2011-05-11T15:24:46-05:00 2010-06-30 RSM McGladrey Inc 201 N Harrison Street Suite 300 Davenport IA 528011999 990 2009-07-01 420698295 MERCY MEDICAL CENTER MERC 3193986107 701 10TH STREET SE CEDAR RAPIDS IA 52403 PHIL PETERSON 3193986107 2011-05-11 1 John J Romano 5638884000 2009 2016-02-24 21:20:13Z PHIL PETERSON 701 10TH STREET SE CEDAR RAPIDS IA 52403 274566653 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 30 2554 646 1379237 0 2143103 7157145 226752893 249637180 -7692161 6064869 25936706 -2188342 247140541 260670852 2831853 3169250 0 112306262 113234696 0 0 112362172 120113865 227500287 236517811 19640254 24153041 382281770 420370403 162982717 166162089 219299053 254208314 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 212081091 3237082 249637180 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) - $23,173,000; OTHER COMMUNITY BENEFITS (INCLUDES SUBSIDIZED HEALTH SERVICES, FINANCIAL CONTRIBUTIONS) - $9,763,000; FREE SERVICE (TO PATIENTS WHO MEET MERCY'S FREE-SERVICE GUIDELINES) - $5,954,000; COSTS IN EXCESS OF MEDICAID REIMBURSEMENT (COSTS OF PROVIDING THE SERVICES LESS THE AMOUNTS RECEIVED FROM MEDICAID) - $1,671,000; PHYSICIAN EDUCATION - $1,053,000.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 55,200 HOUSEHOLDS IN 2010 AT A TOTAL COST OF OVER $59,000. 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 110,100 HOURS TOWARD THE COMMON PURPOSE OF SERVING THE HEALTH CARE OF THE COMMUNITY. THE VALUE OF THESE CONTRIBUTIONS WAS APPROXIMATELY $1,200,000 AND WAS GIVEN BACK THE THE COMMUNITY THROUGH LOWER COSTS. 212081091 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 1 1 0 0 1 249 0 1 2554 1 1 1 0 0 0 0 0 0 0 0 31 30 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 JACK COSGROVE 1.00 X X 0 0 0 KYLE SKOGMAN 1.00 X X 0 0 0 SISTER SHARON SUTHERLAND 1.00 X X 0 0 0 EMMETT SCHERRMAN 1.00 X X 0 0 0 TIM CHARLES 1.00 X X 573722 0 113475 MICHELE BUSSE 1.00 X 0 0 0 TONY GOLOBIC 1.00 X 0 0 0 DON HATTERY 1.00 X 0 0 0 SISTER CORITA HEID 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 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 CHUCK PETERS 1.00 X 0 0 0 FRED PILCHER MD 1.00 X 0 0 0 MARY QUASS 1.00 X 0 0 0 TOM REED 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 ELIOT PROTSCH 1.00 X 0 0 0 PHIL PETERSON 40.00 X 311544 0 50039 JEFFERY CASH 40.00 X 237311 0 40004 BETH HOULAHAN 40.00 X 210966 0 28343 KARL KEELER 40.00 X 234006 0 42857 KATHY KRUSIE 40.00 X 252187 0 61135 DR MARK VALLIERE 40.00 X 380534 0 37520 LARRY DONALDSON 40.00 X 190539 0 58836 HUI LI 40.00 X 235690 0 24296 DESMOND WATERS 40.00 X 153543 0 8765 PENNY GLANZ 40.00 X 154069 0 18301 SUSAN VANGORDEN 40.00 X 135009 0 17289 A JAMES TINKER 1.00 X 121777 26000 0 3190897 26000 500860 32 1 1 0 HOSPITALIST MEDICINE PHYSICIANS 4535 DRESSLER RD NW CANTON OH 44718 HEALTHCARE PROFESSIONAL SERVICES 1893996 VITAL SUPPORT SYSTEMS LLC 11191 AURORA AVENUE URBANDALE IA 50322 HARWARE, SOFTWARE, AND I/S SUPPORT SERVI 792731 ElDERKIN & PIRNIE PLC 115 1ST AVE SE CEDAR RAPIDS IA 52406 LEGAL SERVICES 626526 WELAND CLINICAL LABORATORY PC 1911 1ST AVENUE SE CEDAR RAPIDS IA 52406 HEALTHCARE SERVICES 460542 PHELANS INTERIORS 728 3RD AVENUE SE CEDAR RAPIDS IA 52401 REMODELING SERVICES 407885 21 2010 2338686 4816449 791731 7157145 PATIENT REVENUES 900099 222049588 222049588 LABORATORY REVENUE 621500 26733336 25369524 1363812 FITNESS CENTER REVENUE 900099 555294 555294 FAMILY COUNSELING REVE 624100 298962 298962 249637180 2638376 2638376 1548268 1145762 402506 402506 402506 13730472 33169 9982668 354480 3747804 -321311 3426493 3426493 5688 2010 1946 3742 3742 2503495 2410945 92550 92550 MRI MR ASSOCIATES 621110 1389112 1389112 DISASTER RELIEF 900099 1091275 1091275 PARTNERSHIP ORDINARY I 561000 15425 15425 -5182952 -5182952 -2687140 260670852 244479528 1379237 7654942 3169250 3169250 2134076 2134076 39998 39998 81029213 74030293 6998920 8878755 7924370 954385 15093037 13557097 1535940 6059617 5395321 664296 59746 59746 328132 328132 148317 4317 144000 27084 27084 219831 219831 10545574 7722575 2822999 1576090 1497227 78863 49120558 47244505 1876053 6639109 6622527 16582 6600 6600 3632156 1222459 2409697 301523 