Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 3,494,204 | 3,068,267 | 4,668,553 | 4,616,326 | 3,220,033 | 19,067,383 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 3,494,204 | 3,068,267 | 4,668,553 | 4,616,326 | 3,220,033 | 19,067,383 |
| 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).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 19,067,383 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,494,204 | 3,068,267 | 4,668,553 | 4,616,326 | 3,220,033 | 19,067,383 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 57,858 | 49,616 | 24,590 | 9,270 | 29,957 | 171,291 |
| 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.).. | 330,299 | 305,358 | 210,146 | 190,333 | 195,591 | 1,231,727 |
| 11 | Total support. Add lines 7 through 10 | 20,470,401 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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.).. | ||||||
| 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 | ||||
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part II, Line 10 Other Income | DESCRIPTION - LABORATORY SERVICES, COLUMN A - 170298.0, COLUMN B - 158740.0, COLUMN C - 76591.0, COLUMN D - 41253.0, COLUMN E - 71443.0, COLUMN F - 518325.0; DESCRIPTION - CAFETERIA, COLUMN A - 160001.0, COLUMN B - 146618.0, COLUMN C - 133555.0, COLUMN D - 149080.0, COLUMN E - 124148.0, COLUMN F - 713402.0; |
| Software ID: | 18007697 |
| Software Version: | 2018v3.1 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS | I. INTRODUCTION: Organization's Mission, Vision, and Tax-Exempt Purpose In 1988, Iowa residents were confronted with data showing a high rate of infant mortality in Des Moines and Polk County. Many causes were cited: substance abuse; physical abuse; homelessness; lack of prenatal care; lack of insurance; and, all too often, simply a lack of hope. In response to this situation, Mercy Medical Center - Des Moines and the Sisters of Mercy, founded "House of Mercy." Sister Mary Brigid Condon led the charge, modeling it after the first "House of Mercy" founded in Dublin, Ireland by Sister Catherine McCauley, foundress of the Sisters of Mercy. Located on six acres of land in Des Moines' inner city, a federally designated Enterprise Community, House of Mercy's initial focus was on assisting pregnant, parenting, and non-parenting women in developing personal responsibility and independence through counseling, education, and primary medical care in collaboration with other providers. Over the years, House of Mercy's mission and services have expanded to address the unmet health and human service needs of those in the community. Today, MercyOne House of Mercy is active in its mission and vision to provide person-centered, behavioral health-focused services for people with substance use disorders and mental illness (regardless of gender and parenting status). House of Mercy strives to exceed client expectations and help them create a healthy lifestyle and sense of personal self-worth and well-being. In keeping with this vision House of Mercy is committed to: * Ensuring the safety, health, and well-being of children. * Building healthy families. * Supporting at-risk individuals in their development of a positive self-regard. * Assisting chemically dependent men and women, of all ages, in achieving and maintaining a life of quality recovery. * Assisting chemically dependent individuals in becoming self-sufficient through the enhancement of their educational status and development of the skills necessary to seek and maintain meaningful employment. * Promoting community behavioral health through the provision of quality outpatient behavioral health services to men and women of all ages. * Providing women and women with children with safe, secure, therapeutically supportive housing services. House of Mercy is included in the Official Catholic Directory as a tax-exempt entity. Services are provided to the community on a non-discriminatory basis and governed by a board in which independent persons, representative of the community, comprise the majority. House of Mercy receives funding from government-sponsored health care programs like Medicaid. II. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT Treatment Services Project Together offers residential substance use disorder treatment at High Intensity (3.5), Medium Intensity (3.3) and Low Intensity (3.1) to homeless/non-homeless, pregnant and/or parenting women who need assistance with recovery, self-sufficiency, parenting, and life skills. House of Mercy subscribes to a philosophy of care that focuses on access, engagement, retention, and outcomes. All participating persons in recovery have access to not only substance use disorder treatment services but also co-occurring treatment assistance (such as problem gambling, mental health, and physical health concerns) through a recovery-oriented system of care. Participants work with a counselor to develop and implement an individualized treatment plan that collaboratively addresses the issues which brought them to House of Mercy. Programming