2024-05-13T15:04:07-05:00 2023-06-30 990 2022-07-01 421178403 MERCY HOSPITAL OF FRANCISCAN SISTERS INC MERC 3192836000 201 8TH AVENUE SE OELWEIN IA 50662 TIMOTHY HUBER VP OF FINANCE 3192836000 2024-05-13 TIMOTHY HUBER 999009999 1 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z SEE SCHEDULE O FOR LIST RYAN MEYER 201 8TH AVENUE SE OELWEIN IA 50662 13773911 0 X WWW.MERCYONE.ORG/NORTHEASTIOWA/ X 1982 IA TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 8 4 157 44 0 0 16284 0 13356506 13641706 1222 8415 295156 120639 13669168 13770760 0 6000 0 0 7740948 7153833 0 0 0 7851699 7968273 15592647 15128106 -1923479 -1357346 6618301 13156742 1676785 1719706 4941516 11437036 X WE, MERCY HOSPITAL OF FRANCISCAN SISTERS AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. MERCY HOSPITAL OF FRANCISCAN SISTERS IS A MEMBER OF TRINITY HEALTH. 0 0 12466970 6000 13750798 MERCY HOSPITAL OF FRANCISCAN SISTERS (MERCYONE OELWEIN) IS A 25-BED, CRITICAL ACCESS HOSPITAL PROVIDING ACUTE AND OUTPATIENT CARE TO THE COMMUNITY AND SURROUNDING AREA OF OELWEIN, IOWA. MERCYONE OELWEIN PROVIDES ACUTE INPATIENT CARE, SWING BEDS AND SKILLED CARE, AS WELL AS 24-HOUR EMERGENCY ROOM COVERAGE STAFFED BY REGISTERED NURSES AND PHYSICIANS. MERCYONE OELWEIN PROVIDES AMBULANCE TRANSPORT AND SERVES AS THE EMERGENCY 911 RESPONDER FOR THE CITY OF OELWEIN. OTHER INPATIENT AND OUTPATIENT SERVICES INCLUDE RADIOLOGY WITH CT, MRI, 3D MAMMOGRAPHY, ULTRASOUND, AND DEXA; LABORATORY; INPATIENT PHARMACY; RESPIRATORY THERAPY; REHABILITATION THERAPIES (PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY); ECHO; STRESS TESTS; SLEEP LAB STUDIES; CARDIAC/PULMONARY REHAB; SPIRITUAL CARE; SOCIAL SERVICES AND NUTRITION COUNSELING. RADIOLOGY SERVICES ALSO OFFER BOTH NUCLEAR MEDICINE AND STEREOTACTIC BREAST BIOPSY THROUGH MOBILE UNITS.BEYOND PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTH CARE SERVICES DAILY, MERCYONE OELWEIN EXTENDS ITS HEALING MISSION INTO THE COMMUNITY THROUGH NUMEROUS PROGRAMS AND RESOURCES, INCLUDING OCCUPATIONAL HEALTH SERVICES, A MOBILE FOOD PANTRY IN PARTNERSHIP WITH THE NORTHEAST IOWA FOOD BANK, AND MANY OTHER GENERAL HEALTH EDUCATION AND SCREENING ACTIVITIES.PLEASE SEE SCHEDULE H AND VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES AND SPECIALTIES:WWW.MERCYONE.ORG/LOCATION/MERCYONE-OELWEIN-MEDICAL-CENTER 12466970 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 157 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TIMOTHY HUBER 3192727607 3421 WEST NINTH STREET WATERLOO IA 507025499 ROBERT RITZ DIRECTOR; CEO MERCY HEALTH NETWORK 1.00 54.00 X 0 1923691 64471 JACK DUSENBERY DIR & PRES, MERCYONE NE IA THR 4/23 1.00 49.00 X X 0 705049 45779 MATTHEW SOJKA MD VP, MEDICAL AFFAIRS 1.00 49.00 X 0 460897 43906 RACHELLE MAKINDE MD DIRECTOR; PHYSICIAN 1.00 49.00 X 0 449922 45723 BRIAN BURNETT MD DIRECTOR; PHYSICIAN 1.00 49.00 X 0 363552 59266 TIMOTHY HUBER ASSISTANT TREASURER; VP OF FINANCE 1.00 49.00 X 0 288515 59758 KELLY RICHARDS CHIEF NURSING OFFICER 1.00 49.00 X 0 261858 44208 RYAN MEYER VP, SITE ADMINISTRATOR 1.00 49.00 X 0 197415 36058 JILL GROTH VP, SITE ADMINISTRATOR 40.00 0.00 X 190477 0 35855 MARIUS BALOLA PHARMACIST 40.00 0.00 X 115946 0 40207 NICOLE STAHL REGISTERED NURSE 40.00 0.00 X 126660 0 24374 SHAWN SCHOULTZ REGISTERED NURSE 40.00 0.00 X 128848 0 19019 MARI SALLEE REGISTERED NURSE 40.00 0.00 X 104908 0 27266 KRIS BENGTSON REGISTERED NURSE 40.00 0.00 X 111339 0 16027 NANCY SCHAEFER ASSISTANT SECRETARY; EXEC ASSISTANT 1.00 39.00 X 0 65485 5395 DAVID DEAVER DIRECTOR; CHAIR 1.00 3.00 X X 0 0 0 SANDRA BENAK DIRECTOR 1.00 3.00 X 0 0 0 TIM BOETTGER DIRECTOR 1.00 3.00 X 0 0 0 SHIRLEY DUNLAP DIRECTOR THROUGH 12/22 1.00 2.00 X 0 0 0 ALAN KRUGER DIRECTOR 1.00 3.00 X 0 0 0 CASEY MCLAUGHLIN DIRECTOR THROUGH 12/22 1.00 2.00 X 0 0 0 GREGORY