2014-05-15T12:32:00-05:00 2013-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2012-07-01 391902797 MANNING REGIONAL HEALTHCARE CENTER MANN 7126552072 410 MAIN STREET MANNING IA 51455 ABBEY STANGL 7126552072 2014-05-13 1 BARBARA J FAJEN P00400874 4023302660 2012 2015-11-30 17:44:51Z ABBEY STANGL 410 MAIN STREET MANNING IA 51455 13549099 0 X WWW.MRHCIA.COM X 1997 IA MANNING REGIONAL HEALTHCARE CENTER (MRHC) IS A LICENSED CRITICAL ACCESS HOSPITAL THAT PROVIDES THE FOLLOWING HEALTHCARE SERVICES FOR THE MANNING, IA AND SURROUNDING COMMUNITIES: ACUTE AND SKILLED CARE, EMERGENCY CARE, OUTPATIENT SPECIALTY CLINICS, NURSING HOME CARE, SURGERY, ANCILLARY SERVICES (I.E. - LABORATORY AND RADIOLOGY), HOME HEALTH CARE AND SUBSTANCE ABUSE TREATMENT. MRHC HAS 17 LICENSED SWING-BEDS USED FOR ACUTE AND SKILLED CARE, 13 LICENSED, PARTIAL-RESIDENTIAL, SUBSTANCE ABUSE TREATMENT BEDS (UNDER THE MANNING FAMILY RECOVERY CENTER - A DISTINCT PART UNIT) AND 56 LICENSED LONG-TERM CARE BEDS (UNDER THE MANNING PLAZA). ALL THE MRHC ACTIVITIES ARE PROVIDED BY LICENSED PROFESSIONALS AS REQUIRED BY THE REGULATIONS GOVERNING A HOSPITAL AND NURSING HOME. MRHC PROVIDES FAMILY PRACTICE PHYSICIAN SERVICES AT THE MANNING REGIONAL HEALTHCARE CLINIC. 6 6 233 100 0 -10977 396177 63284 13868417 13423256 24386 9541 53692 49826 14342672 13545907 0 0 0 0 7225297 7441911 0 0 0 5447368 5767342 12672665 13209253 1670007 336654 12968312 20478438 3175017 10348489 9793295 10129949 MANNING REGIONAL HEALTHCARE CENTER (MRHC) WILL PROVIDE A COMPASSIONATE, HOLISTIC HEALTH CARE EXPERIENCE THE COMMUNITY CAN TRUST. 0 0 7254641 7181705 THE MANNING GENERAL HOSPITAL IS A 17-BED FACILITY FEDERALLY DESIGNATED AS A CRITICAL ACCESS HOSPITAL. HOSPITAL SERVICES INCLUDE ACUTE AND SKILLED CARE, EMERGENCY CARE, OUTPATIENT SPECIALTY CLINICS, SURGERY, AND ANCILLARY (I.E. - LABORATORY AND RADIOLOGY) SERVICES. 3221248 3428454 THE MANNING PLAZA (THE PLAZA) PROVIDES INTERMEDIATE CARE TO THE ELDERLY. THE PLAZA IS A 56-BED LONG-TERM CARE FACILITY OFFERING 24-HOUR NURSING CARE AND SPECIALIZED DIETARY SERVICE. IT ALSO OFFERS RECREATIONAL PROGRAMS, REHABILITATIVE SERVICES AND SOCIAL SERVICES. 1178452 2813097 THE MANNING FAMILY RECOVERY CENTER (MFRC) PROVIDES SAFE, EFFICIENT, AND EFFECTIVE CHEMICAL DEPENDENCY TREATMENT TO CHEMICALLY DEPENDENT INDIVIDUALS AND THEIR FAMILIES ACROSS IOWA AND NEBRASKA. SERVICES INCLUDE DETOX AND OUTPATIENT CHEMICAL DEPENDENCY TREATMENT, CO-DEPENDENCY TREATMENT, AFTERCARE, OUTREACH SERVICES, EMPLOYEE ASSISTANCE PROGRAMMING, AND OWI EVALUATION/EDUCATION. THE MFRC IS A 13-BED CO-ED MULTI-LEVEL TREATMENT CENTER. 11654341 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 36 0 1 233 1 1 1 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ABBEY L STANGL CFO 7126558123 410 MAIN STREET MANNING IA 51455 RANDY BEHRENS 1.00 0.00 X X 0 0 0 SHARON KELDERMAN 0.50 0.00 X X 0 0 0 VIRGINIA RASMUSSEN 0.50 0.00 X X 0 0 0 LARRY HAGEDORN 0.50 0.00 X 0 0 0 RUTH OHDE 0.50 0.00 X 0 0 0 BRET RICHARDS 0.50 0.00 X 0 0 0 JOHN O'BRIEN 40.00 0.00 X 146649 0 9819 ABBEY STANGL 40.00 0.00 X 83443 0 28474 AMY DAWSON 40.00 0.00 X 81649 0 24851 DR TRACY KAHL 40.00 0.00 X 344881 0 25948 DR DOUGLAS MCLAWS 40.00 0.00 X 250447 0 25420 907069 0 114512 3 0 1 0 ACI BOLAND 1421 E 104TH STREET SUITE 100 KANSAS CITY MO 64131 ARCHITECTURAL SERVICES 976625 FAWAD