2012-05-01T13:38:26-05:00 2011-06-30 MCGLADREY & PULLEN LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2010-07-01 420698295 MERCY MEDICAL CENTER MERC 3193986107 701 10TH STREET SE CEDAR RAPIDS IA 52403 PHILIP PETERSON 3193986107 2012-04-02 1 JOHN J ROMANO 5638884000 2010 2016-02-24 21:20:13Z PHILIP PETERSON 701 10TH STREET SE CEDAR RAPIDS IA 52403 322256772 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. 34 33 2694 687 1439303 -154501 7157145 3118270 249637180 267529503 6064869 9849536 -2188342 -1795271 260670852 278702038 3169250 3213138 0 0 113234696 117488859 0 0 0 120113865 136863974 236517811 257565971 24153041 21136067 420370403 465167371 166162089 160509805 254208314 304657566 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 231800988 3213138 267529503 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 SUBSTANITALLY 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) - $24,116,000; OTHER COMMUNITY BENEFITS (INCLUDES SUBSIDIZED HEALTH SERVICES, FINANCIAL CONTRIBUTIONS) - $4,195,000; FREE SERVICE (TO PATIENTS WHO MEET MERCY'S FREE-SERVICE GUIDELINES) - $5,074,000; COSTS IN EXCESS OF MEDICAID REIMBURSEMENT (COSTS OF PROVIDING THE SERVICES LESS THE AMOUNTS RECEIVED FROM MEDICAID) - $4,320,000; PHYSICIAN EDUCATION - $882,000.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 66,000 HOUSEHOLDS IN 2011 AT A TOTAL COST OF OVER $54,000. B. PUBLIC AND PROFESSIONAL EDUCATIONAL SEMINARS OFFERED ON TOPICS INCLUDING AGING, BACK AND NECK PAIN, BREAST FEEDING, DIABETES, DISC DISEASE, EATING DISORDERS, MIGRAINE HEADACHES, MULTIPLE SCLEROSIS, OSTEOPOROSIS, PMS, PARENTING, PARKINSON'S DISEASE, PRENATAL CARE, STROKES AND WELLNESS, SPECIALIZED CANCER SEMINARS FOR CLERGY, 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 KIDS FIRST, AMERICAN HEART ASSOCIATION, OVEREATERS ANONYMOUS, AL-ANON, CATHOLIC LAYMEN, UNITED WAY, CATHERINE MCAULEY CENTER FOR WOMEN, AND THE AMERICAN CANCER SOCIETY. D. CONTRIBUTIONS OF 109,300 HOURS TOWARD THE COMMON PURPOSE OF SERVING THE HEALTH CARE OF THE COMMUNITY. THE VALUE OF THESE CONTRIBUTIONS WAS APPROXIMATELY $1,221,000 AND WAS GIVEN BACK THE THE COMMUNITY THROUGH LOWER COSTS. 231800988 1 1 0 1 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 0 0 0 0 0 0 1 1 1 0 0 1 274 0 1 2694 1 1 1 0 0 0 0 0 0 0 0 0 X 34 33 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 IA X KAY CRIST 3193986107 701 10TH STREET SE CEDAR RAPIDS IA 52403 KYLE SKOGMAN 1.00 X X 0 0 0 TOM REED 1.00 X X 1002 0 0 SISTER SHARI SUTHERLAND 1.00 X X 0 0 0 EMMETT SCHERRMAN 1.00 X X 0 0 0 TIM CHARLES 1.00 X X 495984 0 111814 LYDIA BROWN 1.00 X 0 0 0 MICHELE BUSSE 1.00 X 0 0 0 JACK COSGROVE 1.00 X 747 0 0 BARRIE ERNST 1.00 X 0 0 0 TONY GOLOBIC 1.00 X 0 0 0 SISTER LUANN HANNASCH 1.00 X 0 0 0 DON HATTERY 1.00 X 0 0 0 JOE HLADKY 1.00 X 0 0 0 JAN KAZIMOUR 1.00 X 0 0 0 BARB KNAPP 1.00 X 0 0 0 LEE LIU 1.00 X 0 0 0 SISTER TERRY MALTBY 1.00 X 0 0 0 BRUCE MCGRATH 1.00 X 0 0 0 TOM MCINTOSH MD 1.00 X 0 0 0 CHERYLE MITVALSKY 1.00 X 0 0 0 DARREL MORF 1.00 X 0 0 0 DAVE NEUHAUS 1.00 X 0 0 0 RUE PATEL 1.00 X 0 0 0 FRED PILCHER MD 1.00 X 0 0 0 MARY QUASS 1.00 X 0 0 0 SISTER LAURA REICKS 1.00 X 0 0 0 JOHN RIFE 1.00 X 0 0 0 CHARLIE ROHDE 1.00 X 0 0 0 AL RUFFALO 1.00 X 0 0 0 JOHN SMITH 1.00 X 0 0 0 SISTER MAURITA SOUKUP 1.00 X 0 0 0 BOB VERHILLE 1.00 X 0 0 0 SISTER MARGARET WEIGEL 1.00 X 0 0 0 STEPHEN MAZE MD 1.00 X 0 0 0 PHILIP PETERSON 40.00 X 321047 0 40864 BETH HOULAHAN 40.00 X 217851 0 24298 KARL KEELER 40.00 X 226646 0 23506 KATHY KRUSIE 40.00 X 123990 0 15318 DR MARK VALLIERE 40.00 X 394090 0 34604 JEFFREY CASH 40.00 X 225447 0 39039 LARRY DONALDSON 40.00 X 158641 0 9200 HUI LI 40.00 X 214354 0 18420 DESMOND WATERS 40.00 X 138083 0 14798 LAURA REED 40.00 X 131310 0 16081 A JAMES TINKER 1.00 X 121776 26000 4835 2646978 26000 337459 40 1 1 0 HOSPITALIST MEDICINE PHYSICIANS 4535 DRESSLER RD NW CANTON OH 44718 HEALTHCARE PROFESSIONAL SERVICES 2902367 VITAL SUPPORT SYSTEMS LLC 11191 AURORA AVENUE URBANDALE IA 50322 HARWARE, SOFTWARE, AND I/S SUPPORT SERVI 1766329 OPN ARCHITECTS INC 200 FIFTH AVENUE SUITE 201 CEDAR RAPIDS IA 52401 DESIGN SERVICES 1729944 PREFERRED MEDICAL DEPOSIT INC 10604 JUSTIN DRIVE DES MOINES IA 50322 COLLECTION