TY 2015 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) DAVID VELLINGA...................................................................... DIRECTOR; REGIONAL PRESIDENT & CEO	1.00 ................. 54.00	X	X		0	0	0
(2) MILTON AVERY...................................................................... CHAIR	1.00 ................. 1.00	X	X		0	0	0
(3) MARY CORITA HEID RSM...................................................................... VICE CHAIR	1.00 ................. 1.00	X	X		0	0	0
(4) MAURITA SOUKUP RSM...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(5) JAMES CODDINGTON MD...................................................................... DIRECTOR; MERCY NI PHYSICIAN	49.00 ................. 1.00	X			164,772	0	21,996
(6) LAMETTA WYNN...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(7) MARK NIEMER MD...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(8) MARTI RODAMAKER...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(9) CLAYTON FITZHUGH...................................................................... DIRECTOR; TRINITY EVP CHRO	1.00 ................. 54.00	X			0	1,423,114	42,210
(10) RALPH REEDER MD...................................................................... DIRECTOR	1.00 ................. 1.00	X			0	0	0
(11) RODNEY SCHLADER...................................................................... TREASURER; REGIONAL CFO	48.00 ................. 2.00		X		0	371,506	55,264
(12) MARCIA SMITH...................................................................... SECRETARY; ASSOCIATE COUNSEL	44.00 ................. 1.00		X		0	304,349	34,225
(13) JAMES FITZPATRICK...................................................................... PRESIDENT & CEO SIOUX CITY	53.00 ................. 2.00			X	0	774,578	53,265
(14) DANIEL VARNUM...................................................................... CEO NORTH IOWA	55.00 ................. 0.00			X	0	661,883	45,266
(15) RUSSELL KNIGHT...................................................................... CEO DUBUQUE THROUGH 9/15	54.00 ................. 1.00			X	0	617,972	29,574
(16) PAUL MANTERNACH...................................................................... SVP PHYS INTEGRATION/CMO NORTH IOWA	50.00 ................. 0.00			X	0	432,114	38,772
(17) DIANE FISCHELS...................................................................... VP COO NORTH IOWA	50.00 ................. 0.00			X	0	347,538	53,858

(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) HUGH DEPAULIS........................................................................ VP FINANCE SIOUX CITY	46.00 .......................4.00	X			0	256,882	33,571
(19) KAY TAKES........................................................................ PRES DUBUQUE AT 10/15; VP PAT CARE	54.00 .......................1.00	X			0	249,027	44,335
(20) DANETTE ZOOK........................................................................ VP FINANCE NORTH IOWA	48.00 .......................2.00	X			0	220,117	41,635
(21) ROBERT SHAFER........................................................................ CFO DUBUQUE THROUGH 8/15	50.00 .......................0.00	X			0	163,387	52,947
(22) ALIREZA YARAHMADI........................................................................ PHYSICIAN, NEUROLOGY NORTH IOWA	50.00 .......................0.00		X		835,098	0	43,040
(23) MARK HAGANMAN........................................................................ PHYSICIAN,FAMILY MEDICINE NORTH IA	50.00 .......................0.00		X		668,223	0	58,819
(24) JAMES P KARKOS........................................................................ PHYSICIAN, DERMATOLOGY NORTH IOWA	50.00 .......................0.00		X		668,160	0	52,834
(25) BRENT OWEN........................................................................ PHYSICIAN, FAMILY MEDICINE NORTH IA	50.00 .......................0.00		X		593,776	0	38,204
(26) STEPHEN THORN........................................................................ PHYSICIAN, OBGYN NORTH IOWA	50.00 .......................0.00		X		589,761	0	58,139
(27) MARIANNE CUNNINGHAM........................................................................ FORMER OFFICER; TRINITY VP DEBT	0.00 .......................50.00			X	0	253,283	37,168
(28) JAMES BOSSCHER........................................................................ FORMER OFFICER	0.00 .......................0.00			X	0	113,714	1,137
(29) KEDRICK ADKINS........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	768,621	141
(30) STEVEN EAVENSON........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	222,329	21,155
(31) JUDITH PERSICHILLI........................................................................ FORMER OFFICER	0.00 .......................0.00			X	0	1,018,298	7,800
(32) PAUL NEUMANN........................................................................ FORMER OFFICER;TRIN CHIEF LEGAL CNSL	0.00 .......................55.00			X	0	1,232,000	41,886
(33) JENNIFER BARNETT........................................................................ FORMER OFFICER	0.00 .......................0.00			X	0	702,011	23,984
(34) AGNES HAGERTY........................................................................ FORMER OFFICER; TRINITY DEP GEN CSL	0.00 .......................50.00			X	0	844,356	55,579
(35) BENJAMIN CARTER........................................................................ FORMER OFFICER; TRINITY HEALTH CFO	0.00 .......................55.00			X	0	1,510,330	47,466
(36) RICHARD GILFILLAN MD........................................................................ FORMER OFFICER; TRINITY PRES & CEO	0.00 .......................55.00			X	0	2,711,447	45,401
(37) RICHARD O'CONNELL........................................................................ FORMER KE; TRINITY EVP EAST GROUP	0.00 .......................55.00			X	0	1,558,150	47,546
(38) JEROME PIERSON MD........................................................................ FORMER KEY EMPLOYEE;MMC-SC PHYSICIAN	49.00 .......................1.00			X	305,660	250,527	26,307
(39) TERESA MOCK MD........................................................................ FORMER KE; SVP CCO AND CPHO N. IOWA	50.00 .......................0.00			X	0	366,687	44,427
(40) LINDA KREI........................................................................ FORMER KEY EMP; VP CHRO SIOUX CITY	50.00 .......................0.00			X	0	284,963	32,246
(41) GARY GUETZKO........................................................................ FORMER KE;VP BUS DEVELOPMENT DUBUQUE	49.50 .......................0.50			X	0	255,158	57,336
(42) BRIAN MONSMA........................................................................ FORMER KE;VP NTWK DVLPMNT SIOUX CITY	48.00 .......................2.00			X	0	223,715	36,175
(43) TRACY LARSON........................................................................ FORMER KEY EMPLOYEE; CNO SIOUX CITY	50.00 .......................0.00			X	0	222,940	28,994
(44) KIMBERLY CHAMBERLIN........................................................................ FORMER KEY EMPLOYEE; CNO NORTH IOWA	49.00 .......................1.00			X	0	221,984	20,552
(45) SUE MEADE........................................................................ FORMER KE; VP PROF SVCS DUBUQUE	50.00 .......................0.00			X	0	182,011	23,411

(A) Name and business address	(B) Description of services	(C) Compensation
MASON CITY CLINIC PC 250 S CRESCENT DRIVE MASON CITY,IA50401	MEDICAL SERVICES	12,807,831
HENKEL CONSTRUCTION COMPANY 208 E STATE STREET MASON CITY,IA50402	CONSTRUCTION SERVICES	8,143,481
UNITED CLINICAL LABORATORIES 205 BLUFF STREET DUBUQUE,IA52001	LABORATORY SERVICES	7,502,771
CONLON CONSTRUCTION PO BOX 3400 DUBUQUE,IA52004	CONSTRUCTION SERVICES	3,669,931
KRAUS-ANDERSON CONSTRUCTION CO 525 S EIGHT ST MINNEAPOLIS,MN55404	CONSTRUCTION SERVICES	3,544,413
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 106

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 (Form 990 or 990-EZ))

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 in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. 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—2015. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. 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 VI 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) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
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 section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

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

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

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.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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 totaling $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 its Form 990PF, Part I, line 2, 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) 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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization MERCY HEALTH SERVICES - IOWA CORP		Employer identification number 31-1373080

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization MERCY HEALTH SERVICES - IOWA CORP			Employer identification number 31-1373080
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ 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) (2015)

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on 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? ...........................................................................................................

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

113,700

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

Yes

2,800

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

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

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

116,500

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

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	MERCY HEALTH SERVICES - IOWA (MHS-IA) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED MHS-IA WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SIMILARLY, THESE HEALTH CARE ORGANIZATIONS WILL ARRANGE CONFERENCES AND SEMINARS FOR MEMBER ORGANIZATIONS AND THEIR EXECUTIVES WHICH INVOLVE LEGISLATORS OR OTHER POLITICAL FIGURES AS GUEST SPEAKERS. AS A CATHOLIC HEALTH MINISTRY, WE ARE CALLED BOTH TO SERVE AND TO TRANSFORM. WE SERVE PEOPLE AND COMMUNITIES IN NEED, ESPECIALLY THE POOR AND UNDERSERVED. WE ALSO SEEK TO TRANSFORM SYSTEMS OF CARE AND POLICIES TO CREATE JUSTICE FOR ALL. ADVOCACY AT OUR SYSTEM SUPPORTS BOTH OF THESE FOUNDATIONAL ELEMENTS OF OUR FAITH-BASED MISSION. WE ADVOCATE FOR PUBLIC POLICIES THAT SUPPORT BETTER HEALTH, BETTER CARE AND LOWER COSTS TO ENSURE AFFORDABLE, HIGH QUALITY, PEOPLE-CENTERED CARE FOR ALL. OUR SYSTEM'S 2015 AND 2016 FEDERAL AND STATE ADVOCACY GOALS AND PRIORITIES INCLUDED: GOAL 1: ENACT POLICIES THAT SUPPORT BETTER HEALTH, BETTER CARE AND LOWER COST-FURTHER PEOPLE CENTERED 2020: -MEDICARE DELIVERY AND PAYMENT REFORM, INCLUDING MEDICARE SHARED SAVINGS PROGRAM (MSSP) & BUNDLED PAYMENT -"VALUE" NETWORKS (NARROW NETWORKS) -HEALTH INFORMATION TECHNOLOGY (HIT)/INTEROPERABILITY -STATE INNOVATION MODELS (SIM) -MEDICAID INNOVATION -BEHAVIORAL HEALTH -WORKFORCE, INCLUDING INTERSTATE COMPACT -TELEHEALTH -PALLIATIVE CARE GOAL 2: SECURE COVERAGE EXPANSION: -PROTECT RECENT MEDICAID EXPANSION -PUSH FOR MEDICAID EXPANSION IN STATES YET TO ACT -IMPROVE HEALTH INSURANCE EXCHANGE (HIX) ENROLLMENT, PLAN OVERSIGHT, AND OPERABILITY GOAL 3: SUSTAIN CATHOLIC HEALTH MINISTRY, INCLUDING FAIR PAYMENT AND TAX EXEMPTION: -PREVENT ARBITRARY MEDICARE & MEDICAID CUTS -PROTECT DISPROPORTIONATE SHARE PAYMENTS -ENACT POLICIES THAT SUPPORT BETTER HEALTH, BETTER CARE, AND LOWER COST -ENSURE MAXIMUM COVERAGE AND ACCESS, INCLUDING MEDICAID EXPANSION -SUSTAIN CATHOLIC HEALTH MINISTRY, INCLUDING FAIR PAYMENT AND TAX EXEMPTION -DRIVE QUALITY AND EFFICIENCY ACROSS THE CONTINUUM OF CARE WITH VALUE-BASED, SUSTAINABLE PAYMENT MODELS -BOLSTER OUR ADVOCACY VOICE THROUGH EFFECTIVE SYSTEM-WIDE ENGAGEMENT - LEAD THE WAY

Return Reference

Explanation

PART II-B, LINE 1:

MERCY HEALTH SERVICES - IOWA (MHS-IA) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED MHS-IA WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SIMILARLY, THESE HEALTH CARE ORGANIZATIONS WILL ARRANGE CONFERENCES AND SEMINARS FOR MEMBER ORGANIZATIONS AND THEIR EXECUTIVES WHICH INVOLVE LEGISLATORS OR OTHER POLITICAL FIGURES AS GUEST SPEAKERS. AS A CATHOLIC HEALTH MINISTRY, WE ARE CALLED BOTH TO SERVE AND TO TRANSFORM. WE SERVE PEOPLE AND COMMUNITIES IN NEED, ESPECIALLY THE POOR AND UNDERSERVED. WE ALSO SEEK TO TRANSFORM SYSTEMS OF CARE AND POLICIES TO CREATE JUSTICE FOR ALL. ADVOCACY AT OUR SYSTEM SUPPORTS BOTH OF THESE FOUNDATIONAL ELEMENTS OF OUR FAITH-BASED MISSION. WE ADVOCATE FOR PUBLIC POLICIES THAT SUPPORT BETTER HEALTH, BETTER CARE AND LOWER COSTS TO ENSURE AFFORDABLE, HIGH QUALITY, PEOPLE-CENTERED CARE FOR ALL. OUR SYSTEM'S 2015 AND 2016 FEDERAL AND STATE ADVOCACY GOALS AND PRIORITIES INCLUDED: GOAL 1: ENACT POLICIES THAT SUPPORT BETTER HEALTH, BETTER CARE AND LOWER COST-FURTHER PEOPLE CENTERED 2020: -MEDICARE DELIVERY AND PAYMENT REFORM, INCLUDING MEDICARE SHARED SAVINGS PROGRAM (MSSP) & BUNDLED PAYMENT -"VALUE" NETWORKS (NARROW NETWORKS) -HEALTH INFORMATION TECHNOLOGY (HIT)/INTEROPERABILITY -STATE INNOVATION MODELS (SIM) -MEDICAID INNOVATION -BEHAVIORAL HEALTH -WORKFORCE, INCLUDING INTERSTATE COMPACT -TELEHEALTH -PALLIATIVE CARE GOAL 2: SECURE COVERAGE EXPANSION: -PROTECT RECENT MEDICAID EXPANSION -PUSH FOR MEDICAID EXPANSION IN STATES YET TO ACT -IMPROVE HEALTH INSURANCE EXCHANGE (HIX) ENROLLMENT, PLAN OVERSIGHT, AND OPERABILITY GOAL 3: SUSTAIN CATHOLIC HEALTH MINISTRY, INCLUDING FAIR PAYMENT AND TAX EXEMPTION: -PREVENT ARBITRARY MEDICARE & MEDICAID CUTS -PROTECT DISPROPORTIONATE SHARE PAYMENTS -ENACT POLICIES THAT SUPPORT BETTER HEALTH, BETTER CARE, AND LOWER COST -ENSURE MAXIMUM COVERAGE AND ACCESS, INCLUDING MEDICAID EXPANSION -SUSTAIN CATHOLIC HEALTH MINISTRY, INCLUDING FAIR PAYMENT AND TAX EXEMPTION -DRIVE QUALITY AND EFFICIENCY ACROSS THE CONTINUUM OF CARE WITH VALUE-BASED, SUSTAINABLE PAYMENT MODELS -BOLSTER OUR ADVOCACY VOICE THROUGH EFFECTIVE SYSTEM-WIDE ENGAGEMENT - LEAD THE WAY

Schedule C (Form 990 or 990EZ) 2015

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," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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)

Revenue included on 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:

Revenue included on 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) 2015

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability?

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(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

0 %

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages on 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" on 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.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	10,328,607		10,328,607
b	Buildings	395,319,563	251,214,473	144,105,090
c	Leasehold improvements
d	Equipment ...	226,002,463	162,208,038	63,794,425
e	Other ...	12,198,546	405,582	11,792,964
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				230,021,086

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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	48,418,524	F
(B) EQUITY METHOD INVESTMENTS	41,155,745	C
(C) HEDGE FUNDS	29,051,115	F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	118,625,384

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) OTHER RECEIVABLES				13,418,189
(2) INTERCOMPANY ACCOUNTS RECEIVABLE				3,700,213
(3) INVESTMENT IN AFFILIATES				15,767,845
(4) OTHER ASSETS				2,659,440
(5) INTERCOMPANY OTHER LT ASSETS				38,757,227
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				74,302,914

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INTERCOMPANY ACCOUNTS PAYABLE	6,147,187
DEFERRED COMPENSATION	8,781,944
LONG TERM ASSET RETIREMENT OBLIGATION (FIN 47)	4,163,619
INTERCOMPANY NOTES PAYABLE	189,468,003
ANNUITY PAYABLE	51,318
OTHER CURRENT LIABILITIES	880,007
INTERCOMPANY OTHER LIABILITIES	386,441
OTHER LONG-TERM LIABILITIES	141,370
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	210,019,889
2. Liability for uncertain tax positions. 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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference

Explanation

PART V, LINE 4:

THE ENDOWMENT FUNDS OF MERCY HEALTH SERVICES - IOWA INCLUDE $25,000 KNOWN AS THE VIANNA HOLSCHLAG SCHOLARSHIP FUND. INTEREST INCOME FROM THE FUND IS MADE AVAILABLE FOR NURSING SCHOLARSHIPS. PART V, LINE 3A: ENDOWMENTS HELD BY DUBUQUE MERCY HEALTH FOUNDATION AND DYERSVILLE HEALTH FOUNDATION FOR THE BENEFIT OF MERCY HEALTH SERVICES - IOWA ARE REPORTED ON THE FORM 990'S OF THE RESPECTIVE FOUNDATIONS.

Schedule D (Form 990) 2015

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" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 criteria used 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? . . . . . .

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) . . .	4	9,419	6,965,686		6,965,686	1.010 %
b	Medicaid (from Worksheet 3, column a) . . . . .	71	70,786	75,762,801	63,707,489	12,055,312	1.740 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	75	80,205	82,728,487	63,707,489	19,020,998	2.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	58	297,252	2,409,690	141,674	2,268,016	0.330 %
f	Health professions education (from Worksheet 5) . . .	11	793	3,926,547	895,620	3,030,927	0.440 %
g	Subsidized health services (from Worksheet 6) . . . .	26	49,120	20,276,425	10,171,817	10,104,608	1.460 %
h	Research (from Worksheet 7) .	3	832	173,726	106,496	67,230	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	32	96,114	1,055,171	66,110	989,061	0.140 %
j	Total. Other Benefits . .	130	444,111	27,841,559	11,381,717	16,459,842	2.380 %
k	Total. Add lines 7d and 7j .	205	524,316	110,570,046	75,089,206	35,480,840	5.130 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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	1	30	825	825	0 %
3	Community support	3	169	3,559	3,559	0 %
4	Environmental improvements	2	211	5,910	5,910	0 %
5	Leadership development and training for community members	1	203	20,982	20,982	0 %
6	Coalition building
7	Community health improvement advocacy	1	94	2,621	2,621	0 %
8	Workforce development	1	206	6,119	6,119	0 %
9	Other
10	Total	9	913	40,016	40,016

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? ..........................

Yes

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

16,232,703

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. ......

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).....

223,537,429

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

253,376,329

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

-29,838,900

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 FOREST PARK IMAGING LLC	IMAGING SERVICES	52.890 %	47.110 %
22 MAGNETIC RESONANCE SERVICES PARTNERSHIP	MRI SERVICES	49.000 %	51.000 %
33 MASON CITY AMBULATORY SURGERY CENTER LLC	AMBULATORY SURGICAL SERVICES	51.000 %	49.000 %
44 MERCY HEART CENTER OUTPATIENT SERVICES LLC	OUTPATIENT ECHOCARDIOGRAPHY AND NUCLEAR MEDICINE SERVICES	51.000 %	49.000 %
55 SURGICAL CENTER BUILDING ASSOCIATES LLC	OWNS AND LEASES SURGICAL CENTER BUILDING	35.000 %	65.000 %
66 SIOUXLAND SURGERY CENTER LLP (DBA DUNES SURGICAL HOSPITAL)	AMBULATORY SURGICAL SERVICES	30.940 %	44.460 %
77 HEALTH MANAGEMENT SERVICES LLC	AMBULATORY SURGICAL SVCS, OCCUPATIONAL HLTH SVCS AND PRIMARY CARE PHYS SVCS	50.000 %	50.000 %
88 NORTH IOWA COMMUNITY HEALTHCARE LLC	HEALTHCARE PROVIDERS AND MANAGEMENT SERVICES	20.500 %	41.000 %
99 PREFERRED HEALTH CHOICES LLC	MANAGEMENT SERVICES	50.000 %	50.000 %
10
11
12
13

Schedule H (Form 990) 2015

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, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)								Other (Describe)
1	MERCY MEDICAL CENTER-NORTH IOWA 1000 FOURTH STREET SW MASON CITY,IA50401 WWW.MERCYNORTHIOWA.COM 170023H	X	X	X		X	X
2	MERCY MEDICAL CENTER-DUBUQUE 250 MERCY DRIVE DUBUQUE,IA52001 WWW.MERCYDUBUQUE.COM 310003H	X	X				X	REHAB,LAB,PHARM, X-RAY,HOME CARE
3	MERCY MEDICAL CENTER-SIOUX CITY 801 FIFTH STREET SIOUX CITY,IA51102 WWW.MERCYSIOUXCITY.COM 970112H	X	X				X	EMPLOYED PHYSICIANS, SKILLED CARE UNIT
4	MERCY MEDICAL CENTER-NEW HAMPTON 308 NORTH MAPLE AVE NEW HAMPTON,IA50659 WWW.MERCYNEWHAMPTON.COM 190022H	X			X		X	EMPLOYED PHYSICIANS
5	DUNES SURGICAL HOSPITAL 600 N SIOUX POINT ROAD DAKOTA DUNES,SD57049 WWW.DUNESSURGICALHOSPITAL.COM 10580	X	X
6	MERCY MEDICAL CENTER-DYERSVILLE 1111 THIRD STREET SW DYERSVILLE,IA52040 WWW.MERCYDUBUQUE.COM/MERCY-DYERSVILLE 310181H	X	X		X		X	REHAB,LAB,PHARM, X-RAY,HOME CARE

Schedule H (Form 990) 2015

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

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

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.MERCYNORTHIOWA.COM/BUSINESS-OFFICE

The FAP application form was widely available on a website (list url):

WWW.MERCYNORTHIOWA.COM/BUSINESS-OFFICE

A plain language summary of the FAP was widely available on a website (list url):
WWW.MERCYNORTHIOWA.COM/BUSINESS-OFFICE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

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

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

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 Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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 Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

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 12......................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.MERCYSIOUXCITY.COM/FOR-PATIENTS

The FAP application form was widely available on a website (list url):

WWW.MERCYSIOUXCITY.COM/FOR-PATIENTS

A plain language summary of the FAP was widely available on a website (list url):
WWW.MERCYSIOUXCITY.COM/FOR-PATIENTS

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

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

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

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 Section C)

Other (describe in Section C)

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 Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

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 12......................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE

The FAP application form was widely available on a website (list url):

WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

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

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

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 Section C)

Other (describe in Section C)

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 Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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)

	DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

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 12......................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

DUNESSURGICALHOSPITAL.COM/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE

The FAP application form was widely available on a website (list url):

DUNESSURGICALHOSPITAL.COM/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE

A plain language summary of the FAP was widely available on a website (list url):
DUNESSURGICALHOSPITAL.COM/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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 Section C)

Other (describe in Section C)

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 Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

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 12......................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.MERCYNEWHAMPTON.COM/BILLING

The FAP application form was widely available on a website (list url):

WWW.MERCYNEWHAMPTON.COM/BILLING

A plain language summary of the FAP was widely available on a website (list url):
WWW.MERCYNEWHAMPTON.COM/BILLING

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

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

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

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 Section C)

Other (describe in Section C)

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 Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

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 12......................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE

The FAP application form was widely available on a website (list url):

WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
WWW.MERCYDUBUQUE.COM/PATIENT-FINANCIAL-ASSISTANCE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

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

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

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 Section C)

Other (describe in Section C)