96172 205351 12607 12607 2902730 2902730 16786943 13414135 3372808 572378 457 571921 BAD DEBT EXPENSE 17417809 17417809 REPAIRS 6395685 6395685 RESIDENCY EXPENSE 1525107 1525107 DUES & SUBSCRIPTIONS 542435 542435 VEHICLE EXPENSE 375663 375663 977788 874922 102866 236517811 212081091 24436720 0 1572149 503844 13671118 33184130 34670440 35957106 3081264 2859486 3723029 4903950 1508395 1810711 326897451 157208118 169197744 169689333 48000779 47245888 43816137 74534878 63040715 49623480 0 57597 382281770 420370403 25148495 24964222 86350000 84205000 51484222 56992867 162982717 166162089 X 191992053 224744236 5226000 7089893 22081000 22374185 219299053 254208314 382281770 420370403 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 27084 27084 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 23.7% OF MEMBERSHIP DUES TO THE IOWA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES, OR $27,084. 26505127 234657 1633447 486386 27886845 29036036 2000 -2532909 26505127 0.11920 0.80230 0.07850 0 1 1 10573595 10573595 212303782 96921561 115382221 2635277 1732125 903152 101384797 58554432 42830365 169689333 COMMERCIAL PAPER & CASH 9484468 F MONEY MARKET FUNDS 11435 F MUTUAL FUNDS, INVESTED IN CORP BONDS, LLPS & REAL ESTATE 65038975 F 74534878 INVESTMENT IN AFFILIATEs 46403332 F DEFERRED FINANCING COSTS 616533 C INVESTMENT IN CEDAR RAPIDS PHO 601266 F SLEEP LAB JOINT VENTURE 1193596 F INVESTMENT IN MR ASSOCIATES 808753 C 49623480 INTEREST RATE SWAP AGREEMENTS 9472309 PENSION LIABILITY 40529500 SELF INSURANCE RESERVES 5830679 THIRD PARTY SETTLEMENTS 1102782 NET EQUITY IN MERCY MEDICAL CENTER AUXILIARY 57597 56992867 260670852 236517811 24153041 8891631 1864589 10756220 34909261 270744995 8891631 -694058 8197573 262547422 -1876570 -1876570 260670852 235835734 2073948 2073948 233761786 2756025 2756025 236517811 Part V, Line 4: Description of Intended Use of Endowment Funds: 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. Part X: Description of Uncertain Tax Positions Under FIN 48: 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, 2010 AND 2009, 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. THE HOSPITAL'S IRS FORM 990 AND 990T ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED JUNE 30, 2006. 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 Part XII, Line 2d - Other Adjustments: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS: -3783309. CHANGE IN UNRECOGNIZED FUNDED STATUS OF RETIREMENT PLAN: 478859. CHANGE IN INTEREST IN NET ASSETS OF MERCY MEDICAL CENTER FOUNDATION: 3883399. GRANT TO MERCARE SERVICE CORPORATION INCLUDED WITH REVENUES: -2500000. BOOK/TAX DIFFERENCE IN PARTNERSHIP INCOME(LOSS): 1226993. Part XII, Line 4b - Other Adjustments: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES: -1752636. LOSS ON SALE OF ASSETS: -321312. AUXILIARY AND GIFT SHOP REVENUE NOT INCLUDED IN AUDIT REPORT: 197378. Part XIII, Line 2d - Other Adjustments: CAFETERIA COST OF GOODS SOLD NETTED WITH REVENUES: 1752636. LOSS ON SALE OF FIXED ASSETS: 321312. Part XIII, Line 4b - Other Adjustments: GRANT TO MERCYCARE SERVICE CORPORATION INCLUDED WITH REVENUES: 2500000. AUXILIARY AND GIFT SHOP EXPENSES NOT INCLUDED IN AUDIT REPORT: 256025. 1 1 1 X 1 X 1000.000000000000 1 1 1 0 1 1 9443 5608400 0 5608400 0.02560 20364 14864872 13194319 1670553 0.00760 29807 20473272 13194319 7278953 0.03320 13914 837423 0 837423 0.00380 326 1959550 519040 1440510 0.00660 3438 10214227 7601108 2613119 0.01190 291376 0 291376 0.00130 17678 13302576 8120148 5182428 0.02360 47485 33775848 21314467 12461381 0.05680 40078 40078 0.00020 28958 28958 0.00010 3377 3377 0.00000 858 858 0.00000 168259 168259 0.00080 7485 7485 0.00000 9783 9783 0.00000 258798 258798 0.00110 1 5721061 87793726 110966815 -23173089 X 1 1 MR ASSOCIATES LLP PROVIDES MRI SERVICES 0.33000 0.00000 0.33000 EASTERN IOWA SLEEP CENTER LLC PROVIDES SLEEP STUDIES 0.33000 0.00000 0.33000 CEDAR RAPIDS PHYSICIAN HOSPITAL ORGANIZATION PROVIDES PAYOR CONTRACTING 0.39000 0.00000 0.61000 MERCY MEDICAL CENTER

701 10TH STREET SE CEDAR RAPIDS IA 52403

