Baum-Harmon Mercy Hospital

“Mercy medical center - sioux city (mmc-sc) and mercy health network, inc. Have contracted with catholic health initiatives for the provision of interim ceo services at mmc-sc. In calendar year 2014, mmc-sc paid $288,261 plus $14,815 for temporary housing for james fitzpatrick's services as interim ceo of mmc-sc. Mmc-sc does not know how much james fitzpatrick received as wages from catholic health initiatives in calendar 2014. Mr. Fitzpatrick was hired on 8/31/14 as ceo of mmc-sc.”

“The sole member of baum harmon mercy hospital is mercy health services - iowa, corp. See line 7 for additional information.”

“Mercy health services - iowa, corp. Is the sole member of baum harmon mercy hospital. Mercy health services - iowa, corp. Has the right to appoint all persons to the board of directors of baum harmon mercy hospital.”

“As sole member, mercy health services - iowa, corp. Must approve certain decisions of the governing body, including the strategic plan, annual capital plan, and annual operating budget. Mercy health services - iowa, corp. 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 baum harmon mercy hospital is reviewed by senior management. In addition, certain key sections of the form are reviewed by the board of directors. The board receives a copy of the return in its final form before it is filed with the internal revenue service.”

“Baum harmon mercy hospital 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 baum harmon mercy hospital, 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 baum harmon mercy hospital 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 baum harmon mercy hospital (or a delegated committee of the board) on a yearly basis. Interested persons are required to make full disclosure to baum harmon mercy hospital of any financial or business interests that might result in or have the appearance of a conflict of interest. The board of directors of baum harmon mercy hospital (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 baum harmon mercy hospital. 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 top management official's compensation is established and paid by mercy medical center - sioux city, a related organization. Question 15b is answered "no" because the compensation for certain officers of baum harmon mercy hospital is established and paid by trinity health, a related organization. In establishing certain officers' 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 certain officers and directors of baum harmon mercy hospital 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.”

“Baum harmon mercy hospital 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, baum harmon mercy hospital includes a copy of its most recently filed schedule h on trinity health's website. Baum harmon mercy hospital's governing documents and conflict of interest policy are available upon request.”

“Medical specialist fees: program service expenses 132,406. Management and general expenses 0. Fundraising expenses 0. Total expenses 132,406. Other purchased services: program service expenses 33,000. Management and general expenses 10,224. Fundraising expenses 0. Total expenses 43,224. Physical therapy services: program service expenses 160,717. Management and general expenses 0. Fundraising expenses 0. Total expenses 160,717. Billing services: program service expenses 3,840. Management and general expenses 1,791. Fundraising expenses 0. Total expenses 5,631. Laundry/linen services: program service expenses 9,297. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,297. Consulting services: program service expenses 0. Management and general expenses 14,186. Fundraising expenses 0. Total expenses 14,186. Recruiting services: program service expenses 12,525. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,525. Medical services: program service expenses 380,908. Management and general expenses 0. Fundraising expenses 0. Total expenses 380,908. Housekeeping services: program service expenses 23,250. Management and general expenses 0. Fundraising expenses 0. Total expenses 23,250.”

“Equity transfers to/from affiliates 1,000,121.”

“Baum harmon mercy hospital's financial statements were included in the fy15 consolidated financial statements of trinity health, which were audited by an independent public accounting firm.”