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 Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
MERCY MEDICAL CENTER-NORTH IOWA	PART V, SECTION B, LINE 5: DURING THE 2013 CHNA ASSESSMENT PERIOD, MERCY MEDICAL CENTER-NORTH IOWA (MERCY NI) USED TRAINED FACILITATORS TO LEAD FOCUS GROUPS AT THE FOLLOWING LOCATIONS: HISPANIC COMMUNITY-LA LUZ HISPANA, HAMPTON, IA; COMMUNITY KITCHEN, SERVING FOOD TO THOSE WHO ARE LOW-INCOME, ELDERLY, FAMILIES WITH LIMITED RESOURCES, THE WORKING POOR, THOSE WITH MENTAL OR PHYSICAL CHALLENGES, AND PEOPLE WHO ARE LONELY, DISENFRANCHISED, OR NEED THE HOSPITALITY THE FACILITY PROVIDES IN NORTH CENTRAL IOWA; AND THE MASON CITY SENIOR CITIZENS CENTER. A UNIVERSITY OF DES MOINES PUBLIC HEALTH CONSULTANT-LED SURVEY WAS USED FOR FIVE PUBLICIZED COMMUNITY LISTENING GROUPS HELD DURING THE DATA COLLECTION TIME PERIOD. A QUESTIONNAIRE SURVEY WAS EMAILED TO THE STAFF OF THE LARGEST EMPLOYER IN NORTH IOWA AS WELL AS TO AREA SOCIAL SERVICE AGENCIES AND TO A MINISTERIAL CONSORTIUM. INPUT FROM THE COMMUNITY BENEFIT TASK FORCE REPRESENTED HOSPITAL STAFF WHO DIRECTLY TOUCH THE UNINSURED AND UNDERINSURED POPULATION (FINANCIAL AND MEDICATION ASSISTANCE, PHARMACISTS, CASE MANAGEMENT, HISPANIC CLINIC, BEHAVIORAL HEALTH, COMMUNITY CARE COORDINATION PROGRAM (IOWA SAFETY NET FUNDED) ETC.) AS WELL AS REPRESENTATIVES OF COMMUNITY HUMAN SERVICE AGENCIES (PUBLIC HEALTH, COMMUNITY ACTION, SALVATION ARMY, HOMELESS SHELTERS, CRISIS INTERVENTION, CERRO GORDO COUNTY FREE CLINIC (NON-MERCY), ETC.), SCHOOL SYSTEMS, MINISTERIAL, RETIRED MILITARY, AND RETIRED HOSPITAL ADMINISTRATION.
MERCY MEDICAL CENTER-SIOUX CITY	PART V, SECTION B, LINE 5: IN 2015 DUNES SURGICAL HOSPITAL (DUNES), MERCY MEDICAL CENTER-SIOUX CITY (MERCY SC), SIOUXLAND DISTRICT HEALTH DEPARTMENT (SDHD), AND UNITYPOINT HEALTH - ST. LUKE'S PARTNERED TOGETHER TO COMPLETE THE FIRST EVER JOINT CHNA TO DETERMINE THE COMMUNITY'S GREATEST HEALTH NEEDS AND TO COORDINATE EFFORTS TO IMPROVE POPULATION HEALTH OUTCOMES FOR THE SIOUXLAND AREA. PRIOR TO 2015 SDHD HAD SUBMITTED THEIR OWN CHNA IN 2011, WHILE UNITYPOINT HEALTH - ST. LUKE'S AND MERCY SC SUBMITTED A JOINT ASSESSMENT IN 2013. THE AFFORDABLE CARE ACT AND THE HEALTH CARE EDUCATION AFFORDABILITY RECONCILIATION ACT, BOTH ENACTED IN MARCH 2010, MANDATE TAX-EXEMPT HOSPITAL ORGANIZATIONS TO CONDUCT A CHNA EVERY THREE YEARS, BEGINNING IN 2011. THE YEAR-LONG PROCESS INCLUDED COLLABORATION FROM REPRESENTATIVES FROM EACH ORGANIZATION, KNOWN AS THE CHNA PLANNING COMMITTEE, AS WELL AS ENGAGEMENT FROM SEVERAL COMMUNITY PARTNERS. BEGINNING IN EARLY 2015 PRIMARY AND SECONDARY DATA WAS COLLECTED THROUGH SEVERAL SOURCES, AND ANALYZED BY THE CHNA PLANNING COMMITTEE. A COMMUNITY INPUT MEETING WAS HELD DURING THE SUMMER OF 2015, WHILE FINAL SUBMISSION OF THE CHNA OCCURRED EARLY 2016.THE JOINT CHNA LOOKED AT DATA FROM THE FOLLOWING SIX COUNTIES IN THE TRI-STATE SIOUXLAND AREA, AS EACH HOSPITAL SERVES A LARGER TERRITORY OUTSIDE OF JUST WOODBURY COUNTY:-UNION, SD-DAKOTA, DIXON, AND THURSTON, NE-PLYMOUTH AND WOODBURY, IA
MERCY MEDICAL CENTER-DUBUQUE	PART V, SECTION B, LINE 5: INPUT FROM THE COMMUNITY WAS GATHERED THROUGH THE FOLLOWING: THE INVOLVEMENT OF THE CHNA STEERING COMMITTEE MEMBERS AND THE PROMOTING HEALTH BEHAVIORS TASK FORCE, A SURVEY, AND THREE PUBLIC INPUT SESSIONS.THE CHNA STEERING COMMITTEE MET MULTIPLE TIMES, APPROXIMATELY MONTHLY FROM SEPTEMBER 2014 THROUGH MAY 2015. THE PROMOTING HEALTHY BEHAVIORS TASK FORCE MET IN DECEMBER 2014, FEBRUARY 2015, AND MARCH 2015. ORGANIZATIONS PARTICIPATING ON THESE COMMITTEES REPRESENTED BROAD INTERESTS OF THE COMMUNITY, INCLUDING RACIAL AND ETHNIC MINORITIES, A VARIETY OF AGE AND INCOME GROUPS, AND PEOPLE WITH SPECIFIC HEALTH CARE ISSUES:- MERCY MEDICAL CENTER-DYERSVILLE- CITY OF DUBUQUE HEALTH SERVICES- DUBUQUE COUNTY HEALTH DEPARTMENT- CRESCENT COMMUNITY HEALTH CENTER- UNITYPOINT HEALTH-FINLEY HOSPITAL- CITY OF DUBUQUE LEISURE SERVICES- YMCA/YWCA- HOLY FAMILY SCHOOL DISTRICT- HYVEE DIETITIAN SERVICES- WIC- HILLCREST FAMILY SERVICES- HELPING SERVICES OF NE IOWA- DUBUQUE COMMUNITY SCHOOLS- VISITING NURSE ASSOCIATION- MEDICAL ASSOCIATES CLINIC- CITY OF DUBUQUE HUMAN RIGHTS DEPARTMENT- ISU EXTENSION- CITY OF ASBURY CITY PARKSALL OF THESE ORGANIZATIONS PARTICIPATED IN DEVELOPMENT OF THE PROCESS, ANALYSIS OF DATA, CONTRIBUTION OF ADDITIONAL DATA, IDENTIFICATION OF NEEDS, PRIORITIZATION OF NEEDS, AND STRATEGY DEVELOPMENT. MANY OF THEM SERVE POPULATIONS AT RISK IN THE COMMUNITY, INCLUDING LOW INCOME AND MINORITY POPULATIONS, AND SPOKE OF THEIR NEEDS. THE PROCESS VARIED BY ORGANIZATION, BUT MANY OF THESE TASK FORCE MEMBERS TOOK THE INFORMATION BACK TO THEIR ORGANIZATIONS, DISCUSSED IT, AND RETURNED WITH ADDITIONAL INPUT OR IDEAS.THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WAS FIELDED BETWEEN DECEMBER 2014 AND MARCH 2015. THE SURVEY'S BASIC RACIAL/ETHNIC DEMOGRAPHICS ARE REASONABLY REPRESENTATIVE OF THE COMMUNITY AT LARGE. THE SURVEY RESPONDENTS WERE 95.1% WHITE, NON-HISPANIC, COMPARED TO 92.9% FOR DUBUQUE COUNTY IN 2012. TO ACCOMMODATE LOW-INCOME HOUSEHOLDS THAT LACKED ACCESS TO THE INTERNET, SOME PAPER VERSIONS OF THE SURVEY WERE MADE AVAILABLE. AS NOTED IN THE SURVEY FINDINGS, THERE WERE OCCASIONAL DIFFERENCES IN THE OPINIONS OF WHITE NON-HISPANIC COMPARED TO OTHER SURVEY RESPONDENTS.THE THIRD WAY OF SOLICITING INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY WERE THE THREE PUBLIC INPUT SESSIONS CONDUCTED IN LATE APRIL AND EARLY MAY 2015. TO ACCOMMODATE WORK SCHEDULES AND TO ENCOURAGE DIVERSITY AMONG THOSE ATTENDING, THE SESSIONS OCCURRED ON DIFFERENT DAYS, IN DIFFERENT LOCATIONS, AND AT DIFFERENT TIMES OF DAY. THE CITY OF DUBUQUE, ONE OF THE PARTNERS IN THIS ASSESSMENT PROJECT, HAS BEEN USING AN INFORMAL "COMMUNITY CAFE" FORMAT FOR INCREASING COMMUNITY ENGAGEMENT IN A VARIETY OF COMMUNITY PROJECTS. BASED ON THEIR SUCCESS AND THE FAMILIARITY OF THE COMMUNITY WITH THIS CONCEPT, WE CHOSE TO EMPLOY IT FOR THE CHNA.
DUNES SURGICAL HOSPITAL	PART V, SECTION B, LINE 5: IN 2015 DUNES, MERCY SC, SDHD, AND UNITYPOINT HEALTH - ST. LUKE'S PARTNERED TOGETHER TO COMPLETE THE FIRST EVER JOINT CHNA TO DETERMINE THE COMMUNITY'S GREATEST HEALTH NEEDS AND TO COORDINATE EFFORTS TO IMPROVE POPULATION HEALTH OUTCOMES FOR THE SIOUXLAND AREA. PRIOR TO 2015 SDHD HAD SUBMITTED THEIR OWN CHNA IN 2011, WHILE UNITYPOINT HEALTH - ST. LUKE'S AND MERCY SC SUBMITTED A JOINT ASSESSMENT IN 2013. THE AFFORDABLE CARE ACT AND THE HEALTH CARE EDUCATION AFFORDABILITY RECONCILIATION ACT, BOTH ENACTED IN MARCH 2010, MANDATE TAX-EXEMPT HOSPITAL ORGANIZATIONS TO CONDUCT A CHNA EVERY THREE YEARS, BEGINNING IN 2011. THE YEAR-LONG PROCESS INCLUDED COLLABORATION FROM REPRESENTATIVES FROM EACH ORGANIZATION, KNOWN AS THE CHNA PLANNING COMMITTEE, AS WELL AS ENGAGEMENT FROM SEVERAL COMMUNITY PARTNERS. BEGINNING IN EARLY 2015 PRIMARY AND SECONDARY DATA WAS COLLECTED THROUGH SEVERAL SOURCES, AND ANALYZED BY THE CHNA PLANNING COMMITTEE. A COMMUNITY INPUT MEETING WAS HELD DURING THE SUMMER OF 2015, WHILE FINAL SUBMISSION OF THE CHNA OCCURRED EARLY 2016.THE JOINT CHNA LOOKED AT DATA FROM THE FOLLOWING SIX COUNTIES IN THE TRI-STATE SIOUXLAND AREA, AS EACH HOSPITAL SERVES A LARGER TERRITORY OUTSIDE OF JUST WOODBURY COUNTY:-UNION, SD-DAKOTA, DIXON, AND THURSTON, NE-PLYMOUTH AND WOODBURY, IA
MERCY MEDICAL CENTER-NEW HAMPTON	PART V, SECTION B, LINE 5: THE ASSESSMENT PROCESS WAS INITIATED BY MERCY MEDICAL CENTER-NEW HAMPTON (MERCY 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, THREE SEPARATE DISCUSSION GROUPS WERE HELD LOCALLY IN DECEMBER 2015. THE GROUPS REPRESENTED VARYING SECTORS IN THE COMMUNITY: (1) SOCIAL SERVICE PARTNERS, (2) PATIENTS, AND (3) COMMUNITY/BUSINESS REPRESENTATIVES. THERE WAS A 72% 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 NH WORKS CLOSELY WITH, AND COMMUNITY LEADERS/BUSINESS OWNERS WERE SELECTED FOR THEIR KNOWLEDGE OF THE COMMUNITY. SEVEN PARTICIPANTS WERE FROM OUTSIDE NEW HAMPTON (FREDERICKSBURG, LAWLER AND ALTA VISTA); ALL OTHERS WERE FROM NEW HAMPTON. THE OUTSIDE CONSULTANT COLLATED AND ANALYZED THE FOCUS GROUP RESULTS WITH SUPPORT FROM MERCY NI'S PLANNING & MARKETING TEAM IN MASON CITY. MERCY NH ALSO USED OTHER MECHANISMS TO GATHER COMMUNITY INPUT ON SERVICES: SURVEYS, PATIENT FEEDBACK, AND SERVICE UTILIZATION DATA. DATA SOURCES INCLUDED COUNTY HEALTH RANKINGS, THE IOWA HOSPITAL ASSOCIATION, THE ADVISORY BOARD AND THE DEPARTMENT OF HEALTH & HUMAN SERVICES.MERCY NH WAS CAREFUL TO GATHER INPUT FROM REPRESENTATIVES OF VARIOUS MINORITY AND UNDERSERVED INDIVIDUALS INCLUDING: LOW INCOME/UNDERSERVED (SALVATION ARMY, PUBLIC HEALTH AND HERITAGE RESIDENCE REPRESENTATIVES); CHRONIC CONDITIONS (AREA NURSING HOME, MENTAL HEALTH AND HOSPICE REPRESENTATIVES); AND RACIAL/ETHNIC MINORITY (HISPANIC MINISTER FROM HOLY FAMILY).
MERCY MEDICAL CENTER-DYERSVILLE	PART V, SECTION B, LINE 5: INPUT FROM THE COMMUNITY WAS GATHERED THROUGH THE FOLLOWING: THE INVOLVEMENT OF THE CHNA STEERING COMMITTEE MEMBERS AND THE PROMOTING HEALTH BEHAVIORS TASK FORCE, A SURVEY, AND THREE PUBLIC INPUT SESSIONS.THE CHNA STEERING COMMITTEE MET MULTIPLE TIMES, APPROXIMATELY MONTHLY FROM SEPTEMBER 2014 THROUGH MAY 2015. THE PROMOTING HEALTHY BEHAVIORS TASK FORCE MET IN DECEMBER 2014, FEBRUARY 2015, AND MARCH 2015. ORGANIZATIONS PARTICIPATING ON THESE COMMITTEES REPRESENTED BROAD INTERESTS OF THE COMMUNITY, INCLUDING RACIAL AND ETHNIC MINORITIES, A VARIETY OF AGE AND INCOME GROUPS, AND PEOPLE WITH SPECIFIC HEALTH CARE ISSUES:- MERCY MEDICAL CENTER-DUBUQUE- CITY OF DUBUQUE HEALTH SERVICES- DUBUQUE COUNTY HEALTH DEPARTMENT- CRESCENT COMMUNITY HEALTH CENTER- UNITYPOINT HEALTH-FINLEY HOSPITAL- CITY OF DUBUQUE LEISURE SERVICES- YMCA/YWCA- HOLY FAMILY SCHOOL DISTRICT- HYVEE DIETITIAN SERVICES- WIC- HILLCREST FAMILY SERVICES- HELPING SERVICES OF NE IOWA- DUBUQUE COMMUNITY SCHOOLS- VISITING NURSE ASSOCIATION- MEDICAL ASSOCIATES CLINIC- CITY OF DUBUQUE HUMAN RIGHTS DEPARTMENT- ISU EXTENSION- CITY OF ASBURY CITY PARKSALL OF THESE ORGANIZATIONS PARTICIPATED IN DEVELOPMENT OF THE PROCESS, ANALYSIS OF DATA, CONTRIBUTION OF ADDITIONAL DATA, IDENTIFICATION OF NEEDS, PRIORITIZATION OF NEEDS, AND STRATEGY DEVELOPMENT. MANY OF THEM SERVE POPULATIONS AT RISK IN THE COMMUNITY, INCLUDING LOW INCOME AND MINORITY POPULATIONS, AND SPOKE OF THEIR NEEDS. THE PROCESS VARIED BY ORGANIZATION, BUT MANY OF THESE TASK FORCE MEMBERS TOOK THE INFORMATION BACK TO THEIR ORGANIZATIONS, DISCUSSED IT, AND RETURNED WITH ADDITIONAL INPUT OR IDEAS.THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WAS FIELDED BETWEEN DECEMBER 2014 AND MARCH 2015. THE SURVEY'S BASIC RACIAL/ETHNIC DEMOGRAPHICS ARE REASONABLY REPRESENTATIVE OF THE COMMUNITY AT LARGE. THE SURVEY RESPONDENTS WERE 95.1% WHITE, NON-HISPANIC, COMPARED TO 92.9% FOR DUBUQUE COUNTY IN 2012. TO ACCOMMODATE LOW-INCOME HOUSEHOLDS THAT LACKED ACCESS TO THE INTERNET, SOME PAPER VERSIONS OF THE SURVEY WERE MADE AVAILABLE. AS NOTED IN THE SURVEY FINDINGS, THERE WERE OCCASIONAL DIFFERENCES IN THE OPINIONS OF WHITE NON-HISPANIC COMPARED TO OTHER SURVEY RESPONDENTS.THE THIRD WAY OF SOLICITING INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY WERE THE THREE PUBLIC INPUT SESSIONS CONDUCTED IN LATE APRIL AND EARLY MAY 2015. TO ACCOMMODATE WORK SCHEDULES AND TO ENCOURAGE DIVERSITY AMONG THOSE ATTENDING, THE SESSIONS OCCURRED ON DIFFERENT DAYS, IN DIFFERENT LOCATIONS, AND AT DIFFERENT TIMES OF DAY. THE CITY OF DUBUQUE, ONE OF THE PARTNERS IN THIS ASSESSMENT PROJECT, HAS BEEN USING AN INFORMAL "COMMUNITY CAFE" FORMAT FOR INCREASING COMMUNITY ENGAGEMENT IN A VARIETY OF COMMUNITY PROJECTS. BASED ON THEIR SUCCESS AND THE FAMILIARITY OF THE COMMUNITY WITH THIS CONCEPT, WE CHOSE TO EMPLOY IT FOR THE CHNA.
MERCY MEDICAL CENTER-SIOUX CITY	PART V, SECTION B, LINE 6A: MERCY SC'S CHNA WAS CONDUCTED WITH ST. LUKE'S REGIONAL MEDICAL CENTER AND DUNES.
MERCY MEDICAL CENTER-DUBUQUE	PART V, SECTION B, LINE 6A: MERCY MEDICAL CENTER-DUBUQUE (MERCY DUB) CONDUCTED ITS CHNA WITH MERCY MEDICAL CENTER-DYERSVILLE (MERCY DYR) AND UNITYPOINT HEALTH-FINLEY HOSPITAL, DUBUQUE.
DUNES SURGICAL HOSPITAL	PART V, SECTION B, LINE 6A: DUNES' CHNA WAS CONDUCTED WITH MERCY SC AND ST. LUKE'S REGIONAL MEDICAL CENTER
MERCY MEDICAL CENTER-DYERSVILLE	PART V, SECTION B, LINE 6A: MERCY DYR CONDUCTED ITS CHNA WITH MERCY DUB AND UNITYPOINT HEALTH-FINLEY HOSPITAL, DUBUQUE.
MERCY MEDICAL CENTER-SIOUX CITY	PART V, SECTION B, LINE 6B: MERCY SC CONDUCTED ITS CHNA WITH SIOUXLAND DISTRICT HEALTH DEPARTMENT.
MERCY MEDICAL CENTER-DUBUQUE	PART V, SECTION B, LINE 6B: MERCY DUB CONDUCTED ITS CHNA WITH THE FOLLOWING NON-HOSPITAL ORGANIZATIONS:- CITY OF DUBUQUE HEALTH SERVICES- DUBUQUE COUNTY HEALTH DEPARTMENT- CRESCENT COMMUNITY HEALTH CENTER- CITY OF DUBUQUE LEISURE SERVICES- YMCA/YWCA- HOLY FAMILY SCHOOL DISTRICT- HYVEE DIETITIAN SERVICES- WIC- HILLCREST FAMILY SERVICES- HELPING SERVICES OF NE IOWA- DUBUQUE COMMUNITY SCHOOLS- VISITING NURSE ASSOCIATION- MEDICAL ASSOCIATES CLINIC- CITY OF DUBUQUE HUMAN RIGHTS DEPARTMENT- ISU EXTENSION- CITY OF ASBURY CITY PARKS
DUNES SURGICAL HOSPITAL	PART V, SECTION B, LINE 6B: DUNES CONDUCTED ITS CHNA WITH SIOUXLAND DISTRICT HEALTH DEPARTMENT.
MERCY MEDICAL CENTER-DYERSVILLE	PART V, SECTION B, LINE 6B: MERCY DYR CONDUCTED ITS CHNA WITH THE FOLLOWING NON-HOSPITAL ORGANIZATIONS:- CITY OF DUBUQUE HEALTH SERVICES- DUBUQUE COUNTY HEALTH DEPARTMENT- CRESCENT COMMUNITY HEALTH CENTER- CITY OF DUBUQUE LEISURE SERVICES- YMCA/YWCA- HOLY FAMILY SCHOOL DISTRICT- HYVEE DIETITIAN SERVICES- WIC- HILLCREST FAMILY SERVICES- HELPING SERVICES OF NE IOWA- DUBUQUE COMMUNITY SCHOOLS- VISITING NURSE ASSOCIATION- MEDICAL ASSOCIATES CLINIC- CITY OF DUBUQUE HUMAN RIGHTS DEPARTMENT- ISU EXTENSION- CITY OF ASBURY CITY PARKS
MERCY MEDICAL CENTER-SIOUX CITY	PART V, SECTION B, LINE 7D: THE CHNA WAS DISTRIBUTED TO SOCIAL SERVICE AGENCIES.
DUNES SURGICAL HOSPITAL	PART V, SECTION B, LINE 7D: THE CHNA WAS DISTRIBUTED TO SOCIAL SERVICE AGENCIES.
MERCY MEDICAL CENTER-NORTH IOWA	PART V, SECTION B, LINE 11: MERCY NI ADDRESSED THE FOLLOWING SIGNIFICANT HEALTH NEEDS WITHIN ITS IMPLEMENTATION STRATEGY IN TAX YEAR 2015:ACCESS TO CARE: UNINSURED AND UNDERINSURED INDIVIDUALS OFTEN DO NOT SEEK HEALTH CARE SERVICES OR HAVE LIMITED RESOURCES TO ACCESS HEALTH CARE APPROPRIATELY. UTILIZING CARE COORDINATION, INDIVIDUALS RECEIVED ASSISTANCE WITH THE APPLICATION PROCESS TO OBTAIN HEALTH INSURANCE COVERAGE AND/OR OTHER SUPPORTIVE SERVICES TO IMPROVE HEALTH AND REDUCE SOCIAL DETERMINANTS OF HEALTH/DISPARITIES. SUPPORTIVE SERVICES INCLUDED: ACCESS TO MEDICAL, BEHAVIORAL HEALTH, AND SUBSTANCE USE APPOINTMENTS ALONG WITH REDUCING TRANSPORTATION BARRIERS TO THESE APPOINTMENTS. MERCY NI ALSO PROVIDED SUPPORT THROUGH MEDICATION ASSISTANCE PROGRAMS AND THE COORDINATION OF EMERGENT DENTAL CARE FOR ELIGIBLE ADULTS. ASSISTANCE WITH NAVIGATION/COORDINATION TO OBTAIN A PCP/MEDICAL HOME, PHARMACY HOME AND DENTAL HOME WAS ALSO OFFERED. CARE COORDINATION: PROVIDERS AND AGENCIES WHO DO NOT COMMUNICATE WITH EACH OTHER IN A FORMALIZED MANNER PROVIDE CARE IN "SILOS", WHICH OFTEN RESULTS IN GAPS AND DUPLICATIVE SERVICES. RESOURCE PROVIDERS WORKED TOGETHER IN A MORE FORMALIZED MANNER, PROVIDING MORE EFFECTIVE SERVICES WITH IMPROVED HEALTH OUTCOMES FOR RESIDENTS OF NORTH IOWA. THE MOST VULNERABLE INDIVIDUALS WERE TARGETED FOR ENROLLMENT INTO COMMUNITY CARE COORDINATION; INTEGRATED WITH SELF-MANAGEMENT RESOURCES/PROGRAMMING IN A MANNER THAT HELPED THE INDIVIDUALS ACHIEVE WELLNESS AND IMPROVED HEALTH; AND NATIONAL BEST PRACTICE MODELS THAT TARGETED CHRONIC DISEASE WERE IMPLEMENTED. SAFETY NET PROGRAMS: MANY NON-MEDICAL FACTORS CONTRIBUTE TO POOR HEALTH, OFTEN CALLED UNDERLYING SOCIAL DETERMINANTS. MERCY NI HAS ADDRESSED THESE FACTORS, WHICH IS OFTEN ESSENTIAL BEFORE HEALTH ISSUES CAN BE ADDRESSED OR HEALTH IMPROVEMENT IS EXPERIENCED, IN THE FOLLOWING WAYS: - FORMALIZED REFERRAL PROCESS TO BETTER UTILIZE PROGRAMS AND SOCIAL SERVICE AGENCY RESOURCES THAT ADDRESSED UNDERLYING SOCIAL DETERMINANTS.- CONTINUED TO SUPPORT PROVISION OF EMERGENT HOUSING FOR THE HOMELESS OR TRANSIENT.- CONTINUED TO FINANCIALLY SUPPORT A COMMUNITY PARTNER AGENCY PROGRAM THAT ADDRESSES SELF-SUFFICIENCY FOR FAMILIES THAT NEED ECONOMIC AND HEALTH STABILIZATION.- CONTINUED TO PREPARE AND SUBSIDIZE PREPARATION OF HOT, NUTRITIONALLY APPROPRIATE MEALS FOR COMMUNITY MEMBERS WHO NEED MEALS ON WHEELS.SUBSTANCE USE/MENTAL HEALTH: MERCY NI PARTNERED WITH PRAIRIE RIDGE ADDICTION TREATMENT SERVICES TO EXPAND SCREENING AND ASSESSMENT, ENROLLED PARTICIPANTS IN APPROPRIATE TREATMENT PLANS, ENCOURAGED SELF-ACCOUNTABILITY AND COMPLIANCE WITH TREATMENT PLANS, AND MADE APPROPRIATE REFERRALS TO COMMUNITY HEALTH AND SOCIAL SERVICE PROVIDERS.BECAUSE OF LIMITED CAPACITY AND ACTIVITY ALREADY IN PLACE, THE FOLLOWING IDENTIFIED NEEDS WERE SELECTED TO NOT BE DIRECTLY ADDRESSED:- COMMUNITY WELLNESS WAS ALREADY BEING ADDRESSED IN A VARIETY OF COLLABORATIVE WAYS AND WE FINANCIALLY CONTRIBUTED TO THE COMMUNITY BLUE ZONES PROJECT.- THE NEED FOR IMPROVED PARENTING SKILLS/SELF-RESPONSIBILITY IS CAUSAL TO MANY OTHER NEEDS AND WAS BEING ADDRESSED THROUGH INTRODUCTION OF THE NURTURED HEART APPROACH AS A COMMUNICATION FRAMEWORK ACROSS HUMAN SERVICE AGENCIES; MASON CITY AND AREA SCHOOL SYSTEMS; AND HOSPITAL/ PRIMARY CARE HEALTH COACHES/ HEALTH NAVIGATORS. - CHRONIC DISEASE MANAGEMENT FOR DIABETES AND HEART DISEASE WERE COMPONENTS OF SEVERAL CURRENT COMMUNITY-WIDE INITIATIVES.- TRANSPORTATION WILL ALWAYS BE A BARRIER IN RURAL AREAS. THIS ASPECT OF ACCESS TO CARE IS A SHARED RESPONSIBILITY WITHIN THE BROADER COMMUNITY AND THERE ARE GROUPS ALREADY LOOKING AT THIS AND SEEKING ADVOCACY AT THE STATE LEVEL. WE FINANCIALLY CONTRIBUTED TO AN ORGANIZATION THAT PROVIDES MEANS-TESTED TRANSPORTATION. - THE ISSUE OF SAFETY HAS A SCOPE OR SERVICE THAT IS VERY BROAD, ENCOMPASSING FARM ACCIDENTS, MOTORCYCLE ACCIDENTS, HOME FALLS, ETC. CAPACITY DID NOT ALLOW A TARGETED FOCUS.
MERCY MEDICAL CENTER-SIOUX CITY	PART V, SECTION B, LINE 11: AFTER REVIEWING ALL INFORMATION AND DATA AVAILABLE FOR THE 2016 CHNA, THE FOLLOWING SEVEN NEEDS WERE IDENTIFIED FOR THE SIOUXLAND AREA: TOBACCO/SUBSTANCE ABUSE, OBESITY, TEEN BIRTHS, ACCESS TO CARE, MENTAL ILLNESS, CANCER SCREENINGS, AND HOUSING. BOTH MERCY SC AND DUNES HAVE ADDRESSED THESE NEEDS WITHIN THE PAST YEAR.FOR YEARS, SEVERAL AGENCIES HAVE BEEN WORKING ON TOBACCO AND SUBSTANCE ABUSE. SIOUXLAND CARES HAS FOCUSED ON YOUTH PREVENTION FOR NEARLY 25 YEARS, AND HAS POSITIVELY IMPACTED THE SUBSTANCE ABUSE NUMBERS LOCALLY. JACKSON RECOVERY CONTINUES TO OFFER COUNSELING AND TEENS STOP USING TOBACCO (TAP)/TEEN TOBACCO USERS (TEG) DIVERSION CLASSES TO HIGH SCHOOL STUDENTS CAUGHT USING ILLEGAL SUBSTANCE ON SCHOOL GROUNDS. FORMER STRATEGIC PREVENTION FRAMEWORK STATE INCENTIVE GRANTS (SPF-SIG) OFFERED TRAINING FOR INTERVENTION PROCEDURES (TIPS) TRAININGS FOR RESTAURANT AND BAR STAFF, AND PROVIDED SEVERAL MEDIA CAMPAIGNS ABOUT DRINKING AND DRIVING. SDHD HAS WORKED TO PROMOTE QUITLINE IOWA, 2A'S AND R (ASK, ADVICE, REFER) TRAINING FOR CLINIC STAFF, AND PROMOTE SMOKE FREE MULTI-UNIT HOUSING COMPLEXES, EVENTS, WORKSITES, AND PARKS. MERCY SC IS PARTNERING WITH THE SIOUXLAND TOBACCO COALITION, THROUGH THE PARTICIPATION OF THREE MERCY SC BOARD MEMBERS, AND IN PROGRAMS TO CURB TOBACCO USE INCLUDING LOCALLY PRODUCED TV PUBLIC SERVICE ANNOUNCEMENTS.SINCE 2012, MUCH WORK HAS BEGUN IN THE AREA OF OBESITY PREVENTION AND HOPEFULLY DATA MEASURES WILL SOON REFLECT THAT WORK. SEVERAL WORKSITES HAVE IMPLEMENTED WELLNESS POLICIES AND A VARIETY OF PROGRAMMING FOR THEIR EMPLOYEES. BLUEZONES PROVIDED TECHNICAL ASSISTANCE IN AIDING SIOUX CITY TO BECOME A CERTIFIED BLUEZONE COMMUNITY WITH CHANGES TO RESTAURANTS, SCHOOLS, WORKPLACES AND THE COMMUNITY. SDHD HAS PROVIDED TECHNICAL ASSISTANCE TO SEVERAL WORKSITES, CHILD CARE CENTERS, SCHOOLS, CLINICS AND COMMUNITIES ON IMPLEMENTING POLICY, SYSTEM, AND ENVIRONMENTAL CHANGES TO IMPROVE THE HEALTH OF SIOUXLAND RESIDENTS. SEVERAL OTHER ENTITIES IN THE COMMUNITY, INCLUDING BOTH HOSPITALS, HAVE ALSO IMPLEMENTED A VARIETY OF PROGRAMS, INCLUDING BUT NOT LIMITED TO COMMUNITY GARDENS, COMPLETE STREET RESOLUTIONS, WALKING SCHOOL BUSES, AND FARM TO SCHOOL PROGRAMS. ALTHOUGH MUCH WORK HAS ALREADY BEEN DONE, THERE IS STILL MUCH MORE TO BE ACCOMPLISHED. IN AN EFFORT TO CURB THE PREVALENCE OF OBESITY, MERCY SC IS EXECUTING KIDSHAPE, WHICH INVOLVES LIFESTYLE MODIFICATION FOR BOTH CHILDREN AND FAMILIES. KIDSHAPE IS CURRENTLY OFFERED IN 12 WEEK PROGRAMS IN TWO MAJOR ELEMENTARY SCHOOLS, OFFERING ASSISTANCE AND EDUCATION REGARDING DIET, EXERCISE AND RECIPE DEVELOPMENT. MERCY SC ALSO HAS A PARTNERSHIP WITH THE SIOUXLAND Y AIMED DIRECTLY AT TYPE 2 DIABETES AS IT RELATES TO OBESITY.SEVERAL SOCIAL SERVICE AGENCIES PROVIDE IN-HOME VISITATION PROGRAMS TO YOUNG MOTHERS. THESE SERVICES HOPE TO DELAY CONSECUTIVE TEEN BIRTHS BY THE MOTHER. PLANNED PARENTHOOD AND LUTHERAN SERVICES IN IOWA (LSI) IMPLEMENT EVIDENCE-BASED TEEN PREGNANCY PREVENTION PROGRAMS IN SCHOOLS THROUGHOUT WOODBURY COUNTY. IN YEARS PAST, A TEEN SEXUAL HEALTH TASK FORCE HAD BEEN FORMED BUT HAS SINCE DISBANDED. IN 2015, AS FOLLOW-UP TO HOLLY KEEGAN'S TEEN SEXUAL HEALTH SURVEY, A TEEN SEXUAL HEALTH RESOURCE GUIDE WAS DEVELOPED AND DISTRIBUTED TO AREA SERVICE PROVIDERS. IT CONTAINS INFORMATION ON NEARLY 15 ORGANIZATIONS LOCALLY THAT PROVIDE SERVICES RELATED TO PREGNANCY AND STD'S, AS WELL AS COMMUNICATION GUIDES FOR PARENTS TO USE WHEN TALKING TO THEIR CHILDREN ON THE TOPIC. MERCY SC IS WORKING DIRECTLY WITH AND SUPPORTING "HER WOMEN'S HEALTH", A NON-PROFIT CHRISTIAN ORGANIZATION, IN THEIR EFFORTS TO ADDRESS TEEN PREGNANCY.SIOUXLAND COMMUNITY HEALTH CENTER STAFFS CERTIFIED APPLICATION COUNSELORS TO ASSIST PATIENTS AT THE HEALTH CENTER AS WELL AS LOCATIONS AROUND THE SIOUXLAND COMMUNITY. CERTIFIED APPLICATION COUNSELORS ARE AVAILABLE TO ANSWER QUESTIONS REGARDING THE AFFORDABLE CARE ACT AND ALSO ASSIST CONSUMERS WITH THE ENROLLMENT PROCESS. COMMUNITY CLINICS RECRUITMENT OF ADVANCED PRACTICE PROVIDERS (APPS) SUPPLEMENT NEEDS FOR PRIMARY CARE PHYSICIANS AND SPECIALISTS IN THE SERVICE AREA.RECRUITMENT OF PHYSICIANS IS BASED ON NEED AS DETERMINED BY PHYSICIAN-TO-POPULATION RATIOS. MERCY SC IS LOCATED IN A MEDICALLY UNDERSERVED AREA (MUA) WHICH ENABLES THE HOSPITAL TO RECRUIT PHYSICIANS WITH J1 WAIVERS. COMMUNITY HOSPITALS SUPPORT/SUBSIDIZE THE SIOUXLAND MEDICAL EDUCATION FOUNDATION (SMEF), RESIDENCY PROGRAM FOR FAMILY PRACTICE PHYSICIANS. MANY OF THESE PHYSICIANS STAY IN THE LOCAL COMMUNITIES UPON GRADUATION. COMMUNITY URGENT CARE CLINICS AND SIOUXLAND COMMUNITY HEALTH CENTER HAVE EXTENDED HOURS TO ACCOMMODATE NEEDS OF THE PATIENTS' SCHEDULES. IN ADDITION, MERCY SC HAS LEAD EFFORTS TO ENROLL PEOPLE IN THE INSURANCE EXCHANGE, AS WELL AS PARTNERING WITH SOCIAL SERVICES AGENCIES AND OTHER NON-PROFIT ORGANIZATIONS TO PROVIDE COMMUNITY MEMBERS WITH EASY ACCESS TO VIABLE INSURANCE OPTIONS.MERCY SC AND DUNES HAVE COLLABORATED WITH THE SIOUXLAND STREET PROJECT ALONG WITH THE CITY OF SIOUX CITY'S SECTION 6 HOUSING DEPARTMENT TO ADDRESS THE LACK OF LOW INCOME AND TRANSITIONAL HOUSING IN THE REGION. SIOUX CITY HAS THE OLDEST HOUSING STOCK IN THE STATE OF IOWA, COMPOUNDED BY LOW HOUSING STOCK. MERCY SC HAS BEEN WORKING WITH ANAWIM HOUSING OF DES MOINES IOWA, A NON-PROFIT ORGANIZATION SPECIALIZING IN LOW INCOME HOUSING, TO CONDUCT A FEASIBILITY STUDY TO IDENTIFY OPPORTUNITIES TO EXPAND THE AVAILABILITY OF LOW INCOME HOUSING.OVER THE YEARS COLLABORATION HAS OCCURRED TO IMPROVE THE MENTAL ILLNESS THAT IS PREVALENT IN THE SIOUXLAND AREA. SIOUXLAND MENTAL HEALTH HAS BEGUN BOTH THE PEDIATRIC AND ADULT INTEGRATED HOME HEALTH PROGRAM FOR INDIVIDUALS WITH MENTAL HEALTH DIAGNOSIS. BOTH HOSPITALS, ALONG WITH SIOUXLAND COMMUNITY HEALTH CENTER AND SIOUXLAND MENTAL HEALTH, HAVE DEVELOPED A MENTAL HEALTH CARE COORDINATOR POSITION TO WORK WITH INDIVIDUALS WITH A MENTAL HEALTH CONDITION UPON DISCHARGE FROM EITHER HOSPITAL'S ER. SIOUX CITY COMMUNITY SCHOOLS PROVIDE COUNSELORS ONSITE, IN A JOINT EFFORT WITH SIOUXLAND COMMUNITY HEALTH CENTER, AND ARE CURRENTLY TRAINING STAFF USING YOUTH MENTAL HEALTH FIRST AID (YMHFA) CURRICULUM THROUGH A PROJECT AWARE GRANT. YMHFA IS A NATIONAL CERTIFICATION IN WHICH PARTICIPANTS LEARN TO IDENTIFY WHEN A YOUTH IS EXPERIENCING A MENTAL HEALTH CHALLENGE, ASSIST THEM UNTIL APPROPRIATE HELP IS SOUGHT, AND THEN CONNECT THEM TO APPROPRIATE SERVICES. AS OF SEPTEMBER 30, 2015, 275 INDIVIDUALS HAD TAKEN THE TRAINING. MERCY SC IS ALSO WORKING IN COLLABORATION WITH JACKSON RECOVERY CENTER, A NATIONALLY RECOGNIZED MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT CENTER, TO ELIMINATE THE MENTAL HEALTH ACCESS ISSUES IN THE COMMUNITY. MERCY SC PROVIDED PERSONNEL, FINANCIAL, AND PROGRAM DEVELOPMENT SUPPORT TO THE SIOUXLAND DISTRICT HEALTH DEPARTMENT, WHO OFFERS TWO PROGRAMS THAT PROMOTE CANCER SCREENINGS; CARE FOR YOURSELF (MAMMOGRAMS FOR WOMEN) AND IOWA GET SCREENED (COLONOSCOPY). FOR THE CARE FOR YOURSELF PROGRAM, SDHD STAFF PROVIDE ENROLLMENT AND CASE MANAGEMENT SERVICES FOR WOMEN IN EIGHT SURROUNDING COUNTIES. ELIGIBILITY REQUIREMENTS INCLUDE AGE, RESIDENCY, INCOME AND INSURANCE COVERAGE. FOR IOWA GET SCREENED, SDHD STAFF PROVIDES EDUCATION AND AWARENESS TO ALL IOWANS, PROVIDE DIRECT SCREENINGS TO ELIGIBLE PARTICIPANTS AND ENCOURAGE SYSTEM CHANGES TO INCREASE SCREENING RATES.