X X X X 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: COSTS FOR SUBSIDIZED SERVICES WERE CALCULATED BASED ON OUR COST ACCOUNTING SYSTEM. THESE SERVICES WERE SPLIT BETWEEN UNREIMBURSED CHARITY CARE PATIENT ACCOUNTS, MEDICAID PATIENTS ACCOUNTS, AND PATIENTS ACCOUNTS DETERMINED TO BE UNCOLLECTIBLE. The following programs and services are subsidized by Mercy Medical Center 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 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 prediabetes in the PSA is 14,000.Joslin provided care to 3240 patient visits from July 2009-May 2010.Each summer Joslin Diabetes Center 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 be "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 older 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 2010, 5,593 inpatients were served. Other services include telephone triage and 2,788 clients were evaluated and referred to outpatient services. Individuals experiencing multiple life stressors are most vulnerable and need behavior health assistance and coping mechanisms. Our state, and our local community, continues to recover from the catastrophic June 2008 floods that destroyed homes and business. These individuals also 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.While the mission is to meet the needs of the PSA and SSA 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 a 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 due to financial constraints.WOMEN AND CHILDREN'S SERVICES: 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 Care nurse visits the home and NICU staff members are available by telephone 24 hours 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 an RN is set up to prevent such situations. All mothers discharged from Birthplace are offered a home visit if they live within a thirty mile radius or 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: Calendar year 2009 there were 873 babies born on BirthplaceOutcomes: -Weight loss and feeding problems are identified, care plans developed, and follow up is done to assure effectiveness.-Jaundice is identified in newborns, labs drawn and orders received to prevent kernicterus.-Maternal vital changes are identified and physicians notified when necessary.-Education is reinforced and done to assure a safe environment for the baby and mom.-Safety issues are identified in the environment and corrected when necessary.-Signs and symptoms of postpartum depression are identified and addressedMercy's Fast Track Emergency Department also offers distraction kits, movies, etc. to ease children's concerns when they need care in the emergency room. Our 30-minute wait guarantee ensures families that they will not have to wait longer 30 minutes for care to begin for their child. Part I, Line 7f: $17,417,809 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 15.43%, AND THE PERCENTAGE INCREASES TO 66.14% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. 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 payers 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.Charity care is provided for services where the patient's inability to pay is documented and the revenues are not expected to be received. Bad debts, on the other hand, relate to services for which the hospital expected to receive payments, but did not receive the payment. This may be a result of the patient may not beING able to pay for the services, but the hospital is unaware of that fact, or the patient is unwilling to pay for the services. In many cases, it is not possible to determine whether the bad debt amount could be for an indigent or medically needy patient. Not-for-profit hospitals must accept any patient who needs services regardless of their ability to pay. We may even know that a patient has a large balance due on a number of prior services, but we cannot turn the patient away if the services are necessary. Once a patient is stabilized, it does not mean that the patient will be willing to move to another facility for the remainder of their treatment nor does it mean there is another facility that may be willing to accept the patient as a transfer. Bad debt, whether for patients who cannot pay or those who are unwilling to pay, should be considered a community benefit. A hospital cannot deny necessary services even if the patient will not pay for the services. A retailer, on the other hand, can deny credit if the customer has not been paying on their credit card. There is a significant difference between bad debts at the hospital and bad debts in general. 