TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) JOSEPH SWEDISH........................................................................ TRINITY PRES & CEO THROUGH 3/13	1.00 .......................54.00	X	X		3,233,500	601,476
(2) LARRY WARREN........................................................................ INTERIM PRES & CEO 3/13 & 4/13	5.00 .......................50.00	X	X		25,000	0
(3) JUDITH PERSICHILLI........................................................................ TRIN INTERIM PRES & CEO AS OF 5/13	1.00 .......................54.00	X	X		3,890,553	17,510
(4) MARY MOLLISON CSA........................................................................ CHAIR THROUGH 4/13	2.00 .......................14.00	X	X		0	0
(5) MELANIE DREHER PHD RN........................................................................ V CHR THROUGH 4/13; CHAIR AS OF 5/13	2.00 .......................14.00	X	X		25,000	0
(6) BARBARA WHEELEY RSM........................................................................ VICE CHAIR AS OF 5/13	1.00 .......................7.00	X	X		0	0
(7) SUZANNE BRENNAN CSC........................................................................ TRUSTEE	1.00 .......................7.00	X			0	0
(8) JOSE SANTILLAN........................................................................ TRUSTEE THROUGH 2/13	1.00 .......................7.00	X			22,750	0
(9) STANLEY URBAN........................................................................ TRUSTEE AS OF 5/13	1.00 .......................7.00	X			0	0
(10) PAUL NEUMANN........................................................................ SECRETARY, EVP & GENERAL COUNSEL	2.00 .......................48.00		X		812,881	106,329
(11) AGNES HAGERTY........................................................................ ASST SEC/VP DEPUTY GEN CSL TRINITY	2.00 .......................48.00		X		368,657	54,774
(12) JENNIFER BARNETT........................................................................ TREAS AS OF 5/13, TRIN EVP & INT CFO	1.00 .......................49.00		X		927,285	22,601
(13) BENJAMIN CARTER........................................................................ TREAS 4/13; ASST TREAS AS OF 5/13	5.00 .......................45.00		X		799,303	112,810
(14) JAMES BOSSCHER........................................................................ ASST TREAS THR 4/13, TRIN SVP TREAS	1.00 .......................49.00		X		586,570	91,437
(15) KEDRICK ADKINS........................................................................ TRINITY PRES INTEG SYS THR 6/13	1.00 .......................54.00			X	1,821,619	126,167
(16) RICHARD O'CONNELL........................................................................ EVP & PRES TRINITY HEALTH DIV.	1.00 .......................54.00			X	1,036,410	130,423
(17) ROBERT PEEBLES........................................................................ CEO-SIOUX CITY (SC)	48.00 .......................2.00			X	550,713	79,203

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) RUSSELL KNIGHT........................................................................ CEO-DUBUQUE (DUB)	50.00 .......................0.00	X			0	447,380	75,791
(19) RODNEY SCHLADER........................................................................ REGIONAL CFO,INTER. MC CEO THR 8/12	50.00 .......................0.00	X			0	340,025	57,904
(20) STEVEN EAVENSON........................................................................ CFO-SIOUX CITY (SC) THROUGH 12/12	48.00 .......................2.00	X			0	349,713	36,413
(21) PAUL MANTERNACH........................................................................ SVP, PHYS. INTEG. MASON CITY (MC)	50.00 .......................0.00	X			0	404,478	39,459
(22) TERESA MOCK........................................................................ SVP MERCY CLINICS (MC)	50.00 .......................0.00	X			100,879	332,109	54,545
(23) DIANE FISCHELS........................................................................ VP OPERATIONS (MC)	50.00 .......................0.00	X			0	325,903	62,292
(24) MARILYN KAPTAIN-DAHLEN........................................................................ COO (SC) THROUGH 5/13	49.00 .......................1.00	X			0	286,728	62,262
(25) MICHAEL JOHNSTON........................................................................ VP, NTWK DEVELOPMENT (MC) THR 4/13	50.00 .......................0.00	X			0	248,009	36,189
(26) LINDA KREI........................................................................ VP, HR & ORG. INTG. (SC)	50.00 .......................0.00	X			0	228,046	35,822
(27) GARY GUETZKO........................................................................ VP BUSINESS DEVELOPMENT (DUB)	50.00 .......................0.00	X			0	221,358	59,900
(28) KIMBERLY CHAMBERLIN........................................................................ CNO (MC)	50.00 .......................0.00	X			0	208,386	21,653
(29) KAY TAKES........................................................................ VP, PATIENT CARE (DUB)	50.00 .......................0.00	X			0	199,757	45,858
(30) ROBERT SHAFER........................................................................ CFO-DUBUQUE (DUB)	50.00 .......................0.00	X			0	191,795	87,821
(31) BRIAN MONSMA........................................................................ VP, REGIONALIZATION (SC)	48.00 .......................2.00	X			0	183,261	36,490
(32) TRACY LARSON........................................................................ CNO (SC)	50.00 .......................0.00	X			0	166,343	29,690
(33) JAMES BAER........................................................................ PHYSICIAN, RADIATION ONCOLOGY (MC)	50.00 .......................0.00		X		759,193	0	90,279
(34) ALIREZA YARAHMADI........................................................................ PHYSICIAN, NEUROLOGY (MC)	50.00 .......................0.00		X		742,176	0	56,249
(35) JAMES KARKOS........................................................................ PHYSICIAN, DERMATOLOGY (MC)	50.00 .......................0.00		X		677,091	0	76,939
(36) CARL PLANK........................................................................ PHYSICIAN, DERMATOLOGY (MC)	50.00 .......................0.00		X		638,525	0	102,095
(37) JOSEPH BEHR........................................................................ PHYSICIAN, FAMILY MEDICINE (MC)	50.00 .......................0.00		X		605,536	0	62,843
(38) DANIEL HALE........................................................................ FORMER OFFICER	0.00 .......................50.00			X	0	856,049	63,490
(39) MARIANNE CUNNINGHAM........................................................................ FORMER OFFICER	0.00 .......................45.00			X	0	165,279	32,527
(40) PAUL BROWNE........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	480,030	41,852
(41) DEBRA CANALES........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	852,044	102,033
(42) PAUL CONLON........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	488,655	114,364
(43) LOUIS FIERENS........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	518,640	68,929
(44) PRESTON GEE........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	468,475	79,749
(45) MICHAEL HOLPER........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	450,005	94,299
(46) TERRENCE O'ROURKE........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	964,005	56,964
(47) MARIA SZYMANSKI........................................................................ FORMER KEY EMPLOYEE	0.00 .......................50.00			X	0	624,384	76,589
(48) KIM PRICE........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	133,017	0	48,721
(49) MICHAEL MURPHY........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	180,882	16,630
(50) JAMES FITZPATRICK........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	145,151	25,827
(51) LARRY SELLERS........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	213,719	43,051
(52) BERNARD FOX........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	107,532	17,478

(A) Name and business address	(B) Description of services	(C) Compensation
UNITED CLINICAL LABORATORIES205 BLUFF STREETDUBUQUEIA52001	LABORATORY SERVICES	5,953,793
MASON CITY CLINIC PC250 S CRESCENT DRIVEMASON CITYIA50401	MEDICAL SERVICES	5,412,617
HENKEL CONSTRUCTION COMPANY208 E STATE STREETMASON CITYIA50402	CONSTRUCTION SERVICES	4,896,994
CONLON CONSTRUCTIONPO BOX 3400DUBUQUEIA52004	CONSTRUCTION SERVICES	3,680,335
MEDICAL ASSOCIATES CLINIC PC1500 ASSOCIATES DRIVEDUBUQUEIA52002	MEDICAL SERVICES	2,039,522
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 101

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	802,529	802,529
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	165,541	165,541
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	5,667,841		5,667,841
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	402,107	216,679	185,428
7	Other salaries and wages	232,768,506	208,521,551	24,246,955
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	18,895,527	17,011,380	1,884,147
9	Other employee benefits .......	23,031,091	20,425,205	2,605,886
10	Payroll taxes ...........	16,249,255	14,247,347	2,001,908
11	Fees for services (non-employees):
a	Management ......	1,205,346		1,205,346
b	Legal .........	428,885		428,885
c	Accounting ...........	19,525		19,525
d	Lobbying ...........	14,100		14,100
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	44,857,556	39,331,105	5,526,451
12	Advertising and promotion ....	1,947,880	1,707,901	239,979
13	Office expenses .......	9,411,258	8,251,791	1,159,467
14	Information technology ......	31,994,439	28,052,724	3,941,715
15	Royalties ..
16	Occupancy ...........	11,705,883	11,120,589	585,294
17	Travel ............	1,296,961	1,137,175	159,786
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	188,494	165,272	23,222
20	Interest ...........	7,853,181	7,853,181
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	34,265,778	32,552,489	1,713,289
23	Insurance ..............	3,781,965	3,592,867	189,098
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	121,878,915	115,784,969	6,093,946
b	BAD DEBT	38,608,242	38,608,242
c	INTERCO. PURCHASED SVCS	23,499,345	20,604,226	2,895,119
d	CONTRACT LABOR	16,579,419	14,536,835	2,042,584
e	All other expenses	19,030,597	16,686,027	2,344,570
25	Total functional expenses. Add lines 1 through 24e	666,550,166	601,375,625	65,174,541	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	8,054,907	1	4,882,422
2	Savings and temporary cash investments .........	184,914	2	471,815
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	76,134,208	4	76,775,470
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............	2,728,047	7	2,273,794
8	Inventories for sale or use ..............	16,040,653	8	16,170,896
9	Prepaid expenses and deferred charges ..........	2,388,595	9	1,870,097
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	574,514,903
b	Less: accumulated depreciation .....	10b	386,784,580	185,276,052	10c	187,730,323
11	Investments—publicly traded securities ..........	118,256,549	11	152,630,539
12	Investments—other securities. See Part IV, line 11 .....	173,929,347	12	135,207,705
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14	1,259,569
15	Other assets. See Part IV, line 11 ...........	213,480,809	15	82,394,601
16	Total assets. Add lines 1 through 15 (must equal line 34)......	796,474,081	16	661,667,231
	17	Accounts payable and accrued expenses .........	64,741,719	17	63,011,419
18	Grants payable .................		18
19	Deferred revenue ................	883,079	19	449,476
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23	1,870,840
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	234,104,587	25	224,766,058
26	Total liabilities. Add lines 17 through 25.........	299,729,385	26	290,097,793
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	496,540,675	27	371,093,894
28	Temporarily restricted net assets ...........	179,021	28	450,544
29	Permanently restricted net assets ...........	25,000	29	25,000
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	496,744,696	33	371,569,438
34	Total liabilities and net assets/fund balances ........	796,474,081	34	661,667,231

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization MERCY HEALTH SERVICES - IOWA CORP

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization MERCY HEALTH SERVICES - IOWA CORP

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Yes

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Yes

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Yes

138,000

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

22,000

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

160,000

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
EXPLANATION OF LOBBYING ACTIVITIES:	PART II-B, LINE 1:	LOBBYING ACTIVITY INCLUDED ENCOURAGING ASSOCIATES TO WRITE LETTERS TO PUBLIC OFFICIALS AND THE USE OF PAID STAFF MEMBERS AND MANAGEMENT PERSONNEL. MANAGEMENT PERSONNEL REGULARLY ISSUE MAILINGS TO LEGISLATORS ATTEMPTING TO INFLUENCE LEGISLATIVE MATTERS AND REFERENDUM, AND ORGANIZE AND HOST MEETINGS AMONG HOSPITAL EXECUTIVES AND THEIR LEGISLATORS. PAID STAFF MEMBERS HAVE ON LIMITED OCCASIONS WRITTEN LETTERS TO LEGISLATORS. MERCY HEALTH SERVICES - IOWA, CORP (MHS-IA) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS. THESE ORGANIZATIONS HAVE PROVIDED MHS-IA WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS THAT ARE USED FOR LOBBYING ACTIVITIES. SIMILARLY, THESE HEALTH CARE ORGANIZATIONS WILL ARRANGE CONFERENCES AND SEMINARS FOR MEMBER ORGANIZATIONS AND THEIR EXECUTIVES THAT WILL INVOLVE LEGISLATORS OR OTHER POLITICAL FIGURES AS GUEST SPEAKERS. FEDERAL AND STATE ADVOCACY PRIORITIES FOR FY13 INCLUDED: - ENSURING MAXIMUM COVERAGE AND ACCESS, INCLUDING SUPPORTING EXCHANGE IMPLEMENTATION AND MEDICAID EXPANSION - DRIVING QUALITY AND EFFICIENCY ACROSS THE CONTINUUM OF CARE WITH VALUE-BASED, SUSTAINABLE PAYMENT MODELS LOBBYING ACTIVITY PERFORMED BY MERCY HEALTH SERVICES-IOWA, CORP. INCLUDED: - AN "ADVOCACY ACTION" WEBSITE TO ENGAGE ASSOCIATES IN FEDERAL ADVOCACY - DESIGNATE AN ADVOCACY LIAISON - ENGAGEMENT OF A LOBBYIST IN WASHINGTON, D.C. BY TRINITY HEALTH CORPORATION - LEGISLATOR VISITS - COLLABORATION WITH THE CATHOLIC HOSPITAL ASSOCIATION, AND THE AMERICAN HOSPITAL ASSOCIATION - COLLABORATION WITH THE IOWA HOSPITAL ASSOCIATION - ADVOCACY ACTION DAY AT THE FEDERAL LEVEL ATTENDED BY EXECUTIVES REPRESENTING MEMBER HOSPITALS

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	25,000	25,000	25,000	25,000	25,000
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	25,000	25,000	25,000	25,000	25,000

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

Yes

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	10,445,234		10,445,234
b	Buildings ................	333,468,218	218,876,602	114,591,616
c	Leasehold improvements ............
d	Equipment ................	217,123,519	167,559,025	49,564,494
e	Other .................	13,477,932	348,953	13,128,979
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				187,730,323

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES	41,390,114	F
(B) EQUITY METHOD INVESTMENTS	49,668,136	C
(C) HEDGE FUNDS	44,149,455	F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	135,207,705

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) OTHER RECEIVABLES				11,918,929
(2) INTERCOMPANY ACCOUNTS RECEIVABLE				2,791,833
(3) INVESTMENT IN AFFILIATES				26,665,441
(4) OTHER ASSETS				2,377,862
(5) INTERCOMPANY OTHER LT ASSETS				38,640,536




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				82,394,601

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
INTERCOMPANY ACCOUNTS PAYABLE		5,523,475
DEFERRED COMPENSATION		11,426,292
LONG TERM ASSET RETIREMENT OBLIGATION (FIN 47)		3,629,153
INTERCOMPANY NOTES PAYABLE		200,997,609
OTHER LIABILITIES		3,070,816
LEASE OBLIGATION		58,829
ANNUITY PAYABLE		59,884


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		224,766,058
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	PART V, LINE 4:	THE ENDOWMENT FUNDS OF MERCY HEALTH SERVICES - IOWA, CORP. INCLUDE $25,000 KNOWN AS THE VIANNA HOLSCHLAG SCHOLARSHIP FUND. INTEREST INCOME FROM THE FUND IS MADE AVAILABLE FOR NURSING SCHOLARSHIPS.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	5	16,136	12,581,872	0	12,581,872	2.000 %
b	Medicaid (from Worksheet 3, column a) ....	64	50,843	43,483,605	39,815,109	3,668,496	0.580 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	3	2,893	0	0
d	Total Financial Assistance and Means-Tested Government Programs .	72	69,872	56,065,477	39,815,109	16,250,368	2.580 %
Other Benefits		68	134,046	3,155,819	53,488	3,102,331	0.490 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	68	134,046	3,155,819	53,488	3,102,331	0.490 %
f	Health professions education (from Worksheet 5) ..	16	18,714	8,689,755	3,459,754	5,230,001	0.830 %
g	Subsidized health services (from Worksheet 6) ..	26	65,504	18,072,039	9,595,177	8,476,862	1.350 %
h	Research (from Worksheet 7)	3	1,563	229,596	0	229,596	0.040 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	21	56,762	985,023	73,138	911,885	0.150 %
j	Total. Other Benefits ..	134	276,589	31,132,232	13,181,557	17,950,675	2.860 %
k	Total. Add lines 7d and 7j .	206	346,461	87,197,709	52,996,666	34,201,043	5.440 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	2	180	12,423	12,423	0 %
3	Community support	5	1,028	26,004	26,004	0 %
4	Environmental improvements	4	240	15,950	15,950	0 %
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	2	1,075	51,066	51,066	0.010 %
8	Workforce development	3	582	100,162	100,162	0.020 %
9	Other
10	Total	16	3,105	205,605	205,605	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

12,929,808

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

5,605,072

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

207,684,331

Enter Medicare allowable costs of care relating to payments on line 5.....

219,264,681

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-11,580,350

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 TRI-STATE SURGERY CENTER LLC FKA DUBUQUE REGIONAL AMBULATORY SURGICAL C	AMBULATORY SURGICAL SERVICES	50.000 %	50.000 %
22 MEDICAL ASSOCIATESMERCY FAMILY CARE NETWORK LLC	PRIMARY CARE PHYSICIAN SERVICES	50.000 %	50.000 %
33 TRI-STATE OCCUPATIONAL HEALTH LLC	OCCUPATIONAL HEALTH SERVICES	50.000 %	50.000 %
44 FOREST PARK IMAGING LLC	IMAGING SERVICES	52.890 %	47.110 %
55 MAGNETIC RESONANCE SERVICES PARTNERSHIP	MRI SERVICES	49.000 %	51.000 %
66 MASON CITY AMBULATORY SURGERY CENTER LLC	AMBULATORY SURGICAL SERVICES	51.000 %	49.000 %
77 MERCY HEART CENTER OUTPATIENT SERVICES LLC	OUTPATIENT ECHOCARDIOGRAPHY AND NUCLEAR MEDICINE SERVICES	51.000 %	49.000 %
88 SURGICAL CENTER BUILDING ASSOCIATES LLC	OWNS AND LEASES SURGICAL CENTER BUILDING	35.000 %	65.000 %
99 SIOUXLAND SURGERY CENTER	AMBULATORY SURGICAL SERVICES	30.940 %	69.060 %
1010 MERCY WEIGHT LOSS CENTER LLC	PRE-OP AND POST-OP COUNSELING SERVICES TO BARIATRIC PATIENTS	25.000 %	75.000 %
1111 HEALTH MANAGEMENT SERVICES LLC	AMBULATORY SURGICAL SVCS, OCCUPATIONAL HLTH SVCS AND PRIMARY CARE PHYS SVCS	50.000 %	50.000 %
1212 NORTH IOWA COMMUNITY HEALTHCARE LLC	HEALTHCARE PROVIDERS AND MANAGEMENT SERVICES	19.250 %	38.500 %
1313 PREFERRED HEALTH CHOICES LLC	MANAGEMENT SERVICES	50.000 %	50.000 %

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?6 Name, address, and primary website address								Other (Describe)
1	MERCY MEDICAL CENTER-NORTH IOWA 1000 FOURTH STREET SW MASON CITY,IA50401 WWW.MERCYNORTHIOWA.COM	X	X	X		X	X
2	MERCY MEDICAL CENTER-SIOUX CITY 801 FIFTH STREET SIOUX CITY,IA51102 WWW.MERCYSIOUXCITY.COM	X	X				X	EMPLOYED PHYSICIANS, SKILLED CARE UNIT
3	MERCY MEDICAL CENTER - DUBUQUE 250 MERCY DRIVE DUBUQUE,IA52001 WWW.MERCYDUBUQUE.COM	X	X				X	REHAB,LAB,PHARM, X-RAY,HOME CARE
4	SIOUXLAND SURGERY CENTER 600 SIOUX POINT ROAD DAKOTA DUNES,SD57049 WWW.SIOUXLANDSURG.COM	X	X
5	MERCY MEDICAL CENTER-NEW HAMPTON 308 NORTH MAPLE AVE NEW HAMPTON,IA50659 WWW.MERCYNEWHAMPTON.COM	X			X		X	EMPLOYED PHYSICIANS
6	MERCY MEDICAL CENTER - DYERSVILLE 1111 THIRD STREET SW DYERSVILLE,IA52040 WWW.MERCYDUBUQUE.COM/MERCY-DYERSVILLE	X	X		X		X	REHAB,LAB,PHARM, X-RAY,HOME CARE

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MERCY MEDICAL CENTER-NORTH IOWA
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 10

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MERCY MEDICAL CENTER-SIOUX CITY
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MERCY MEDICAL CENTER-DUBUQUE
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 11

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	SIOUXLAND SURGERY CENTER
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15		No
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MERCY MEDICAL CENTER-NEW HAMPTON
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MERCY MEDICAL CENTER-DYERSVILLE
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?15
Name and address		Type of Facility (describe)
1	MEDICAL ASSOCIATES WEST CAMPUS 1500 ASSOCIATES DRIVE DUBUQUE,IA52001	OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
2	MEDICAL ASSOCIATES CLINIC 1240 BIG JACK ROAD PLATTEVILLE,WI53818	X-RAY, LAB, EMPLOYED PHYSICIANS
3	TRI-STATE OCCUPATIONAL HEALTH 1920 ELM STREET DUBUQUE,IA52001	PHYS THERAPY,EMPLOYED PHYSICIANS
4	MEDICAL ASSOCIATES CLINIC 10988 BARTELL BLVD GALENA,IL61036	HOME CARE,LAB, EMPLOYED PHYSICIANS
5	MERCY MEDICAL CENTER - DYERSVILLE 1121 THIRD STREET SW DYERSVILLE,IA52040	EMPLOYED PHYSICIANS
6	MEDICAL ASSOCIATES CLINIC 208 N 12TH STREET BELLEVUE,IA52031	EMPLOYED PHYSICIANS
7	MEDICAL ASSOCIATES CLINIC 911 NW CARTER ELKADER,IA52043	EMPLOYED PHYSICIANS
8	CASCADE FAMILY HEALTH CENTER 805 JOHNSON STREET SW CASCADE,IA52033	EMPLOYED PHYSICIANS, LAB, X-RAY, PT
9	MEDICAL ASSOCIATES CLINIC 117 SOUTH MADISON CUBA CITY,WI53807	X-RAY, LAB, EMPLOYED PHYSICIANS
10	MEDICAL ASSOCIATES CLINIC 560 PLEASANT ST ELIZABETH,IL61028	EMPLOYED PHYSICIANS
11	MEDICAL ASSOCIATES CLINIC 107 S PAGE MONONA,IA52159	EMPLOYED PHYSICIANS
12	MEDICAL ASSOCIATES EAST CAMPUS 1000 LANGWORTHY DUBUQUE,IA52001	OCC. HEALTH, PHYSICAL THERAPY
13	MERCY DAKOTA DUNES 705 SIOUX POINT ROAD DAKOTA DUNES,SD57049	WEIGHT LOSS CENTER
14	MASON CITY SURGERY CENTER 990 4TH STREET MASON CITY,IA50401	AMBULATORY SURGERY
15	MERCY FAMILY PRACTICE - BUFFALO CENTER 115 NORTH MAIN BUFFALO CENTER,IA50424	X-RAY, LAB, EMPLOYED PHYSICIANS