SCHMITZ DIRECTOR THROUGH 12/22 1.00 2.00 X 0 0 0 CAROL TOUSLEY DIRECTOR 1.00 3.00 X 0 0 0 778178 4716384 567312 7 0 1 0 ACUTE CARE INC 1609 N ANKENY BLVD SUITE 200 ANKENY IA 50023 PHYSICIAN SERVICES 3179595 LAWRENCE RECRUITING SPECIALIST PO BOX 850781 MINNEAPOLIS MN 55485 MEDICAL SERVICES 435053 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 299846 MEDICAL SOLUTIONS LLC PO BOX 850737 MINNEAPOLIS MN 55485 MEDICAL SERVICES 241460 GRAPETREE MEDICAL STAFFING PO BOX 5340 SIOUX FALLS SD 57117 MEDICAL SERVICES 223232 10 NET PATIENT SERVICE REVENUE 622110 13641706 13641706 13641706 11566 11566 11547 0 11547 11547 11547 3151 -3151 -3151 -3151 OTHER REVENUE 622110 109092 109092 109092 13770760 13750798 0 19962 X 6000 6000 226332 226332 5253422 5166011 87411 265238 263137 2101 1037710 1007325 30385 371131 355892 15239 3191646 2384495 807151 320 320 193176 168429 24747 421413 420578 835 6020 5954 66 1455 1455 796355 790876 5479 I/C PURCHASED SERVICES 1468439 40523 1427916 MEDICAL SUPPLIES EXP 1126047 1126047 BAD DEBT EXPENSE 508889 508889 EQUIPMENT MAINTENANCE 191567 190353 1214 62946 31006 31940 15128106 12466970 2661136 0 476230 1715187 1727750 94889 83240 29386 40993 11443391 683339 4228448 10760052 544707 74161 0 6618301 13156742 783335 1262793 18273 893450 438640 1676785 1719706 X 4867355 11378688 74161 58348 4941516 11437036 6618301 13156742 X -1357346 7852866 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 1739 0 0 1739 0 PART II-B, LINE 1: MERCY HOSPITAL OF FRANCISCAN SISTERS (MERCYONE OELWEIN) 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 MERCYONE OELWEIN WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 370000 370000 9457083 417183 9039900 1616308 266156 1350152 10760052 ASSET RETIREMENT OBLIGATION 416753 OTHER CURRENT LIABILITIES 21887 438640 1 1 X 1 X 1 X 1 1 0 1 1 117518 117518 0.00800 2936844 3082495 0 0.00000 3054362 3082495 117518 0.00800 7 754 85103 85103 0.00580 1 5 1994 1994 0.00010 1 6686 6686 0.00050 3 2598 7635 7635 0.00050 12 3357 101418 101418 0.00690 12 3357 3155780 3082495 218936 0.01490 5 2150 2150 0.00010 5 2150 2150 0.00010 1 508889 0 2868341 2865727 2614 X 1 1 1 1 MERCYONE OELWEIN MEDICAL CENTER 201 8TH AVENUE SE OELWEIN IA 50662 WWW.MERCYONE.ORG 330141H X X X X MERCYONE OELWEIN MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE SCHEDULE H, PART V, SECTION C X 1 21 1 SEE SCHEDULE H, PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 MERCYONE OELWEIN MEDICAL CENTER PART V, SECTION B, LINE 3J: N/ALINE 3E:MERCY HOSPITAL OF FRANCISCAN SISTERS, INC. (MERCYONE OELWEIN) INCLUDED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: - PREVENTION- MENTAL HEALTH- NUTRITION- SOCIAL AND ECONOMIC FACTORS- PHYSICAL ENVIRONMENT MERCYONE OELWEIN MEDICAL CENTER PART V, SECTION B, LINE 5: MERCYONE OELWEIN WORKED WITH FAYETTE COUNTY PUBLIC HEALTH AND THE HEALTHY FAYETTE COUNTY COALITION TO IDENTIFY AND ADDRESS NEEDS WITHIN THE COMMUNITY. ALTHOUGH FAYETTE COUNTY PUBLIC HEALTH IS ON A DIFFERENT CYCLE, THEIR DATA WAS UTILIZED TO DEVELOP THE ASSESSMENT AND IMPLEMENTATION PLAN. MERCYONE OELWEIN CONDUCTED A SURVEY IN APRIL 2022. POSTCARDS WERE SENT OUT TO ALL FAYETTE COUNTY RESIDENTS WITH INFORMATION AND A QR CODE TO ACCESS THE ONLINE SURVEY. FAYETTE COUNTY PUBLIC HEALTH ALSO PROMOTED THIS ON THEIR FACEBOOK ACCOUNT. FLYERS AND PAPER COPY SURVEYS WERE DISTRIBUTED TO 16 DIFFERENT LOCATIONS THROUGHOUT FAYETTE COUNTY. RESIDENTS ATTENDING THE MOBILE FOOD TRUCK IN APRIL 2022 WERE ALL ASKED TO COMPLETE A SURVEY WHILE WAITING IN LINE. SURVEYS WERE TAKEN TO THE DEPARTMENT OF CORRECTIONS AND INDIVIDUALS WORKING WITH THE DEPARTMENT OF HUMAN SERVICES WERE ALSO REQUESTED TO PARTICIPATE. HEALTHY FAYETTE COUNTY COALITION HAD PREVIOUSLY ESTABLISHED FOCUS AREAS BASED ON THEIR CHNA. THIS INFORMATION WAS UTILIZED IN THE