SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
CATHOLIC HEALTH INITIATIVES - IOWA CORP
 
Employer identification number

42-0680448
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
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) . . . 		0 6,350 4,179,290 0 4,179,290 0.480 %
b Medicaid (from Worksheet 3, column a) . . . . . 0 0 41,296,645 0 41,296,645 4.780 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . . 0 0 0 0    
d Total Financial Assistance and Means-Tested Government Programs . . . . .   6,350 45,475,935   45,475,935 5.260 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 2 4,082 384,878 0 384,878 0.040 %
f Health professions education (from Worksheet 5) . . . 1 0 6,000,000 0 6,000,000 0.700 %
g Subsidized health services (from Worksheet 6) . . . . 1 0 797,835 0 797,835 0.090 %
h Research (from Worksheet 7) . 0 0 0 0    
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 2 0 208,583 0 208,583 0.020 %
j Total. Other Benefits . . 6 4,082 7,391,296   7,391,296 0.850 %
k Total. Add lines 7d and 7j . 6 10,432 52,867,231   52,867,231 6.110 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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 (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     0 0   0 %
2 Economic development     0 0   0 %
3 Community support     0 0   0 %
4 Environmental improvements     0 0   0 %
5 Leadership development and
training for community members		     0 0   0 %
6 Coalition building     0 0   0 %
7 Community health improvement advocacy     0 0   0 %
8 Workforce development     0 0   0 %
9 Other     0 0   0 %
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
26,539,150
3
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. ......
3
0
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
172,468,725
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
191,089,517
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-18,620,792
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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 % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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?2Name, 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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 MERCY MEDICAL CENTER - DES MOINES
1111 6TH AVENUE
DES MOINES,IA50314
HTTPS://WWW.MERCYONE.ORG/DESMOINES
770033H 		X X         X     A
2 MERCY MEDICAL CENTER - WESTLAKES
1601 60TH STREET
WEST DES MOINES,IA50266
HTTPS://WWW.MERCYDESMOINES.ORG
770158H 		X X         X     A
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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)
FACILITY REPORTING GROUP - A
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 No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.MERCYONE.ORG/DESMOINES/ABOUT-US/COMMUNITY-BENEFIT
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2020
Schedule H (Form 990) 2020
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 6
Part VFacility Information (continued)

Billing and Collections
FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 nonpayment?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
PART V, LINE 7A, CHNA WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/ABOUT-US/COMMUNITY-BENEFIT
PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD-PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A CHI HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS.
PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA.
PART V, SECTION B, LINE 5: MERCY MEDICAL CENTER - DES MOINES WAS A MEMBER OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CENTRAL IOWA STEERING COMMITTEE, WHICH INCLUDED REPRESENTATIVES FROM THE UNITED WAY OF CENTRAL IOWA, THE THREE LARGEST NON-PROFIT HOSPITALS, THE THREE COUNTY HEALTH DEPARTMENTS, AND THE GREATER DES MOINES PARTNERSHIP.
