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. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MANNING REGIONAL HEALTHCARE CENTER
Employer identification number
39-1902797
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
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).
f
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
..................................................
g
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
No
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)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(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
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
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.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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
.......................
b
33 1/3% support test—2012.
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
.....................
17a
10%-facts-and-circumstances test—2013.
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
.....................................................
b
10%-facts-and-circumstances test—2012.
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
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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.)..
14
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.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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
........
b
33 1/3% support tests—2012.
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
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MANNING REGIONAL HEALTHCARE CENTER
Employer identification number
39-1902797
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
MANAGED CONTRACT AFFILIATION AGREEMENT WITH MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, IOWA - THE ADMINISTRATOR OF MANNING REGIONAL HEALTHCARE CENTER (MRHC) IS AN EMPLOYEE OF MERCY BUT REPORTS TO THE MRHC BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11
THE FINANCIAL STATEMENT PREPARATION AND RECORDING PROCESSES OF MRHC ARE THE PRIMARY RESPONSIBILITIES OF ABBEY STANGL, CFO. UPON RECEIVING THE FORM 990 ORGANIZER DURING THE AUDIT BY SEIM JOHNSON, LLP, THE CFO BEGINS TO PREPARE DOCUMENTATION FOR THE FORM 990. UPON THE SUBMISSION OF THE FORM 990 ORGANIZER TO THE PREPARER, SEIM JOHNSON, LLP, ANY QUESTIONS ARE CLARIFIED AND ANSWERED. PRIMARY REVIEWING RESPONSIBILITY OF THE FORM 990 LIES WITH THE CFO, THE CEO, AND THE FINANCE SUB-COMMITTEE OF THE BOARD OF DIRECTORS, WHICH ENABLES BOARD REVIEW DURING INTERIM BOARD MEETING PERIODS. IT IS ALWAYS THE INTENT TO HAVE THE FORM 990 PREPARED AND REVIEWED PRIOR TO THE INITIAL FILING DEADLINE, BUT IF FOR ANY REASON THIS CANNOT BE ACHIEVED, REQUESTS TO EXTEND THE FILING DEADLINE ARE FILED. EACH MEMBER OF THE BOARD OF DIRECTORS IS GIVEN A COPY OF THE FORM 990 TO REVIEW BEFORE FILING IS COMPLETED.
FORM 990, PART VI, SECTION B, LINE 12C
THROUGHOUT THE YEAR, ANY ISSUE THAT INVOLVES A CONFLICT OF INTEREST WITH A TRUSTEE, DIRECTOR, OFFICER, OR KEY EMPLOYEE WOULD REQUIRE THAT THE INDIVIDUAL BE SEPARATED FROM THE DECISION-MAKING PROCESS RELATED TO THE POTENTIAL CONFLICT OF INTEREST. IN REGARD TO ANNUAL COMPLIANCE, THE REFERENCE TO THE CONFLICT OF INTEREST POLICY OUTLINES CURRENT PRACTICES. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FULFILLMENT OF THIS OBJECTIVE WILL FALL UNDER THE MRHC ADMINISTRATIVE POLICY REVIEW PROCESS.
FORM 990, PART VI, SECTION B, LINE 15
MANNING REGIONAL HEALTHCARE CENTER (MRHC) DETERMINES COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES BY CONSULTING THE CURRENT IOWA HOSPITAL ASSOCIATION (IHA) SALARY SURVEY. THIS SURVEY IS DONE ANNUALLY WITH THE HOPE OF 100% PARTICIPATION OF ALL IOWA HOSPITALS. MRHC USES THE INFORMATION FROM ITS PEER GROUP AS COMPARATIVE DATA FOR DETERMINING WAGES. THE PEER GROUP IS SELECTED BY MRHC AND CONSISTS OF HOSPITALS IN THE VICINITY OF MRHC AND HOSPITALS THAT ARE APPROXIMATELY THE SAME SIZE AS MRHC. MRHC WILL ALSO FACTOR IN YEARS OF EXPERIENCE WHEN DETERMINING WAGES FOR NEWLY HIRED EMPLOYEES OR WHETHER OR NOT MARKET INCREASES ARE NEEDED FOR EXISTING KEY EMPLOYEES OR OFFICERS. IN ADDITION TO ASSESSING MARKET INFORMATION, ANY ANNUAL COMPENSATION INCREASES (I.E. - MERIT RAISES) ARE DETERMINED BY ASSESSING FACILITY-WIDE FINANCIAL PERFORMANCE AND INSTITUTED CONSISTENTLY FOR ALL POSITIONS FACILITY-WIDE. FOR THE CEO POSITION SPECIFICALLY, AS THAT POSITION IS MANAGED THROUGH MERCY HOSPITAL MEDICAL CENTER OF DES MOINES, THE SALARY AND COMPENSATION IS DETERMINED BY SARA DROBNICH, MERCY NETWORK VICE PRESIDENT, IN CONJUNCTION WITH THE MRHC BOARD OF DIRECTORS. TO DETERMINE THE SALARY, THE IHA SALARY SURVEY IS FIRST REVIEWED, WHICH RECOGNIZES SALARY RANGES BASED ON HOSPITAL REVENUES, NUMBER OF FTE'S AND ALSO BASED ON CAH. A CHICAGO-BASED COMPANY, HR ADVANTAGE, IS ALSO USED IN A SURVEY COMPILING COMMUNITY DEMOGRAPHICS.
FORM 990, PART VI, SECTION C, LINE 19
MRHC PROVIDES INFORMATION REGARDING THESE DOCUMENTS TO INDIVIDUALS AND BUSINESSES UPON REQUEST. AS THE ORGANIZATION IS A NOT-FOR-PROFIT ENTITY, IRS FILINGS ARE AVAILABLE VIA PUBLIC PORTALS (I.E. GUIDESTAR) THAT FACILITATE THE PRESENTATION OF THIS DATA.
FORM 990, PART IX, LINE 11G
ANESTHESIA FEES: PROGRAM SERVICE EXPENSES 387,613. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 387,613. PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 136,534. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,534. PHARMACY FEES: PROGRAM SERVICE EXPENSES 147,691. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 147,691. EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 257,034. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 257,034. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 532,388. MANAGEMENT AND GENERAL EXPENSES 87,952. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 620,340.
FORM 990, PART XI, LINE 2C
THE BOARD OF DIRECTORS TAKES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.