DEVELOPMENT OF MERCYONE OELWEIN'S CHNA. HEALTHY FAYETTE COUNTY ALREADY HAD DEVELOPED WORKGROUPS SURROUNDING THE IDENTIFIED COMMUNITY HEALTH NEEDS. MERCYONE OELWEIN COLLABORATED WITH SEVERAL ORGANIZATIONS TO GATHER INFORMATION: FAYETTE COUNTY HEALTH DEPARTMENT, GUNDERSON PALMER LUTHERAN HEALTH, NORTH FAYETTE VALLEY COMMUNITY COALITION (NFVCC), HEALTHY FAYETTE COUNTY COALITION, AND HELPING SERVICES FOR YOUTH AND FAMILIES. MERCYONE OELWEIN MEDICAL CENTER PART V, SECTION B, LINE 6B: MERCYONE OELWEIN CONDUCTED THE CHNA WITH THE FOLLOWING ORGANIZATIONS: FAYETTE COUNTY PUBLIC HEALTH, NORTH FAYETTE VALLEY COMMUNITY COALITION (NFVCC), GUNDERSON PALMER LUTHERAN HEALTH, AND HEALTHY FAYETTE COUNTY COALITION. MERCYONE OELWEIN MEDICAL CENTER PART V, SECTION B, LINE 11: MERCYONE OELWEIN ACTIVELY PARTICIPATED IN THE HEALTHY FAYETTE COUNTY COALITION. A SENIOR COMMUNITY BENEFIT COORDINATOR SERVES ON THE LEADERSHIP TEAM, AS WELL AS PARTICIPATES IN THE THREE WORK GROUPS THAT MEET MONTHLY. QUARTERLY, ALL THREE WORKGROUPS COME TOGETHER. THE COALITION HAS BEEN HIGHLY ACTIVE IN IDENTIFYING WAYS IN WHICH ALL CAN WORK TOGETHER TO POSITIVELY IMPACT FAYETTE COUNTY.PREVENTION:MERCYONE OELWEIN, IN COLLABORATION AND SUPPORT WITH BLACK HAWK COUNTY PUBLIC HEALTH AND THE CARE FOR YOURSELF PROGRAM, PARTNERED TO OFFER FREE MAMMOGRAMS IN OCTOBER FOR WOMEN AGES FORTY AND OLDER WHO HAVE COST BARRIERS TO RECEIVING THEIR YEARLY MAMMOGRAM. MERCYONE OELWEIN HAS A COMMUNITY HEALTH WORKER (CHW) EMBEDDED IN THE CLINICAL TEAM IN CEDAR FALLS TO SUPPORT PATIENTS IN ADDRESSING HEALTH-RELATED SOCIAL NEEDS. MENTAL HEALTH:MERCYONE OELWEIN PARTNERED WITH COUNTY SOCIAL SERVICES TO OFFER MENTAL HEALTH FIRST AID TO EMPLOYEES. EIGHT EMPLOYEES AND ONE COMMUNITY PARTNER (DEPARTMENT OF CORRECTIONS) PARTICIPATED IN THIS 7-HOUR TRAINING AND RECEIVED THEIR MATERIALS FOR FREE. MERCYONE OELWEIN AND COUNTY SOCIAL SERVICES HAS WORKED WITH OELWEIN COMMUNITY SCHOOL TO GET MENTAL HEALTH FIRST AID ADDED TO THEIR PROFESSIONAL DEVELOPMENT CALENDAR IN FY24. MERCYONE OELWEIN HAS ONE KNOWN TRAINED 'MAKE IT OK' AMBASSADOR. NUTRITION:MERCYONE OELWEIN PROVIDED $6,000 OF RESTRICTED FINANCIAL CONTRIBUTIONS TO PLENTIFUL PANTRY. IN ADDITION, WE CONTINUED IN A MEMORANDUM OF UNDERSTANDING WITH THE PANTRY UNTIL JANUARY, WHEN THEY WERE ABLE TO GET THEIR OWN TAX-EXEMPT STATUS. MERCYONE OELWEIN HAS EMPLOYEES WHO VOLUNTEER AT THE PANTRY. MERCYONE OELWEIN DID NOT DIRECTLY ADDRESS ALL OF THE NEEDS IDENTIFIED IN THIS CHNA CYCLE DUE TO COMPETING PRIORITIES, LACK OF RESOURCES, AND OTHER AGENCIES AND ORGANIZATIONS ALREADY ADDRESSING THESE ISSUES. FOR THIS REASON, THE CATEGORIES OF SOCIAL AND ECONOMIC FACTORS (UNEMPLOYMENT, INCOME INEQUITY, POVERTY, CRIME, AND DEATH RATE) AND PHYSICAL ENVIRONMENT (AIR POLLUTION, HOUSING, AND COMMUTE DRIVING) WERE NOT ADDRESSED IN FY23. MERCYONE OELWEIN MEDICAL CENTER 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: ACCOUNTS DISCHARGED THROUGH BANKRUPTCY AND PATIENTS DETERMINED TO BE ELIGIBLE FOR IOWA MEDICAID. MERCYONE OELWEIN MEDICAL CENTER - PART V, SECTION B, LINE 7A: WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/ MERCYONE OELWEIN MEDICAL CENTER - 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. MERCYONE OELWEIN MEDICAL CENTER - PART V, SECTION B, LINE 10A: WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/ MERCYONE OELWEIN MEDICAL CENTER - PART V, SECTION B, LINE 16A: WWW.MERCYONE.ORG/NORTHEASTIOWA/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE MERCYONE OELWEIN MEDICAL CENTER - PART V, SECTION B, LINE 16B: WWW.MERCYONE.ORG/NORTHEASTIOWA/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE MERCYONE OELWEIN MEDICAL CENTER - PART V, SECTION B, LINE 16C: WWW.MERCYONE.ORG/NORTHEASTIOWA/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE 1 1 - OUTPATIENT REHAB