MERCY MEDICAL CENTER-DUBUQUE	PART V, SECTION B, LINE 11: THE SIGNIFICANT NEED TO BE ADDRESSED IS OBESITY. OBESITY IS CHARACTERISTIC OF 29% OF DUBUQUE COUNTY ADULTS. THE GOAL IS REDUCE OBESITY AMONG DUBUQUE COUNTY ADULTS TO 27% BY JUNE 30, 2018.MERCY DUB WAS INVOLVED IN THE FOLLOWING PROJECTS FOR FISCAL YEAR 2016, TO HELP REDUCE OBESITY IN OUR COMMUNITY:MERCY DUB IS A MEMBER OF DUBUQUE COUNTY WELLNESS COALITION AND A PARTNER OF DUBUQUE EATS WELL. WITH THIS, MERCY DUB IS CONNECTED WITH THE IOWA STATE UNIVERSITY DESIGN LAB TO ADDRESS COMMUNITY NEED PROJECTS. DOUBLE-UP BUCKS PROMOTION - DOUBLES THE VALUE OF THE FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP). FOR EVERY "BUCK" SPENT, A MATCHED DOLLAR IS GIVEN TO BE EXCLUSIVELY SPENT ON FRUITS AND VEGETABLES AT THE FARMERS MARKET.SINSINAWA COLLABORATIVE FARM - SERVES THE NEEDS OF BEGINNING FARMERS IN ACCESS TO LAND, ESPECIALLY TO UNDER-SERVED POPULATIONS, TO GROW FRESH FOODS AND VEGETABLES. FARM TO INSTITUTIONS NETWORK AND PROCUREMENT - LONG TERM STRATEGIC PLAN FOR INCREASING THE SUPPLY AND DEMAND OF FRESH FRUITS AND VEGETABLES AT INSTITUTIONS. MERCY DUB PARTERNED WITH DUBUQUE WELLNESS COALITION AND DUBUQUE COMMUNITY SCHOOL DISTRICT TO SPONSOR AN EVENT, "DUBUQUE ON THE MOVE," TO CONNECT COMMUNITY MEMBERS WITH HEALTH AND WELLNESS PROFESSIONALS DURING A WALKING EVENT. IN EFFORTS FOR WEIGHT REDUCTION, MERCY DUB OFFERS THE FOLLOWING COMMUNITY CLASSES: "12 WEEK WEIGHT LOSS PROGRAM AND "JUST FOR YOU WEIGHT LOSS PROGRAM". GRANT MONEY IS AVAILABLE FOR COMMUNITY MEMBERS THROUGH MERCY DUB'S COMMUNITY BENEFIT MINISTRY PROGRAM FOR THOSE WHO CANNOT AFFORD THE PROGRAM. MERCY DUB ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. MERCY DUB IS NOT PLANNING TO TAKE ACTION AT THIS TIME ON THE FOLLOWING HEALTH NEEDS:REDUCING ALCOHOL AND SUBSTANCE ABUSE - NOT INCLUDED FOR ACTION IN MERCY DUB'S IMPLEMENTATION STRATEGY BECAUSE OF OTHER ORGANIZATIONS THAT ARE ALREADY HAVING SOME SUCCESS IN THIS AREA, ESPECIALLY THE SUBSTANCE ABUSE COALITION.DIABETES SCREENING AND MANAGEMENT - NOT INCLUDED FOR ACTION IN MERCY DUB'S IMPLEMENTATION STRATEGY BECAUSE OF LIMITED RESOURCES, EXISTING PROGRAMS IN THE COMMUNITY, AND COMPETING PRIORITIES.NONCOMPLIANCE WITH BLOOD PRESSURE MEDICATIONS - NOT INCLUDED FOR ACTION IN MERCY DUB'S IMPLEMENTATION STRATEGY BECAUSE THIS WAS FELT TO BE AN EFFORT BEST HANDLED BY THE MEDICAL COMMUNITY (I.E., INDIVIDUAL PHYSICIANS).PROSTATE CANCER SCREENING - NOT INCLUDED FOR ACTION IN MERCY DUB'S IMPLEMENTATION STRATEGY BECAUSE OF LIMITED RESOURCES AND COMPETING PRIORITIES.INSUFFICIENT ACCESS TO MENTAL HEALTH PROVIDERS - NOT INCLUDED FOR ACTION IN MERCY DUB'S IMPLEMENTATION STRATEGY BECAUSE OF INSUFFICIENT REIMBURSEMENT FROM INSURANCE AND PUBLIC FUNDING PROGRAMS, AND PROVEN DIFFICULTY IN RECRUITING SUCH PROFESSIONALS, AT LEAST PARTIALLY BECAUSE OF THAT LACK OF REIMBURSEMENT.MORE BILINGUAL HEALTHCARE PROVIDERS - NOT INCLUDED FOR ACTION IN MERCY DUB'S IMPLEMENTATION STRATEGY BECAUSE OF THE LOW FEASIBILITY OF SUCCESS IN ATTRACTING SUCH PROVIDERS TO THIS COMMUNITY.
DUNES SURGICAL HOSPITAL	PART V, SECTION B, LINE 11: AFTER REVIEWING ALL INFORMATION AND DATA AVAILABLE FOR THE 2016 CHNA, THE FOLLOWING SEVEN NEEDS WERE IDENTIFIED FOR THE SIOUXLAND AREA: TOBACCO/SUBSTANCE ABUSE, OBESITY, TEEN BIRTHS, ACCESS TO CARE, MENTAL ILLNESS, CANCER SCREENINGS, AND HOUSING. BOTH MERCY SC AND DUNES HAVE ADDRESSED THESE NEEDS WITHIN THE PAST YEAR.FOR YEARS, SEVERAL AGENCIES HAVE BEEN WORKING ON TOBACCO AND SUBSTANCE ABUSE. SIOUXLAND CARES HAS FOCUSED ON YOUTH PREVENTION FOR NEARLY 25 YEARS, AND HAS POSITIVELY IMPACTED THE SUBSTANCE ABUSE NUMBERS LOCALLY. JACKSON RECOVERY CONTINUES TO OFFER COUNSELING AND TEENS STOP USING TOBACCO (TAP)/TEEN TOBACCO USERS (TEG) DIVERSION CLASSES TO HIGH SCHOOL STUDENTS CAUGHT USING ILLEGAL SUBSTANCE ON SCHOOL GROUNDS. FORMER STRATEGIC PREVENTION FRAMEWORK STATE INCENTIVE GRANTS (SPF-SIG) OFFERED TRAINING FOR INTERVENTION PROCEDURES (TIPS) TRAININGS FOR RESTAURANT AND BAR STAFF, AND PROVIDED SEVERAL MEDIA CAMPAIGNS ABOUT DRINKING AND DRIVING. SDHD HAS WORKED TO PROMOTE QUITLINE IOWA, 2A'S AND R (ASK, ADVICE, REFER) TRAINING FOR CLINIC STAFF, AND PROMOTE SMOKE FREE MULTI-UNIT HOUSING COMPLEXES, EVENTS, WORKSITES, AND PARKS. MERCY SC IS PARTNERING WITH THE SIOUXLAND TOBACCO COALITION, THROUGH THE PARTICIPATION OF THREE MERCY SC BOARD MEMBERS, AND IN PROGRAMS TO CURB TOBACCO USE INCLUDING LOCALLY PRODUCED TV PUBLIC SERVICE ANNOUNCEMENTS.SINCE 2012, MUCH WORK HAS BEGUN IN THE AREA OF OBESITY PREVENTION AND HOPEFULLY DATA MEASURES WILL SOON REFLECT THAT WORK. SEVERAL WORKSITES HAVE IMPLEMENTED WELLNESS POLICIES AND A VARIETY OF PROGRAMMING FOR THEIR EMPLOYEES. BLUEZONES PROVIDED TECHNICAL ASSISTANCE IN AIDING SIOUX CITY TO BECOME A CERTIFIED BLUEZONE COMMUNITY WITH CHANGES TO RESTAURANTS, SCHOOLS, WORKPLACES AND THE COMMUNITY. SDHD HAS PROVIDED TECHNICAL ASSISTANCE TO SEVERAL WORKSITES, CHILD CARE CENTERS, SCHOOLS, CLINICS AND COMMUNITIES ON IMPLEMENTING POLICY, SYSTEM, AND ENVIRONMENTAL CHANGES TO IMPROVE THE HEALTH OF SIOUXLAND RESIDENTS. SEVERAL OTHER ENTITIES IN THE COMMUNITY, INCLUDING BOTH HOSPITALS, HAVE ALSO IMPLEMENTED A VARIETY OF PROGRAMS, INCLUDING BUT NOT LIMITED TO COMMUNITY GARDENS, COMPLETE STREET RESOLUTIONS, WALKING SCHOOL BUSES, AND FARM TO SCHOOL PROGRAMS. ALTHOUGH MUCH WORK HAS ALREADY BEEN DONE, THERE IS STILL MUCH MORE TO BE ACCOMPLISHED. IN AN EFFORT TO CURB THE PREVALENCE OF OBESITY, MERCY SC IS EXECUTING KIDSHAPE, WHICH INVOLVES LIFESTYLE MODIFICATION FOR BOTH CHILDREN AND FAMILIES. KIDSHAPE IS CURRENTLY OFFERED IN 12 WEEK PROGRAMS IN TWO MAJOR ELEMENTARY SCHOOLS, OFFERING ASSISTANCE AND EDUCATION REGARDING DIET, EXERCISE AND RECIPE DEVELOPMENT. MERCY SC ALSO HAS A PARTNERSHIP WITH THE SIOUXLAND Y AIMED DIRECTLY AT TYPE 2 DIABETES AS IT RELATES TO OBESITY.SEVERAL SOCIAL SERVICE AGENCIES PROVIDE IN-HOME VISITATION PROGRAMS TO YOUNG MOTHERS. THESE SERVICES HOPE TO DELAY CONSECUTIVE TEEN BIRTHS BY THE MOTHER. PLANNED PARENTHOOD AND LUTHERAN SERVICES IN IOWA (LSI) IMPLEMENT EVIDENCE-BASED TEEN PREGNANCY PREVENTION PROGRAMS IN SCHOOLS THROUGHOUT WOODBURY COUNTY. IN YEARS PAST, A TEEN SEXUAL HEALTH TASK FORCE HAD BEEN FORMED BUT HAS SINCE DISBANDED. IN 2015, AS FOLLOW-UP TO HOLLY KEEGAN'S TEEN SEXUAL HEALTH SURVEY, A TEEN SEXUAL HEALTH RESOURCE GUIDE WAS DEVELOPED AND DISTRIBUTED TO AREA SERVICE PROVIDERS. IT CONTAINS INFORMATION ON NEARLY 15 ORGANIZATIONS LOCALLY THAT PROVIDE SERVICES RELATED TO PREGNANCY AND STD'S, AS WELL AS COMMUNICATION GUIDES FOR PARENTS TO USE WHEN TALKING TO THEIR CHILDREN ON THE TOPIC. MERCY SC IS WORKING DIRECTLY WITH AND SUPPORTING "HER WOMEN'S HEALTH", A NON-PROFIT CHRISTIAN ORGANIZATION, IN THEIR EFFORTS TO ADDRESS TEEN PREGNANCY.SIOUXLAND COMMUNITY HEALTH CENTER STAFFS CERTIFIED APPLICATION COUNSELORS TO ASSIST PATIENTS AT THE HEALTH CENTER AS WELL AS LOCATIONS AROUND THE SIOUXLAND COMMUNITY. CERTIFIED APPLICATION COUNSELORS ARE AVAILABLE TO ANSWER QUESTIONS REGARDING THE AFFORDABLE CARE ACT AND ALSO ASSIST CONSUMERS WITH THE ENROLLMENT PROCESS. COMMUNITY CLINICS RECRUITMENT OF ADVANCED PRACTICE PROVIDERS (APPS) SUPPLEMENT NEEDS FOR PRIMARY CARE PHYSICIANS AND SPECIALISTS IN THE SERVICE AREA.RECRUITMENT OF PHYSICIANS IS BASED ON NEED AS DETERMINED BY PHYSICIAN-TO-POPULATION RATIOS. MERCY SC IS LOCATED IN A MEDICALLY UNDERSERVED AREA (MUA) WHICH ENABLES THE HOSPITAL TO RECRUIT PHYSICIANS WITH J1 WAIVERS. COMMUNITY HOSPITALS SUPPORT/SUBSIDIZE THE SIOUXLAND MEDICAL EDUCATION FOUNDATION (SMEF), RESIDENCY PROGRAM FOR FAMILY PRACTICE PHYSICIANS. MANY OF THESE PHYSICIANS STAY IN THE LOCAL COMMUNITIES UPON GRADUATION. COMMUNITY URGENT CARE CLINICS AND SIOUXLAND COMMUNITY HEALTH CENTER HAVE EXTENDED HOURS TO ACCOMMODATE NEEDS OF THE PATIENTS' SCHEDULES. IN ADDITION, MERCY SC HAS LEAD EFFORTS TO ENROLL PEOPLE IN THE INSURANCE EXCHANGE, AS WELL AS PARTNERING WITH SOCIAL SERVICES AGENCIES AND OTHER NON-PROFIT ORGANIZATIONS TO PROVIDE COMMUNITY MEMBERS WITH EASY ACCESS TO VIABLE INSURANCE OPTIONS.MERCY SC AND DUNES HAVE COLLABORATED WITH THE SIOUXLAND STREET PROJECT ALONG WITH THE CITY OF SIOUX CITY'S SECTION 6 HOUSING DEPARTMENT TO ADDRESS THE LACK OF LOW INCOME AND TRANSITIONAL HOUSING IN THE REGION. SIOUX CITY HAS THE OLDEST HOUSING STOCK IN THE STATE OF IOWA, COMPOUNDED BY LOW HOUSING STOCK. MERCY SC HAS BEEN WORKING WITH ANAWIM HOUSING OF DES MOINES IOWA, A NON-PROFIT ORGANIZATION SPECIALIZING IN LOW INCOME HOUSING, TO CONDUCT A FEASIBILITY STUDY TO IDENTIFY OPPORTUNITIES TO EXPAND THE AVAILABILITY OF LOW INCOME HOUSING.OVER THE YEARS COLLABORATION HAS OCCURRED TO IMPROVE THE MENTAL ILLNESS THAT IS PREVALENT IN THE SIOUXLAND AREA. SIOUXLAND MENTAL HEALTH HAS BEGUN BOTH THE PEDIATRIC AND ADULT INTEGRATED HOME HEALTH PROGRAM FOR INDIVIDUALS WITH MENTAL HEALTH DIAGNOSIS. BOTH HOSPITALS, ALONG WITH SIOUXLAND COMMUNITY HEALTH CENTER AND SIOUXLAND MENTAL HEALTH, HAVE DEVELOPED A MENTAL HEALTH CARE COORDINATOR POSITION TO WORK WITH INDIVIDUALS WITH A MENTAL HEALTH CONDITION UPON DISCHARGE FROM EITHER HOSPITAL'S ER. SIOUX CITY COMMUNITY SCHOOLS PROVIDE COUNSELORS ONSITE, IN A JOINT EFFORT WITH SIOUXLAND COMMUNITY HEALTH CENTER, AND ARE CURRENTLY TRAINING STAFF USING YOUTH MENTAL HEALTH FIRST AID (YMHFA) CURRICULUM THROUGH A PROJECT AWARE GRANT. YMHFA IS A NATIONAL CERTIFICATION IN WHICH PARTICIPANTS LEARN TO IDENTIFY WHEN A YOUTH IS EXPERIENCING A MENTAL HEALTH CHALLENGE, ASSIST THEM UNTIL APPROPRIATE HELP IS SOUGHT, AND THEN CONNECT THEM TO APPROPRIATE SERVICES. AS OF SEPTEMBER 30, 2015, 275 INDIVIDUALS HAD TAKEN THE TRAINING. MERCY SC IS ALSO WORKING IN COLLABORATION WITH JACKSON RECOVERY CENTER, A NATIONALLY RECOGNIZED MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT CENTER, TO ELIMINATE THE MENTAL HEALTH ACCESS ISSUES IN THE COMMUNITY. MERCY SC PROVIDED PERSONNEL, FINANCIAL, AND PROGRAM DEVELOPMENT SUPPORT TO THE SIOUXLAND DISTRICT HEALTH DEPARTMENT, WHO OFFERS TWO PROGRAMS THAT PROMOTE CANCER SCREENINGS; CARE FOR YOURSELF (MAMMOGRAMS FOR WOMEN) AND IOWA GET SCREENED (COLONOSCOPY). FOR THE CARE FOR YOURSELF PROGRAM, SDHD STAFF PROVIDE ENROLLMENT AND CASE MANAGEMENT SERVICES FOR WOMEN IN EIGHT SURROUNDING COUNTIES. ELIGIBILITY REQUIREMENTS INCLUDE AGE, RESIDENCY, INCOME AND INSURANCE COVERAGE. FOR IOWA GET SCREENED, SDHD STAFF PROVIDES EDUCATION AND AWARENESS TO ALL IOWANS, PROVIDE DIRECT SCREENINGS TO ELIGIBLE PARTICIPANTS AND ENCOURAGE SYSTEM CHANGES TO INCREASE SCREENING RATES.
MERCY MEDICAL CENTER-NEW HAMPTON	PART V, SECTION B, LINE 11: MERCY NH APPROVED THE FISCAL YEAR 2016 IMPLEMENTATION STRATEGY IN NOVEMBER 2016. THIS STRATEGY WILL BE IMPLEMENTED IN THE COMING THREE YEARS AND WILL ADDRESS PRIMARY CARE ACCESS, BEHAVIORAL HEALTH/CHEMICAL DEPENDENCY, AND MAINTAINING AND INCREASING ACCESS TO SPECIALTY SERVICES. ALTHOUGH THE STRATEGY WAS NOT IMPLEMENTED WITHIN FISCAL YEAR 2016, MERCY NH CONTINUED TO ADDRESS THE FOLLOWING SIGNIFICANT NEEDS FROM THE PREVIOUS CHNA PROCESS: IMPROVE COMMUNITY HEALTH: MERCY NH HAS IMPLEMENTED A PROGRAMING SYSTEM TO IMPROVE THE HEALTH OF CHICKASAW COUNTY RESIDENTS. MEDVENTIVE PATIENT HEALTH REGISTRY WAS IMPLEMENTED AND WILL ENABLE THE FAMILY CLINIC TO TRACK PATIENTS BY DISEASE CONDITIONS. A HEALTH COACH HAS BEEN HIRED TO TRACK PATIENTS BY DISEASE CONDITIONS (DIABETES AND HEART DISEASE). THE HEALTH COACH HAS ALSO BEEN MAKING PHONE CALLS TO ALL PATIENTS DUE FOR A PHYSICAL, MAMMOGRAM OR COLONOSCOPY. OUR WELLNESS COORDINATOR/ATHLETIC TRAINER IS WORKING WITH SCHOOLS FOR ATHLETIC TRAINER RESPONSIBILITIES. THE WELLNESS COORDINATOR IS ALSO WORKING WITH CHICKASAW WELLNESS COMPLEX TO PROMOTE MEMBERSHIP FROM OUR STAFF AND FROM PATIENTS THAT COMPLETED PHYSICAL THERAPY SERVICES HERE. WE PROVIDE IN-KIND SUPPORT FOR THE CHICKASAW COUNTY COALITION FOR PREVENTING UNDERAGE DRINKING BY HAVING OUR PHYSICIANS ACTIVELY INVOLVED IN PREVENTION STRATEGY PLANNING.IMPROVE ACCESS: A NEW PROCESS WAS PUT INTO PLACE TO HELP IMPROVE ACCESS TO HEALTHCARE SERVICES AT THE MERCY FAMILY CLINIC. EFFORTS INCLUDED INCREASING THE NUMBER OF APPOINTMENTS AVAILABLE AND THOSE AVAILABLE SAME-DAY. INCREASE HEALTH LITERACY: BUILDING THE COMMUNITY'S AWARENESS OF AVAILABLE SERVICES AND HEALTH IMPROVEMENT OPTIONS/OPPORTUNITIES, USING NEW COMMUNICATIONS CHANNELS AND TECHNOLOGIES. UNDER THE THEORY THAT UNDERSERVED POPULATIONS CANNOT BENEFIT FROM SERVICES ABOUT WHICH THEY ARE UNAWARE, MERCY NH HAS IDENTIFIED CURRENT LEVELS OF AWARENESS IN NEW HAMPTON AND CHICKASAW COUNTY AND BUILT AWARENESS AND UNDERSTANDING AMONG SPECIFIC AT-RISK POPULATIONS. INCREASE ACCESS TO MENTAL HEALTH SERVICES: THIS STRATEGY HAS BEEN THE MOST DIFFICULT TO ACCOMPLISH OVER THE LAST TWO YEARS DUE TO THE OVERALL SHORTAGE OF MENTAL HEALTH SERVICES NATIONWIDE. WE SET OUT TO BUILD LOCAL CAPACITY IN MENTAL HEALTH AND CHEMICAL DEPENDENCY SERVICES. WE HAVE ESTABLISHED STRONGER RELATIONSHIPS WITH AREA PROVIDERS IN ORDER TO ENHANCE COMMUNICATION WITH PRIMARY PROVIDERS AND HAVE DETERMINED THAT ADDITIONAL MENTAL HEALTH PROVIDERS IN OUR COUNTY ARE NEEDED. WE CONTINUE TO WORK CLOSELY WITH PATHWAYS BEHAVIORAL SERVICES TO ASSESS PLACING A LICENSED SOCIAL WORKER AT MERCY FAMILY CLINIC ON A FULL-TIME BASIS. MERCY NH ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE 2016 CHNA PROCESS, AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. MERCY NH WILL NOT TAKE ACTION ON THE FOLLOWING HEALTH NEED:AREA PHARMACY DEMAND EXCEEDS AVAILABILITY - MERCY NH HAS BEEN WORKING CLOSELY WITH THE NEW HAMPTON ECONOMIC DEVELOPMENT OFFICE ON RECRUITING ANOTHER PHARMACY TO THE AREA AND CONTINUE TO WORK CLOSELY WITH PHARMACIES IN NORTHEAST IOWA ABOUT THE OPPORTUNITIES AVAILABLE IN NEW HAMPTON. IN PARTICULAR, THE POTENTIAL OPPORTUNITY FOR TELE-PHARMACY AS IT IS BROUGHT TO IOWA IN 2017.
MERCY MEDICAL CENTER-DYERSVILLE	PART V, SECTION B, LINE 11: THE SIGNIFICANT NEED TO BE ADDRESSED IS OBESITY. OBESITY IS CHARACTERISTIC OF 29% OF DUBUQUE COUNTY ADULTS. THE GOAL IS REDUCE OBESITY AMONG DUBUQUE COUNTY ADULTS TO 27% BY JUNE 30, 2018.MERCY DYR WAS INVOLVED IN THE FOLLOWING PROJECTS FOR FISCAL YEAR 2016 TO HELP REDUCE OBESITY IN OUR COMMUNITY: MERCY DYR IS A MEMBER OF DUBUQUE COUNTY WELLNESS COALITION AND A PARTNER OF DUBUQUE EATS WELL. WITH THIS, MERCY DYR IS CONNECTED WITH THE IOWA STATE UNIVERSITY DESIGN LAB TO ADDRESS COMMUNITY NEED PROJECTS. DOUBLE-UP BUCKS PROMOTION - DOUBLES THE VALUE OF THE FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP). FOR EVERY "BUCK" SPENT, A MATCHED DOLLAR IS GIVEN TO BE EXCLUSIVELY SPENT ON FRUITS AND VEGETABLES AT THE FARMERS MARKET.SINSINAWA COLLABORATIVE FARM - SERVES THE NEEDS OF BEGINNING FARMERS IN ACCESS TO LAND, ESPECIALLY TO UNDER-SERVED POPULATIONS, TO GROW FRESH FOODS AND VEGETABLES. FARM TO INSTITUTIONS NETWORK AND PROCUREMENT - LONG TERM STRATEGIC PLAN FOR INCREASING THE SUPPLY AND DEMAND OF FRESH FRUITS AND VEGETABLES AT INSTITUTIONS. MERCY DYR PARTNERED WITH DUBUQUE WELLNESS COALITION AND DUBUQUE COMMUNITY SCHOOL DISTRICT TO SPONSOR AN EVENT, "DUBUQUE ON THE MOVE," TO CONNECT COMMUNITY MEMBERS WITH HEALTH AND WELLNESS PROFESSIONALS DURING A WALKING EVENT. IN EFFORTS FOR WEIGHT REDUCTION, MERCY DYR OFFERS THE FOLLOWING COMMUNITY CLASSES: "12 WEEK WEIGHT LOSS PROGRAM AND "JUST FOR YOU WEIGHT LOSS PROGRAM". GRANT MONEY IS AVAILABLE FOR COMMUNITY MEMBERS THROUGH MERCY DYR'S CBM PROGRAM FOR THOSE WHO CANNOT AFFORD THE PROGRAM. MERCY DYR ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. MERCY DYR IS NOT PLANNING TO TAKE ACTION AT THIS TIME ON THE FOLLOWING HEALTH NEEDS:REDUCING ALCOHOL AND SUBSTANCE ABUSE - NOT INCLUDED FOR ACTION IN MERCY DYR'S IMPLEMENTATION STRATEGY BECAUSE OF OTHER ORGANIZATIONS THAT ARE ALREADY HAVING SOME SUCCESS IN THIS AREA, ESPECIALLY THE SUBSTANCE ABUSE COALITION.DIABETES SCREENING AND MANAGEMENT - NOT INCLUDED FOR ACTION IN MERCY DYR'S IMPLEMENTATION STRATEGY BECAUSE OF LIMITED RESOURCES, EXISTING PROGRAMS IN THE COMMUNITY, AND COMPETING PRIORITIES.NONCOMPLIANCE WITH BLOOD PRESSURE MEDICATIONS - NOT INCLUDED FOR ACTION IN MERCY DYR'S IMPLEMENTATION STRATEGY BECAUSE THIS WAS FELT TO BE AN EFFORT BEST HANDLED BY THE MEDICAL COMMUNITY (I.E., INDIVIDUAL PHYSICIANS).PROSTATE CANCER SCREENING - NOT INCLUDED FOR ACTION IN MERCY DYR'S IMPLEMENTATION STRATEGY BECAUSE OF LIMITED RESOURCES AND COMPETING PRIORITIES.INSUFFICIENT ACCESS TO MENTAL HEALTH PROVIDERS - NOT INCLUDED FOR ACTION IN MERCY DYR'S IMPLEMENTATION STRATEGY BECAUSE OF INSUFFICIENT REIMBURSEMENT FROM INSURANCE AND PUBLIC FUNDING PROGRAMS, AND PROVEN DIFFICULTY IN RECRUITING SUCH PROFESSIONALS, AT LEAST PARTIALLY BECAUSE OF THAT LACK OF REIMBURSEMENT.MORE BILINGUAL HEALTHCARE PROVIDERS - NOT INCLUDED FOR ACTION IN MERCY DYR'S IMPLEMENTATION STRATEGY BECAUSE OF THE LOW FEASIBILITY OF SUCCESS IN ATTRACTING SUCH PROVIDERS TO THIS COMMUNITY.
MERCY MEDICAL CENTER-NORTH IOWA	PART V, SECTION B, LINE 13H: 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 13H: 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 13H: 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 13H: 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 13H: 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 16I: PLAIN LANGUAGE SUMMARIES OF THE FAP WERE SENT TO SIOUXLAND COMMUNITY HEALTH CENTER.
MERCY MEDICAL CENTER-DUBUQUE	PART V, SECTION B, LINE 16I: PLAIN LANGUAGE SUMMARIES OF THE FAP AND FINANCIAL ASSISTANCE BROCHURES WERE SENT TO CRESCENT COMMUNITY HEALTH CENTER.
MERCY MEDICAL CENTER-NEW HAMPTON	PART V, SECTION B, LINE 16I: ASSISTANCE AVAILABILITY AND CONTACT INFORMATION FOR FINANCIAL COUNSELORS IS PRINTED ON PATIENT BILLING STATEMENTS.
MERCY MEDICAL CENTER-DYERSVILLE	PART V, SECTION B, LINE 16I: PLAIN LANGUAGE SUMMARIES OF THE FAP AND FINANCIAL ASSISTANCE BROCHURES WERE SENT TO CRESCENT COMMUNITY HEALTH CENTER.
MERCY MEDICAL CENTER-NORTH IOWA	PART V, SECTION B, LINE 20E: WE PROVIDE A ZERO OR LOW-INTEREST LOAN PROGRAM FOR THE PAYMENT OF OUTSTANDING DEBTS FOR PATIENTS WHO HAVE THE ABILITY TO PAY BUT CANNOT MEET THE SHORT-TERM PAYMENT REQUIREMENTS.
MERCY MEDICAL CENTER-NORTH IOWA	PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE.
MERCY MEDICAL CENTER-SIOUX CITY	PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE.
MERCY MEDICAL CENTER-DUBUQUE	PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE.
DUNES SURGICAL HOSPITAL	PART V, SECTION B, LINE 22D: 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 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE.
MERCY MEDICAL CENTER-DYERSVILLE	PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE.
MERCY MEDICAL CENTER-NORTH IOWA - PART V, SECTION B, LINE 7A	WWW.MERCYNORTHIOWA.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
MERCY MEDICAL CENTER-NORTH IOWA - PART V, SECTION B, LINE 10A	WWW.MERCYNORTHIOWA.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
MERCY MEDICAL CENTER-SIOUX CITY - PART V, SECTION B, LINE 7A	WWW.MERCYSIOUXCITY.COM/COMMUNITY-BENEFIT
MERCY MEDICAL CENTER-SIOUX CITY - PART V, SECTION B, LINE 10A	WWW.MERCYSIOUXCITY.COM/COMMUNITY-BENEFIT
MERCY MEDICAL CENTER-DUBUQUE - PART V, SECTION B, LINE 7A	WWW.MERCYDUBUQUE.COM/COMMUNITY-BENEFIT
MERCY MEDICAL CENTER-DUBUQUE - PART V, SECTION B, LINE 10A	WWW.MERCYDUBUQUE.COM/COMMUNITY-BENEFIT
DUNES SURGICAL HOSPITAL - PART V, SECTION B, LINE 7A	WWW.DUNESSURGICALHOSPITAL.COM/ABOUT-US
DUNES SURGICAL HOSPITAL - PART V, SECTION B, LINE 10A	WWW.DUNESSURGICALHOSPITAL.COM/ABOUT-US
MERCY MEDICAL CENTER-NEW HAMPTON - PART V, SECTION B, LINE 7A	WWW.MERCYNEWHAMPTON.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
MERCY MEDICAL CENTER-NEW HAMPTON - PART V, SECTION B, LINE 10A	WWW.MERCYNEWHAMPTON.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
MERCY MEDICAL CENTER-DYERSVILLE - PART V, SECTION B, LINE 7A	WWW.MERCYDUBUQUE.COM/DYERSVILLE-COMMUNITY-BENEFIT
DUNES SURGICAL HOSPITAL - PART V, SECTION B, LINE 7A	WWW.MERCYDUBUQUE.COM/DYERSVILLE-COMMUNITY-BENEFIT
MERCY MEDICAL CENTER-NEW HAMPTON - PART V, SECTION B, LINE 9	AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. 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?17
Name and address		Type of Facility (describe)
1	1 - MEDICAL ASSOCIATES WEST CAMPUS 1500 ASSOCIATES DRIVE DUBUQUE,IA52001	OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
2	2 - MEDICAL ASSOCIATES CLINIC 1240 BIG JACK ROAD PLATTEVILLE,WI53818	X-RAY, LAB, EMPLOYED PHYSICIANS
3	3 - TRI-STATE OCCUPATIONAL HEALTH 1920 ELM STREET DUBUQUE,IA52001	PHYS THERAPY,EMPLOYED PHYSICIANS
4	4 - MEDICAL ASSOCIATES CLINIC 10988 BARTELL BLVD GALENA,IL61036	HOME CARE,LAB, EMPLOYED PHYSICIANS
5	5 - MERCY MEDICAL CENTER - DYERSVILLE 1121 THIRD STREET SW DYERSVILLE,IA52040	CLINIC
6	6 - MEDICAL ASSOCIATES CLINIC 208 N 12TH STREET BELLEVUE,IA52031	CLINIC
7	7 - MEDICAL ASSOCIATES CLINIC 911 NW CARTER ELKADER,IA52043	CLINIC
8	8 - CASCADE FAMILY HEALTH CENTER 805 JOHNSON STREET SW CASCADE,IA52033	EMPLOYED PHYSICIANS, LAB, X-RAY, PT
9	9 - MEDICAL ASSOCIATES CLINIC 117 SOUTH MADISON CUBA CITY,WI53807	X-RAY, LAB, EMPLOYED PHYSICIANS
10	10 - MEDICAL ASSOCIATES CLINIC 560 PLEASANT ST ELIZABETH,IL61028	CLINIC
11	11 - MEDICAL ASSOCIATES CLINIC 107 S PAGE MONONA,IA52159	CLINIC
12	12 - MEDICAL ASSOCIATES EAST CAMPUS 1000 LANGWORTHY DUBUQUE,IA52001	OCC. HEALTH, PHYSICAL THERAPY
13	13 - DUNES MEDICAL LABORATORY 350 W ANCHOR DRIVE SUITE 20 DAKOTA DUNES,SD57049	REFERENCE LABORATORY
14	14 - MASON CITY SURGERY CENTER 990 4TH STREET MASON CITY,IA50401	AMBULATORY SURGERY
15	15 - MERCY FAMILY CLINIC - BUFFALO CENTER 115 NORTH MAIN BUFFALO CENTER,IA50424	X-RAY, LAB, EMPLOYED PHYSICIANS
16	16 - MERCY MATERNAL HEALTH CLINIC 200 MERCY DRIVE DUBUQUE,IA52001	OUTPATIENT CLINIC, PRENATAL CARE, PREGNANCY TESTING
17	17 - TRI-STATE SURGERY CENTER 1500 ASSOCIATES DRIVE DUBUQUE,IA52002	OUTPATIENT CLINIC, OPHTHALMOLOGY, ORTHOPEDICS

