVICE AREA.THE TOTAL POPULATION OF LINN COUNTY IN 2012 IS 215,295. THE TOTAL POPULATION OF BOTH PRIMARY AND SECONDARY SERVICE AREAS IS 488,735. THE PROJECTED 10-YEAR POPULATION GROWTH FOR THE PSA IS 1% AND THE SSA, 1%, ANNUALLY. - 13.4% OF PERSONS LIVING IN MERCY'S COMBINED SERVICE AREA ARE AGE 65 OR OLDER. - 93.3% ARE HIGH SCHOOL GRADUATES, WHILE 32.3% HOLD A BACHELOR'S DEGREE OR HIGHER. - THE MEDIAN HOUSEHOLD INCOME IS $53,722. - THE PERCENTAGE OF PEOPLE LIVING BELOW POVERTY LEVEL IS 11.7%, AS COMPARED TO 11.9% FOR ALL OF IOWA. - THE IOWAN UNINSURED RATE WAS 11% BEFORE THE EXPANDED ACA COVERAGE BECOME AVAILABLE. THE UNINSURED RATE IN LINN COUNTY WAS 9%. THE EIGHT CONTIGUOUS UNINSURED RATES RANGED FROM 8 TO 14%. WHILE PRIVATE AGENCIES HAVE RELEASED ESTIMATES BASED ON SURVEYS, CONCRETE NUMBERS REFLECTING THE IMPACT OF THE ACA ARE NOT CURRENTLY AVAILABLE. - THE AVERAGE PERSONS PER HOUSEHOLD ARE 2.42.DEMOGRAPHICS FOR THE COMBINED SERVICE AREA ARE AS FOLLOWS: - 49.7% MALE, 50.3% FEMALE - 91.5% CAUCASIAN - 3.5% AFRICAN AMERICAN - 0.5% NATIVE AMERICAN - 2.6% ASIAN/PACIFIC - 1.9% TWO OR MORE RACES - 3.3% HISPANICAS OF AUGUST 2014, THE UNEMPLOYMENT RATE FOR LINN COUNTY IS 4.2%. THE EIGHT CONTIGUOUS UNEMPLOYMENT RATES RANGE FROM 3.1 TO 5.5%. LINN COUNTY FEATURES A DIVERSE EMPLOYER BASE, INCLUDING MANUFACTURING, TRADE, EDUCATION, SERVICE, FINANCE AND AGRICULTURE. PART VI, LINE 5: MERCY MEDICAL CENTER CONTRIBUTES TO THE HEALTH OF THE COMMUNITIES IT SERVES IN A NUMBER OF WAYS. MERCY PROVIDES REPRESENTATION ON SEVERAL COMMUNITY BOARDS, COALITIONS AND COMMITTEES ADDRESSING HEALTH NEEDS. EXAMPLES INCLUDE: - THE ARC OF EAST CENTRAL IOWA BOARD - ALZHEIMER'S ASSOCIATION BOARD - BLUE ZONES PROJECT COMMITTEES - COMMUNITY HEALTH FREE CLINIC BOARD - GEMS OF HOPE BOARD - PARTNERSHIP FOR A DRUG-FREE COMMUNITY COALITIION - SEXUAL ASSAULT RESPONSE TEAM OF LINN COUNTYMERCY HONORED THE LIFETIME ACCOMPLISHMENTS OF SR. MARY LAWRENCE HALLAGAN WITH A NON-PROFIT COMMUNITY CENTER THAT OPENED SEPT. 6, 2011 TO PROVIDE SPACE AND DIRECT CLIENT SERVICES TO NONPROFIT ORGANIZATIONS AT 420 6TH STREET, CEDAR RAPIDS. TENANTS INCLUDE: GEMS OF HOPE; KIDS FIRST LAW CENTER; YOUNG PARENTS NETWORK AND BOYS & GIRLS CLUB; CATHOLIC CHARITIES; AND METRO CATHOLIC OUTREACH. THESE AGENCIES SHARE MERCY'S VISION TO ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. TOGETHER, WE MAKE A DIFFERENCE IN THE LIVES OF MANY. MERCY LEASES THE SPACE FOR $1 PER YEAR, PLUS THE COST OF MONTHLY UTILITIES.MERCY SUPPORTS THE CEDAR RAPIDS MEDICAL SELF-SUPPORTED MUNICIPAL IMPROVEMENT DISTRICT - THE MEDICAL QUARTER REGIONAL MEDICAL DISTRICT (MEDQUARTER) - TO ENHANCE OUR COMMUNITY'S NATIONALLY RECOGNIZED REPUTATION FOR HIGH-QUALITY, LOW-COST CARE WITH A CONCENTRATED AREA OF MEDICAL SERVICES THAT ARE EASILY ACCESSIBLE.MERCY MEDICAL CENTER PARTNERS WITH UNITYPOINT HEALTH - ST. LUKE'S HOSPITAL TO SUPPORT A FAMILY PRACTICE RESIDENCY PROGRAM. A COMMUNITY-BASED PROGRAM UNDERSCORES A COMMITMENT TO THE CONCEPT OF THE PATIENT-CENTERED MEDICAL