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 the 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 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 on the Medicare cost report, do not show the costs and payments associated with these services for Medicare beneficiaries.For Mercy Medical Center, 50.2% 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 59,188 Medicare patients who were discharged during the 2010 fiscal year, 12,678, or 21.4%, had Medicaid coverage. This does not reflect any of the patients whose primary coverage is a Medicare replacement policy. Based on information from the American Hospital Association, 46% of Medicare spending is for beneficiaries whose income is below 200% of the federal poverty level. 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-sponsoredcoverage or Medical Center's financial aid program, Mercy will notknowingly 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. FORM 990, SCHEDULE H, PART I, LINE 3B:Mercy Medical Center utilizes a presumptive charity care process for Medicaid, medically needy, food stamp, state-assisted, or self-pay patients. These patients receive a 25% discount without having to submit an application for financial assistance. Full charity care will be provided to uninsured and underinsured patients earning 200% or less of the Federal Poverty Income Guidelines (FPIG). Patients whose income, as determined by the Federal Poverty Income Guideline, is more than 200% and less than or equal to 1000% of the poverty guidelines may be eligible for assistance under the "Sliding Scale Discount Program." A sliding scale discount will be applied to the patient's balance BASED ON THE the lower of 10% of 2 years household income or the discounted AMOUNT BASED ON A THE PATIENT'S PERCENT OF fEDERAL POVERTY INCOME GUIDELINES. Part VI, Line 2: Mercy Medical Center takes a collaborative approach in assessing the needs of the community it serves AS A SPONSORING PARTNER OF THE HEALTHY LINN CARE NETWORK. A Community Health Needs Assessment was conducted in 2005 by Healthy Linn Care Network, a branch of the Linn County Public Health Department. Data and information was collected through qualitative and quantitative methods and a Health Improvement Plan was developed. Mercy partnered with several community organizations to form coalitions to address the top five community health needs:-Obesity (and related chronic health conditions including diabetes and cardiovascular disease)-Mental Health-Substance Abuse-Cancer-Sexually Transmitted Infections and Human Immunodeficiency VirusMercy staff members participate on the following committees and coalitions:-Women's Health Network-Colorectal Cancer Committee-Linn County Mental Health Services Planning Committee-Healthy Living Coalition-Linn County Senior Coalition-STI/HIV/AIDS Alliance-Linn County Partnership on Substance Abuse-Community Indigent/Low Income Service Committee-Linn County Family Violence Coalition-Linn County Asthma Reduction Coalition-Make it Safe CoalitionHealthy Linn Care Network has made a commitment to the community to provide a Health Needs Assessment every 3 years. The most current assessment is due for completion in February, 2011.Mercy Medical Center understands the need for ongoing assessment and uses data and information obtained from Federal Census Bureau reports, hospital charity care cases, Linn County Public Health Department, Community Free Clinics, schools, United Way, County Health Ranking report, and the Cedar Rapids Healthcare Alliance to modify current programs and create new programs to address health needs. 