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	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 (MHS-IA) REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.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.
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, LN 7 COL(F):	THE FOLLOWING NUMBER, $16,232,703, 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-SIOUX CITY (MERCY SC):COMMUNITY SUPPORT: MERCY SC CONTRIBUTED TO THE LOCAL FIRE DEPARTMENT FOR PURPOSES OF CONTINUOUS IMPROVEMENT AND PREPARATION FOR UNFORESEEN DISASTERS, SUCH AS A CHEMICAL SPILL.ENVIRONMENTAL IMPROVEMENTS: A DOWNTOWN GARDEN OF GREEN SPACE WAS DEVELOPED AND MERCY SC CONTRIBUTED FOR THE MAINTENANCE AND IMPROVEMENTS TO THE GARDEN ANNUALLY.LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: MANY COLLEAGUES OF MERCY SC ARE INVOLVED IN COMMUNITY BOARDS THAT HELP DEVELOP LEADERSHIP SKILLS IN INDIVIDUALS IN OUR COMMUNITY, WHICH IS A GREAT BENEFIT TO THE REGION. WORKFORCE DEVELOPMENT: ATTENDING LOCAL SCHOOLS IN THE TRISTATE AREA TO GIVE THE STUDENTS AN OPPORTUNITY TO HAVE A CHANCE TO EXPERIENCE THE POSSIBILITY OF GOING INTO A HEALTH CARE CAREER.MERCY SC (HUMAN RESOURCES) PARTNERED WITH NATIVE AMERICAN SCHOOLS IN WINNEBAGO, NEBRASKA ON PROJECT SEARCH. THIS JOINT EFFORT ENABLED NATIVE AMERICANS TO PARTICIPATE IN A 5TH YEAR SENIOR JOB TRAINING PROGRAM, WITH GRADUATION. THE PROGRAM IS WELL RECEIVED AND PRODUCED GREAT RESULTS FOR TRAINING AND HELPING YOUNG ADULTS BECOME EMPLOYABLE. MERCY MEDICAL CENTER-NEW HAMPTON (MERCY NH):AS ONE OF THE LARGEST EMPLOYERS IN THE AREA, MERCY NH TAKES ITS CIVIC RESPONSIBILITY VERY SERIOUSLY. SUPPORT OF AND CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS, EVENTS, AND PROGRAMS, SUCH AS THE CHAMBER, NEW HORIZONS, AND THE INDUSTRIAL DEVELOPMENT CORPORATION HELP IMPROVE THE ECONOMY OF MERCY NH'S CATCHMENT COUNTIES. BY PROMOTING ECONOMIC DEVELOPMENT, MERCY NH HELPS CREATE A COMMUNITY THAT CONTINUES TO BUILD ITSELF THROUGH THE LEADERS WHO WORK AND VOLUNTEER AT THE HOSPITAL. ECONOMIC STABILITY IS INTRINSICALLY LINKED TO THE PREVENTION OF HEALTH PROBLEMS ASSOCIATED WITH POVERTY, HOMELESSNESS, AND ENVIRONMENTAL CHALLENGES, AND IS CRUCIAL IF THE COMMUNITY HOPES TO MAINTAIN A VIABLE HOSPITAL COMPLEX WITH A BROAD SPECTRUM OF ESSENTIAL SERVICES. IN ADDITION TO SUPPORTING ECONOMIC DEVELOPMENT IN OUR REGION, MERCY NH ENCOURAGES ITS LEADERSHIP STAFF TO SUPPORT AND PROVIDE LEADERSHIP TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE AREA. MERCY 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 NH PROVIDES SUPPORT AND EXPERTISE TO THE CHICKASAW CONNECTIONS. THIS PARTNERSHIP INCLUDES ACTIVE INVOLVEMENT FROM ALL OF OUR FAMILY MEDICINE PHYSICIANS AND THE MARKETING DEPARTMENT IN THIS UNDERAGE DRINKING COALITION.MERCY NH WORKS CLOSELY WITH NEW HAMPTON COMMUNITY SCHOOLS TO EDUCATE STUDENTS ABOUT HEALTH AND WELLNESS. HANDWASHING LESSONS ARE TAUGHT TO ALL PRE-SCHOOL AND KINDERGARTEN CLASSES. THOSE AGE GROUPS ALSO TOUR THE HOSPITAL TO BECOME COMFORTABLE WITH OUR ENVIRONMENT AND KNOW THAT THE HOSPITAL IS NOT A SCARY PLACE. MERCY NH ALSO INVITES ALL 8TH GRADE STUDENTS FOR A TOUR IN WHICH THEY LEARN ABOUT THE VARIETY OF HEALTHCARE CAREERS AVAILABLE TO THEM.MERCY NH PARTNERED WITH CHICKASAW AMBULANCE SERVICE, CHICKASAW COUNTY RESCUE SQUAD/FIRST RESPONDERS AND MERCY AIR MED, TO HOST A COMMUNITY OPEN HOUSE. FAMILIES ATTENDING WERE ABLE TO VIEW DEMONSTRATIONS, GET INFORMATION ON CAR SEAT USE FOR CHILDREN, TOUR THE ER, AND VIEW ALL THE EMERGENCY VEHICLES, INCLUDING THE MERCY AID MED HELICOPTER. MERCY NH ALSO PROVIDED A FREE DINNER TO ALL THE VOLUNTEERS SERVING OUR EMS PROGRAMS IN CHICKASAW COUNTY.
PART III, LINE 2:	METHODOLOGY USED FOR LINE 2 - 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:	MHS-IA 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. FOR FINANCIAL STATEMENT PURPOSES, MHS-IA IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, MHS-IA IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL.
PART III, LINE 4:	MHS-IA IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 15 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 AND UNDERINSURED 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 THE HEALTH MINISTRIES 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 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION.
PART III, LINE 8:	MHS-IA DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION 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:	MHS-IA'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.
PART VI, LINE 2:	NEEDS ASSESSMENT - MHS-IA HOSPITALS ASSESS THE HEALTH STATUS OF THEIR COMMUNITIES, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORT TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. IN THE ASSESSMENT OF THEIR COMMUNITIES, 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.MERCY NI AND MERCY NH EACH HAVE A LOCAL BOARD OF GOVERNANCE COMPOSED OF AREA RESIDENTS, EMPLOYERS AND REPRESENTATIVES OF DEMOGRAPHIC GROUPS. THESE HOSPITALS ALSO COMMUNICATE WITH OTHER AGENCIES ABOUT WHAT SERVICES ARE NEEDED LOCALLY. IN PARTICULAR, OUR PRIMARY CARE PHYSICIANS HAVE A STRONG AWARENESS OF PATIENT NEEDS. TASK FORCES ARE CREATED WHEN SPECIAL CONCERNS ARISE; A RECENT EXAMPLE BEING DENTAL ACCESS. A COMMITTEE MEETS QUARTERLY THAT IS COMPRISED OF COMMUNITY MEMBERS AND HOSPITAL PERSONNEL THAT WORK DIRECTLY WITH THE UNINSURED, UNDERINSURED AND UNDERSERVED. THE COMMUNITY BENEFIT MINISTRY OFFICER INTERFACES REGULARLY WITH COMMUNITY HUMAN SERVICE AGENCIES AND COALITIONS. MERCY SC AND DUNES STAFF ROUTINELY (MONTHLY) MEET WITH VARIOUS COMMUNITY AGENCIES, CHURCHES, AND SCHOOLS IN SEARCH OF OPPORTUNITIES TO PARTNER WITH TO ADDRESS (1) ACCESS TO PRIMARY CARE, (2) EXERCISE AND NUTRITION FOR YOUTH, (3) ACCESS TO MENTAL HEALTH SERVICES, AND (4) SOCIAL DETERMINANTS OF HEALTH GENERAL POVERTY, HOMELESSNESS, EDUCATION AND HUNGER.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MHS-IA HOSPITALS ARE 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 AMERICAN HOSPITAL ASSOCIATION 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 OBLIGATIONSTHE HOSPITALS COMMUNICATE EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS 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. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT.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. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING THE OTHER LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITALS. THE HOSPITALS HAVE ESTABLISHED WRITTEN POLICIES FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. THE HOSPITALS MAKE EVERY EFFORT TO ADHERE TO THEIR POLICIES AND ARE COMMITTED TO IMPLEMENTING AND APPLYING THE POLICIES FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER.
PART VI, LINE 4:	COMMUNITY INFORMATION - MERCY NI SERVES A 14-COUNTY 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). THE CURRENT CENSUS INFORMATION WAS REPORTED ON JULY 1, 2015. THE SERVICE AREA HAD AN ESTIMATED POPULATION OF 200,116 ACCORDING TO ESTIMATES ON THE UNITED STATES CENSUS BUREAU WEBSITE (HTTP://WWW.CENSUS.GOV/QUICKFACTS/):- OF SERVICE AREA RESIDENTS, 93.41% ARE CAUCASIAN. HISPANICS, AT LESS THAN 3.96%, REPRESENT THE AREA'S LARGEST MINORITY GROUP. THE AVERAGE HOUSEHOLD INCOME REPORTED FROM 2010-2014 WAS $48,049. PERSONS LIVING IN POVERTY WAS 11.09%, UP 0.3% FROM THE PREVIOUS REPORT.- THOSE UNDER 18 YEARS OF AGE COMPRISED 22.64% OF THE POPULATION, WHILE THOSE AGE 65 AND OLDER WERE 20.85%. INDIVIDUALS ON MEDICARE, WHO WERE HOSPITALIZED DURING 7/1/15 - 6/30/16 COUNTED FOR 47.83% OF ALL HOSPITAL ADMISSIONS.- MEDIAN HOUSEHOLD INCOME OF CERRO GORDO COUNTY WAS $45,012, AS COMPARED TO THE NATIONAL MEDIAN OF $53,482. OF THE NATIONAL POPULATION, 13.5% LIVED IN POVERTY, COMPARED TO 12.2% IN IOWA.- ACCORDING TO IOWA WORKFORCE DEVELOPMENT, UNEMPLOYMENT IS UP IN MERCY NI'S SERVICE AREA. FROM OCTOBER 2015 - SEPTEMBER 2016, THE UNEMPLOYMENT RATE INCREASED FROM 2.99% TO 3.51%, YET REMAINS BELOW THE STATE'S UNEMPLOYMENT RATE OF 3.6% FOR THE TIME PERIOD. THERE ARE 11 CRITICAL ACCESS HOSPITALS WITHIN MERCY NI'S SERVICE AREA PROVIDING PRIMARY HEALTH CARE SERVICES, EIGHT OF WHICH ARE AFFILIATES. PATIENTS FROM THE REMAINING IOWA COUNTIES UTILIZE MERCY NI 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 NI'S MARKET SHARE FOR THE 14-COUNTY SERVICE AREA IN CALENDAR YEAR 2015 WAS 48.13% AS REPORTED BY IOWA HOSPITAL ASSOCIATION DATA. MERCY DUB AND MERCY DYR'S PRIMARY SERVICE AREA IS DUBUQUE COUNTY, IOWA, WHICH IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. THIS DEFINITION OF THE COMMUNITY IS BASED ON THE RESIDENCE OF THE HOSPITALS' PATIENTS: IN CALENDAR YEAR 2014, 61.6% OF MERCY DUB'S INPATIENT CASES AND 75.2% OF MERCY DUB'S EMERGENCY DEPARTMENT CASES WERE FOR DUBUQUE COUNTY RESIDENTS, WHILE 93.8% OF MERCY DYR'S INPATIENT CASES AND 77.7% OF MERCY DYR'S EMERGENCY DEPARTMENT CASES WERE FOR DUBUQUE COUNTY RESIDENTS. BEYOND DUBUQUE COUNTY, RESIDENTS USE OF THE HOSPITAL IS MORE SCATTERED. IN 2014, FOR EXAMPLE, MERCY DUB AND MERCY DYR DISCHARGED INPATIENTS WHO RESIDED IN 18 DIFFERENT STATES.DUBUQUE COUNTY'S POPULATION IN 2012 WAS 95,097. THE POPULATION GREW ABOUT 5% BETWEEN 2000 AND 2010. OF THE POPULATION, 73% IS URBAN AND 27% IS RURAL. IT HAS AN AVERAGE POPULATION DENSITY OF 156 PEOPLE PER SQUARE MILE. IN MARCH 2012, THE COST OF LIVING INDEX FOR DUBUQUE COUNTY WAS 86.8, COMPARED TO THE US AVERAGE OF 100. WHITE NON-HISPANIC PEOPLE COMPRISE 92.9% OF THE POPULATION; BLACK NON-HISPANICS 2.6%; HISPANIC OR LATINO 1.9%; TWO OR MORE RACES 1.2%, AND ASIAN 0.9%. THE MEDIAN RESIDENT AGE IS 38.0 YEARS, THE SAME AS IOWA'S. IN ADDITION TO MERCY DUB AND MERCY DYR, UNITYPOINT HEALTH FINLEY HOSPITAL IS THE THIRD HOSPITAL LOCATED IN DUBUQUE COUNTY.MERCY SC AND DUNES:SIOUX CITY, IOWA SERVES AS THE REGIONAL HUB FOR BUSINESS, EMPLOYMENT, INDUSTRY, RETAIL TRADE, MEDICAL CARE, AND EDUCATIONAL OPPORTUNITIES. SIX COUNTIES IN THE TRI-STATE AREA OF NORTHWESTERN IOWA, NORTHEASTERN NEBRASKA, AND SOUTHWESTERN SOUTH DAKOTA ARE INCLUDED IN THE SIOUXLAND COMMUNITY HEALTH NEEDS ASSESSMENT. INDIVIDUALS RESIDING IN THESE COUNTIES LIVE WITHIN A 40-MILE RADIUS OF SIOUX CITY. THE AREA INCLUDES THE IOWA COUNTIES OF WOODBURY AND PLYMOUTH; THE NEBRASKA COUNTIES OF DAKOTA, DIXON, AND THURSTON; AND THE SOUTH DAKOTA COUNTY OF UNION. THE TOTAL AREA FOR THESE COUNTIES IS 3,354 SQUARE MILES, WITH WOODBURY AND PLYMOUTH REPRESENTING 52% OF THE TOTAL AREA. THE SIOUXLAND REGION HAS A TOTAL CURRENT POPULATION OF 177,740 WITH AN ESTIMATED 1% INCREASE BY 2020.ABOUT 22% OF THE POPULATION IS UNDER THE AGE OF 14 YEARS AND 15% OF THE POPULATION IS OVER THE AGE OF 65 YEARS. THE RACE/ETHNICITY DISTRIBUTION IN THE AREA IS 76% WHITE, 15% HISPANIC, 2% BLACK, 2% ASIAN, AND 5% OTHER.IN THE AREA, 50% OF THE HOUSEHOLDS ARE IN AN ANNUAL INCOME GROUP OF LESS THAN $50K. THE REGIONAL ECONOMY IS BASED ON FOOD MANUFACTURING, AGRICULTURE, HEALTH CARE AND SOCIAL ASSISTANCE, EDUCATION, AND THE FOOD SERVICE INDUSTRIES. THE AUGUST 2015 UNEMPLOYMENT RATE FOR THE LARGEST COUNTIES IN THE REGION - WOODBURY, PLYMOUTH, AND DAKOTA - WAS 3.5%, 2.5%, AND 3.9% RESPECTIVELY. THE UNEMPLOYMENT RATE FOR THURSTON COUNTY, WITH A POPULATION OF APPROXIMATELY 7,000, HAS RISEN TO 6.0%. WOODBURY COUNTY HAS A POPULATION OF 104,080, WHICH REPRESENTS 59% OF THE SIOUXLAND REGIONAL TOTAL. THE COMMUNITY RESIDENTS OF SIOUX CITY AND SERGEANT BLUFF REPRESENT NEARLY 90% OF THE WOODBURY COUNTY POPULATION. PLYMOUTH COUNTY HAS A POPULATION OF 23,085, OR 13% OF THE SIOUXLAND REGIONAL TOTAL. THE LARGEST COMMUNITY IN THE COUNTY IS LEMARS WITH A POPULATION OF 12,600. AT 12% OF THE REGIONAL POPULATION, DAKOTA COUNTY HAS A POPULATION OF 21,660. SOUTH SIOUX CITY AND DAKOTA CITY TOTAL RESIDENTS REPRESENT 84% OF THE COUNTY POPULATION. UNION COUNTY HAS A POPULATION OF 16,200 WHICH REPRESENTS 9% OF THE REGIONAL TOTAL. NORTH SIOUX CITY AND DAKOTA DUNES TOTAL RESIDENTS REPRESENT 40% OF THE COUNTY POPULATION. THE TOTAL RESIDENTS IN THE COMMUNITIES OF SIOUX CITY, SERGEANT BLUFF, LEMARS, SOUTH SIOUX CITY, DAKOTA CITY, NORTH SIOUX CITY, AND DAKOTA DUNES TOTAL 128,800. COMPLETING THE SIX-COUNTY AREA IS THURSTON COUNTY WITH A POPULATION OF 6,860 AND DIXON COUNTY WITH A POPULATION OF 5,860 REPRESENTING 7% OF THE REGIONAL TOTAL.MERCY NH 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 U.S. CENSUS BUREAU, CHICKASAW COUNTY HAD AN ESTIMATED POPULATION OF 12,097 IN 2015. CHICKASAW COUNTY EXPERIENCED AN ESTIMATED 2.7% PERCENT DECLINE IN POPULATION FROM 2010 TO 2015. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. OF THE CHICKASAW POPULATION, 19.4% WERE OVER AGE 65 IN 2015, COMPARED TO 16.1% FOR THE STATE AND 14.9% FOR THE NATION. IOWA RANKS FOURTH IN PERCENTAGE OF POPULATION OVER THE AGE OF 65. THIS LARGE PERCENTAGE FOR THIS AGE GROUP PRESENTS SPECIAL CHALLENGES TO HEALTH CARE PROVIDERS, BECAUSE THIS AGE GROUP HAS 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 2016, 50.4% OF MERCY NH'S REVENUES (HOSPITAL INPATIENT AND OUTPATIENT) WERE GENERATED FROM MEDICARE PATIENTS. THE MEDIAN HOUSEHOLD INCOME IN CHICKASAW COUNTY WAS ESTIMATED AT $46,020 IN 2014. INDIVIDUALS BELOW THE POVERTY LEVEL COMPRISE 9.8% OF THE POPULATION. THE FISCAL YEAR 2016 PAYER MIX AT POINT OF REGISTRATION INCLUDES 47% COVERED BY MEDICARE, 11% COVERED BY MEDICAID AND 4% SELF-PAY.
PART VI, LINE 5:	OTHER INFORMATION - MERCY NI 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 NI HAS TO OFFER AS A MAJOR REFERRAL CENTER. MERCY NI 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 NI IS INTENTIONAL IN DEVELOPING TRIPLE AIM ACCOUNTABLE CARE ORGANIZATION (ACO) RELATIONSHIPS, COLLABORATING WITH COMMUNITY HEALTH PROVIDERS AND SOCIAL SERVICE AGENCIES IN CREATING SYSTEM OF CARE COORDINATION PROCESSES. THERE ARE NEARLY 100 PROFESSIONALS REPRESENTING ALL ASPECTS OF HEALTHCARE IN OUR 14-COUNTY SERVICE AREA PARTICIPATING IN TRANSITIONS OF CARE. ITS PURPOSE IS TO IMPROVE COMMUNICATION AND PROCESSES IN ORDER TO IMPROVE QUALITY AND SAFETY OF TRANSITIONS BETWEEN FACILITIES. A GRANT FROM THE IOWA DEPARTMENT OF PUBLIC HEALTH WAS RECEIVED TO EXTEND COMMUNITY CARE COORDINATION PROGRAM IMPLEMENTATION EFFORTS FOCUSED ON THE SAFETY NET POPULATION.AS A TEACHING HOSPITAL, MERCY NI HOSTS A 3-YEAR FAMILY PRACTICE RESIDENCY PROGRAM; PHARMACY RESIDENCY; CARDIOLOGY FELLOWSHIP; HOSPICE AND PALLIATIVE CARE FELLOWSHIP, AND A SCHOOL OF RADIOLOGIC TECHNOLOGY. THE HOSPITAL SERVES AS 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-PROFIT ORGANIZATIONS.AS A SOLE COMMUNITY PROVIDER, SPECIALIZED SERVICES INCLUDE A HEART AND VASCULAR INSTITUTE, 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 NI PROVIDES A SUITE WITH TWO FULLY FURNISHED OPERATORIES TO ACCOMMODATE EMERGENT DENTAL NEEDS. HALF-DAY CLINICS ARE MANNED BY AREA DENTISTS AND DENTAL ASSISTANTS VOLUNTEERING THEIR TIME AND SKILLS.PARTNERSHIP FOR A TOBACCO FREE CERRO GORDO COUNTY IS A COALITION OF COMMUNITY PARTNERS AND PUBLIC HEALTH THAT FOCUSED ON COMMUNITY GOALS TARGETING TOBACCO USE AND OBESITY. MERCY NI PROVIDED OVER THE COUNTER NICOTINE REPLACEMENT THERAPY (NRT) FOR THOSE WITH INCOME LIMITATIONS, PURCHASED SMOKE FREE SIGNS FOR CITY PARKS AND CESSATION BOOKLETS FOR DISTRIBUTION THROUGHOUT OUR WHOLLY OWNED CLINIC NETWORK. MERCY NI ALSO COLLABORATED WITH STATE ADVOCACY REPRESENTATIVES AND OTHER HEALTH MINISTRIES TO INTRODUCE TOBACCO 21 LEGISLATION, WHICH ADVOCATES INCREASING THE LEGAL AGE TO PURCHASE TOBACCO FROM 18 TO 21. MERCY NI BEGAN THE BABY FRIENDLY JOURNEY AND HAS ACCOMPLISHED SEVERAL STEPS IN THE IMPLEMENTATION PROCESS. BABY FRIENDLY HOSPITALS ARE HOSPITALS THAT ARE RECOGNIZED FOR ENCOURAGING BREASTFEEDING AND MOTHER/BABY BONDING, WHICH IS KNOWN TO PROVIDE HEALTH BENEFITS FOR INFANTS, CHILDREN, AND MOTHERS.MERCY NI AND ITS VENDORS MADE IMPROVEMENTS TO VENDING ASSORTMENTS THAT INCLUDE HEALTHIER OPTIONS, SUCH AS BOTTLED WATER, AND REPLACED TRADITIONAL POTATO CHIPS WITH HEALTHIER BAKED OPTIONS, AND REPLACED CANDY OPTIONS WITH GRANOLA BARS, BELVITA CRISPS, CLIFF BARS, AND ASSORTED FRUIT SNACKS. IN FISCAL YEAR 2016, MERCY NI FORMED A NEW PARTNERSHIP WITH THE NORTH IOWA FARMERS' MARKET TO ENCOURAGE THE COMMUNITY TO EAT HEALTHY, LOCALLY-GROWN FRUITS AND VEGETABLES AND PROVIDED MARKETING SUPPORT FOR THE FARMERS' MARKET. MERCY NI HELD SEVERAL EDUCATION AND HEALTH SCREENING EVENTS DURING MARKET HOURS, INCLUDING NUTRITION EDUCATION AND PERIPHERAL ARTERY DISEASE AND BLOOD PRESSURE SCREENING. MERCY NI FURTHER INVESTS IN THE COMMUNITY TO ENHANCE THE HEALTH OF RESIDENTS BY PROVIDING:- PRE-DIABETES CLASSES AND SUPPORT GROUP MEETINGS AT NO CHARGE - SUPPORT FOR TRANSPORTATION TO ELIMINATE BARRIERS TO HEALTHCARE- COLLABORATION TO SUPPORT A SELF-SUFFICIENCY PROGRAM- MERCY FAMILY HEALTH LINE, A 24-HOUR/7-DAY A WEEK TELEPHONE MEDICAL TRIAGE AND INFORMATION SERVICE- PARTICIPATION OF THE HOSPITAL KITCHEN IN PREPARATION OF MEALS ON WHEELS- FIVE HEALTH CAREER SCHOLARSHIPS GIVEN ANNUALLY TO COMMUNITY RECIPIENTS THE HOSPITAL VOLUNTEER AUXILIARYMERCY DUB AND MERCY DYR ARE ADVISED BY LOCAL BOARDS AND OPERATE EMERGENCY ROOMS WHICH ARE AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY. MERCY DUB ALSO PROVIDES SEVERAL SERVICES THAT ARE UNIQUE TO THE COMMUNITY, INCLUDING OPEN HEART SURGERY, NEONATAL INTENSIVE CARE AND INPATIENT COMMUNITY PSYCHIATRIC SERVICES. MERCY SC 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 SC 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 SC 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, MERCY SC COLLABORATES WITH ST. LUKE'S COLLEGE OF NURSING, WITCC SCHOOL OF NURSING AND BRIAR CLIFF UNIVERSITY SCHOOL OF NURSING.MERCY SC IS SHIFTING FOCUS AND COMMITTING RESOURCES TO PEOPLE-CENTERED HEALTH CARE. MERCY SC HAS RECEIVED BLUE ZONE DISTINCTION AS AN EMPLOYER AND IS WORKING TO ASSIST OTHERS TO RECEIVE THIS. RIVERSIDE ELEMENTARY IS ON SCHEDULE TO RECEIVE THIS DISTINCTION, IN PART DUE TO MERCY SC'S SUPPORT OF EXERCISE EQUIPMENT FOR STUDENTS AND PLUMBING TO SUPPORT A COMMUNITY GARDEN.
PART VI, LINE 6:	MHS-IA IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2016, GOALS INCLUDED 1) PARTNERING WITH COMMUNITY ORGANIZATIONS IN INSURANCE ENROLLMENT ACTIVITIES TARGETED AT UNINSURED INDIVIDUALS TO IMPROVE ACCESS TO HEALTHCARE, 2) PARTICIPATING IN LOCAL ADVOCACY EFFORTS AIMED AT CURBING TOBACCO USE AND PREVENTING OBESITY, AND 3) DEVELOPING A STRATEGY WITH MULTI-DISCIPLINARY TEAMS TO OPTIMIZE CARE FOR VULNERABLE PERSONS, WITH PARTICULAR FOCUS ON THOSE WHO ARE DUALLY ENROLLED IN MEDICAID AND MEDICARE. TRINITY HEALTH APPRECIATES THE IMPACT SOCIAL DETERMINANTS SUCH AS ADEQUATE HOUSING, SAFETY, ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE HAVE ON THE HEALTH OF THE COMMUNITY. IN FISCAL YEAR 2016, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), AWARDING EIGHT COMMUNITIES FUNDING TO IMPROVE THE HEALTH AND WELL-BEING OF THEIR COMMUNITIES IN PARTNERSHIP WITH THE LOCAL TRINITY HEALTH MEMBER HOSPITAL. THE AWARDED PROGRAMS FOCUS ON POLICY, SYSTEM, AND ENVIRONMENTAL CHANGES THAT SPECIFICALLY IMPACT COMMUNITY IDENTIFIED AREAS OF NEED AND THAT WILL REDUCE OBESITY AND TOBACCO USE.AS A SYSTEM, TRINITY HEALTH SUPPORTED PROGRAMS AND ORGANIZATIONS WHO ADDRESS THESE SOCIAL DETERMINANTS OF HEALTH. PROGRAMS INCLUDE GRANTING SEVEN DACA "DREAMERS" LOW INTEREST LOANS, ENABLING RECIPIENTS TO ATTEND MEDICAL SCHOOL AT STRITCH SCHOOL OF MEDICINE, AND PROVIDING A GRANT TO THE U.S. SOCCER FOUNDATION TO FUND ITS SOCCER FOR SUCCESS PROGRAM IN NINE COMMUNITIES, OFFERING STUDENTS IN UNDERSERVED AREAS THE OPPORTUNITY TO SAFELY AND COST-EFFECTIVELY ENGAGE IN A HEALTHY AND ACTIVE LIFESTYLE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO OUR COMMUNITIES 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. ANNUALLY, THE ORGANIZATION INVESTS NEARLY $1 BILLION 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 THE SPECIFIC NEEDS OF EACH COMMUNITY.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG

Schedule H (Form 990) 2015

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) DUBUQUE COMMUNITY SCHOOLS 2500 CHANEY ROAD DUBUQUE,IA52001	42-6001531	PUBLIC SCHOOL	15,000		SUPPORT OF ATHLETIC TRAINER PROGRAM FOR TWO HIGH SCHOOLS
(2) WAHLERT CATHOLIC HIGH SCHOOL 2005 KANE ST DUBUQUE,IA52001	42-0792429	RELIGIOUS SCHOOL	7,500		SUPPORT OF ATHLETIC TRAINER PROGRAM FOR HIGH SCHOOL
(3) CRESCENT COMMUNITY HEALTH CENTER 1789 ELM ST SUITE A DUBUQUE,IA52001	48-1302204	501(C)(3)	16,425		SUPPORT FOR COMMUNITY GARDENING PROGRAM
(4) ALMOST HOME GUEST HOUSE AT ST JOHN'S LUTHERAN CHURCH 1296 WHITE ST DUBUQUE,IA52001	42-7421408	501(C)(3)	10,000		SUPPORT FOR ST. JOHN'S LUTHERAN GUESTHOUSE FOR THE HOMELESS
(5) MARY'S INN 3761 HILLCREST RD DUBUQUE,IA52001	36-4768362	501(C)(3)	10,000		SUPPORT FOR PREGNANT, HOMELESS MOTHERS & BABIES
(6) PROJECT CONCERN 1789 ELM ST SUITE B DUBUQUE,IA52001	42-1298833	501(C)(3)	10,000		SUPPORT OF SHELTER PLUS CARE PROGRAM
(7) CLARKE UNIVERSITY OF DUBUQUE IOWA 1550 CLARKE DR DUBUQUE,IA52001	42-0680408	501(C)(3)	10,000		SUPPORT OF GERIATRIC WELLNESS FALLS PREVENTION PROGRAM
(8) DUBUQUE RESCUE MISSION 398 MAIN ST DUBUQUE,IA52001	42-0844836	501(C)(3)	5,000		SUPPORT OF MISSION SCHOOL OF PRESERVATION
(9) DUBUQUE MERCY HEALTH FOUNDATION 250 MERCY DRIVE DUBUQUE,IA52001	26-2227941	501(C)(3)	434,924		FUNDING SUPPORT
(10) DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE,IA52040	20-5383271	501(C)(3)	133,355		FUNDING SUPPORT
(11) NORTHEAST IOWA COMMUNITY ACTION CORP 305 MONTGOMERY ST DECORAH,IA52101	42-6092713	501(C)(3)	6,000	0	SUPPORT RESIDENTS OF CHICKASAW COUNTY THAT ARE FACING HOMELESSNESS AND/OR LOSS OF UTILITIES
(12) CITY OF MASON CITY 10 1ST ST NW MASON CITY,IA50401	42-6004948	GOVERNMENT ORG	25,000		BLUE ZONE PROJECT PLEDGE
(13) DOCS FOR HOPE WORLDWIDE PO BOX 135 NEW HAMPTON,IA50659	45-4010956	501(C)(3)	10,000		COMMUNITY SUPPORT
(14) NORTH IOWA AREA COMMUNITY COLLEGE FOUNDATION 500 COLLEGE DRIVE MASON CITY,IA50401	23-7023677	501(C)(3)	6,500		SUPPORT PERFORMING ARTS SERIES
(15) NORTH IOWA COMMUNITY ACTION ORGANIZATION PO BOX 1627 MASON CITY,IA50402	42-0921505	501(C)(3)	63,600		COMMUNITY PARTNERS CONTRACT
(16) NORTH IOWA CORRIDOR ECONOMIC DEVELOPMENT 9 N FEDERAL MASON CITY,IA50401	75-3190471	501(C)(6)	20,000		ANNUAL INVESTOR CAMPAIGN PLEDGE
(17) NORTHERN LIGHTS ALLIANCE FOR THE HOMELESS 307 N MONROE MASON CITY,IA50401	42-1501295	501(C)(3)	62,741		SUPPORT OF EXECUTIVE DIRECTOR'S SALARY AND BENEFITS, AND COMMUNITY SUPPORT
(18) REGIONAL HEALTH SERVICES OF HOWARD COUNTY 235 8TH AVE WEST CRESCO,IA52136	42-1021780	501(C)(3)	5,000		CRESCO BUILDING PLEDGE
(19) SALVATION ARMY 747 VILLAGE GREEN DR MASON CITY,IA50401	36-2167910	501(C)(3)	99,000		SUPPORT FOR ADULT DAY CARE TRANSPORTATION TO MEDICAL APPOINTMENTS
(20) AMERICAN HEART ASSOCIATION PO BOX 4002902 DES MOINES,IA50340	13-5613797	501(C)(3)	16,000		COMMUNITY SUPPORT
(21) AMERICAN RED CROSS SIOUXLAND 4200 WAR EAGLE DRIVE SIOUX CITY,IA51109	53-0196605	501(C)(3)	16,500		COMMUNITY SUPPORT
(22) BIG 12 YOUTH DEVELOPMENT PROGRAM 3435 JACKSON ST SIOUX CITY,IA51104	20-4018698	501(C)(3)	6,500		SUPPPORT AFTER SCHOOL AND SUMMER PROGRAMS
(23) BISHOP HEELAN CATHOLIC SCHOOLS 1018 GRANDVIEW BLVD SIOUX CITY,IA51103	42-0698209	501(C)(3)	5,500		COMMUNITY SUPPORT
(24) BOY SCOUTS OF AMERICA 326 MID AMERICA COUNCIL 12401 W MAPLE ROAD OMAHA,NE68164	47-0376545	501(C)(3)	6,500		SUPPORT CHARACTER PROGRAM
(25) BOYS CLUB OF SIOUX CITY 823 PEARL STREET SIOUX CITY,IA51101	42-0940032	501(C)(3)	5,000		SUPPPORT RECREATION BUDGET
(26) BRIAR CLIFF UNIVERSITY 3302 REBBECA ST SIOUX CITY,IA51104	42-0707124	501(C)(3)	27,000		SUPPORT SCHOLARSHIP PROGRAMS
(27) CAMP HIGH HOPES 5804 CORRECTIONVILLE RD SIOUX CITY,IA51106	20-1314342	501(C)(3)	5,700		SUPPORT CAMP FOR DISABLED
(28) CATHOLIC CHARITIES OF THE DIOCESE OF SIOUX CITY 1601 MILITARY ROAD SIOUX CITY,IA51103	42-0681062	501(C)(3)	9,380		SUPPORT THERAPIST TRAINING
(29) COMMUNITY ACTION AGENCY SIOUXLAND 2700 LEECH AVENUE SIOUX CITY,IA51106	42-0989589	501(C)(3)	5,908		SUPPORT EMERGENCY CLIENT ASSISTANCE
(30) THE CRITTENTON CENTER 303 WEST 24TH STREET SIOUX CITY,IA51104	42-0698246	501(C)(3)	8,000		SUPPORT YOUTH SHELTER/CAR SEATS
(31) DAKOTA VALLEY SCHOOL DISTRICT 1150 NORTH SHORE DRIVE NORTH SIOUX CITY,SD57049	46-6003189	PUBLIC SCHOOL	5,000		SUPPORT LEADERSHIP CONFERENCE/ACT PREP
(32) FOOD BANK OF SIOUXLAND PO BOX 985 SIOUX CITY,IA51102	42-1381516	501(C)(3)	5,000		SUPPORT BACKPACK PROGRAM AND FOOD ASSISTANCE
(33) GOODWILL OF THE GREAT PLAINS 3100 W 4TH STREET SIOUX CITY,IA51103	42-0727509	501(C)(3)	5,500		CAMP SPONSOR
(34) THE GOSPEL MISSION 500 BLUFF ST PO BOX 3745 SIOUX CITY,IA51102	42-0819319	501(C)(3)	10,000		SUPPORT MEN & CHILDREN SHELTER
(35) HER HEALTH WOMENS CENTER 5732 SUNNYBROOK DR SIOUX CITY,IA51106	42-1282535	501(C)(3)	18,000		SUPPORT PARENTING EDUCATION AND MEDICAL SVCS
(36) IOWA LEGAL AID 520 NEBRASKA ST SIOUX CITY,IA51101	42-1079227	501(C)(3)	5,000		SUPPORT HEALTH & LAW INTERGRATION
(37) JACKSON RECOVERY CENTERS 800 5TH ST STE 200 SIOUX CITY,IA51101	39-1900255	501(C)(3)	27,500		SUPPORT ADOLESCENT ADDICTION RECOVERY HOSPITAL
(38) MARY J TREGLIA COMMUNITY HOUSE 900 JENNINGS ST SIOUX CITY,IA51105	42-0681107	501(C)(3)	7,500		SUPPORT IMMIGRANT POPULATION SERVICES
(39) NEW HORIZON TUTORING 498 BISON TRAIL DAKOTA DUNES,SD57049	63-6744586		37,000		SUPPORT ACT PREP TUTORING
(40) NORTHEAST COMMUNITY COLLEGE FOUNDATION 801 EAST BENJAMIN AVE NORFOLK,NE68702	51-0145185	501(C)(3)	30,000		SUPPORT SCHOLARSHIP ASSISTANCE
(41) RONALD MCDONALD HOUSE CHARITIES OF SIOUXLAND 2500 NEBRASKA ST SIOUX CITY,IA51104	42-1369988	501(C)(3)	5,650		COMMUNITY SUPPORT
(42) SANFORD CENTER 1700 GENEVA STREET SIOUX CITY,IA51103	42-0698174	501(C)(3)	5,000		SUPPORT ASIAN FESTIVAL AND SUMMER YOUTH PROGRAM
(43) THE SHEPHERD'S GARDEN 601 NEBRASKA STREET SIOUX CITY,IA51101	27-2258821	501(C)(3)	5,000		ANNUAL UPKEEP AND MAINTENANCE-CHRISTIAN SPACE
(44) SIOUX CITY CONSERVATORY OF MUSIC 1309 PIERCE ST SIOUX CITY,IA51105	45-1544074	501(C)(3)	16,000		EXPANSION PROJECT-UNDERPRIVILEDGED CHILDREN
(45) SIOUXLAND CHAMBER OF COMMERCE 101 PIERCE STREET SIOUX CITY,IA51101	42-1229237	501(C)(6)	6,500		COMMUNITY SUPPORT
(46) SIOUXLAND COMMUNITY HEALTH FOUNDATION 1021 NEBRASKA STREET SIOUX CITY,IA51102	42-1411570	501(C)(3)	21,250		COMMUNITY SUPPORT
(47) SIOUXLAND COMMUNITY HEALTH CENTER 1021 NEBRASKA STREET SIOUX CITY,IA51102	42-1374894	501(C)(3)	42,151		MEDICAL AND DENTAL CARE SUPPORT
(48) SIOUXLAND DISTRICT HEALTH DEPARTMENT 1014 NEBRASKA STREET SIOUX CITY,IA51105	42-6005221	GOVERNMENT ORG	15,500		TOBACCO INIATIVE
(49) SIOUXLAND HUMAN INVESTMENT PARTNERSHIP 1520 MORNINGSIDE AVE SIOUX CITY,IA51106	42-1495836	501(C)(3)	18,500		BLUE ZONE PROJECT
(50) SIOUXLAND MENTAL HEALTH SERVICES PO BOX 1917 SIOUX CITY,IA51102	42-6122297	501(C)(3)	39,455		COMMUNITY CARE COORDINATOR PROGRAM
(51) THE SIOUXLAND Y 601 RIVERVIEW DRIVE SOUTH SIOUX CITY,NE68776	42-0738980	501(C)(3)	15,000		SOCCER TEAM SUPPORT/COMMUNITY PROGRAM SUPPORT
(52) SIOUXLAND YOUTH FOR CHRIST PO BOX 1626 SIOUX CITY,IA51102	42-1108779	501(C)(3)	10,000		YOUTH MINISTRY AND CITY CENTER
(53) SAINT GABRIEL COMMUNICATIONS 705 DOUGLAS ST STE 238 SIOUX CITY,IA51101	42-1516853	501(C)(3)	15,723		UNDERWRITE AIR TIME
(54) ST MICHAELS SCHOOL 1315 FIRST AVENUE SOUTH SIOUX CITY,NE68776	47-0457873	RELIGIOUS SCHOOL	15,000		EDUCATION SPONSORSHIP
(55) SUNNYBROOK COMMUNITY CHURCH 5601 SUNNYBROOK DRIVE SIOUX CITY,IA51106	42-1018560	CHURCH	7,000		MIRACLE LEAGUE BASEBALL/CRITTENTON CENTER CHRISTMAS
(56) UNITED WAY OF SIOUXLAND INC PO BOX 204 SIOUX CITY,IA51102	42-0680395	501(C)(3)	5,000		COMMUNITY SUPPORT
(57) THE WARMING SHELTER INC 916 NEBRASKA ST PO BOX 147 SIOUX CITY,IA51102	47-1257560	501(C)(3)	17,500		HOMELESS SHELTER
(58) IOWA STATE UNIVERSITY EXTENSION AND OUTREACH 4301 SERGEANT RD STE 213 SIOUX CITY,IA51106	42-6021487	PUBLIC SCHOOL	10,500		YOUTH HEALTH & WELLNESS PROGRAMS
(59) SIOUXLAND MEDICAL EDUCATION FOUNDATION 2501 PIERCE ST SIOUX CITY,IA51104	42-1036971	501(C)(3)	1,109,951		PHYSICIAN RESIDENTS EDUCATION SUPPORT
(60) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION 801 5TH STREET SIOUX CITY,IA51102	14-1880022	501(C)(3)	260,345		FUNDING SUPPORT

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) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1) HOUSING AND UTILITIES	11	2,429
(2) TRANSPORTATION ASSISTANCE	176	5,454
(3) MEDICAL BILLS	23	2,931
(4) SCHOLARSHIPS	8	4,000
(5) LOAN ASSISTANCE AND OTHER MISCELLANEOUS ASSISTANCE	10	5,337
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	DONATIONS MADE BY MERCY HEALTH SERVICES - IOWA 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) 2015

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 on 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
directors, trustees, officers, including 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 on 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? ................

Yes

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

For persons listed on 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 on 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" on 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) 2015

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 on 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 in column(B) reported as deferred on 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)
1JAMES CODDINGTON MDDIRECTOR; MERCY NI PHYSICIAN	(i) (ii)	90,692 ------------- 0	46,221 ------------- 0	27,859 ------------- 0	10,568 ------------- 0	11,428 ------------- 0	186,768 ------------- 0	0 ------------- 0
2CLAYTON FITZHUGHDIRECTOR; TRINITY EVP CHRO	(i) (ii)	0 ------------- 737,704	0 ------------- 321,392	0 ------------- 364,018	0 ------------- 26,350	0 ------------- 15,860	0 ------------- 1,465,324	0 ------------- 0
3RODNEY SCHLADERTREASURER; REGIONAL CFO	(i) (ii)	0 ------------- 299,750	0 ------------- 70,419	0 ------------- 1,337	0 ------------- 31,346	0 ------------- 23,918	0 ------------- 426,770	0 ------------- 0
4MARCIA SMITHSECRETARY; ASSOCIATE COUNSEL	(i) (ii)	0 ------------- 231,410	0 ------------- 25,938	0 ------------- 47,001	0 ------------- 11,556	0 ------------- 22,669	0 ------------- 338,574	0 ------------- 0
5JAMES FITZPATRICKPRESIDENT & CEO SIOUX CITY	(i) (ii)	0 ------------- 470,200	0 ------------- 191,187	0 ------------- 113,191	0 ------------- 28,840	0 ------------- 24,425	0 ------------- 827,843	0 ------------- 0
6DANIEL VARNUMCEO NORTH IOWA	(i) (ii)	0 ------------- 398,637	0 ------------- 161,279	0 ------------- 101,967	0 ------------- 16,614	0 ------------- 28,652	0 ------------- 707,149	0 ------------- 0
7RUSSELL KNIGHTCEO DUBUQUE THROUGH 9/15	(i) (ii)	0 ------------- 268,993	0 ------------- 165,581	0 ------------- 183,398	0 ------------- 21,141	0 ------------- 8,433	0 ------------- 647,546	0 ------------- 25,440
8PAUL MANTERNACHSVP PHYS INTEGRATION/CMO NORTH IOWA	(i) (ii)	0 ------------- 349,639	0 ------------- 81,920	0 ------------- 555	0 ------------- 15,900	0 ------------- 22,872	0 ------------- 470,886	0 ------------- 0
9DIANE FISCHELSVP COO NORTH IOWA	(i) (ii)	0 ------------- 281,010	0 ------------- 65,311	0 ------------- 1,217	0 ------------- 36,838	0 ------------- 17,020	0 ------------- 401,396	0 ------------- 0
10HUGH DEPAULISVP FINANCE SIOUX CITY	(i) (ii)	0 ------------- 207,739	0 ------------- 48,300	0 ------------- 843	0 ------------- 15,186	0 ------------- 18,385	0 ------------- 290,453	0 ------------- 0
11KAY TAKESPRES DUBUQUE AT 10/15; VP PAT CARE	(i) (ii)	0 ------------- 196,587	0 ------------- 51,020	0 ------------- 1,420	0 ------------- 23,557	0 ------------- 20,778	0 ------------- 293,362	0 ------------- 0
12DANETTE ZOOKVP FINANCE NORTH IOWA	(i) (ii)	0 ------------- 177,513	0 ------------- 42,228	0 ------------- 376	0 ------------- 22,519	0 ------------- 19,116	0 ------------- 261,752	0 ------------- 0
13ROBERT SHAFERCFO DUBUQUE THROUGH 8/15	(i) (ii)	0 ------------- 113,896	0 ------------- 48,834	0 ------------- 657	0 ------------- 39,170	0 ------------- 13,777	0 ------------- 216,334	0 ------------- 0
14ALIREZA YARAHMADIPHYSICIAN, NEUROLOGY NORTH IOWA	(i) (ii)	510,464 ------------- 0	270,685 ------------- 0	53,949 ------------- 0	11,925 ------------- 0	31,115 ------------- 0	878,138 ------------- 0	0 ------------- 0
15MARK HAGANMANPHYSICIAN,FAMILY MEDICINE NORTH IA	(i) (ii)	483,853 ------------- 0	141,276 ------------- 0	43,094 ------------- 0	28,856 ------------- 0	29,963 ------------- 0	727,042 ------------- 0	0 ------------- 0
16JAMES P KARKOSPHYSICIAN, DERMATOLOGY NORTH IOWA	(i) (ii)	403,665 ------------- 0	211,353 ------------- 0	53,142 ------------- 0	22,457 ------------- 0	30,377 ------------- 0	720,994 ------------- 0	0 ------------- 0
17BRENT OWENPHYSICIAN, FAMILY MEDICINE NORTH IA	(i) (ii)	354,139 ------------- 0	186,054 ------------- 0	53,583 ------------- 0	11,925 ------------- 0	26,279 ------------- 0	631,980 ------------- 0	0 ------------- 0
18STEPHEN THORNPHYSICIAN, OBGYN NORTH IOWA	(i) (ii)	445,826 ------------- 0	103,016 ------------- 0	40,919 ------------- 0	11,925 ------------- 0	46,214 ------------- 0	647,900 ------------- 0	0 ------------- 0
19MARIANNE CUNNINGHAMFORMER OFFICER; TRINITY VP DEBT	(i) (ii)	0 ------------- 195,820	0 ------------- 55,857	0 ------------- 1,606	0 ------------- 15,010	0 ------------- 22,158	0 ------------- 290,451	0 ------------- 0
20JAMES BOSSCHERFORMER OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 37,892	0 ------------- 75,822	0 ------------- 1,137	0 ------------- 0	0 ------------- 114,851	0 ------------- 0
21KEDRICK ADKINSFORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 768,621	0 ------------- 0	0 ------------- 141	0 ------------- 768,762	0 ------------- 767,689
22STEVEN EAVENSONFORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 159,794	0 ------------- 60,615	0 ------------- 1,920	0 ------------- 10,038	0 ------------- 11,117	0 ------------- 243,484	0 ------------- 0
23JUDITH PERSICHILLIFORMER OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 1,018,298	0 ------------- 7,800	0 ------------- 0	0 ------------- 1,026,098	0 ------------- 0
24PAUL NEUMANNFORMER OFFICER;TRIN CHIEF LEGAL CNSL	(i) (ii)	0 ------------- 608,088	0 ------------- 268,674	0 ------------- 355,238	0 ------------- 11,925	0 ------------- 29,961	0 ------------- 1,273,886	0 ------------- 128,891
25JENNIFER BARNETTFORMER OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 702,011	0 ------------- 7,800	0 ------------- 16,184	0 ------------- 725,995	0 ------------- 565,943
26AGNES HAGERTYFORMER OFFICER; TRINITY DEP GEN CSL	(i) (ii)	0 ------------- 405,473	0 ------------- 159,574	0 ------------- 279,309	0 ------------- 34,306	0 ------------- 21,273	0 ------------- 899,935	0 ------------- 0
27BENJAMIN CARTERFORMER OFFICER; TRINITY HEALTH CFO	(i) (ii)	0 ------------- 798,221	0 ------------- 356,711	0 ------------- 355,398	0 ------------- 11,925	0 ------------- 35,541	0 ------------- 1,557,796	0 ------------- 129,972
28RICHARD GILFILLAN MDFORMER OFFICER; TRINITY PRES & CEO	(i) (ii)	0 ------------- 1,428,965	0 ------------- 877,072	0 ------------- 405,410	0 ------------- 11,925	0 ------------- 33,476	0 ------------- 2,756,848	0 ------------- 0
29RICHARD O'CONNELLFORMER KE; TRINITY EVP EAST GROUP	(i) (ii)	0 ------------- 859,386	0 ------------- 383,634	0 ------------- 315,130	0 ------------- 11,925	0 ------------- 35,621	0 ------------- 1,605,696	0 ------------- 39,124
30JEROME PIERSON MDFORMER KEY EMPLOYEE;MMC-SC PHYSICIAN	(i) (ii)	255,445 ------------- 173,391	48,918 ------------- 76,406	1,297 ------------- 730	0 ------------- 11,315	7,505 ------------- 7,487	313,165 ------------- 269,329	0 ------------- 0
31TERESA MOCK MDFORMER KE; SVP CCO AND CPHO N. IOWA	(i) (ii)	0 ------------- 296,143	0 ------------- 69,236	0 ------------- 1,308	0 ------------- 22,222	0 ------------- 22,205	0 ------------- 411,114	0 ------------- 0
32LINDA KREIFORMER KEY EMP; VP CHRO SIOUX CITY	(i) (ii)	0 ------------- 230,915	0 ------------- 53,170	0 ------------- 878	0 ------------- 27,658	0 ------------- 4,588	0 ------------- 317,209	0 ------------- 0
33GARY GUETZKOFORMER KE;VP BUS DEVELOPMENT DUBUQUE	(i) (ii)	0 ------------- 197,756	0 ------------- 56,184	0 ------------- 1,218	0 ------------- 39,640	0 ------------- 17,696	0 ------------- 312,494	0 ------------- 0
34BRIAN MONSMAFORMER KE;VP NTWK DVLPMNT SIOUX CITY	(i) (ii)	0 ------------- 180,496	0 ------------- 42,968	0 ------------- 251	0 ------------- 13,466	0 ------------- 22,709	0 ------------- 259,890	0 ------------- 0
35TRACY LARSONFORMER KEY EMPLOYEE; CNO SIOUX CITY	(i) (ii)	0 ------------- 180,134	0 ------------- 42,556	0 ------------- 250	0 ------------- 7,084	0 ------------- 21,910	0 ------------- 251,934	0 ------------- 0
36KIMBERLY CHAMBERLINFORMER KEY EMPLOYEE; CNO NORTH IOWA	(i) (ii)	0 ------------- 179,005	0 ------------- 42,286	0 ------------- 693	0 ------------- 6,579	0 ------------- 13,973	0 ------------- 242,536	0 ------------- 0
37SUE MEADEFORMER KE; VP PROF SVCS DUBUQUE	(i) (ii)	0 ------------- 141,322	0 ------------- 40,422	0 ------------- 267	0 ------------- 10,844	0 ------------- 12,567	0 ------------- 205,422	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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.