Schedule H (Form 990) 2012

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
		PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS.
		PART I, LINE 6A: MERCY HEALTH SERVICES-IOWA REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, THE HOSPITAL DIVISIONS OF MERCY HEALTH SERVICES-IOWA (MHS-IA) INCLUDE A COPY OF THEIR MOST RECENT SCHEDULE H ON THEIR RESPECTIVE WEBSITES. TRINITY HEALTH ALSO INCLUDES MHS-IA'S MOST RECENTLY FILED SCHEDULE H ON ITS WEBSITE.
		PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITALS' COST ACCOUNTING SYSTEMS.
		PART I, L7 COL(F): THE FOLLOWING NUMBER, $38,608,242, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F).
		PART II: COMMUNITY BUILDING ACTIVITIES - MERCY MEDICAL CENTER - NORTH IOWA (MMC-NI) AND MERCY MEDICAL CENTER - NEW HAMPTON (MMC-NH): AS THE LARGEST EMPLOYER IN OUR 14-COUNTY AREA, MHS-IA, DOING BUSINESS AS MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON TAKES CIVIC RESPONSIBILITY VERY SERIOUSLY. THERE ARE OTHER ENDEAVORS IN WHICH THESE HOSPITALS PARTICIPATE TO IMPACT THE UPSTREAM HEALTH OF THE COMMUNITY IN WAYS THAT ARE NOT CURRENTLY ELIGIBLE FOR COMMUNITY BENEFIT REPORTING, SUCH AS:WORKFORCE DEVELOPMENT: NORTH IOWA IS NOT ALWAYS THE PREFERRED LOCATION OF CHOICE FOR MEDICAL PROFESSIONALS. FOR THIS REASON, MERCY MEDICAL CENTER - NORTH IOWA ACTIVELY RECRUITS PHYSICIANS IN AN EFFORT TO PROMOTE ACCESSIBLE HEALTH CARE TO THE RESIDENTS OF THE COMMUNITIES WE SERVE THAT HAVE BEEN DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND/OR MEDICALLY UNDERSERVED AREA (MUA). THESE EFFORTS SUPPORT THE COMMUNITIES BY PROVIDING EXPERTISE AND HEALTHCARE SERVICES, AND AS A CLAUSE IN THEIR CONTRACT STATES, SPECIAL CARE FOR INDIGENT AND UNDERSERVED POPULATIONS. OTHER COMMUNITY BUILDING ACTIVITIES INCLUDE: ECONOMIC DEVELOPMENT TO STRENGTHEN THE ECONOMY OF OUR CATCHMENT COUNTIES; WHICH IN TURN ENCOURAGES EMPLOYMENT OPPORTUNITIES AND ENHANCES HEALTH AND WELL-BEING ON MULTIPLE FRONTS. DEVELOPMENT EFFORTS INCLUDE FINANCIAL CONTRIBUTIONS AND VOLUNTEER CONTRIBUTIONS TO:NORTH IOWA CORRIDOR ECONOMIC DEVELOPMENT CORP. CHAMBER OF COMMERCENEW HORIZONSTHE INDUSTRIAL DEVELOPMENT CORPORATION IN ADDITION TO SUPPORTING ECONOMIC DEVELOPMENT IN OUR REGION, THE HOSPITALS ENCOURAGE THEIR LEADERSHIP STAFF TO SUPPORT AND PROVIDE LEADERSHIP TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE AREA. MMC- NH HAS WORKED TO CREATE AWARENESS OF HEALTHCARE OPPORTUNITIES IN RURAL IOWA BY PARTICIPATING IN:PARTNERS IN EDUCATION - TO EDUCATE ON HEALTH ISSUES, HUMAN DEVELOPMENT, AND HEALTHCARE CAREERS; INCLUDING INVITING LOCAL HIGH SCHOOL STUDENTS TO SHADOW A VARIETY OF HEALTH-RELATED OCCUPATIONS.CHICKASAW COUNTY COALITION FOR PREVENTING UNDERAGE DRINKING - THIS PARTNERSHIP INCLUDES ACTIVE INVOLVEMENT FROM ALL OF OUR FAMILY MEDICINE PHYSICIANS AND THE MARKETING DEPARTMENT.MMC-NH ALSO IDENTIFIED A NEED FOR MEMBERS OF THE COMMUNITY TO MORE SAFELY DISPOSE OF THEIR SHARPS AND CONTAINERS. THE HOSPITAL NOW COLLABORATES WITH PHARMACIES IN NEW HAMPTON TO COLLECT THE CONTAINERS.MERCY MEDICAL CENTER - SIOUX CITY:THE CHANGING DEMOGRAPHICS OF THE SIOUXLAND AREA REQUIRE AN UNDERSTANDING OF AND COMMITMENT TO DIVERSITY AND INCLUSION. MERCY MEDICAL CENTER-SIOUX CITY IS ENGAGED IN A COMPREHENSIVE PHYSICIAN RECRUITING EFFORT TO BRING NEEDED PHYSICIANS TO HEALTH PROFESSIONAL SHORTAGE AREAS. PHYSICIANS ARE RECRUITED BASED ON COMMUNITY NEED/SHORTAGE. WE ADVOCATE FOR AND SPEND RESOURCES TO BRING PHYSICIANS TO OUR COMMUNITY. THE PHYSICIANS USUALLY HAVE PRIVILEGES AT BOTH LOCAL HOSPITALS. AREAS OF CONCERN/NEED ARE RADIATION ONCOLOGY, PSYCHIATRY, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, ANESTHESIOLOGY, CARDIOLOGY, AND NEUROLOGY. MERCY MEDICAL CENTER GIFTED/SOLD PROPERTY IN THE DOWNTOWN AREA TO A LOCAL FOUNDATION FOR USE AS A PUBLIC SPIRITUAL GARDEN/GREEN SPACE. AFTER MUCH FUNDRAISING, GROUNDBREAKING BEGAN IN FISCAL YEAR 2013. THE LOCATION IS NEXT TO THE DOWNTOWN PRESBYTERIAN CHURCH. THE DOWNTOWN PARTNERS AND THE LOCAL CHURCH BELIEVE THE PROPERTY WILL BENEFIT THE COMMUNITY. MERCY HAS WORKED WITH THE FOUNDATION TO RAISE NEARLY $500,000 TO BEGIN CONSTRUCTION. MERCY MEDICAL CENTER-SIOUX CITY STAFF ARE ALSO INVOLVED IN THE NW IOWA AMERICAN HEART TASK FORCE, SIOUXLAND INFECTIOUS DISEASE COMMITTEE, TRI-STATE DISASTER COMMITTEE, IOWA DISASTER MEDICAL ASSISTANCE TEAM, EMERGENCY CONFERENCE COMMITTEE (MERCY COMMITTEE), MERCY EMERGENCY PLANNING COMMITTEE AND HEALTH RESOURCE SERVICE ADMINISTRATION (HRSA).MERCY IS WORKING WITH LOCAL CHURCHES AND AGENCIES TO ADDRESS SOCIAL FACTORS CONTRIBUTING TO LESS THAN OPTIMAL HEALTH. THE FOCUS IS ON THE NEIGHBORHOODS WITH THE HIGHEST COMMUNITY NEEDS INDEX, AN INDEX THAT UTILIZES U.S. CENSUS DATA TO IDENTIFY NEEDS BASED ON A NUMBER OF DEMOGRAPHIC AND SOCIAL FACTORS. INTERVENTIONS ARE TARGETED IN 55103, 51105, AND 68776 ZIP CODES WITH THE HIGHEST NEEDS INDEX. A SELF-HELP KIOSK THAT DIRECTS PATIENTS TO LOCAL RESOURCES WILL BE RELOCATED FROM MERCY'S SOUTH SIOUX CITY, NEBRASKA CLINIC TO MARY TREGLIA HOUSE, AN IMMIGRATION/MINORITY ASSISTANCE AGENCY IN SIOUX CITY, IOWA.MERCY IS WORKING WITH THE MIDTOWN COMMUNITY CENTER AND AMERICORPS WORKERS ON BENEFITS ENROLLMENT OF LOCAL RESIDENTS OFF SITE (AT A NON HEALTH CARE SITE). THE AMERICORPS WORKERS ARE FAMILIAR WITH PEOPLE IN THE AREA AND THE ENVIRONMENT IS LESS INTIMIDATING OR OVERWHELMING THAN THE HOSPITAL ENVIRONMENT. IT IS BELIEVED THAT MANY PATIENTS IN THE LOCAL NEIGHBORHOOD QUALIFY FOR BENEFITS, BUT ARE NOT ENROLLING IN PROGRAMS. THIS LEADS TO INABILITY TO PAY, AND LACK OF ACCESS TO PRIMARY AND PREVENTATIVE HEALTH CARE. PLANS ARE BEING MADE FOR HEALTH EXCHANGE INFORMATION AND ENROLLMENT ASSISTANCE.THE MEDICAL CENTER WORKS MOST CLOSELY WITH THE SIOUXLAND COMMUNITY HEALTH CENTER AND WINNEBAGO INDIAN HEALTH SERVICES. RECENTLY THE INDIAN HEALTH SERVICES (IHS) CLINIC RECEIVED AMERICAN DIABETES ASSOCIATION CREDENTIALING. MERCY SUPPORTED THE EFFORT WITH FUNDING AND IN KIND DONATIONS. MERCY IS A PARTNER IN THE HEALTHY SIOUXLAND INITIATIVES (A COLLABORATIVE GROUP OF HEALTH PROVIDERS AND SOCIAL SERVICE ORGANIZATIONS). MERCY AND UNITY POINT-ST LUKE'S PRESENTED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLANS TO IHS. AGAIN, MERCY PARTNERED WITH COMMUNITY ACTION OF SIOUXLAND AND MARY TREGLIA TO EDUCATE HEAD START AND OTHER FAMILIES ON HEALTH PROMOTION, ILLNESS PREVENTION, MEDICAL HOMES, AND EMERGENCY DEPARTMENT UTILIZATION.MERCY IS WORKING WITH THE YMCA AND ST. MICHAEL'S CATHOLIC CHURCH IN SOUTH SIOUX CITY TO ENCOURAGE EXERCISE AND OTHER HEALTHY BEHAVIORS. MERCY IS ALSO WORKING WITH GIRLS, INC., SIOUX CITY BOYS CLUB, AND LOCAL SIOUX CITY SCHOOLS TO ENCOURAGE EXERCISE, NUTRITION, AND HEALTHY BEHAVIOR CHOICES FOR YOUTH. IN THE PLANNING STAGES ARE HEALTH SCREENINGS AT THE CHURCH AND THE LOCAL MERCY CLINIC. MERCY INCREASED COLLABORATION WITH GIRLS, INC., GIRL SCOUTS OF AMERICA, AND BOY SCOUTS OF AMERICA IN REGARDS TO EDUCATION AND NUTRITION. MERCY SUPPORTED THE STEM INITIATIVES (SCIENCE, TECHNOLOGY, ENGINEERING, AND MATH) THROUGH THE GIRLS INC. AND THE BOY SCOUTS.MERCY PARTNERED WITH THE SIOUXLAND MENTAL HEALTH CENTER TO BETTER ADDRESS THE NEEDS OF PATIENTS WITH MENTAL ILLNESS. MERCY MEDICAL CENTER AND UNITY POINT-ST LUKE'S COLLABORATED TO FUND ($30,000 EACH) A MENTAL HEALTH CARE COORDINATOR TO SERVE PATIENTS IN ADDRESSING BARRIERS TO SERVICE. THIS EFFORT RESULTED IN INCREASED PATIENT OUTCOMES AND PATIENT SATISFACTION, INCREASED EASE OF COMMUNITY APPOINTMENT SCHEDULING, AND DECREASED EMERGENCY DEPARTMENT VISITS.MERCY MEDICAL CENTER - DUBUQUE:DURING ITS FISCAL YEAR ENDING JUNE 30, 2013, MERCY MEDICAL CENTER - DUBUQUE WAS ENGAGED IN TWO ACTIVITIES THAT WERE DOCUMENTED IN OUR COMMUNITY BENEFIT EXPENSES AS COMMUNITY BUILDING ACTIVITIES:MERCY SUBSIDIZES THE WAGES OF SEVERAL DEVELOPMENTALLY DISABLED YOUNG ADULTS WHO WORK AT MERCY IN THE ENVIRONMENTAL SERVICES DEPARTMENT. THIS PROGRAM IS IN PARTNERSHIP WITH GOODWILL INDUSTRIES. THE PARTNERS IN EMPLOYMENT ALLIANCE PROGRAM CONTRIBUTES TO THE ECONOMIC DEVELOPMENT OF THE COMMUNITY, IN A SMALL BUT VERY MEANINGFUL WAY, BY PROVIDING AN OPPORTUNITY FOR SKILL BUILDING AND JOB READINESS TO PEOPLE WHO HAVE THE POTENTIAL TO BECOME PRODUCTIVE MEMBERS OF THE COMMUNITY.MERCY SUBSIDIZES, FULLY OR PARTIALLY, THE FEES ASSOCIATED WITH ITS LIFELINE EMERGENCY RESPONSE SYSTEM FOR SENIORS AND HANDICAPPED INDIVIDUALS. THE PROGRAM EXTENDS THE PERIOD OF TIME THAT AN INDIVIDUAL CAN CONTINUE LIVING AT HOME OR WITH MINIMUM DIRECT SUPERVISION, BY PROVIDING A RELIABLE MEANS OF EMERGENCY COMMUNICATION. THIS IMPROVES THE COMMUNITY BY INCREASING THE NUMBER OF PEOPLE WHO ARE ABLE TO AGE IN THE LEAST RESTRICTIVE ENVIRONMENT.
		PART III, LINE 4: MERCY HEALTH SERVICES - IOWA, CORP. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 17 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY MINISTRY ORGANIZATION AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."PART III, LINE 2:METHODOLOGY USED FOR LINE 2- BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY. ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.PART III, LINE 3: MERCY HEALTH SERVICES - IOWA, CORP. USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FY13 WAS THE FIRST YEAR MERCY HEALTH SERVICES - IOWA, CORP. UTILIZED THE PREDICTIVE MODEL WITH RESULTS USED FOR ANALYSIS ONLY. STARTING IN FY14, MERCY HEALTH SERVICES - IOWA, CORP. IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL.
		PART III, LINE 8: MERCY HEALTH SERVICES - IOWA, CORP. DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT.
		PART III, LINE 9B: MERCY HEALTH SERVICES - IOWA, CORP'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN EACH ORGANIZATION'S COLLECTION POLICY. THE HOSPITALS HAVE IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS.
MERCY MEDICAL CENTER-NORTH IOWA		PART V, SECTION B, LINE 3: TRAINED FACILITATORS LED THESE FOCUS GROUPS: HISPANIC COMMUNITY GROUP, COMMUNITY KITCHEN GROUP, AND SENIOR CITIZENS GROUP. A UNIVERSITY OF DES MOINES PUBLIC HEALTH CONSULTANT-LED SURVEY WAS USED; A QUESTIONNAIRE SURVEY WAS MAILED TO RANDOMLY SELECTED ADDRESSES THROUGHOUT OUR SERVICE AREA, AND WAS ALSO SENT TO THE HOSPITAL STAFF (BECAUSE THE HOSPITAL IS LARGEST EMPLOYER IN THE AREA, AND MANY DRIVE FROM OUTLYING COMMUNITIES). AN ABBREVIATED SURVEY WAS SENT TO CREDENTIALED MEDICAL STAFF AND AREA MINISTERIAL GROUP. THE CBM TASK FORCE INPUT REPRESENTS HOSPITAL STAFF WHO DIRECTLY TOUCH THE UNINSURED AND UNDERINSURED POPULATION (FINANCIAL AND MEDICATION ASSISTANCE, PHARMACISTS, CASE MANAGEMENT, HISPANIC CLINIC, ETC.) AS WELL AS REPRESENTATIVES OF COMMUNITY HUMAN SERVICE AGENCIES (PUBLIC HEALTH, COMMUNITY ACTION, SALVATION ARMY, ETC.), SCHOOL SYSTEMS, HOMELESS SHELTERS, MINISTERIAL, RETIRED MILITARY, AND RETIRED HOSPITAL ADMINISTRATION.
MERCY MEDICAL CENTER-SIOUX CITY		PART V, SECTION B, LINE 3: MERCY MEDICAL CENTER-SIOUX CITY'S (SC) STAFF CONSULTED AGENCIES PROVIDING SOCIAL SERVICE DIRECTLY TO THE POOR AND THE MARGINALIZED. MERCY MEDICAL CENTER- SC NETWORKED WITH LOCAL CHURCHES AND HOSTED COMMUNITY EVENTS ON SITE AT THE HOSPITAL AND IN THE COMMUNITY. COMMUNITY MEMBERS WHO WOULD BE DIRECT RECIPIENTS OF THE SERVICES PARTICIPATED AT THESE EVENTS ALONG WITH PROVIDERS. MERCY MEDICAL CENTER- SC MET WITH THE BOARD OF DIRECTORS, ADMINISTRATORS, AND KEY PHYSICIANS FROM THE SIOUXLAND SURGERY CENTER TO SOLICIT INPUT AND PARTICIPATION IN THE COMMUNITY BENEFIT PLANS FOR THE TRI-STATE AREA. MERCY MEDICAL CENTER- SC PARTICIPATED IN THE CONVOY OF HOPE AND PROVIDED DIRECT EDUCATION AND RECEIVED DIRECT INPUT REGARDING NEEDS FROM 4,000 POOR AND/OR MARGINALIZED IN OUR COMMUNITY.
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 3: THE PROCESS INVOLVED GATHERING COMMUNITY STAKEHOLDERS WHO HAVE A ROLE IN THE DELIVERY AND PARTNERSHIP OF PUBLIC HEALTH SERVICES. A STEERING COMMITTEE WAS FORMED TO OVERSEE THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT -HEALTH IMPROVEMENT PLAN PROCESS. THE STEERING COMMITTEE CONSISTED OF STAFF FROM THE COUNTY BOARD OF HEALTH, COUNTY HEALTH DEPARTMENT, DUBUQUE VISITING NURSE ASSOCIATION AND THE CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT, AND MERCY MEDICAL CENTER. AS DESCRIBED IN THE CHNA DOCUMENT, FOUR COMMUNITY FORUMS WERE HELD ON DIFFERENT DAYS OF THE WEEK, TIMES OF THE DAY, AND LOCATIONS AROUND THE COUNTY TO PROVIDE OPPORTUNITIES FOR COMMUNITY MEMBERS TO PROVIDE INPUT TO THE PLANNING PROCESS. THE MEETINGS WERE WIDELY PUBLICIZED IN THE LOCAL NEWSPAPER, HOSPITAL NEWSLETTERS, AND THE NEWSLETTERS AND WEBSITES OF OTHER COMMUNITY ORGANIZATIONS.
SIOUXLAND SURGERY CENTER		PART V, SECTION B, LINE 3: SIOUXLAND SURGERY CENTER COLLABORATED WITH MERCY MEDICAL CENTER - SIOUX CITY AND UNITY POINT-ST. LUKE'S REGIONAL MEDICAL CENTER IN CONDUCTING THE CHNA. PLEASE SEE EXPLANATION UNDER MERCY MEDICAL CENTER - SIOUX CITY FOR MORE INFORMATION.
MERCY MEDICAL CENTER-NEW HAMPTON		PART V, SECTION B, LINE 3: THE ASSESSMENT PROCESS WAS INITIATED BY MMC-NH. A PLANNING TEAM WAS FORMED CONSISTING OF REPRESENTATIVES FROM HOSPITAL GOVERNANCE, LEADERSHIP AND MEDICAL STAFF, AREA EMPLOYERS, SCHOOL DISTRICTS AND AREA HEALTH PROFESSIONALS. FACILITATED BY AN OUTSIDE CONSULTANT, FOUR SEPARATE DISCUSSION GROUPS WERE HELD LOCALLY. THE GROUPS REPRESENTED VARYING SECTORS IN THE COMMUNITY: (1) SOCIAL SERVICE PARTNERS, (2) PATIENTS, (3) COMMUNITY/BUSINESS REPRESENTATIVES, AND (4) INDUSTRIAL WORKERS. THERE WAS A 63% RESPONSE TO INVITATIONS TO PARTICIPATE. THE PATIENT GROUP WAS PULLED RANDOMLY FROM A PATIENT LISTING OVER THE PRECEDING SIX MONTHS, SOCIAL SERVICE PARTNERS WERE A CROSS-SECTION OF THE AGENCIES MERCY WORKS CLOSELY WITH, AND COMMUNITY LEADERS/BUSINESS OWNERS WERE SELECTED FOR THEIR KNOWLEDGE OF THE COMMUNITY. INDUSTRIAL WORKERS ON GROUP 4 WERE IDENTIFIED BY THEIR EMPLOYER.THE OUTSIDE CONSULTANT COLLATED AND ANALYZED THE FOCUS GROUP RESULTS WITH SUPPORT FROM MERCY MEDICAL CENTER - NORTH IOWA'S (MMC-NI) PLANNING & MARKETING TEAM IN MASON CITY.
MERCY MEDICAL CENTER-SIOUX CITY		PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - SIOUX CITY'S CHNA WAS CONDUCTED WITH ST. LUKE'S REGIONAL MEDICAL CENTER AND SIOUXLAND SURGERY CENTER.
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - DUBUQUE CONDUCTED ITS CHNA WITH MERCY MEDICAL CENTER - DYERSVILLE.
SIOUXLAND SURGERY CENTER		PART V, SECTION B, LINE 4: MERCY MEDICAL CENTER - SIOUX CITY AND ST. LUKE'S REGIONAL MEDICAL CENTER
MERCY MEDICAL CENTER-NORTH IOWA		PART V, SECTION B, LINE 5C: LINE 5A:HTTP://WWW.MERCYNORTHIOWA.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
MERCY MEDICAL CENTER-SIOUX CITY		PART V, SECTION B, LINE 5C: THE CHNA WAS DISTRIBUTED TO SOCIAL AGENCIES AND THE PLAN TO ADDRESS UNMET NEEDS WAS EXPLAINED.LINE 5A:HTTP://WWW.MERCYSIOUXCITY.COM/WORKFILES//CHNA-MERCY-%20SL%20SEPT%202013%20%282%29.PDF
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 5C: LINE 5A:HTTP://WWW.MERCYDUBUQUE.COM/WORKFILES/COMMUNITY%20HEALTH%20NEEDS%20ASSESSMENT.PDF
SIOUXLAND SURGERY CENTER		PART V, SECTION B, LINE 5C: A COPY OF THE SIOUXLAND SURGERY CENTER CHNA REPORT WILL BE POSTED AT THE MERCY MEDICAL CENTER - SIOUX CITY WEBSITE.
MERCY MEDICAL CENTER-NEW HAMPTON		PART V, SECTION B, LINE 5C: LINE 5A:HTTP://WWW.MERCYNEWHAMPTON.COM/WORKFILES/CHNA%20DRAFT%20MAY%202013.PDF
MERCY MEDICAL CENTER-NORTH IOWA		PART V, SECTION B, LINE 7: MERCY MEDICAL CENTER - NORTH IOWA (MMC-NI) HAS DEVELOPED A ROBUST IMPLEMENTATION PLAN THAT OFFERS STRATEGIES FOR MANY BARRIERS AND COMPLICATIONS WITHIN EACH OF THE THREE NEEDS IDENTIFIED IN THE CHNA WHICH ARE: MANAGE CHRONIC CONDITIONS, SUPPORT WELLNESS THROUGH ACCESS TO CARE AND SERVICES, AND SUPPORT WELLNESS THROUGH SOCIAL SUPPORTS. HOWEVER, DUE TO THE LACK OF FINANCIAL AND PERSONNEL RESOURCES, AND THE PRESENCE OF OTHER COMMUNITY ORGANIZATIONS' EFFORTS TO ADDRESS THESE NEEDS, MMC-NI DID NOT IMPLEMENT STRATEGIES THAT ADDRESS EACH INDIVIDUAL BARRIER AND COMPLICATION WITHIN THESE THREE NEEDS. MMC-NI WILL ACCOMPLISH A NEW COMMUNITY HEALTHCARE NEEDS ASSESSMENT IN 2013 THROUGH COMMUNITY COLLABORATION AND WILL UPDATE ITS IMPLEMENTATION PLAN.
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 7: THE FOLLOWING PROBLEMS OR NEEDS WERE IDENTIFIED, BUT NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY OR OTHER REASONS LISTED. 1. CANCER PREVENTION/EARLY DETECTION: TOBACCO USE (SMOKING 16%) 44% RATE (STATE 39.5%/100,000). 2. SUBSTANCE ABUSE (BINGE DRINKING, UNDERAGE EOTH USE, MARIJUANA USE, PRESCRIPTION DRUGS, TOBACCO, ALCOHOL); INCLUDES HIGH RISK BEHAVIOR BY YOUTH USING ALCOHOL AND DRUG USE. 3. MENTAL HEALTH ACCESS. (NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF HUMAN RESOURCES OR STAFF.) 4. HIGH RISK SEXUAL BEHAVIORS INCLUDING YOUTH INITIATING SEXUAL ACTIVITY AT YOUNGER AGE. (NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF FINANCIAL RESOURCES.) 5. PREVENTION/SCREENING FOR CHRONIC DISEASE. 6. ACCESS TO PRENATAL CARE IN 1ST TRIMESTER OF PREGNANCY. 7. NEED FOR INCREASED EDUCATION ON HEALTHY LIFESTYLE BEHAVIORS (INCLUDING REGULAR EXERCISE AND HEALTHY DIET/NUTRITION HABITS) AMONG YOUNG (PRE-SCHOOL TO GRADE SCHOOL) CHILDREN. (NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND COMMUNITY PARTNERS DO NOT EXIST.) 8. ACCESS TO MEDICAL AND DENTAL CARE FOR ALL AGES; ACCESS TO VACCINES FOR ADULTS. (NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF FINANCIAL RESOURCES.)9. RESPITE CARE SERVICES FOR CAREGIVERS IN THE HOME SETTING. (NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY AND LACK OF ACCESS TO TECHNICAL ASSISTANCE AND SERVICES.) 10. COMMUNITY AWARENESS TO ACCESS SERVICES FOR RESIDENTS/FAMILIES DISCHARGED FROM THE MILITARY AND VETERANS REGARDLESS OF AGE. (NOT INCLUDED IN THE HEALTH IMPROVEMENT PLAN BECAUSE OF COMPETING PROJECTS OR PRIORITIES IN THE COMMUNITY, LACK OF ACCESS TO TECHNICAL ASSISTANCE AND SERVICES, AND LEAD ORGANIZATION DOES NOT EXIST.)
SIOUXLAND SURGERY CENTER		PART V, SECTION B, LINE 7: SIOUXLAND SURGERY CENTER ADDRESSED COMMUNITY HEALTH NEEDS WITHIN THE SCOPE OF THE HOSPITAL'S EXPERTISE (EXCERCISE AND NUTRITION FOR YOUTH AND POVERTY IMPACTING HEALTH). MENTAL HEALTH SERVICES AND PRIMARY CARE ARE NOT WITHIN THE SCOPE OF THE ORGANIZATION, AND OTHERS IN THE COMMUNITY ARE BETTER SKILLED TO ADDRESS THESE NEEDS.
MERCY MEDICAL CENTER-NEW HAMPTON		PART V, SECTION B, LINE 7: MMC-NH HAS CHOSEN NOT TO DIRECTLY ADDRESS THESE COMMUNITY NEEDS: PHYSICAL INACTIVITY AND ACCESS TO RECREATION AND FITNESS FACILITIES. THOUGH THE 8.04 ESTABLISHMENT RATE PER 100,000 POPULATION IS WELL BELOW BOTH IOWA'S AND THE COUNTRY'S AVERAGES, MMC-NH BELIEVES THAT WORKING WITH AND THROUGH THE CHICKASAW WELLNESS CENTER (CWC) TO MAXIMIZE ITS ALREADY-EXCELLENT ROSTER OF PROGRAMS AND SERVICES IS A MORE EFFECTIVE USE OF SCARCE COMMUNITY RESOURCES.ALSO, THOUGH CHICKASAW COUNTY'S PERCENT OF MEDICARE ENROLLEES WITH DIABETES HAVING AN ANNUAL EXAM (87.21%) IS AGAIN BELOW IOWA'S BENCHMARK, AS A MEMBER OF THE MERCY HEALTH NETWORK, MMC-NH BELIEVES THAT WORKING WITHIN THE NETWORK'S OVERALL STRATEGY FOR MANAGING DIABETES AND OTHER CHRONIC DISEASES IS, AGAIN, A MORE EFFECTIVE USE OF SCARCE INSTITUTIONAL RESOURCES. MMC-NH'S CLINICAL TEAM, INCLUDING PHYSICIANS, IS PLAYING AN ACTIVE ROLE IN BRINGING THE NETWORK'S METHODOLOGIES TO NEW HAMPTON AND CHICKASAW COUNTY.
MERCY MEDICAL CENTER-NORTH IOWA		PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCY MEDICAL CENTER-SIOUX CITY		PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCY MEDICAL CENTER-NEW HAMPTON		PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCY MEDICAL CENTER-DYERSVILLE		PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCY MEDICAL CENTER-NORTH IOWA		PART V, SECTION B, LINE 14G: NOTICES REGARDING THE FINANCIAL ASSISTANCE POLICY ARE POSTED IN PATIENT REGISTRATION AREAS.
MERCY MEDICAL CENTER-SIOUX CITY		PART V, SECTION B, LINE 14G: SUMMARY INFORMATION IS PROVIDED TO PATIENTS IN THEIR ADMISSION PACKETS RELATED TO FINANCIAL ASSISTANCE AND PATIENT BALANCE RESOLUTION. BROUCHURES ARE AVAILABLE IN CENTRAL REGISTRATION AND THE EMERGENCY DEPARTMENT THAT SUMMARIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS. SUMMARY STATEMENTS ARE PRESENT ON THE PATIENTS BILL STATING THAT ASSISTANCE MAY BE AVAILABLE. FINANCIAL COUNSELORS DO VISIT WITH ALL UNINSURED INPATIENTS AND OFFER ASSISTANCE THROUGH THE FINANCIAL ASSISTANCE PROGRAM. THE DETAILED POLICY IS AVAILABLE TO PATIENTS UPON REQUEST FROM ON-SITE FINANCIAL COUNSELORS NEAR CENTRAL REGISTRATION AND THE EMERGENCY DEPARTMENT. INFORMATION ON THE FINANCIAL ASSISTANCE PROGRAM CAN ALSO BE OBTAINED BY CALLING THE SHARED SERVICE CENTER CUSTOMER SERVICE LINE.
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 14G: SIGNS AND BROCHURES REFERRING TO FINANCIAL ASSISTANCE ARE POSTED AND AVAILABLE AT ALL REGISTRATION SITES AS WELL AS IN PATIENT FINANCIAL SERVICES. AN FAP APPLICATION IS PROVIDED WITH THE PATIENT'S FIRST STATEMENT OR CAN BE REQUESTED BY CALLING PATIENT FINANCIAL SERVICES. IN FY 13, PATIENTS WERE PROVIDED INFORMATION UPON REGISTRATION, WITH THEIR FIRST STATEMENT OR UPON REQUEST. THE FAP SUMMARY IS ALSO AVAILABLE ON THE HOSPITAL WEBSITE AT: HTTP://WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE
MERCY MEDICAL CENTER-NEW HAMPTON		PART V, SECTION B, LINE 14G: NOTICES REGARDING THE FINANCIAL ASSISTANCE POLICY ARE POSTED IN PATIENT REGISTRATION AREAS.
MERCY MEDICAL CENTER-DYERSVILLE		PART V, SECTION B, LINE 14G: SIGNS AND BROCHURES REFERRING TO FINANCIAL ASSISTANCE ARE POSTED AND AVAILABLE AT ALL REGISTRATION SITES AS WELL AS IN PATIENT FINANCIAL SERVICES. AN FAP APPLICATION IS PROVIDED WITH THE PATIENT'S FIRST STATEMENT OR CAN BE REQUESTED BY CALLING PATIENT FINANCIAL SERVICES. IN FY 13, PATIENTS WERE PROVIDED INFORMATION UPON REGISTRATION, WITH THEIR FIRST STATEMENT OR UPON REQUEST. THE FAP SUMMARY IS ALSO AVAILABLE ON THE HOSPITAL WEBSITE AT: HTTP://WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE
MERCY MEDICAL CENTER-NORTH IOWA		PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE.
MERCY MEDICAL CENTER-SIOUX CITY		PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE.
MERCY MEDICAL CENTER-DUBUQUE		PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE.
SIOUXLAND SURGERY CENTER		PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 300% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE.
MERCY MEDICAL CENTER-NEW HAMPTON		PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE.
MERCY MEDICAL CENTER-DYERSVILLE		PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE.