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 displaysand/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 Centers financial assistance program. -Communications to the public regarding financial assistance are writtenin consumer-friendly terminology and in a language that the patient canunderstand. -Information is included in hospital bills about the availability of financialassistance and how to obtain further information and apply for financial assistance.-Information on financial assistance policies is posted in key public areas withinstructions on how to apply or obtain further information. Brochures are also Available.-Patients are educated about their responsibilities, the potential financial OBligation they may incur, their obligations for completing eligibilitydocumentation, and the hospital's bill collection policies.-Patients are referred to and/or provided with assistance regardingapplying for Medicaid, Iowa Care, Healthy Start, General Assistance and/orlocal county funds for future care needs. In addition to English, patient financial assistance information is also available in Spanish for those with limited English proficiency, reflecting other dominant languages spoken in the communities served by Mercy Medical Center. 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). The total population of Linn County is 209,226. The total population of both primary and secondary service areas is 328,256. The projected 10 year population growth for the PSA is 2% and the SSA, 1%. 12.7% of persons living in Mercy's combined service area are age 65 or older. 90.6% are high school graduates while 27.7% hold a Bachelors degree or higher. The median household income is $55,173. The percentage of people living below poverty level is 9,3% as compared to 10.1% for all of Iowa. 1 in 9 Iowans is uninsured or 12% (includes children and nonelderly adults). The average persons per household are 2.4.Demographics for the service area are as follows:49.5% male, 50.5% female92% Caucasian3.5% African American.4% Native American1.9% Asian/Pacific2.2% HispanicThe current unemployment rate for Linn County is 6.3%, THE SAME RATE AS THE STATE OF IOWA. Linn County features a diverse employer base including manufacturing, trade, education, service, finance and agriculture. Part VI, Line 5: Cash contributions: Mercy Medical Center gives cash contributions to several area non-profit organizations, especially those that address health, emergency housing and the needs of children. Examples include:-American Cancer Society-Waypoint-Juvenile Diabetes Association-Horizons Meals on Wheels-Camp Courageous-Tanager Place-Young Parents Network-Alzheimer's Association-Cedar Rapid Health Care AllianceMercy Medical Center also provides in-kind printing services for several area non-profits.Meeting space for nonprofits: Mercy Medical Center provides meeting space for a variety of non-profit organizations throughout the year at no charge. Mercy also provides no charge catering services for several non-profit community organizations. Mercy Medical Center hosts many community support groups for individuals facing emotion and physical challenges including cancer, pulmonary disease, heart disease, prostate cancer, dialysis, grief and mental health issues. In-kind space for nonprofits: Mercy Medical Center provides space for operations for several local community non-profits. These include:-Young Parents Network and Wee Care Shop-Gems of Hope-Boys and Girls Club-Kids First Law office-American Cancer SocietyCommunity 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 SOCIETY-Catherine McAuley Center BoardCOMMUNITY IMPACT EVALUATIONS ARE REQUESTED TO ASSURE FUNDS ARE ADDRESSING COMMUNITY NEEDS. Part VI, Line 6: Mercy Regional Cancer CenterCancer is now Iowa's leading cause of death with more than 16,000 Iowans diagnosed each year. In Linn County alone, one person dies from cancer every day; those numbers will continue to rise with the growing aging population. Mercy's cancer programs and services are patient-focused, with an integrated approach to care. Additional comprehensive services such as forums, support groups, and genetic counseling, are open to the community participation as well as our patients and family members.