Return Reference

Explanation

PART I, LINE 3

MERCY HEALTH SERVICES - IOWA (MHS-IA) IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MHS-IA HOSPITAL CEO'S ARE PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MHS-IA CEO'S: - 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, LINES 4A-B

THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2015. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $532,835 JENNIFER BARNETT - $565,943 JUDITH PERSICHILLI - $177,179 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2015. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2015, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2015. THE FOLLOWING PAYOUTS FOR 2015 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $234,854 JENNIFER BARNETT - $135,880 JAMES BOSSCHER - $75,822 BENJAMIN CARTER - $194,694 RICHARD GILFILLAN, MD - $358,530 CLAYTON FITZHUGH - $276,846 JAMES FITZPATRICK - $27,708 AGNES HAGERTY - $97,266 RUSSELL KNIGHT - $87,004 PAUL NEUMANN - $143,799 RICHARD O'CONNELL - $207,673 DANIEL VARNUM - $85,931 COLUMN (F) OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION OR RETENTION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($265,000 FOR 2015). THE FOLLOWING PAYOUTS FOR 2015 FOR THESE PLANS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: BENJAMIN CARTER - $135,796 RUSSELL KNIGHT - $25,440 PAUL NEUMANN - $136,786 RICHARD O'CONNELL - $39,142 COLUMN (F) OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ARE PARTICIPANTS IN A MERCY HEALTH SERVICES - IOWA NON-QUALIFIED ELECTIVE DEFERRED COMPENSATION PLAN. THE FOLLOWING DEFERRALS FOR 2015 FOR THIS PLAN ARE INCLUDED IN COLUMN B (III) OF SCHEDULE J, PART II: JAMES CODDINGTON, MD - $23,718 MARK HAGANMAN - $41,691 JAMES P. KARKOS - $49,387 BRENT OWEN - $30,258 STEPHEN THORN - $36,159 ALIREZA YARAHMADI - $48,963

Schedule J (Form 990) 2015

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

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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), section 501(c)(4), and 501(c)(29) 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 Benefiting 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) 2015

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) NATHAN MOCK	FAMILY MEMBER OF TERESA MOCK, FORMER KEY EMPLOYEE	27,690	EMPLOYMENT ARRANGEMENT		No
(2) AVERY OUTDOOR	MILTON AVERY, BOARD OFFICER, IS AN OWNER OF AVERY OUTDOOR	201,286	PAYMENTS MADE FOR SIGNS AND BILLBOARDS		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

MERCY HEALTH SERVICES - IOWA CORP

Employer identification number

31-1373080

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	RODNEY SCHLADER, OFFICER, DANIEL VARNUM, KEY EMPLOYEE, AND MARTI RODAMAKER, BOARD DIRECTOR, HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA (MHS-IA) IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION.
FORM 990, PART VI, SECTION A, LINE 7A	TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF MHS-IA. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MHS-IA.
FORM 990, PART VI, SECTION A, LINE 7B	AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS AND MODIFICATIONS TO GOVERNING DOCUMENTS.
FORM 990, PART VI, SECTION B, LINE 11	PRIOR TO FILING, THE FORM 990 FOR MHS-IA IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. EACH MEMBER OF THE 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	MHS-IA HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF MHS-IA, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF MHS-IA AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. 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 PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF MHS-IA (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MHS-IA OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MHS-IA (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF MHS-IA. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 15	QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MHS-IA IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO COMPENSATION, 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 THE HOSPITAL CEO'S AND CFO'S OF MHS-IA 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	MHS-IA 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 CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, MHS-IA INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE. MHS-IA'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:	NET EQUITY TRANSFERS TO/FROM AFFILIATES -7,696,295. OTHER TRANSACTIONS -341,159. EQUITY GAIN/LOSS IN UNCONSOLIDATED AFFILIATES 3,910,575.
FORM 990, PART XII, LINE 2:	MHS-IA'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY16 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM.
FORM 990, PAGE 1, DOING BUSINESS AS NAMES:	DUNES MEDICAL LABORATORIES, FOREST PARK PHARMACY, HEALTHWORKS, MARIAN HEALTH CENTER, MERCY FAMILY PHARMACY, MERCY HEALTH CENTER-DUBUQUE (ST. JOSEPH'S), MERCY HEALTH CENTER-DYERSVILLE (ST. MARY'S),MERCY HEART CENTER & VASCULAR INSTITUTE, MERCY HOME CARE-NORTH IOWA, MERCY HOME HEALTHCARE DUBUQUE, MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER-DYERSVILLE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA, MERCY MEDICAL CENTER-SIOUX CITY, MERCY VASULAR MEDICINE CLINIC, MHC ANESTHESIA SERVICES, NORTH IOWA MERCY CLINICS, NORTH IOWA MERCY HEALTH CENTER, NORTH IOWA MERCY HOME HEALTHCARE, SHEFFIELD PHARMACY, SIOUXLAND PATHOLOGY GROUP-SMHC, SIOUXLAND RADIOLOGY-SMHC, 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) 2015

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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" on 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
(1) MERCY CARE CONNECTIONS LLC 1000 4TH STREET SW MASON CITY,IA50401 35-2473948	ACCOUNTABLE CARE ORGANIZATION	IA	0	0	MERCY HEALTH SERVICES-IOWA CORP