SERVICES 1481601 MERCY PHYSICIAN SERVICES 311 3RD AVENUE SE CEDAR RAPIDS IA 52403 HEALTHCARE PROFESSIONAL SERVICES 783111 32 3065560 52710 3118270 PATIENT REVENUES 900099 218439402 218439402 LABORATORY REVENUE 621500 48348033 46919382 1428651 FITNESS CENTER REVENUE 900099 484194 484194 FAMILY COUNSELING REVE 624100 257874 257874 267529503 3684031 3684031 1681577 1225981 455596 455596 455596 44772775 1234006 38353230 1488046 6419545 -254040 6165505 6165505 2547836 2487477 60359 60359 MRI MR ASSOCIATES 621110 2822782 2822782 PARTNERSHIP ORDINARY I 561000 10652 10652 MRI JOINT VENTURE 621110 -5144660 -5144660 -2311226 278702038 263778974 1439303 10365491 3213138 3213138 1823601 1823601 85653095 78052526 7600569 7883816 7050268 833548 15827182 14231536 1595646 6301165 5620093 681072 57763 57763 276799 276799 147376 147376 24938 24938 162821 162821 9559413 6714838 2844575 1778659 1698204 80455 55178121 52995870 2182251 6829500 6808216 21284 65910 65910 3367956 543523 2824433 269473 155167 114306 32708 32708 2982560 2982560 18676737 15267569 3409168 936846 346 936500 BAD DEBT EXPENSE 19374587 19374587 REPAIRS 5154621 5154621 CONTRACTED SERVICES 4755409 4755409 EQUIPMENT RENTAL & MAIN 2714650 2714650 RESIDENCY EXPENSE 1665028 1665028 2852099 2621520 230579 257565971 231800988 25764983 0 503844 629158 33184130 28004569 35957106 39341216 2859486 2172243 4903950 5255100 1810711 2437953 349855042 171888640 169689333 177966402 47245888 58887930 74534878 93390859 49623480 56969239 57597 112702 420370403 465167371 24964222 30402376 84205000 81800000 56992867 48307429 166162089 160509805 X 224744236 272378106 7089893 9394869 22374185 22884591 254208314 304657566 420370403 465167371 X 21136067 29313185 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24938 24938 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 21.4% OF MEMBERSHIP DUES TO THE IOWA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES, OR $24,938. 27886845 151882 2300310 543500 29795537 26505127 234657 1633447 486386 27886845 29036036 2000 -2532909 26505127 0.13060 0.76800 0.10140 0 1 1 12728692 12728692 225488869 109044699 116444170 2730133 1875320 854813 108907348 60968621 47938727 177966402 COMMERCIAL PAPER & CASH 12299754 F MONEY MARKET FUNDS 11438 F MUTUAL FUNDS, INVESTED IN CORP BONDS, LLPS & REAL ESTATE 81079667 F 93390859 INVESTMENT IN AFFILIATES 53032148 F DEFERRED FINANCING COSTS 569091 C INVESTMENT IN CEDAR RAPIDS PHO 678000 F SLEEP LAB JOINT VENTURE 1123000 F INVESTMENT IN MR ASSOCIATES 767000 C INVESTMENT IN MEDICAL MALL 800000 F 56969239 INTEREST RATE SWAP AGREEMENTS 7198573 PENSION LIABILITY 33391282 SELF INSURANCE RESERVES 6588140 THIRD PARTY SETTLEMENTS 1016732 NET EQUITY IN MERCY MEDICAL CENTER AUXILIARY 56544 NET EQUITY IN MERCY MEDICAL CENTER FLOWER SHOP 56158 48307429 278702038 257565971 21136067 13231280 16081905 29313185 50449252 307130348 13231280 13708402 26939682 280190666 -1488628 -1488628 278702038 256681096 1901747 1901747 254779349 2786622 2786622 257565971 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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 CANCER CENTER, NEUROSCIENCES, HOSPICE OF MERCY, HOSPICE HOUSE, PATIENT CARE, TRAUMA CENTER, ESPECIALLY FOR ME, FIT FAMILIES, HALLMAR, HUSTON FUND (RADIOLOGY), EDUCATIONAL SCHOLARSHIPS, LIPSKY EDUCATIONAL FUND, BENEFICIAL INTERESTS IN REMAINDER & PERPETUAL TRUSTS, WATTS LIBRARY, MERCY MEDICAL CENTER CAPITAL PROJECTS, AND GENERAL ENDOWMENT FUNDS TO BE USED AT THE BOARD OF DIRECTORS' DISCRETION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 (UBIT). UBIT 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, 2011 AND 2010, 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 8 - OTHER ADJUSTMENTS: CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY AND GIFT SHOP CONTRIBUTION REVENUE RECORDED AS A LIABILITY PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 2,273,736. CHANGE IN UNRECOGNIZED FUNDED STATUS OF RETIREMENT PLAN 7,825,992. CHANGE IN INTEREST IN NET ASSETS OF MERCY MEDICAL CENTER FOUNDATION 6,628,816. GRANT TO MERCARE SERVICE CORPORATION INCLUDED WITH REVENUES -2,500,000. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) -304,102. OTHER CEDAR RAPIDS PHYSICIAN-HOSP ORG LC K-1 INCOME 46,380. AUXILIARY CONTRIBUTION EXPENSE INCLUDED IN REVENUE -200,920. GRANT EXPENSE INCLUDED WITH REVENUE -61,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES -1,844,160. LOSS ON SALE OF FIXED ASSETS -60,763. AUXILIARY AND FLOWER SHOP REVENUE NOT INCLUDED IN AUDIT REPORT 32,535. RENTAL REVENUE IN EXPENSES ON REPORT 2,096. CONTRIBUTION REVENUE INCLUDED IN EXPENSE ON REPORT 3,176. RECLASSIFICATION OF EFY CONTRIBUTION REVENUE 378,488. PART XIII, LINE 2D - OTHER ADJUSTMENTS: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES 1,844,160. LOSS ON SALE OF FIXED ASSETS 60,763. CONTRIBUTION REVENUE INCLUDED WITH EXPENSE ON REPORT -3,176. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GRANT TO MERCYCARE SERVICE CORPORATION INCLUDED WITH REVENUES 2,500,000. ADDITIONAL BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME/(LOSS) 22,106. RENTAL REVENUE IN EXPENSES ON REPORT 2,096. AUXILIARY CONTRIBUTION EXPENSE INCLUDED IN REVENUE 200,920. GRANT EXPENSE INCLUDED WITH REVENUE 61,500. 1 1 1 X 1 X 1000.000000000000 1 1 1 0 1 1 5073963 0 5073963 0.02130 15931675 11612345 4319330 0.01810 21005638 11612345 9393293 0.03940 951253 0 951253 0.00400 2199762 878312 1321450 0.00550 9358162 7109098 2249064 0.00940 325716 0 325716 0.00140 12834893 7987410 4847483 0.02030 33840531 19599755 14240776 0.05970 19509 19509 0.00010 15970 15970 0.00010 264 264 0.00000 189769 189769 0.00080 4327 4327 0.00000 229839 229839 0.00100 1 6154638 95598663 118714706 -23116043 X 1 1 1 MR ASSOCIATES LLP PROVIDES MRI SERVICES 0.33000 0.00000 0.33000 2 EASTERN IOWA SLEEP CENTER LLC PROVIDES SLEEP STUDIES 0.33000 0.00000 0.33000 3 CEDAR RAPIDS PHYSICIAN HOSPITAL ORGANIZATION PROVIDES PAYOR CONTRACTING 0.38000 0.00000 0.62000 4 PCI REGIONAL MED MALL LLC REAL ESTATE 0.10000 0.00000 0.80000 1 1 MERCY MEDICAL CENTER

701 10TH STREET SE CEDAR RAPIDS IA 52403

X X X X NA 1 PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: THE FOLLOWING COSTS ARE CALCULATED BASED ON THE COST TO CHARGE RATIO CALCULATED ON WORKSHEET 2: MEDICAID, FREE CLINIC SERVICES, CHARITY CARE, MEDICARE, AND BAD DEBTS. PART I, LINE 7G: THE FOLLOWING PROGRAMS AND SERVICES ARE SUBSIDIZED BY MERCY MEDICAL CENTER (MERCY) TO ADDRESS COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH OUR COMMUNITY ASSESSMENT PROCESS:MERCY'S JOSLIN DIABETIC CENTER: ONLY ONE OF EIGHT FACILITIES OF ITS KIND IN IOWA, MERCY'S JOSLIN DIABETES CENTER (JOSLIN) PROVIDES DIABETES PATIENTS AND THEIR FAMILY MEMBERS WITH THE COMPREHENSIVE INFORMATION THEY NEED TO BETTER MANAGE THIS DISEASE AND DECREASE THEIR RISK FOR COMPLICATIONS. JOSLIN DIABETES CENTER TEAM MEMBERS INCLUDE AN ENDOCRINOLOGIST, NURSE EDUCATORS, DIETITIAN EDUCATORS, A PODIATRIST AND AN EXERCISE SPECIALIST. DIABETES EDUCATION AND INSULIN MANAGEMENT SERVICES ARE PROVIDED FOR CHILDREN (TODDLER THROUGH ADOLESCENTS) AND ADULTS (ALL AGES). MEDICAL DIABETES CARE IS PROVIDED FOR ADOLESCENTS AND ADULTS. THE ESTIMATED NUMBER OF PATIENTS WITH DIABETES OR PRE-DIABETES IN THE PRIMARY SERVICE AREA IS 14,000. JOSLIN SERVED 1,279 PATIENTS THROUGH 4,465 PATIENT VISITS FROM JULY 2010-JUNE 2011.EACH SUMMER JOSLIN PLAYS A KEY ROLE IN A ONE-WEEK DIABETES CAMP HELD AT CAMP TANAGER IN MOUNT VERNON FOR CHILDREN WITH DIABETES. JOSLIN EXPERTS EDUCATE THE CAMP STAFF ABOUT DIABETES, AND PROVIDE NURSING AND DIETARY SUPPORT. JOSLIN ALSO DONATES EQUIPMENT AND SUPPLIES USED AT THE CAMP.FOR ONE WEEK CHILDREN WITH DIABETES CAN RELISH THE OPPORTUNITY TO BE WITH THEIR PEERS AND NOT FEEL "DIFFERENT." AS AN ADDED BONUS, PARENTS CAN RELAX AND REST ASSURED THAT THEIR CHILD IS IN A SAFE PLACE WHERE ANY SPECIAL NEEDS ARE SURE TO BE MET. THIS EXPERIENCE ENHANCES THE QUALITY OF LIFE FOR THESE CHILDREN AND CREATES LONG-LASTING MEMORIES FOR THEM.BEHAVIORAL HEALTH SERVICES: MERCY SERVES PATIENTS WHO ARE IN A CRISIS STATE RELATED TO A MENTAL HEALTH, CHEMICAL DEPENDENCY OR CO-OCCURRING MENTAL HEALTH AND CHEMICAL DEPENDENCY DIAGNOSIS. PATIENTS ORIGINATE FROM LINN COUNTY AND THE SECONDARY SERVICE AREA. IN FY 2011, MERCY REPORTED 6,025 INPATIENT DAYS. OTHER SERVICES INCLUDE THE ACCESS DEPARTMENT WHICH PROVIDES TRIAGE IN THE EMERGENCY DEPARTMENT, CONSULTATIONS THROUGHOUT THE