EXPLANATION FOR NOT COMPLETING THE CHNA:	MERCY MEDICAL CENTER - DYERSVILLE SCHEDULE H, PART V, SECTION B, LINES 1-8	MERCY MEDICAL CENTER - DYERSVILLE (THE HOSPITAL) CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PRIOR TO JUNE 30, 2012 IN COLLABORATION WITH MERCY MEDICAL CENTER - DUBUQUE. ALTHOUGH THE CHNA WAS COMPLETED, THE HOSPITAL WAS UNABLE TO COMPLY WITH ALL REQUIREMENTS OF SECTION 501(R)(3) BY JUNE 30, 2013. THE FAILURE TO COMPLY WAS CORRECTED AS SOON AS POSSIBLE AND BEFORE FILING IRS FORM 990 FOR THE TAX YEAR ENDING JUNE 30, 2013. IN ACCORDANCE WITH THE PROPOSED GUIDANCE FOR DISCLOSURE OF FAILURE TO COMPLY IN IRS NOTICE 2014-3, MERCY MEDICAL CENTER - DYERSVILLE DISCLOSES:FAILURE TO COMPLY:1) THE CHNA AND ITS IMPLEMENTATION PLAN WERE APPROVED BY THE MERCY MEDICAL CENTER - DYERSVILLE BOARD AFTER JUNE 30, 2013, SPECIFICALLY ON JANUARY 27, 2014.2) THE CHNA WAS AVAILABLE UPON REQUEST, AND WAS MADE WIDELY AVAILABLE ON THE HOSPITAL WEB SITE AFTER JUNE 30, 2013; THE MANAGEMENT OF MERCY MEDICAL CENTER - DYERSVILLE BELIEVED THAT THE CHNA HAD BEEN POSTED ON ITS WEBSITE SOON AFTER IT WAS APPROVED BY THE MERCY MEDICAL CENTER - DUBUQUE BOARD OF DIRECTORS. WHEN IT WAS DISCOVERED THAT IT WAS NOT YET AVAILABLE, STEPS WERE TAKEN IMMEDIATELY TO CORRECT THIS. NO FAILURE TO COMPLY WAS THE RESULT OF RECKLESS DISREGARD OR WILLFUL NEGLECT; THE HOSPITAL HAD EVERY INTENTION AND MADE EVERY EFFORT TO COMPLY WITH SECTION 501(R)(3) BY JUNE 30, 2013. THE FAILURE TO COMPLY DID NOT RESULT IN A DENIAL OF HOSPITAL CARE TO NEEDY INDIVIDUALS. THE FAILURE TO COMPLY WAS SIMPLY A TIMING ISSUE THAT THE HOSPITAL HAS MADE EVERY EFFORT TO CORRECT.DISCOVERY OF FAILURE:MERCY MEDICAL CENTER - DYERSVILLE IS A MEMBER OF THE CHE TRINITY HEALTH SYSTEM, THE SECOND LARGEST CATHOLIC HOSPITAL SYSTEM IN THE U.S. MANY FUNCTIONS RELATED TO THE ADMINISTRATION AND MANAGEMENT OF MEMBER HOSPITALS ARE COORDINATED ON A SYSTEM-WIDE AND CENTRALIZED BASIS INCLUDING (BUT NOT LIMITED TO) COMMUNICATIONS AND INTERNET COMMUNICATIONS, COMMUNITY BENEFIT MINISTRY (CBM) STANDARDS AND REPORTING, AND IRS COMPLIANCE. THE CHE TRINITY HEALTH CBM DEPARTMENT ASSISTED MANY OF ITS MEMBERS WITH GUIDANCE FOR THE CHNA. 1) MERCY MEDICAL CENTER - DYERSVILLE IS A SMALL, CRITICAL ACCESS HOSPITAL IN THE GREATER DUBUQUE, IOWA AREA. THE EXECUTIVE MANAGEMENT OF MERCY MEDICAL CENTER - DUBUQUE (CEO, CFO, AND OTHER VICE PRESIDENTS) ALSO SERVES AS EXECUTIVE MANAGEMENT FOR MERCY MEDICAL CENTER - DYERSVILLE. HOWEVER, THE TWO HOSPITALS HAVE SEPARATE LOCAL BOARDS OF DIRECTORS. THE CHNA WAS APPROVED BY THE LOCAL BOARD OF MERCY MEDICAL CENTER - DUBUQUE PRIOR TO JUNE 30, 2012. THE CHNA HAD BEEN DONE IN COLLABORATION WITH MERCY MEDICAL CENTER - DYERSVILLE, AND IT WAS SIMPLY OVERLOOKED THAT THE LOCAL BOARD FOR THE DYERSVILLE HOSPITAL HAD NOT APPROVED THE CHNA. THIS WAS DISCOVERED DURING THE PREPARATION PROCESS FOR THE JUNE 30, 2013 IRS FORM 990.2) IT WAS ALSO DISCOVERED DURING THIS SAME TIME THAT MERCY MEDICAL CENTER - DYERSVILLE HAD NOT SUBMITTED THE IMPLEMENTATION PLAN TO ITS BOARD OF DIRECTORS IN TIME FOR APPROVAL BY JUNE 30, 2013. THE IMPLEMENTATION PLAN WAS SUBMITTED TO, AND APPROVED BY THE BOARD AT ITS NEXT SCHEDULED BOARD MEETING.3) THE MANAGEMENT OF MERCY MEDICAL CENTER - DYERSVILLE BELIEVED THAT BECAUSE THE CHNA HAD BEEN POSTED ON THE WEBSITE FOR MERCY MEDICAL CENTER - DUBUQUE, IT WAS WIDELY AVAILABLE. ALTHOUGH THERE ARE LINKS FROM THE DUBUQUE WEBSITE (MAINTAINED BY MERCY HEALTH NETWORK) TO THE DYERSVILLE MAIN PAGE, THERE WAS NO LINK CONNECTING THE CHNA TO THE MERCY MEDICAL CENTER - DYERSVILLE PAGE. THIS WAS DISCOVERED BY THE COMMUNITY BENEFIT MINISTRY AND TAX DEPARTMENTS OF CHE TRINITY HEALTH DURING THE PREPARATION PHASE FOR IRS FORM 990. MERCY MEDICAL CENTER - DYERSVILLE MANAGEMENT WAS IMMEDIATELY ALERTED.CORRECTIONS MADE:1) THE MERCY MEDICAL CENTER - DYERSVILLE BOARD OF DIRECTORS APPROVED THE CHNA AND IMPLEMENTATION PLAN AT ITS NEXT BOARD MEETING AS SOON AS POSSIBLE, SPECIFICALLY ON JANUARY 27, 2014.2) WHEN IT WAS DISCOVERED THAT THE CHNA WAS NOT POSTED ON THE HOSPITAL WEBSITE, STEPS WERE TAKEN IMMEDIATELY TO CORRECT THIS. THE COMMUNICATIONS DEPARTMENT ASSISTED IN MAKING THE CHNA WIDELY AVAILABLE. ADDITIONALLY THE CBM DEPARTMENT OF CHE TRINITY HEALTH IS IMPLEMENTING A CENTRALIZED PROCESS FOR COMPLIANCE WITH SECTION 501(R)(3). PRACTICES AND PROCEDURES:TO MINIMIZE THE LIKELIHOOD OF A RECURRENCE OF THIS FAILURE, MERCY MEDICAL CENTER - DYERSVILLE AND CHE TRINITY HEALTH HAVE DEVELOPED BEST PRACTICE PROCEDURES TO ENSURE COMPLIANCE. FURTHER TRAINING WILL BE PROVIDED TO ALL PERSONNEL PRIOR TO THE COMPLETION OF THE FISCAL YEAR.THE FOLLOWING OUTLINES THE STEPS AND PROCEDURES THAT MERCY MEDICAL CENTER - DYERSVILLE FOLLOWED AS PART OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT:THE CHNA WAS FORMALLY APPROVED BY THE HOSPITAL'S BOARD ON JANUARY 27, 2014.THE MERCY MEDICAL CENTER - DYERSVILLE CHNA REPORT DESCRIBES:- A DEFINITION OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY-DEMOGRAPHICS OF THE COMMUNITY-EXISTING HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT ARE AVAILABLE TO RESPOND TO THE HEALTH NEEDS OF THE COMMUNITY-HOW DATA WAS OBTAINED-THE HEALTH NEEDS OF THE COMMUNITY-PRIMARY AND CHRONIC DISEASE NEEDS AND OTHER HEALTH ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS-THE PROCESS FOR IDENTIFYING AND PRIORITIZING COMMUNITY HEALTH NEEDS AND SERVICES TO MEET THE COMMUNITY HEALTH NEEDS-THE PROCESS FOR CONSULTING WITH PERSONS REPRESENTING THE COMMUNITY'S INTERESTS-INFORMATION GAPS THAT LIMIT THE HOSPITAL FACILITY'S ABILITY TO ASSESS THE COMMUNITY'S HEALTH NEEDSTHE LAST CHNA THAT THE HOSPITAL CONDUCTED WAS IN TAX YEAR 2011, AND WAS APPROVED BY THE MERCY MEDICAL CENTER-DYERSVILLE BOARD IN TAX YEAR 2013.IN CONDUCTING THIS CHNA THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.THE PROCESS INVOLVED GATHERING COMMUNITY STAKEHOLDERS WHO HAVE A ROLE IN THE DELIVERY AND PARTNERSHIP OF PUBLIC HEALTH SERVICES. A STEERING COMMITTEE WAS FORMED TO OVERSEE THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT -HEALTH IMPROVEMENT PLAN PROCESS. THE STEERING COMMITTEE CONSISTED OF STAFF FROM THE COUNTY BOARD OF HEALTH, COUNTY HEALTH DEPARTMENT, DUBUQUE VISITING NURSE ASSOCIATION AND THE CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT, AND MERCY MEDICAL CENTER. AS DESCRIBED IN THE CHNA DOCUMENT, FOUR COMMUNITY FORUMS WERE HELD ON DIFFERENT DAYS OF THE WEEK, TIMES OF THE DAY, AND LOCATIONS AROUND THE COUNTY TO PROVIDE OPPORTUNITIES FOR COMMUNITY MEMBERS TO PROVIDE INPUT TO THE PLANNING PROCESS. THE MEETINGS WERE WIDELY PUBLICIZED IN THE LOCAL NEWSPAPER, HOSPITAL NEWSLETTERS, AND THE NEWSLETTERS AND WEBSITES OF OTHER COMMUNITY ORGANIZATIONS.THE HOSPITAL'S CHNA WAS CONDUCTED WITH MERCY MEDICAL CENTER - DUBUQUE. THE HOSPITAL'S CHNA REPORT HAS BEEN MADE WIDELY AVAILABLE TO THE PUBLIC: IT IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE AT:HTTP://WWW.MERCYDUBUQUE.COM/WORKFILES/DYERSVILLE_COMMUNITY_BENEFIT_CHNA_IMPROVEMENT_PLAN.PDF AND IT IS AVAILABLE UPON REQUEST.THE HOSPITAL FACILITY ADDRESSED NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA THROUGH:-ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA-EXECUTION OF THE IMPLEMENTATION STRATEGY-PARTICIPATION IN THE DEVELOPMENT OF A COMMUNITY-WIDE PLAN-PARTICIPATION IN THE EXECUTION OF A COMMUNITY-WIDE PLAN-INCLUSION OF A COMMUNITY BENEFIT SECTION IN OPERATION PLANS-ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA-PRIORITIZATION OF HEALTH NEEDS IN ITS COMMUNITY-PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY THE HOSPITAL FACILITY DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA:PLEASE SEE MERCY MEDICAL CENTER-DUBUQUE'S INFORMATION FOR AN EXPLANATION FOR SCHEDULE H, SECTION B, LINE 7.
		PART VI, LINE 2: NEEDS ASSESSMENT - MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA) ASSESSES THE HEALTH NEEDS OF THE COMMUNITY THROUGH COMMUNITY NEEDS ASSESSMENTS EVERY THREE YEARS. MERCY HEALTH SERVICES - IOWA, CORP. IS COMPRISED OF FIVE ENTITIES: MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER - DYERSVILLE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA AND MERCY MEDICAL CENTER-SIOUX CITY. EACH MEDICAL CENTER COMPLETES ITS OWN NEEDS ASSESSMENT.A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR OUR STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES. MHS-IA'S COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED- IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE MHS-IA COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES.OUR HOSPITALS ASSESS THE HEALTH STATUS OF THE COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. OUR HOSPITALS MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY.MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON EACH HAVE A LOCAL BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS, EMPLOYERS AND DEMOGRAPHIC GROUPS. THESE HOSPITALS ALSO COMMUNICATE WITH OTHER VARIOUS AGENCIES ABOUT WHAT SERVICES ARE NEEDED LOCALLY. IN PARTICULAR, OUR PRIMARY CARE PHYSICIANS HAVE A STRONG AWARENESS OF PATIENT NEEDS.MERCY MEDICAL CENTER-SIOUX CITY STAFF ROUTINELY (WEEKLY) MEETS WITH VARIOUS COMMUNITY AGENCIES, CHURCHES, AND SCHOOLS IN SEARCH OF OPPORTUNITIES TO PARTNER TO ADDRESS (1) ACCESS TO PRIMARY CARE, (2) EXERCISE AND NUTRITION FOR YOUTH, (3) ACCESS TO MENTAL HEALTH SERVICES, AND (4) GENERAL POVERTY AND HOMELESSNESS AND HUNGER.
		PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCY HEALTH SERVICES-IOWA IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- 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 - 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 A COMMUNITYIN ACCORDANCE WITH AHA RECOMMENDATIONS, MHS-IA HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSMHS-IA COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES IS MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED IN VARIOUS ADMISSION AREAS THROUGHOUT THE HOSPITALS AND CLINICS. A "PATIENT FINANCIAL GUIDELINES" BROCHURE IS ALSO AVAILABLE AT EACH ADMISSION AREA. THIS BROCHURE PROVIDES INFORMATION REGARDING PAYMENT OPTIONS, FINANCIAL ASSISTANCE AND BILLING QUESTIONS. FINANCIAL COUNSELING IS ALSO PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. AT TIME OF ADMISSION, THE NAMES OF UNINSURED AND UNDERINSURED PATIENTS ARE GIVEN TO FINANCIAL COUNSELORS WHO MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. THE FINANCIAL COUNSELORS HAVE A GOOD WORKING RELATIONSHIP WITH THE DEPARTMENT OF HUMAN SERVICES AND VARIOUS COUNTY AND COMMUNITY PROGRAMS. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION FOR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.THE HOSPITALS OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. OUTPATIENTS, REFERRALS, OR SELF-REFERRALS RECEIVE THE SAME ATTENTION AND ASSISTANCE FROM FINANCIAL COUNSELORS. CONTACT MAY BE BY PHONE AND/OR LETTER PROCESS IF FACE-TO-FACE CONTACT IS NOT POSSIBLE.INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON THE HOSPITALS' WEBSITES, IN THE ADMISSION PACKAGE DURING INTAKE, AND "PATIENT ASSISTANCE" BROCHURES AS WELL AS ON HOSPITAL WEBSITES. ALL HOSPITALS HAVE ESTABLISHED WRITTEN POLICIES FOR BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS.MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON:IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. PATIENT FINANCIAL SERVICES IS ABLE TO ASSIST SPANISH-SPEAKING PATIENTS WITH THE FINANCIAL APPLICATION PROCESS. A LANGUAGE LINE CONNECTION IS ALSO AVAILABLE FOR MORE THAN 170 OTHER LANGUAGES.MERCY MEDICAL CENTER - NORTH IOWA AND MERCY MEDICAL CENTER - NEW HAMPTON EDUCATE STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS ABOUT THESE POLICIES, WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. THE PATIENT FINANCIAL SERVICES DEPARTMENT HAS ITS OWN TRAINING DEPARTMENT AND TRAINERS. THE PATIENT REGISTRATION, FINANCIAL ASSISTANCE, PATIENT FINANCIAL SERVICES, CUSTOMER SERVICE, AND BILLING DEPARTMENTS RECEIVE TRAINING REGARDING THE POLICIES THAT ARE RELEVANT TO THEIR POSITIONS AND OUR MISSION VALUES. SCRIPTING IS USED AND FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE IN ENGLISH AND SPANISH. MERCY MEDICAL CENTER - NORTH IOWA ALSO PROVIDES FINANCIAL ASSISTANCE FOR PRESCRIBED MEDICATIONS. THERE ARE SEVERAL SHORT-TERM ASSISTANCE PROGRAMS, AS WELL AS A SOCIAL WORKER FACILITATING THE APPLICATION PROCESS FOR LONG-TERM ASSISTANCE FROM PHARMACEUTICAL PROGRAMS.MERCY MEDICAL CENTER - SIOUX CITY:MERCY MEDICAL CENTER-SIOUX CITY NOT ONLY COMMUNICATES FINANCIAL ASSISTANCE POLICIES VIA TRADITIONAL CHANNELS (REGISTRATION, AND BILLING); THE ORGANIZATION SHARES ITS FINANCIAL ASSISTANCE POLICY WITH OTHER SERVICE AGENCIES AND NOT-FOR-PROFIT ORGANIZATIONS. FOR EXAMPLE, THROUGH THE MISSION HEALTH PROGRAM, A COLLABORATION BETWEEN THE SIOUXLAND COMMUNITY HEALTH CENTER, MMC-SIOUX CITY AND UNITY POINT - ST. LUKE'S HOSPITAL, MERCY MEDICAL CENTER-SIOUX CITY REACHES OUT TO CHURCHES AND SCHOOLS TO FIND THOSE WHO MAY BE IN NEED OF FINANCIAL ASSISTANCE. PARTICIPANTS ARE PRE-QUALIFIED FOR FINANCIAL ASSISTANCE AT BOTH LOCAL HOSPITALS, AND ARE INVITED TO CHOOSE A MEDICAL HOME. THE MISSION HEALTH PROGRAM HAS OVER 1,400 ENROLLED PATIENTS, ALL OF WHOM HAVE A BETTER UNDERSTANDING AND REDUCED ANXIETY CONCERNING FINANCIAL OBLIGATIONS AND ASSISTANCE IF HOSPITALIZATION IS NEEDED. AS THE AFFORDABLE CARE ACT IS IMPLEMENTED MERCY WILL INCREASE EFFORTS TO EDUCATE PATIENTS REGARDING MEDICAID EXPANSION AND ASSIST WITH ENROLLMENT OF PATIENTS.FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTHCARE SERVICES. MERCY MEDICAL CENTER-SIOUX CITY SOCIAL WORKERS PROVIDE ASSISTANCE AND COUNSELING REGARDING FINANCIAL ASSISTANCE OPPORTUNITIES WITHIN THE ORGANIZATION, AND REFER PATIENTS AND FAMILIES TO APPROPRIATE AGENCIES FOR COVERAGE. MERCY MEDICAL CENTER-SIOUX CITY ALSO WORKS WITH THE MIDLANDS GROUP TO ENLIST PATIENTS IN QUALIFYING PROGRAMS. MERCY MEDICAL CENTER-SIOUX CITY UTILIZES A COMMUNITY NEEDS INDEX (CNI) TO TARGET SPECIFIC ZIP CODES WHERE PATIENTS IN NEED OF FINANCIAL ASSISTANCE OFTEN RESIDE. THE HOSPITAL PLANS TO HIRE A MINORITY OUTREACH COORDINATOR TO SOLICIT INPUT REGARDING MINORITY HEALTH AND SOCIAL NEEDS. THIS BI-LINGUAL PERSON WILL ALSO ASSIST IN EDUCATION REGARDING UPCOMING ACA AND MEDICAID EXPANSION OPPORTUNITIES.MERCY MEDICAL CENTER - DUBUQUE AND MERCY MEDICAL CENTER - DYERSVILLE:FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTH CARE SERVICES. MERCY MEDICAL CENTER-DUBUQUE CONTRACTS WITH A FIRM WITH A LONG TRACK RECORD OF COMPASSIONATE SERVICE TO PROVIDE COUNSELING, REFERRALS, AND ASSISTANCE TO PATIENTS IN DETERMINING ELIGIBILITY AND ENROLLING IN A WIDE VARIETY OF PUBLIC AND PRIVATE ASSISTANCE PROGRAMS, SUCH AS MEDICARE, MEDICAID, HAWK-I (AND THE CORRESPONDING SCHIPS PROGRAMS FOR ILLINOIS AND WISCONSIN) AND IOWA CARE, IOWA'S STATE ASSISTANCE PROGRAM FOR INDIGENT PERSONS.PATIENT ACCOUNTS COUNSELORS ARE AVAILABLE TO HELP PATIENTS UNDERSTAND THEIR BILLS AND FIND RESOURCES TO ASSIST IN PAYING THEM. MERCY MEDICAL CENTER-DUBUQUE ALSO OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE IN BROCHURES AT EVERY SITE WHERE PATIENTS ARE ADMITTED, AND AT THE BILLING OFFICE, DESCRIBING MERCY'S CHARITY CARE POLICIES, THRESHOLDS, LIMITATIONS, AND PROCESS. AN APPLICATION FOR FINANCIAL ASSISTANCE IS PROVIDED WITH BILLING STATEMENTS. INFORMATION ABOUT MERCY'S CHARITY CARE POLICY IS ALSO INCLUDED IN THE "PATIENT AND VISITOR INFORMATION" GUIDEBOOK, WHICH IS AVAILABLE IN ENGLISH AND SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY THE HOSPITAL. BROCHURES ARE AVAILABLE IN ALL ADMISSION AREAS.SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO ALL HUMAN SERVICE AGENCIES WITHIN THE MERCY MEDICAL CENTER-DUBUQUE AND DYERSVILLE SERVICE AREAS. MERCY MEDICAL CENTER-DUBUQUE AND DYERSVILLE EDUCATE ALL STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS ABOUT THESE POLICIES, WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT. THIS TRAINING OCCURS AT THE TIME OF HIRE AND ALSO THROUGH IN-SERVICE TRAINING.
		PART VI, LINE 4: COMMUNITY INFORMATION - MERCY MEDICAL CENTER - NORTH IOWA: SERVES A 14-COUNTY SERVICE AREA WITHIN A 70-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM MASON CITY. THE PRIMARY SERVICE AREA CONSISTS OF CERRO GORDO AND WORTH COUNTIES IN IOWA, WHILE THE SECONDARY SERVICE AREA IS COMPRISED OF AN ADDITIONAL 12 CONTIGUOUS COUNTIES IN IOWA (BUTLER, CHICKASAW, FLOYD, FRANKLIN, HANCOCK, HARDIN, HOWARD, KOSSUTH, MITCHELL, PALO ALTO, WINNEBAGO, AND WRIGHT). IN 2012 THE 14-COUNTY SERVICE AREA HAD AN ESTIMATED POPULATION OF 204,551 ACCORDING TO NEILSEN COUNTY AND 2013 TRUVEN HEALTH ANALYTICS, INC. 94.1 PERCENT OF RESIDENTS ARE CAUCASIAN. HISPANICS, AT LESS THAN 3.7%, REPRESENT THE AREA'S LARGEST MINORITY GROUP. THE AVERAGE HOUSEHOLD INCOME IS $52,972. HOUSEHOLDS MAKING $25,000 OR LESS COMPRISE 25.4 PERCENT; THOSE MAKING FROM $25,000-$50,000 ARE 32.3 PERCENT; $50,000-$75,000 IS 22.8 PERCENT AND THOSE MAKING $75,000 OR MORE REPRESENT 19.4 PERCENT. THERE ARE 11 CRITICAL ACCESS HOSPITALS WITHIN MERCY - NORTH IOWA'S SERVICE AREA PROVIDING PRIMARY HEALTH CARE SERVICES, EIGHT OF WHICH ARE MERCY - NORTH IOWA AFFILIATES. PATIENTS FROM THE REMAINING IOWA COUNTIES UTILIZE MERCY - NORTH IOWA FOR TERTIARY LEVEL CARE. THE UNIVERSITY OF IOWA HOSPITALS IN IOWA CITY AND MAYO CLINIC IN ROCHESTER, MINNESOTA ALSO PROVIDE TERTIARY CARE FOR THIS AREA.MERCY - NORTH IOWA'S MARKET SHARE FOR THE 14-COUNTY SERVICE AREA IN CY 2012 IS 52 PERCENT, AS REPORTED BY IOWA HOSPITAL ASSOCIATION DATA.THE AVERAGE INCOME IN MERCY - NORTH IOWA'S SERVICE AREA IN 2010 WAS ESTIMATED TO BE $31,765, ACCORDING TO BUREAU OF ECONOMIC ANALYSIS (IOWA WORKFORCE DEVELOPMENT NEWS AND TRENDS). UNEMPLOYMENT WENT DOWN IN MERCY - NORTH IOWA'S SERVICE AREA. IN OCTOBER 2011, THE UNEMPLOYMENT RATE WAS 4.9 PERCENT AND IN OCTOBER 2012, IT WAS 4.3 PERCENT, ACCORDING TO IOWA WORKFORCE DEVELOPMENT.MERCY MEDICAL CENTER - NEW HAMPTON SERVES THE CHICKASAW AREA AND SURROUNDING COUNTIES WITHIN A 20-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM NEW HAMPTON. THE PRIMARY SERVICE AREA CONSISTS OF THE TOWNS OF NEW HAMPTON, FREDERICKSBURG, ALTA VISTA, IONIA, ELMA, WAUCOMA, LAWLER AND NASHUA. THE ESTIMATED POPULATION OF THIS AREA IS 13,500. ACCORDING TO THE NIELSEN COMPANY, CHICKASAW COUNTY HAD AN ESTIMATED POPULATION OF 12,427 IN 2012. CHICKASAW COUNTY EXPERIENCED AN ESTIMATED 5.4% PERCENT DECLINE IN POPULATION FROM 2000-2012. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. EIGHTEEN PERCENT OF THE POPULATION IN THE CHICKASAW AREA WAS OVER AGE 65 IN 2012, COMPARED TO 15 PERCENT FOR THE STATE AND 13 PERCENT FOR THE NATION. IOWA RANKS FIFTH IN PERCENTAGE OF POPULATION OVER THE AGE OF 65. THIS LARGE PERCENTAGE OF ELDERLY PRESENTS SPECIAL CHALLENGES TO HEALTH CARE PROVIDERS BECAUSE THE ELDERLY HAVE THE HIGHEST INCIDENCE OF DISEASE AND MORTALITY IN MOST CATEGORIES AND, CORRESPONDINGLY, ARE THE BIGGEST USERS OF HEALTH CARE SERVICES. IN ADDITION, MEDICARE PAYMENT SHORTFALLS PRESENT AN ADDITIONAL BURDEN FOR RURAL HEALTH PROVIDERS. FOR FISCAL YEAR 2013, 56.2 PERCENT OF MMC-NH'S REVENUES (HOSPITAL INPATIENT AND OUTPATIENT) WERE GENERATED FROM MEDICARE PATIENTS. THE MEDIAN HOUSEHOLD INCOME IN CHICKASAW COUNTY WAS ESTIMATED AT $51,085 IN 2012. INDIVIDUALS BELOW THE POVERTY LEVEL COMPRISE 9.2% OF THE POPULATION. THE FISCAL YEAR 2013 PAYER MIX AT POINT OF REGISTRATION INCLUDES 53% COVERED BY MEDICARE, 7% COVERED BY MEDICAID AND 4% SELF-PAY.MERCY MEDICAL CENTER-SIOUX CITY: SERVES A 33-COUNTY AREA OF WESTERN IOWA, EASTERN NEBRASKA AND SOUTHEASTERN SOUTH DAKOTA, AN AREA THAT INCLUDES MANY ZIP CODES WITH A HIGH COMMUNITY NEED. IN ADDITION TO THE MAIN HOSPITAL IN SIOUX CITY, MERCY MEDICAL CENTER-SIOUX CITY OWNS RURAL HOSPITALS IN PRIMGHAR, IOWA, AND OAKLAND, NEBRASKA; MANAGES HOSPITALS IN PENDER, NEBRASKA AND HAWARDEN, IOWA; AND OPERATES A PRIMARY CARE CLINIC NETWORK, SPECIALTY CARE CLINICS AND HOME HEALTH SERVICES. MERCY ALSO PARTNERS WITH OTHER COMMUNITY HEALTHCARE PROVIDERS TO SPONSOR A REGIONAL CANCER CENTER, PARAMEDIC SERVICES, HOSPICE SERVICES, A FREESTANDING SURGERY CENTER AND A VARIETY OF OTHER HEALTH SERVICES.THE PRIMARY SERVICE AREA IS CONSIDERED URBAN (WITHIN SIOUX CITY). HOWEVER, MERCY SERVES MANY RURAL COMMUNITIES THROUGHOUT THE 33 COUNTY AREA, AND MANY DISTINCT ETHNIC AND CULTURAL GROUPS, INCLUDING HISPANIC, VIETNAMESE, SOMALI, AND NATIVE AMERICAN (WINNEBAGO, OMAHA, LAKOTA, AND PONCA TRIBES). THE AVERAGE HOUSEHOLD INCOME FOR THE 14-COUNTY SIOUX CITY AREA IS $55,562. ACCORDING TO THE STATE HEALTH ACCESS DATA ASSISTANCE CENTER, IN 2007, 27.9% PERCENT OF RESIDENTS WERE BELOW THE FEDERAL POVERTY GUIDELINES. MORE THAN 8.7% OF THE COMMUNITY IS UNINSURED, AND APPROXIMATELY 35.1% OF FAMILIES ARE ON MEDICAID OR OTHER ASSISTANCE PROGRAMS.ACCORDING TO 2012 NIELSEN COMPANY DATA, THE 14-COUNTY COMMUNITY HAS A POPULATION OF 301,832. EIGHT-TWO PERCENT OF THE POPULATION IS WHITE, 12% HISPANIC, 2% ASIAN & PACIFIC ISLANDER AND 1% BLACK. MEDICAID ENROLLMENT IS 34% IN NEBRASKA AND 37.5% IN SOUTH DAKOTA. THE PERCENT OF POPULATIONS IN EACH STATE BELOW 200% OF THE FEDERAL POVERTY LEVEL IS 28.8% IN NEBRASKA AND 30.9% IN SOUTH DAKOTA.MERCY MEDICAL CENTER - DUBUQUE AND MERCY MEDICAL CENTER - DYERSVILLE: FOR PURPOSES OF THEIR COMMUNITY HEALTH NEEDS ASSESSMENTS, MERCY MEDICAL CENTER'S PRIMARY SERVICE AREA IS DUBUQUE COUNTY, IOWA. ABOUT 60% OF MERCY'S INPATIENT CASES AND MORE THAN 75% OF MERCY'S EMERGENCY DEPARTMENT CASES WERE FOR DUBUQUE COUNTY RESIDENTS.DUBUQUE COUNTY'S POPULATION IS 89,143. IT INCLUDES ONE URBAN COMMUNITY, THE CITY OF DUBUQUE. ITS 65+ POPULATION IS ALMOST AS HIGH AS IOWA'S, AND SIGNIFICANTLY HIGHER THAN THE U.S. AVERAGE FOR THIS AGE RANGE. CONVERSELY, THE 16-24 POPULATION IS NOTICEABLY LOWER THAN THE U.S. AVERAGE. ALTHOUGH MINORITY POPULATIONS IN DUBUQUE COUNTY HAVE INCREASED DURING THE LAST DECADE, THE POPULATION IS STILL 97.1% WHITE, WITH NO OTHER SINGLE RACIAL GROUP ACCOUNTING FOR MORE THAN 1%. THE COUNTY'S HISPANIC OR LATINO POPULATION IS 1.2%CONSIDERING ONLY THE POPULATION OF DUBUQUE COUNTY RESIDENTS WHO ARE 25 OR OLDER, DUBUQUE COUNTY HAS A HIGHER PERCENTAGE OF RESIDENTS WITH ONLY A HIGH SCHOOL DIPLOMA OR EQUIVALENT THAN IOWA AND THE U.S. THERE IS A SMALLER PERCENTAGE OF DUBUQUE COUNTY RESIDENTS WITH SOME COLLEGE THAN IOWA OR THE U.S.MEDIAN INCOME IN DUBUQUE COUNTY IS $39,582, SLIGHTLY HIGHER THAN IOWA, BUT LOWER THAN THE U.S. MEDIAN. IN THE COUNTY, HOUSEHOLDERS UNDER 25 AND OLDER THAN 65 ARE BELOW THAT MEDIAN, WHICH IS ALSO TRUE FOR IOWA AND THE U.S. PER CAPITA INCOME IN DUBUQUE COUNTY IS $19,600, EQUAL TO IOWA AND SOMEWHAT LOWER THAN THE U.S. DUBUQUE COUNTY BLACK PER CAPITA INCOME IS 51% OF WHITE PER CAPITA INCOME, COMPARED TO 61% IN IOWA AND 60% NATIONALLY. DUBUQUE COUNTY HISPANIC PER CAPITA INCOME IS 58% OF WHITE PER CAPITA INCOME, COMPARED TO 54% IN IOWA AND 51% NATIONALLY. THE GROWING ELDERLY POPULATION IS OF CONCERN TO THE COMMUNITY. WE ANTICIPATE A SHORTAGE OF HEALTH CARE WORKERS TO CARE FOR THE ELDERLY, LIMITED TRANSPORTATION OPTIONS, LIMITED ADULT DAY CARE OPTIONS AND LIMITED FUNDING FOR SERVICES FOR THE ELDERLY. THE HIGH COST OF PRESCRIPTION MEDICATIONS AND CHRONIC ILLNESSES CAUSING LONG-TERM DISABILITY PRESENT FINANCIAL CONCERNS AS WELL. SEVERAL HEALTH CONCERNS HAVE BEEN IDENTIFIED IN THE SERVICE AREA, INCLUDING WOMEN NOT RECEIVING PRENATAL CARE DURING THE FIRST TRIMESTER; A HIGHER THAN AVERAGE RATE OF PROSTATE, LUNG, BREAST AND COLORECTAL CANCER; OBESITY AND ITS CONTRIBUTION TO HEART DISEASE, DIABETES, ARTHRITIS, AND HIGH BLOOD PRESSURE; AN INCREASING INCIDENCE OF DIABETES IN BOTH CHILDREN AND ADULTS; HEART DISEASE; AND ASTHMA. THE RECENT COMMUNITY HEALTH ASSESSMENT ADDS OBESITY AND SPECIFICALLY CHILDHOOD OBESITY TO THESE CONCERNS.
		PART VI, LINE 5: OTHER INFORMATION - MERCY MEDICAL CENTER - NORTH IOWA: HAS BEEN PROVIDING MANAGEMENT SERVICES FOR RURAL HOSPITALS SINCE 1978. THESE COMMUNITY HOSPITALS OFFER QUALITY HEALTH CARE AND YET ARE STILL ABLE TO TAKE ADVANTAGE OF ALL THE RESOURCES MERCY MEDICAL CENTER - NORTH IOWA HAS TO OFFER AS A MAJOR REFERRAL CENTER. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTHCARE PROVIDERS IN ORDER TO BEST MEET THE NEEDS OF THOSE WHO LIVE IN NORTH IOWA COMMUNITIES. MERCY - NORTH IOWA IS INTENTIONAL IN DEVELOPING TRIPLE AIM ACO RELATIONSHIPS, COLLABORATING WITH COMMUNITY HEALTH PROVIDERS AND SOCIAL SERVICE AGENCIES IN CREATING CARE COORDINATION PROCESSES. THERE IS ACTIVE PARTICIPATION IN TRANSITIONS OF CARE AND THE START OF THE TRIAD PROJECT, WHICH IS A COMMUNITY-BASED SYSTEM OF CARE APPROACH FOR PERSONS WITH THE CO-OCCURRING MORBIDITIES OF SUBSTANCE USE DISORDER, CHRONIC DISEASE AND POSSIBLY MENTAL HEALTH DISORDER.AS A TEACHING HOSPITAL, MERCY MEDICAL CENTER - NORTH IOWA HOSTS A FAMILY PRACTICE RESIDENCY PROGRAM, PHARMACY RESIDENCY, CARDIOLOGY FELLOWSHIP, AND A SCHOOL OF RADIOLOGIC TECHNOLOGY. MERCY MEDICAL CENTER - NORTH IOWA IS A CLINICAL SITE FOR STUDENTS STUDYING TO BECOME PHYSICIANS, NURSES, PARAMEDICS, PHARMACISTS, MEDICAL ASSISTANTS AND OTHER ALLIED HEALTH PROFESSIONALS. IN ADDITION, THE MEDICAL CENTER MANAGES AN ADULT DAY CARE CENTER AND SUPPORTS HOMELESS SHELTERS FOR MEN AND WOMEN IN COLLABORATION WITH OTHER NON-PROFITS. AS A SOLE COMMUNITY PROVIDER, SPECIALIZED SERVICES INCLUDE A HEART CENTER, CANCER CENTER, DIABETES CENTER, STROKE CENTER, BARIATRIC CENTER, LEVEL II BIRTH CENTER AND A LEVEL II EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. BECAUSE OF THE NEED BY INDIGENT ADULTS FOR DENTAL CARE, MERCY - NORTH IOWA PROVIDES A SUITE WITH TWO FULLY FURNISHED OPERATORIES TO ACCOMMODATE EMERGENT DENTAL NEEDS. HALF-DAY CLINICS ARE MANNED BY AREA DENTISTS AND DENTAL ASSISTANTS WHO VOLUNTEER THEIR TIME AND GUIDANCE. MERCY - NORTH IOWA INVESTS IN THE COMMUNITY TO ENHANCE THE HEALTH OF RESIDENTS BY PROVIDING:- SERVICES SUCH AS FREE HEALTH SCREENINGS- SUBSIDIZED TRANSPORTATION SERVICES TO ELIMINATE BARRIERS TO HEALTHCARE- MERCY FAMILY HEALTH LINE, A 24-HOUR/7-DAY A WEEK TELEPHONE INFORMATION SERVICE- PARTICIPATION OF THE HOSPITAL KITCHEN IN MEALS ON WHEELS- MEDICAL SERVICES FOR RESIDENTS OF THE NORTHERN LIGHTS HOMELESS SHELTER- VOLUNTEER SERVICES AS PROVIDED BY THE MERCY AMBASSADORS, THE HOSPITAL VOLUNTEER AUXILIARY, INCLUDING SCHOLARSHIPS, INFANT SEAT RENTALS, AND FACILITATION OF HEALTHCARE SCREENINGS.MERCY MEDICAL CENTER - NEW HAMPTON:AS A SOLE COMMUNITY PROVIDER, MERCY MEDICAL CENTER - NEW HAMPTON PROVIDES A RANGE OF SPECIALIZED SERVICES, DIABETES EDUCATION AND NUTRITION AND AN EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. EMERGENCY SERVICES ARE PROVIDED AT A FINANCIAL LOSS, BUT ARE A CRITICALLY-NEEDED SERVICE. MERCY COOPERATES WITH OTHER AGENCIES TO IMPROVE OVERALL COMMUNITY HEALTH AND WELL-BEING. FOR EXAMPLE, WE SPONSOR A COMMUNITY GARDEN, AND PRODUCE IS PROVIDED TO THE COMMUNITY'S FOOD PANTRY (WHICH UTILIZES HOSPITAL SPACE, AT NO COST).THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTHCARE PROVIDERS, IN ORDER TO BEST MEET THE NEEDS OF OUR NORTHEAST IOWA COMMUNITIES.MMC-NH HAS ABOUT 200 VOLUNTEERS, WHO SERVE IN NEARLY EVERY DEPARTMENT OF THE MEDICAL CENTER. FROM CLERICAL WORK TO PROVIDING PATIENT AND VISITOR SERVICES, MERCY VOLUNTEERS TRULY DO MAKE A DIFFERENCE. THROUGH FUNDRAISERS, THE VOLUNTEERS ALSO PROVIDE FINANCIAL SUPPORT TO A VARIETY OF AREAS WITHIN THE HOSPITAL. MERCY AUXILIARY AWARDS SCHOLARSHIPS TO HIGH SCHOOL AND NON-TRADITIONAL STUDENTS PURSUING EDUCATION IN THE HEALTHCARE FIELD. THE AUXILIARY ALSO SPONSORS NUMEROUS BLOOD DRIVES AND LUNCH-AND-LEARN EVENTS ON HEALTHCARE SUBJECTS. THEY ALSO PROVIDE WIGS AND TURBANS TO THOSE INDIVIDUALS WHO HAVE LOST THEIR HAIR DUE TO ILLNESS.MERCY MEDICAL CENTER-SIOUX CITY:MERCY MEDICAL CENTER-SIOUX CITY HAS EARNED MORE NATIONAL RECOGNITION FOR QUALITY PATIENT OUTCOMES THAN ANY OTHER HOSPITAL IN THE REGION. THE MEDICAL CENTER HAS EARNED MULTIPLE HONORS FOR ITS LEADERSHIP AND EXCELLENCE IN SEVERAL CLINICAL AREAS, INCLUDING CARDIAC CARE, ORTHOPEDIC SERVICES, VASCULAR SURGERY, STROKE CARE AND CANCER CARE.MERCY MEDICAL CENTER-SIOUX CITY IS HOME TO THE ONLY LEVEL II TRAUMA CENTER IN WESTERN IOWA, AND PROVIDES A VITAL, LIFESAVING LINK TO RURAL AREAS VIA MERCY AIR CARE, THE HOSPITAL'S HELICOPTER AMBULANCE SERVICE.MERCY MEDICAL CENTER-SIOUX CITY IS INVOLVED IN A NUMBER OF COMMUNITY VENTURES, AND SUPPORTS THE SIOUXLAND MEDICAL EDUCATION FOUNDATION (FAMILY PRACTICE RESIDENCY). WE ALSO WORK CLOSELY WITH WINNEBAGO INDIAN HEALTH SERVICES TO CLOSE HEALTH OUTCOMES DISPARITIES. IN ADDITION, THE MEDICAL CENTER COLLABORATES WITH ST. LUKE'S COLLEGE OF NURSING, WITCC SCHOOL OF NURSING AND BRIAR CLIFF UNIVERSITY SCHOOL OF NURSING.MERCY MEDICAL CENTER-DUBUQUE: MERCY MEDICAL CENTER-DUBUQUE PROVIDES SEVERAL SERVICES THAT ARE UNIQUE TO THE COMMUNITY, INCLUDING OPEN HEART SURGERY, NEONATAL INTENSIVE CARE AND INPATIENT COMMUNITY PSYCHIATRIC SERVICES. IN ADDITION, THE HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.
		PART VI, LINE 6: MERCY HEALTH SERVICES-IOWA IS A MEMBER OF CHE TRINITY HEALTH, THE SECOND-LARGEST CATHOLIC HEALTH CARE SYSTEM IN THE COUNTRY. CHE TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, CHE TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT CHE TRINITY HEALTH, VISIT WWW.NEWHEALTHMINISTRY.ORG.