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on 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	Yes
(2)ALBANY MEMORIAL HOSPITAL 600 NORTHERN BLVD ALBANY,NY12204 14-1338457	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(3)ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR,FL34684 58-1492325	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	FL	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION	Yes
(4)AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA,MI48152 38-2949053	HOSPICE SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(5)ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD,CT06105 06-1450170	HEALTHCARE SERVICES	CT	501(C)(3)	LINE 3	TRINITY HEALTH - NEW ENGLAND INC	Yes
(6)BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR,IA51245 42-1500277	HEALTHCARE AND HOSPITAL SERVICES	IA	501(C)(3)	LINE 3	MERCY HEALTH SERVICES-IOWA CORP	Yes
(7)BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR,IA51245 26-2973307	FOUNDATION	IA	501(C)(3)	LINE 11A, I	BAUM HARMON MERCY HOSPITAL	Yes
(8)BEECHWOOD INC 2212 BURDETT AVE TROY,NY12180 14-1651563	TITLE HOLDING COMPANY	NY	501(C)(2)	N/A	LTC (EDDY) INC	Yes
(9)BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS,NY12159 14-1717028	SENIOR LIVING COMMUNITY	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(10)BRIGHTSIDE INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 04-2182395	HEALTHCARE SERVICES	MA	501(C)(3)	LINE 9	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(11)CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES,NY12047 14-1701597	LONG TERM CARE	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(12)CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR,MI48106 38-2507173	HEALTHCARE SERVICES (INACTIVE)	MI	501(C)(3)	LINE 3	TRINITY HEALTH-MICHIGAN	Yes
(13)CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA,MI48152	GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM	VT	501(C)(3)	LINE 1	N/A		No
(14)COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK,NJ07102 26-2616342	INACTIVE ENTITY	NJ	501(C)(3)	LINE 9	SAINT MICHAEL'S MEDICAL CENTER	Yes
(15)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	Yes
(16)CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY,MI48098 38-3320699	HOSPICE SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(17)DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS,OH43213 34-2032340	HEALTHCARE AND HOSPITAL SERVICES	OH	501(C)(3)	LINE 3	MOUNT CARMEL HEALTH SYSTEM	Yes
(18)DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE,IA52001 26-2227941	FOUNDATION	IA	501(C)(3)	LINE 11A, I	MERCY HEALTH SERVICES-IOWA CORP	Yes
(19)DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE,IA52040 20-5383271	FOUNDATION	IA	501(C)(3)	LINE 11A, I	MERCY HEALTH SERVICES-IOWA CORP	Yes
(20)EAST NORRITON PHYSICIANS SERVICES ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2515999	HEALTHCARE SERVICES	PA	501(C)(3)	LINE 3	MERCY PHYSICIAN NETWORK	Yes
(21)EDDY LICENSED HOME CARE AGENCY INC 433 RIVER ST SUITE 3000 TROY,NY12180 14-1818568	HOME HEALTH SERVICES	NY	501(C)(3)	LINE 3	LTC (EDDY) INC	Yes
(22)EMBRACING AGE INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT,NY13214 46-1051881	PACE PROGRAM	NY	501(C)(3)	LINE 9	ST JOSEPH'S HEALTH INC	Yes
(23)EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA,NY12020 14-1795732	HOME HEALTH SERVICES	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(24)FARREN CARE CENTER INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 04-2501711	LONG TERM CARE	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(25)FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON,DE19805 22-3008680	LONG TERM CARE (INACTIVE)	DE	501(C)(3)	LINE 9	ST FRANCIS HOSPITAL	Yes
(26)GLEN EDDY INC ONE GLEN EDDY DRIVE NISKAYUNA,NY12309 14-1794150	SENIOR LIVING COMMUNITY	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(27)GLOBAL HEALTH MINISTRY 20555 VICTOR PARKWAY LIVONIA,MI48152 42-1253527	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION	Yes
(28)GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO,GA30642 26-1720984	HEALTHCARE AND HOSPITAL SERVICES	GA	501(C)(3)	LINE 3	ST MARY'S HEALTH CARE SYSTEM INC	Yes
(29)GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK,IL60160 36-3332852	COMMUNITY OUTREACH	IL	501(C)(3)	LINE 9	GOTTLIEB MEMORIAL HOSPITAL	Yes
(30)GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK,IL60160 74-3260011	FOUNDATION	IL	501(C)(3)	LINE 11C, III-FI	N/A		No
(31)GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK,IL60160 36-2379649	HEALTHCARE AND HOSPITAL SERVICES	IL	501(C)(3)	LINE 3	LOYOLA UNIVERSITY HEALTH SYSTEM	Yes
(32)GRAND RAPIDS MEDICAL EDUCATION PARTNERS INC 945 OTTAWA AVE NW GRAND RAPIDS,MI49503 23-7270669	MEDICAL EDUCATION TRAINING PROGRAMS	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN	Yes
(33)HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON,MI49443 38-2299878	SELF INSURANCE	MI	501(C)(3)	LINE 11B, II	MERCY HEALTH PARTNERS	Yes
(34)HACKLEY LIFE COUNSELING 125 E SOUTHERN AVENUE MUSKEGON,MI49442 38-1386362	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 9	MERCY HEALTH PARTNERS	Yes
(35)HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH,NY12061 80-0102840	SENIOR LIVING COMMUNITY	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(36)HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY,NY12180 14-1725101	LONG TERM CARE	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(37)HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS,MI48152 52-1945054	LONG TERM CARE	MD	501(C)(3)	LINE 9	HOLY CROSS HEALTH INC	Yes
(38)HOLY CROSS HEALTH FOUNDATION INC 1500 FOREST GLEN RD SILVER SPRING,MD20910 20-8428450	FOUNDATION	MD	501(C)(3)	LINE 7	HOLY CROSS HEALTH INC	Yes
(39)HOLY CROSS HEALTH INC 1500 FOREST GLEN RD SILVER SPRING,MD20910 52-0738041	HEALTHCARE AND HOSPITAL SERVICES	MD	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(40)HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 59-0791028	HEALTHCARE AND HOSPITAL SERVICES	FL	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(41)HOLY CROSS MEDICAL PROPERTIES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 65-0666283	BUILDING MANAGEMENT SERVICES	FL	501(C)(2)	N/A	HOLY CROSS HOSPITAL INC	Yes
(42)HOLY CROSS OUTPATIENT SERVICES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 46-5421068	HEALTHCARE SERVICES	FL	501(C)(3)	LINE 9	HOLY CROSS HOSPITAL INC	Yes
(43)HOLY CROSS PRIMARY CARE INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 81-2531495	HEALTHCARE SERVICES	FL	501(C)(3)	LINE 9	HOLY CROSS HOSPITAL INC	Yes
(44)HOME & COMMUNITY HEALTH SERVICES INC 201 CHESTNUT HILL ROAD STAFFORD SPRINGS,CT06076 81-0723591	HOME HEALTH SERVICES	CT	501(C)(3)	LINE 9	TRINITY HEALTH - NEW ENGLAND INC	Yes
(45)HOME AIDE SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY,NY12180 14-1514867	HOME HEALTH SERVICES	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(46)HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY,IA50401 42-1173708	HOSPICE SERVICES	IA	501(C)(3)	LINE 9	MERCY HEALTH SERVICES-IOWA CORP	Yes
(47)HOSPICE OF SIOUXLAND 4300 HAMILTON BLVD SIOUX CITY,IA51104 38-3320710	HOSPICE SERVICES	IA	501(C)(3)	LINE 11A, I	N/A		No
(48)HOSPICE OF WASHTENAW II 806 AIRPORT BLVD ANN ARBOR,MI48108 38-3320707	HOSPICE SERVICES (INACTIVE)	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN	Yes
(49)IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR,MI48106 38-3316559	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN	Yes
(50)JOHNSON HEALTH CARE INC 201 CHESTNUT HILL ROAD STAFFORD SPRINGS,CT06076 81-0709903	HEALTHCARE SERVICES	CT	501(C)(3)	LINE 9	TRINITY HEALTH - NEW ENGLAND INC	Yes
(51)JOHNSON MEMORIAL HOSPITAL INC 201 CHESTNUT HILL ROAD STAFFORD SPRINGS,CT06076 47-5676956	HEALTHCARE AND HOSPITAL SERVICES	CT	501(C)(3)	LINE 3	TRINITY HEALTH - NEW ENGLAND INC	Yes
(52)JOHNSON MEMORIAL MEDICAL CENTER INC 201 CHESTNUT HILL ROAD STAFFORD SPRINGS,CT06076 81-0696923	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	CT	501(C)(3)	LINE 11B, II	TRINITY HEALTH - NEW ENGLAND INC	Yes
(53)LANGHORNE MRI INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2519529	HEALTHCARE SERVICES (INACTIVE)	PA	501(C)(3)	LINE 9	ST MARY MEDICAL CENTER	Yes
(54)LANGHORNE PHYSICIAN SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2571699	HEALTHCARE SERVICES	PA	501(C)(3)	LINE 9	ST MARY MEDICAL CENTER	Yes
(55)LIFE AT LOURDES INC 2475 MCCLELLAN AVENUE PENNSAUKEN,NJ08109 26-1854750	PACE PROGRAM	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES	Yes
(56)LIFE AT ST FRANCIS HEALTHCARE INC 7TH CLAYTON STREETS WILMINGTON,DE19805 45-2569214	PACE PROGRAM	DE	501(C)(3)	LINE 9	ST FRANCIS HOSPITAL	Yes
(57)LIFE ST FRANCIS CORPORATION 1435 LIBERTY STREET HAMILTON,NJ08629 22-2797282	PACE PROGRAM	NJ	501(C)(3)	LINE 9	ST FRANCIS MEDICAL CENTER TRENTON NJ	Yes
(58)LIFE ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SOUTHERN PINES,NC28387 27-2159847	PACE PROGRAM	NC	501(C)(3)	LINE 3	ST JOSEPH OF THE PINES INC	Yes
(59)LIFE ST MARY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 26-2976184	PACE PROGRAM	PA	501(C)(3)	LINE 9	ST MARY MEDICAL CENTER	Yes
(60)LOURDES ANCILLARY SERVICES 1600 HADDON AVENUE CAMDEN,NJ08103 22-2568525	VOLUNTEER SERVICE AUXILIARY	NJ	501(C)(3)	LINE 11B, II	OUR LADY OF LOURDES HEALTH CARE SERVICES	Yes
(61)LOURDES CARDIOLOGY SERVICES PC 1600 HADDON AVENUE CAMDEN,NJ08103 27-4357794	HEALTHCARE SERVICES	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES	Yes
(62)LOURDES MEDICAL CENTER OF BURLINGTON COUNTY 218 SUNSET ROAD WILLINGBORO,NJ08046 22-3612265	HEALTHCARE AND HOSPITAL SERVICES	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES	Yes
(63)LOYOLA MEDICINE TRANSPORT LLC 905 W NORTH AVE MELROSE PARK,IL60160 47-4147171	TRANSPORATION SERVICES	IL	501(C)(3)	LINE 9	LOYOLA UNIVERSITY MEDICAL CENTER	Yes
(64)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	Yes
(65)LOYOLA UNIVERSITY MEDICAL CENTER 2160 SOUTH FIRST AVENUE MAYWOOD,IL60153 36-4015560	HEALTHCARE AND HOSPITAL SERVICES	IL	501(C)(3)	LINE 3	LOYOLA UNIVERSITY HEALTH SYSTEM	Yes
(66)LTC (EDDY) INC 2212 BURDETT AVE TROY,NY12180 22-2564710	MANAGEMENT SERVICES FOR LONG TERM CARE	NY	501(C)(3)	LINE 11B, II	ST PETER'S HEALTH PARTNERS	Yes
(67)MARIAN COMMUNITY HOSPITAL 3805 WEST CHESTER PIKE STE 100 NEWTOWN SQUARE,PA19073 24-0711230	HEALTHCARE SERVICES (INACTIVE)	PA	501(C)(3)	LINE 9	MAXIS HEALTH SYSTEM	Yes
(68)MARIAN HOME HEALTHCARE 801 5TH STREET SIOUX CITY,IA51101 38-3320705	HOME HEALTH SERVICES (INACTIVE)	IA	501(C)(3)	LINE 11A, I	MERCY HEALTH SERVICES-IOWA CORP	Yes
(69)MARYCREST HEIGHTS PO BOX 9184 FARMINGTON HILLS,MI48333 27-0291722	SENIOR LIVING COMMUNITY	MI	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES	Yes
(70)MAXIS HEALTH SYSTEM 3805 WEST CHESTER PIKE STE 100 NEWTOWN SQUARE,PA19073 91-1940902	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT (INACTIVE)	PA	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION	Yes
(71)MCAULEY CENTER INC 275 STEELE ROAD WEST HARTFORD,CT06117 06-1058086	SENIOR LIVING COMMUNITY	CT	501(C)(3)	LINE 9	MERCY COMMUNITY HEALTH INC	Yes
(72)MCAULEY CLINIC CORPORATION PO BOX 992 ANN ARBOR,MI48106 38-2561013	HEALTHCARE SERVICES (INACTIVE)	MI	501(C)(3)	LINE 3	CATHERINE MCAULEY HEALTH SERVICES CORP	Yes
(73)MCAULEY MINISTRIES 3333 FIFTH AVENUE PITTSBURGH,PA15213 94-3436142	GRANT MAKING	PA	501(C)(3)	LINE 11B, II	PITTSBURGH MERCY HEALTH SYSTEM	Yes
(74)MERCY AMICARE HOME HEALTHCARE OAKLAND 1111 W LONG LAKE RD STE 102 TROY,MI48098 38-3320698	HOME HEALTH SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(75)MERCY AMICARE HOME HEALTHCARE PORT HURON 17410 COLLEGE PARKWAY STE 150 LIVONIA,MI48152 38-3320701	HOME HEALTH SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(76)MERCY CARE FOUNDATION 424 DECATUR STREET ATLANTA,GA30312 58-1448522	FOUNDATION	GA	501(C)(3)	LINE 7	SAINT JOSEPH'S HEALTH SYSTEM INC	Yes
(77)MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-1352191	HEALTHCARE AND HOSPITAL SERVICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(78)MERCY COMMUNITY HEALTH INC 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-1492707	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	CT	501(C)(3)	LINE 11B, II	TRINITY CONTINUING CARE SERVICES	Yes
(79)MERCY FAMILY SUPPORT 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD,PA19064 23-2325059	HOME HEALTH SERVICES	PA	501(C)(3)	LINE 9	MERCY HOME HEALTH SERVICES	Yes
(80)MERCY FOUNDATION INC 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-3227350	FOUNDATION	IL	501(C)(3)	LINE 7	MERCY HEALTH SYSTEM OF CHICAGO	Yes
(81)MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE 888 TERRACE STREET MUSKEGON,MI49440 38-3321856	HOSPICE & HOME HEALTH SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(82)MERCY HEALTH FOUNDATION OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2829864	FOUNDATION	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(83)MERCY HEALTH NETWORK INC 1111 6TH AVENUE DES MOINES,IA50314 42-1478417	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	DE	501(C)(3)	LINE 11B, II	N/A		No
(84)MERCY HEALTH PARTNERS 1500 E SHERMAN BLVD MUSKEGON,MI49444 38-2589966	HEALTHCARE AND HOSPITAL SERVICES	MI	501(C)(3)	LINE 3	TRINITY HEALTH-MICHIGAN	Yes
(85)MERCY HEALTH PLAN ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 22-2483605	MEDICAID MANAGED CARE PLAN	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(86)MERCY HEALTH SERVICES - IOWA CORP 1000 4TH STREET SW MASON CITY,IA50401 31-1373080	HEALTHCARE AND HOSPITAL SERVICES	DE	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION		No
(87)MERCY HEALTH SYSTEM OF CHICAGO 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-3163327	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IL	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(88)MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2212638	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	PA	501(C)(3)	LINE 11C, III-FI	TRINITY HEALTH CORPORATION	Yes
(89)MERCY HEALTHCARE CENTER 114 WAWBEEK AVENUE TUPPER LAKE,NY12986 15-0532211	HEALTHCARE AND HOSPITAL SERVICES (INACTIVE)	NY	501(C)(3)	LINE 3	MERCY UIHLEIN HEALTH CORPORATION	Yes
(90)MERCY HEALTHCARE FOUNDATION-CLINTON 1410 N 4TH ST CLINTON,IA52732 42-1316126	FOUNDATION	IA	501(C)(3)	LINE 7	N/A		No
(91)MERCY HOME HEALTH 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD,PA19064 23-1352099	HOME HEALTH SERVICES	PA	501(C)(3)	LINE 9	MERCY HOME HEALTH SERVICES	Yes
(92)MERCY HOME HEALTH SERVICES 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD,PA19064 23-2325058	MANAGEMENT SERVICES FOR HOME HEALTH	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(93)MERCY HOSPITAL AND MEDICAL CENTER 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-2170152	HEALTHCARE AND HOSPITAL SERVICES	IL	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF CHICAGO	Yes
(94)MERCY HOSPITAL CADILLAC FOUNDATION 1820 44TH ST SE KENTWOOD,MI49508 20-3357131	FOUNDATION	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN	Yes
(95)MERCY HOSPITAL GIFT SHOP 2601 ELECTRIC AVE PORT HURON,MI48060 38-1630480	VOLUNTEER SERVICE AUXILIARY	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN	Yes
(96)MERCY HOSPITAL INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 04-3398280	HEALTHCARE AND HOSPITAL SERVICES	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(97)MERCY HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE,FL33308 59-0791034	HEALTHCARE SERVICES (INACTIVE)	FL	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(98)MERCY LIFE CENTER CORPORATION 1200 REEDSDALE STREET PITTSBURGH,PA15233 25-1604115	COMMUNITY OUTREACH	PA	501(C)(3)	LINE 9	PITTSBURGH MERCY HEALTH SYSTEM	Yes
(99)MERCY LIFE OF ALABAMA PO BOX 7957 MOBILE,AL36670 27-3163002	PACE PROGRAM	AL	501(C)(3)	LINE 3	TRINITY HEALTH PACE	Yes
(100)MERCY LIFE INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 45-3086711	PACE PROGRAM	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE CARE CENTERS INC	Yes
(101)MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2627944	HEALTHCARE SERVICES	PA	501(C)(3)	LINE 3	MERCY PHYSICIAN NETWORK	Yes
(102)MERCY MEDICAL CENTER - CLINTON INC 1410 NORTH 4TH ST CLINTON,IA52732 42-1336618	HEALTHCARE AND HOSPITAL SERVICES	DE	501(C)(3)	LINE 3	MERCY HEALTH SERVICES-IOWA CORP	Yes
(103)MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION 801 5TH STREET SIOUX CITY,IA51102 14-1880022	FOUNDATION	IA	501(C)(3)	LINE 7	MERCY HEALTH SERVICES-IOWA CORP	Yes
(104)MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA 1000 4TH STREET SW MASON CITY,IA50401 42-1229151	FOUNDATION	IA	501(C)(3)	LINE 7	MERCY HEALTH SERVICES-IOWA CORP	Yes
(105)MERCY MEDICAL CORPORATION PO BOX 7957 MOBILE,AL36670 63-6002215	HOSPICE & HOME HEALTH SERVICES	AL	501(C)(3)	LINE 9	TRINITY HEALTH CORPORATION	Yes
(106)MERCY MEDICAL GROUP C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 45-4884805	HEALTHCARE SERVICES	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(107)MERCY PHYSICIAN NETWORK ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 46-1187365	MANAGEMENT SERVICES FOR PHYSICIAN SERVICE ORGANIZATIONS	PA	501(C)(3)	LINE 11B, II	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(108)MERCY SENIOR CARE INC 424 DECATUR STREET ATLANTA,GA30312 58-1366508	COMMUNITY OUTREACH	GA	501(C)(3)	LINE 7	SAINT JOSEPH'S HEALTH SYSTEM INC	Yes
(109)MERCY SERVICES DOWNTOWN INC 424 DECATUR STREET ATLANTA,GA30312 27-2046353	TITLE HOLDING COMPANY	GA	501(C)(3)	LINE 11B, II	SAINT JOSEPH'S HEALTH SYSTEM INC	Yes
(110)MERCY SERVICES FOR AGING NON-PROFIT HOUSING CORPORATION PO BOX 9184 FARMINGTON HILLS,MI48333 38-2719605	LONG TERM CARE	MI	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES	Yes
(111)MERCY SPECIALIST PHYSICIANS INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 26-4033168	HEALTHCARE SERVICES	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(112)MERCY SUBURBAN HOSPITAL ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-1396763	HEALTHCARE AND HOSPITAL SERVICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(113)MERCY UIHLEIN HEALTH CORPORATION 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,NY19073 16-1535133	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT (INACTIVE)	NY	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(114)MISSION HEALTH CORPORATION 37595 SEVEN MILE ROAD LIVONIA,MI48152 38-3181557	BUILDING MANAGEMENT SERVICES	DE	501(C)(3)	LINE 11A, I	N/A		No
(115)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	Yes
(116)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	Yes
(117)MOUNT CARMEL HEALTH PLAN INC 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1471229	MEDICARE HMO	OH	501(C)(4)	N/A	MOUNT CARMEL HEALTH SYSTEM	Yes
(118)MOUNT CARMEL HEALTH SYSTEM 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1439334	HEALTHCARE AND HOSPITAL SERVICES	OH	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(119)MOUNT CARMEL HEALTH SYSTEM FOUNDATION 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1113966	FOUNDATION	OH	501(C)(3)	LINE 11A, I	MOUNT CARMEL HEALTH SYSTEM	Yes
(120)MOUNT CARMEL HOME CARE LLC 501 WEST SCHROCK ROAD WESTERVILLE,OH43081 26-2729300	HOME HEALTH SERVICES	OH	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(121)MOUNT SINAI HOSPITAL FOUNDATION INC 500 BLUE HILLS AVENUE HARTFORD,CT06112 22-2584082	FOUNDATION	CT	501(C)(3)	LINE 11C, III-FI	N/A		No
(122)MOUNT SINAI REHABILITATION HOSPITAL INC 114 WOODLAND STREET HARTFORD,CT06105 06-1422973	HEALTHCARE AND HOSPITAL SERVICES	CT	501(C)(3)	LINE 3	TRINITY HEALTH - NEW ENGLAND INC	Yes
(123)MRI MOBILE SERVICES OF WEST MICHIGAN 1820 44TH STREET KENTWOOD,MI49508 38-3073745	HEALTHCARE SERVICES (INACTIVE)	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN	Yes
(124)MUSKEGON COMMUNITY HEALTH PROJECT 565 W WESTERN AVENUE MUSKEGON,MI49440 91-1932918	COMMUNITY OUTREACH	MI	501(C)(3)	LINE 7	MERCY HEALTH PARTNERS	Yes
(125)NAZARETH HEALTH CARE FOUNDATION 2701 HOLME AVENUE PHILADELPHIA,PA19152 23-2300951	FOUNDATION	PA	501(C)(3)	LINE 11A, I	NAZARETH HOSPITAL	Yes
(126)NAZARETH HOSPITAL 2601 HOLME AVENUE PHILADELPHIA,PA19152 23-2794121	HEALTHCARE AND HOSPITAL SERVICES	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(127)NAZARETH PHYSICIAN SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 20-3261266	HEALTHCARE SERVICES	PA	501(C)(3)	LINE 3	MERCY PHYSICIAN NETWORK	Yes
(128)NE PHYSICIAN SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2497355	HEALTHCARE SERVICES (INACTIVE)	PA	501(C)(3)	LINE 3	MERCY PHYSICIAN NETWORK	Yes
(129)NORTHEAST HEALTH INC 2212 BURDETT AVE TROY,NY12180 04-2450756	HEALTHCARE SYSTEM SUPPORT	NY	501(C)(3)	LINE 11B, II	ST PETER'S HEALTH PARTNERS	Yes
(130)OAKLAND MERCY HOSPITAL 601 EAST 2ND STREET OAKLAND,NE68045 20-8072234	HEALTHCARE AND HOSPITAL SERVICES	NE	501(C)(3)	LINE 3	MERCY HEALTH SERVICES-IOWA CORP	Yes
(131)OAKLAND MERCY HOSPITAL FOUNDATION 601 E 2ND STREET OAKLAND,NE68045 31-1678345	FOUNDATION	NE	501(C)(3)	LINE 11C, III-FI	N/A		No
(132)ONE THOUSAND CORPORATION 1000 ASYLUM AVENUE HARTFORD,CT06105 06-0922325	BUILDING MANAGEMENT SERVICES	CT	501(C)(2)	N/A	SAINT FRANCIS HOSPITAL AND MEDICAL CENTER	Yes
(133)OSUMOUNT CARMEL HEALTH ALLIANCE 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1654603	COOPERATIVE HEALTHCARE DELIVERY SYSTEM	OH	501(C)(3)	LINE 11A, I	N/A		No
(134)OUR LADY OF LOURDES HEALTH CARE SERVICES 1600 HADDON AVENUE CAMDEN,NJ08103 22-2568528	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	NJ	501(C)(3)	LINE 11B, II	MAXIS HEALTH SYSTEM	Yes
(135)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	Yes
(136)OUR LADY OF LOURDES MEDICAL CENTER 1600 HADDON AVENUE CAMDEN,NJ08103 21-0635001	HEALTHCARE AND HOSPITAL SERVICES	NJ	501(C)(3)	LINE 3	OUR LADY OF LOURDES HEALTH CARE SERVICES	Yes
(137)OUR LADY OF MERCY LIFE CENTER 2 MERCYCARE LANE GUILDERLAND,NY12084 14-1743506	LONG TERM CARE	NY	501(C)(3)	LINE 3	ST PETER'S HOSPITAL	Yes
(138)PIONEER VALLEY CARDIOLOGY ASSOCIATES INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 45-4208896	HEALTHCARE SERVICES	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(139)PITTSBURGH MERCY HEALTH SYSTEM 3333 5TH AVENUE PITTSBURGH,PA15213 25-1464211	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	PA	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(140)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	Yes
(141)PROBILITY THERAPY SERVICES 2058 S STATE STREET ANN ARBOR,MI48104 20-2020239	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 9	TRINITY HEALTH-MICHIGAN	Yes
(142)PROFESSIONAL MED TEAM 965 FORK STREET MUSKEGON,MI49442 38-2638284	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 9	MERCY HEALTH PARTNERS	Yes
(143)SAINT AGNES MEDICAL CENTER 1303 EAST HERNDON AVE FRESNO,CA93720 94-1437713	HEALTHCARE AND HOSPITAL SERVICES	CA	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(144)SAINT AGNES MEDICAL FOUNDATION (FKA PROFESSIONAL OFFICE CORPORATION) 1303 EAST HERNDON AVE FRESNO,CA93720 94-2839324	HEALTHCARE SERVICES	CA	501(C)(3)	LINE 11A, I	SAINT AGNES MEDICAL CENTER	Yes
(145)SAINT ALPHONSUS BUILDING COMPANY INC 1055 NORTH CURTIS RD BOISE,ID83706 82-0401011	BUILDING MANAGEMENT SERVICES	ID	501(C)(3)	LINE 9	SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC	Yes
(146)SAINT ALPHONSUS DIVERSIFIED CARE INC 1055 NORTH CURTIS RD BOISE,ID83706 94-3028978	HEALTHCARE SYSTEM SUPPORT	ID	501(C)(3)	LINE 11A, I	SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC	Yes
(147)SAINT ALPHONSUS FOUNDATION-BAKER CITY INC 3325 POCAHONTAS ROAD BAKER CITY,OR97814 94-3164869	FOUNDATION	OR	501(C)(3)	LINE 7	SAINT ALPHONSUS MEDICAL CENTER - BAKER CITY	Yes
(148)SAINT ALPHONSUS FOUNDATION-ONTARIO INC 351 SW 9TH STREET ONTARIO,OR97914 20-2683560	FOUNDATION	OR	501(C)(3)	LINE 7	SAINT ALPHONSUS MEDICAL CENTER-ONTARIO	Yes
(149)SAINT ALPHONSUS HEALTH SYSTEM INC 1055 N CURTIS ROAD BOISE,ID83706 27-1929502	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	ID	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(150)SAINT ALPHONSUS MEDICAL CENTER ONTARIO VOLUNTEERS 351 SW 9TH STREET ONTARIO,OR97914 94-3059469	VOLUNTEER SERVICE AUXILIARY	OR	501(C)(3)	LINE 9	SAINT ALPHONSUS MEDICAL CENTER-ONTARIO	Yes
(151)SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY INC 3325 POCAHONTAS ROAD BAKER CITY,OR97814 27-1790052	HEALTHCARE AND HOSPITAL SERVICES	OR	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC	Yes
(152)SAINT ALPHONSUS MEDICAL CENTER-NAMPA HEALTH FOUNDATION INC 1512 12TH AVENUE ROAD NAMPA,ID83686 26-1737256	FOUNDATION	ID	501(C)(3)	LINE 7	SAINT ALPHONSUS MEDICAL CENTER-NAMPA	Yes
(153)SAINT ALPHONSUS MEDICAL CENTER-NAMPA INC 1512 12TH AVENUE ROAD NAMPA,ID83686 82-0200896	HEALTHCARE AND HOSPITAL SERVICES	ID	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC	Yes
(154)SAINT ALPHONSUS MEDICAL CENTER-ONTARIO INC 351 SW 9TH STREET ONTARIO,OR97914 27-1789847	HEALTHCARE AND HOSPITAL SERVICES	OR	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC	Yes
(155)SAINT ALPHONSUS REGIONAL MEDICAL CENTER 1055 NORTH CURTIS RD BOISE,ID83706 82-0200895	HEALTHCARE AND HOSPITAL SERVICES	ID	501(C)(3)	LINE 3	SAINT ALPHONSUS HEALTH SYSTEM INC	Yes
(156)SAINT FRANCIS EMERGENCY MEDICAL GROUP INC 114 WOODLAND STREET HARTFORD,CT06105 45-1994612	HEALTHCARE SERVICES	CT	501(C)(3)	LINE 11B, II	SAINT FRANCIS MEDICAL GROUP INC	Yes
(157)SAINT FRANCIS FOUNDATION INC 114 WOODLAND STREET HARTFORD,CT06105 06-1008255	FOUNDATION	CT	501(C)(3)	LINE 11B, II	TRINITY HEALTH - NEW ENGLAND INC	Yes
(158)SAINT FRANCIS HOSPITAL AND MEDICAL CENTER 114 WOODLAND STREET HARTFORD,CT06105 06-0646813	HEALTHCARE AND HOSPITAL SERVICES	CT	501(C)(3)	LINE 3	TRINITY HEALTH - NEW ENGLAND INC	Yes
(159)SAINT FRANCIS MEDICAL GROUP INC 114 WOODLAND STREET HARTFORD,CT06105 06-1450168	HEALTHCARE SERVICES	CT	501(C)(3)	LINE 3	TRINITY HEALTH - NEW ENGLAND INC	Yes
(160)SAINT JAMES CARE INC 111 CENTRAL AVENUE NEWARK,NJ07102 26-2616230	INACTIVE ENTITY	NJ	501(C)(3)	LINE 9	SAINT MICHAEL'S MEDICAL CENTER	Yes
(161)SAINT JOSEPH PACE INC 20555 VICTOR PARKWAY LIVONIA,MI48152 47-3129127	PACE PROGRAM	IN	501(C)(3)	LINE 7	TRINITY HEALTH PACE	Yes
(162)SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC PO BOX 670 PLYMOUTH,IN46563 35-1142669	HEALTHCARE AND HOSPITAL SERVICES	IN	501(C)(3)	LINE 3	SAINT JOSEPH REGIONAL MEDICAL CENTER INC	Yes
(163)SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC 5215 HOLY CROSS PARKWAY MISHAWAKA,IN46545 35-0868157	HEALTHCARE AND HOSPITAL SERVICES	IN	501(C)(3)	LINE 3	SAINT JOSEPH REGIONAL MEDICAL CENTER INC	Yes
(164)SAINT JOSEPH REGIONAL MEDICAL CENTER MISHAWAKA AUXILIARY INC 5215 HOLY CROSS PARKWAY MISHAWAKA,IN46545 35-6033285	VOLUNTEER SERVICE AUXILIARY	IN	501(C)(4)	N/A	SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC	Yes
(165)SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH AUXILIARY INC 1915 LAKE AVENUE PLYMOUTH,IN46563 35-6043563	VOLUNTEER SERVICE AUXILIARY	IN	501(C)(3)	LINE 11B, II	SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC	Yes
(166)SAINT JOSEPH REGIONAL MEDICAL CENTER INC 5215 HOLY CROSS PARKWAY MISHAWAKA,IN46545 35-1568821	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IN	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(167)SAINT JOSEPH'S HEALTH SYSTEM INC 424 DECATUR STREET ATLANTA,GA30312 58-1744848	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	GA	501(C)(3)	LINE 11C, III-FI	TRINITY HEALTH CORPORATION	Yes
(168)SAINT JOSEPH'S MERCY CARE SERVICES INC 424 DECATUR STREET ATLANTA,GA30312 58-1752700	HEALTHCARE SERVICES	GA	501(C)(3)	LINE 7	SAINT JOSEPH'S HEALTH SYSTEM INC	Yes
(169)SAINT JOSEPH'S TOWER INC PO BOX 9184 FARMINGTON HILLS,MI48333 31-1040468	SENIOR LIVING COMMUNITY	IN	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES - INDIANA INC	Yes
(170)SAINT MARY'S AMICARE HOME HEALTHCARE 1430 MONROE NW STE 120 GRAND RAPIDS,MI49505 38-3320700	HOME HEALTH SERVICES	MI	501(C)(3)	LINE 9	TRINITY HOME HEALTH SERVICES	Yes
(171)SAINT MARY'S FOUNDATION 200 JEFFERSON ST SE GRAND RAPIDS,MI49503 38-1779602	FOUNDATION	MI	501(C)(3)	LINE 7	TRINITY HEALTH-MICHIGAN	Yes
(172)SAINT MICHAEL'S MEDICAL CENTER 111 CENTRAL AVENUE NEWARK,NJ07102 26-2616046	HEALTHCARE AND HOSPITAL SERVICES	NJ	501(C)(3)	LINE 3	MAXIS HEALTH SYSTEM	Yes
(173)SAMARITAN CHILD CARE CENTER INC 2213 BURDETT AVE TROY,NY12180 14-1710225	CHILD CARE	NY	501(C)(3)	LINE 9	ST PETER'S HEALTH PARTNERS	Yes
(174)SAMARITAN HOSPITAL 2215 BURDETT AVE TROY,NY12180 14-1338544	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(175)SENIOR CARE CONNECTION INC 504 STATE ST SCHENECTADY,NY12305 14-1708754	PACE PROGRAM	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(176)SETON AUXILIARY INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1505031	VOLUNTEER SERVICE AUXILIARY	NY	501(C)(3)	LINE 9	SETON HEALTH SYSTEM INC	Yes
(177)SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE 1 ABELE BLVD CLIFTON PARK,NY12065 14-1756230	LONG TERM CARE	NY	501(C)(3)	LINE 9	SETON HEALTH SYSTEM INC	Yes
(178)SETON HEALTH FOUNDATION INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 22-2345416	FOUNDATION	NY	501(C)(3)	LINE 11A, I	SETON HEALTH SYSTEM INC	Yes
(179)SETON HEALTH SYSTEM INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1776186	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(180)SISTERS OF PROVIDENCE CARE CENTERS INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 22-2541103	LONG TERM CARE	MA	501(C)(3)	LINE 3	SISTERS OF PROVIDENCE HEALTH SYSTEM INC	Yes
(181)SISTERS OF PROVIDENCE HEALTH SYSTEM INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE,MA01040 04-3398374	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	MA	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(182)SJ MANAGEMENT COMPANY OF SYRACUSE INC 301 PROSPECT AVENUE SYRACUSE,NY13203 27-1763712	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	NY	501(C)(3)	LINE 11C, III-FI	ST JOSEPH'S HOSPITAL HEALTH CENTER	Yes
(183)SJHSJOC HOLDINGS INC 424 DECATUR STREET ATLANTA,GA30312 47-2299757	HEALTHCARE SYSTEM SUPPORT	GA	501(C)(3)	LINE 11B, II	SAINT JOSEPH'S HEALTH SYSTEM INC	Yes
(184)ST AGNES CONTINUING CARE CENTER ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2840137	PACE PROGRAM	PA	501(C)(3)	LINE 3	MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA	Yes
(185)ST AGNES CONTINUING CARE CENTER FOUNDATION ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN,PA19428 23-2415137	FOUNDATION	PA	501(C)(3)	LINE 11A, I	ST AGNES CONTINUING CARE CENTER	Yes
(186)ST FRANCIS FOUNDATION PO BOX 2500 WILMINGTON,DE19805 51-0374158	FOUNDATION	DE	501(C)(3)	LINE 11A, I	ST FRANCIS HOSPITAL	Yes
(187)ST FRANCIS HOSPITAL INC PO BOX 2500 WILMINGTON,DE19805 51-0064326	HEALTHCARE AND HOSPITAL SERVICES	DE	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(188)ST FRANCIS MEDICAL CENTER FOUNDATION INC 601 HAMILTON AVENUE TRENTON,NJ08629 52-1025476	FOUNDATION	NJ	501(C)(3)	LINE 7	ST FRANCIS MEDICAL CENTER TRENTON NJ	Yes
(189)ST FRANCIS MEDICAL CENTER TRENTON NJ 601 HAMILTON AVENUE TRENTON,NJ08629 22-3431049	HEALTHCARE AND HOSPITAL SERVICES	NJ	501(C)(3)	LINE 3	MAXIS HEALTH SYSTEM	Yes
(190)ST JAMES MERCY HEALTH SYSTEM INC 411 CANISTEO STREET HORNELL,NY14843 22-3127184	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	NY	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(191)ST JAMES MERCY HOSPITAL 411 CANISTEO STREET HORNELL,NY14843 16-0743310	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST JAMES MERCY HEALTH SYSTEM INC	Yes
(192)ST JOSEPH MERCY OAKLAND FOUNDATION 44405 WOODWARD AVE PONTIAC,MI48341 35-2356789	FOUNDATION	MI	501(C)(3)	LINE 11A, I	TRINITY HEALTH-MICHIGAN	Yes
(193)ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SOUTHERN PINES,NC28387 56-0694200	LONG TERM CARE	NC	501(C)(3)	LINE 3	TRINITY CONTINUING CARE SERVICES	Yes
(194)ST JOSEPH'S COLLEGE OF NURSING AT ST JOSEPH'S HOSPITAL HEALTH CENTER 206 PROSPECT AVENUE SYRACUSE,NY13203 20-2497520	COLLEGE OF NURSING	NY	501(C)(3)	LINE 2	ST JOSEPH'S HOSPITAL HEALTH CENTER	Yes
(195)ST JOSEPH'S HEALTH CENTER PROPERTIES INC 301 PROSPECT AVENUE SYRACUSE,NY13203 23-7219294	BUILDING MANAGEMENT SERVICES	NY	501(C)(3)	LINE 11B, II	ST JOSEPH'S HEALTH INC	Yes
(196)ST JOSEPH'S HEALTH INC 301 PROSPECT AVENUE SYRACUSE,NY13203 47-4754987	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	NY	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION	Yes
(197)ST JOSEPH'S HOSPITAL HEALTH CENTER 301 PROSPECT AVENUE SYRACUSE,NY13203 15-0532254	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST JOSEPH'S HEALTH INC	Yes
(198)ST JOSEPH'S HOSPITAL HEALTH CENTER FOUNDATION INC 301 PROSPECT AVENUE SYRACUSE,NY13203 22-2149775	FOUNDATION	NY	501(C)(3)	LINE 11A, I	ST JOSEPH'S HEALTH INC	Yes
(199)ST JOSEPH'S MEDICAL PC 301 PROSPECT AVENUE SYRACUSE,NY13203 27-3899821	HEALTHCARE SERVICES	NY	501(C)(3)	LINE 11A, I	ST JOSEPH'S HOSPITAL HEALTH CENTER	Yes
(200)ST JOSEPH'S PHYSICIAN HEALTH PC 301 PROSPECT AVENUE SYRACUSE,NY13203 16-1516863	HEALTHCARE SERVICES	NY	501(C)(3)	LINE 11A, I	ST JOSEPH'S HOSPITAL HEALTH CENTER	Yes
(201)ST MARY BUILDING AND DEVELOPMENT COMPANY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 46-1827502	TITLE HOLDING COMPANY	PA	501(C)(2)	N/A	ST MARY MEDICAL CENTER	Yes
(202)ST MARY EMERGENCY MEDICAL SERVICES 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 46-5354512	HEALTHCARE SERVICES	PA	501(C)(3)	LINE 9	ST MARY MEDICAL CENTER	Yes
(203)ST MARY HOME INCORPORATED 2021 ALBANY AVENUE WEST HARTFORD,CT06117 06-0646843	LONG TERM CARE	CT	501(C)(3)	LINE 3	MERCY COMMUNITY HEALTH INC	Yes
(204)ST MARY MEDICAL CENTER 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-1913910	HEALTHCARE AND HOSPITAL SERVICES	PA	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(205)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	Yes
(206)ST MARY'S FOUNDATION INC 1230 BAXTER STREET ATHENS,GA30606 58-2544232	FOUNDATION	GA	501(C)(3)	LINE 11A, I	ST MARY'S HEALTH CARE SYSTEM INC	Yes
(207)ST MARY'S HEALTH CARE SYSTEM INC 1230 BAXTER STREET ATHENS,GA30606 58-0566223	HEALTHCARE AND HOSPITAL SERVICES	GA	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(208)ST MARY'S HIGHLAND HILLS INC 1230 BAXTER STREET ATHENS,GA30606 02-0576648	SENIOR LIVING COMMUNITY	GA	501(C)(3)	LINE 3	ST MARY'S HEALTH CARE SYSTEM INC	Yes
(209)ST MARY'S MEDICAL GROUP INC 1230 BAXTER STREET ATHENS,GA30606 26-1858563	HEALTHCARE SERVICES	GA	501(C)(3)	LINE 3	ST MARY'S HEALTH CARE SYSTEM INC	Yes
(210)ST MARY'S SACRED HEART HOSPITAL INC 367 CLEAR CREEK PARKWAY LAVONIA,GA30553 47-3752176	HEALTHCARE AND HOSPITAL SERVICES	GA	501(C)(3)	LINE 3	ST MARY'S HEALTH CARE SYSTEM INC	Yes
(211)ST MICHAEL'S FOUNDATION INC 111 CENTRAL AVENUE NEWARK,NJ07102 22-3311976	FOUNDATION	NJ	501(C)(3)	LINE 11A, I	SAINT MICHAEL'S MEDICAL CENTER	Yes
(212)ST PETER'S HEALTH CARE SERVICES 315 SOUTH MANNING BLVD ALBANY,NY12208 22-2702507	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	NY	501(C)(3)	LINE 9	ST PETER'S HEALTH PARTNERS	Yes
(213)ST PETER'S HEALTH PARTNERS 315 SOUTH MANNING BLVD ALBANY,NY12208 45-3570715	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	NY	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(214)ST PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES PC 315 SOUTH MANNING BLVD ALBANY,NY12208 46-1177336	HEALTHCARE SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(215)ST PETER'S HOSPITAL 315 SOUTH MANNING BLVD ALBANY,NY12208 14-1348692	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(216)ST PETER'S HOSPITAL FOUNDATION INC 319 SOUTH MANNING BLVD ALBANY,NY12208 22-2262982	FOUNDATION	NY	501(C)(3)	LINE 7	ST PETER'S HEALTH PARTNERS	Yes
(217)SUNNYVIEW HOSPITAL & REHABILITATION CENTER 1270 BELMONT AVE SCHENECTADY,NY12308 14-1338386	HEALTHCARE AND HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(218)SUNNYVIEW HOSPITAL & REHABILITATION CENTER FOUNDATION INC 1270 BELMONT AVE SCHENECTADY,NY12308 22-2505127	FOUNDATION	NY	501(C)(3)	LINE 11A, I	SUNNYVIEW HOSPITAL & REHABILITATION CENTER	Yes
(219)THE COMMUNITY HOSPICE FOUNDATION INC 295 VALLEY VIEW BLVD RENSSELAER,NY12144 22-2692940	FOUNDATION	NY	501(C)(3)	LINE 7	THE COMMUNITY HOSPICE INC	Yes
(220)THE COMMUNITY HOSPICE INC 295 VALLEY VIEW BLVD RENSSELAER,NY12144 14-1608921	HOSPICE SERVICES	NY	501(C)(3)	LINE 3	ST PETER'S HEALTH PARTNERS	Yes
(221)THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER 707 EAST CEDAR STREET SOUTH BEND,IN46617 35-1654543	FOUNDATION	IN	501(C)(3)	LINE 7	SAINT JOSEPH REGIONAL MEDICAL CENTER INC	Yes
(222)THE JAMES A EDDY MEMORIAL GERIATRIC CENTER INC 2256 BURDETT AVE TROY,NY12180 22-2570478	LONG TERM CARE	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(223)THE MARJORIE DOYLE ROCKWELL CENTER INC 421 WEST COLUMBIA ST COHOES,NY12047 14-1793885	LONG TERM CARE	NY	501(C)(3)	LINE 9	LTC (EDDY) INC	Yes
(224)THE NORTHEAST HEALTH FOUNDATION INC 2224 BURDETT AVE TROY,NY12180 22-2743478	FOUNDATION	NY	501(C)(3)	LINE 7	ST PETER'S HEALTH PARTNERS	Yes
(225)THE WOMEN'S AUXILIARY OF SAINT FRANCIS HOSPITAL AND MEDICAL CENTER INC 114 WOODLAND STREET HARTFORD,CT06105 06-0660403	VOLUNTEER SERVICE AUXILIARY	CT	501(C)(3)	LINE 11A, I	N/A		No
(226)TRI-HOSPITAL EMERGENCY MEDICAL SERVICES 309 GRAND RIVER PORT HURON,MI48060 38-2485700	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 11D, III-O	N/A		No
(227)TRI-HOSPITAL MRI CENTER 4190 24TH AVENUE FORT GRATIOT,MI48054 38-2884297	HEALTHCARE SERVICES	MI	501(C)(3)	LINE 3	TRINITY HEALTH-MICHIGAN	Yes
(228)TRINITY CONTINUING CARE SERVICES PO BOX 9184 FARMINGTON HILLS,MI48333 38-2559656	LONG TERM CARE	MI	501(C)(3)	LINE 9	TRINITY HEALTH CORPORATION	Yes
(229)TRINITY CONTINUING CARE SERVICES - INDIANA INC PO BOX 9184 FARMINGTON HILLS,MI48333 93-0907047	LONG TERM CARE	IN	501(C)(3)	LINE 9	TRINITY CONTINUING CARE SERVICES	Yes
(230)TRINITY HEALTH - MICHIGAN 20555 VICTOR PARKWAY LIVONIA,MI48152 38-2113393	HEALTHCARE AND HOSPITAL SERVICES	MI	501(C)(3)	LINE 3	TRINITY HEALTH CORPORATION	Yes
(231)TRINITY HEALTH - NEW ENGLAND INC (FKA SAINT FRANCIS CARE INC) 114 WOODLAND STREET HARTFORD,CT06105 06-1491191	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	CT	501(C)(3)	LINE 11A, I	TRINITY HEALTH CORPORATION	Yes
(232)TRINITY HEALTH CORPORATION 20555 VICTOR PARKWAY LIVONIA,MI48152 35-1443425	HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT	IN	501(C)(3)	LINE 11B, II	CATHOLIC HEALTH MINISTRIES	Yes
(233)TRINITY HEALTH LIFE PENNSYLVANIA INC 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 47-5244984	PACE PROGRAM	PA	501(C)(3)	LINE 9	TRINITY HEALTH PACE	Yes
(234)TRINITY HEALTH PACE 20555 VICTOR PARKWAY LIVONIA,MI48152 47-3073124	PACE PROGRAM	MI	501(C)(3)	LINE 11B, II	TRINITY HEALTH CORPORATION	Yes
(235)TRINITY HEALTH WELFARE BENEFIT TRUST 20555 VICTOR PARKWAY LIVONIA,MI48152 20-8151733	RETIREE MEDICAL AND RETIREE LIFE INSURANCE	MI	501(C)(9)	N/A	TRINITY HEALTH CORPORATION	Yes
(236)TRINITY HOME HEALTH SERVICES 17410 COLLEGE PARKWAY STE 150 LIVONIA,MI48152 38-2621935	MANAGEMENT SERVICES FOR HOME HEALTH SYSTEM	MI	501(C)(3)	LINE 9	TRINITY HEALTH CORPORATION	Yes
(237)UIHLEIN MERCY CENTER 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE,PA19073 15-0532190	HEALTHCARE SERVICES (INACTIVE)	NY	501(C)(3)	LINE 3	MERCY UIHLEIN HEALTH CORPORATION	Yes
(238)UNIVERSITY HEIGHTS PROPERTY COMPANY INC 111 CENTRAL AVENUE NEWARK,NJ07102 22-3100162	TITLE HOLDING COMPANY	NJ	501(C)(2)	N/A	SAINT MICHAEL'S MEDICAL CENTER	Yes
(239)VILLA MARY IMMACULATE 301 HACKETT BLVD ALBANY,NY12208 14-1438749	LONG TERM CARE	NY	501(C)(3)	LINE 3	ST PETER'S HOSPITAL	Yes
(240)WESTSHORE HEALTH NETWORK 1820 44TH STREET KENTWOOD,MI49508 38-3280200	HEALTH NETWORK	MI	501(C)(4)	N/A	MERCY HEALTH PARTNERS	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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 V-UBI 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 V-UBI 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) CATHERINE HORAN BUILDING ASSOCIATES LP 1221 MAIN STREET SUITE 105 HOLYOKE,MA01040 04-2723429	PROPERTY MANAGEMENT	MA	N/A
(4) CENTENNIAL SURGUNIT LLC 502 CENTENNIAL BLVD SUITE 1 VOORHEES,NJ08043 22-3580847	HEALTHCARE SERVICES	NJ	N/A
(5) CENTER FOR DIGESTIVE CARE LLC 5300 ELLIOTT DRIVE YPSILANTI,MI48197 03-0447062	PROVIDE GASTROINTESTINAL SERVICES	MI	N/A
(6) CENTRAL NEW JERSEY HEART SERVICES LLC PO BOX 148 BAYONNE,NJ07002 20-8525458	CARDIAC PROGRAM	NJ	N/A
(7) CLINTON IMAGING SERVICES LLC 615 VALLEY VIEW DR STE 202 MOLINE,IL61265 41-2044739	MRI DIAGNOSTIC SERVICES	IA	N/A
(8) EAST NORRITON MEDICAL ASSOCIATES ONE WEST ELM STREET CONSHOHOCKEN,PA19428 23-2319531	MEDICAL OFFICE BUILDING	PA	N/A
(9) 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	1,847,121	443,624		No		Yes		52.890 %
(10) FRANCES WARDE MEDICAL LABORATORY 300 WEST TEXTILE ROAD ANN ARBOR,MI48104 38-2648446	LABORATORY	MI	N/A
(11) FRESNO IMAGING CENTER 1303 E HERNDON AVE FRESNO,CA93720 77-0363563	FORMERLY DIAGNOSTIC IMAGING, IN DISSOLUTION	CA	N/A
(12) GATEWAY HEALTH PLAN LP 444 LIBERTY AVE PITTSBURGH,PA15222 25-1691945	MEDICAID & MEDICARE/SPECIAL NEEDS MANAGED CARE ORGANIZATION	PA	N/A
(13) GREATER HARTFORD LITHOTRIPSY LLC 144 WOODLAND ST HARTFORD,CT06105 06-1578891	LITHOTRIPSY SERVICES	CT	N/A
(14) HAWARDEN REGIONAL HEALTH CLINICS LLC 1122 AVENUE L HAWARDEN,IA51023 20-1444339	MEDICAL CLINIC	IA	N/A
(15) IDAHO ASC HOLDINGS LLC 1055 N CURTIS ROAD BOISE,ID83706 36-4729605	HOLDING COMPANY FOR AMBULATORY SURGERY	ID	N/A
(16) INNOVATIVE HEALTH ALLIANCE OF NEW YORK LLC 14 COLUMBIA CIRCLE DRIVE ALBANY,NY12203 46-5676066	ACCOUNTABLE CARE ORGANIZATION	NY	N/A
(17) LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 36-4119522	SURGICAL SERVICES	IL	N/A
(18) MAGNETIC RESONANCE SERVICES PARTNERSHIP 1416 SIXTH STREET SW MASON CITY,IA50401 42-1328388	MRI SERVICES	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	967,889	19,658		No		Yes		49.000 %
(19) 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	3,571,306	3,211,995		No		Yes		51.000 %
(20) MCE MOB IV LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 42-1544707	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(21) MCMC POB III LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1392994	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(22) MDRMRI TECHNICAL SERVICES LLC 5640 EAST TAFT ROAD 3770 SYRACUSE,NY13220 16-1590982	MRI SERVICES	NY	N/A
(23) MEDILUCENT MOB I 793 W STATE STREET COLUMBUS,OH43222 20-4911370	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(24) MEDWORKS LLC 375 EAST CEDAR STREET NEWINGTON,CT06111 06-1490483	REHABILITATION SERVICES	CT	N/A
(25) MERCY ADVANCED MRI LLC 2525 SOUTH MICHIGAN AVE CHICAGO,IL60616 26-2116721	SUBLEASE MRI EQUIPMENT	IL	N/A
(26) MERCY HEART CTR OP SERVICES LLC 1000 4TH STREET SW MASON CITY,IA50401 13-4237594	CARDIOVASCULAR SERVICES	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	155,768	269,132		No			No	51.000 %
(27) MERCYMANOR PARTNERSHIP PO BOX 10086 TOLEDO,OH43699 52-1931012	NURSING HOME	PA	N/A
(28) MERCYUSP HEALTH VENTURES LLC 15305 DALLAS PARKWAY STE 1600 LB 28 ADDISON,TX75001 47-1290300	OUTPATIENT SURGERY	IA	MERCY HEALTH SERVICES-IOWA CORP	RELATED	9,073,406	64,884,989		No			No	55.710 %
(29) MOUNT CARMEL EAST POB III LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1369473	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(30) NAZARETH MEDICAL OFFICE BUILDING ASSOCIATES LP C/O NAZARETH HOSP 2601 HOLME AVE PHILADELPHIA,PA19152 23-2388040	MEDICAL OFFICE BUILDING	PA	N/A
(31) NEWCO AMBULATORY SURGERY CTR LLP 4190 24TH AVENUE FORT GRATIOT,MI48059 30-0136708	OUTPATIENT SURGERY CENTER	MI	N/A
(32) PHYSICIANS OUTPATIENT SURGERY CENTER LLC 1000 NE 56TH STREET OAKLAND PARK,FL33334 35-2325646	AMBULATORY SURGERY CENTER	FL	N/A
(33) RADISSON SJH PROPERTIES LLC 5000 CAMPUSWOOD DRIVE SUITE 100 EAST SYRACUSE,NY13057 46-1892799	MEDICAL OFFICE BUILDING	NY	N/A
(34) SARMED OUTPATIENT PHARMACY LLC 999 N CURTIS RD STE 102 BOISE,ID83706 51-0483218	PHARMACY	ID	N/A
(35) SIXTY FOURTH STREET LLC 2373 64TH ST STE 2200 BYRON CENTER,MI49315 20-2443646	PROVIDE OUTPATIENT SURGICAL CARE	MI	N/A
(36) SJLS LLC 7650 SE 27TH ST STE 200 MERCER ISLAND,WA98040 20-1796650	DIALYSIS SERVICES	NY	N/A
(37) SJV MANAGEMENT LLC 200 CENTURY PKWY STE 200E MOUNT LAUREL,NJ08054 20-2273476	RADIOLOGY	NJ	N/A
(38) SMMC MOB II LP 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 36-4559869	INVESTMENT AND OPERATION OF A MEDICAL BUILDING	PA	N/A
(39) 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
(40) ST ALPHONSUS CALDWELL CANCER CTR LLC 3123 MEDICAL DR CALDWELL,ID83605 82-0526861	HEALTH CARE SERVICES	ID	N/A
(41) ST ANN'S MEDICAL OFFICE BLDG II LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS,OH43222 31-1603660	MEDICAL OFFICE BUILDING RENTAL	OH	N/A
(42) ST JOSEPH'S IMAGING ASSOCIATES PLLC 104 UNION AVE SUITE 905 SYRACUSE,NY13203 16-1104293	RADIOLOGY SERVICES	NY	N/A
(43) ST MARY REHABILITATION HOSPITAL LLP 680 SOUTH FORTH STREET LOUISVILLE,KY40202 27-3938747	HEALTHCARE SERVICES	DE	N/A
(44) ST PETER'S AMBULATORY SURGERY CENTER LLC 1375 WASHINGTON AVENUE STE 201 ALBANY,NY12206 46-0463892	OUTPATIENT SURGERY	NY	N/A
(45) TAMARACK MEDICAL CLINIC LLC 402 LAKE CASCADE PARKWAY CASCADE,ID83611 20-1637921	OUTPATIENT MEDICAL SERVICES	ID	N/A
(46) THE AMBULATORY SURGERY CENTER AT ST MARY LLC 1203 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2871206	OUTPATIENT SURGERY	PA	N/A
(47) TOTAL LAUNDRY COLLABORATIVE LLC 114 WOODLAND STREET HARTFORD,CT06105 20-8335788	LAUNDRY SERVICES	CT	N/A
(48) TRINITY HEALTH PARTNERS LLC 20555 VICTOR PARKWAY LIVONIA,MI48152 47-2798085	POPULATION HEALTH MANAGEMENT	DE	N/A
(49) WOODLAND IMAGING CENTER LLC 5301 E HURON RIVER DR ANN ARBOR,MI48106 76-0820959	RADIOLOGY/ IMAGING	MI	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on 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) AFFILIATED MANAGEMENT SERVICES CORPORATION INC 1300 MASSACHUSETTS AVENUE TROY,NY12180 14-1668024	REAL ESTATE	NY	N/A	C				Yes
(2) CARBONDALE PHYSICIANS' SERVICES INC 100 LINCOLN AVE CARBONDALE,PA18407 23-2365077	PHARMACY	PA	N/A	C				Yes
(3) CATHERINE HORAN BUILDING CORP 1233 MAIN STREET HOLYOKE,MA01040 04-2938160	BUILDING MANAGEMENT	MA	N/A	C				Yes
(4) CHESTNUT RISK SERVICES LTD 11 VICTORIA STREET HAMILTON BD	INSURANCE	BD	N/A	C				Yes
(5) DIVERSIFIED COMMUNITY SERVICES INC 1233 MAIN STREET HOLYOKE,MA01040 04-3128890	MEDICAL SERVICES	MA	N/A	C				Yes
(6) FHS SERVICES INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT,NY13214 27-2995699	MEDICAL SERVICES	NY	N/A	C				Yes
(7) FRANCISCAN ASSOCIATES INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT,NY13214 20-2991688	MEDICAL SERVICES	NY	N/A	C				Yes
(8) FRANCISCAN HEALTH SUPPORT INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT,NY13214 16-1236354	MEDICAL SERVICES	NY	N/A	C				Yes
(9) FRANCISCAN MANAGEMENT SERVICES INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT,NY13214 16-1351193	MANAGEMENT SERVICES	NY	N/A	C				Yes
(10) GOTTLIEB MANAGEMENT SERVICES INC 701 W NORTH AVE MELROSE PARK,IL60160 36-3330529	MANAGEMENT SERVICES	IL	N/A	C				Yes
(11) HEF INC 1820 44TH STREET SE KENTWOOD,MI49508 38-3086401	OFFICE STAFFING	MI	N/A	C				Yes
(12) HACKLEY HEALTH MANAGEMENT INC 1820 44TH STREET SE KENTWOOD,MI49508 38-2961814	WEIGHT MANAGEMENT	MI	N/A	C				Yes
(13) HACKLEY HEALTH VENTURES INC 1820 44TH STREET SE KENTWOOD,MI49508 38-2589959	OTHER MEDICAL SERVICES	MI	N/A	C				Yes
(14) HACKLEY HEALTHCARE EQUIPMENT CORP 1820 44TH STREET SE KENTWOOD,MI49508 38-2578569	HOME MEDICAL EQUIPMENT	MI	N/A	C				Yes
(15) HACKLEY PROFESSIONAL CENTER INC 1820 44TH STREET SE KENTWOOD,MI49508 38-3024797	REAL ESTATE RENTAL	MI	N/A	C				Yes
(16) HACKLEY PROFESSIONAL PHARMACY INC 1820 44TH STREET SE KENTWOOD,MI49508 38-2447870	PHARMACY	MI	N/A	C				Yes
(17) HEALTH CARE MANAGEMENT ADMINISTRATORS INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT,NY13214 16-1450960	HEALTHCARE MANAGEMENT	NY	N/A	C				Yes
(18) HEALTH MANAGEMENT SERVICES ORG INC 500 GROVE STREET SUITE 100 HADDON HEIGHTS,NJ08035 22-3366580	MEDICAL ADMINISTRATION	NJ	N/A	C				Yes
(19) HOLY CROSS PRIVATE HOME SERVICES CORP 1500 FOREST GLEN RD SILVER SPRING,MD20910 52-1986562	HOME CARE SERVICES	MD	N/A	C				Yes
(20) HPC CO-OWNERS ASSOCIATION 1700 CLINTON MUSKEGON,MI49442 27-0734448	CONDOMINIUM ASSOCIATION	MI	N/A	C				Yes
(21) HURON ARBOR CORPORATION 5301 EAST HURON RIVER DR YPSILANTI,MI48197 38-2475644	PROVIDES OFFICE RENTAL SPACE	MI	N/A	C				Yes
(22) IHA AFFILIATION CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR,MI48106 38-3188895	MEDICAL MANAGEMENT	MI	N/A	C				Yes
(23) LANGHORNE SERVICES II INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 25-3795549	GENERAL PARTNER OF LMOB PARTNERS, II	PA	N/A	C				Yes
(24) LANGHORNE SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE,PA19047 23-2625981	GENERAL PARTNER OF LMOB PARTNERS	PA	N/A	C				Yes
(25) LIFECARE PHYSICIANS PC 601 HAMILTON AVENUE TRENTON,NJ08629 26-1649038	HEALTH CARE SERVICES	NJ	N/A	C				Yes
(26) LOURDES MEDICAL ASSOCIATES PA 500 GROVE STREET SUITE 100 HADDON HEIGHTS,NJ08035 22-3361862	MEDICAL SERVICES	NJ	N/A	C				Yes
(27) LOURDES URGENT CARE SERVICES PC 1600 HADDON AVENUE CAMDEN,NJ08103 46-4188202	URGENT CARE CENTER	NJ	N/A	C				Yes
(28) MARYLAND CARE GROUP INC 1500 FOREST GLEN RD SILVER SPRING,MD20910 52-1815313	HEALTHCARE HOLDING	MD	N/A	C				Yes
(29) MCMC EASTWICK INC C/O MHS ONE WEST ELM STREET STE 100 CONSHOHOCKEN,PA19428 23-2184261	MEDICAL OFFICE BUILDINGS	PA	N/A	C				Yes
(30) MEDNOW INC 1512 12TH AVENUE ROAD NAMPA,ID83686 82-0389927	MEDICAL SERVICES	ID	N/A	C				Yes
(31) MERCY INPATIENT MEDICAL ASSOCIATES INC 1233 MAIN STREET HOLYOKE,MA01040 04-3029929	MEDICAL SERVICES	MA	N/A	C				Yes
(32) MERCY MEDICAL SERVICES 801 5TH STREET SIOUX CITY,IA51101 42-1283849	PRIMARY CARE PHYSICIANS	IA	MERCY HEALTH SERVICES-IOWA CORP	C	-5,843,782	13,882,740	100.000 %	Yes
(33) MERCY SERVICES CORPORATION 2525 SOUTH MICHIGAN AVENUE CHICAGO,IL60616 36-3227348	DORMANT	IL	N/A	C				Yes
(34) MOUNT CARMEL HEALTH PROVIDERS INC 6150 EAST BROAD STREET COLUMBUS,OH43213 31-1382442	MEDICAL SERVICES	OH	N/A	C				Yes
(35) NURSING NETWORK INC 4725 NORTH FEDERAL HIGHWAY FORT LAUDERDALE,FL33308 59-1145192	MEDICAL SERVICES	FL	N/A	C				Yes
(36) PHYSICIANS MEDICAL OFFICE BUILDING CONDOMINIUM TRUST 1221 MAIN STREET SUITE 108 HOLYOKE,MA01040 04-6608649	PROPERTY MANAGEMENT	MA	N/A	C				Yes
(37) PRIORITY PLUS OF CALIFORNIA PO BOX 27230 FRESNO,CA93729 77-0395267	FORMERLY HLTH MGMT NOW DISCONTINUED OPERATIONS	CA	N/A	C				Yes
(38) PROVIDENCE HOME CARE INC 1233 MAIN STREET HOLYOKE,MA01040 04-3317426	HEALTH CARE SERVICES	MA	N/A	C				Yes
(39) SAINT ALPHONSUS HEALTH ALLIANCE INC 1055 NORTH CURTIS ROAD BOISE,ID83706 82-0524649	ACCOUNTABLE CARE ORGANIZATION	ID	N/A	C				Yes
(40) SAINT ALPHONSUS PHYSICIANS PA 1055 NORTH CURTIS ROAD BOISE,ID83706 33-1078261	HEALTH CARE SERVICES (INACTIVE)	ID	N/A	C				Yes
(41) SAINT FRANCIS BEHAVIORAL HEALTH GROUP PC 114 WOODLAND STREET HARTFORD,CT06105 06-1384686	MEDICAL SERVICES	CT	N/A	C				Yes
(42) SAINT FRANCIS CARE MEDICAL GROUP PC 114 WOODLAND STREET HARTFORD,CT06105 06-1432373	MEDICAL SERVICES	CT	N/A	C				Yes
(43) SAMARITAN MEDICAL OFFICE BUILDING INC 2212 BURDETT AVENUE TROY,NY12180 14-1607244	REAL ESTATE	NY	N/A	C				Yes
(44) SJM PROPERTIES INC 411 CANISTEO STREET HORNELL,NY14843 16-1294991	PROPERTY HOLDINGS	NY	N/A	C				Yes
(45) SJPE PRACTICE MANAGEMENT SERVICES INC 301 PROSPECT AVE SYRACUSE,NY13203 45-4164964	MANAGEMENT SERVICES	NY	N/A	C				Yes
(46) SJRMC HOLDINGS INC 5215 HOLY CROSS PARKWAY MISHAWAKA,IN46545 47-4763735	PROPERTY HOLDINGS	IN	N/A	C				Yes
(47) ST ELIZABETH HEALTH SUPPORT SERVICES INC 2209 GENESEE STREET UTICA,NY13501 16-1540486	MEDICAL SERVICES	NY	N/A	C				Yes
(48) ST MARY'S HIGHLAND HILLS VILLAGE INC 1230 BAXTER STREET ATHENS,GA30606 58-2276801	ASSISTED LIVING	GA	N/A	C				Yes
(49) SYSTEM COORDINATED SERVICES INC 1233 MAIN STREET HOLYOKE,MA01040 04-2938161	LAB SERVICES	MA	N/A	C				Yes
(50) THRE SERVICES LLC 20555 VICTOR PARKWAY LIVONIA,MI48152 45-2603654	REAL ESTATE BROKERAGE SERVICES	MI	N/A	C				Yes
(51) TRINITY ASSURANCE LTD PO BOX 1051 GRAND CAYMAN GRAND CAYMAN CJ 98-0453602	PROVISION OF INSURANCE COVERAGE	CJ	N/A	C				Yes
(52) TRINITY HEALTH ACO INC 20555 VICTOR PARKWAY LIVONIA,MI48152 47-3794666	ACCOUNTABLE CARE ORGANIZATION	DE	N/A	C				Yes
(53) TRINITY HEALTH EMPLOYEE BENEFIT TRUST 20555 VICTOR PARKWAY LIVONIA,MI48152 38-3410377	GRANTOR TRUST	MI	N/A	T				Yes
(54) TRINITY SENIOR SERVICES MANAGEMENT INC PO BOX 9184 FARMINGTON HILLS,MI48333 37-1572595	SENIOR SERVICES	PA	N/A	C				Yes
(55) WEST SHORE PROFESSIONAL BUILDING CONDOMINIUM 1820 44TH STREET SE KENTWOOD,MI49508 38-2700166	CONDOMINIUM ASSOCIATION	MI	N/A	C				Yes
(56) WORKPLACE HEALTH OF GRAND HAVEN INC 1820 44TH STREET SE KENTWOOD,MI49508 38-3112035	OCCUPATIONAL HEALTH	MI	N/A	C				Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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) ......................