HOSPITAL, AND PROVIDES A 24 HOUR CRISIS TELEPHONE LINE. 2,578 CLIENTS ARE EVALUATED AND REFERRED TO INPATIENT OR OUTPATIENT SERVICES. IN ADDITION, MERCY HANDLED 3,165 CRISIS PHONE CALLS AND MADE THE APPROPRIATE OUTPATIENT/COMMUNITY REFERRALS OR ARRANGED TO BRING PATIENTS IN FOR EVALUATION IN THE EMERGENCY DEPARTMENT. INDIVIDUALS EXPERIENCING MULTIPLE LIFE STRESSORS ARE MOST VULNERABLE AND NEED BEHAVIOR HEALTH ASSISTANCE AND COPING MECHANISMS. MANY INDIVIDUALS ARE IMPACTED BY THE EFFECTS OF THE NATIONAL ECONOMIC DOWNTURN, AND BEHAVIOR HEALTH SERVICES CONTINUES TO SERVE A ROLE IN PROVIDING MENTAL HEALTH AND CHEMICAL DEPENDENCY RESOURCES TO A GROWING NUMBER OF PEOPLE WHO REQUIRE SUPPORT.WHILE THE MISSION IS TO MEET THE NEEDS OF THE PRIMARY SERVICE AREA AND SECONDARY SERVICE AREA PATIENTS, MERCY HAS BEEN INCREASINGLY CALLED UPON TO MEET STATE-WIDE NEEDS AND HAS RECEIVED PATIENTS FROM AS FAR AWAY AS ILLINOIS. TRANSPORTATION IS PROVIDED TO SAFELY SEND PATIENTS BACK TO THEIR HOME LOCATION WITHOUT RECEIVING REIMBURSEMENT FROM THE SENDING COUNTIES. IOWA IS SUFFERING A SEVERE SHORTAGE OF MENTAL HEALTH BEDS, AND MENTAL HEALTH AND CHEMICAL DEPENDENCY RESOURCES. THERE ARE LONG WAITING LISTS FOR PATIENTS TO BE SEEN BY PSYCHIATRISTS AND MENTAL HEALTH OR CHEMICAL DEPENDENCY PROVIDERS. THIS SAME POPULATION IS FREQUENTLY EITHER UNINSURED OR THEIR MENTAL HEALTH BENEFITS ARE SEVERELY LIMITED OR CAPPED AT LOW LEVELS FOR A LIFETIME. THE STATE OF IOWA AND LINN COUNTY ARE TARGETING PATIENTS WITH CO-OCCURRING DISORDERS AS A PARTICULARLY DIFFICULT POPULATION TO TREAT AND HAVE HISTORICALLY POOR OUTCOMES. AS PART OF THIS STATE AND COUNTY WIDE INITIATIVE, THE BEHAVIORAL HEALTH UNIT IS PARTICIPATING IN DATA COLLECTION, STAFF EDUCATION AND CONSISTENT TREATMENT INITIATIVES THAT HAVE BEEN IDENTIFIED AS EVIDENCED BASE BEST PRACTICE. WHEN PATIENTS CANNOT AFFORD DISCHARGE MEDICATIONS, MERCY PROVIDES AN INITIAL 30-DAY SUPPLY TO PREVENT IMMEDIATE READMISSION DUE TO NONCOMPLIANCE BECAUSE OF FINANCIAL CONSTRAINTS. THE STATE OF IOWA IS NOW FACING AN IMMINENT CHANGE IN HOW MENTAL HEALTH RESOURCES ARE BEING ADMINISTERED AND FUNDED. UNDER NEW REFORM INITIATIVES, RESIDENTIAL BEDS ARE CLOSING, THERE ARE WAITING LISTS FOR TREATMENT AND MEDICATION APPROVAL AND OUTPATIENT SERVICES ARE BEING CUT OR DOWNSIZED. ALL OF THESE CHANGES WILL IMPACT LENGTH OF STAY, WHICH IN TURN IMPACTS BED AVAILABILITY AS TURNOVER SLOWS AND, PREDICTABLY, MAKES IT MORE DIFFICULT FOR PATIENTS TO REMAIN STABLE AND AVOID READMISSION. THE BEHAVIORAL HEALTH DEPARTMENT IS IMPLEMENTING A PROGRAM IN AN EFFORT TO STABILIZE PATIENTS FOLLOWING DISCHARGE AND REDUCE READMISSIONS THROUGH A PSYCHIATRIC HOME HEALTH NURSE. THE PROGRAM WAS LAUNCHED IN APRIL AND HAS WORKED WITH 14 PATIENTS THUS FAR. ONLY ONE OF THEM WAS READMITTED DURING HOME CARE FOLLOW-UP. TWO MORE WERE READMITTED AFTER THEY HAD COMPLETED HOME CARE. IN ADDITION, THE HOME PSYCH NURSE HAS PROVIDED VALUABLE RESOURCES TO THE MEDICAL PATIENTS WHO HAVE PSYCHIATRIC ISSUES AND ARE RECEIVING HOME HEALTH CARE. BIRTHPLACE AND NEONATAL INTENSIVE CARE UNIT (NICU): MERCY'S NICU/BIRTHPLACE HAS A FAMILY-CENTERED CARE APPROACH THAT STARTS BEFORE BIRTH WITH EDUCATIONAL CLASSES AND CONTINUES AFTER A FAMILY LEAVES THE HOSPITAL WITH THEIR BABY. A DAY OR TWO AFTER DISCHARGE A MERCY HOME NURSE VISITS THE HOME. THERE ALSO IS A WEEKLY BREASTFEEDING SUPPORT GROUP AVAILABLE TO NURSING MOTHERS AND NICU STAFF MEMBERS ARE AVAILABLE BY TELEPHONE 24-HOURS PER DAY. MERCY ALSO SUPPORTS A DEVELOPMENTAL CLINIC, WHICH FOLLOWS UP ON MERCY NICU BABIES AT REGULAR INTERVALS UP TO AGE 30 MONTHS. THE PURPOSE OF THE OBSTETRIC HOME VISIT PROGRAM IS TO PROVIDE SUPPORT AND EDUCATION TO PARENTS OF NEWBORNS AFTER THEIR DISCHARGE FROM THE HOSPITAL AND BEFORE THEIR FIRST VISIT TO THEIR HEALTHCARE PROVIDER AT APPROXIMATELY TWO WEEKS OF AGE. WHEN MOTHER AND NEWBORNS STARTED DISCHARGING FROM THE HOSPITAL TWO OR THREE DAYS AFTER BIRTH, THERE WERE A NUMBER OF CASES WHERE BABIES AND SOMETIMES MOTHERS DEVELOPED SERIOUS MEDICAL CONDITIONS WHICH WERE NOT IDENTIFIED UNTIL THEY WERE SERIOUSLY COMPROMISED. THE HOME VISIT BY A NURSE IS SET UP TO PREVENT SUCH SITUATIONS. ALL MOTHERS DISCHARGED FROM BIRTHPLACE ARE OFFERED