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
MERCY HEALTH SERVICES - IOWA CORP

Employer identification number
31-1373080

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) CLARKE UNIVERSITY 1550 CLARKE DRIVE DUBUQUE,IA52001	42-0680408	501(C)3		6,000	2 WHIRLPOOLS	SUPPORT OF PHYSICAL THERAPY PROGRAM
(2) DUBUQUE COMMUNITY SCHOOLS 2500 CHANEY RD DUBUQUE,IA52001	42-6001531	PUBLIC SCHOOL	20,000			SUPPORT OF ATHLETIC TRAINERS AT 2 PUBLIC HIGH SCHOOLS
(3) WAHLERT CATHOLIC HIGH SCHOOL 2005 KANE ST DUBUQUE,IA52001	42-0792429	RELIGIOUS SCHOOL	10,000			SUPPORT OF ATHLETIC TRAINERS AT RELIGOUS HIGH SCHOOL
(4) CRESCENT COMMUNITY HEALTH CENTER 1789 ELM STREET DUBUQUE,IA52001	48-1302204	501(C)3	9,999			COMMUNITY GARDENING PROJECT GRANT
(5) NORTH IOWA CORRIDOR ECONOMIC DEVELOPMENT CORPORATION 9 NORTH FEDERAL AVE MASON CITY,IA50401	75-3190471	501(C)6	20,000			PLEDGE
(6) NORTH IOWA COMMUNITY ACTION ORGANIZATION 218 5TH ST SW MASON CITY,IA50401	42-0921505	501(C)3	63,700			PARTNERS CONTRACT
(7) UNITED WAY OF NORTH CENTRAL IOWA 600 1ST STREET NW 102 MASON CITY,IA50401	42-0680431	501(C)3	5,833			PLEDGES
(8) NORTHERN LIGHTS ALLIANCE FOR THE HOMELESS INC 307 NORTH MONROE MASON CITY,IA50401	42-1501295	501(C)3	71,141			EXECUTIVE DIRECTOR SALARY AND BENEFITS
(9) NORTHEAST IOWA COMMUNITY ACTION CORP 305 MONTGOMERY ST DECORAH,IA52101	42-6092713	501(C)3	6,000	0		COMMUNITY SUPPORT
(10) SIOUX CITY SYMPHONY ORCHESTRA 520 PIERCE STREET SIOUX CITY,IA51101	42-6006580	501(C)3	5,000			PROGRAM SUPPORT - SPONSORSHIP OF IOWA PIANO COMPETITION
(11) SIOUXLAND COMMUNITY HEALTH CENTER 1021 NEBRASKA STREET SIOUX CITY,IA51102	42-1374894	501(C)3	109,832			COMMUNITY SUPPORT
(12) THE CRITTENTON CENTER 303 WEST 24TH STREET SIOUX CITY,IA51104	42-0698246	501(C)3	45,848			COMMUNITY SUPPORT
(13) WINNEBAGO TRIBE OF NEBRASKA PO BOX 687 WINNEBAGO,NE68071	47-0489118	TRIBAL GOVERNMENT	5,000			SUPPORT WELLNESS AND DIABETES PROGRAM
(14) LEGENDS OF GOLD INC 47256 29TH STREET BERESFORD,SD57004	27-3794971	501(C)3	5,000			SUPPORT FOR CAMP SCHOLARSHIP
(15) DAKOTA VALLEY SCHOOL DISTRICT #61-8 1150 NORTHSHORE DRIVE NORTH SIOUX CITY,SD57049	46-6003189	PUBLIC SCHOOL	5,200			SUPPORT FOR SCHOLARSHIPS
(16) SIOUXLAND MENTAL HEALTH SERVICES PO BOX 1917 SIOUX CITY,IA51102	42-6122297	501(C)3	23,000			COMMUNITY SUPPORT
(17) SISTERS OF ST FRANCIS 3390 WINDSOR AVE DUBUQUE,IA52001	42-0757421	RELIGIOUS	6,000			GENERAL SUPPORT
(18) SUNRISE MANOR DBA SUNRISE RETIREMENT COMMUNITY 5501 GORDON DRIVE SIOUX CITY,IA51106	42-0805391	501(C)3	5,000			DONATION TO CAPITAL CAMPAIGN AND FOUNTAINVIEW SPONSOR BENEFIT CONCERT
(19) BOYS CLUB OF SIOUX CITY INC 823 PEARL STREET SIOUX CITY,IA51101	42-0940032	501(C)3	9,400			DONATION
(20) BRIAR CLIFF UNIVERSITY 3302 REBBECA ST SIOUX CITY,IA51104	42-0707124	501(C)3	17,600			SUPPORT FOR SCHOLARSHIPS
(21) GIGI'S PLAYHOUSE INC 1551 INDIAN HILLS DR SIOUX CITY,IA51104	20-0058563	501(C)3	5,000			DONATION
(22) COMMUNITY ACTION AGENCY OF SIOUX CITY 2700 LEECH AVENUE SIOUX CITY,IA51106	42-0989589	501(C)3	5,000			COMMUNITY SUPPORT
(23) MARY J TREGLIA COMMUNITY HOUSE 900 JENNINGS ST SIOUX CITY,IA51105	42-0681107	501(C)3	5,250			COMMUNITY SUPPORT
(24) GIRLS INCORPORATED OF SIOUX CITY PO BOX 3380 SIOUX CITY,IA51102	42-1272032	501(C)3	10,500			COMMUNITY SUPPORT
(25) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	501(C)3	13,100			COMMUNITY SUPPORT
(26) BOY SCOUTS OF AMERICA 326 MID-AMERICA COUNCIL 12401 WEST MAPLE RD OMAHA,NE68164	47-0376545	501(C)3	5,000			DONATION
(27) SAINT GABRIEL COMMUNICATIONS LTD 705 DOUGLAS ST STE 238 SIOUX CITY,IA51101	42-1516853	501(C)3	12,000			DONATION TO UNDWRITE AIR TIME ON CATHOLIC RADIO STATION
(28) ST MICHAEL'S SCHOOL 1315 1ST AVE SOUTH SIOUX CITY,NE68776	47-0457873	501(C)3	11,400			DONATION
(29) WESTERN STATES WRESTLING CLUB LLC 3130 NORWAY DR SIOUX CITY,IA51104	73-1714642		6,400			SUPPORT FOR CAMP SCHOLARSHIPS
(30) RAISE THE BAR FITNESS LLC 31344 195TH ST LEMARS,IA51031	27-1014455		6,000			DOWNTOWN YOUTH EXERCISE
(31) BIG TWELVE YOUTH DEVELOPMENT PROGRAM INC 3435 JACKSON ST SIOUX CITY,IA51104	20-4018698	501(C)3	6,000			DONATION FOR AFTER SCHOOL YOUTH ACTIVITIES
(32) HOLY SPIRIT RETIREMENT HOME 1701 W 25TH STREET SIOUX CITY,IA51103	42-6102778	501(C)3	100,000			CAPITAL CAMPAIGN PAID OVER 5 YEARS (PAID $20K IN AUG 2012)

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) HOUSING, UTILITIES AND AUTO SUPPORT		7,615
(2) FOOD, CLOTHING AND TRANSPORTATION ASSISTANCE		3,254
(3) NURSING SCHOLARSHIPS		500
(4) MEDICAL BILLS		774
(5) LONG TERM CARE AND MEDICATIONS	13	145,898
(6) BOYS CLUB SCHOLARSHIPS	0	7,500

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	PART I, LINE 2:	SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H.

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2012

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)JOSEPH SWEDISHTRINITY PRES & CEO THROUGH 3/13	(i) (ii)	0 1,402,192	0 786,411	0 1,044,897	0 572,762	0 28,714	0 3,834,976	0 520,902
(2)JUDITH PERSICHILLITRIN INTERIM PRES & CEO AS OF 5/13	(i) (ii)	0 1,253,511	0 735,075	0 1,901,967	0 10,500	0 7,010	0 3,908,063	0 0
(3)PAUL NEUMANNSECRETARY, EVP & GENERAL COUNSEL	(i) (ii)	0 494,416	0 202,805	0 115,660	0 77,823	0 28,506	0 919,210	0 0
(4)AGNES HAGERTYASST SEC/VP DEPUTY GEN CSL TRINITY	(i) (ii)	0 344,298	0 0	0 24,359	0 39,568	0 15,206	0 423,431	0 0
(5)JENNIFER BARNETTTREAS AS OF 5/13, TRIN EVP & INT CFO	(i) (ii)	0 544,376	0 209,584	0 173,325	0 11,250	0 11,351	0 949,886	0 0
(6)BENJAMIN CARTERTREAS 4/13; ASST TREAS AS OF 5/13	(i) (ii)	0 523,380	0 202,878	0 73,045	0 80,824	0 31,986	0 912,113	0 0
(7)JAMES BOSSCHERASST TREAS THR 4/13, TRIN SVP TREAS	(i) (ii)	0 333,362	0 135,303	0 117,905	0 78,514	0 12,923	0 678,007	0 13,830
(8)KEDRICK ADKINSTRINITY PRES INTEG SYS THR 6/13	(i) (ii)	0 784,856	0 366,716	0 670,047	0 112,792	0 13,375	0 1,947,786	0 265,335
(9)RICHARD O'CONNELLEVP & PRES TRINITY HEALTH DIV.	(i) (ii)	0 607,209	0 284,428	0 144,773	0 97,104	0 33,319	0 1,166,833	0 0
(10)ROBERT PEEBLESCEO-SIOUX CITY (SC)	(i) (ii)	0 374,071	0 120,488	0 56,154	0 56,633	0 22,570	0 629,916	0 0
(11)RUSSELL KNIGHTCEO-DUBUQUE (DUB)	(i) (ii)	0 306,294	0 82,839	0 58,247	0 66,483	0 9,308	0 523,171	0 10,823
(12)RODNEY SCHLADERREGIONAL CFO,INTER. MC CEO THR 8/12	(i) (ii)	0 275,190	0 63,469	0 1,366	0 35,900	0 22,004	0 397,929	0 0
(13)STEVEN EAVENSONCFO-SIOUX CITY (SC) THROUGH 12/12	(i) (ii)	0 262,050	0 56,763	0 30,900	0 20,450	0 15,963	0 386,126	0 0
(14)PAUL MANTERNACHSVP, PHYS. INTEG. MASON CITY (MC)	(i) (ii)	0 331,466	0 71,892	0 1,120	0 20,204	0 19,255	0 443,937	0 0
(15)TERESA MOCKSVP MERCY CLINICS (MC)	(i) (ii)	0 270,524	0 58,991	100,879 2,594	0 34,888	0 19,657	100,879 386,654	0 0
(16)DIANE FISCHELSVP OPERATIONS (MC)	(i) (ii)	0 267,244	0 57,316	0 1,343	0 53,473	0 8,819	0 388,195	0 0
(17)MARILYN KAPTAIN-DAHLENCOO (SC) THROUGH 5/13	(i) (ii)	0 232,872	0 50,495	0 3,361	0 43,667	0 18,595	0 348,990	0 0
(18)MICHAEL JOHNSTONVP, NTWK DEVELOPMENT (MC) THR 4/13	(i) (ii)	0 202,477	0 45,095	0 437	0 18,261	0 17,928	0 284,198	0 0
(19)LINDA KREIVP, HR & ORG. INTG. (SC)	(i) (ii)	0 187,128	0 40,019	0 899	0 31,762	0 4,060	0 263,868	0 0
(20)GARY GUETZKOVP BUSINESS DEVELOPMENT (DUB)	(i) (ii)	0 185,196	0 34,442	0 1,720	0 40,471	0 19,429	0 281,258	0 0
(21)KIMBERLY CHAMBERLINCNO (MC)	(i) (ii)	0 170,452	0 37,110	0 824	0 10,558	0 11,095	0 230,039	0 0
(22)KAY TAKESVP, PATIENT CARE (DUB)	(i) (ii)	0 167,971	0 30,971	0 815	0 28,453	0 17,405	0 245,615	0 0
(23)ROBERT SHAFERCFO-DUBUQUE (DUB)	(i) (ii)	0 161,009	0 29,356	0 1,430	0 82,730	0 5,091	0 279,616	0 0
(24)BRIAN MONSMAVP, REGIONALIZATION (SC)	(i) (ii)	0 149,395	0 33,545	0 321	0 15,274	0 21,216	0 219,751	0 0
(25)TRACY LARSONCNO (SC)	(i) (ii)	0 136,066	0 29,988	0 289	0 8,729	0 20,961	0 196,033	0 0
(26)JAMES BAERPHYSICIAN, RADIATION ONCOLOGY (MC)	(i) (ii)	742,486 0	0 0	16,707 0	22,150 0	68,129 0	849,472 0	0 0
(27)ALIREZA YARAHMADIPHYSICIAN, NEUROLOGY (MC)	(i) (ii)	523,853 0	151,857 0	66,466 0	19,850 0	36,399 0	798,425 0	0 0
(28)JAMES KARKOSPHYSICIAN, DERMATOLOGY (MC)	(i) (ii)	376,538 0	181,215 0	119,338 0	31,835 0	45,104 0	754,030 0	69,316 0
(29)CARL PLANKPHYSICIAN, DERMATOLOGY (MC)	(i) (ii)	485,176 0	121,285 0	32,064 0	35,736 0	66,359 0	740,620 0	0 0
(30)JOSEPH BEHRPHYSICIAN, FAMILY MEDICINE (MC)	(i) (ii)	486,361 0	77,550 0	41,625 0	19,850 0	42,993 0	668,379 0	0 0
(31)DANIEL HALEFORMER OFFICER	(i) (ii)	0 527,004	0 213,622	0 115,423	0 42,104	0 21,386	0 919,539	0 24,468
(32)MARIANNE CUNNINGHAMFORMER OFFICER	(i) (ii)	0 164,476	0 0	0 803	0 13,596	0 18,931	0 197,806	0 0
(33)PAUL BROWNEFORMER KEY EMPLOYEE	(i) (ii)	0 243,006	0 185,010	0 52,014	0 28,955	0 12,897	0 521,882	0 21,648
(34)DEBRA CANALESFORMER KEY EMPLOYEE	(i) (ii)	0 508,488	0 236,816	0 106,740	0 82,290	0 19,743	0 954,077	0 22,307
(35)PAUL CONLONFORMER KEY EMPLOYEE	(i) (ii)	0 308,921	0 120,954	0 58,780	0 88,694	0 25,670	0 603,019	0 7,849
(36)LOUIS FIERENSFORMER KEY EMPLOYEE	(i) (ii)	0 329,192	0 133,901	0 55,547	0 53,208	0 15,721	0 587,569	0 9,499
(37)PRESTON GEEFORMER KEY EMPLOYEE	(i) (ii)	0 298,570	0 117,923	0 51,982	0 49,970	0 29,779	0 548,224	0 0
(38)MICHAEL HOLPERFORMER KEY EMPLOYEE	(i) (ii)	0 292,196	0 109,035	0 48,774	0 69,949	0 24,350	0 544,304	0 5,807
(39)TERRENCE O'ROURKEFORMER KEY EMPLOYEE	(i) (ii)	0 548,590	0 254,064	0 161,351	0 24,584	0 32,380	0 1,020,969	0 0
(40)MARIA SZYMANSKIFORMER KEY EMPLOYEE	(i) (ii)	0 429,715	0 159,037	0 35,632	0 60,935	0 15,654	0 700,973	0 20,460
(41)KIM PRICEFORMER KEY EMPLOYEE	(i) (ii)	127,230 0	0 0	5,787 0	25,869 0	22,852 0	181,738 0	0 0
(42)MICHAEL MURPHYFORMER KEY EMPLOYEE	(i) (ii)	0 139,488	0 0	0 41,394	0 4,650	0 11,980	0 197,512	0 0
(43)JAMES FITZPATRICKFORMER KEY EMPLOYEE	(i) (ii)	0 110,324	0 0	0 34,827	0 20,167	0 5,660	0 170,978	0 19,535
(44)LARRY SELLERSFORMER KEY EMPLOYEE	(i) (ii)	0 166,723	0 0	0 46,996	0 32,249	0 10,802	0 256,770	0 0
(45)BERNARD FOXFORMER KEY EMPLOYEE	(i) (ii)	0 77,434	0 28,093	0 2,005	0 13,064	0 4,414	0 125,010	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
	PART I, LINE 3	MERCY HEALTH SERVICES - IOWA, CORP. IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MERCY HEALTH SERVICES - IOWA, CORP. HOSPITAL CEOS ARE PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MERCY HEALTH SERVICES - IOWA, CORP. CEOS: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
	PART I, LINE 4B	THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($250,000 FOR 2012). THE FOLLOWING ACCRUALS FOR 2012 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $100,292 JAMES BOSSCHER - $47,142 PAUL BROWNE - $9,066 DEBRA CANALES - $60,671 BENJAMIN CARTER - $60,824 PAUL CONLON - $42,044 LOUIS FIERENS - $33,235 PRESTON GEE - $30,120 MICHAEL HOLPER - $38,052 RUSSELL KNIGHT - $36,093 PAUL NEUMANN - $57,823 RICHARD O'CONNELL - $77,104 ROBERT PEEBLES - $36,633 JOSEPH SWEDISH - $543,977 MARIA SZYMANSKI - $21,247 PART II: THE FOLLOWING INDIVIDUALS ARE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $185,540 JENNIFER BARNETT- $140,275 JUDITH PERSICHILLI- $1,855,709 JOSEPH SWEDISH - $530,000 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A MERCY HEALTH SERVICES - IOWA CORP. NON-QUALIFIED ELECTIVE DEFERRED COMPENSATION PLAN. THE FOLLOWING DEFERRALS FOR 2012 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JAMES BAER- $10,597 JOSEPH BEHR- $30,422 JAMES KARKOS- $46,507 CARL PLANK- $32,064 ALIREZA YARAHMADI- $61,595

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) UNITED CLINICAL LABORATORIES (UCL)	R. SHAFER, K. TAKES & B. FOX (FORMER), KEY EMPLOYEES, ARE ON UCL BD	6,218,625	PAYMENTS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO UNITED CLINICAL LABORATORIES FOR LABORATORY SERVICES.		No
(2) BARBARA SHAFER	FAMILY MEMBER OF ROBERT SHAFER, KEY EMPLOYEE	65,380	EMPLOYMENT ARRANGEMENT		No
(3) NANCY ROLING	FAMILY MEMBER OF ROBERT SHAFER, KEY EMPLOYEE	131,921	EMPLOYMENT ARRANGEMENT		No
(4) PREFERRED HEALTH CHOICES LLC (PHC)	RUSSELL KNIGHT, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF PHC	20,990,962	PAYMENTS MADE BY PREFERRED HEALTH CHOICES TO MERCY HEALTH SERVICES - IOWA, CORP. FOR MEDICAL SERVICES PROVIDED.		No
(5) PREFERRED HEALTH CHOICES LLC (PHC)	RUSSELL KNIGHT, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF PHC	13,984,818	PAYMENTS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO PREFERRED HEALTH CHOICES FOR REIMBURSEMENT OF THIRD PARTY ADMINISTRATOR PAYMENTS.		No
(6) WELLMARK BLUE CROSS BLUE SHIELD OF IOWA AND SOUTH DAKOTA	MELANIE DREHER, BOARD MEMBER, ALSO SERVES ON THE BOARD OF WELLMARK BCBS	106,363,921	PAYMENTS MADE BY WELLMARK BCBS TO MERCY HEALTH SERVICES - IOWA, CORP FOR MEDICAL SERVICES PROVIDED.		No
(7) TRI-STATE SURGERY CENTER LLC (TSSC)	RUSSELL KNIGHT & KAY TAKES, KEY EMPLOYEES, ALSO SERVE ON THE BOARD OF TSSC	2,382,500	PARTNERSHIP DISTRIBUTION MADE BY TSSC TO MHS-IA (MHS-IA IS A 50% PARTNER IN TSSC)		No
(8) MEDICAL ASSOCIATESMERCY FAMILY CARE NETWORK LLC (MAMFCN)	RUSSELL KNIGHT & KAY TAKES, KEY EMPLOYEES, ALSO SERVE ON THE BD OF MA/MFCN	185,000	PARTNERSHIP CAPITAL CONTRIBUTION MADE TO MA/MFCN BY MHS-IA (MHS-IA IS A 50% PARTNER IN MA/MFCN)		No
(9) RODGER MOCK	FAMILY MEMBER OF TERESA MOCK, KEY EMPLOYEE	19,378	EMPLOYMENT ARRANGEMENT		No
(10) SIOUXLAND SURGERY CENTER	ROBERT PEEBLES, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF SIOUXLAND SURGERY	8,573,250	PARTNERSHIP DISTRIBUTION MADE BY SIOUXLAND SURGERY CENTER TO MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA IS A 31% PARTNER IN SIOUXLAND SURGERY CENTER)		No
(11) HEALTH MANAGEMENT SERVICES LLC (HMS)	R. KNIGHT, R. SHAFER & G. GUETZKO, KEY EMPLOYEES, ARE ALSO HMS BD MEMBERS	939,560	PARTNERSHIP DISTRIBUTION MADE BY HEALTH MANAGEMENT SERVICES, LLC TO MHS-IA (MHS-IA IS A 50% PARTNER IN HEALTH MGMT SVCS)		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Identifier	Return Reference	Explanation
	FORM 990, PART VI, SECTION A, LINE 3	MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA) HAS CONTRACTED WITH TATUM, LLC AS OF DECEMBER 2012 FOR THE PROVISION OF INTERIM CFO SERVICES AT ITS SIOUX CITY HOSPITAL.
	FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA, CORP. IS TRINITY HEALTH - MICHIGAN. SEE LINE 7 FOR ADDITIONAL INFORMATION.
	FORM 990, PART VI, SECTION A, LINE 7A	TRINITY HEALTH - MICHIGAN IS THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA, CORP. TRINITY HEALTH - MICHIGAN HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF MERCY HEALTH SERVICES - IOWA, CORP.
	FORM 990, PART VI, SECTION A, LINE 7B	AS SOLE MEMBER, TRINITY HEALTH - MICHIGAN MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH - MICHIGAN MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS.
	FORM 990, PART VI, SECTION B, LINE 11	PRIOR TO FILING, THE FORM 990 FOR MERCY HEALTH SERVICES - IOWA, CORP. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS ARE REVIEWED BY THE IOWA REGIONAL BOARD OF THE CHE TRINITY HEALTH SYSTEM. THE MHS-IA BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE.
	FORM 990, PART VI, SECTION B, LINE 12C	MERCY HEALTH SERVICES - IOWA, CORP. HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF MERCY HEALTH SERVICES - IOWA, CORP., WHICH INCLUDES TRUSTEES, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH MERCY HEALTH SERVICES - IOWA, CORP.'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCY HEALTH SERVICES - IOWA, CORP. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES OF MERCY HEALTH SERVICES - IOWA, CORP. IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO MERCY HEALTH SERVICES - IOWA, CORP. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF TRUSTEES OF MERCY HEALTH SERVICES - IOWA, CORP. ON AN ANNUAL BASIS.
	FORM 990, PART VI, SECTION B, LINE 15	TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MERCY HEALTH SERVICES - IOWA, CORP. ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS.
	FORM 990, PART VI, SECTION C, LINE 19	MERCY HEALTH SERVICES - IOWA, CORP. IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, THE HOSPITAL DIVISIONS OF MHS-IA INCLUDE A COPY OF THEIR MOST RECENT SCHEDULE H ON THEIR RESPECTIVE WEBSITES. TRINITY HEALTH ALSO INCLUDES MHS-IA'S MOST RECENTLY FILED SCHEDULE H ON ITS WEBSITE.
TRUSTEES:	FORM 990, PART VII, SECTION A, LINE 1:	SR. SUZANNE BRENNAN, CSC, IS A MEMBER OF THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS. HAVING TAKEN A VOW OF POVERTY, SR. SUZANNE BRENNAN DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HEALTH SERVICES - IOWA, CORP. INSTEAD, A TOTAL OF $25,000 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS FOR SR. SUZANNE BRENNAN'S SERVICES AS A TRUSTEE FOR TRINITY HEALTH CORPORATION, MERCY HEALTH SERVICES - IOWA, CORP. AND TRINITY HEALTH - MICHIGAN. SR. MARY MOLLISON, CSA, IS A MEMBER OF THE CONGREGATION OF SAINT AGNES. HAVING TAKEN A VOW OF POVERTY, SR. MARY MOLLISON DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HEALTH SERVICES - IOWA, CORP. INSTEAD, A TOTAL OF $50,000 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE CONGREGATION OF SAINT AGNES FOR SR. MARY MOLLISON'S SERVICES AS BOARD CHAIR FOR TRINITY HEALTH CORPORATION, MERCY HEALTH SERVICES - IOWA, CORP. AND TRINITY HEALTH - MICHIGAN.
CHANGES IN NET ASSETS OR FUND BALANCES:	FORM 990, PART XI, LINE 9:	NET EQUITY TRANSFERS TO AFFILIATES -10,628,864. EQUITY EARNINGS IN UNCONSOLIDATED AFFILIATES 10,615,724. OTHER TRANSACTIONS -133,762,595.
	FORM 990, PART XII, LINE 2:	MERCY HEALTH SERVICES -IOWA, CORP.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY13 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM.
	FORM 990, PAGE 1, DOING BUSINESS AS NAMES:	FOREST PARK PHARMACY, MARIAN HEALTH CENTER, MERCY HEALTH CENTER-DUBUQUE (ST. JOSEPH'S), MERCY HEALTH CENTER-DYERSVILLE (ST. MARY'S), MERCY HOME CARE-NORTH IOWA, MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER-DYERSVILLE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA, MERCY MEDICAL CENTER-SIOUX CITY, NORTH IOWA MERCY HEALTH CENTER, NORTH IOWA MERCY HOME HEALTHCARE, SHEFFIELD PHARMACY, ST. JOSEPH COMMUNITY HOSPITAL

