Hospice of North Iowa

“The sole member of hospice of north iowa is mercy health services - iowa. See line 7 for additional information.”

“Mercy health services - iowa, doing business as mercy medical center - north iowa, is the sole member of hospice of north iowa. Mercy health services - iowa has the right to appoint all persons to the board of directors of hospice of north iowa.”

“As sole member, mercy health services - iowa must approve certain decisions of the governing body, including the strategic plan, annual capital plan, and annual operating budget. Mercy health services - iowa must also approve significant changes such as a merger, dissolution, sale of assets in excess of certain limits and modifications to governing documents.”

“Prior to filing, the form 990 for the hospice of north iowa is reviewed by management. Each member of the board receives a copy of the return in its final form before it is filed with the internal revenue service.”

“Hospice of north iowa 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 hospice of north iowa, 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 hospice of north iowa and to avoid situations involving a conflict of interest. On an annual basis, interested persons are required to complete a conflict of interest disclosure statement and to affirm their receipt of the conflict of interest policy, compliance with its requirements, and agree to notify the organization of changes impacting their annual disclosure in accordance with the policy. The annual disclosures are provided to internal legal counsel and the integrity and compliance officer, from which legal counsel prepares a report for the board chair and ceo. A summary of potential conflicts is reviewed with the board of directors of hospice of north iowa (or a delegated committee of the board) on a yearly basis. Interested persons are required to make full disclosure to hospice of north iowa of any financial or business interests that might result in or have the appearance of a conflict of interest. The board of directors of hospice of north iowa (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 hospice of north iowa. 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.”

“Question 15a is answered "no" because the compensation for the hospice of north iowa's executive director is established and paid by mercy medical center - north iowa, a related organization. Question 15b is answered "no" because the compensation for certain officers of the hospice of north iowa is established by trinity health, a related organization. In establishing cfo compensation, trinity health follows a process and policy that is intended to mirror the irc section 4958 guidelines for obtaining a "rebuttable presumption of reasonableness" with regard to compensation and benefits. As part of that process, the compensation and benefits of the cfo of the hospice of north iowa are reviewed at least annually by the trinity health board or the trinity health human resources and compensation committee (hrcc) of the board, authorized to act on behalf of the board with respect to certain compensation matters. As part of its review process, the hrcc retains an independent firm experienced in compensation and benefit matters for not-for-profit healthcare organizations to advise it in the determinations it makes on the reasonableness of proposed compensation and benefits arrangements.”

“Hospice of north iowa 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. Hospice of north iowa's governing documents and conflict of interest policy are available upon request.”

“Medical specialist fees: program service expenses 29,552. Management and general expenses 0. Fundraising expenses 0. Total expenses 29,552. Consulting fees expense: program service expenses 423. Management and general expenses 0. Fundraising expenses 0. Total expenses 423. Outpatient transport services: program service expenses 88,321. Management and general expenses 0. Fundraising expenses 0. Total expenses 88,321. Hospital inpatient services: program service expenses 173,394. Management and general expenses 0. Fundraising expenses 0. Total expenses 173,394. Outpatient medical services: program service expenses 30,565. Management and general expenses 0. Fundraising expenses 0. Total expenses 30,565. Respite care: program service expenses 10,248. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,248. Nursing home r&b: program service expenses 1,073,315. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,073,315. Physical, occupational, and speech therapies: program service expenses 2,848. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,848. Massage therapy: program service expenses 111,460. Management and general expenses 0. Fundraising expenses 0. Total expenses 111,460. Music therapy: program service expenses 13,937. Management and general expenses 0. Fundraising expenses 0. Total expenses 13,937. Misc. Purchased services: program service expenses 5,234. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,234.”

“Hospice of north iowa's financial statements were included in the fy16 consolidated financial statements of trinity health, which were audited by an independent public accounting firm.”