A HOME VISIT IF THEY LIVE WITHIN A 30 MILE RADIUS, OR THEY ARE ENCOURAGED TO RETURN TO THE HOSPITAL FOR AN IN HOSPITAL VISIT IF THEY LIVE BEYOND THAT. THIS VISIT IS DONE WITHIN THE FIRST FEW DAYS THEY ARE HOME. THE MOTHER AND BABY ARE ASSESSED WITH VITAL SIGNS AND A WEIGHT CHECK ON THE BABY. ANY CONCERNS OR ISSUES ARE CALLED TO THE PHYSICIAN AND FOLLOWED UP. NUMBER SERVED: IN CALENDAR YEAR 2010, 781 WERE BABIES BORN AT THE BIRTHPLACE. SOME OF THE OUTCOMES ARE AS FOLLOWS: -WEIGHT LOSS AND FEEDING PROBLEMS WERE IDENTIFIED, CARE PLANS DEVELOPED, AND FOLLOW-UP WAS DONE TO ASSURE EFFECTIVENESS. -JAUNDICE WAS IDENTIFIED IN NEWBORNS, LABS DRAWN AND ORDERS RECEIVED TO PREVENT KERNICTERUS. -MATERNAL VITAL CHANGES WERE IDENTIFIED AND PHYSICIANS NOTIFIED WHEN NECESSARY. -EDUCATION IS REINFORCED AND DONE TO ASSURE A SAFE ENVIRONMENT FOR THE BABY AND MOM. -SAFETY ISSUES WERE IDENTIFIED IN THE ENVIRONMENT AND CORRECTED WHEN NECESSARY. -SIGNS AND SYMPTOMS OF POSTPARTUM DEPRESSION WERE IDENTIFIED AND ADDRESSEDPEDIATRICS: CHILDREN AGES 17 AND UNDER EXPERIENCE A CONTINUITY OF CARE TO REDUCE STRESS AND ENHANCE CARE. MERCY PROVIDES AGE-APPROPRIATE VIDEO GAMES, MOVIES, AND BOOKS TO HELP CHILDREN RELAX, REST, AND RECUPERATE. A PEDIATRIC CLINICAL NURSE SPECIALIST ASSISTS THE NURSES TO COORDINATE SERVICES FOR PATIENTS AND THEIR FAMILIES. MERCY'S FAST TRACK EMERGENCY DEPARTMENT ALSO OFFERS DISTRACTION KITS, MOVIES, ETC. TO EASE CHILDREN'S CONCERNS WHEN THEY NEED CARE IN THE EMERGENCY ROOM. PART I, L7 COL(F): $19,374,587 OF BAD DEBT EXPENSE IS SUBTRACTED FOR PURPOSES OF COMPUTING THE PERCENTAGE IN PART I, LINE 7K, COLUMN F. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES, LESS BAD DEBT, IS 14.21%, AND THE PERCENTAGE INCREASES TO 64.05% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. PART II: COMMUNITY HEALTH IMPROVEMENT THROUGH COALITION BUILDING/COMMUNITY BOARD PARTICIPATION: MERCY MEDICAL CENTER CONTRIBUTED TO THE ECONOMIC AND CIVIC HEALTH OF THE SURROUNDING COMMUNITY BY SERVING ON SEVERAL COMMUNITY AND AREA BOARDS. MERCY ALSO SUPPORTED THE EFFORTS OF LOCAL ROTARY AND CHAMBER OF COMMERCE AS WELL AS ORGANIZATIONS ESTABLISHED TO INCREASE AWARENESS ON ECONOMIC GROWTH AND DIVERSITY. EXAMPLES INCLUDE:-UNITED WAY-CEDAR RAPIDS CHAMBER OF COMMERCE-MARION CHAMBER OF COMMERCE-DAYBREAK ROTARY-WAYPOINT KIDS BOARD-DIVERSITY FOCUS BOARD-FREEDOM FROM HUNGER PLANNING COMMITTEE-JUNIOR ACHIEVEMENT BOARD-KIRKWOOD COLLEGE ADVISORY BOARD-AGING SERVICES BOARD-HEALTHY LINN CARE NETWORK BOARD-AMERICAN CANCER ASSOCIATION BOARD-CATHERINE MCAULEY CENTER BOARDSR. MARY LAWRENCE COMMUNITY CENTER RENOVATION PROJECT: MERCY MEDICAL CENTER RENOVATED THE PENNYSAVER BUILDING TO BECOME THE SR. MARY LAWRENCE COMMUNITY CENTER IN AN EFFORT TO PROVIDE OFFICE AND PROGRAMMING SPACE FOR LOCAL NONPROFITS. GIRLS AND BOYS CLUB, GEMS OF HOPE, KIDS FIRST LAW CENTER, AND YOUNG PARENTS NETWORK PAY $1 PLUS THE COST OF THEIR UTILITIES AS RENT FOR THE YEAR. THE MONEY THEY SAVE FROM OVERHEAD IS PUT BACK INTO THEIR OPERATIONS SO THEY CAN SERVE MORE WITHIN OUR COMMUNITY.ENCOURAGING OUR YOUTH: TEACHING HEALTHY LIFESTYLE HABITS IS PART OF MERCY'S COMMITMENT TO PREVENTION AS A PART OF HEALTH CARE. IN 2011, MERCY TEAMED UP WITH MCKINLEY AND TAFT MIDDLE SCHOOLS' STAFF AND STUDENTS TO EDUCATE STUDENTS ON THE DANGERS OF TOBACCO USE AND THE GIMMICKS BIG TOBACCO CORPORATIONS USE TO LURE KIDS INTO TRYING TOBACCO PRODUCTS. THE OPPORTUNITY FOR HIGH SCHOOL STUDENTS TO JOB SHADOW IS COORDINATED THROUGH THE WORKPLACE LEARNING CONNECTION. THIS YEAR, STUDENTS EXPERIENCED SEVERAL DIFFERENT JOB SHADOW AREAS WITHIN 23 DEPARTMENTS AT MERCY, INCLUDING A BEHIND-THE-SCENES LOOK AT THE OPERATING ROOM WITH THE OPPORTUNITY TO TALK TO PROFESSIONALS ABOUT THEIR JOBS. PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. THE HOSPITAL DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: THE COSTS SHOWN FOR THE MEDICARE SHORTFALL ARE BASED ON TOTAL CHARGES OF ALL MEDICARE AND MEDICARE REPLACEMENT 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, AND MANY SERVICES SUCH AS LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND OTHER SERVICES 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 THE MEDICARE COST