PART V, SECTION B, LINE 11: THE FOLLOWING APPLIES TO BOTH DES MOINES AND WESTLAKE. THE TWO FACILITIES ARE IN CLOSE PROXIMITY TO ONE ANOTHER, DEFINE THEIR COMMUNITY THE SAME AND SHARE RESOURCES. MERCYONE- DES MOINES HAS A PRIMARY SERVICE AREA OF THREE COUNTIES AND A SECONDARY REACH TO THE SURROUNDING SIX COUNTIES. THE POPULATION SERVED INCLUDES BOTH URBAN AND RURAL COMMUNITIES, WITH A GROWING NUMBER OF PEOPLE RESIDING IN THE 3-COUNTY PRIMARY SERVICE AREA (POLK, DALLAS, AND WARREN). THESE RESIDENTS HAVE A MEDIAN INCOME OF $66,558, WITH EIGHT PERCENT LIVING BELOW THE POVERTY LINE. OF THOSE WHO LIVE BELOW THE POVERTY LEVEL, 53 PER CENT ARE SINGLE-PARENT FAMILIES WITH CHILDREN UNDER 5 YEARS OF AGE.WITH AN INCREASING IMMIGRANT AND REFUGEE POPULATION RELOCATING TO CENTRAL IOWA, APPROXIMATELY 13 PER CENT OF OUR 3- COUNTY POPULATION SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME. THERE ARE AS MANY AS 106 INDIVIDUAL LANGUAGES SPOKEN BY FAMILIES IN THE DES MOINES PUBLIC SCHOOLS. THE LARGEST NEW IOWAN POPULATION HAS LATINO ORIGINS, REPRESENTING 20% OF THE COMMUNITY IN THE DES MOINES AREA.THE CHNA CONDUCTED ON 8/1/2019 IDENTIFIED THE SIGNIFICANT HEALTH NEEDS WITHIN THE MERCYONE DES MOINES COMMUNITY. THOSE NEEDS WERE THEN PRIORITIZED BASED ON INPUT FROM PERSONS WHO REPRESENT THE INTERESTS OF THE COMMUNITY SERVED. THE SIGNIFICANT HEALTH NEEDS IDENTIFIED, IN ORDER OF PRIORITY INCLUDE:A. IN ORDER TO ENSURE ACCESS TO HEALTH FOR ALL, MERCY WILL:*INCREASE INVESTMENTS/REIMBURSEMENTS FOR PREVENTION*REFORM MEDICAID MANAGED CARE TO REDUCE BARRIERS TO ACCESSING NECESSARY SERVICES*INCREASE COMMUNITY UNDERSTANDING AND SUPPORT OF MENTAL HEALTH, REDUCING STIGMA AND ENCOURAGING PARITY BETWEEN MENTAL HEALTH AND PHYSICAL HEALTH*REDUCE TRANSPORTATION BARRIERS, PARTICULARLY FOR PEOPLE WITH LOW INCOME AND RURAL FAMILIES*ENSURE INDIVIDUALS WITH MENTAL HEALTH NEEDS ARE CONNECTED TO APPROPRIATE SERVICES AVOIDING UNNECESSARY JAIL AND EMERGENCY ROOM REFERRALS*INCREASE AVENUES OF UNDERSTANDING AND CULTURAL HUMILITY, REDUCING BARRIERS FOR INDIVIDUALS SEEKING ASSISTANCEB. ESTABLISH COMMUNITIES AND NEIGHBORHOODS THAT ARE SAFE, ACCESSIBLE AND AVAILABLE TO EVERYONE, INCLUDE PUBLIC GATHERING PLACES FOR DIVERSE AND INTEGRATED ENGAGEMENT, AND PROMOTE HEALTHY RELATIONSHIPS, MERCY WILL:*INCREASE AND UTILIZE PHYSICAL COMMUNITY SPACES TO FOSTER SOCIAL CONNECTIVITY, CIVILITY AND BUILD TRUSTING RELATIONSHIPS*REFORM MEDICAID MANAGED CARE TO ALLOW FOR MORE FLEXIBLE REIMBURSEMENT STRATEGIES*ENSURE EVERYONE HAS A PLACE TO BE SAFE AND ACTIVE*INCREASE THE AVAILABILITY OF SAFE AFFORDABLE AND STABLE HOUSINGC. IMPROVE THE SOCIAL/EMOTIONAL WELL-BEING OF THE COMMUNITY, MERCY WILL:*IDENTIFY AND IMPLEMENT WORK-SITE STRATEGIES TO REDUCE STRESS/TRAUMA*ADVOCATE FOR THE ESTABLISHMENT AND IMPLEMENTATION OF A CHILDREN'S MENTAL HEALTH SYSTEM TO INCREASE EARLY IDENTIFICATION, DETECTION AND INTERVENTION PROGRAMS FOR CHILDREN*INCREASE PSYCHIATRIC RESIDENCY SLOTS AND EFFORTS TO INCREASE PRACTITIONER RETENTION*REFORM MEDICAID MANAGED CARE TO IMPROVE REIMBURSEMENT RATES, AND THE TIMELINESS OF PAYMENTS, TO PREVENT THE DISRUPTION OR ELIMINATION OF NECESSARY SERVICES AND VALUABLE PROVIDERS D. INCREASE THE CAPACITY (SIZE AND SKILLS) OF THE HEALTHCARE WORKFORCE TO CREATE AND SUSTAIN HEALTH, MERCY WILL:*INCREASE TRAINING OPPORTUNITIES FOR TRAUMA INFORMED CARE, MENTAL HEALTH FIRST AID AND OTHER EVIDENCE BASED MENTAL HEALTH SERVICES*EXPAND EFFORTS TO DEVELOP A MORE DIVERSE WORKFORCE THAT BETTER REFLECTS THE PATIENT POPULATION*INCREASE THE NUMBER OF PEOPLE AND ORGANIZATIONS WHO RECEIVE CULTURAL HUMILITY AND IMPLICIT BIAS TRAINING*REFORM MEDICAID MANAGED CARE TO IMPROVE REIMBURSEMENT RATES TO MINIMIZE STAFF TURNOVER*IMPROVE RECRUITMENT AND RETENTION RATES TO ADDRESS THE UNIQUE CHALLENGES OF RURAL POLK, DALLAS AND WARREN COUNTIES