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 32 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. In addition, five seats are allocated to women religious who ensure the organization remains true to it charitable mission. Mercy also provides Board-level support in a Community Benefit committee comprised of community members from Linn County. This committee was formed to provide guidance, support and make recommendations for program development to improve the health of the communities served by Mercy.Mercy Medical Center maintains an open medical staff, as privileges are extended to all qualified PROVIDERS. CURRENTLY THERE ARE 423 MEDICAL STAFF MEMBERS AND 73 MID-LEVEL PROVIDERS. Mercy Medical Center partners with St. Luke's hospital to support a Family Practice Residency program. THE CEDAR RAPIDS MEDICAL EDUCATION FOUNDATION WAS ESTABLISHED IN 1971. SINCE THAT TIME, THERE HAVE BEEN 255 GRADUATES. OF THESE, 68 ARE PRACTICING IN THE 7 COUNTY AREA CONSIDERD AS PART OF MERCY MEDICAL CENTER'S SERVICE AREA. THE VAST MAJORITY OF THE RESIDENTS STAY IN THE MIDWEST STATES (NEBRASKA TO INDIANA, MINNESOTA TO MISSOURI.) THE PROGRAM ADDRESSES GAPS IN COMMUNITY CARE FOR THE UNINSURED AND UNDERINSURED. Mercy Medical Center provides health professions education through precepting nursing and other allied health students within the hospital and on off-campus sites. 10,600 employee hours were reported for precepting health care students in FY 2010. Mercy Medical Center provides no charge radiology, laboratory and in-patient care services for patients originating from two free health clinics within the PSA. This strategy assisted 2,451 patients and equated to $345,231 in charity care. Mercy Medical Center has developed several key programs to address the physical and mental health needs identified through our community health needs assessment process. Examples include:-Especially For You - Race Against Breast Cancer - raises funds to pay for free pap and mammography services for uninsured females in the PSA and SSA. For 19 years, this annual race is held at Mercy Medical Center. The OCTOBER 2009 race was the largest in the event's history, with 11,575 people registered. Since 1991 the fund has been accessed by 4,300 women, for a total of $1.13M in services.-Parish Nurse Education Program - Mercy became an education affiliate of the International Parish Nurse Resource Center to offer a parish nurse curriculum at a reduced rate to area nurses. 37 nurses have taken the course. Mercy also created a Parish Nurse Advisory Council, comprised of community representatives who provide program oversight and guidance. Parish nurses play a key role in health care navigation and health education within their faith communities. -Vascular screening - Free outreach screenings are provided to determine risk for PVD/PAD for those older than age 50, smoke, have high blood pressure, diabetes or suffer from leg pain when walking. Screenings help participants understand their risks, share prevention tips and outline treatment options. Patients served: 333.-Sexual Abuse Nurse Examiner (SANE) Program - Started more than 10 years ago, this free service was the first program developed in Cedar Rapids. Nurses have in-depth training to provide all aspects of the forensic and health-care processes for sexual assault victims, and a sexual assault nurse examination. In FY 2010, 228 hours of direct SANE patient care; 192 hours orientation and training for SANE; 75 hours on Case Study and CEU's SANE-specific; on-call hours total for the year was 3712. Today we offer sexual assault nurse examination services 24/7 through our Emergency Department. We have a Sexual Assault Response Team (SART) for Linn County which includes but is not limited to representatives from Mercy's Sexual Assault program, Waypoint Advocacy Services, local police departments, Child Protection Center, Planned Parenthood, and the Linn County Attorney's Office.-Parochial School Nurse Health Clinic Program - Episodic care, evaluation of illness, health promotion, health education, case management, management of chronic illnesses, management of outbreaks and communicable diseases is provided by one advanced practice nurse at two elementary school sites. 