HOME. THE MEDICAL HOME IS A COMMUNITY HEALTH CENTER, A FEDERALLY QUALIFIED HEALTH CENTER, ONE WHICH ALLOWS RESIDENTS TO CARE FOR THE NEEDS OF BOTH RURAL AND URBAN UNDERSERVED POPULATIONS. MERCY MEDICAL CENTER HAS COMMITTED A FULL-TIME EQUIVALENT TO THE ROLE OF MANAGER, COMMUNITY BENEFIT AND MISSION OUTREACH MINISTRIES. IN ADDITION, MERCY ADMINISTRATION BUDGETS 2 HOURS PER FULL-TIME EQUIVALENT THAT IS USED TO SUPPORT COMMUNITY BENEFIT VOLUNTEER ACTIVITIES AND PRECEPTING. IN THE PAST YEAR, MERCY MEDICAL CENTER EMPLOYEES ACCRUED 20,102 COMMUNITY BENEFIT HOURS, OR 11.72 HOURS PER FULL-TIME EMPLOYEE. THE HOSPITAL ALSO HAS A SUPPORTIVE COMMITTEE STRUCTURE THAT WORKS WITH THE MANAGER OF COMMUNITY BENEFIT AND MISSION OUTREACH MINISTRIES IN DEVELOPING THE COMMUNITY BENEFIT PLAN AND EVALUATING THE IMPACT OF PROGRAMS AND ACTIVITIES ESTABLISHED TO MEET GAPS IN CARE WITHIN THE PRIMARY AND SECONDARY SERVICE AREAS. THE COMMITTEES REFERENCED ABOVE ARE THE HOSPITAL COMMUNITY BENEFIT COMMITTEE, CONSISTING OF SEVERAL HOSPITAL AND CLINIC REPRESENTATIVES, AND THE HOSPITAL BOARD COMMITTEE FOR COMMUNITY BENEFIT. THE MANAGER OF COMMUNITY BENEFIT AND MISSION OUTREACH MINISTRIES REPORTS TO THE VICE PRESIDENT OF MISSION INTEGRATION, WHO REPORTS TO THE PRESIDENT & CHIEF EXECUTIVE OFFICER (CEO).MERCY MEDICAL CENTER MAINTAINS AN OPEN MEDICAL STAFF, AS PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS.MERCY MEDICAL CENTER'S BOARD OF TRUSTEES IS MADE UP OF VOLUNTEERS, THE MAJORITY OF WHOM ARE RESIDENTS WITHIN THE PSA. THE BOARD CONSISTS OF 30 MEMBERS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. THE GOVERNANCE STRUCTURE ENSURES THAT COMMUNITY INTERESTS ARE REPRESENTED IN DECISION-MAKING FOR THE ORGANIZATION. FIVE SEATS ARE ALLOCATED TO WOMEN RELIGIOUS WHO ENSURE THE ORGANIZATION REMAINS TRUE TO ITS CHARITABLE MISSION.MERCY MEDICAL CENTER UTILIZES OPERATING INCOME SURPLUSES TO FUND CAPITAL EXPENDITURES. THE PROPOSED CAPITAL ITEMS ARE REVIEWED BY STAFF, MEDICAL STAFF AND ADMINISTRATION TO ENSURE ITEMS WILL PROVIDE ONGOING HIGH QUALITY, LOW COST CARE TO PATIENTS AND ALIGN WITH THE STRATEGIC INITIATIVES OF THE FACILITY. ANY EXCESS OPERATING FUNDS ARE RETAINED BY THE ORGANIZATION FOR FUTURE CAPITAL IMPROVEMENTS OR OPERATING FUNDS AS NEEDED. PART VI, LINE 7, REPORTS FILED WITH STATES IA 1 MERCYCARE SERVICE CORPORATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 421199429 501(C)(3) 2500000 FOR USE IN CONTINUING OPERATIONS MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 510233180 501(C)(3) 806764 FOR USE IN CONTINUING OPERATIONS AMERICAN CANCER SOCIETY INC 250 WILLIAMS STREET NW ATLANTA GA 30303 131788491 501(C)(3) 40000 GENERAL SUPPORT ENTREPRENEURIAL DEVELOPMENT CENTER INC 230 2ND STREET SE STE 212 CEDAR RAPIDS IA 52401 421447565 501(C)(6) 20000 GENERAL SUPPORT CEDAR RAPIDS SYMPHONY ORCHESTRA ASSOCIATION INC 119 3RD AVENUE SE CEDAR RAPIDS IA 52401 420772544 501(C)(3) 12500 GENERAL SUPPORT UNITED WAY OF EAST CENTRAL IOWA 317 7TH AVENUE SE STE 401 CEDAR RAPIDS IA 52401 