PART V, SECTION B, LINE 6A: UNITY POINT HEALTH DES MOINES, BROADLAWNS MEDICAL CENTER, DALLAS COUNTY HOSPITAL
PART V, SECTION B, LINE 6B: UNITY POINT HEALTH DES MOINES, DALLAS COUNTY PUBLIC HEALTH DEPT., POLK COUNTY PUBLIC HEALTH DEPT., WARREN COUNTY HEALTH SERVICES, DES MOINES UNIVERSITY, PRIMARY HEALTH CARE, NATIONAL ALLIANCE ON MENTAL ILLNESS GREATER DES MOINES, DES MOINES PUBLIC SCHOOL NURSES, GREATER DES MOINES PARTNERSHIP, GREATER DES MOINES COMMUNITY FOUNDATION, UNITED WAY OF CENTRAL IOWA, CAPITAL CROSSROADS, ORCHARD PLACE, WELLMARK FOUNDATION, AARP, HEALTHIEST STATE INITIATIVE, DES MOINES AREA METRO PLANNING ORGANIZATION, IOWA CAREGIVERS ASSOCIATION, EVERYSTEP, LUTHERAN SERVICES IN IOWA, POLK COUNTY HEALTH SERVICES, POLK COUNTY MEDICAL SOCIETY, NATIONAL ALLIANCE ON MENTAL ILLNESS IOWA, U.S. COMMITTEE FOR REFUGEES AND IMMIGRANTS, MID-IOWA HEALTH FOUNDATION, AND DES MOINES AREA RELIGIOUS COUNCIL.
PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.MERCYONE.ORG/DESMOINES/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 9
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?18
Name and address Type of Facility (describe)
1 1 - MERCY OUTPATIENT CARDIAC TESTING
5880 UNIVERSITY SUITE 211
WEST DES MOINES,IA50266 		AMBULATORY HEALTH CARE
2 2 - MERCY AMBULATORY SURGERY CENTER
411 LAUREL STREET
DES MOINES,IA50314 		AMBULATORY HEALTH CARE
3 3 - MERCY FRANKLIN CENTER
1818 48TH STREET
DES MOINES,IA50314 		BEHAVIORAL HEALTH
4 4 - RCG MERCY DES MOINES LLC
920 WINTER STREET
WALTHAM,MA02451 		PHYSICIAN SERVICES
5 5 - RIVER HILLS SURGERY CENTER
1111 6TH AVENUE
DES MOINES,IA50314 		SURGERY CENTER
6 6 - CENTRAL IOWA CYBERKNIFE
411 LAUREL STREET
DES MOINES,IA50314 		PHYSICIAN OFFICE
7 7 - MERCY WEIGHT LOSS & NUTRITION CENTER
12493 UNIVERSITY AVENUE SUITE 110
WEST DES MOINES,IA50325 		AMBULATORY HEALTH CARE
8 8 - MERCY WEST ENDOSCOPY
1601 NW 114TH STREET SUITE 244
CLIVE,IA50325 		AMBULATORY HEALTH CARE
9 9 - MERCY OUTPATIENT CARDIAC TESTING
411 LAUREL STREET
DES MOINES,IA50314 		AMBULATORY HEALTH CARE
10 10 - MERCY WEST RADIOLOGY
1601 NW 114TH STREET SUITE 149
CLIVE,IA50325 		MEDICAL IMAGING
11 11 - MERCY CANCER CENTER
411 LAUREL STREET
DES MOINES,IA50314 		PHYSICIAN SERVICES
12 12 - WEST LAKES SURGERY CENTER LLC
12499 UNIVERSITY AVENUE SUITE 100
CLIVE,IA50325 		SURGERY CENTER
13 13 - RADIOLOGY CENTER
12495 UNIVERSITY AVENUE
CLIVE,IA50325 		MEDICAL IMAGING
14 14 - MERCY SLEEP CENTER
1449 NW 128TH STREET SUITE 100
CLIVE,IA50325 		AMBULATORY HEALTH CARE
15 15 - MERCY RIVERSIDE REHABILITATION CENTER
730 EAST 2ND STREET
DES MOINES,IA50309 		REHABILITATION CENTER
16 16 - MERCY CARDIAC & PULMONARY REHABILITATION
411 LAUREL STREET
DES MOINES,IA50314 		AMBULATORY HEALTH CARE
17 17 - MERCY ATRIUM IMAGING
411 LAUREL STREET
DES MOINES,IA50314 		MEDICAL IMAGING
18 18 - MERCY FAMILY MEDICINE RESIDENCY CENTER
250 LAUREL STREET
DES MOINES,IA50314 		PHYSICIAN OFFICE
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 10
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: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: *THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. *THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG. *THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP]. *THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: *RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; *HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; *PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); *FOOD STAMP ELIGIBILITY; *SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; *ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); *LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR *PATIENT IS DECEASED WITH NO KNOWN ESTATE.