THERAPY 317 8TH AVENUE SE OELWEIN IA 50662 PHYSICAL THERAPY OCCUPATIONAL/SPEECH THERAPY 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 HOSPITAL OF FRANCISCAN SISTERS (MERCYONE OELWEIN) 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.MERCYONE OELWEIN ALSO INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S 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 HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $508,889, 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: MERCYONE OELWEIN PARTNERED WITH NORTHEAST IOWA COMMUNITY COLLEGE TO OFFER AN EMT COURSE TO NINE STUDENTS FROM OELWEIN HIGH SCHOOL. A STATE GRANT COVERED THE INSTRUCTIONAL FEES, LAB KIT, ONLINE ACCESS ACCOUNTS, PSYCHOMOTOR EXAM, AND THE FIRST ATTEMPT AT THE NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS (NREMT) COGNITIVE EXAM. MERCYONE OELWEIN ASSISTED IN CLASSROOM INSTRUCTION AND PAID FOR THE COST OF TEXTBOOKS, WORKBOOKS, UNIFORMS, IOWA DEPARTMENT OF PUBLIC HEALTH (IDPH) LICENSE FEE AND IDPH BACKGROUND FEE, MAKING THE COURSE FREE TO THOSE STUDENTS WHO PARTICIPATED. 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: IN DETERMINING BAD DEBT AMOUNTS, MERCYONE OELWEIN USES A TWO-LEVEL SCORING PROCESS AS FOLLOWS: FIRST, FOR ANY PATIENT ACCOUNT THAT IS CATEGORIZED AS HAVING NO INSURANCE, WHEN THE AMOUNT BECOMES 60 DAYS OVERDUE OR GREATER, THE PATIENT'S ACCOUNT IS REVIEWED FOR FINANCIAL ASSISTANCE QUALIFICATION. IF THE PATIENT IS FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE, THE NECESSARY STEPS ARE TAKEN TO APPLY, AND THE NEEDED ADJUSTMENTS ARE MADE TO TREAT AS CHARITY CARE AND NOT AS BAD DEBT.A SIMILAR SCORING PROCESS IS COMPLETED FOR THOSE PATIENTS WHO DO HAVE INSURANCE, BUT AFTER 120 DAYS OR GREATER, STILL HAVE NOT PAID THE PATIENT RESPONSIBILITY PORTION. AGAIN, THESE PATIENT ACCOUNTS ARE REVIEWED FOR FINANCIAL ASSISTANCE, AND IF THEY QUALIFY, SIMILAR STEPS ARE TAKEN TO REMOVE FROM BAD DEBT.AS A RESULT OF THESE SCORING PROCEDURES, MERCYONE OELWEIN'S POSITION IS THAT NONE OF THE PATIENTS RESULTING IN UNCOLLECTIBLE ACCOUNTS WOULD HAVE QUALIFIED AS CHARITY CARE PATIENTS AS THIS DETERMINATION IS MADE AT THE TIME OF ADMISSION, OR LATER WITH THE TIMING OF THE SCORING PROCEDURES DESCRIBED ABOVE. BAD DEBT IS THEREFORE ONLY DETERMINED AT THE TIME THE AMOUNT DUE IS TRULY DETERMINED TO BE UNCOLLECTIBLE, AFTER FINANCIAL ASSISTANCE HAS BEEN DETERMINED, AND AFTER MANY MONTHS OF COLLECTION EFFORTS.ADDITIONALLY, MERCYONE OELWEIN FOLLOWS GUIDELINES ESTABLISHED BY THE CATHOLIC HEALTH ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION, WHO RECOMMEND THAT NO BAD DEBT AMOUNTS BE INCLUDED IN COMMUNITY BENEFIT AMOUNTS.FOR THESE REASONS, PART III, SECTION A, LINE 3 IS REPORTED AT ZERO. PART III, LINE 4: MERCYONE OELWEIN IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 13 OF THOSE STATEMENTS: "AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE.THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED." PART III, LINE 8: MERCYONE OELWEIN 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 HEALTH CARE 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 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION.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: THE HOSPITAL'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. THE HOSPITAL HAS 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 - MERCYONE OELWEIN ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, 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. TO ASSESS THE HEALTH OF ITS COMMUNITY, THE HOSPITAL 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. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCYONE OELWEIN COMMUNICATES 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, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE 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 HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. MERCYONE OELWEIN OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. NOTIFICATION ABOUT FINANCIAL ASSISTANCE AND GOVERNMENT PROGRAMS, 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. INFORMATION REGARDING FINANCIAL ASSISTANCE AND GOVERNMENT PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. PART VI, LINE 4: COMMUNITY INFORMATION - MERCYONE OELWEIN IS LOCATED IN OELWEIN, IOWA, PRIMARILY SERVING RESIDENTS OF FAYETTE COUNTY. IN JULY 2021, THE CENSUS GOVERNMENT/QUICK FACTS ESTIMATED FAYETTE COUNTY POPULATION AT JUST OVER 19,500. NEARLY 96% OF FAYETTE COUNTY RESIDENTS ARE WHITE, 1.5% ARE BLACK/AFRICAN AMERICAN, 2.7% ARE HISPANIC AND 1.2% ARE ASIAN. APPROXIMATELY 21.5% OF THE POPULATION ARE OVER THE AGE OF 65, WHICH CONTINUES TO BE HIGHER THAN THE NATIONAL AVERAGE OF 16.5%, AND APROXIMATELY 21% ARE UNDER THE AGE OF 18, WHICH IS LOWER THAN THE NATIONAL AVERAGE OF 22.3%. IN THE COUNTY, 91.6% OF THE RESIDENTS ARE A HIGH SCHOOL GRADUATE OR HIGHER, WHICH IS ABOVE THE NATIONAL AVERAGE OF 88.5%. THE MEDIAN HOUSEHOLD INCOME IS $49,834, COMPARED TO IOWA'S MEDIAN AVERAGE OF $61,836 AND THE U.S. AVERAGE OF $64,994. OF FAYETTE COUNTY RESIDENTS, 11.8% ARE LIVING IN POVERTY, SLIGHTLY ABOVE THE NATIONAL AVERAGE OF 11.4% AND THE STATE AVERAGE OF 10.2%. OF THE 99 COUNTIES IN IOWA, FAYETTE COUNTY WAS COMPARED TO THE 50 MOST POPULOUS COUNTIES AND TO THOSE ENTITIES THAT CONTAIN OR SUBSTANTIALLY OVERLAP WITH FAYETTE COUNTY. OF FAYETTE COUNTY HOUSEHOLDS, 12.9% RECEIVE FOOD STAMPS (STATISTICAL ATLAS).FAYETTE, A RURAL IOWA COUNTY, HAS A PRIMARY CARE PROVIDER (PCP) RATIO SHORTAGE OF 2,810:1, COMPARED TO THE STATE'S RATIO OF 1,350:1 (RWJF 2022). MOST RESIDENTS HAVE HEALTH CARE INSURANCE, WITH ONLY 6% UNINSURED, WHICH IS CONSISTENT WITH BOTH THE STATE AND NATIONAL STATISTICS. BECAUSE FAYETTE COUNTY IS RURAL, RESIDENTS ARE SPREAD OUT, CAUSING ACCESS AND TRANSPORTATION ISSUES. THE FAYETTE COUNTY MENTAL HEALTH PROVIDER RATIO IS 1,750:1, COMPARED TO THE STATE RATIO OF 570:1 AND THE NATIONAL RATIO OF 250:1. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH - MERCYONE OELWEIN IS A 25-BED, CRITICAL ACCESS HOSPITAL PROVIDING ACUTE AND OUTPATIENT CARE TO THE COMMUNITY AND SURROUNDING AREA OF OELWEIN, IOWA. MERCYONE OELWEIN PROVIDES ACUTE INPATIENT CARE, SWING BEDS AND SKILLED CARE, AS WELL AS 24-HOUR EMERGENCY ROOM COVERAGE STAFFED BY REGISTERED NURSES AND PHYSICIANS. MERCYONE OELWEIN PROVIDES AMBULANCE TRANSPORT SERVICES AS THE EMERGENCY 911 RESPONDER FOR THE CITY OF OELWEIN. MERCYONE OELWEIN CONTINUES TO INVEST IN ITS COMMUNITY TO ENHANCE THE HEALTH AND WELL-BEING OF RESIDENTS BY:- PARTICIPATING IN THE FAYETTE COUNTY INTERAGENCY COMMITTEE- PROVIDING FREE TRANSPORTATION SERVICES THROUGH A CARE-A-VAN PROGRAM- COLLABORATING WITH LOCAL POLICE AND COUNTY RESPONSE TEAM FOR EMT SERVICES- PROVIDING FREE TELEPHONE TRIAGE SERVICES THAT OFFER MEDICAL ADVICE AND ARE AVAILABLE TO THE PUBLIC 24 HOURS A DAY, SEVEN DAYS A WEEK - PROVIDING FREE NEEDLE BOXES TO AREA RESIDENTS IN NEED- OFFERING CONFERENCE ROOM SPACE TO OUTSIDE ORGANIZATIONS - DONATING TO THE NORTHEAST IOWA FOOD BANK- MERCYONE OELWEIN EMPLOYEES, ADMINISTRATION AND EMT VOLUNTEERING THEIR TIME TO ORGANIZE AND PARTICIPATE IN THE CITY'S 150TH BIRTHDAY CELEBRATION- OPERATING A WELLNESS CENTER IN PARTNERSHIP WITH OELWEIN SCHOOL AND THE CITY OF OELWEIN- OFFERING A MILITARY/VETERANS PROGRAM PART VI, LINE 6: MERCYONE OELWEIN IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH'S COMMUNITY HEALTH AND WELL-BEING (CHWB) STRATEGY PROMOTES OPTIMAL HEALTH FOR PEOPLE EXPERIENCING POVERTY AND OTHER VULNERABILITIES IN THE COMMUNITIES WE SERVE - EMPHASIZING THE NECESSITY TO INTEGRATE SOCIAL AND CLINICAL CARE. WE DO THIS BY: 1. ADDRESSING