is holistic in scope, research/best practices-based, gender-specific, and unique in that it allows for mothers to pursue treatment while still residing with their children. Keeping mothers and their children together or reuniting them after a prolonged absence is important to the healing process. Participants (and their children) have access to: individual and group therapy; 12-step meetings; assertiveness/communication education; trauma education and counseling; mental health counseling; life skills education; smoking education and cessation services; primary medical care (including prenatal care); primary pediatric care (including immunizations); child care; therapeutic interventions to address relationship, sexual and physical abuse issues; gender specific services; urinalysis related to substance abuse services; and, parenting education and skill development sessions. When participants have demonstrated progress and stability in the areas of recovery and parenting, they expand their treatment focus to include self-sufficiency programming. This includes, but is not limited to, HiSET classes and college courses, job skill training sessions, employment search initiatives, money management and debt reparation activities, etc. All programming is respectful of client issues related to diversity including language, culture, religion, ethnicity, and disability. Specialized efforts are directed towards providing services sensitive to the needs of those served (e.g. interpreter services, use of culturally specific media, etc.). During the time period July 2018 through June 2019: 503 women and children received residential services resulting in 35,979 bed days of care being provided. House of Mercy Recovery Housing allows persons in recovery from a substance use disorder with high vulnerability more time to improve functioning while residing in an affordable, safe, clean, and supportive environment. The program is uniquely designed to assist tenants in living as independently as possible, in a permanent recovery-based setting. Supportive services that promote residential stability, increased skill level and/or income, and greater self-determination are provided/coordinated by staff in collaboration with community partners. All program participants are encouraged to: continue working a positive recovery program including serving as a support to other women in the program; develop a self-sufficiency program that has a full-time focus on either education, employment or a combination of the two; further develop critical life skills; and achieve stability with respect to decision making, emotional health circumstances, and relationship choices. All participants are expected to make a year-long commitment to the program with no maximum length of stay requirement. During the time period July 2018 through June 2019, 21 women and children participated in the program. Child Care Programming House of Mercy/John R. Grubb Child Development Center is a licensed and nationally accredited child-care facility that serves the children of House of Mercy's clientele. The center serves children six weeks old through school age. On average, twenty to thirty percent of the children residing at House of Mercy have been affected by the drug use of their mothers during pregnancy and as a result have special needs. Some of these children are developmentally delayed and suffer from fetal alcohol syndrome. All children at House of Mercy qualify as at-risk children. Services provided by the Child Development Center are available to any child of a client participating in House of Mercy's residential treatment program. A limited number of childcare slots are also available to clients participating in other House of Mercy services. Teachers provide a non-biased, multi-cultural, developmentally appropriate curriculum. Developmental assessments are completed regularly on all of the children to support their individual learning plans. Children are offered experiences designed to promote positive self-concept, social skills, critical thinking/problem solving, language development, physical development, and creative expression. Child Development Center staff also work with the clients to assist them in enhancing their existing skills and developing new, more effective parenting approaches. Parenting education is age specific and complimented by a structured daily "family activity" that focuses on assisting mothers in the development of the skills they require to interact appropriately with their children. Childcare services were provided to 122 children at House of Mercy during FY 2019. Community Services Programming Outpatient Counseling Services are available to children, adolescents, and adults and consist of: Level 0.5, Level I, and Level II.1 Substance Use Disorder Treatment services: Individual, Family, and Group Mental/Behavioral Health services and Behavioral Health Intervention services. House of Mercy subscribes to a philosophy of care that focuses on access, engagement, retention, and outcomes. All participating persons in recovery have access to not only substance abuse services but also co-occurring issues (such as problem gambling, mental health, and physical health concerns) through a recovery-oriented system of care. (Continued below) |
| Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS (Continued) | Substance Use Disorder Treatment services are available to any individual (regardless of age or gender) who needs support to establish and maintain a recovery program. All participants work with a certified addictions counselor to develop and implement an individualized treatment plan. Participants are involved in research based/best practices curriculum in the area of recovery (e.g. education in relapse prevention, early recovery skills, trauma and recovery). They receive individual and group therapy; case management services; and, encouraged to develop a support system within the community utilizing the 12-step program, SMART Recovery, etc. Clients participating in outpatient programming have access to a flexible menu of services including: individual and group counseling; chemical dependency related educational offerings; trauma education and counseling; therapeutic interventions to address relationship, sexual and physical abuse issues; gender specific services; urinalysis related to substance abuse services; parenting classes, and self-sufficiency activities (e.g., education and employment assistance). Continuing Care groups are open to anyone who could benefit from having additional therapeutic support in reinforcing a positive recovery outcome. These groups provide a group therapy format that participants can utilize for support as they face the daily challenges of reinforcing recovery, parenting and overall living skills on their own. Group sessions are facilitated by staff that are also available to provide individual therapy, as well as, case management services. Participants are encouraged to commit to their Continuing Care group for at least one year secondary to discharge yet can continue to attend indefinitely. During FY 2019, There were 1,780 individuals assessed and of those 864 admitted who received outpatient or continuing care substance use disorder services one or more times through this program. Mental and Behavioral Health services are provided by masters prepared, licensed therapists and are available to anyone with an identified/diagnosable mental health or behavioral health need. A board-certified psychiatrist is available to provide treatment oversight, evaluate medication needs, and provide additional needed mental health supports. House of Mercy mental health treatment services include, but are not limited to, individual, marital, family, and group therapy sessions, as well as, pharmacological interventions. Behavioral Health Intervention Services (BHIS) are available to children and adults. BHIS are intended to build skills and help reduce symptoms and behaviors that are associated with a diagnosed psychological disorder. BHIS are specifically designed to restore mental health functioning that the individual lost or never achieved because of interference in the normal maturational and learning process due to individual or parental dysfunction. Individuals receiving BHIS begin with a behavioral health assessment, which will determine a diagnosis and recommendation for service. A treatment plan is then established, where goals and objectives are specifically listed and outlined. Individual Interventions are provided through a predictable schedule of formal sessions that are directed at the cognitive and emotional dynamics that influence behavior. Family Interventions enhance the family's ability to effectively interact with the child and support the child's functioning. Crisis Interventions are unscheduled intensive interventions for the purpose of restoring adequate child or family functioning. During FY 2019, There were 721 adults and children who received outpatient Mental/Behavioral Health services one or more times through this program. Student Internships and Educational Programming are provided by House of Mercy for students from a variety of disciplines as part of its mission and purpose. Students are provided diverse "real life" experiences as they work on their degrees, from associate of arts to graduate level. A variety of human service and health care related professionals participate in programming at House of Mercy in order to gain valuable experience in real life work situations. Human services related learning experiences are available in such professional degree areas as counseling, addictions, vocational rehabilitation, human services, marriage/family counseling, children and family services, child development, etc. House of Mercy personnel are also available to provide educational programs on topics related to the various programs and services offered at House of Mercy. Staff frequently guest lecture at area schools, colleges and universities as a part of the facility's commitment to community education and outreach. |