325 students were served at St. Matthew's and All Saints Schools.-Chronic Disease Self-management program - Live Active, Live Healthy chronic disease self management workshops educate patients about how to get the most of each day while living with a chronic condition. Mercy is licensed through Stanford University to offer the workshops and maintains fidelity through a Stanford certified master. Number of individuals served from 07/01/09 - 06/30/10: 179.-Fit Families - This physician-driven clinic helps overweight children and teenagers, and their families through a series of clinic visits with a doctor, dietitian and exercise specialist. The goal is to help families understand that obesity affects many people throughout our community and that there is hope for change. -Trim Kids - a family-oriented fitness and nutrition class created through a unique partnership between Mercy's Fit Families and the Cedar Rapids metropolitan area YMCA to help families become aware of healthier nutrition and fitness. Clinically proven to be effective, the program assists families in making positive lifestyle changes through 6 weeks of lifestyle training. -Mobile Mammography - Residents within a 75-mile radius of Mercy Medical Center have access to the same high level of digital mammography equipment available at Mercy's Women's Center via a mobile digital mammography van. Mercy Medical Center provides on-going community health education presentations and programs. These include classes on nutrition and healthy eating, chronic disease, cancer, exercise and substance abuse. Mercy staff members present in churches, community centers, grocery stores, schools, manufacturing plants, colleges, assisted living and nursing homes.Examples include:-Sisters of Mercy: Arthritis-Young Parents Expectant Moms Group: Having a Healthy Pregnancy-Mount Mercy College: Accessing Mental Health Services-Linn County Office Administration: Stress Reduction Exercises-Advancement Services, Disabled Adults: Nutrition-Options of Linn County, Disabled Adults: Healthy Lifestyle, Exercise, and Nutrition-Mount Zion Baptist Church: Healthy Living and Nutrition-Steps2Health and the Walk with a Doc programMercy Medical Center supports Project Access, a program of Healthy Linn Care Network, a branch of the Linn County Public Health Department. Project Access assists patient who earn 200% FPG or less obtain specialty inpatient and outpatient medical services. Mercy assisted 188 patients obtain these services this fiscal year. 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. THE FINANCIAL POSITION AND RESULTS OF OPERATIONS OF THE PARENT AND MCM ARE NOT INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. 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) 132788 FOR USE IN CONTINUING OPERATIONS AMERICAN DIABETES ASSOCIATION 1026 A AVE NW CEDAR RAPIDS IA 52402 131623888 501(c)(3) 10000 GENERAL SUPPORT AMERICAN CANCER SOCIETY 4080 1st ave ne ste 101 CEDAR RAPIDS IA 52402 410724036 501(c)(3) 48046 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) 21000 GENERAL SUPPORT ESPECIALLY FOR YOU 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(c)(3) 10000 GENERAL SUPPORT HEALTHY LINN CARE NETWORK PO BOX 3026 CEDAR RAPIDS IA 52406 421106819 501(c)(3) 30000 GENERAL SUPPORT JUVENILE DIABETES FOUNDATION 1026 A AVENUE NE CEDAR RAPIDS IA 52402 231907729 501(c)(3) 10000 GENERAL SUPPORT JUNIOR ACHIEVEMENT OF EAST CENTRAL IOWA 315 3RD AVENUE SE CEDAR RAPIDS IA 52401 420919209 501(c)(3) 10500 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) 20240 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) 6000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 3220 GREY WOLF HIAWATHA IA 52233 135613797 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) 37060 DONATED SPACE FOR OPERATIONS ENTREPRENEURIAL DEVELOPMENT CENTER 230 2ND STREET SE STE 212 CEDAR RAPIDS IA 52401 421447565 501(C)(6) 20000 CAPITAL CAMPAIGN CONTRIBUTIONS 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) 9000 CORPORATE EVENT SPONSORSHIP KIDS FIRST 621 4TH AVENUE SE CEDAR RAPIDS IA 52401 202199649 501(c)(3) 16296 DONATED SPACE FOR OPERATIONS YOUNG PARENTS NETWORK 205 12TH STREET SE CEDAR RAPIDS