PATIENT SOCIAL NEEDS, 2. INVESTING IN OUR COMMUNITIES, AND 3. STRENGTHENING THE IMPACT OF OUR COMMUNITY BENEFIT. TRINITY HEALTH CHWB TEAMS LEAD THE DEVELOPMENT AND IMPLEMENTATION OF TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES AND FOCUS INTENTIONALLY ON ENGAGING COMMUNITIES AND RESIDENTS EXPERIENCING POVERTY AND OTHER VULNERABILITIES. WE BELIEVE THAT COMMUNITY MEMBERS AND COMMUNITIES THAT ARE THE MOST IMPACTED BY RACISM AND OTHER FORMS OF DISCRIMINATION EXPERIENCE THE GREATEST DISPARITIES AND INEQUITIES IN HEALTH OUTCOMES AND SHOULD BE INCLUSIVELY ENGAGED IN ALL COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT EFFORTS. THROUGHOUT OUR WORK, WE DISMANTLE OPPRESSIVE SYSTEMS, AND BUILD COMMUNITY CAPACITY AND PARTNERSHIPS.TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FISCAL YEAR 2023 (FY23), TRINITY HEALTH CONTRIBUTED $1.47 BILLION IN COMMUNITY BENEFIT SPENDING TO AID THOSE WHO ARE VULNERABLE AND LIVING IN POVERTY, AND TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES IN WHICH WE SERVE. IN ADDITION TO ANNUAL COMMUNITY BENEFIT SPENDING, TRINITY HEALTH IMPLEMENTS A SOCIALLY RESPONSIBLE INVESTING PROGRAM. AS OF THE END OF FY23, $62.7 MILLION (INCLUDING $7.0 MILLION IN NEW LENDING) WAS ALLOCATED IN THE FOLLOWING AREAS:- HOUSING: BUILDING AFFORDABLE HOUSING; IMPROVING ACCESS TO SENIOR HOUSING; AND COMBATTING HOMELESSNESS ($35.5 MILLION)- EDUCATION: SUPPORTING STUDENTS ENTERING THE HEALTH PROFESSIONS ($10.1 MILLION)- FACILITIES: BUILDING COMMUNITY FACILITIES FOR NONPROFITS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY-BASED ORGANIZATIONS ($9.7 MILLION)- ECONOMIC DEVELOPMENT: ENCOURAGING SMALL BUSINESS DEVELOPMENT, CREATING LOCAL JOBS AND SUPPORTING ACCESS TO HEALTHY FOODS; QUALITY CHILDCARE; AND OTHER COMMUNITY SERVICES ($7.4 MILLION)ACROSS THE SYSTEM, NEARLY 700,000 OF PATIENTS SEEN IN PRIMARY CARE SETTINGS WERE SCREENED FOR SOCIAL NEEDS. FOR ABOUT 30% OF THOSE PATIENTS, AT LEAST ONE SOCIAL NEED WAS IDENTIFIED. TOGETHERCARE - TRINITY HEALTH'S ELECTRONIC HEALTH RECORD, POWERED BY EPIC - HAS MADE IT POSSIBLE FOR TRINITY HEALTH TO STANDARDIZE SCREENING FOR SOCIAL NEEDS AND CONNECT PATIENTS TO COMMUNITY RESOURCES THROUGH THE COMMUNITY RESOURCE DIRECTORY (COMMUNITYRESOURCES.TRINITY-HEALTH.ORG). COMMUNITY HEALTH WORKERS (CHW'S) SERVE AS LIAISONS BETWEEN HEALTH AND SOCIAL SERVICES. TRINITY HEALTH CHW'S PARTNERED WITH POPULATION HEALTH NURSES AND SOCIAL WORK CARE MANAGERS TO SERVE MEDICARE PATIENTS AT RISK FOR PREVENTABLE HOSPITALIZATIONS, RESULTING IN A DECREASE IN PREVENTABLE HOSPITALIZATIONS FOR THE MEDICARE POPULATION OVERALL, AND ALSO FOR LOW-INCOME PATIENTS DUALLY ENROLLED IN MEDICARE AND MEDICAID. CHW'S ADVANCE SOCIAL AND CLINICAL CARE INTEGRATION BY ASSESSING AND ADDRESSING A PATIENT'S SOCIAL NEEDS, HOME ENVIRONMENT AND OTHER SOCIAL RISK FACTORS, AND ULTIMATELY CONNECTING THE PATIENT (AND THEIR FAMILY) TO SERVICES WITHIN THE COMMUNITY. TRINITY HEALTH PROVIDES A 40+ HOUR FOUNDATIONAL CHW AND CHRONIC DISEASE-SPECIFIC TRAINING TO TRINITY HEALTH-EMPLOYED CHW'S AND ALSO TO COMMUNITY PARTNERS THAT EMPLOY CHW'S. IN 2017, TRINITY HEALTH RECEIVED A SIX-YEAR, $8.5 MILLION GRANT FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION TO INCREASE THE NUMBER OF NATIONAL DIABETES PREVENTION PROGRAM (DPP) DELIVERY SITES, INCREASE PROGRAM ENROLLMENT, MAINTAIN PARTICIPATION RATES, AND INCREASE BENEFIT COVERAGE. IN ADDITION, THE GRANT WAS USED TO STANDARDIZE CLINICAL SCREENING AND DETECTION OF DIABETES. DURING THE GRANT PERIOD, TRINITY HEALTH BUILT THE NATIONAL DPP INTO ITS ELECTRONIC HEALTH RECORD SYSTEM TO MAKE IDENTIFYING PATIENTS AND ENROLLING THEM IN THE PROGRAM EASIER. SINCE SEPTEMBER 2017, OVER 6,000 PARTICIPANTS HAVE ENROLLED IN A TRINITY HEALTH NATIONAL DPP AND HAVE COLLECTIVELY LOST A TOTAL OF OVER 51,000 POUNDS.LASTLY, TRINITY HEALTH'S FY23 SHAREHOLDER ADVOCACY PRIORITIES FOCUSED ON IMPROVING CORPORATE POLICIES AND PRACTICES THAT IMPACT COMMUNITIES, WITH THE AIM OF REDUCING STRUCTURAL RACISM AND HEALTH INEQUITIES. TRINITY HEALTH, IN COLLABORATION WITH ITS PARTNERS THE INTERFAITH CENTER ON CORPORATE RESPONSIBILITY AND THE INVESTOR ENVIRONMENTAL HEALTH NETWORK, FILED SHAREHOLDER PROPOSALS AT 20 COMPANIES. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 1 PLENTIFUL PANTRY 26 W CHARLES ST OELWEIN IA 50662 882911779 501(C)(3) 6000 0 SUPPORT OF CHARITABLE ACTIVITY 1 0 PART I, LINE 2: DONATIONS MADE BY MERCY HOSPITAL OF FRANCISCAN SISTERS (MERCYONE OELWEIN) 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. 0 1 0 0 0 0 0 0 0 ROBERT RITZ DIRECTOR; CEO MERCY HEALTH NETWORK 0 1340299 0 433955 0 149437 0 27617 0 36854 0 1988162 0 0 JACK DUSENBERY DIR & PRES, MERCYONE NE IA THR 4/23 0 569178 0 120621 0 15250 0 18300 0 27479 0 750828 0 0 MATTHEW SOJKA MD VP, MEDICAL AFFAIRS 0 401122 0 56897 0 2878 0 13725 0 30181 0 504803 0 0 RACHELLE MAKINDE MD DIRECTOR; PHYSICIAN 0 422630 0 0 0 27292 0 11458 0 34265 0 495645 0 0 BRIAN BURNETT MD DIRECTOR; PHYSICIAN 0 362631 0 0 0 921 0 22875 0 36391 0 422818 0 0 TIMOTHY HUBER ASSISTANT TREASURER; VP OF FINANCE 0 247137 0 36164 0 5214 0 22697 0 37061 0 348273 0 0 KELLY RICHARDS CHIEF NURSING OFFICER 0 226422 0 31841 0 3595 0 20047 0 24161 0 306066 0 0 RYAN MEYER VP, SITE ADMINISTRATOR 0 172505 0 24770 0 140 0 8711 0 27347 0 233473 0 0 JILL GROTH VP, SITE ADMINISTRATOR 162995 0 23939 0 3543 0 12054 0 23801 0 226332 0 0 0 MARIUS BALOLA PHARMACIST 115869 0 0 0 77 0 5837 0 34370 0 156153 0 0 0 NICOLE STAHL REGISTERED NURSE 120637 0 6000 0 23 0 7416 0 16958 0 151034 0 0 0 PART I, LINE 3 MERCY HOSPITAL OF FRANCISCAN SISTERS' PRESIDENT IS PAID DIRECTLY BY A RELATED ENTITY, COVENANT MEDICAL CENTER. COVENANT MEDICAL CENTER USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MERCY HOSPITAL OF FRANCISCAN SISTERS' PRESIDENT: - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B DURING THE 2022 CALENDAR YEAR, ROBERT RITZ WAS A PARTICIPANT IN THE COMMONSPIRIT HEALTH SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES. DUE TO THE "SUPER" VESTING RULES UNDER THIS PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS AGE, OR AGE AND YEARS OF SERVICE, ARE ELIGIBLE TO RECEIVE THEIR 2022 CONTRIBUTIONS IN CASH. DURING 2022, THE FOLLOWING PAYMENT WAS MADE PURSUANT TO THE SUPER VESTING RULES AND IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: ROBERT RITZ - $127,049 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MERCY HOSPITAL OF FRANCISCAN SISTERS (MERCYONE OELWEIN) IS WHEATON FRANCISCAN HEALTHCARE-IOWA. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A WHEATON FRANCISCAN HEALTHCARE-IOWA IS THE SOLE MEMBER OF MERCYONE OELWEIN. WHEATON FRANCISCAN HEALTHCARE-IOWA, INC HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MERCYONE OELWEIN. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, WHEATON FRANCISCAN HEALTHCARE-IOWA MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. WHEATON FRANCISCAN HEALTHCARE-IOWA MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. AS THE PARENT OF WHEATON FRANCISCAN HEALTHCARE-IOWA, CERTAIN POWERS ARE RESERVED TO MERCY HEALTH NETWORK. THESE INCLUDE THE AUTHORITY TO APPROVE CHANGES TO THE ORGANIZATION'S GOVERNING DOCUMENTS, TO APPROVE MAJOR CHANGES SUCH AS A MERGER OR DISSOLUTION, AND TO APPROVE SIGNIFICANT FINANCE MATTERS IN EXCESS OF CERTAIN LIMITS ESTABLISHED BY MERCY HEALTH NETWORK. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR MERCYONE OELWEIN 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 MERCYONE OELWEIN 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 MERCYONE OELWEIN. 