ZAFAR MD PC 13682 LAKESHORE DRIVE CLIVE IA 50325 EQUIPMENT RENTAL 183050 ST ANTHONY REGIONAL HOSPITAL 311 S CLARK STREET CARROLL IA 51401 PHYSICAL/OCCUPATIONAL THERAPY SERVICES 177904 MANNING PHARMACY 317 MAIN STREET MANNING IA 51455 PHARMACIST 136954 SEIM JOHNSON 18081 BURT STREET SUITE 200 OMAHA NE 68022 AUDITING/TAX/CONSULTING SERVICES 125401 5 24154 39130 63284 PATIENT REVENUE 624100 6561929 6561929 MEDICARE PAYMENTS 624100 4357345 4357345 MEDICAID PAYMENTS 624100 2439276 2439276 EMR INCENTIVE PAYMENTS 624100 37543 37543 IMMUNIZATION CLINIC REVENUE 624100 9325 9325 17838 17838 13423256 12733 12733 2500 0 2500 2500 2500 3192 -3192 -3192 -3192 CAFETERIA REVENUE 624100 47326 47326 47326 13545907 13423256 0 59367 374885 374885 5789236 5453576 335660 101291 98566 2725 735616 735616 440883 395529 45354 197720 197720 16844 16844 69892 69892 1279092 1224020 55072 160853 160853 1149311 966910 182401 229607 196543 33064 58685 49018 9667 29670 29670 997472 887750 109722 191223 183012 8211 MEDICAL SUPPLIES 924463 924463 BAD DEBT EXPENSE 200476 200476 DUES & SUBSCRIPTIONS 132644 62255 70389 MISCELLANEOUS EXPENSES 129390 86084 43306 13209253 11654341 1554912 0 116 5576426 5431948 1438743 1628034 30000 30000 305348 73356 166978 152370 67978 55284 20555468 8125089 4906186 12430379 293704 0 76079 68025 106870 608926 12968312 20478438 860374 2444000 1235000 7483247 1079643 421242 3175017 10348489 X 9489424 10090982 303871 38967 9793295 10129949 12968312 20478438 336654 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3390 3390 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MANNING REGIONAL HEALTHCARE CENTER (MRHC) PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA), IOWA HEALTH CARE ASSOCIATION (IHCA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. IN FY 2013, MRHC PAID DUES OF $5,951, 4,052, AND 6,028 OF WHICH 23%, 14.2% AND 23.98%, REPECTIVELY, WERE ESTIMATED TO BE NON-DEDUCTIBLE EXPENSES (BY THE ASSOCIATIONS) FOR LOBBYING ACTIVITIES. 428518 428518 6357877 4983443 1374434 3224462 2407255 817207 10544611 734391 9810220 12430379 CAPITAL LEASE OBLIGATIONS 16206 DUE TO FISCAL INTERMEDIARY 314118 DEFERRED MEDICARE REVENUE 90918 421242 X 13345431 0 13345431 200476 200476 13545907 13008777 0 13008777 200476 200476 13209253 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HEALTHCARE CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HEALTHCARE CENTER HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HEALTHCARE CENTER TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HEALTHCARE CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTHCARE CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2013, THE HEALTHCARE CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE HEALTHCARE CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS ENDED PRIOR TO 2010. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 200,476. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 200,476. 1 1 1 X 1 X 190.000000000000 1 1 1 0 1 1 48 204559 0 204559 0.01570 66443 0 66443 0.00510 48 271002 271002 0.02080 316 7145 7145 0.00050 305 13415 13415 0.00100 621 20560 20560 0.00150 669 291562 291562 0.02230 1 200476 3801899 3749536 52363 X 1 1 1 1 MANNING REGIONAL HEALTHCARE CENTER

410 MAIN STREET MANNING IA 51455