REPORT, DO NOT SHOW THE COSTS AND PAYMENTS ASSOCIATED WITH THESE SERVICES FOR MEDICARE BENEFICIARIES. FOR MERCY MEDICAL CENTER, 49.6% OF OUR GROSS CHARGES ARE FOR MEDICARE PATIENTS INCLUDING THOSE WITH MEDICARE REPLACEMENTS. ANOTHER 6.7% OF OUR CHARGES ARE FOR PATIENTS WHO QUALIFY FOR MEDICAID COVERAGE. NEITHER GOVERNMENT PROGRAM PAYS ENOUGH TO COVER THE COSTS OF THE SERVICES PROVIDED TO THESE PATIENTS. IF WE DID NOT SERVE THE MEDICARE AND MEDICAID PATIENTS, ANOTHER FACILITY WOULD HAVE TO PROVIDE THE SERVICE. OF THE 64,484 MEDICARE PATIENTS WHO WERE DISCHARGED DURING THE 2011 FISCAL YEAR, 13,240, OR 20.6%, HAD MEDICAID COVERAGE. THIS DOES NOT REFLECT ANY OF THE PATIENTS WHOSE PRIMARY COVERAGE IS MEDICARE REPLACEMENT POLICY. 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 HAVE TO COMPLETE PAPERWORK. MERCY UTILIZES AN OUTSIDE VENDOR TO ASSIST IN DETERMINING A PATIENT'S FINANCIAL RISK. MERCY MEDICAL CENTER USES BILLING AND COLLECTION RECOMMENDATIONS ESTABLISHED BY THE IOWA HOSPITAL ASSOCIATION. THESE RECOMMENDATIONS INCLUDE:-MERCY MEDICAL CENTER WILL PROVIDE TO ALL PATIENTS THE SAME INFORMATION CONCERNING SERVICES AND CHARGES.-FOR A PATIENT WHO HAS AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED COVERAGE OR MEDICAL CENTER'S FINANCIAL AID PROGRAM, MERCY WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO A COLLECTION AGENCY BEFORE THE INITIAL ELIGIBILITY 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 VI, LINE 2: IN ORDER TO ENSURE OUTREACH EFFORTS ARE TRULY REFLECTIVE OF CONTINUALLY CHANGING COMMUNITY HEALTH NEEDS, MERCY MEDICAL CENTER WORKED TO DEVELOP A FORMALIZED APPROACH TO CAPTURE THE COMMUNITY'S VOICE. IN 2010, MERCY MEDICAL CENTER ESTABLISHED A COMMUNITY BENEFIT COMMITTEE OF THE BOARD COMPRISED OF COMMUNITY MEMBERS FROM LINN COUNTY. THIS COMMITTEE WAS FORMED TO PROVIDE INSIGHT INTO ADDRESSING THE HEALTH NEEDS IDENTIFIED IN A HEALTH NEEDS ASSESSMENT AND PROVIDES GUIDANCE, SUPPORT, AND RECOMMENDATIONS FOR PROGRAM DEVELOPMENT.HEALTHY LINN CARE NETWORK, A BRANCH OF LINN COUNTY PUBLIC HEALTH, COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2011. A MIXED METHODOLOGY APPROACH WAS USED TO PROVIDE A COMPREHENSIVE OVERVIEW OF THE LOCAL SERVICE AREA. DATA SOURCES WERE BOTH QUALITATIVE AND QUANTITATIVE AND INCLUDED: IOWA DEPARTMENT OF PUBLIC HEALTH, VITAL STATISTICS OF IOWA, MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, IOWA DEPARTMENT OF PUBLIC SAFETY, U.S. CENSUS, CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, LINN COUNTY PUBLIC HEALTH, ENVIRONMENTAL PROTECTION AGENCY, IOWA DEPARTMENT OF EDUCATION, IOWA DEPARTMENT OF HUMAN SERVICES, PREVENT CHILD ABUSE IOWA AND THE IOWA YOUTH SURVEILLANCE REPORT. MERCY PROVIDED REPRESENTATION ON THE COMMUNITY STEERING COMMITTEE. MERCY ALSO REVIEWED THE RESULTS OF THE 6 CONTIGUOUS COUNTIES SURROUNDING LINN TO ASSESS THEIR REPORTED HEALTH NEEDS.IN ADDITION, MERCY MEDICAL CENTER UNDERSTANDS THE NEED FOR ONGOING ASSESSMENT AND USES DATA AND INFORMATION OBTAINED FROM HOSPITAL CHARITY CARE CASES, COMMUNITY FREE CLINICS, SCHOOLS, UNITED WAY AND COUNTY HEALTH RANKING REPORTS TO MODIFY CURRENT ACTIVITIES AND CREATE NEW PROGRAMS TO ADDRESS HEALTH NEEDS. ALL OF THIS INFORMATION WAS UTILIZED TO COMPLETE A COMMUNITY BENEFIT PLAN FOR THE HOSPITAL. 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;-COMMUNICATING INFORMATION ABOUT FINANCIAL ASSISTANCE IN A CLEAR AND CONSISTENT MANNER.-BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN THE COMMUNITY. MERCY WILL NOTIFY PROSPECTIVE PATIENTS THAT THE HOSPITAL WILL PROVIDE, UPON REQUEST, AN ESTIMATED PRICE OR PRICE RANGE FOR THE CONTEMPLATED SERVICES.COMMUNICATE THE AVAILABILITY OF FINANCIAL AID:-PUBLICLY DISPLAYING BILLING AND COLLECTION POLICIES - MERCY DISPLAYS AND/OR MAKES AVAILABLE OUR BILLING AND COLLECTION POLICIES, INCLUDING DISCOUNT AND CHARITY CARE POLICIES. BROCHURES LIST ALL AVAILABLE FINANCIAL RESOURCES. -COMMUNICATION WITH PATIENTS - MERCY PROVIDES INFORMATION ON POLICIES WITHIN PATIENT REGISTRATION PACKETS. FINANCIAL COUNSELORS ARE AVAILABLE SEVEN DAYS A WEEK, 24 HOURS A DAY, TO COMMUNICATE THESE POLICIES AND ASSIST PATIENTS IN APPLYING FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. MERCY MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, SOCIAL WORK, BILLING AND COLLECTIONS) ABOUT HOSPITAL BILLING, COLLECTION POLICIES AND PRACTICES, FINANCIAL ASSISTANCE, AND OUR COMMITMENT TO CARE FOR ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY FOR SERVICES. EDUCATION IS ALSO PROVIDED REGARDING FEDERAL, STATE AND LOCAL PUBLIC FINANCIAL ASSISTANCE PROGRAMS AND MERCY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM. -COMMUNICATIONS TO THE PUBLIC REGARDING FINANCIAL ASSISTANCE ARE WRITTEN IN CONSUMER-FRIENDLY TERMINOLOGY AND IN A LANGUAGE THAT THE PATIENT CAN UNDERSTAND. -INFORMATION IS INCLUDED IN HOSPITAL BILLS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN FURTHER INFORMATION AND APPLY FOR FINANCIAL ASSISTANCE.-INFORMATION ON FINANCIAL ASSISTANCE POLICIES IS POSTED IN KEY PUBLIC AREAS WITH INSTRUCTIONS ON HOW TO APPLY OR OBTAIN FURTHER INFORMATION. BROCHURES ARE ALSO AVAILABLE.-PATIENTS ARE EDUCATED ABOUT THEIR RESPONSIBILITIES, THE POTENTIAL FINANCIAL OBLIGATIONS THEY MAY INCUR, THEIR OBLIGATIONS FOR COMPLETING ELIGIBILITY DOCUMENTATION, AND THE HOSPITAL'S BILL COLLECTION POLICIES.-PATIENTS ARE REFERRED TO AND/OR PROVIDED WITH ASSISTANCE REGARDING APPLYING FOR MEDICAID, IOWA CARES, HEALTHY AND WELL KIDS IN IOWA (HAWKI), GENERAL ASSISTANCE AND/OR LOCAL COUNTY FUNDS FOR FUTURE CARE NEEDS. MERCY ALSO HAS INTERPRETING SERVICES AVAILABLE FOR LIMITED ENGLISH PROFICIENCY PATIENTS WHO SPEAK OTHER LANGUAGES. PART VI, LINE 4: MERCY MEDICAL CENTER SERVES A PRIMARY SERVICE AREA (PSA) OF LINN COUNTY AND A SECONDARY SERVICE AREA (SSA) OF 7 CONTIGUOUS COUNTIES (BENTON, BUCHANAN, CEDAR, DELAWARE, IOWA, JOHNSON AND JONES). 17.5% OF MERCY'S PATIENTS COME FROM THE SECONDARY SERVICE AREA (DATA FROM IOWA HOSPITAL ASSOCIATION).THE TOTAL POPULATION OF LINN COUNTY IN 2010 IS 211,226. THE TOTAL POPULATION OF BOTH PRIMARY AND SECONDARY SERVICE AREAS IS 462,398. BASED ON THE 2010 U.S. CENSUS, THE FOLLOWING FACTS PERTAIN TO PERSONS LIVING IN MERCY'S PSA & SSA:-12.6% OF PERSONS ARE AGE 65 OR OLDER-81.3% OF PERSONS AGE 18 AND OLDER GRADUATED FROM HIGH SCHOOL-28.3% OF PERSONS AGE 18 AND OLDER HAVE A BACHELORS DEGREE OR HIGHER-MEDIAN HOUSEHOLD INCOME IS $62,211-11.7% OF THE POPULATION LIVE BELOW POVERTY LEVEL-AVERAGE PERSONS PER HOUSEHOLD IS 2.43-49.7% OF THE POPULATION ARE MALE-50.3% OF THE POPULATION ARE FEMALE-91.2% OF THE POPULATION ARE CAUCASIAN-3.3% OF THE POPULATION ARE AFRICAN AMERICAN-0.2% OF THE POPULATION ARE NATIVE AMERICAN-2.4% OF THE POPULATION ARE ASIAN, NATIVE HAWAIIAN, OR PACIFIC ISLANDER-2.9% OF THE POPULATION ARE HISPANIC PART VI, LINE 6: PART VI, LINE 7: MERCY HOSPITAL, D/B/A MERCY MEDICAL CENTER (HOSPITAL), IS AN IOWA NOT-FOR-PROFIT CORPORATION. THE HOSPITAL PROVIDES SERVICES FROM ITS FACILITY LOCATED IN CEDAR RAPIDS, IOWA. THE ACCOMPANYING FINANCIAL STATEMENTS INCLUDE THE HOSPITAL'S INTEREST IN THE NET ASSETS OF THE MERCY HOSPITAL ENDOWMENT FOUNDATION, INC., D/B/A MERCY MEDICAL CENTER FOUNDATION (FOUNDATION). THE FOUNDATION WAS ESTABLISHED TO FOSTER SUPPORT AND ENCOURAGE THE ACTIVITIES AND PURPOSES OF THE HOSPITAL.MERCYCARE SERVICE CORPORATION (PARENT), AN IOWA NOT-FOR-PROFIT CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. ANOTHER RELATED CORPORATION, MERCY CARE MANAGEMENT, INC. (MCM), IS ALSO CONTROLLED BY THE PARENT. REPORTS FILED WITH STATES PART VI, LINE 7 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) 282420 FOR USE IN CONTINUING OPERATIONS AGING SERVICES 800 FIRST ST NW CEDAR RAPIDS IA 52405 237085316 501(C)(3) 6000 GENERAL SUPPORT AMERICAN CANCER SOCIETY 4080 1ST AVE NE STE 101 CEDAR RAPIDS IA 52402 410724036 501(C)(3) 26050 GENERAL SUPPORT CEDAR RAPIDS HEALTHCARE ALLIANCE 600 7TH ST SE CEDAR RAPIDS IA 52401 203178229 501(C)(3) 25000 GENERAL SUPPORT DIVERSITY FOCUS 205 SECOND STREET SE CEDAR RAPIDS IA 52401 203420207 501(C)(3) 11500 GENERAL SUPPORT ESPECIALLY FOR YOU 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 20000 GENERAL SUPPORT HEALTHY LINN CARE NETWORK PO BOX 3026 CEDAR RAPIDS IA 52406 421106819 501(C)(3) 42500 GENERAL SUPPORT JUVENILE DIABETES FOUNDATION 1026 A AVENUE NE CEDAR RAPIDS IA 52402 231907729 501(C)(3) 10022 GENERAL SUPPORT LINN COUNTY MEDICAL SOCIETY 813 1ST