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS,MI49503 27-2491974	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN		No
(2) AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA,MI48152 38-2949053	PROVIDE HOSPICE SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES INC		No
(3) AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO,OR97914 94-3059469	SUPPORTS SERVICES OF RELATED HOSPITAL	OR	501(C)(3)	LINE 9	SAINT ALPHONSUS MEDICAL CENTER-ONTARIO		No
(4) BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR,IA51245 42-1500277	ACUTE/AMBULATORY HEALTHCARE SERVICES	IA	501(C)(3)	LINE 3	MERCY HEALTH SERVICES-IOWA CORP	Yes
(5) BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR,IA51245 26-2973307	SUPPORT THE SERVICES OF RELATED HOSPITAL	IA	501(C)(3)	LINE 11A, I	BAUM HARMON MERCY HOSPITAL	Yes
(6) CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR,MI48106 38-2507173	FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES	MI	501(C)(3)	LINE 11B, II	TRINITY HEALTH-MICHIGAN		No
(7) CHE TRINITY INC 20555 VICTOR PARKWAY LIVONIA,MI48152 90-0931907	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IN	501(C)(3)	LINE 11B, II	N/A		No
(8) COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND,IN46619 26-3051440	HEALTHCARE SERVICES	IN	501(C)(3)	LINE 3	SAINT JOSEPH REGIONAL MEDICAL CENTER INC		No
(9) CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY,MI48098 38-3320699	PROVIDE HOSPICE HEALTH SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HOME HEALTH SERVICES INC		No
(10) DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS,OH43213 34-2032340	HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO	OH	501(C)(3)	LINE 3	MOUNT CARMEL HEALTH SYSTEM		No
(11) DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE,IA52001 26-2227941	SUPPORT THE SERVICES OF RELATED HOSPITAL	IA	501(C)(3)	LINE 11A, I	MERCY HEALTH SERVICES-IOWA CORP	Yes
(12) DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE,IA52040 20-5383271	SUPPORT THE SERVICES OF RELATED HOSPITAL	IA	501(C)(3)	LINE 11A, I	MERCY HEALTH SERVICES-IOWA CORP	Yes
(13) GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK,IL60160 36-3332852	SUPPORT THE SERVICES OF RELATED HOSPITAL	IL	501(C)(3)	LINE 9	GOTTLIEB MEMORIAL HOSPITAL		No
(14) GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK,IL60160 74-3260011	SUPPORT THE SERVICES OF RELATED HOSPITAL	IL	501(C)(3)	LINE 11C, III-FI	N/A		No
(15) GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK,IL60160 36-2379649	HEALTHCARE SERVICES	IL	501(C)(3)	LINE 3	LOYOLA UNIVERSITY HEALTH SYSTEM		No
(16) HACKLEY HOSPITAL 1700 CLINTON ST PO BOX 3302 MUSKEGON,MI494433302 38-1358196	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 3	MERCY HEALTH PARTNERS		No
(17) HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON,MI494433302 38-2299878	SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY	MI	501(C)(3)	LINE 11C, III-FI	MERCY HEALTH PARTNERS		No
(18) HACKLEY LIFE COUNSELING 1352 TERRACE ST MUSKEGON,MI494423545 38-1386362	COUNSELING, EDUCATION, AND SUPPORT	MI	501(C)(3)	LINE 9	MERCY HEALTH PARTNERS		No
(19) HACKLEY VISITING NURSE SERVICES AND HOSPICE INC 888 TERRACE ST MUSKEGON,MI49440 38-1359598	PROVIDE HOME HEALTH CARE SERVICES	MI	501(C)(3)	LINE 7	MERCY HEALTH PARTNERS		No
(20) HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS,MI48333 52-1945054	LONG-TERM CARE AND REHABILITATION FOR THE ELDERLY	MD	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES		No
(21) HOLY CROSS HEALTH FOUNDATION INC 11801 TECH ROAD SILVER SPRING,MD20904 20-8428450	CHARITABLE FUNDRAISING	MD	501(C)(3)	LINE 11A, I	HOLY CROSS HEALTH INC		No
(22) HOLY CROSS HEALTH INC 1500 FOREST GLEN RD SILVER SPRING,MD209101484 52-0738041	HEALTHCARE SERVICES	MD	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION		No
(23) HOLY CROSS MEDICAL CENTER 20555 VICTOR PARKWAY LIVONIA,MI48152 95-1985442	HEALTHCARE SERVICES (FORMERLY)	CA	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION		No
(24) HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY,IA504016208 42-1173708	HOSPICE HEALTH CARE SERVICES	IA	501(C)(3)	LINE 7	MERCY HEALTH SERVICES-IOWA CORP	Yes
(25) HOSPICE OF SIOUXLAND 4300 HAMILTON BLVD SIOUX CITY,IA51104 38-3320710	HOSPICE SERVICES	IA	501(C)(3)	LINE 11A, I	N/A		No
(26) HOSPICE OF WASHTENAW II 806 AIRPORT BLVD ANN ARBOR,MI48108 38-3320707	HOSPICE HEALTH CARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN		No
(27) IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR,MI48106 38-3316559	PROVIDES OFFICE-BASED MEDICAL CARE	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN		No
(28) LAKESHORE COMMUNITY HOSPITAL INC 72 S STATE STREET SHELBY,MI494551228 38-2549295	ACUTE HEALTHCARE SERVICES	MI	501(C)(3)	LINE 3	MERCY HEALTH PARTNERS		No
(29) LOYOLA UNIVERSITY HEALTH SYSTEM 2160 SOUTH FIRST AVENUE MAYWOOD,IL60153 36-3342448	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IL	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION		No
(30) LOYOLA UNIVERSITY MEDICAL CENTER 2160 SOUTH FIRST AVENUE MAYWOOD,IL60153 36-4015560	HEALTHCARE SERVICES	IL	501(C)(3)	LINE 3	LOYOLA UNIVERSITY HEALTH SYSTEM		No
(31) MARIAN HOME HEALTHCARE 801 5TH STREET SIOUX CITY,IA51101 38-3320705	PROVIDE HOME HEALTH CARE SERVICES	IA	501(C)(3)	LINE 11A, I	MERCY HEALTH SERVICES-IOWA CORP	Yes
(32) MARYCREST HEIGHTS PO BOX 9184 FARMINGTON HILLS,MI48333 27-0291722	PROVIDES HOUSING FOR ELDERLY INDIVIDUALS	MI	501(C)(3)	LINE 11A, I	TRINITY CONTINUING CARE SERVICES		No
(33) MCAULEY CLINIC CORPORATION PO BOX 992 ANN ARBOR,MI48106 38-2561013	HEALTHCARE SERVICES (FORMERLY)	MI	501(C)(3)	LINE 3	CATHERINE MCAULEY HEALTH SERVICES CORP		No
(34) MERCY AMICARE HOME HEALTHCARE OAKLAND 1111 W LONG LAKE RD STE 102 TROY,MI48098 38-3320698	PROVIDE HOME HEALTH CARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HOME HEALTH SERVICES INC		No
(35) MERCY AMICARE HOME HEALTHCARE PORT HURON 505 HURON AVENUE PORT HURON,MI48060 38-3320701	PROVIDE HOME HEALTH CARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HOME HEALTH SERVICES INC		No
(36) MERCY FOUNDATION INC 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-3227350	SUPPORTS THE SERVICES OF RELATED HEALTH CARE SYSTEM	IL	501(C)(3)	LINE 11A, I	MERCY HEALTH SYSTEM OF CHICAGO		No
(37) MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE 684 HARVEY STREET MUSKEGON,MI49442 38-3321856	PROVIDE HOME HEALTH CARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HOME HEALTH SERVICES INC		No
(38) MERCY HEALTH NETWORK 1111 6TH AVENUE DES MOINES,IA50314 42-1478417	HEALTHCARE MANAGEMENT	DE	501(C)(3)	LINE 11A, I	N/A		No
(39) MERCY HEALTH PARTNERS 1415 LEAHY STREET MUSKEGON,MI49442 38-2589966	HEALTHCARE SYSTEM SUPPORT	MI	501(C)(3)	LINE 3	TRINITY HEALTH-MICHIGAN		No
(40) MERCY HEALTH SERVICES - IOWA CORP 1000 4TH STREET SW MASON CITY,IA50401 31-1373080	HEALTHCARE SERVICES	DE	501(C)(3)	LINE 3	TRINITY HEALTH-MICHIGAN	Yes
(41) MERCY HEALTH SYSTEM OF CHICAGO 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-3163327	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IL	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION		No
(42) MERCY HEALTH SYSTEM OF CHICAGO LIABILITY SELF INSURANCE TRUST BK OF AMERICA 231 S LASALLE CHICAGO,IL60697 91-2092113	SELF INSURANCE FOR PROFESSIONAL AND COMPREHENSIVE LIABILITY	IL	501(C)(3)	LINE 11C, III-FI	MERCY HEALTH SYSTEM OF CHICAGO		No
(43) MERCY HEALTHCARE FOUNDATION 1410 N 4TH ST CLINTON,IA52732 42-1316126	FUNDRAISING AND FINANCIAL ASSISTANCE FOR HOSPITAL CHARITABLE SERVICES	IA	501(C)(3)	LINE 11C, III-FI	N/A		No
(44) MERCY HOSPITAL AND MEDICAL CENTER 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-2170152	HEALTHCARE SERVICES	IL	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF CHICAGO		No
(45) MERCY HOSPITAL CADILLAC FOUNDATION 400 HOBART CADILLAC,MI496012331 20-3357131	SUPPORT THE SERVICES OF RELATED HOSPITAL	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN		No
(46) MERCY HOSPITAL GIFT SHOP 2601 ELECTRIC AVE PORT HURON,MI48060 38-1630480	VOLUNTEER SERVICE AUXILIARY	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN		No
(47) MERCY MEDICAL CENTER - CLINTON INC 1410 NORTH 4TH ST CLINTON,IA527322940 42-1336618	TO PROVIDE QUALITY HEALTH CARE	DE	501(C)(3)	LINE 3	MERCY HEALTH SERVICES-IOWA CORP	Yes
(48) MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION 801 5TH STREET SIOUX CITY,IA51102 14-1880022	SUPPORT THE SERVICES OF RELATED HOSPITAL	IA	501(C)(3)	LINE 7	MERCY HEALTH SERVICES-IOWA CORP	Yes
(49) MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA 1000 4TH STREET SW MASON CITY,IA504012800 42-1229151	SUPPORT THE SERVICES OF RELATED HOSPITAL	IA	501(C)(3)	LINE 11C, III-FI	N/A		No
(50) MERCY NORTH HOMECARE AND HOSPICE 7985 MACKINAW TRAIL CADILLAC,MI49601 38-3313897	HOME HEALTH AND HOSPICE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HOME HEALTH SERVICES INC		No
(51) MERCY PHYSICIAN GROUP INC 1512 12TH AVENUE ROAD NAMPA,ID83686 20-8192593	TO PROVIDE QUALITY HEALTH CARE	ID	501(C)(3)	LINE 9	SAINT ALPHONSUS MEDICAL CENTER-NAMPA		No
(52) MERCY SERVICES FOR AGING NON-PROFIT HOUSING CORPORATION PO BOX 9184 FARMINGTON HILLS,MI483339184 38-2719605	PROVIDES LONG-TERM CARE FOR THE ELDERLY	MI	501(C)(3)	LINE 11B, II	TRINITY CONTINUING CARE SERVICES		No
(53) MIDWEST MEDFLIGHT 1300 VICTORS WAY ANN ARBOR,MI48108 38-2684671	AEROMEDICAL TRANSPORT	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN		No
(54) MISSION HEALTH CORPORATION 37595 SEVEN MILE ROAD LIVONIA,MI48152 38-3181557	FACILITY USED FOR AMBULATORY CARE	DE	501(C)(3)	LINE 11A, I	N/A		No
(55) MOUNT CARMEL COLLEGE OF NURSING 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1308555	COLLEGE OF NURSING	OH	501(C)(3)	LINE 2	MOUNT CARMEL HEALTH SYSTEM		No
(56) MOUNT CARMEL HEALTH INSURANCE COMPANY 6150 EAST BROAD STREET COLUMBUS,OH43213 25-1912781	HEALTH INSURANCE	OH	501(C)(4)	N/A	MOUNT CARMEL HEALTH SYSTEM		No
(57) MOUNT CARMEL HEALTH PLAN INC 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1471229	MEDICARE HMO FOR SENIORS	OH	501(C)(4)	N/A	MOUNT CARMEL HEALTH SYSTEM		No
(58) MOUNT CARMEL HEALTH SYSTEM 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1439334	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	OH	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION		No
(59) MOUNT CARMEL HEALTH SYSTEM FOUNDATION 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1113966	SUPPORT THE SERVICES OF RELATED HOSPITAL	OH	501(C)(3)	LINE 11A, I	MOUNT CARMEL HEALTH SYSTEM		No
(60) MOUNT CARMEL HOME CARE LLC 1144 DUBLIN ROAD SUITE B COLUMBUS,OH43215 26-2729300	PROVIDE HOME HEALTH CARE SERVICES	OH	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES INC		No
(61) MRI MOBILE SERVICES OF WEST MICHIGAN 1820 - 44TH STREET KENTWOOD,MI49508 38-3073745	OPERATE MAGNETIC IMAGING RESONANCE (FORMERLY)	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN		No
(62) MUSKEGON COMMUNITY HEALTH PROJECT 565 W WESTERN AVENUE MUSKEGON,MI49440 91-1932918	FACILITATE AND COORDINATE HEALTHCARE AND RELATED SERVICES	MI	501(C)(3)	LINE 7	MERCY HEALTH PARTNERS		No
(63) OAKLAND MERCY HOSPITAL 601 EAST 2ND STREET OAKLAND,NE68045 20-8072234	HEALTHCARE SERVICES	NE	501(C)(3)	LINE 3	MERCY HEALTH SERVICES-IOWA CORP	Yes
(64) OAKLAND MERCY HOSPITAL FOUNDATION 601 E 2ND STREET OAKLAND,NE68045 31-1678345	SUPPORTS SERVICES OF RELATED HOSPITAL	NE	501(C)(3)	LINE 11C, III-FI	N/A		No
(65) OSUMOUNT CARMEL HEALTH ALLIANCE 793 WEST STATE STREET COLUMBUS,OH43222 31-1654603	COOPERATIVE HEALTH CARE DELIVERY SYSTEM	OH	501(C)(3)	LINE 11A, I	N/A		No
(66) PORT HURON MERCY FAMILY CARE INC 2601 ELECTRIC AVE PORT HURON,MI48060 20-1855647	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN		No
(67) PROFESSIONAL MED TEAM 965 FORK STREET MUSKEGON,MI494423257 38-2638284	MEDICAL CARE, TRANSPORTATION AND EDUCATION	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN		No
(68) PROFESSIONAL OFFICE CORPORATION 1303 EAST HERNDON AVE FRESNO,CA93720 94-2839324	HEALTHCARE SERVICES	CA	501(C)(3)	LINE 11A, I	SAINT AGNES MEDICAL CENTER		No
(69) SAINT AGNES MEDICAL CENTER 1303 EAST HERNDON AVE FRESNO,CA93720 94-1437713	HEALTHCARE SERVICES	CA	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION		No
(70) SAINT ALPHONSUS BUILDING COMPANY INC 1055 NORTH CURTIS RD BOISE,ID83706 82-0401011	SUPPORTS SERVICES OF RELATED HOSPITAL	ID	501(C)(3)	LINE 11A, I	SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC		No
(71) SAINT ALPHONSUS DIVERSIFIED CARE INC 1055 NORTH CURTIS RD BOISE,ID83706 94-3028978	SUPPORTS SERVICES OF RELATED HOSPITAL	ID	501(C)(3)	LINE 11A, I	SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC		No
(72) SAINT ALPHONSUS FOUNDATION-BAKER CITY INC 3325 POCAHONTAS ROAD BAKER CITY,OR97814 94-3164869	SUPPORT THE SERVICES OF RELATED HOSPITAL	OR	501(C)(3)	LINE 7	SAINT ALPHONSUS MEDICAL CENTER - BAKER CITY		No
(73) SAINT ALPHONSUS FOUNDATION-ONTARIO INC 351 SW 9TH STREET ONTARIO,OR97914 20-2683560	SUPPORT THE SERVICES OF RELATED HOSPITAL	OR	501(C)(3)	LINE 11A, I	SAINT ALPHONSUS MEDICAL CENTER-ONTARIO		No
(74) SAINT ALPHONSUS HEALTH SYSTEM INC 1055 N CURTIS ROAD BOISE,ID83706 27-1929502	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	ID	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION		No
(75) SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY INC 3325 POCAHONTAS ROAD BAKER CITY,OR97814 27-1790052	TO PROVIDE QUALITY HEALTH CARE	OR	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC		No
(76) SAINT ALPHONSUS MEDICAL CENTER-NAMPA INC 1512 12TH AVENUE ROAD NAMPA,ID83686 82-0200896	TO PROVIDE QUALITY HEALTH CARE	ID	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC		No
(77) SAINT ALPHONSUS MEDICAL CENTER-NAMPA HEALTH FOUNDATION INC 1512 12TH AVENUE ROAD NAMPA,ID83686 26-1737256	SUPPORT THE SERVICES OF RELATED HOSPITAL	ID	501(C)(3)	LINE 7	SAINT ALPHONSUS MEDICAL CENTER-NAMPA		No
(78) SAINT ALPHONSUS MEDICAL CENTER-ONTARIO INC 351 SW 9TH STREET ONTARIO,OR97914 27-1789847	TO PROVIDE QUALITY HEALTH CARE	OR	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC		No
(79) SAINT ALPHONSUS REGIONAL MEDICAL CENTER 1055 NORTH CURTIS RD BOISE,ID83706 82-0200895	HEALTHCARE SERVICES	ID	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC		No
(80) SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC 1915 LAKE AVENUE PO BOX 670 PLYMOUTH,IN46563 35-1142669	HEALTHCARE SERVICES	IN	501(C)(3)	LINE 3	SAINT JOSEPH REGIONAL MEDICAL CENTER INC		No
(81) SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC PO BOX 1935 SOUTH BEND,IN466341935 35-0868157	HEALTHCARE SERVICES	IN	501(C)(3)	LINE 3	SAINT JOSEPH REGIONAL MEDICAL CENTER INC		No
(82) SAINT JOSEPH REGIONAL MEDICAL CENTER MISHAWAKA AUXILIARY INC 5215 HOLY CROSS PARKWAY MISHAWAKA,IN46545 35-6033285	HOSPITAL SERVICE AUXILIARY	IN	501(C)(4)	N/A	SAINT JOSEPH REGIONAL MEDICAL CENTER-S BEND		No
(83) SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH AUXILIARY INC 1915 LAKE AVENUE PLYMOUTH,IN46563 35-6043563	HOSPITAL SERVICE AUXILIARY	IN	501(C)(3)	LINE 11B, II	SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH		No
(84) SAINT JOSEPH REGIONAL MEDICAL CENTER INC 801 EAST LASALLE AVE SOUTH BEND,IN46617 35-1568821	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IN	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION		No
(85) SAINT JOSEPH'S TOWER INC PO BOX 9184 FARMINGTON HILLS,MI483339184 31-1040468	PROVIDES HOUSING FOR LOW INCOME ELDERLY INDIVIDUALS	IN	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES-INDIANA		No
(86) SAINT MARY'S AMICARE HOME HEALTHCARE 1430 MONROE NW GRAND RAPIDS,MI49505 38-3320700	PROVIDE HOME HEALTH CARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HOME HEALTH SERVICES INC		No
(87) SAINT MARY'S FOUNDATION 200 JEFFERSON ST SE GRAND RAPIDS,MI49503 38-1779602	SUPPORTS SERVICES OF RELATED HOSPITAL	MI	501(C)(3)	LINE 7	TRINITY HEALTH-MICHIGAN		No
(88) ST JOSEPH MERCY OAKLAND FOUNDATION 44405 WOODWARD AVE PONTIAC,MI48341 35-2356789	SUPPORTS SERVICES OF RELATED HOSPITAL	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN		No
(89) THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER 4215 EDISON LAKES PARKWAY MISHAWAKA,IN46545 35-1654543	SUPPORTS SERVICES OF RELATED HOSPITAL	IN	501(C)(3)	LINE 11A, I	SAINT JOSEPH REGIONAL MEDICAL CENTER INC		No
(90) TRI-HOSPITAL EMERGENCY MEDICAL SERVICES 309 GRAND RIVER PORT HURON,MI48060 38-2485700	PROVIDE EMERGENCY AMBULANCE SERVICES	MI	501(C)(3)	LINE 11D, III-O	N/A		No
(91) TRI-HOSPITAL MRI CENTER 4190 24TH AVENUE FORT GRATIOT,MI48054 38-2884297	MRI SERVICES	MI	501(C)(3)	LINE 3	TRINITY HEALTH-MICHIGAN		No
(92) TRINITY CONTINUING CARE SERVICES PO BOX 9184 FARMINGTON HILLS,MI483339184 38-2559656	MANAGEMENT SERVICES FOR LONG TERM CARE AND SENIOR LIVING FACILITIES	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION		No
(93) TRINITY CONTINUING CARE SERVICES - INDIANA INC PO BOX 9184 FARMINGTON HILLS,MI483339184 93-0907047	PROVIDES LONG-TERM CARE AND RESIDENTIAL HOUSING	IN	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES		No
(94) TRINITY HEALTH - MICHIGAN 20555 VICTOR PARKWAY LIVONIA,MI48152 38-2113393	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION		No
(95) TRINITY HEALTH CORPORATION 20555 VICTOR PARKWAY LIVONIA,MI48152 35-1443425	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IN	501(C)(3)	LINE 11B, II	CHE TRINITY INC		No
(96) TRINITY HEALTH INTERNATIONAL 20555 VICTOR PARKWAY LIVONIA,MI48152 42-1253527	HEALTHCARE TRAINING AND SUPPORT SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION		No
(97) TRINITY HEALTH WELFARE BENEFIT TRUST 20555 VICTOR PARKWAY LIVONIA,MI48152 20-8151733	RETIREE MEDICAL AND RETIREE LIFE INSURANCE COVERAGE	MI	501(C)(9)	N/A	TRINITY HEALTH CORPORATION		No
(98) TRINITY HOME HEALTH SERVICES INC 17410 COLLEGE PARKWAY LIVONIA,MI48152 38-2621935	HOME HEALTH CARE SYSTEM MANAGEMENT SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION		No
(99) CONTINUING CARE MANAGEMENT SERVICES NETWORK 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 35-2336834	MANAGEMENT & SUPPORT SERVICES	PA	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(100) VNA HOME HEALTH & HOSPICE 50 FODEN ROAD SOUTH PORTLAND,ME04106 01-0246804	HOME HEALTH & HOSPICE	ME	501(C)(3)	LINE 11A, I	MERCY HEALTH SYSTEM OF MAINE		No
(101) MERCY HOSPITAL 144 STATE STREET PORTLAND,MA04101 01-0211534	HOSPITAL	ME	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF MAINE		No
(102) MERCY HEALTH SYSTEM OF MAINE 144 STATE STREET PORTLAND,MA04101 01-0484074	MANAGEMENT & SUPPORT SERVICES	ME	501(C)(3)	LINE 11C, III-FI	CATHOLIC HEALTH EAST		No
(103) SUNNYVIEW HOSPITAL & REHABILITATION CENTER FOUNDATION 1270 BELMONT AVE SCHENECTADY,NY12308 22-2505127	SUPPORTING FOUNDATION	NY	501(C)(3)	LINE 11A, I	SUNNYVIEW HOSPITAL & REHABILITATION CTR		No
(104) ST MARY'S WOODLAND VILLAGE INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1675183	DISCONTINUED OPERATIONS	NY	501(C)(3)	LINE 9	SETON HEALTH SYSTEM INC		No
(105) MERCY CARE FOR KIDS INC 310 SOUTH MANNING BLVD ALBANY,NY12208 14-1717564	DAY CARE CENTER	NY	501(C)(3)	LINE 9	ST PETER'S HEALTH CARE SERVICES		No
(106) OUR LADY OF MERCY LIFE CENTER 2 MERCYCARE LANE GUILDERLAND,NY12084 14-1743506	NURSING HOME FACILITY	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH CARE SERVICES		No
(107) ST PETER'S AUXILIARY 315 SOUTH MANNING BLVD ALBANY,NY01228 22-2843206	AUXILIARY	NY	501(C)(3)	LINE 11A, I	ST PETER'S HEALTH CARE SERVICES		No
(108) ST PETER'S HEALTH CARE SERVICES 315 SOUTH MANNING BLVD ALBANY,NY12208 22-2702507	MANAGEMENT & SUPPORT SERVICES	NY	501(C)(3)	LINE 9	ST PETER'S HEALTH PARTNERS		No
(109) ST PETER'S HOSPITAL 315 SOUTH MANNING BLVD ALBANY,NY12208 14-1348692	HOSPITAL	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH CARE SERVICES		No
(110) ST PETER'S HOSPITAL FOUNDATION INC 319 SOUTH MANNING BLVD SUITE 309 ALBANY,NY12208 22-2262982	FUNDRAISING & PUBLIC RELATIONS	NY	501(C)(3)	LINE 7	ST PETER'S HEALTH CARE SERVICES		No
(111) EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY,NY12180 14-1818568	HOME HEALTH	NY	501(C)(3)	LINE 3	LTC(EDDY) INC		No
(112) THE COMMUNITY HOSPICE FOUNDATION INC 295 VALLEY VIEW BLVD RENSSELAER,NY12144 22-2692940	FUNDRAISING & PUBLIC RELATIONS	NY	501(C)(3)	LINE 7	THE COMMUNITY HOSPICE INC		No
(113) THE COMMUNITY HOSPICE INC 295 VALLEY VIEW BLVD RENSSELAER,NY12144 14-1608921	SERVING SERIOUSLY ILL PEOPLE & THEIR FAMILIES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH CARE SERVICES		No
(114) VILLA MARY IMMACULATE 301 HACKETT BLVD ALBANY,NY12208 14-1438749	NURSING HOME & PHYSICAL REHAB	NY	501(C)(3)	LINE 3	ST PETER'S HOSPITAL		No
(115) WARDE SERVICE CORPORATION INC 159 WOLF ROAD 3RD FLOOR ALBANY,NY12205 14-1732097	SUPPORTING & STRENGTHING THE MINISTRIES OF REL. SR. MERCY	NY	501(C)(3)	LINE 9	ST PETER'S HEALTH CARE SERVICES		No
(116) NORTHEAST HEALTH INC 2212 BURDETT AVE TROY,NY12180 04-2450756	SUPPORTING ORGANIZATION	NY	501(C)(3)	LINE 11B, II	ST PETER'S HEALTH PARTNERS		No
(117) MEMORIAL HOSPITAL ALBANY NY 600 NORTHERN BLVD ALBANY,NY12204 14-1338457	GENERAL HOSPITAL	NY	501(C)(3)	LINE 3	NORTHEAST HEALTH INC		No
(118) SAMARITAN HOSPITAL OF TROY NEW YORK 2215 BURDETT AVE TROY,NY12180 14-1338544	GENERAL HOSPITAL	NY	501(C)(3)	LINE 3	NORTHEAST HEALTH INC		No
(119) THE NORTHEAST HEALTH FOUNDATION INC 2224 BURDETT AVE TROY,NY12180 22-2743478	SUPPORTING FOUNDATION	NY	501(C)(3)	LINE 7	NORTHEAST HEALTH INC		No
(120) SAMARITAN CHILD CARE CENTER INC 2213 BURDETT AVE TROY,NY12180 14-1710225	CHILD DAY CARE	NY	501(C)(3)	LINE 9	NORTHEAST HEALTH INC		No
(121) SHAKER PROPERTIES INC 2212 BURDETT AVE TROY,NY12180 22-3119822	REAL ESTATE HOLDING	NY	501(C)(2)	N/A	NORTHEAST HEALTH INC		No
(122) SUNNYVIEW HOSPITAL & REHABILITATION CTR 1270 BELMONT AVE SCHENECTADY,NY12308 14-1338386	REHABILITATION HOSPITAL	NY	501(C)(3)	LINE 3	LTC (EDDY) INC		No
(123) JAMES A EDDY MEMORIAL GERIATRIC CENTER INC 2256 BURDETT AVE TROY,NY12180 22-2570478	NURSING HOME	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(124) CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES,NY12047 14-1701597	NURSING HOME	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(125) HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY,NY12180 14-1725101	NURSING HOME	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(126) THE MARJORIE DOYLE ROCKWELL CENTER INC 421 WEST COLUMBIA ST COHOES,NY12047 14-1793885	ADULT HOME/ALZHEIMERS	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(127) BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS,NY12159 14-1717028	INDEPENDENT/ASSISTED LIVING RETIREMENT COMMUNITY	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(128) HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH,NY12061 80-0102840	INDEPENDENT/ASSISTED LIVING RETIREMENT COMMUNITY	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(129) GLEN EDDY INC ONE GLEN EDDY DRIVE NISKAYUNA,NY12309 14-1794150	INDEPENDENT/ASSISTED LIVING COMMUNITY	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(130) BEECHWOOD INC 2212 BURDETT AVE TROY,NY12180 14-1651563	REAL ESTATE HOLDING	NY	501(C)(2)	N/A	LTC (EDDY) INC		No
(131) SENIOR CARE CONNECTION INC 504 STATE ST SCHENECTADY,NY12305 14-1708754	PACE PROGRAM	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(132) HOME AID SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY,NY12180 14-1514867	HOME CARE	NY	501(C)(3)	LINE 9	LTC (EDDY) INC		No
(133) SETON HEALTH SYSTEM INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1776186	HOSPITAL	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS		No
(134) SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE 1 ABELE BLVD CLIFTON PARK,NY12065 14-1756230	SKILLED NURSING	NY	501(C)(3)	LINE 9	SETON HEALTH SYSTEM INC		No
(135) SETON HEALTH FOUNDATION 1300 MASSACHUSETTS AVENUE TROY,NY12180 22-2345416	SUPPORTING ORGANIZATION	NY	501(C)(3)	LINE 11A, I	SETON HEALTH SYSTEM INC		No
(136) SETON AUXILIARY INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1505031	SUPPORTING ORGANIZATION	NY	501(C)(3)	LINE 9	SETON HEALTH SYSTEM INC		No
(137) SETON LICENSED HOME CARE INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1809134	LICENSED HOME HEALTH AGENCY	NY	501(C)(3)	LINE 3	SETON HEALTH SYSTEM INC		No
(138) EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA,NY12020 14-1795732	HOME CARE	NY	501(C)(3)	LINE 9	HOME AID SERVICE OF EASTERN NEW YORK INC		No
(139) LTC (EDDY) INC 2212 BURDETT AVE TROY,NY12180 22-2564710	ELDERLY HEALTH/HOUSING SUPPORTING ORG	NY	501(C)(3)	LINE 11A, I	NORTHEAST HEALTH INC		No
(140) ST PETER'S HEALTH PARTNERS 315 SOUTH MANNING BLVD ALBANY,NY12208 45-3570715	MANAGEMENT & SUPPORT SERVICES	NY	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(141) ST PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES PC 315 SOUTH MANNING BLVD ALBANY,NY12208 46-1177336	PHYSICIANS PRACTICE	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS		No
(142) PROVIDENCE PLACE INC 5 GAMELIN STREET HOLYOKE,MA01040 04-3404084	RETIREMENT COMMUNITY	MA	501(C)(3)	LINE 9	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(143) BRIGHTSIDE INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 04-2182395	BEHAVIORAL CARE	MA	501(C)(3)	LINE 9	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(144) FARREN CARE CENTER INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 04-2501711	LONG TERM CARE	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(145) MERCY HOSPITAL INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 04-3398280	ACUTE CARE	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(146) MERCY SPECIALIST PHYSICIANS INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 26-4033168	NEUROSURGERY MEDICAL SERVICES	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(147) SISTERS OF PROVIDENCE CARE CENTERS INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 22-2541103	LONG TERM CARE	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(148) SISTERS OF PROVIDENCE HEALTH SYSTEM INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 04-3398374	MANAGEMENT & SUPPORT SERVICES	MA	501(C)(3)	LINE 11A, I	CATHOLIC HEALTH EAST		No
(149) MERCY LIFE INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 45-3086711	ACUTE CARE	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(150) PIONEER VALLEY CARDIOLOGY ASSOCIATES INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 45-4208896	CARDIOLOGY SERVICES	MA	501(C)(3)	LINE 4	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(151) MERCY ONCOLOGY SERVICES INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 45-4884805	ONCOLOGY MEDICAL SERVICES	MA	501(C)(3)	N/A	SISTERS OF PROVIDENCE HEALTH SYSTEM INC		No
(152) MCAULEY CENTER INC 275 STEELE ROAD WEST HARTFORD,CT06117 06-1058086	INDEPENDENT LIVING	CT	501(C)(3)	LINE 9	MERCY COMMUNITY HEALTH INC		No
(153) MERCY COMMUNITY HEALTH INC 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-1492707	MANAGEMENT & SUPPORT SERVICES	CT	501(C)(3)	LINE 11A, I	CATHOLIC HEALTH EAST		No
(154) MERCY COMMUNITY HOMECARE SERVICES 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-1488137	IN HOME HEALTH CARE	CT	501(C)(3)	LINE 9	MERCY COMMUNITY HEALTH INC		No
(155) MERCY SERVICES 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-1453323	SUPPORT SERVICES	CT	501(C)(3)	LINE 1	MERCY COMMUNITY HEALTH INC		No