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) ............................

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) DYERSVILLE MERCY HEALTH FOUNDATION INC	B	133,355	PER BOOKS
(2) TRINITY HEALTH CORPORATION	A	2,837	PER BOOKS
(3) TRINITY HEALTH CORPORATION	B	20,018,591	PER BOOKS
(4) TRINITY HEALTH CORPORATION	M	70,344,907	PER BOOKS
(5) TRINITY HEALTH CORPORATION	P	18,828,714	PER BOOKS
(6) TRINITY HEALTH CORPORATION	Q	6,099,210	PER BOOKS
(7) TRINITY HEALTH CORPORATION	R	6,970,926	PER BOOKS
(8) TRINITY HEALTH CORPORATION	S	292,285	PER BOOKS
(9) TRINITY CONTINUING CARE SERVICES	M	123,423	PER BOOKS
(10) MERCY HEART CTR OP SERVICES LLC	C	157,722	PER BOOKS
(11) MERCY HEART CTR OP SERVICES LLC	L	109,612	PER BOOKS
(12) FOREST PARK IMAGING LLC	C	1,549,782	PER BOOKS
(13) FOREST PARK IMAGING LLC	L	765,557	PER BOOKS
(14) HOSPICE OF NORTH IOWA	L	51,144	PER BOOKS
(15) HOSPICE OF NORTH IOWA	M	162,408	PER BOOKS
(16) HOSPICE OF NORTH IOWA	Q	583,336	PER BOOKS
(17) MERCY MEDICAL CENTER FOUNDATION-NORTH IOWA	B	135,784	PER BOOKS
(18) MERCY MEDICAL CENTER FOUNDATION-NORTH IOWA	C	188,381	PER BOOKS
(19) BAUM HARMON MERCY HOSPITAL	C	1,458,701	PER BOOKS
(20) BAUM HARMON MERCY HOSPITAL	L	104,813	PER BOOKS
(21) BAUM HARMON MERCY HOSPITAL	M	97,173	PER BOOKS
(22) BAUM HARMON MERCY HOSPITAL	P	205,008	PER BOOKS
(23) BAUM HARMON MERCY HOSPITAL	Q	314,946	PER BOOKS
(24) OAKLAND MERCY HOSPITAL	C	1,541,006	PER BOOKS
(25) OAKLAND MERCY HOSPITAL	L	86,454	PER BOOKS
(26) OAKLAND MERCY HOSPITAL	P	272,383	PER BOOKS
(27) OAKLAND MERCY HOSPITAL	Q	396,157	PER BOOKS
(28) MERCY MEDICAL SERVICES	B	6,827,082	PER BOOKS
(29) MERCY MEDICAL SERVICES	L	395,641	PER BOOKS
(30) MERCY MEDICAL SERVICES	M	219,573	PER BOOKS
(31) MERCY MEDICAL SERVICES	P	1,668,553	PER BOOKS
(32) MERCY MEDICAL SERVICES	Q	2,079,789	PER BOOKS
(33) MASON CITY AMBULATORY SURGERY CENTER LLC	C	3,254,452	PER BOOKS
(34) MASON CITY AMBULATORY SURGERY CENTER LLC	L	353,334	PER BOOKS
(35) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION	B	260,522	PER BOOKS
(36) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION	C	480,348	PER BOOKS
(37) MERCYUSP HEALTH VENTURES LLC	C	11,122,708	PER BOOKS
(38) DUBUQUE MERCY HEALTH FOUNDATION	C	1,549,540	PER BOOKS
(39) DUBUQUE MERCY HEALTH FOUNDATION	L	434,924	PER BOOKS
(40) MAGNETIC RESONANCE SERVICES PARTNERSHIP	C	937,564	PER TAX RETURN
(41) DYERSVILLE MERCY HEALTH FOUNDATION INC	C	121,175	PER BOOKS

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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 V-UBI 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HEALTHCARE AND HOSPITAL SERVICES
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	5,990
6	Total number of volunteers (estimate if necessary) .............	6	513
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	35,100,952
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,808,722	4,359,500
9	Program service revenue (Part VIII, line 2g) .........	661,183,514	659,260,674
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	10,851,691	-561,583
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	81,034,401	43,163,557
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	756,878,328	706,222,148
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,582,693	3,177,623
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)	305,037,333	320,917,451
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)....	375,779,003	383,190,852
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	683,399,029	707,285,926
19	Revenue less expenses. Subtract line 18 from line 12.......	73,479,299	-1,063,778
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	692,061,905	664,736,075
21	Total liabilities (Part X, line 26).............	295,404,928	280,892,360
22	Net assets or fund balances. Subtract line 21 from line 20.....	396,656,977	383,843,715

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 664,015,997 including grants of $ 3,177,623 ) (Revenue $ 663,529,429 )
	MERCY HEALTH SERVICES-IOWA (MHS-IA) IS COMPRISED OF FOUR HOSPITAL DIVISIONS IN THE STATE OF IOWA THAT PROVIDED OVER 149,000 PATIENT DAYS OF HEALTHCARE SERVICES TO THEIR COMMUNITIES THROUGHOUT THE STATE OF IOWA AND SURROUNDING STATES.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS, AND AWARDS: WWW.TRINITY-HEALTH.ORG/IOWA

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 expenses664,015,997

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,825,450	18,764,991	1,396,665

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,917,305
e	Government grants (contributions)		1e	679,787

f	All other contributions, gifts, grants, and similar amounts not included above		1f	762,408

g	Noncash contributions included in lines 1a-1f:$ 1,780
h Total.Add lines 1a-1f.......		4,359,500

			Business Code
2a	NET PATIENT SERVICE REVENUE	622110	602,956,942	602,956,942
b	PHARMACY REVENUE	446110	53,856,045	23,480,406	30,375,639
c	LABORATORY REVENUE	621500	2,447,687		2,447,687
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			659,260,674

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			3,149,769			3,149,769
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,478,098
b	Less: rental expenses		1,237,784
c	Rental income or (loss)		240,314
d	Net rental income or (loss)......			240,314			240,314
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	327,691
b	Less: cost or other basis and sales expenses	326,757	3,712,286
c	Gain or (loss)	934	-3,712,286
d	Net gain or (loss).....			-3,711,352			-3,711,352
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..
Business Code			Miscellaneous Revenue
11a	MANAGEMENT REVENUE		541618	3,777,189	2,375,275	1,401,914
b	CAFETERIA REVENUE		722514	3,475,842			3,475,842
c	GOV'T SUBSIDY-EHR		622110	954,723	954,723
d	All other revenue ....			34,715,489	33,762,083	875,712	77,694
e	Total. Add lines 11a–11d ......			42,923,243
12	Total revenue. See Instructions......			706,222,148	663,529,429	35,100,952	3,232,267

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	3,157,472	3,157,472
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	20,151	20,151
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 ....	5,068,570	186,768	4,881,802
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	2,619,024	43,435	2,575,589
7	Other salaries and wages	256,931,706	240,825,106	16,106,600
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,514,147	9,056,363	457,784
9	Other employee benefits .......	29,165,585	26,956,071	2,209,514
10	Payroll taxes ...........	17,618,419	16,094,663	1,523,756
11	Fees for services (non-employees):
a	Management ......	2,165,346	1,978,073	187,273
b	Legal .........	425,030		425,030
c	Accounting ...........	7,561		7,561
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	370,011		370,011
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	56,108,200	55,004,534	1,103,666
12	Advertising and promotion ....	2,085,309	1,904,958	180,351
13	Office expenses .......	10,648,560	9,727,603	920,957
14	Information technology ......	35,030,678	32,000,995	3,029,683
15	Royalties ..
16	Occupancy ...........	12,541,313	11,456,489	1,084,824
17	Travel ............	1,175,523	1,073,856	101,667
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	214,459	195,911	18,548
20	Interest ...........	6,654,639	6,654,639
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	38,278,825	34,968,221	3,310,604
23	Insurance ...	3,043,407	2,780,193	263,214
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	143,455,689	143,455,689
b	INTERCO. PURCHASED SVCS	24,496,058	22,377,478	2,118,580
c	BAD DEBT	16,232,703	16,232,703
d	UBI TAXES	24,235		24,235
e	All other expenses	30,233,306	27,864,626	2,368,680
25	Total functional expenses. Add lines 1 through 24e	707,285,926	664,015,997	43,269,929	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).

1	Cash–non-interest-bearing ........			6,013,938	1	4,731,541
2	Savings and temporary cash investments .........			394,548	2	395,119
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			82,163,740	4	82,168,618
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 ....			2,828,348	7	2,471,252
8	Inventories for sale or use ........			18,490,858	8	17,017,543
9	Prepaid expenses and deferred charges ......			1,776,930	9	2,068,095
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	643,849,179
b	Less: accumulated depreciation	10b	413,828,093	224,239,683	10c	230,021,086
11	Investments—publicly traded securities .			148,749,966	11	132,934,523
12	Investments—other securities. See Part IV, line 11 .....			137,018,734	12	118,625,384
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			70,385,160	15	74,302,914
16	Total assets. Add lines 1 through 15 (must equal line 34)...			692,061,905	16	664,736,075

17	Accounts payable and accrued expenses .....	73,238,731	17	65,339,480
18	Grants payable ...		18
19	Deferred revenue .........	252,570	19	1,445,068
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 ..	3,678,163	23	4,087,923
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	218,235,464	25	210,019,889
26	Total liabilities. Add lines 17 through 25..	295,404,928	26	280,892,360

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	396,295,815	27	383,498,186
28	Temporarily restricted net assets ...........	336,162	28	320,529
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 ...........	396,656,977	33	383,843,715
34	Total liabilities and net assets/fund balances ........	692,061,905	34	664,736,075