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 MERCYONE OELWEIN 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 THE INTEGRITY AND COMPLIANCE OFFICER. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE INTEGRITY AND COMPLIANCE OFFICER SHARES THE DISCLOSURES WITH INTERNAL LEGAL COUNSEL, 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 MERCYONE OELWEIN (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCYONE OELWEIN OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MERCYONE OELWEIN (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 MERCYONE OELWEIN. 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 FORM 990, PART VI, LINE 15A: QUESTION 15A IS ANSWERED "NO" BECAUSE THE COMPENSATION FOR THE PRESIDENT OF MERCYONE OELWEIN IS ESTABLISHED AND PAID BY A RELATED ENTITY, COVENANT MEDICAL CENTER. IN ESTABLISHING THE PRESIDENT'S COMPENSATION, COVENANT MEDICAL CENTER FOLLOWS A PROCESS WHICH INCLUDES THE FOLLOWING: USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND COMPENSATION STUDY, USE OF A WRITTEN EMPLOYMENT CONTRACT, AND REVIEW AND APPROVAL BY THE MERCY HEALTH NETWORK BOARD OF DIRECTORS. THIS PROCESS IS PERFORMED ANNUALLY. FORM 990, PART VI, LINE 15B: QUESTION 15B IS ANSWERED "NO" BECAUSE THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES OF MERCYONE OELWEIN IS ESTABLISHED AND PAID BY A RELATED ENTITY, COVENANT MEDICAL CENTER. IN ESTABLISHING OTHER OFFICER AND KEY EMPLOYEE COMPENSATION, COVENANT MEDICAL CENTER FOLLOWS A PROCESS WHICH INCLUDES THE FOLLOWING: USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND COMPENSATION STUDY, USE OF A WRITTEN EMPLOYMENT CONTRACT, AND REVIEW AND APPROVAL BY THE COVENANT MEDICAL CENTER AND MERCYONE NORTHEAST IOWA PRESIDENT, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. THIS PROCESS IS PERFORMED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 MERCYONE OELWEIN 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, MERCYONE OELWEIN INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. MERCYONE OELWEIN'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 237,069. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 237,069. MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 1,637,336. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,637,336. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 508,598. MANAGEMENT AND GENERAL EXPENSES 798,051. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,306,649. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 1,492. MANAGEMENT AND GENERAL EXPENSES 9,100. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,592. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS FROM AFFILIATES 12,396,365. OTHER TRANSACTIONS 74,671. PURCHASE ACCOUNTING ADJUSTMENT DUE TO ACQUISITION BY TRINITY HEALTH SYSTEM ON SEPT 1, 2022 -4,618,170. FORM 990, PART XII, LINE 2 MERCYONE OELWEIN'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY23 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE 1, DOING BUSINESS AS NAMES: MERCY LIVING PLUS MERCYONE OELWEIN MEDICAL CENTER ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 200 JEFFERSON AVE SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 114 WOODLAND STREET HARTFORD CT 06105 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL HEALTH FOUNDATION-EAST TRENTON INC 601 HAMILTON AVENUE TRENTON NJ 08629 521025476 FOUNDATION NJ 501(C)(3) LINE 7 CAPITAL HEALTH-EAST TRENTON INC 1 CAPITAL HEALTH LIFE INC 7500 K JOHNSON BOULEVARD BORDENTOWN NJ 08505 222797282 PACE PROGRAM NJ 501(C)(3) LINE 10 CAPITAL HEALTH-EAST TRENTON INC 1 CAPITAL HEALTH MEDICAL GROUP-EAST TRENTON PA 601 HAMILTON AVENUE TRENTON NJ 08629 832199054 HEALTH CARE SERVICES NJ 501(C)(3) LINE 3 CAPITAL HEALTH-EAST TRENTON INC 1 CAPITAL HEALTH-EAST TRENTON INC 601 HAMILTON AVENUE TRENTON NJ 08629 223431049 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