PART I, LINE 7: A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS.THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/2021 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE.BASED ON THAT FORMULA, $660,806,946/3,305,095,519 RESULTS IN A 19.99% COST-TO-CHARGE RATIO.
PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 19.99%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE.
PART III, LINE 3: CATHOLIC HEALTH INITIATIVES - IOWA CORP DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE.
PART III, LINE 4: CATHOLIC HEALTH INITIATIVES - IOWA CORP DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS:COMMONSPIRIT RELIES ON THE RESULTS OF DETAILED REVIEWS OF HISTORICAL WRITE-OFFS AND COLLECTIONS IN ESTIMATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE. UPDATES TO THE HINDSIGHT ANALYSIS ARE PERFORMED AT LEAST QUARTERLY USING PRIMARILY A ROLLING EIGHTEEN-MONTH COLLECTION HISTORY AND WRITE-OFF DATA. SUBSEQUENT CHANGES TO ESTIMATES OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT REVENUE IN THE PERIOD OF THE CHANGE.SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN A THIRD-PARTY PAYOR'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE IN PURCHASED SERVICES AND OTHER IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. BAD DEBT EXPENSE FOR 2021 AND 2020 WAS NOT SIGNIFICANT.
PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS.COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES, CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. CATHOLIC HEALTH INITIATIVES - IOWA CORP'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $18,620,792 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.
PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY APPLIES TO ALL INDIVIDUALS PRESENTING FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE POLICY CONTAINS PROVISIONS FOR COLLECTING AMOUNTS DUE FROM THOSE PATIENTS WHO THE ORGANIZATION KNOWS TO QUALIFY FOR FINANCIAL ASSISTANCE EITHER THROUGH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS OR THROUGH PRESUMPTIVE ELIGIBILITY PROCESSES. BEFORE ENGAGING IN EXTRAORDINARY COLLECTION ACTIONS (ECAS) TO OBTAIN PAYMENT FOR EMCARE, HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IN NO EVENT WILL AN ECA BE INITIATED PRIOR TO 120 DAYS FROM THE DATE THE FACILITY PROVIDES THE FIRST POST-DISCHARGE BILLING STATEMENT (I.E., DURING THE NOTIFICATION PERIOD) UNLESS ALL REASONABLE EFFORTS HAVE BEEN MADE.HOSPITAL FACILITIES WILL NOT REFER ACCOUNTS FOR COLLECTION WHERE THE PATIENT HAS INITIALLY APPLIED FOR FINANCIAL ASSISTANCE, AND THE HOSPITAL FACILITY HAS NOT YET MADE REASONABLE EFFORTS WITH RESPECT TO THE ACCOUNT. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. PATIENTS WHO QUALIFY FOR MEDICAID ARE PRESUMED TO QUALIFY FOR A FULL CHARITY WRITE OFF. ANY CHARGES FOR DAYS OR SERVICES WRITTEN OFF (EXCLUDING MEDICAID DENIALS RELATED TO TIMELINESS OF BILLING, INSUFFICIENT MEDICAL RECORD DOCUMENTATION, MISSING INVOICES, AUTHORIZATION, OR ELIGIBILITY ISSUES) AS A RESULT OF A MEDICAID ARE BOOKED AS CHARITY.SOME MEDICAID PLANS OFFER COVERAGE FOR A LIMITED OR RESTRICTED LIST OF SERVICES. IF A PATIENT IS ELIGIBLE FOR MEDICAID, ANY CHARGES FOR DAYS OR SERVICES NOT COVERED BY THE PATIENT'S COVERAGE MAY BE WRITTEN OFF TO CHARITY WITHOUT A COMPLETED APPLICATION. THIS DOES NOT INCLUDE ANY SHARE OF COST (SOC) OR OTHER PATIENT COST-SHARING AMOUNTS SUCH AS DEDUCTIBLES OR COPAYMENTS, AS SUCH COSTS ARE DETERMINED BY THE STATE TO BE AN AMOUNT THAT THE PATIENT MUST PAY BEFORE THE PATIENT IS ELIGIBLE FOR MEDICAID. HEALTH AND HUMAN SERVICES (HSS) USES THE TERM "SPEND DOWN" INSTEAD OF SHARE OF COST.ALL COLLECTION ACTIVITIES CONDUCTED BY THE FACILITY, A DESIGNATED SUPPLIER, OR ITS THIRD-PARTY COLLECTION AGENTS WILL BE IN CONFORMANCE WITH ALL FEDERAL AND STATE LAWS GOVERNING DEBT COLLECTION PRACTICES. ALL THIRD-PARTY AGREEMENTS GOVERNING COLLECTION AND RECOVERY ACTIVITIES MUST INCLUDE A PROVISION REQUIRING COMPLIANCE WITH THE HOSPITAL FACILITIES' FINANCIAL ASSISTANCE AND BILLING AND COLLECTIONS POLICY AND INDEMNIFICATION FOR FAILURES AS A RESULT OF ITS NONCOMPLIANCE. THIS INCLUDES, BUT IS NOT LIMITED TO, AGREEMENTS BETWEEN THIRD PARTIES WHO SUBSEQUENTLY SELL OR REFER DEBT OF THE HOSPITAL FACILITY.
PART VI, LINE 2: WORKING WITH NEARLY THIRTY COMMUNITY-BASED ORGANIZATIONS, MERCY MEDICAL CENTER - DES MOINES JOINED IN AN IN-DEPTH EVALUATION OF THE HEALTH OF OUR COMMUNITY. DESIGNED TO IDENTIFY NEEDS AND DEVELOP IMPROVEMENT STRATEGIES, THE PROCESS ENGAGED THOUSANDS OF RESIDENTS AND VESTED LEADERS IN THIS VALUABLE DISCUSSION. MANY SERVICES PROVIDED BY MERCY CONTINUE TO SURFACE ARE AREAS OF GREATEST NEED. ACCESS TO A MEDICAL HOME, NEED FOR COORDINATED SPECIALTY CARE AND FINANCIAL ASSISTANCE FOR THE UNINSURED AND UNDERSERVED WERE IDENTIFIED BY THE PARTICIPANTS. THESE BARRIERS, COMBINED WITH NEEDED ACCESS TO HEALTHY FOOD, SAFE HOUSING AND PUBLIC TRANSPORTATION, HAVE GUIDED THE COMMUNITY-BASED ACTIVITIES FOR MERCY.