IA 52403 421355480 501(c)(3) 53134 GENERAL SUPPORT 19 3 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 X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 TIM CHARLES 387023 0 58795 0 127904 0 105465 0 8010 0 687197 0 0 0 PHIL PETERSON 248210 0 56560 0 6774 0 42035 0 8004 0 361583 0 0 0 JEFFERY CASH 181013 0 33472 0 22826 0 32003 0 8001 0 277315 0 0 0 BETH HOULAHAN 170039 0 35063 0 5864 0 20342 0 8001 0 239309 0 0 0 KARL KEELER 191580 0 31014 0 11412 0 34855 0 8002 0 276863 0 0 0 KATHY KRUSIE 182173 0 37429 0 32585 0 53134 0 8001 0 313322 0 0 0 DR MARK VALLIERE 310189 0 63731 0 6614 0 29513 0 8007 0 418054 0 0 0 LARRY DONALDSON 171719 0 11760 0 7060 0 50835 0 8001 0 249375 0 0 0 HUI LI 235590 0 0 0 100 0 16222 0 8074 0 259986 0 0 0 DESMOND WATERS 146871 0 6672 0 0 0 691 0 8074 0 162308 0 0 0 PENNY GLANZ 122971 0 5803 0 25295 0 10227 0 8074 0 172370 0 0 0 SUSAN VANGORDEN 118034 0 0 0 16975 0 9215 0 8074 0 152298 0 0 0 A JAMES TINKER 0 0 0 0 121777 26000 0 0 0 0 121777 26000 0 0 Part I, Line 1a TRAVEL FOR COMPANIONS AND HEALTH OR SOCIAL CLUB DUES: LIMITED TRAVEL FOR COMPANIONS AND HEALTH AND SOCIAL CLUB DUES 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 4a THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN AND RECEIVED A DISTRIBUTION IN 2009: A. JAMES TINKER - $81,411 AND CAROL WATSON - $3,457. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2009: PHILIP PETERSON - $17,375, BETH HOULAHAN - $11,903, TIMOTHY CHARLES - $85,795, MARK VALLIERE - $21,713, KATHLEEN KRUSIE - $12,752, KARL KEELER - $21,165, LARRY DONALDSON - $12,020, AND JEFFREY CASH - $16,390. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY THE ORGANIZATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009. CITY OF CEDAR RAPIDS IOWA 426004336 150543AA4 2003-04-10 30000000 REIMBURSE HOSPITAL FOR COSTS OF ACQUIRING AND CONSTRUCTING FACILITIES 0 0 CITY OF CEDAR RAPIDS IOWA 426004336 150543AB2 2005-11-17 58405000 ADVANCE REFUND OF 1999 BONDS 0 0 30000000 1288620 28711380 2003 0 0 1 1 58405000 56852500 1552500 2005 0 1 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 1 UBS AG 29.000000000000 0 0 0 0 0 1 UBS AG 24.000000000000 0 0 0 TIMOTHY CHARLES PERSONAL X 75000 54911 0 1 1 54911 ALLIANT ENERGY ENTITY IN WHICH ELIOT PROTSCH, A BOARD MEMBER, IS AN OFFICER. 1616623 ALLIANT ENERGY PROVIDES UTILITY SERVICES TO MERCY MEDICAL CENTER. 0 BARBARA PROTSCH BARBARA PROTSCH IS THE WIFE OF ELIOT PROTSCH, A BOARD MEMBER FOR MMC. 64619 COMPENSATION 0 X 1 791731 COST 1 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): THE ORGANIZATION IS REPORTING BOTH THE NUMBER OF CONTRIBUTIONS RECEIVED AND THE NUMBER OF CONTRIBUTORS ON LINE 11, COLUMN B. 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 10, 2010. 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 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. MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION INC 701 10TH STREET SE CEDAR RAPIDS IA 52403 510233180 FUNDRAISING FOR MERCY MEDICAL CENTER IA 501(C)(3) 11B/II MERCY MEDICAL CENTER MERCYCARE SERVICE CORPORATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 421199429 HEALTHCARE OVERSIGHT IA 501(C)(3) 11C/III-FI N/A MR ASSOCIATES LLP 1455 SHERMAN ROAD HIAWATHA IA 52233 421260463 MEDICAL IMAGING IA N/A RELATED 1389329 2304142 0 1 MERCY CARE MANAGEMENT INC PO BOX 786 CEDAR RAPIDS IA 52406 421198970 MEDICAL CLINICS IA MERCYCARE SERVICE CORPORATION C 3332471 80918807 1.00000 MERCY PHYSICIANS ASSOCIATES (SUB OF MERCY CARE MANAGEMENTINC) PO BOX 786 CEDAR RAPIDS IA 52406 421442443 MEDICAL SERVICES IA MERCY CARE MANAGEMENT INC C 16933838 134693616 1.00000 MERCY PHYSICIAN SERVICES (SUB OF MERCY CARE MANAGEMENTINC) PO BOX 786 CEDAR RAPIDS IA 52406 421442442 SUPPORT SERVICES IA MERCY CARE MANAGEMENT INC C -23596466 18968108 1.00000 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION B 132788 MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION C 2338686 MERCYCARE SERVICE CORPORATION B 2500000 MERCY CARE MANAGEMENT INC A 456000 MERCYCARE SERVICE CORPORATION C 307056 MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION P 439228 MERCY HOSPITAL CEDAR RAPIDS IA ENDOWMENT FOUNDATION I 1