420861239 501(C)(3) 11200 GENERAL SUPPORT JDRF INTERNATIONAL 26 BROADWAY 15TH FLOOR NEW YORK NY 10004 231907729 501(C)(3) 10600 GENERAL SUPPORT AMERICAN DIABETES ASSOCIATION INC 1701 N BEAUREGARD STREET ALEXANDRIA VA 22311 131623888 501(C)(3) 10000 GENERAL SUPPORT DIVERSITY FOCUS 222 SECOND STREET SE CEDAR RAPIDS IA 52401 203420207 501(C)(3) 10000 GENERAL SUPPORT JUNIOR ACHIEVEMENT OF EASTERN IOWA 324 3RD STREET SE STE 200 CEDAR RAPIDS IA 52401 420919209 501(C)(3) 7600 GENERAL SUPPORT GEMS OF HOPE INC 420 6TH STREET SE CEDAR RAPIDS IA 52401 203155610 501(C)(3) 7500 GENERAL SUPPORT ALZHEIMER'S DISEASE & RELATED DISORDERS ASSOCIATION 225 N MICHIGAN AVE STE 17TH FLR CHICAGO IL 60601 133039601 501(C)(3) 7500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 6500 GENERAL SUPPORT ZACH JOHNSON FOUNDATION PO BOX 2336 CEDAR RAPIDS IA 52406 272683100 501(C)(3) 6500 GENERAL SUPPORT FOUR OAKS FAMILY AND CHILDREN SERVICES 5400 KIRKWOOD BLVD SW CEDAR RAPIDS IA 52404 420998726 501(C)(3) 5500 GENERAL SUPPORT LINN COUNTY MEDICAL SOCIETY 813 1ST AVENUE SE CEDAR RAPIDS IA 52402 237410746 501(C)(6) 5500 GENERAL SUPPORT CEDAR RAPIDS METRO ECONOMIC ALLIANCE 501 FIRST STREET SE CEDAR RAPIDS IA 52401 420172900 501(C)(6) 5350 GENERAL SUPPORT 14 3 PART I, LINE 2: ALL CHECKS ARE ISSUED DIRECTLY TO THE ORGANIZATION TO BE USED AT THEIR DISCRETION. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 TIMOTHY L CHARLES PRESIDENT & CEO 422782 0 0 0 38799 0 61314 0 15323 0 538218 0 0 0 PHILIP PETERSON FORMER CHIEF FINANCIAL OFFICER 268461 0 0 0 10011 0 47276 0 15753 0 341501 0 0 0 JEFFREY CASH CHIEF INFORMATION OFFICER 213232 0 0 0 8113 0 27122 0 15196 0 263663 0 0 0 DOUG JONTZ VP - HUMAN RESOURCES 180166 0 0 0 8792 0 32164 0 13761 0 234883 0 0 0 TIMOTHY QUINN CHIEF OF CLINICAL OPERATIONS 0 397256 0 0 0 6943 0 34711 0 16397 0 455307 0 0 DR MARK VALLIERE CHIEF MEDICAL OFFICER 342766 0 0 0 10557 0 37900 0 22861 0 414084 0 0 0 CAM CAMPBELL PHYSICIAN 293706 0 0 0 278 0 6835 0 10303 0 311122 0 0 0 DAVID GLASSMAN PHYSICIAN 286784 0 0 0 58 0 6594 0 9582 0 303018 0 0 0 NICHOLAS HODGMAN PHYSICIAN 284472 0 0 0 65 0 5725 0 9986 0 300248 0 0 0 SUNDARA MUNAGALA PHYSICIAN 255370 0 0 0 540 0 13306 0 12066 0 281282 0 0 0 HOUSAM SOUKIEH PHYSICIAN 285750 0 0 0 1003 0 0 0 11126 0 297879 0 0 0 MICHAEL TRACTA FORMER CHIEF OPERATING OFFICER 174513 0 0 0 181278 0 18517 0 8895 0 383203 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS: LIMITED TRAVEL FOR COMPANIONS IS PAID BY THE ORGANIZATION ON BEHALF OF TOP MANAGEMENT. IN TAX YEAR 2013, TIMOTHY L. CHARLES, AN OFFICER AND TRUSTEE REPORTED IN PART VII, RECEIVED THIS BENEFIT. THIS AMOUNT IS INCLUDED IN REPORTABLE COMPENSATION AS REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II. PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE OR CHANGE OF CONTROL PAYMENT FROM THE ORGANIZATION IN 2013: MICHAEL TRACHTA - $177,103. THE DOLLAR AMOUNT IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2013: JEFFREY CASH - $14,629, TIMOTHY L. CHARLES - $29,789, DOUG JONTZ - $4,981, PHILIP PETERSON - $19,104 AND DR. MARK VALLIERE - $23,875. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY THE ORGANIZATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2013. THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2013: TIMOTHY QUINN - $27,061. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY MERCYCARE MANAGEMENT, A RELATED ORGANIZATION, ON BEHALF OF THE INDIVIDUAL TO THE PLAN IN 2013. A CITY OF CEDAR RAPIDS IOWA 426004336 150543AA4 2003-04-10 30000000 REIMBURSE HOSPITAL FOR COSTS OF ACQUIRING AND CONSTRUCTING FACILITIES 0 0 0 B CITY OF CEDAR RAPIDS IOWA 426004336 150543AB2 2005-11-17 58405000 ADVANCE REFUND OF 1999 BONDS 0 0 0 C IOWA FINANCE AUTHORITY 521699886 4624466EQ 2012-12-13 45604359 REIMBURSE HOSPITAL FOR CAPITAL 0 0 0 A 3650000 30000000 1288620 28711380 2003 0 0 1 1 B 10705000 58405000 1552500 56852500 2005 0 1 1 1 C 45604359 604359 45000000 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 UBS AG 29.000000000000 0 0 0 0 1 B 0 0 0 1 1 1 UBS AG 24.000000000000 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF CEDAR RAPIDS, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2008 ISSUER NAME: CITY OF CEDAR RAPIDS, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 04/01/2009 TIMOTHY CHARLES PRESIDENT & CHIEF EXECUTIVE OFFICER PERSONAL X 75000 10714 0 1 1 10714 MERCY CARE MANAGEMENT INC SEE BELOW IN PART V 818400 MERCY CARE MANAGEMENT, INC. PAID MERCY MEDICAL CENTER RENT. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B TIMOTHY L. CHARLES AND EMMETT SCHERRMAN ARE OFFICERS AND JAN KAZIMOUR, BRUCE MCGRATH, KYLE SKOGMAN AND BOB VERHILLE ARE MEMBERS OF THE BOARD OF TRUSTEES OF MERCY MEDICAL CENTER AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, ALL THE AFOREMENTIONED INDIVIDUALS WERE OFFICERS OR MEMBERS OF THE BOARD OF DIRECTORS OF MERCY CARE MANAGEMENT, INC. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MERCY MEDICAL CENTER IS MERCYCARE SERVICE CORPORATION, AN IOWA NONPROFIT CORPORATION. THE SOLE MEMBER HAS THE EXCLUSIVE POWER TO APPOINT, AFTER CONSIDERATION OF ANY RECOMMENDATIONS FROM THE CORPORATION'S BOARD OF TRUSTEES, ANY TRUSTEE TO THE CORPORATION'S BOARD AND TO REMOVE ANY TRUSTEE FROM THE CORPORATION'S BOARD AT ANY TIME FOR ANY REASON. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF MERCY MEDICAL CENTER, MERCYCARE SERVICE CORPORATION HAS THE EXCLUSIVE POWER TO APPOINT, AFTER CONSIDERATION OF ANY RECOMMENDATIONS FROM THE CORPORATION'S BOARD OF TRUSTEES, ANY TRUSTEE TO THE CORPORATION'S BOARD AND TO REMOVE ANY TRUSTEE FROM THE CORPORATION'S BOARD AT ANY TIME FOR ANY REASON. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF MERCY MEDICAL CENTER, MERCYCARE SERVICE CORPORATION HAS THE POWER TO APPROVE THE FOLLOWING ACTIONS: 1. AMEND, REPEAL, OR RESTATE THE ARTICLES OF INCORPORATION; 2. ANY MATTER DIRECTLY RELATED TO THE RELIGIOUS PRINCIPLES AND MORAL PHILOSOPHY OF THE SISTERS OF MERCY; 3. ADOPT OR CHANGE THE PHILOSOPHY AND MISSION OF THE CORPORATION; 4. SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, AND MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER ENTITY; 5. DISSOLUTION OF THE CORPORATION; 6. ADOPTION OR AMENDMENT TO LONG-TERM STRATEGIC PLANS; 7. ADOPTION OR AMENDMENT TO ANNUAL CAPITAL OR OPERATING BUDGETS; AND 8. APPOINTMENT OR REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED WITH THE EXECUTIVE COMMITTEE (SUBCOMMITTEE OF THE BOARD OF TRUSTEES) PRIOR TO FILING THE FORM. THE COMMITTEE IS PROVIDED WITH GENERAL BACKGROUND INFORMATION REGARDING THE FORM 990, AND THE FORM ITSELF (INCLUDING ATTACHMENTS) IS REVIEWED. UPON REQUEST, THE TAX RETURN WILL BE AVAILABLE FOR REVIEW BY THE BOARD OF TRUSTEES. MEMBERS OF THE EXECUTIVE COMMITTEE AND MANAGEMENT ARE AVAILABLE TO ANSWER QUESTIONS FROM THE TRUSTEES ON THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES, AS WELL AS EACH EMPLOYEE TO DISCLOSE ANY INTEREST IN, OBLIGATION OR DUTY TO, OR ACTIVITY FOR ANY CONCERN IN WHICH A DIRECTOR, OFFICER, KEY EMPLOYEE, OR EMPLOYEE OR THEIR FAMILY MEMBER MAY BE INVOLVED THAT: MIGHT CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OR MIGHT HAVE THE APPEARANCE OF ADVERSELY AFFECTING THE DIRECTOR'S, OFFICER'S, KEY EMPLOYEE'S, OR EMPLOYEE'S JUDGMENT OR ACTIONS IN PERFORMING HIS/HER DUTIES TOWARDS MERCY. ALL DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES SHALL FILE AN INITIAL CONFLICT OF INTEREST REPORT UPON HIRE AND SHALL BE REQUIRED TO FILE AN UPDATED REPORT IMMEDIATELY IF ANY CHANGES OCCUR WHICH RESULT IN A CONFLICT OF INTEREST OR FINANCIAL INTEREST. ALL DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES (SUPERVISOR AND ABOVE), PHYSICIANS, AND ANY EMPLOYEE IN A POSITION TO INFLUENCE A PURCHASE DECISION SHALL RE-SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WITH ANY NECESSARY CHANGES, EACH YEAR AND IMMEDIATELY IF ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. ALL BOARD MEMBERS SHALL SUBMIT IN WRITING A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND CONFLICTING INTERESTS. THE STATEMENT SHALL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR AND AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT IS SET BY THE COMPENSATION COMMITTEE. THE COMMITTEE USES MCGLADREY & PULLEN LLP FOR THE REVIEW OF SALARIES AND COMPARES THEM TO COMPARABLE ENTITIES IN THE REGION. THIS PROCESS WAS LAST COMPLETED ON APRIL 16, 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -5,375,970. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 5,056,891. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -75,504. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) -1,066,558. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY AND GIFT SHOP -38,533. LAND FROM MERCY CARE MANAGEMENT -191,107. CONTRIBUTION NOT RECORDED FOR BOOK PURPOSES -46,171. FORM 990, PART XI, LINE 2C MERCY MEDICAL CENTER'S GOVERNING BOARD ENGAGES THE INDEPENDENT ACCOUNTANTS TO PERFORM THE AUDIT. IN ADDITION, THE AUDITORS REVIEW THE MANAGEMENT LETTER WITH THE GOVERNING BOARD. 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