(156) MERCYKNOLL INC 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-0757380	SKILLED NURSING	CT	501(C)(3)	LINE 3	MERCY COMMUNITY HEALTH INC		No
(157) SAINT MARY HOME II INC 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-1164104	ELDERLY CARE	CT	501(C)(3)	LINE 3	MERCY COMMUNITY HEALTH INC		No
(158) ST MARY HOME INCORPORATED 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-0646843	SKILLED NURSING	CT	501(C)(3)	LINE 3	MERCY COMMUNITY HEALTH INC		No
(159) MERCY HEALTHCARE CENTER 114 WAWBEEK AVENUE TUPPER LAKE,NY12986 15-0532211	IN DISSOLUTION	NY	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(160) MERCY UIHLEIN HEALTH CORPORATION 185 OLD MILITARY ROAD LAKE PLACID,NY12946 16-1535133	MGT. & SUPPORT SERVICES	NY	501(C)(3)	LINE 11B, II	MERCY HEALTHCARE CENTER		No
(161) UIHLEIN MERCY CENTER 185 OLD MILITARY ROAD TUPPER LAKE,NY12986 15-0532190	IN DISSOLUTION	NY	501(C)(3)	LINE 3	MERCY HEALTHCARE CENTER		No
(162) ST JAMES MERCY FOUNDATION INC 411 CANISTEO STREET HORNELL,NY14843 16-1486437	FOUNDATION	NY	501(C)(3)	LINE 7	ST JAMES MERCY HEALTH SYSTEM INC		No
(163) ST JAMES MERCY HEALTH SYSTEM INC 411 CANISTEO STREET HORNELL,NY14843 22-3127184	MANAGEMENT & SUPPORT SERVICES	NY	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(164) ST JAMES MERCY HOSPITAL 411 CANISTEO STREET HORNELL,NY14843 16-0743310	HOSPITAL	NY	501(C)(3)	LINE 3	ST JAMES MERCY HEALTH SYSTEM INC		No
(165) MAXIS MEDICAL SERVICES 100 LINCOLN AVE CARBONDALE,PA18407 23-2577185	PHYSICIAN PRACTICES	PA	501(C)(3)	LINE 3	MAXIS HEALTH SYSTEM		No
(166) MARIAN COMMUNITY HOSPITAL 100 LINCOLN AVE CARBONDALE,PA18407 24-0711230	HOSPITAL	PA	501(C)(3)	LINE 3	MAXIS HEALTH SYSTEM		No
(167) MARIAN COMMUNITY HOSPITAL AUXILIARY 100 LINCOLN AVE CARBONDALE,PA18407 25-1874733	FUNDRAISING	PA	501(C)(3)	LINE 11B, II	MAXIS HEALTH SYSTEM		No
(168) MAXIS FOUNDATION 100 LINCOLN AVE CARBONDALE,PA18407 23-2330090	FUNDRAISING	PA	501(C)(3)	LINE 11B, II	MAXIS HEALTH SYSTEM		No
(169) MAXIS HEALTH SYSTEM 100 LINCOLN AVE CARBONDALE,PA18407 91-1940902	HEALTH CARE SYSTEM	PA	501(C)(3)	LINE 11B, II	MAXIS HEALTH SYSTEM		No
(170) TRI-COUNTY HUMAN SERVICES CENTER INC PO BOX 517 CARBONDALE,PA18407 23-1938528	BEHAVIORAL HEALTH ORGANIZATION	PA	501(C)(3)	LINE 7	MAXIS HEALTH SYSTEM		No
(171) COLUMBUS ACQUISITION CORP 1160 RAYMOND BOULEVARD NEWARK,NJ07102 26-2616342	INACTIVE ENTITY	NJ	501(C)(3)	LINE 9	SAINT MICHAELS MEDICAL CENTER		No
(172) SAINT MICHAELS MEDICAL CENTER 111 CENTRAL AVENUE NEWARK,NJ07102 26-2616046	HOSPITAL	NJ	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(173) ST JAMES CARE INC 1160 RAYMOND BOULEVARD NEWARK,NJ07102 26-2616230	INACTIVE ENTITY	NJ	501(C)(3)	LINE 9	SAINT MICHAELS MEDICAL CENTER		No
(174) ST MICHAEL'S FOUNDATION INC 1160 RAYMOND BOULEVARD NEWARK,NJ07102 22-3311976	FOUNDATION	NJ	501(C)(3)	LINE 11A, I	SAINT MICHAELS MEDICAL CENTER		No
(175) UNIVERSITY HEIGHTS PROPERTY COMPANY INC 1160 RAYMOND BOULEVARD NEWARK,NJ07102 22-3100162	MEDICAL PROPERTY HOLDING COMPANY	NJ	501(C)(2)	N/A	SAINT MICHAELS MEDICAL CENTER		No
(176) LIFE ST FRANCIS CORPORATION 601 HAMILTON AVENUE TRENTON,NJ08629 22-2797282	HEALTH SERVICES	NJ	501(C)(3)	LINE 11A, I	ST FRANCIS MEDICAL CENTER TRENTON NJ		No
(177) ST FRANCIS MEDICAL CENTER FOUNDATION NJ 601 HAMILTON AVENUE TRENTON,NJ08629 52-1025476	FOUNDATION	NJ	501(C)(3)	LINE 11A, I	ST FRANCIS MEDICAL CENTER TRENTON NJ		No
(178) ST FRANCIS MEDICAL CENTER TRENTON NJ 601 HAMILTON AVENUE TRENTON,NJ08629 22-3431049	HOSPITAL	NJ	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(179) LANGHORNE MRI INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2519529	INACTIVE ENTITY	PA	501(C)(3)	LINE 9	ST MARY MEDICAL CENTER		No
(180) LANGHORNE PHYSICIAN SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2571699	PHYSICIAN SERVICES	PA	501(C)(3)	LINE 9: 509(A)(2)	ST MARY MEDICAL CENTER		No
(181) LIFE ST MARY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 26-2976184	ELDERLY CARE	PA	501(C)(3)	LINE 9	ST MARY MEDICAL CENTER		No
(182) ST MARY MEDICAL CENTER 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-1913910	HOSPITAL	PA	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(183) ST MARY MEDICAL CENTER FOUNDATION INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2567468	FOUNDATION	PA	501(C)(3)	LINE 7	ST MARY MEDICAL CENTER		No
(184) EAST NORRITON PHYSICIAN SERVICES C/O ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2515999	PHYSICIAN SERVICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(185) MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-1352191	ACUTE CARE HOSPITAL	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(186) MERCY FAMILY SUPPORT 1001 BALTIMORE PIKE SUITE 301 SPRINGFIELD,PA19064 23-2325059	HOME HEALTH	PA	501(C)(3)	LINE 9	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(187) MERCY HEALTH FOUNDATION OF SOUTHEASTERN PENNSYLVANIA C/O ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2829864	FUNDRAISING	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(188) MERCY HEALTH PLAN C/O ONE WEST ELM STREET CONSHOHOCKEN,PA19428 22-2483605	HEALTH PLANS	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(189) MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2212638	MANAGEMENT & SUPPORT SERVICES	PA	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(190) MERCY HOME HEALTH 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD,PA19064 23-1352099	HOME HEALTH	PA	501(C)(3)	LINE 9	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(191) MERCY HOME HEALTH SERVICES 1001 BALTIMORE PIKE SUITE 301 SPRINGFIELD,PA19064 23-2325058	HOME HEALTH	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(192) MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2627944	PHYSICIAN PRACTICES	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(193) MERCY SUBURBAN HOSPITAL ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-1396763	ACUTE CARE HOSPITAL	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(194) NAZARETH HEALTH CARE FOUNDATION 2701 HOLME AVENUE PHILADELPHIA,PA19152 23-2300951	FUNDRAISING	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(195) NAZARETH HOSPITAL 2601 HOLME AVENUE PHILADELPHIA,PA19152 23-2794121	ACUTE CARE HOSPITAL	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(196) NAZARETH PHYSICIAN SERVICES INC 2601 HOLME AVENUE PHILADELPHIA,PA19152 20-3261266	PHYSICIAN PRACTICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(197) NE PHYSICIAN SERVICES 2601 HOLME AVENUE PHILADELPHIA,PA19152 23-2497355	PHYSICIAN PRACTICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(198) ST AGNES CONTINUING CARE CENTER 1900 S BROAD STREET PHILADELPHIA,PA19145 23-2840137	CONTINUING CARE SERVICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(199) ST AGNES CONTINUING CARE CENTER FOUNDATION 1900 S BROAD STREET PHILADELPHIA,PA19145 23-2415137	FUNDRAISING	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA		No
(200) LIFE AT LOURDES INC 1600 HADDON AVENUE CAMDEN,NJ08108 26-1854750	ELDERLY CARE	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(201) LOURDES ANCILLARY SERVICES 1600 HADDON AVENUE CAMDEN,NJ08103 22-2568525	SUPPORTING ORGANIZATION	NJ	501(C)(3)	LINE 11B, II	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(202) LOURDES DIALYSIS AT INNOVA INC 1600 HADDON AVENUE CAMDEN,NJ08108 26-3237625	HOSPITAL	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(203) LOURDES MEDICAL CENTER BURLINGTON COUNTY 218 SUNSET ROAD WILLINGBORO,NJ08046 22-3612265	HOSPITAL	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(204) OUR LADY OF LOURDES HEALTH CARE SERVICES 1600 HADDON AVENUE CAMDEN,NJ08103 22-2568528	MANAGEMENT & SUPPORT SERVICES	NJ	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(205) OUR LADY OF LOURDES HEALTH FOUNDATION INC 1600 HADDON AVENUE CAMDEN,NJ08103 22-2351960	FOUNDATION	NJ	501(C)(3)	LINE 7	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(206) OUR LADY OF LOURDES MEDICAL CENTER 1600 HADDON AVENUE CAMDEN,NJ08103 21-0635001	HOSPITAL	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(207) LOURDES CARDIOLOGY SERVICES PC 1600 HADDON AVENUE CAMDEN,NJ08108 27-4357794	CARDIOLOGY SERVICES	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES		No
(208) FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON,DE19805 22-3008680	ELDERCARE	DE	501(C)(3)	LINE 9	ST FRANCIS HOSPITAL		No
(209) ST FRANCIS FOUNDATION PO BOX 2500 WILMINGTON,DE19805 51-0374158	FOUNDATION	DE	501(C)(3)	LINE 11B, II	ST FRANCIS HOSPITAL		No
(210) ST FRANCIS HOSPITAL PO BOX 2500 WILMINGTON,DE19805 51-0064326	HOSPITAL	DE	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(211) LIFE AT ST FRANCIS HEALTHCARE INC 7TH CLAYTON STREETS WILMINGTON,DE19805 45-2569214	ELDERLY CARE	DE	501(C)(3)	LINE 3	ST FRANCIS HOSPITAL		No
(212) MCAULEY MINISTRIES MCAULEY HALL 3333 FIFTH AVENUE PITTSBURGH,PA15213 94-3436142	MANAGEMENT & SUPPORT SERVICES	PA	501(C)(3)	LINE 9	PITTSBURGH MERCY HEALTH SYSTEM		No
(213) MERCY JEANNETTE HOSPITAL 3805 WEST CHESTER PIKE NEWTOWN SQUARE,PA19073 25-1310602	INACTIVE ENTITY	PA	501(C)(3)	LINE 9	PITTSBURGH MERCY HEALTH SYSTEM		No
(214) MERCY LIFE CENTER CORPORATION 1200 REEDSDALE STREET PITTSBURGH,PA15233 25-1604115	COMMUNITY TREATMENT	PA	501(C)(3)	LINE 9	PITTSBURGH MERCY HEALTH SYSTEM		No
(215) PITTSBURGH MERCY HEALTH SYSTEM 3333 5TH AVENUE PITTSBURGH,PA15213 25-1464211	MANAGEMENT & SUPPORT SERVICES	PA	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(216) ST JOSEPH'S OF THE PINES INC 100 GOSSMAN DRIVE SUITE B SOUTHERN PINES,NC28387 56-0694200	HOSPITAL	NC	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(217) LIFE ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SUITE B SOUTHERN PINES,NC28387 27-2159847	HEALTHCARE SERVICES	NC	501(C)(3)	LINE 3	ST JOSEPH'S OF THE PINES INC		No
(218) MERCY SENIOR CARE INC 300 CHATILLON ROAD PO BOX 866 ROME,GA30162 58-1366508	COMMUNITY OUTREACH	GA	501(C)(3)	LINE 7	SAINT JOSEPH'S HEALTH SYSTEM INC		No
(219) SAINT JOSEPH'S HEALTH SYSTEM INC 424 DECATUR STREET ATLANTA,GA30312 58-1744848	MANAGEMENT & SUPPORT SERVICES	GA	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(220) SAINT JOSEPH'S MERCY CARE SERVICES INC 424 DECATUR STREET ATLANTA,GA30312 58-1752700	COMMUNITY OUTREACH	GA	501(C)(3)	LINE 7	SAINT JOSEPH'S HEALTH SYSTEM INC		No
(221) SAINT JOSEPH'S MERCY FOUNDATION INC 424 DECATUR STREET ATLANTA,GA30312 58-1448522	FUNDRAISING	GA	501(C)(3)	LINE 11B, II	SAINT JOSEPH'S HEALTH SYSTEM INC		No
(222) MERCY SERVICES DOWNTOWN INC 424 DECATUR STREET ATLANTA,GA30312 27-2046353	REAL ESTATE HOLDING COMPANY	GA	501(C)(3)	LINE 11B, II	SAINT JOSEPH'S HEALTH SYSTEM INC		No
(223) ST MARY'S HEALTH CARE SYSTEM INC 1230 BAXTER STREET ATHENS,GA30606 58-0566223	HOSPITAL	GA	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(224) ST MARY'S FOUNDATION INC 1230 BAXTER STREET ATHENS,GA30606 58-2544232	FUNDRAISING	GA	501(C)(3)	LINE 11B, II	ST MARY'S HEALTH CARE SYSTEM INC		No
(225) ST MARY'S HIGHLAND HILLS INC 1230 BAXTER STREET ATHENS,GA30606 02-0576648	ASSISTED LIVING & RETIREMENT COMMUNITY	GA	501(C)(3)	LINE 3	ST MARY'S HEALTH CARE SYSTEM INC		No
(226) ST MARY'S MEDICAL GROUP INC 1230 BAXTER STREET ATHENS,GA30606 26-1858563	HOSPITAL / PHYSICIAN SERVICES	GA	501(C)(3)	LINE 3	ST MARY'S HEALTH CARE SYSTEM INC		No
(227) GOOD SAMARITAN HOSPITAL INC 1201 SILOAM ROAD GREENSBORO,GA30462 26-1720984	HOSPITAL	GA	501(C)(3)	LINE 3	SAINT JOSEPH'S HEALTH SYSTEM INC		No
(228) MERCY MEDICAL CORPORATION PO BOX 1090 101 VILLA DRIVE DAPHNE,AL36526 63-6002215	HOSPITAL	AL	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(229) MERCY LIFE OF ALABAMA PO BOX 1090 101 VILLA DRIVE DAPHNE,AL36526 27-3163002	HOSPITAL	AL	501(C)(3)	LINE 3	MERCY MEDICAL CORPORATION		No
(230) ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR,FL34684 58-1492325	MANAGEMENT & SUPPORT SERVICES	FL	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH EAST		No
(231) ST FRANCIS HOSPITAL INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR,FL34684 59-0624442	GRANT-MAKING ORGANIZATION	FL	501(C)(3)	LINE 11A, I	ALLEGANY FRANCISCAN MINISTRIES INC		No
(232) HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 59-0791028	HOSPITAL-HEALTHCARE PROVIDER	FL	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(233) HOLY CROSS LONG-TERM INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 65-0787320	MEDICAL SERVICES	FL	501(C)(3)	LINE 3	HOLY CROSS HOSPITAL INC		No
(234) HOLY CROSS MEDICAL PROPERTIES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 65-0666283	MEDICAL BUILDING REAL ESTATE MANAGEMENT	FL	501(C)(2)	N/A	HOLY CROSS HOSPITAL INC		No
(235) SSJ HEALTH FOUNDATION INC 3663 SOUTH MIAMI AVENUE MIAMI,FL33133 59-1709438	FUNDRAISING	FL	501(C)(3)	LINE 7	MERCY HOSPITAL INC		No
(236) MERCY HOSPITAL INC 3663 SOUTH MIAMI AVENUE MIAMI,FL33133 59-0791034	HOSPITAL	FL	501(C)(3)	LINE 3	CATHOLIC HEALTH EAST		No
(237) MERCY MEDICAL DEVELOPMENT INC 3663 SOUTH MIAMI AVENUE MIAMI,FL33133 59-2789194	OUTPATIENT SERVICES	FL	501(C)(3)	LINE 9	MERCY HOSPITAL INC		No
(238) MERCY MISSION SERVICES INC 3663 SOUTH MIAMI AVENUE MIAMI,FL33133 65-0435764	HEALTH CARE	FL	501(C)(3)	LINE 11A, I	MERCY HOSPITAL INC		No
(239) MERCY OUTPATIENT SERVICES INC DBA SISTER EMMANUEL HOSPITAL 3663 SOUTH MIAMI AVENUE MIAMI,FL33133 51-0461511	HOSPITAL	FL	501(C)(3)	LINE 3	MERCY HOSPITAL INC		No
(240) GLOBAL HEALTH MINISTRY 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 23-3068656	HEALTH CARE	PA	501(C)(3)	LINE 7	CATHOLIC HEALTH EAST		No
(241) INTRACOASTAL HEALTH SYSTEMS 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 65-0556413	MANAGEMENT & SUPPORT SERVICES	PA	501(C)(3)	LINE 11A, I	CATHOLIC HEALTH EAST		No
(242) CATHOLIC HEALTH EAST 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 23-2929748	MANAGEMENT SERVICES	PA	501(C)(3)	LINE 11C, III-FI	CHE TRINITY INC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ADVENT REHABILITATION LLC 607 DEWEY AVENUE SUITE 300 GRAND RAPIDS,MI49504 38-3306673	REHABILITATION THERAPY SERVICES	MI	N/A
(2) BIG RUN MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1608125	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(3) CENTER FOR DIGESTIVE CARE LLC 5300 ELLIOTT DRIVE YPSILANTI,MI48197 03-0447062	PROVIDE GASTROINTESTINAL SERVICES	MI	N/A
(4) CENTRAL OHIO SLEEP MEDICINE LTD 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1701029	SLEEP MEDICINE SERVICES	OH	N/A
(5) CLINTON IMAGING SERVICES LLC 615 VALLEY VIEW DR STE 202 MOLINE,IL61265 41-2044739	MRI DIAGNOSTIC SERVICES	IA	N/A
(6) FOREST PARK IMAGING LLC 1000 4TH STREET SW MASON CITY,IA50401 13-4365966	X-RAY AND MAMMOGRAPHY SERVICES	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	1,336,997	299,735		No		Yes		52.890 %
(7) FRANCES WARDE MEDICAL LABORATORY 300 WEST TEXTILE ROAD ANN ARBOR,MI48104 38-2648446	LABORATORY	MI	N/A
(8) FRESNO IMAGING CENTER 1303 E HERNDON AVE FRESNO,CA93720 77-0363563	DIAGNOSTIC IMAGING	CA	N/A
(9) HAWARDEN REGIONAL HEALTH CLINICS LLC 1122 AVENUE L HAWARDEN,IA51023 20-1444339	MEDICAL CLINIC	IA	N/A
(10) IDAHO GYNONCOLOGY SERVICES LLC 1055 N CURTIS RD BOISE,ID83706 20-2975807	PROVIDE GYN ONCOLOGY SERVICES	ID	N/A
(11) INTERMOUNTAIN MEDICAL IMAGING LLC 877 WEST MAIN ST STE 603 BOISE,ID83702 82-0514422	PROVIDE IMAGING SERVICES	ID	N/A
(12) LOYOLA AMBULATORY SURGERY CENTER 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM,AL35244 36-4119522	SURGICAL SERVICES	IL	N/A
(13) MAGNETIC RESONANCE SERVICES PARTNERSHIP 1416 SIXTH STREET SW MASON CITY,IA50401 42-1328388	MRI SERVICES	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	1,238,897	9,460		No		Yes		49.000 %
(14) MASON CITY AMBULATORY SURGERY CENTER LLC 990 4TH STREET SW MASON CITY,IA50401 20-1960348	SURGERY-SAME DAY	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	2,812,138	1,554,466		No		Yes		51.000 %
(15) MCE MOB IV LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 42-1544707	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(16) MCMC POB III LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1392994	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(17) MEDILUCENT MOB I 793 W STATE STREET COLUMBUS,OH43222 20-4911370	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(18) MERCY ADVANCED MRI LLC 2525 SOUTH MICHIGAN AVE CHICAGO,IL60616 26-2116721	SUBLEASE MRI EQUIPMENT	IL	N/A
(19) MERCY HEART & VASCULAR LLC 2525 SOUTH MICHIGAN AVE CHICAGO,IL60616 20-5272726	SUBLEASE CT EQUIPMENT	IL	N/A
(20) MERCY HEART CTR OP SERVICES LLC 1000 4TH STREET SW MASON CITY,IA50401 13-4237594	CARDIOVASCULAR SERVICES	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	529,675	545,020		No			No	51.000 %
(21) MICHIANA HEALTH INFORMATION NETWORK LLC 215 WEST MADISON STREET SOUTH BEND,IN46601 35-2050128	COMMUNITY BASED CLINICAL INFO SYS & DATA DEPOSITORY	IN	N/A
(22) MOUNT CARMEL EAST POB III LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1369473	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(23) NEWCO AMBULATORY SURGERY CTR LLP 4190 24TH AVENUE FORT GRATIOT,MI48059 30-0136708	OUTPATIENT SURGERY CENTER	MI	N/A
(24) SARMED OUTPATIENT PHARMACY LLC 999 N CURTIS RD STE 102 BOISE,ID83706 51-0483218	PHARMACY	ID	N/A
(25) SIXTY FOURTH STREET LLC 2373 64TH ST STE 2200 BYRON CENTER,MI49315 20-2443646	PROVIDE OUTPATIENT SURGICAL CARE	MI	N/A
(26) ST ALPHONSUS CALDWELL CANCER CTR LLC 3123 MEDICAL DR CALDWELL,ID83605 82-0526861	RADIATION ONCOLOGY	ID	N/A
(27) ST ANN'S MEDICAL OFFICE BLDG II LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1603660	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(28) TAMARACK MEDICAL CLINIC LLC 402 OLD STATE HWY CASCADE,ID83611 20-1637921	OUTPATIENT MEDICAL SERVICES	ID	N/A
(29) WESTAR MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1784409	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(30) WOODLAND IMAGING CENTER LLC 5301 E HURON RIVER DR ANN ARBOR,MI48106 76-0820959	RADIOLOGY/IMAGING	MI	N/A
(31) ST PETER'S AMBULATORY SURGERY CENTER LLC 1375 WASHINGTON AVENUE STE 201 ALBANY,NY12206 46-0463892	OUTPATIENT SURGERY	NY	N/A
(32) CATHERINE HORAN BUILDING LIMITED PARTNERSHIP 1221 MAIN STREET ROOM 108 HOLYOKE,MA010400000 04-2723429	PROPERTY MANAGEMENT	MA	N/A
(33) WESTERN MASSACHUSETTS PETCT IMAGING CENTER LLC 100 BAYVIEW CIRCLE STE 400 NEWPORT BEACH,CA92660 20-4744663	OUTPATIENT MEDICAL SERVICES	DE	N/A
(34) CENTRAL NEW JERSEY HEART SERVICES LLC 29 E 29TH STREET 2ND FLOOR BAYONNE,NJ07002 20-8525458	CARDIAC PROGRAM	NJ	N/A
(35) SMMC MOB II LP 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 36-4559869	INVESTMENT AND OPERATION OF A MEDICAL BUILDING	PA	N/A
(36) THE AMBULATORY SURGERY CENTER AT ST MARY LLC 1203 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2871206	OUTPATIENT SURGERY	PA	N/A
(37) EAST NORRITON MEDICAL ASSOCIATES ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2319531	MEDICAL OFFICE BUILDING	PA	N/A
(38) GATEWAY HEALTH PLAN 300 GRANT STREET PITTSBURGH,PA15219 25-1691945	MEDICAID & MEDICARE/SPECIAL NEEDS MANAGED CARE ORGANIZATION	PA	N/A
(39) MERCYMANOR PARTNERSHIP PO BOX 10086 TOLEDO,OH436990086 52-1931012	NURSING HOME	PA	N/A
(40) ST AGNES LONG TERM INTENSIVE CARE LLP C/O MHS ONE WEST ELM ST STE 100 CONSHOHOCKEN,PA19428 20-0984882	LONG TERM INTENSIVE CARE	PA	N/A
(41) NAZARETH MEDICAL OFFICE BUILDING ASSOCIATES LP C/O NAZARETH HOSP 2601 HOLME AVE PHILADELPHIA,PA19152 23-2388040	MEDICAL OFFICE BUILDING	PA	N/A
(42) SJV MANAGEMENT LLC 200 CENTURY PKWY STE 200E MOUNT LAUREL,NJ08054 20-2273476	RADIOLOGY	NJ	N/A
(43) PHYSICIANS OUTPATIENT SURGERY CENTER LLC 1000 NE 56TH STREET OAKLAND PARK,FL33334 35-2325646	AMBULATORY SURGERY CENTER	FL	N/A
(44) CENTER FOR SURGERY & DIGESTIVE ORDERS 3641 SOUTH MIAMI AVENUE MIAMI,FL33133 51-0438152	OUTPATIENT MEDICAL SERVICES	FL	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) COMMUNITY HEALTH VENTURES INC 565 W WESTERN AVE MUSKEGON,MI49440 38-3522260	SOFTWARE MARKETING	MI	N/A	C					No
(2) GOTTLIEB MANAGEMENT SERVICES INC 701 W NORTH AVE MELROSE PARK,IL60160 36-3330529	MANAGEMENT SERVICES	IL	N/A	C					No
(3) HACKLEY HEALTH MANAGEMENT CENTER 1415 LEAHY ST MUSKEGON,MI49442 38-2961814	WEIGHT MANAGEMENT	MI	N/A	C					No
(4) HACKLEY HEALTH VENTURES INC 1415 LEAHY ST MUSKEGON,MI49442 38-2589959	OTHER MEDICAL SERVICES	MI	N/A	C					No
(5) HACKLEY HEALTHCARE EQUIPMENT 1415 LEAHY ST MUSKEGON,MI49442 38-2578569	HOME MEDICAL EQUIPMENT	MI	N/A	C					No
(6) HACKLEY PROFESSIONAL CENTER 1415 LEAHY ST MUSKEGON,MI49442 38-3024797	REAL ESTATE RENTAL	MI	N/A	C					No
(7) HACKLEY PROFESSIONAL PHARMACY 1415 LEAHY ST MUSKEGON,MI49442 38-2447870	PHARMACY	MI	N/A	C					No
(8) HEF INC 1415 LEAHY ST MUSKEGON,MI49442 38-3086401	OFFICE STAFFING	MI	N/A	C					No
(9) HOLY CROSS PRIVATE HOME SERVICES CORP 11801 TECH ROAD SILVER SPRING,MD20904 52-1986562	HOME CARE SERVICES	MD	N/A	C					No
(10) HPC CO-OWNERS ASSOCIATION 1700 CLINTON MUSKEGON,MI49442 27-0734448	CONDOMINIUM ASSOCIATION	MI	N/A	C					No
(11) HURON ARBOR CORPORATION 5301 EAST HURON RIVER DR PO BOX 992 ANN ARBOR,MI48106 38-2475644	PROVIDES OFFICE RENTAL SPACE	MI	N/A	C					No
(12) IHA AFFILIATION CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR,MI48106 38-3188895	MEDICAL MANAGEMENT	MI	N/A	C					No
(13) MARYLAND CARE GROUP INC 11801 TECH ROAD SILVER SPRING,MD20904 52-1815313	HEALTHCARE HOLDING	MD	N/A	C					No
(14) MEDNOW INC 1512 12TH AVENUE ROAD NAMPA,ID83686 82-0389927	OUTPATIENT PHARMACY	ID	N/A	C					No
(15) MERCY MEDICAL SERVICES 801 5TH STREET SIOUX CITY,IA51101 42-1283849	PRIMARY CARE PHYSICIANS	IA	MERCY HEALTH SERVICES-IOWA CORP	C	-8,450,677	11,948,286	100.000 %	Yes
(16) MERCY SERVICES CORPORATION 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-3227348	DORMANT	IL	N/A	C					No
(17) MICHIGAN ATHLETIC CLUB 2500 BURTON GRAND RAPIDS,MI49546 38-2647304	ATHLETIC CLUB	MI	N/A	C					No
(18) MOUNT CARMEL HEALTH PROVIDERS INC 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1382442	MEDICAL SERVICES	OH	N/A	C					No
(19) NORTH IOWA MERCY MEDICAL SERVICES INC 1000 4TH ST SW MASON CITY,IA50401 42-1382308	MEDICAL SERVICES	IA	MERCY HEALTH SERVICES-IOWA CORP	C			100.000 %	Yes
(20) PRIORITY PLUS OF CALIFORNIA PO BOX 27230 FRESNO,CA93729 77-0395267	FORMERLY HLTH MGMT NOW DISCONTINUED OPERATIONS	CA	N/A	C					No
(21) SAINT ALPHONSUS PHYSICIANS PA 1055 NORTH CURTIS ROAD BOISE,ID837061370 33-1078261	PHYSICIANS	ID	N/A	C					No
(22) SAINT MARY'S HEALTH MANAGEMENT COMPANY 1640 EAST PARIS SE GRAND RAPIDS,MI49546 38-3450733	ATHLETIC CLUB	MI	N/A	C					No
(23) SURGERY CENTER FINANCING CORPORATION 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1531102	FINANCE, INSURANCE AND REAL ESTATE	OH	N/A	C					No
(24) THRE SERVICES LLC 20555 VICTOR PARKWAY LIVONIA,MI48152 45-2603654	REAL ESTATE BROKERAGE SERVICES	MI	N/A	C					No
(25) TRINITY HEALTH EMPLOYEE BENEFIT TRUST 20555 VICTOR PARKWAY LIVONIA,MI48152 38-3410377	GRANTOR TRUST	MI	N/A	T					No
(26) VENZKE INSURANCE COMPANY LTD PO BOX 1051 GRAND CAYMAN GRAND CAYMAN CJ 98-0453602	PROVISION OF INSURANCE COVERAGE	CJ	N/A	C					No
(27) WEST SHORE PROFESSIONAL BUILDING CONDOMINIUM 1820 44TH STREET SE KENTWOOD,MI49508 38-2700166	CONDOMINIUM ASSOCIATION	MI	N/A	C					No
(28) WESTSHORE HEALTH NETWORK 1820 44TH STREET KENTWOOD,MI49508 38-3280200	PHYSICIAN HOSPITAL ORGANIZATION	MI	N/A	C					No
(29) WORKPLACE HEALTH OF GRAND HAVEN 1415 LEAHY ST MUSKEGON,MI49442 38-3112035	OCCUPATIONAL HEALTH	MI	N/A	C					No
(30) SAMARITAN MEDICAL OFFICE BUILDING INC 2212 BURDETT AVENUE TROY,NY12180 14-1607244	REAL ESTATE	NY	N/A	C					No
(31) AFFILIATED MANAGEMENT SERVICES CORPORATION INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1668024	REAL ESTATE	NY	N/A	C					No
(32) CATHERINE HORAN BUILDING INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA010400000 04-2938160	BUILDING MANAGEMENT	MA	N/A	C					No
(33) DIVERSIFIED COMMUNITY SERVICES INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA010400000 04-3128890	MEDICAL SERVICES	MA	N/A	C					No
(34) MERCY INPATIENT MEDICAL ASSOCIATES INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA010400000 04-3029929	MEDICAL SERVICES	MA	N/A	C					No
(35) PROVIDENCE HOME CARE INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA010400000 04-3317426	HEALTH CARE SERVICES	MA	N/A	C					No
(36) SYSTEM COORDINATED SERVICES INC C/O SPHS 1221 MAIN STREET SUITE 108 HOLYOKE,MA010400000 04-2938181	LAB SERVICES	MA	N/A	C					No
(37) PHYSICIANS MEDICAL OFFICE BUILDING CONDOMINIUM TRUST 1221 MAIN STREET ROOM 108 HOLYOKE,MA010400000 04-6608649	PROPERTY MANAGEMENT	MA	N/A	C					No
(38) SJM PROPERTIES INC 411 CANISTEO STREET HORNELL,NY148482101 16-1294991	PROPERTY HOLDINGS	NY	N/A	C					No
(39) CARBONDALE AREA PHYSICIANS' ASSOCIATION PC 100 LINCOLN AVE CARBONDALE,PA18407 23-2801677	MEDICAL INSURANCE CONTRACTING	PA	N/A	C					No
(40) CARBONDALE AREA PHYSICIANS' PHO INC 100 LINCOLN AVE CARBONDALE,PA18407 23-2801676	INACTIVE	PA	N/A	C					No
(41) CARBONDALE PHYSICIANS' SERVICES INC 100 LINCOLN AVE CARBONDALE,PA18407 23-2365077	PHARMACY	PA	N/A	C					No
(42) CHESTNUT RISK SERVICES LTD 11 VICTORIA STREET HAMILTON BD	INSURANCE	BD	N/A	C					No
(43) LIFECARE PHYSICIANS PC 601 HAMILTON AVENUE TRENTON,NJ086291986 26-1649038	HEALTH CARE SERVICES	NJ	N/A	C					No
(44) MULTICARE PLUS INC 601 HAMILTON AVENUE TRENTON,NJ086291986 22-3435844	INACTIVE	NJ	N/A	C					No
(45) LANGHORNE SERVICES II INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 25-3795549	GENERAL PARTNER OF LMOB PARTNERS, II	PA	N/A	C					No
(46) LANGHORNE SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2625981	GENERAL PARTNER OF LMOB PARTNERS,	PA	N/A	C					No
(47) GATEWAY HEALTH PLAN INC 600 GRANT STREET PITTSBURGH,PA15219 25-1505506	HEALTH CARE	PA	N/A	C					No
(48) GATEWAY HEALTH PLAN INC OF OHIO 600 GRANT STREET PITTSBURGH,PA15219 30-0282076	HEALTH CARE	PA	N/A	C					No
(49) MCMC EASTWICK INC C/O MHS ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2184261	MEDICAL OFFICE BUILDINGS	PA	N/A	C					No
(50) HEALTH MANAGEMENT SERVICES ORG INC 500 GROVE STREET SUITE 100 HADDON HEIGHTS,NJ08035 22-3366580	HEALTH CARE BILLING	NJ	N/A	C					No
(51) LOURDES MEDEICAL ASSOCIATES PA 500 GROVE STREET SUITE 100 HADDON HEIGHTS,NJ08035 22-3361862	MEDICAL SERVICES	NJ	N/A	C					No
(52) JEANNETTE MEDICAL PROVIDERS 3805 WEST CHESTER PIKE NEWTOWN SQUARE,PA19073 25-1787334	HOLDING COMPANY	PA	N/A	C					No
(53) JEANNETTE OBGYN GROUP 1 INC 3805 WEST CHESTER PIKE NEWTOWN SQUARE,PA19073 23-2890748	HOLDING COMPANY	PA	N/A	C					No
(54) JEANNETTE PRIMARY CARE GROUP 1 INC 3805 WEST CHESTER PIKE NEWTOWN SQUARE,PA19073 23-2890743	HOLDING COMPANY	PA	N/A	C					No
(55) GEORGIA HEALTH ENTERPRISES LLC 1230 BAXTER STREET ATHENS,GA30606 54-1806329	HEALTHCARE	GA	N/A	C					No
(56) ST MARY'S HIGHLAND HILLS VILLAGE INC 1660 JENNINGS MILL PKLY BOGART,GA30622 58-2276801	ASSISTED LIVING	GA	N/A	C					No
(57) GHE PHYSICIANS PC 3500 PIEDMONT ROAD ATLANTA,GA30305 58-2277939	PRACTICE MANAGEMENT	GA	N/A	C					No
(58) NURSING NETWORK INC 4725 NORTH FEDERAL HIGHWAY FORT LAUDERDALE HIGHWA,FL333080000 59-1145192	MEDICAL SERVICES	FL	N/A	C					No
(59) MERCY PHYSICIAN GROUP INC 3663 SOUTH MIAMI AVENUE MIAMI,FL33133 20-2970015	HEALTH CARE	FL	N/A	C					No
(60) STELLA MARIS INSURANCE COMPANY LIMITED PO BOX 69 GRAND CAYMAN,CAYMAN ISLANDSKY1-1102 CJ 98-0078266	INSURANCE	CJ	N/A	C					No
(61) CATHOLIC HEALTH EAST SENIOR SERVICES 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 37-1572595	SENIOR SERVICES	PA	N/A	C					No