AVENUE SE CEDAR RAPIDS IA 52402 237410746 501(C)(6) 5000 GENERAL SUPPORT PRIORITY ONE 424 1ST AVENUE NE CEDAR RAPIDS IA 52401 420172900 501(C)(6) 20000 GENERAL SUPPORT WAYPOINT SERVICES FOR WOMEN & CHILDREN 318 5TH STREET SE CEDAR RAPIDS IA 52401 420680307 501(C)(3) 5680 GENERAL SUPPORT ALZHEIMER'S ASSOCIATION OF EAST CENTRAL IOWA 1570 42ND AVENUE NE CEDAR RAPIDS IA 52402 421333384 501(C)(3) 7000 GENERAL SUPPORT BOYS AND GIRLS CLUB OF CEDAR RAPIDS 621 4TH AVENUE SE CEDAR RAPIDS IA 52401 421434056 501(C)(3) 1000 DONATED SPACE FOR OPERATIONS ENTREPRENEURIAL DEVELOPMENT CENTER 230 2ND STREET SE STE 212 CEDAR RAPIDS IA 52401 421447565 501(C)(6) 20000 CAPITAL CAMPAIGN FOUR OAKS 5400 KIRKWOOD BLVD SW CEDAR RAPIDS IA 52404 420998726 501(C)(3) 10000 GENERAL SUPPORT HORIZONS 819 5TH STREET SE CEDAR RAPIDS IA 52401 421135083 501(C)(3) 5000 CAPITAL CAMPAIGN CONTRIBUTIONS JUNIOR LEAGUE OF CEDAR RAPIDS 2100 1ST AVENUE NE CEDAR RAPIDS IA 52402 426060212 501(C)(3) 5670 CORPORATE EVENT SPONSORSHIP CEDAR RAPIDS SYMPHONY 800 SECOND AVE SE CEDAR RAPIDS IA 52401 420772544 501(C)(3) 15000 GENERAL SUPPORT IOWA HEALTHCARE COLLABORATIVE 100 EAST GRAND STE 360 DES MOINES IA 50309 203869767 501(C)(3) 20000 GENERAL SUPPORT MERCY PHYSICIAN ASSOCIATION FREE CLINIC 311 THIRD AVE SE 4TH FLOOR CEDAR RAPIDS IA 52401 421442443 8453 DONATED STAFF HOURS SISTERS OF MERCY 1125 PRAIRIE DRIVE NE CEDAR RAPIDS IA 52402 420680250 501(C)(3) 5000 GENERAL SUPPORT UNITED WAY OF EAST CENTRAL IOWA 1030 5TH ST SE STE 100 CEDAR RAPIDS IA 52403 420861239 501(C)(3) 8070 GENERAL SUPPORT UNIVERSITY OF IOWA FOUNDATION 200 HAWKINS DRIVE IOWA CITY IA 52242 420796760 501(C)(3) 10000 GENERAL SUPPORT PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 X 0 1 0 0 0 0 0 0 0 TIM CHARLES 396804 0 75275 0 23905 0 99240 0 12574 0 607798 0 0 0 PHILIP PETERSON 251364 0 62799 0 6884 0 27652 0 13212 0 361911 0 0 0 BETH HOULAHAN 169871 0 41356 0 6624 0 12278 0 12020 0 242149 0 0 0 KARL KEELER 160230 0 39450 0 26966 0 14076 0 9430 0 250152 0 0 0 DR MARK VALLIERE 312196 0 75170 0 6724 0 22317 0 12287 0 428694 0 0 0 JEFFREY CASH 181541 0 37286 0 6620 0 26073 0 12966 0 264486 0 0 0 LARRY DONALDSON 120147 0 12118 0 26376 0 0 0 9200 0 167841 0 0 0 HUI LI 214354 0 0 0 0 0 5319 0 13101 0 232774 0 0 0 DESMOND WATERS 134112 0 3971 0 0 0 0 0 14798 0 152881 0 0 0 A JAMES TINKER 0 0 0 0 121776 26000 4835 0 0 0 126611 26000 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS: LIMITED TRAVEL FOR COMPANIONS ARE PAID BY THE ORGANIZATION ON BEHALF OF TOP MANAGEMENT. THESE AMOUNTS ARE INCLUDED IN REPORTABLE COMPENSATION AS REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2010: PHILIP PETERSON - $17,858, BETH HOULAHAN - $12,278, TIMOTHY CHARLES - $95,057, MARK VALLIERE - $22,317, KARL KEELER - $9,863, AND JEFFREY CASH - $19,603. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY THE ORGANIZATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010. CITY OF CEDAR RAPIDS IOWA 426004336 150543AA4 2003-04-10 30000000 REIMBURSE HOSPITAL FOR COSTS OF ACQUIRING AND CONSTRUCTING FACILITIES 0 0 0 CITY OF CEDAR RAPIDS IOWA 426004336 150543AB2 2005-11-17 58405000 ADVANCE REFUND OF 1999 BONDS 0 0 0 30000000 1288620 28711380 2003 0 0 1 1 58405000 56852500 1552500 2005 0 1 1 1 0 0 0 0 1 0 0 0 0 1 0 0 1 UBS AG 29.000000000000 0 0 0 0 0 0 0 1 UBS AG 24.000000000000 0 0 0 0 0 TIMOTHY CHARLES PERSONAL X 75000 43929 0 1 1 43929 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 RSM MCGLADREY, INC. FOR THE REVIEW OF SALARIES AND COMPARES THEM TO COMPARABLE ENTITIES IN THE REGION. THIS PROCESS WAS LAST COMPLETED ON SEPTEMBER 28, 2011. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 13,231,280. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS 7,825,992. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 6,628,816. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 2,273,736. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS) -235,616. CHANGE IN INTEREST IN NET ASSETS OF AUXILIARY AND GIFT SHOP -32,535. CONTRIBUTION REVENUE RECORDED AS A LIABILITY -378,488. TOTAL TO FORM 990, PART XI, LINE 5: 29,313,185. 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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