| Form 990, Part VI, Line 15 PROCESS USED TO ESTABLISH COMPENSATION OF OFFICERS/KEY EMPLOYEES | During the tax year ended 6/30/2019, no officers, directors or trustees received compensation from the organization. Any executive compensation paid to officers, directors or trustees by related organizations was set by the related organization's compensation committee utilizing both an independent consultant and comparability studies to determine compensation. Therefore, these questions are more appropriately answered as N/A. |
| Form 990, Part VI, Line 12c Conflict of Interest Policy | c) Board evaluation of non-transactional conflicts - I. The board carefully reviews and scrutinizes any non-transactional conflict of interest (e.g., disclosure of nonpublic information, competition with CHI or a CHI entity, failure to disclose a corporate opportunity, excessive gifts or entertainment, etc.). II. In such circumstances, by a majority vote of the disinterested trustees, the board takes whatever action is deemed appropriate with respect to the trustee or corporate officer under the circumstances (including possible disciplinary or corrective action) to best protect the interests of CHI or the CHI entity. The board is encouraged to consult with the general counsel of CHI or his or her designee when considering disciplinary or corrective action. III. The conflicted trustee or corporate officer is not permitted to use his or her personal influence with respect to the conflict matter. However, if requested, such trustee or corporate officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from trustees, as his or her knowledge may be relevant. The trustee or corporate officer is excused from the meeting during discussion and vote on the conflict of interest. d) Record of proceedings - with respect to board member and officer conflicts of interest, minutes of the board are expected to reflect the identity of the individual making the disclosure, the nature of the disclosure, discussion regarding any proposed transaction, the decision made by the board, and that the interested trustee or corporate officer was excused during the discussion, and that the interested trustee abstained from voting. D. Conflicts reporting: All conflicts of interest are reported by CHI as required by law, regulations, and policy. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE ORGANIZATION'S SOLE CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA, CORP. DBA MERCY MEDICAL CENTER - DES MOINES, (CHI-IOWA CORP), AN IOWA NON-PROFIT CORPORATION. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | According to the organization's bylaws, directors shall be appointed or refused by CHI-Iowa Corp, the sole corporate member. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. (CHCF Reserved Rights) Except as otherwise provided in the Corporation's Articles of Incorporation or the laws of the State of organization, Catholic Health Care Federation ("CHCF") shall have such rights as are reserved to the Corporate Member, acting in its capacity as the membership body of CHCF, under the Governance Matrix. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | The organization's corporate member is CATHOLIC HEALTH INITIATIVES-IOWA, CORP. DBA MERCY MEDICAL CENTER-DES MOINES ("CHI-IOWA CORP"). Pursuant to the organization's bylaws, both CHI-IOWA CORP and CommonSpirit Health (CATHOLIC HEALTH INITIATIVES - IOWA, CORP's sole corporate member) have reserved powers as outlined in the CommonSpirit Health governance matrix. Pursuant to the governance matrix the following rights are held by the CHI-IOWA CORP Board: * Approve members of the HOUSE OF MERCY board * Amendment of the corporate documents of the HOUSE OF MERCY * Approve removal of a member of the governing body of the HOUSE OF MERCY * Adoption of long range and strategic plans for the HOUSE OF MERCY The following rights are reserved to the CommonSpirit Health Board directly or through powers delegated to the CommonSpirit Health Chief Executive Officer: * Substantial change in the mission or philosophy of the HOUSE OF MERCY * Removal of a member of the governing body of the HOUSE OF MERCY * Approval of issuance of debt by HOUSE OF MERCY * Approval of participation of HOUSE OF MERCY in a joint venture * Approval of formation of a new corporation by HOUSE OF MERCY * Approval of a merger involving the HOUSE OF MERCY * Approval of the sale of all or substantially all of the assets of the HOUSE OF MERCY * To require the transfer of assets by the HOUSE OF MERCY to CommonSpirit Health to accomplish CommonSpirit Health's goals and objectives, and to satisfy CommonSpirit Health debts. Pursuant to Section V of the organization's bylaws, CHI-IOWA CORP or CommonSpirit Health may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate." (CHCF Reserved Rights) Except as otherwise provided in the Corporation's Articles of Incorporation or the laws of the State of organization, Catholic Health Care Federation ("CHCF") shall have such rights as are reserved to the Corporate Member, acting in its capacity as the membership body of CHCF, under the Governance Matrix. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | ONCE THE RETURN IS PREPARED, THE CFO REVIEWS THE RETURN AND ANY NECESSARY REVISIONS ARE INCLUDED IN THE FINAL VERSION WHICH IS APPROVED FOR FILING WITH THE IRS. SUBSEQUENT TO REVIEW BY THE CHIEF FINANCIAL OFFICER, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. SUBSEQUENT TO E-FILING, THE FINAL E-FILED FORM 990 IS PRESENTED TO THE BOARD AT A REGULARLY SCHEDULED BOARD MEETING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization has a conflicts of interest ("COI") policy (the "policy") in place to maintain the integrity of its activities. Through February 7, 2019, conflicts were administered solely through Catholic Health Initiatives' ("CHI") Governance Policy No. 1 (described below). On February 8, 2019, in connection with the alignment of the Catholic Health Ministries of CHI and Dignity Health, the CommonSpirit Health Board of Stewardship Trustees approved CommonSpirit Health Corporate Responsibility Policy No. G-001, a CommonSpirit Health conflicts of interest policy. This policy stipulates that, at minimum, the pre-closing CHI COI policies and pre-closing Dignity Health COI policies identify the individuals that are covered under the new policy. In addition, subject to certain exceptions, pre-closing CHI COI policies shall continue to apply to the CHI entities and the individuals who were subject to the Pre-Closing CHI COI policies; and the Pre-Closing Dignity Health COI policies shall continue to apply to the Dignity Health entities and the individuals who were subject to the Pre-Closing Dignity Health COI policies. Until CommonSpirit Health adopts a single process for identifying and managing conflicts of interest for all system entities, the following individuals shall be subject to the Pre-Closing CHI COI policies from and after the effective date of Corporate Responsibility Policy No. G-001: 1. Members of the CommonSpirit Health Board of Stewardship Trustees and members of the committees of the Board of Stewardship Trustees; 2. Corporate officers of CommonSpirit Health; 3. Members of the Board of Directors of Dignity Health and members of the committees of the Board of Directors of Dignity Health. CHI Governance Policy No. 1: The policy applies to the following persons: members of the CHI board of stewardship trustees and its committees; members of any CHI direct affiliate or subsidiary (each a CHI entity) board and their committees; employees of CHI entities, and all CHI researchers (as defined in the policy). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure review process. A. Disclosure obligations: 1. Ongoing: Each person is required to promptly and fully disclose to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must disclose the actual or potential conflict as soon as she/he becomes aware of it. In any situation in which the person is in doubt it is expected that full disclosure be made to permit dan impartial and objective determination as to the existence of a conflict. 2. Periodic written: In addition to the ongoing disclosure obligation, periodic written conflict of interest disclosure forms must be completed as follows: a) Initially: 1) Upon hiring (employees), 2) Appointment (board / committee members), 3) Upon consideration of affiliation with research sponsor (researchers). b) Annually: 1) Board / committee members, 2) Employees at the level vice president or above, 3) Researchers, 4) Supply chain employees at the level of vice president and above and those employees involved in contracting regardless of employment level, 5) Other employees as determined by CommonSpirit Health leadership. 3. Failure to disclose - an individual who fails to disclose a perceived, potential, or actual conflict of interest, or all material facts surrounding an actual or potential conflict or fails to abide by the final decision regarding the conflict may be subject to disciplinary or corrective actions such as termination of employment, removal from a board or committee, loss or restriction of clinical privileges, or restrictions on research activities in accordance with applicable laws, regulations, rules, contracts, and bylaws. B. Conflicts review: 1. No disclosed conflicts: In the absence of perceived, potential or actual conflicts of interest, no follow-up conflicts review is required or performed. 