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) TRINITY HEALTH CORPORATION	B	5,774,992	PER BOOKS
(2) TRINITY HEALTH CORPORATION	M	53,069,392	PER BOOKS
(3) TRINITY HEALTH CORPORATION	P	50,082,836	PER BOOKS
(4) TRINITY HEALTH CORPORATION	Q	1,284,366	PER BOOKS
(5) TRINITY HEALTH CORPORATION	R	9,140,199	PER BOOKS
(6) DUBUQUE MERCY HEALTH FOUNDATION	C	118,224	PER BOOKS
(7) DUBUQUE MERCY HEALTH FOUNDATION	B	271,062	PER BOOKS
(8) DUBUQUE MERCY HEALTH FOUNDATION	L	417,709	PER BOOKS
(9) DYERSVILLE HEALTH FOUNDATION INC	B	110,277	PER BOOKS
(10) DYERSVILLE HEALTH FOUNDATION INC	L	134,564	PER BOOKS
(11) MERCY HEART CTR OP SERVICES LLC	A	14,306	PER BOOKS
(12) MERCY HEART CTR OP SERVICES LLC	C	908,976	PER BOOKS
(13) MERCY HEART CTR OP SERVICES LLC	M	974,336	PER BOOKS
(14) MASON CITY AMBULATORY SURGERY CENTER LLC	C	2,936,826	PER BOOKS
(15) MASON CITY AMBULATORY SURGERY CENTER LLC	L	332,364	PER BOOKS
(16) FOREST PARK IMAGING LLC	C	1,159,738	PER BOOKS
(17) FOREST PARK IMAGING LLC	P	933,320	PER BOOKS
(18) FOREST PARK IMAGING LLC	Q	50,856	PER BOOKS
(19) HOSPICE OF NORTH IOWA	Q	588,213	PER BOOKS
(20) HOSPICE OF NORTH IOWA	M	187,922	PER BOOKS
(21) OAKLAND MERCY HOSPITAL	B	1,011,645	PER BOOKS
(22) OAKLAND MERCY HOSPITAL	Q	300,127	PER BOOKS
(23) OAKLAND MERCY HOSPITAL	P	118,711	PER BOOKS
(24) MERCY MEDICAL SERVICES	B	6,351,269	PER BOOKS
(25) MERCY MEDICAL SERVICES	M	133,698	PER BOOKS
(26) MERCY MEDICAL SERVICES	P	1,605,730	PER BOOKS
(27) MERCY MEDICAL SERVICES	Q	2,103,420	PER BOOKS
(28) BAUM HARMON MERCY HOSPITAL	B	1,825,835	PER BOOKS
(29) BAUM HARMON MERCY HOSPITAL	M	55,363	PER BOOKS
(30) BAUM HARMON MERCY HOSPITAL	P	186,309	PER BOOKS
(31) BAUM HARMON MERCY HOSPITAL	Q	270,270	PER BOOKS
(32) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION	B	262,668	PER BOOKS
(33) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION	C	536,422	PER BOOKS
(34) MERCY MEDICAL CENTER-CLINTON INC	L	187,574	PER BOOKS
(35) MERCY MEDICAL CENTER FOUNDATION-NORTH IOWA	B	267,968	PER BOOKS
(36) TRINITY HOME HEALTH SERVICES INC	L	115,040	PER BOOKS
(37) MAGNETIC RESONANCE SERVICES PARTNERSHIP	C	1,248,276	PER TAX RETURN

