Baum-Harmon Mercy Hospital

“The sole member of baum harmon mercy hospital (mercyone primghar) is mercy health services - iowa (mhs-ia). See line 7 for additional information.”

“Mhs-ia is the sole member of mercyone primghar. Mhs-ia has the right to appoint all persons to the board of directors of mercyone primghar.”

“As sole member, mhs-ia must approve certain decisions of the governing body, including the strategic plan, annual capital plan, and annual operating budget. Mhs-ia 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 the national trinity health system, certain powers are reserved to trinity health corporation. These include the authority to adopt or modify 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 trinity health corporation.”

“Line 8b is answered "no" because mercyone primghar had no committees with authority to act on behalf of the governing body.”

“Prior to filing, the form 990 for mercyone primghar 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.”

“Mercyone primghar 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 primghar, which includes directors, principal officers, and key employees. Interested persons are expected to discharge their duties in a manner the person reasonably believes to be in the best interests of mercyone primghar 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 primghar on a yearly basis. Interested persons are required to make full disclosure to mercyone primghar 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 primghar 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 will either avoid the conflict or appropriately scrutinize the transaction to ensure it is in the best interests of mercyone primghar. 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 certain officers and key management officials of mercyone primghar is established by trinity health, a related organization. In establishing ceo 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 ceo of mercyone primghar 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 health care organizations to advise it in the determinations it makes on the reasonableness of proposed compensation and benefits arrangements. Question 15b is answered "no" because the compensation for the vice president finance of mercyone primghar is established and paid by mercyone siouxland medical center, a related organization.”

“Mercyone primghar 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 primghar includes a copy of its most recently filed schedule h on trinity health's website. Mercyone primghar's governing documents and conflict of interest policy are available upon request.”

“Dba: mercyone primghar medical center dba: mercyone hartley family medicine clinic dba: mercyone paullina family medicine clinic dba: mercyone primghar family medicine clinic dba: mercyone sutherland family medicine clinic”

“Medical services: program service expenses 290,010. Management and general expenses 0. Fundraising expenses 0. Total expenses 290,010. Contract labor: program service expenses 907,810. Management and general expenses 0. Fundraising expenses 0. Total expenses 907,810. Medical specialist fees: program service expenses 16,589. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,589. Misc. Purchased services: program service expenses 45,082. Management and general expenses 173,598. Fundraising expenses 0. Total expenses 218,680. Laundry/linen services: program service expenses 7,324. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,324. Billing services: program service expenses 785. Management and general expenses 2,031. Fundraising expenses 0. Total expenses 2,816. Recruiting services: program service expenses 346. Management and general expenses 31,333. Fundraising expenses 0. Total expenses 31,679.”

“Mercyone primghar's financial statements were included in the fy22 consolidated financial statements of trinity health, which were audited by an independent public accounting firm.”