X X X X OUTPATIENT PHYSICIAN CLINIC, SKILLED NURSING FACILITY, CHEM DEP REHAB CENTER MANNING REGIONAL HEALTHCARE CENTER 1 1 X X X X X X X 12 1 0 1 X X 1 0 1 1 100.000000000000 1 190.000000000000 0 1 1 X X 1 0 X X X 1 X 0 0 1 MANNING REGIONAL HEALTHCARE CLINIC

321 CENTER STREET MANNING IA 51455

HEALTHCARE CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 7: THE PATIENT CARE COST TO CHARGE RATIO WAS USED TO DETERMINE CHARITY CARE AT COST. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST AS DERIVED FROM MANNING REGIONAL HEALTHCARE CENTER'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: THERE ARE NO SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 200476. PART II: THE ORGANIZATION CURRENTLY DOES NOT ENGAGE IN COMMUNITY BUILDING ACTIVITIES. METHODOLOGY USED BY THE ORGANIZATION TO ESTIMATE BAD DEBT EXPENSE: PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTHCARE CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTHCARE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTHCARE CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE, NET," "NET PATIENT SERVICE REVENUE," AND "CHARITY CARE":PATIENT ACCOUNTS RECEIVABLE, NET:THE HEALTHCARE CENTER REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTHCARE CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTHCARE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTHCARE CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN INTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE HEALTHCARE CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING BALANCES OWED.NET PATIENT SERVICE REVENUE:THE HEALTHCARE CENTER HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HEALTHCARE CENTER AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.CHARITY CARE:THE HEALTHCARE CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HEALTHCARE CENTER DOES NOT PURSUE COLLECTION OF THESE AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEARS ENDED JUNE 30, 2013 AND 2012 WERE APPROXIMATELY $102,000 AND $44,000, RESPECTIVELY. PART III, LINE 8: "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT, D, E, H AND M WORKSHEETS, OR PS&R. PART III, LINE 9B: PART 1 OF THE PATIENT FINANCIAL ASSISTANCE POLICY "GUIDELINES" SECTION PROVIDES THAT ONCE THE RESPONSIBLE PARTY HAS BEEN DETERMINED TO BE ELIGIBLE FOR PATIENT FINANCIAL ASSISTANCE, A BILL WILL NOT BE SENT TO THE REPSONSIBLE PARTY. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 3: THE HEALTHCARE CENTER INVITED COMMUNITY MEMBERS TO MEETINGS REGARDING THE CHNA AND FROM THERE CONDUCTED SURVEYS TO REACH THE MAJORITY OF THE POPULATION. THE HEALTHCARE CENTER ALSO COLLABORATED WITH MEMBERS OF VARIOUS HEALTH IMPROVEMENT PLAN COMMITTEES FROM CARROLL COUNTY PUBLIC HEALTH. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 5C: THE COMMUNITY HEALTH NEEDS ASSESSMENT RESULTS CAN BE VIEWED AT HTTP://WWW.MRHCIA.COM/WORDPRESS/WP-CONTENT/UPLOADS/2013/07/COMPLETE-2013-CHNA-REPORT.PDF MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 18E: IN OCTOBER 2012, MANNING REGIONAL HEALTHCARE CENTER CONTRACTED WITH A THIRD PARTY ORGANIZATION (MARS), AS AN EARLY OUT COLLECTION VENDOR. PART OF THE PROCESS MARS PERFORMS ON BEHALF OF MRHC IS TO CALL PATIENTS, INFORM THEM OF THE OPTION OF FINANCIAL ASSISTANCE, AND SEND THE PATIENT THE APPLICATION SHOULD THEY BE QUALIFIED OR REQUESTED IT. MARS DOCUMENTS THE PATIENT COMMUNICATIONS WITHIN OUR PATIENT MANAGEMENT