2. Disclosure of perceived, potential or actual conflicts: a) Are initially reviewed by national or regional legal or corporate responsibility team members (depending upon the role of the individual disclosing the actual or potential conflict) to determine whether an actual or potential for a conflict may exist. b) If it is determined that a potential or actual conflict may exist, I. In the case of board or committee members or officers, issues are elevated to the executive committee of the board or board chair. II. In the case of other persons, conflicts issues are elevated to the conflicts of interest review committee ("C-CIRC"). C. Conflicts determination and management: 1. Matters elevated to C-CIRC: a) The C-CIRC determines whether a disclosed or otherwise identified interest is a conflict of interest. If the C-CIRC determines that a COI exists, and adequate controls are not in place to mitigate the conflict, the C-CIRC facilitates development of a COI management plan designed to mitigate the conflict. Designated entity staff are responsible for monitoring the COI management plan and for documenting monitoring activities. Notwithstanding the foregoing, at its sole discretion, an entity may reject a person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential conflict of interest. b) Appeal - if a person does not agree with a determination made by the C-CIRC, its interpretation of the COI policy, still seeks an exemption or exception, or seeks further clarification of the C-CIRC 's decision, the individual may appeal the decision through his or her manager for reconsideration by the C-CIRC, and the C-CIRC will review and issue a final determination based upon any new or additional information presented. 2. Matters elevated to the executive committee or board chair: a) Determination of existence of conflict - the board chair or his or her designee performs any further investigation of any conflict of interest disclosures as he or she may deem appropriate. If the conflict involves the board chair, the vice chair assumes the chair's role outlined in the COI policy. Based on review and evaluation of the relevant facts and circumstances, the board chair makes an initial determination as to whether a conflict of interest exists and whether, pursuant to the COI policy, review and approval or other action by the board is required. A written record of the board chair's determination, including relevant facts and circumstances, is made. The board chair then makes an appropriate report to the executive committee of the board concerning the COI review, evaluation and determination. If a difference of opinion exists between the board chair and another trustee as to whether the facts and circumstances of a given situation constitute a conflict of interest or whether board review and approval or other action is required under the COI policy, the matter is submitted to the board's executive committee, which makes a final determination as to the matter presented. That determination, including relevant facts and circumstances, is reflected in the executive committee minutes and is reported to the board. b) Board evaluation of transactions involving an officer / board member conflict of interest - I. The board carefully scrutinizes and must in good faith approve or disapprove any transaction in which CHI or a CHI entity is a party and in which the trustee or a corporate officer either: 1. Has a material financial interest; or 2. Is a trustee or corporate officer of the other party (other than a CHI affiliated organization). II. The board must approve the transaction by a majority of the trustees on the board (not counting any interested trustee). In reviewing such transactions between CHI or CHI entities and vendors or other contractors who are, or are affiliated with, trustees or corporate officers, the board acts no more or less favorably than it would in reviewing transactions with unrelated third parties. The transaction is not approved unless the board determines that the transaction is fair to CHI or the CHI entity. III. A conflicted trustee or corporate officer is not permitted to use his or her personal influence with respect to the approval or disapproval of the conflicted transaction. However, if requested, such trustee or corporate officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from trustees, as his or her knowledge may be relevant. The trustee or corporate officer is excused from the meeting during discussion and vote on the conflict of interest. (Continued below) |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in CommonSpirit Health's consolidated audited financial statements that are available at www.catholichealthinitiatives.org. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT, AND ON THE IOWA SECRETARY OF STATE'S WEBSITE. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. |
| Form 990, Part IX, Line 11g Other Fees | Other Fees for Services - Total Expense: 27640, Program Service Expense: 26258, Management and General Expenses: 1382, Fundraising Expenses: 0; Purchased Services - Total Expense: 168009, Program Service Expense: 159609, Management and General Expenses: 8400, Fundraising Expenses: 0; SALARIES AND WAGES - Total Expense: 3454442, Program Service Expense: 3371535, Management and General Expenses: 82907, Fundraising Expenses: 0; OTHER EMPLOYEE BENEFITS - Total Expense: 640953, Program Service Expense: 637107, Management and General Expenses: 3846, Fundraising Expenses: 0; PAYROLL TAXES - Total Expense: 249942, Program Service Expense: 243694, Management and General Expenses: 6248, Fundraising Expenses: 0; |
| Software ID: | 18007697 |
| Software Version: | 2018v3.1 |