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: HEALTH CARE SERVICES
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	5
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	5,796
6	Total number of volunteers (estimate if necessary) .............	6	819
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	24,910,922
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-1,146,033

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,119,441	1,380,476
9	Program service revenue (Part VIII, line 2g) .........	596,818,878	610,555,317
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	7,604,918	12,653,174
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	43,539,149	44,355,535
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	653,082,386	668,944,502
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	760,366	968,070
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	292,395,511	297,014,327
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	355,998,098	368,567,769
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	649,153,975	666,550,166
19	Revenue less expenses. Subtract line 18 from line 12.......	3,928,411	2,394,336
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	796,474,081	661,667,231
21	Total liabilities (Part X, line 26).............	299,729,385	290,097,793
22	Net assets or fund balances. Subtract line 21 from line 20.....	496,744,696	371,569,438

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 601,375,625 including grants of $ 968,070 ) (Revenue $ 609,382,307 )
	MERCY HEALTH SERVICES-IOWA, CORP. OPERATED FOUR HOSPITAL DIVISIONS IN THE STATE OF IOWA THAT PROVIDED 148,087 PATIENT DAYS OF HEALTHCARE SERVICES TO THEIR COMMUNITIES. THE MISSION STATEMENT OF MERCY HEALTH SERVICES-IOWA CORP. IS AS FOLLOWS:WE, CHE TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses601,375,625

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,656,417	24,748,382	3,355,727

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		702,733
e	Government grants (contributions)1e		188,031

f	All other contributions, gifts, grants, and similar amounts not included above1f		489,712

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,380,476
			Business Code
2a	NET PATIENT SVC REV		900099	570,125,690	570,125,690
b	PHARMACY REVENUE		446110	37,771,323		20,701,984	17,069,339
c	LABORATORY REVENUE		621500	2,658,304		2,658,304
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			610,555,317
3	Investment income (including dividends, interest, and other similar amounts).......			8,133,802			8,133,802
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	1,619,942
b	Less: rental expenses	1,278,769
c	Rental income or (loss)	341,173
d	Net rental income or (loss).......			341,173			341,173
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	4,479,120	710,716
b	Less: cost or other basis and sales expenses	0	670,464
c	Gain or (loss)	4,479,120	40,252
d	Net gain or (loss)..........			4,519,372			4,519,372
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	MEDICARE/MEDICAID HIT		900099	4,782,872	4,782,872
b	CAFETERIA REVENUE		900099	3,119,124			3,119,124
c	PARKING & TELEPHONE		900099	87,987			87,987
d	All other revenue ....			36,024,379	34,473,745	1,550,634
e	Total. Add lines 11a–11d ......			44,014,362
12	Total revenue. See Instructions......			668,944,502	609,382,307	24,910,922	33,270,797


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			8,054,907	1	4,882,422
2	Savings and temporary cash investments .........			184,914	2	471,815
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			76,134,208	4	76,775,470
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............			2,728,047	7	2,273,794
8	Inventories for sale or use ..............			16,040,653	8	16,170,896
9	Prepaid expenses and deferred charges ..........			2,388,595	9	1,870,097
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	574,514,903
b	Less: accumulated depreciation .....	10b	386,784,580	185,276,052	10c	187,730,323
11	Investments—publicly traded securities ..........			118,256,549	11	152,630,539
12	Investments—other securities. See Part IV, line 11 .....			173,929,347	12	135,207,705
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14	1,259,569
15	Other assets. See Part IV, line 11 ...........			213,480,809	15	82,394,601
16	Total assets. Add lines 1 through 15 (must equal line 34)......			796,474,081	16	661,667,231
17	Accounts payable and accrued expenses .........			64,741,719	17	63,011,419
18	Grants payable .................				18
19	Deferred revenue ................			883,079	19	449,476
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23	1,870,840
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			234,104,587	25	224,766,058
26	Total liabilities. Add lines 17 through 25.........			299,729,385	26	290,097,793
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			496,540,675	27	371,093,894
28	Temporarily restricted net assets ...........			179,021	28	450,544
29	Permanently restricted net assets ...........			25,000	29	25,000
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			496,744,696	33	371,569,438
34	Total liabilities and net assets/fund balances ........			796,474,081	34	661,667,231