SYSTEM. MANNING REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 20D: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS SILENT ON THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. PART VI, LINE 2: MANNING REGIONAL HEALTH CENTER INCLUDES INPUT AND INFORMATION FROM REPRESENTATIVES OF THE MEDICAL STAFF, BOARD COMMITTEE, AND HOSPITAL ADMINISTRATIVE STAFF TO REVIEW THE TREATMENT OF PATIENTS TO DETERMINE MEDICAL NECESSITY AND OTHER CRITERIA ARE MET IN ORDER TO PROMOTE MAXIMUM TREATMENT BENEFITS. THIS GROUP OVERSEES THE QUALITY OF PATIENT CARE, ASSURING RESOURCES ARE USED APPROPRIATELY TO PROMOTE OPTIMAL PATIENT CARE.MANNING REGIONAL HEALTH CENTER ALSO PARTICIPATED IN AND SET GOALS BASED ON A HEALTH NEEDS ASSESSMENT PERFORMED BY CARROLL COUNTY, IOWA. PART VI, LINE 3: PATIENTS ARE MADE AWARE THROUGH A FINANCIAL ASSISTANCE INFORMATION PACKET, USUALLY OBTAINED AT ADMISSION. THOSE WITHOUT INSURANCE ARE PROVIDED THE INFORMATION PACKET AT ADMISSION, AND THE PACKET IS PROVIDED AS PART OF THE DISCHARGE PROCESS FOR ER SERVICES. ADDITIONALLY, MANNING REGIONAL HEALTH CARE CENTER HAS CONTRACTED WITH A THIRD-PARTY VENDOR FOR BILLINGS AND COLLECTIONS. THE VENDOR CONTACTS FORMER PATIENTS BY TELEPHONE DURING THE 2ND 30 DAYS THAT AN INVOICE IS PAST DUE. PATIENTS ARE SCREENED FOR FINANCIAL ASSISTANCE NEEDS WITH THAT TELEPHONE CALL.THE FINANCIAL ASSISTANCE INFORMATION PACKET, INCLUDING THE APPLICATION, ARE ALSO AVAILABLE ON THE HEALTH CENTER'S WEBSITE. PART VI, LINE 4: CITIES OF MANNING (POPULATION 1500), TEMPLETON (POPULATION 350), AND MANILLA (POPULATION 900) ALONG WITH OTHER SURROUNDING RURAL COMMUNITIES IN WEST CENTRAL IOWA. MANNING, IOWA IS 90 MILES NORTHWEST OF DES MOINES, IOWA, 80 MILES NORTHEAST OF OMAHA, NEBRASKA AND 80 MILES SOUTHEAST OF SIOUX CITY, IOWA. PART VI, LINE 5: MANNING GENERAL HOSPITAL PROVIDES OUTPATIENT CLINICS IN WHICH SPECIALTY DOCTORS COME TO MANNING ON A REGULAR BASIS. THE HOSPITAL ALSO SPONSORS FREE EDUCATIONAL SEMINARS ON VARIOUS HEALTH TOPICS TO THE COMMUNITY. THE MANNING FAMILY RECOVERY CENTER PROVIDES ALCOHOLICS ANONYMOUS, AL-ANON, AND NARCOTICS ANONYMOUS MEETINGS. THE CENTER ALSO PROVIDES A FREE, OPEN TO THE PUBLIC, EDUCATION PROGRAM THAT EXPLORES CHEMICAL DEPENDENCY AND ITS EFFECTS. PART VI, LINE 6: MANNING REGIONAL HEALTHCARE CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 IA 0 0 0 0 0 0 0 0 0 JOHN O'BRIEN 145703 0 0 0 946 0 0 0 9819 0 156468 0 0 0 DR TRACY KAHL 344881 0 0 0 0 0 7500 0 18448 0 370829 0 0 0 DR DOUGLAS MCLAWS 250447 0 0 0 0 0 0 0 25420 0 275867 0 0 0 A CITY OF TEMPLETON IOWA 426005274 2012-11-28 10000000 FINANCE ACQUISITION AND CONSTRUCTION OF PROJECT 0 0 0 B CITY OF MANNING IOWA 426004919 2012-11-28 10000000 FINANCE ACQUISITION AND CONSTRUCTION OF PROJECT 0 0 0 A 156345 156345 0 0 0 1 B 7326902 39166 174273 7113462 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) AS THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND THE TOTAL PRINCIPAL AVAILABLE HAS NOT YET BEEN DRAWN. DR MCLAWS SIGNING AND STARTING BONUS X 30000 30000 0 1 1 30000 FORM 990, PART VI, SECTION A, LINE 3 MANAGED CONTRACT AFFILIATION AGREEMENT WITH MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, IOWA - THE ADMINISTRATOR OF MANNING REGIONAL HEALTHCARE CENTER (MRHC) IS AN EMPLOYEE OF MERCY BUT REPORTS TO THE MRHC BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCIAL STATEMENT PREPARATION AND RECORDING PROCESSES OF MRHC ARE THE PRIMARY RESPONSIBILITIES OF ABBEY STANGL, CFO. UPON THE ISSUANCE OF THE FORM 990 ORGANIZER FROM THE TAX RETURN PREPARER, SEIM JOHNSON, LLP, THE CFO BEGINS TO PREPARE DOCUMENTATION FOR THE FORM 990. UPON THE SUBMISSION OF THE FORM 990 ORGANIZER TO THE PREPARER, ANY QUESTIONS ARE CLARIFIED AND ANSWERED. PRIMARY REVIEWING RESPONSIBILITY OF THE FORM 990 LIES WITH THE CFO, THE CEO, AND THE FINANCE SUB-COMMITTEE OF THE BOARD OF DIRECTORS, WHICH ENABLES BOARD REVIEW DURING INTERIM BOARD MEETING PERIODS. IT IS ALWAYS THE INTENT TO HAVE THE FORM 990 PREPARED AND REVIEWED PRIOR TO THE INITIAL FILING DEADLINE, BUT IF FOR ANY REASON THIS CANNOT BE ACHIEVED, REQUESTS TO EXTEND THE FILING DEADLINE ARE FILED. EACH MEMBER OF THE BOARD OF DIRECTORS IS GIVEN A COPY OF THE FORM 990 TO REVIEW BEFORE FILING IS COMPLETED. FORM 990, PART VI, SECTION B, LINE 12C THROUGHOUT THE YEAR, ANY ISSUE THAT INVOLVES A CONFLICT OF INTEREST WITH A TRUSTEE, DIRECTOR, OFFICER, OR KEY EMPLOYEE WOULD REQUIRE THAT THE INDIVIDUAL BE SEPARATED FROM THE DECISION-MAKING PROCESS RELATED TO THE POTENTIAL CONFLICT OF INTEREST. IN REGARD TO ANNUAL COMPLIANCE, THE REFERENCE TO THE CONFLICT OF INTEREST POLICY OUTLINES CURRENT PRACTICES. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FULFILLMENT OF THIS OBJECTIVE WILL FALL UNDER THE MRHC ADMINISTRATIVE POLICY REVIEW PROCESS. FORM 990, PART VI, SECTION B, LINE 15 MANNING REGIONAL HEALTHCARE CENTER (MRHC) DETERMINES COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES BY CONSULTING THE CURRENT IOWA HOSPITAL ASSOCIATION (IHA) SALARY SURVEY. THIS SURVEY IS DONE ANNUALLY WITH THE HOPE OF GETTING 100% PARTICIPATION OF ALL IOWA HOSPITALS. MRHC USES THE INFORMATION FROM ITS PEER GROUP AS COMPARATIVE DATA FOR DETERMINING WAGES. THE PEER GROUP IS SELECTED BY MRHC AND CONSISTS OF HOSPITALS IN THE VICINITY OF MRHC AND HOSPITALS THAT ARE APPROXIMATELY THE SAME SIZE AS MRHC. MRHC WILL ALSO FACTOR IN YEARS OF EXPERIENCE WHEN DETERMINING WAGES FOR NEWLY HIRED EMPLOYEES OR WHETHER OR NOT MARKET INCREASES ARE NEEDED FOR EXISTING KEY EMPLOYEES OR OFFICERS. IN ADDITION TO ASSESSING MARKET INFORMATION, ANY ANNUAL COMPENSATION INCREASES (I.E. - MERIT RAISES) ARE DETERMINED BY ASSESSING FACILITY-WIDE FINANCIAL PERFORMANCE AND INSTITUTED CONSISTENTLY FOR ALL POSITIONS FACILITY-WIDE. FOR THE CEO POSITION SPECIFICALLY, AS THAT POSITION IS MANAGED THROUGH MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, THE SALARY AND COMPENSATION IS DETERMINED BY SARA DROBNICH, MERCY NETWORK VICE PRESIDENT, IN CONJUNCTION WITH THE MRHC BOARD OF DIRECTORS. TO DETERMINE THE SALARY, THE IHA SALARY SURVEY IS FIRST REVIEWED, WHICH RECOGNIZES SALARY RANGES BASED ON HOSPITAL REVENUES, NUMBER OF FTE'S AND ALSO BASED ON CAH. A CHICAGO-BASED COMPANY, HR ADVANTAGE, IS ALSO USED IN A SURVEY COMPILING COMMUNITY DEMOGRAPHICS. FORM 990, PART VI, SECTION C, LINE 19 MRHC PROVIDES INFORMATION REGARDING THESE DOCUMENTS TO INDIVIDUALS AND BUSINESSES UPON REQUEST. AS THE ORGANIZATION IS A NOT-FOR-PROFIT ENTITY, IRS FILINGS ARE AVAILABLE VIA THE IRS WEBSITE AND PUBLIC PORTALS (I.E. GUIDESTAR) THAT FACILITATE THE PRESENTATION OF THIS DATA. FORM 990, PART XI, LINE 2C THE BOARD OF DIRECTORS TAKES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.