PART VI, LINE 3: NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM CHI HOSPITAL ORGANIZATIONS SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: *CONSPICUOUS PUBLICATION OF NOTICES IN PATIENT BILLS; *NOTICES POSTED IN EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING/REGISTRATION DEPARTMENTS, BUSINESS OFFICES, AND AT OTHER PUBLIC PLACES AS A HOSPITAL FACILITY MAY ELECT; AND *PUBLICATION OF A SUMMARY OF THIS POLICY ON THE HOSPITAL FACILITY'S WEBSITE AND AT OTHER PLACES WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL FACILITY AS IT MAY ELECT. SUCH NOTICES AND SUMMARY INFORMATION SHALL INCLUDE A CONTACT NUMBER AND SHALL BE PROVIDED IN ENGLISH, SPANISH, AND OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY AN INDIVIDUAL HOSPITAL FACILITY, AS APPLICABLE. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE CHI HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.IN ADDITION, HOSPITAL REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES. ONCE IT IS DETERMINED THAT THE PATIENT DOES NOT QUALIFY FOR ANY THIRD PARTY FUNDING, THE PATIENT IS VERBALLY NOTIFIED ABOUT THE EXISTENCE OF FINANCIAL ASSISTANCE APPLICATION AND ADDITIONAL SCREENING TAKES PLACE BY A HOSPITAL EMPLOYEE TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR CHARITY SERVICE PRIOR TO DISCHARGE. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY OF THAT POLICY, AND AN APPLICATION FOR ASSISTANCE. HOSPITAL REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON-ENGLISH-SPEAKING INDIVIDUALS. PATIENTS THAT HAVE BEEN DISCHARGED PRIOR TO CHARITY SCREENING, SUCH AS EMERGENCY ROOM PATIENTS, RECEIVE A WRITTEN NOTIFICATION OF POSSIBLE ELIGIBILITY FOR SERVICES. IF THE PATIENT IS DETERMINED NOT TO BE ELIGIBLE FOR GOVERNMENT ASSISTANCE, HE/SHE MAY NOTIFY THE HOSPITAL THAT THEY SEEK CHARITY ASSISTANCE. THE APPROPRIATE CHARITY FORM IS SENT TO THE PATIENT/GUARANTOR FOR COMPLETION AND THEN RETURNED TO THE HOSPITAL FOR EVALUATION AND QUALIFICATION. ONCE DETERMINATION OF ELIGIBILITY IS MADE, THE PATIENT IS SENT A NOTICE INFORMING HIM/HER IF THEY QUALIFY FOR FULL, PARTIAL, OR NO CHARITY CARE SERVICES.HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER ANY INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART VI, LINE 4: MERCY MEDICAL CENTER - DES MOINES IS A REGIONAL HOSPITAL, WITH A PRIMARY SERVICE AREA OF THREE COUNTIES AND A SECONDARY REACH TO THE SURROUNDING SIX COUNTIES. THE POPULATION SERVED INCLUDES BOTH URBAN AND RURAL COMMUNITIES, WITH A GROWING NUMBER OF PEOPLE RESIDING IN THE 3-COUNTY PRIMARY SERVICE AREA (POLK, DALLAS AND WARREN.) THESE RESIDENTS HAVE A MEDIAN HOUSEHOLD INCOME OF $61,721, WITH ROUGHLY 8 PERCENT OF PERSONS LIVING BELOW THE POVERTY LEVEL. OF THOSE WHO LIVE BELOW THE POVERTY LEVEL, 52 PERCENT ARE SINGLE-PARENT HOMES WITH CHILDREN UNDER 5 YEARS OF AGE.WITH AN INCREASING IMMIGRANT AND REFUGEE POPULATION RELOCATING TO IOWA, APPROXIMATELY 10 PERCENT OF OUR 3-COUNTY AREA SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME. THE LARGEST NON-NATIVE POPULATION HAS HISPANIC ORIGIN. ANOTHER DEMOGRAPHIC FACTOR IMPACTING IOWA'S DEMAND FOR HEALTH CARE SERVICE IS OUR ELDERLY, WITH 14.9 PERCENT OF OUR RESIDENTS BEING OVER 65 YEARS OF AGE.THE UNINSURED POPULATION OF OUR 3-COUNTY SERVICE AREA IS APPROXIMATELY EIGHT PERCENT.MEDICARE AND MEDICAID COVER 22 PERCENT OF OUR POPULATION. MERCY IS ONE OF TWO LARGE HEALTH CARE SYSTEMS IN OUR COMMUNITY. IN ADDITION, POLK AND DALLAS COUNTIES EACH HAVE A COUNTY HOSPITAL.
PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITY(IES) PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY(IES) HAVE AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITY(IES) TREAT PERSONS PAYING THEIR BILLS WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT.
PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. COMMONSPIRIT HEALTH IS COMPRISED OF MORE THAN 1,500 CARE SITES, CONSISTING OF 140 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2021, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.5 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $5.1 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.25 BILLION IN FISCAL YEAR 2021, HAS TOTAL ASSETS OF APPROXIMATELY $54.87 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY.
Schedule H (Form 990) 2020
Additional Data


Software ID:  
Software Version: