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THE AMOUNT SHOWN ON LINE 1F ABOVE REPRESENTS THIS ENTITY'S SHARE OF ALLOCATED LOBBYING EXPENSES: AHA $1,464; CHA $1,050."}]},"ScheduleD":{"endowment_funds":{"current_year":{"beginning_year_balance":15626,"investment_earnings_or_losses":2163,"end_year_balance":17789},"current_year_minus1":{"beginning_year_balance":18559,"investment_earnings_or_losses":-2933,"end_year_balance":15626},"board_designated_eoy_percentage":0.36,"permanent_endowment_eoy_percentage":0.64,"held_by_unrelated_organizations":false,"held_by_related_organizations":false},"land_buildings_equipment":{"land":{"other_cost_or_other_basis":8214793,"book_value":8214793},"buildings":{"other_cost_or_other_basis":52227831,"book_value":46749759,"depreciation":5478072},"leasehold_improvements":{"other_cost_or_other_basis":2526955,"book_value":1817256,"depreciation":709699},"equipment":{"other_cost_or_other_basis":44289073,"book_value":23864313,"depreciation":20424760},"other_land_buildings":{"other_cost_or_other_basis":1699929,"book_value":1699929,"depreciation":0},"total_book_value":82346050},"securities":{"other_securities":[{"description":"CHI OIP - Fixed Income","book_value":8558301},{"description":"CHI OIP - Equity Securities","book_value":7904820}],"total_book_value":16463121},"other_liabilities":{"federal_income_tax_liability":0,"liabilities":[{"description":"LOAN GUARANTEE LIABILITY","amount":147359},{"description":"FEDERAL INCOME TAXES PAYABLE","amount":132139},{"description":"UNCLAIMED PROPERTY","amount":16197},{"description":"INTERCOMPANY PAYABLES","amount":73253008}],"total_liability":73548703},"net_assets_reconciliation":{"total_revenue":127143383,"total_expenses":114375282,"excess_or_deficit_for_year":12768101,"net_unrealized_gains_losses_on_investments":196815,"other_amount":-367720,"total_adjustments":-170905,"excess_or_deficit_per_financial_statements":12597196},"supplemental_information":[{"identifier":"INTENDED USES OF ENDOWMENT FUNDS","form_and_line_reference":"SCHEDULE D, PART V, Q.4","explanation":"The intended uses of all endowment funds are to further the mission of Mercy Regional Medical Center of Durango."},{"identifier":"REPORTING OF LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740","form_and_line_reference":"SCHEDULE D, PART V","explanation":"Mercy Regional Medical Center of Durango's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (\"CHI\"), a related organization. CHI's FIN 48 footnote for the year ended June 30, 2010 reads as follows: CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements."},{"identifier":"OTHER RECONCILING ITEMS","form_and_line_reference":"SCHEDULE D, PART XI, LINE 8","explanation":"CHI CONNECT DEPRECIATION $200,000 CAPITAL RESOURCE POOL CONTRIBUTION $(567,720) ------------ NET ADJUSTMENT $(367,720) ============"}]},"ScheduleH":{"policies":{"financial_assistance_policy":true,"written_policy":true,"fpg_reference_free_care":false,"fpg_reference_discounted_care":false,"free_or_discounted_care_medically_indigent":true,"financial_assistance_budget":true,"expenses_exceed_budget":true,"unable_to_provide_care":false,"annual_community_benefit_report":true,"report_publicly_available":true},"bad_debt_medicare_collections":{"bad_debt_expense_reported":true,"bad_debt_expense":8931149,"reimbursed_by_medicare":29701041,"cost_of_care_reimbursed_by_medicare":42398209,"medicare_surplus_or_shortfall":-12697168,"cost_to_charge_ratio":true,"written_debt_collection_policy":true,"financial_assistance_provision":true},"community_benefit":{"financial_assistance_at_cost":{"persons_served":593,"total_community_benefit_expense":1901643,"direct_offsetting_revenue":102636,"net_community_benefit_expense":1799007,"total_expense_percentage":0.0171},"unreimbursed_medicaid":{"persons_served":5129,"total_community_benefit_expense":12655572,"direct_offsetting_revenue":6503151,"net_community_benefit_expense":6152421,"total_expense_percentage":0.0583},"unreimbursed_costs":{"persons_served":529,"total_community_benefit_expense":3370214,"direct_offsetting_revenue":2524231,"net_community_benefit_expense":845983,"total_expense_percentage":0.008},"total_financial_assistance":{"persons_served":6251,"total_community_benefit_expense":17927429,"direct_offsetting_revenue":9130018,"net_community_benefit_expense":8797411,"total_expense_percentage":0.0834},"community_health_services":{"activities_or_programs":5,"persons_served":52937,"total_community_benefit_expense":130296,"direct_offsetting_revenue":51700,"net_community_benefit_expense":78596,"total_expense_percentage":0.0007},"health_professions_education":{"activities_or_programs":2,"total_community_benefit_expense":16383,"net_community_benefit_expense":16383,"total_expense_percentage":0.0002},"cash_and_inkind_contributions":{"activities_or_programs":2,"total_community_benefit_expense":23412,"net_community_benefit_expense":23412,"total_expense_percentage":0.0002},"total_other_benefits":{"activities_or_programs":9,"persons_served":52937,"total_community_benefit_expense":170091,"direct_offsetting_revenue":51700,"net_community_benefit_expense":118391,"total_expense_percentage":0.0011},"total_community_benefits":{"activities_or_programs":9,"persons_served":59188,"total_community_benefit_expense":18097520,"direct_offsetting_revenue":9181718,"net_community_benefit_expense":8915802,"total_expense_percentage":0.0845}},"community_building":{"community_support":{"activities_or_programs":5,"persons_served":211,"total_community_benefit_expense":169005,"net_community_benefit_expense":169005,"total_expense_percentage":0.0016},"coalition_building":{"activities_or_programs":2,"total_community_benefit_expense":3496,"net_community_benefit_expense":3496,"total_expense_percentage":0.0},"health_improvement_advocacy":{"activities_or_programs":1,"persons_served":67,"total_community_benefit_expense":1130,"net_community_benefit_expense":1130,"total_expense_percentage":0.0},"total_community_building_activities":{"activities_or_programs":8,"persons_served":278,"total_community_benefit_expense":173631,"net_community_benefit_expense":173631,"total_expense_percentage":0.0016}},"hospital_facilities":[{"business_name_line1":"Mercy Regional Medical Center","address_line1":"1010 Three Spring Blvd","city":"Durango","state":"CO","zip":"81301","licensed_hospital":true,"general_medical_and_surgical":true,"name":"Mercy Regional Medical Center","address":"1010 Three Spring Blvd, Durango, CO, 81301"}],"part_vi_explanations":{"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. Mercy Regional Medical Center of Durango, along with its affiliated outpatient facilities are part of Catholic Health Initiatives. Catholic Health Initiatives (CHI) is a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 73 hospitals; 40 long-term care, assisted- and residential-living facilities; and two community health-services organizations. Together, these facilities provided $590 million in charity care and community benefit in the 2010 fiscal year, including services for the poor, free clinics, education and research. CHI provides strategic planning and management services as well as centralized \"shared services\" for the MBOs. 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 MBOs. Cost savings associated with centralized services for the fiscal year ended June 30, 2010 include more than $105 million in supply chain expense, approximately $30 million for insurance costs and more than $3.9 million as the result of a system-wide effort to coordinate and negotiate technology and equipment purchases. The cost savings achieved through CHI's centralization enable MBOs to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society.","annual_community_benefit":"If the organization's community benefit report is contained in a report prepared by a related organization, rather than a separate report prepared by the organization, identify the related organization. Mercy Regional Medical Center prepares its own written community benefit report. Its community benefit report is not contained in that of a related organization.","bad_debt_footnote":"Provide the rationale and the costing methodology used to determine the amount reported in Part III lines 2 and 3. Describe how the organization accounts for discounts and payments on patient accounts in determining bad debt expense. Also describe the method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information has been available to make a determination as to their eligibility. Also, provide if applicable, the text of the footnote to the organization's financial statements that describes bad debt expense. If the organization's financial statements include a footnote on these issues that also includes other information, report only the relevant portions of the footnote. If the organization's financial statements do not contain such a footnote, state that the organization's financial statements do not include such a footnote and explain how the financial statements account for bad debt, if at all. Costing methodology for amounts reported on Line 2 is determined using the organization's cost/charge ratio of 44.63% (attributable of MRMC). Where discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. MRMC 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. MRMC does not issue separate company audited financial statements, thus there is no footnote separate footnote. However, mrmc is included in the consolidated audited financial statements of catholic health initiatives (chi). The chi footnote reads as follows: \"the provision for bad debts is based upon mamagement's assessment of historical and expected net collections considering historical business and economic conditions, trends in health caree coverage, and other collection indicators. management periodically assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. the results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. after satisfaction of amounts due from insurance, chi follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on colectioin efforts as determined by each facility.\"","community_building_activities":"Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above.","community_information":"Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above.","costing_method_used":"Provide an explanation of the costing methodology used to calculate the amounts reported in the table. If a cost accounting system was used, indicate whether the cost accounting system addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured or self pay). Also indicate whether a cost-to-charge ratio was used for any of the figures reported in the table. Describe whether this cost-to-charge ratio was derived from Worksheet 2, and, if not, what kind of cost-to-charge ratio was used and how it was derived. If some other costing methodology was used besides a cost accounting system, cost-to-charge ratio, or a combination of the two, describe the method used. Costs in the table were computed using the organization's cost-to-charge ratio that covers all patient segments. The cost-to-charge ratio was 44.63% for the year ended 6/30/10 computed using the following formula: Cost-To-Charge Ratio Calculation FY08 C:C Ratio 47.11% 50.29% 44.6% Baseline Charges 100 112.70 FY08 Expense 100,935,191 Fy09 Expense 107,753,791 % Change 106.8% FY08 Charges 80,975,032 FY09 Charges 91,259,022 % Change 112.7% Worksheet 2 was not used in determining the ratio.","debt_collection_policy":"If the organization has a written debt collection policy and answered \"yes\" to Part III, line 9b, describe the collection practices set forth in the policy that apply to patients who it knows qualify for charity care or financial assistance, whether or not such practices apply specifically to such patients or more broadly to also cover other types of patients. MRMC's debt collection policy provides that MRMC will perform a reasonable review of each patient account, prior to turning an account to a third-party collection agent and prior to instituting any legal action for non-payment, to assure that the patient and patient guarantor are not eligible for any assistance program (e.g. Medicaid) and do not qualify for coverage through MRMC community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the MRMC community assistance policy is required to be returned immediately by the third-party collection agent to MRMC for appropriate follow-up. All of Catholic Health Initiatives' hospitals contracts with third party collection agencies include the following standards: 1. Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; 2. Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and 3. No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiative Mission, Core Values and Standard of Conduct to make sure all patients are treated with dignity and respect.","income_based_criteria":"If applicable, describe the income-based criteria for determining eligibility for free or discounted care under the organization's charity care policy. Also describe whether the organization uses the asset test or other threshold regardless of income to determine eligibility for free or discounted care. When Catholic Health Initiatives (the parent organization to Mercy Regional Medical Center) established its charity care policy it was determined that establishing a household income scale based on the HUD very low income guidelines was more inclusive than other poverty guidelines and more accurately reflects the socioeconomic dispersions among the 69 urban and rural communities in 20 states served by CHI hospitals and health care facilities. In comparing HUD guidelines to the Federal Poverty Guidelines (\"FPG\"), we find that on average HUD guidelines compute to approximately 200% to 250% (and sometimes 300%) of FPG such that more individuals qualify for financial assistance under HUD guidelines that under FPG. Mercy Regional Medical Center (MRMC) bases its charity care eligibility on HUD\"S 130% of Very Low Income Guidelines based on geography, and affords the uninsured and under insured the ability to obtain charity care write-offs, based on a sliding scale. An individual's income under the HUD guidelines is a significant factor in determining eligibility for charity care. However, in determining whether to extend discounted or free care to a patient, the patient's assets may also be taken into consideration. For example a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's basic financial (and ultimately physical) well-being and survival. Such a patient may be extended discounted or free care based upon the facts and circumstances.","needs_assessment":"Describe how the organization assesses the health care needs of the communities it serves. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves. Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting health of the community (e.g. open medical staff, community board, use of surplus funds, etc). Introduction Mercy Hospital of the San Juans was founded in 1882 by five Sisters of Mercy who traveled by rail to the small mining town of Durango, Colorado. The Sisters of Mercy established Durango's first hospital according to their mission of compassionately serving others-especially the poor. Today, 127 years later, the Sisters' legacy of care continues at Mercy Regional Medical Center, now an 82-bed, full-service, acute care hospital. Although the facility and name have changed, the hospital's guiding mission to provide care to all who need it, regardless of ability to pay, remains firmly in place. This mission is carried out every day by more than 800 employees and is stewarded by an independent board of directors, comprised primarily of local community members, who ensure the hospital is meeting the community's needs as best it can. In addition to a wide array of specialty services, Mercy Regional Medical Center acts as the community's healthcare safety net, providing care to all who need it, regardless of ability to pay, type of insurance, or other factors. The hospital's emergency department is open 24 hours per day, every day, and the hospital accepts all insurances, including Medicare and Medicaid. The hospital also provides care to those with no insurance. Community service has been an integral part of Mercy since its founding in 1882. Today, services provided include not only direct patient care, but also preventive and wellness programs, promotion of healthy communities in the physical, spiritual, emotional, and economic sense, and provision of educational opportunities for medical professionals, support of other not-for-profit organizations through monetary donations and gifts of in-kind services, and more. Mercy Regional Medical Center was granted tax exempt status in March of 1946 as a hospital. Community Benefit Approach Located in Durango, Colorado, Mercy Regional Medical Center serves southwest Colorado and parts of the Four Corners Region, which includes La Plata County, CO; Archuleta County, CO; Montezuma County, CO; San Juan County, CO; and parts of San Juan County, NM. Together, these areas encompass the hospital's primary service area, which has a service area population of more approximately 189,000. Process Mercy Regional Medical Center's Community Benefit Plan is based on addressing the needs of the communities we serve. An understanding of these needs is gained from collaboration with other entities and organizations and through formal environmental assessments. Access to Primary Care While the quality of life has helped in attracting and retaining medical specialists in the area, Medicare, Medicaid, and low-income/uninsured reimbursement shortfalls for primary care providers present significant access issues in the community. In 2007, one of the largest primary care provider practices closed, leaving thousands of patients without access. While many of the commercially insured patients were absorbed by other practices, most of the medically underserved were left without a medical home. Foreseeing the impending crisis that would be caused by these patients not having access to essential services, such as management of medications and chronic illnesses, Mercy Regional Medical Center joined a community coalition whose purpose was to solve the problem. Other stakeholders included La Plata County, the City of Durango, the Citizens Health Advisory Council, and others. Together, the coalition decided it was necessary to open a stop-gap clinic to meet the immediate needs of those who lost access to much needed primary care services. In May of 2007, Mercy Regional Medical Center, with contributions from the City of Durango and La Plata County, opened a primary care clinic called the Health Services Clinic (HSC). To develop a more sustainable answer to the needs of the medically underserved, the coalition retained a consulting firm that conducted in-depth research. Summary of Assessment Findings Recommendations for addressing the sustainable long-term needs of the medically underserved included the Health Services Clinic's application for rural health clinic status to improve reimbursements for Medicare and Medicaid patients. The Health Services Clinic was granted this status in october 2009. Meanwhile, the hospital, with future contributions from the city and county in question, continues to subsidize Health Services Clinic operations. Because of ongoing shortfalls in reimbursement for the uninsured, Mercy Regional Medical Center expects the HSC to continue facing financial shortfalls beyond fiscal year 2010. Uncompensated Care for the Poor Mercy Regional Medical Center provides a significant level of free care each year. In fiscal year 2010, the cost of charity care provided by the organization was more than $1.8 million. Mercy Regional Medical Center also incurred $6.1 million in unreimbursed costs for services provided to Medicaid patients. Frequently, the cost of providing services to Medicaid patients is greater than the payments Mercy Regional Medical Center receives from the Medicaid program. Mercy Regional Medical Center also participates in the Colorado Indigent Care Program. The unreimbursed cost of providing care to patients enrolled in the CICP totaled $845,983. Financial assistance information is made available to patients at check-in and on the facility's web site, and financial counselors are also available to help patients after they receive their hospital bills. Examples of Community Outreach for the Broader Community Community Based Clinical Services Area Public School Presentations Clinical and technical staff makes numerous free presentations about general health care, safety, nursing and other medical professions throughout the school year to elementary, middle and high schools throughout La Plata County. Participation in Economic Development Organizations Mercy regional medical center employees participate in various meetings at organizations that promote economic development in the region. Participation in Community Boards and Committees Mercy regional medical center employees act as board and committee members at Ft. Lewis College, Community Foundation Serving SW Colorado, Durango Transit, Durango Fire and Rescue, and more. Community Emergency Preparedness Mercy Regional Medical Center participates in various region-wide emergency preparedness meetings and mass-casualty exercises that better prepare area responders and healthcare providers for real emergencies. Education: Clinical Services and Medical Professionals Mercy Regional Medical Center employees provide clinical training and opportunities for students to observe hospital operations as part of their education. Mrmc also hosts and coordinates continuing medical education opportunities for area providers on a regular basis. Mercy is the area's primary resource for continuing medical education for physicians and other medical professionals. Participation in Health Fairs Mercy Regional Medical Center participates in community health fairs that provide affordable or free access to diagnostic tests and other health screenings. Hospital personnel participate in other fairs and events where they distribute free health information to the public. Cash and In-kind Donations to other Not-for-Profit Organizations Mercy Regional Medical Center regularly donates to a number of local not-for-profit organizations that promote health and wellness in the communities it serves.","other_information":"Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting health of the community (e.g. open medical staff, community board, use of surplus funds, etc). Please refer to the Needs Assessment Narrative, Part VI, Item 2. above.","patient_education_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 charity care policy. MRMC displays information concerning its financial assistance policy in obvious locations throughout the hospital and on the facility's website. At the time of scheduling, or when patients present to registration, once all EMTALA requirements are met, patients without Medicare/Medicaid, State financial assistance or adequate health insurance will receive either: A) A handout notifying them that financial assistance is available in lieu of applications being handed out, or B) immediate financial counseling from staff. Each person requesting financial assistance will be screened for all programs available to them. Once a determination has been made to what program is appropriate, they will be provided the information that is needed to apply. Mercy regional medical center now has the ability for on-site applications for medicaid. The handout and the application information will be provided in English and Spanish. Patients requiring assistance with other languages will be referred to the translators on staff or to the interpretation line.","percent_of_total_expense":"If applicable, state the bad debt expense included on Form 990 Part IX, line 25, column (A) but subtracted for purposes of calculating the percentage in this column. Total bad debt expense reported on Form 990 Part IX, line 25, Column A was $8,931,149.","shortfall_as_community_benefit":"Describe the costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected in the amount reported in Part III, line 6. Describe, if applicable, the extent to which any shortfall reported in Part III, line 7 should be treated as a community benefit, and the rationale for the organization's position. Using essentially the same Medicare cost report principles as to the allocation of general services costs and \"apportionment\" methods, the \"chi workbook\" calculates a payers' gross allowable costs by service (to facilitate a corresponding comparison between gross allowable costs and ultimate payments recieved.) The term \"gross allowable costs\" means costs before any deductibles or co-insurance are subtracted. Mercy Regional Medical Center's ultimate reimbursement will be reduced by any appplicable copayment/deductible. where medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from medicare allowable costs because the amounts are typically immaterial. MRMC believes that excluding Medicare losses makes the overall community benefit report more credible for these reasons. Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit Hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as a community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as \"subsidized health services.\" Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states afford to pay.","subsidized_health_services":"To the extent that an organization includes any costs associated with physician clinics as subsidized health services in Part I, line 7g it must describe that it has done so and report in Part VI such costs included in part I, line 7g, line 1. There are no physician clinics included in subsidized health services."}},"ScheduleI":{"grant_records_maintained":true,"reported_domestic_org_grants":19679,"reported_domestic_individual_grants":0,"reported_domestic_org_grants_program_services":19679,"total_501c3_and_government_organizations":1,"grants":[{"ein":840902211,"irc_section":"501(c)(3)","cash":6600,"purpose":"Program Support","address_line1":"1010 Three Springs Blvd","city":"DURANGO","state":"CO","zip":"81301","name":"Mercy Health Foundation","address":"1010 Three Springs Blvd, DURANGO, CO, 81301"}],"total_domestic_grants":19679,"total_domestic_program_services":19679,"detail_org_grants_total":6600,"detail_domestic_grants_total":6600,"supplemental_information":[{"identifier":"procedures for monitoring the use of grant funds","form_and_line_reference":"schedule i, part i, q.2","explanation":"THE GRANTS MADE BY MERCY REGIONAL MEDICAL CENTER OF DURANGO (\"MRMCD\") TO MERCY HEALTH FOUNDATION (\"MHF\"), A RELATED TAX-EXEMPT ORGANIZATION, WERE MONITORED BY THE BOARD OF DIRECTORS OF MRMCD TO BE CONSISTENT WITH THE EXEMPT PURPOSES OF MRMCD."}],"grant_monitoring":{"claims_monitoring_procedures":false,"requires_financial_reports":false,"requires_narrative_reports":false,"conducts_site_visits":false,"conducts_field_audits":false,"requires_grant_agreements":false,"may_suspend_future_funding":false,"may_require_repayment":false}},"ScheduleF":{"reported_foreign_grants":0},"ScheduleJ":{"benefits_and_procedures":{"tax_indemnification_and_gross_up_payments":true,"substantiation_required":true,"written_policy_travel_and_entertainment":true},"compensation_arrangements":{"compensation_based_on_revenue_filing_org":false,"compensation_based_on_revenue_related_orgs":false,"compensation_based_on_net_earnings_filing_org":false,"compensation_based_on_net_earnings_related_orgs":false,"nonfixed_payments":true,"initial_contract_exception":false,"severance_payment":false,"supplemental_nonqualified_retirement_plan":true,"equity_based_compensation_arrangement":false},"compensation":[{"person_name":"JOHN BOYD","base_compensation_filing_org":191777,"nontaxable_benefits_filing_org":27828,"other_compensation_filing_org":674,"total_compensation_filing_org":220278,"name":"JOHN BOYD"},{"person_name":"GREGORY DEEM","base_compensation_filing_org":356447,"bonus_filing_org":4000,"nontaxable_benefits_filing_org":41064,"other_compensation_filing_org":357,"total_compensation_filing_org":401868,"name":"GREGORY DEEM"},{"person_name":"Kirk Dignum","bonus_related_orgs":78131,"compensation_based_on_related_orgs":279673,"comp_report_prior_990_related_orgs":33078,"deferred_compensation_related_orgs":15271,"nontaxable_benefits_related_orgs":43795,"other_compensation_related_orgs":62791,"total_compensation_related_orgs":479661,"name":"Kirk Dignum"},{"person_name":"ROGER HIRST","base_compensation_filing_org":359322,"nontaxable_benefits_filing_org":36749,"other_compensation_filing_org":562,"total_compensation_filing_org":396633,"name":"ROGER HIRST"},{"person_name":"NANCY HOYT","base_compensation_filing_org":178018,"nontaxable_benefits_filing_org":28109,"other_compensation_filing_org":241,"total_compensation_filing_org":206368,"name":"NANCY HOYT"},{"person_name":"David Goode","bonus_related_orgs":120573,"compensation_based_on_related_orgs":453182,"comp_report_prior_990_related_orgs":410385,"deferred_compensation_related_orgs":126,"nontaxable_benefits_related_orgs":43341,"other_compensation_related_orgs":459299,"total_compensation_related_orgs":1076521,"name":"David Goode"},{"person_name":"MICHAEL MCCALLUM","base_compensation_filing_org":382336,"nontaxable_benefits_filing_org":34135,"other_compensation_filing_org":391,"total_compensation_filing_org":416862,"name":"MICHAEL MCCALLUM"},{"person_name":"STEVEN MOROZOWICH","base_compensation_filing_org":358061,"nontaxable_benefits_filing_org":38746,"other_compensation_filing_org":356,"total_compensation_filing_org":397163,"name":"STEVEN MOROZOWICH"},{"person_name":"JOSEPH PEDLEY","base_compensation_filing_org":112684,"bonus_filing_org":31246,"compensation_based_on_related_orgs":49898,"nontaxable_benefits_filing_org":37866,"other_compensation_filing_org":9227,"other_compensation_related_orgs":604,"total_compensation_filing_org":191022,"total_compensation_related_orgs":50502,"name":"JOSEPH PEDLEY"},{"person_name":"ALBERT WHITESELL","base_compensation_filing_org":364571,"bonus_filing_org":10000,"nontaxable_benefits_filing_org":37323,"other_compensation_filing_org":561,"total_compensation_filing_org":412454,"name":"ALBERT WHITESELL"}],"supplemental_information":[{"identifier":"Tax Indemnification and gross-up payments","form_and_line_reference":"schedule J, PART I, Q. 1A","explanation":"THE CFO, JOSEPH PEDLEY, RECEIVED GROSSED-UP MOVING EXPENSES ASSOCIATED WTIH HIS CHANGE OF EMPLOYMENT."},{"identifier":"METHODS USED TO ESTABLISH CEO COMPENSATION","form_and_line_reference":"SCHEDULE J, PART I, Q. 3","explanation":"COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF MERCY REGIONAL MEDICAL CENTER OF DURANGO WAS ESTABLISHED AND PAID BY A RELATED ORGANIZATION, CATHOLIC HEALTH INITIATIVES (\"CHI\"). CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACT; (4) COMPENSATION SURVEY OR STUDY; AND (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE."},{"identifier":"POST TERMINATION PAYMENTS","form_and_line_reference":"SCHEDULE J, PART I, Q. 4A","explanation":"POST-TERMINATION PAYMENTS ARE ADDRESSED IN THE EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVE'S MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM CHI DURING THE 2009 CALENDAR YEAR."},{"identifier":"SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN","form_and_line_reference":"SCHEDULE J, PART I, Q. 4B","explanation":"DURING THE 2009 CALENDAR YEAR, CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: KIRK DIGNUM AND DAVID GOODE. for the 2009 calendar year contributions were made on behalf of; KIRK DIGNUM; $15,271 AND DAVID GOODE; $126. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN DURING THE 2009 CALENDAR YEAR, AND THE FOLLOWING AMOUNTS WERE INCLUDED IN THE INDIVIDUAL'S REPORTABLE COMPENSATION ON SCHEDULE J: Kirk Dignum; $33,078 AND DAVID GOODE; $423,784."},{"identifier":"NON-FIXED PAYMENTS","form_and_line_reference":"SCHEDULE J, PART I, Q.7","explanation":"UNDER AN INCENTIVE PLAN APPROVED BY THE EXECUTIVE COMMITTEE, THE EXECUTIVE OFFICERS OF MRMCD WERE ELIGIBLE FOR CERTAIN DISCRETIONARY BONUSES BASED ON MEETING PERFORMANCE CRITERIA UNDER EACH OF MRMCD'S STRATEGIC GOALS (PEOPLE, QUALITY, STEWARDSHIP, AND INDIVIDUAL PERFORMANCE) AT THE CLOSE OF THE FISCAL YEAR. UNDER A BOARD-APPROVED INCENTIVE PLAN, DISCRETIONARY BONUSES WERE PAID TO CERTAIN INDIVIDUALS AS REFLECTED ON SCH. J, PART II."}]},"ScheduleL":{"business_transactions_involving_interested_persons":[{"person_name":"Carolyn Newbold","relationship":"Family member","description":"COMPENSATION","amount":103505,"sharing_of_revenues":false,"name":"Carolyn Newbold"},{"person_name":"FOUR CORNERS HEART CLINIC","relationship":"DUAL BOARD MEMBER","description":"CONTRACT MEDICAL SERVICES","amount":147494,"sharing_of_revenues":true,"name":"FOUR CORNERS HEART CLINIC"},{"person_name":"FOUR CORNERS REGIONAL HEART CLINIC","relationship":"GREATER THAN 5% OWNER","description":"CARDIAC CATHETERIZATION","amount":5327283,"sharing_of_revenues":true,"name":"FOUR CORNERS REGIONAL HEART CLINIC"},{"person_name":"MARK STERN SURGICAL SERCVICES PLCC","relationship":"SOLE OWNER","description":"MEDICAL STAFF PRESIDENT","amount":48000,"sharing_of_revenues":true,"name":"MARK STERN SURGICAL SERCVICES PLCC"},{"person_name":"SOUTHWEST SURGICAL ASSOCIATION","relationship":"DUAL BOARD MEMBER","description":"TRAUMA SERVICES","amount":352200,"sharing_of_revenues":true,"name":"SOUTHWEST SURGICAL ASSOCIATION"},{"person_name":"PEDIATRIC PARTNERS","relationship":"DUAL BOARD MEMBER","description":"CONTRACT MEDICAL SERVICES","amount":336257,"sharing_of_revenues":true,"name":"PEDIATRIC PARTNERS"},{"person_name":"DURANGO ORTHOPEDICS","relationship":"DUAL BOARD MEMBER","description":"CONTRACT MEDICAL SERVICES","amount":108225,"sharing_of_revenues":true,"name":"DURANGO ORTHOPEDICS"}]},"ScheduleR":{"tax_exempt_organizations":[{"ein":710897107,"business_name_line1":"St Joseph Community Health Services","primary_activities":"Community","exempt_code_section":"501(c)(3)","public_charity_status":"11a","legal_domicile_state":"NM","direct_controlling_business_name_line1":"CHI","address_line1":"300 Central SW Suite 300","city":"Albuquerque","state":"NM","zip":"87102","name":"St Joseph Community Health Services","address":"300 Central SW Suite 300, Albuquerque, NM, 87102"},{"ein":850253087,"business_name_line1":"St Joseph Community Health Foundation","primary_activities":"Foundation","exempt_code_section":"501(c)(3)","public_charity_status":"7","legal_domicile_state":"NM","direct_controlling_business_name_line1":"SJCHS","address_line1":"300 Central SW Suite 300","city":"Albuquerque","state":"NM","zip":"87102","name":"St Joseph Community Health Foundation","address":"300 Central SW Suite 300, Albuquerque, NM, 87102"},{"ein":930412495,"business_name_line1":"St Francis of Baker City","primary_activities":"Hospital","exempt_code_section":"501(c)(3)","public_charity_status":"3","legal_domicile_state":"OR","direct_controlling_business_name_line1":"CHI","address_line1":"3325 Pocahontas Road","city":"Baker City","state":"OR","zip":"97814","name":"St Francis of Baker City","address":"3325 Pocahontas Road, Baker City, OR, 97814"},{"ein":943164869,"business_name_line1":"St Elizabeth Health Care Foundation","primary_activities":"Foundation","exempt_code_section":"501(c)(3)","public_charity_status":"7","legal_domicile_state":"OR","direct_controlling_business_name_line1":"SEHS","address_line1":"3325 Pocahontas Road","city":"Baker City","state":"OR","zip":"97814","name":"St Elizabeth Health Care Foundation","address":"3325 Pocahontas Road, Baker City, OR, 97814"},{"ein":562351341,"business_name_line1":"Flaget Memorial Hospital Foundation Inc","primary_activities":"Fundraising","exempt_code_section":"501(c)(3)","public_charity_status":"11a","legal_domicile_state":"KY","direct_controlling_business_name_line1":"FH","address_line1":"4305 New Shepherdsville Road","city":"Bardstown","state":"KY","zip":"40004","name":"Flaget Memorial Hospital Foundation Inc","address":"4305 New Shepherdsville Road, Bardstown, KY, 40004"},{"ein":611345363,"business_name_line1":"Flaget Healthcare DBA Flaget Memorial","primary_activities":"Hospital","exempt_code_section":"501(c)(3)","public_charity_status":"3","legal_domicile_state":"KY","direct_controlling_business_name_line1":"CHI","address_line1":"4305 New Shepherdsville Road","city":"Bardstown","state":"KY","zip":"40004","name":"Flaget Healthcare DBA Flaget Memorial","address":"4305 New Shepherdsville Road, Bardstown, KY, 40004"},{"ein":410758434,"business_name_line1":"Lakewood Health Center","primary_activities":"LTerm Care","exempt_code_section":"501(c)(3)","public_charity_status":"3","legal_domicile_state":"MN","direct_controlling_business_name_line1":"CHI","address_line1":"600 Main Avenue South","city":"Baudette","state":"MN","zip":"56623","name":"Lakewood Health Center","address":"600 Main Avenue South, Baudette, MN, 56623"},{"ein":411850500,"business_name_line1":"Appletree Court","primary_activities":"Senior Homes","exempt_code_section":"501(c)(3)","public_charity_status":"9","legal_domicile_state":"MN","direct_controlling_business_name_line1":"SFH","address_line1":"601 Oak Street","city":"Breckenridge","state":"MN","zip":"56520","name":"Appletree Court","address":"601 Oak Street, Breckenridge, MN, 56520"},{"ein":760761782,"business_name_line1":"Healthcare and Wellness Foundation","primary_activities":"Foundation","exempt_code_section":"501(c)(3)","public_charity_status":"11a","legal_domicile_state":"MN","direct_controlling_business_name_line1":"SFMC","address_line1":"2400 St Francis Drive","city":"Breckenridge","state":"MN","zip":"56520","name":"Healthcare and Wellness Foundation","address":"2400 St Francis Drive, Breckenridge, MN, 56520"},{"ein":410729978,"business_name_line1":"St Francis Home","primary_activities":"LTerm Care","exempt_code_section":"501(c)(3)","public_charity_status":"9","legal_domicile_state":"MN","direct_controlling_business_name_line1":"CHI","address_line1":"2400 St 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Also describe the method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information has been available to make a determination as to their eligibility. Also, provide if applicable, the text of the footnote to the organization's financial statements that describes bad debt expense. If the organization's financial statements include a footnote on these issues that also includes other information, report only the relevant portions of the footnote. If the organization's financial statements do not contain such a footnote, state that the organization's financial statements do not include such a footnote and explain how the financial statements account for bad debt, if at all. Costing methodology for amounts reported on Line 2 is determined using the organization's cost/charge ratio of 44.63% (attributable of MRMC). Where discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. MRMC 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. MRMC does not issue separate company audited financial statements, thus there is no footnote separate footnote. However, mrmc is included in the consolidated audited financial statements of catholic health initiatives (chi). The chi footnote reads as follows: \"the provision for bad debts is based upon mamagement's assessment of historical and expected net collections considering historical business and economic conditions, trends in health caree coverage, and other collection indicators. management periodically assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. the results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. after satisfaction of amounts due from insurance, chi follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on colectioin efforts as determined by each facility.\"","community_building_activities":"Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above.","community_information":"Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above.","costing_method_used":"Provide an explanation of the costing methodology used to calculate the amounts reported in the table. If a cost accounting system was used, indicate whether the cost accounting system addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured or self pay). Also indicate whether a cost-to-charge ratio was used for any of the figures reported in the table. Describe whether this cost-to-charge ratio was derived from Worksheet 2, and, if not, what kind of cost-to-charge ratio was used and how it was derived. If some other costing methodology was used besides a cost accounting system, cost-to-charge ratio, or a combination of the two, describe the method used. Costs in the table were computed using the organization's cost-to-charge ratio that covers all patient segments. The cost-to-charge ratio was 44.63% for the year ended 6/30/10 computed using the following formula: Cost-To-Charge Ratio Calculation FY08 C:C Ratio 47.11% 50.29% 44.6% Baseline Charges 100 112.70 FY08 Expense 100,935,191 Fy09 Expense 107,753,791 % Change 106.8% FY08 Charges 80,975,032 FY09 Charges 91,259,022 % Change 112.7% Worksheet 2 was not used in determining the ratio.","debt_collection_policy":"If the organization has a written debt collection policy and answered \"yes\" to Part III, line 9b, describe the collection practices set forth in the policy that apply to patients who it knows qualify for charity care or financial assistance, whether or not such practices apply specifically to such patients or more broadly to also cover other types of patients. MRMC's debt collection policy provides that MRMC will perform a reasonable review of each patient account, prior to turning an account to a third-party collection agent and prior to instituting any legal action for non-payment, to assure that the patient and patient guarantor are not eligible for any assistance program (e.g. Medicaid) and do not qualify for coverage through MRMC community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the MRMC community assistance policy is required to be returned immediately by the third-party collection agent to MRMC for appropriate follow-up. All of Catholic Health Initiatives' hospitals contracts with third party collection agencies include the following standards: 1. Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; 2. Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and 3. No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiative Mission, Core Values and Standard of Conduct to make sure all patients are treated with dignity and respect.","income_based_criteria":"If applicable, describe the income-based criteria for determining eligibility for free or discounted care under the organization's charity care policy. Also describe whether the organization uses the asset test or other threshold regardless of income to determine eligibility for free or discounted care. When Catholic Health Initiatives (the parent organization to Mercy Regional Medical Center) established its charity care policy it was determined that establishing a household income scale based on the HUD very low income guidelines was more inclusive than other poverty guidelines and more accurately reflects the socioeconomic dispersions among the 69 urban and rural communities in 20 states served by CHI hospitals and health care facilities. In comparing HUD guidelines to the Federal Poverty Guidelines (\"FPG\"), we find that on average HUD guidelines compute to approximately 200% to 250% (and sometimes 300%) of FPG such that more individuals qualify for financial assistance under HUD guidelines that under FPG. Mercy Regional Medical Center (MRMC) bases its charity care eligibility on HUD\"S 130% of Very Low Income Guidelines based on geography, and affords the uninsured and under insured the ability to obtain charity care write-offs, based on a sliding scale. An individual's income under the HUD guidelines is a significant factor in determining eligibility for charity care. However, in determining whether to extend discounted or free care to a patient, the patient's assets may also be taken into consideration. For example a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's basic financial (and ultimately physical) well-being and survival. Such a patient may be extended discounted or free care based upon the facts and circumstances.","needs_assessment":"Describe how the organization assesses the health care needs of the communities it serves. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves. Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting health of the community (e.g. open medical staff, community board, use of surplus funds, etc). Introduction Mercy Hospital of the San Juans was founded in 1882 by five Sisters of Mercy who traveled by rail to the small mining town of Durango, Colorado. The Sisters of Mercy established Durango's first hospital according to their mission of compassionately serving others-especially the poor. Today, 127 years later, the Sisters' legacy of care continues at Mercy Regional Medical Center, now an 82-bed, full-service, acute care hospital. Although the facility and name have changed, the hospital's guiding mission to provide care to all who need it, regardless of ability to pay, remains firmly in place. This mission is carried out every day by more than 800 employees and is stewarded by an independent board of directors, comprised primarily of local community members, who ensure the hospital is meeting the community's needs as best it can. In addition to a wide array of specialty services, Mercy Regional Medical Center acts as the community's healthcare safety net, providing care to all who need it, regardless of ability to pay, type of insurance, or other factors. The hospital's emergency department is open 24 hours per day, every day, and the hospital accepts all insurances, including Medicare and Medicaid. The hospital also provides care to those with no insurance. Community service has been an integral part of Mercy since its founding in 1882. Today, services provided include not only direct patient care, but also preventive and wellness programs, promotion of healthy communities in the physical, spiritual, emotional, and economic sense, and provision of educational opportunities for medical professionals, support of other not-for-profit organizations through monetary donations and gifts of in-kind services, and more. Mercy Regional Medical Center was granted tax exempt status in March of 1946 as a hospital. Community Benefit Approach Located in Durango, Colorado, Mercy Regional Medical Center serves southwest Colorado and parts of the Four Corners Region, which includes La Plata County, CO; Archuleta County, CO; Montezuma County, CO; San Juan County, CO; and parts of San Juan County, NM. Together, these areas encompass the hospital's primary service area, which has a service area population of more approximately 189,000. Process Mercy Regional Medical Center's Community Benefit Plan is based on addressing the needs of the communities we serve. An understanding of these needs is gained from collaboration with other entities and organizations and through formal environmental assessments. Access to Primary Care While the quality of life has helped in attracting and retaining medical specialists in the area, Medicare, Medicaid, and low-income/uninsured reimbursement shortfalls for primary care providers present significant access issues in the community. In 2007, one of the largest primary care provider practices closed, leaving thousands of patients without access. While many of the commercially insured patients were absorbed by other practices, most of the medically underserved were left without a medical home. Foreseeing the impending crisis that would be caused by these patients not having access to essential services, such as management of medications and chronic illnesses, Mercy Regional Medical Center joined a community coalition whose purpose was to solve the problem. Other stakeholders included La Plata County, the City of Durango, the Citizens Health Advisory Council, and others. Together, the coalition decided it was necessary to open a stop-gap clinic to meet the immediate needs of those who lost access to much needed primary care services. In May of 2007, Mercy Regional Medical Center, with contributions from the City of Durango and La Plata County, opened a primary care clinic called the Health Services Clinic (HSC). To develop a more sustainable answer to the needs of the medically underserved, the coalition retained a consulting firm that conducted in-depth research. Summary of Assessment Findings Recommendations for addressing the sustainable long-term needs of the medically underserved included the Health Services Clinic's application for rural health clinic status to improve reimbursements for Medicare and Medicaid patients. The Health Services Clinic was granted this status in october 2009. Meanwhile, the hospital, with future contributions from the city and county in question, continues to subsidize Health Services Clinic operations. Because of ongoing shortfalls in reimbursement for the uninsured, Mercy Regional Medical Center expects the HSC to continue facing financial shortfalls beyond fiscal year 2010. Uncompensated Care for the Poor Mercy Regional Medical Center provides a significant level of free care each year. In fiscal year 2010, the cost of charity care provided by the organization was more than $1.8 million. Mercy Regional Medical Center also incurred $6.1 million in unreimbursed costs for services provided to Medicaid patients. Frequently, the cost of providing services to Medicaid patients is greater than the payments Mercy Regional Medical Center receives from the Medicaid program. Mercy Regional Medical Center also participates in the Colorado Indigent Care Program. The unreimbursed cost of providing care to patients enrolled in the CICP totaled $845,983. Financial assistance information is made available to patients at check-in and on the facility's web site, and financial counselors are also available to help patients after they receive their hospital bills. Examples of Community Outreach for the Broader Community Community Based Clinical Services Area Public School Presentations Clinical and technical staff makes numerous free presentations about general health care, safety, nursing and other medical professions throughout the school year to elementary, middle and high schools throughout La Plata County. Participation in Economic Development Organizations Mercy regional medical center employees participate in various meetings at organizations that promote economic development in the region. Participation in Community Boards and Committees Mercy regional medical center employees act as board and committee members at Ft. Lewis College, Community Foundation Serving SW Colorado, Durango Transit, Durango Fire and Rescue, and more. Community Emergency Preparedness Mercy Regional Medical Center participates in various region-wide emergency preparedness meetings and mass-casualty exercises that better prepare area responders and healthcare providers for real emergencies. Education: Clinical Services and Medical Professionals Mercy Regional Medical Center employees provide clinical training and opportunities for students to observe hospital operations as part of their education. Mrmc also hosts and coordinates continuing medical education opportunities for area providers on a regular basis. Mercy is the area's primary resource for continuing medical education for physicians and other medical professionals. Participation in Health Fairs Mercy Regional Medical Center participates in community health fairs that provide affordable or free access to diagnostic tests and other health screenings. Hospital personnel participate in other fairs and events where they distribute free health information to the public. Cash and In-kind Donations to other Not-for-Profit Organizations Mercy Regional Medical Center regularly donates to a number of local not-for-profit organizations that promote health and wellness in the communities it serves.","other_information":"Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting health of the community (e.g. open medical staff, community board, use of surplus funds, etc). Please refer to the Needs Assessment Narrative, Part VI, Item 2. above.","patient_education_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 charity care policy. MRMC displays information concerning its financial assistance policy in obvious locations throughout the hospital and on the facility's website. At the time of scheduling, or when patients present to registration, once all EMTALA requirements are met, patients without Medicare/Medicaid, State financial assistance or adequate health insurance will receive either: A) A handout notifying them that financial assistance is available in lieu of applications being handed out, or B) immediate financial counseling from staff. Each person requesting financial assistance will be screened for all programs available to them. Once a determination has been made to what program is appropriate, they will be provided the information that is needed to apply. Mercy regional medical center now has the ability for on-site applications for medicaid. The handout and the application information will be provided in English and Spanish. Patients requiring assistance with other languages will be referred to the translators on staff or to the interpretation line.","percent_of_total_expense":"If applicable, state the bad debt expense included on Form 990 Part IX, line 25, column (A) but subtracted for purposes of calculating the percentage in this column. Total bad debt expense reported on Form 990 Part IX, line 25, Column A was $8,931,149.","shortfall_as_community_benefit":"Describe the costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected in the amount reported in Part III, line 6. Describe, if applicable, the extent to which any shortfall reported in Part III, line 7 should be treated as a community benefit, and the rationale for the organization's position. Using essentially the same Medicare cost report principles as to the allocation of general services costs and \"apportionment\" methods, the \"chi workbook\" calculates a payers' gross allowable costs by service (to facilitate a corresponding comparison between gross allowable costs and ultimate payments recieved.) The term \"gross allowable costs\" means costs before any deductibles or co-insurance are subtracted. Mercy Regional Medical Center's ultimate reimbursement will be reduced by any appplicable copayment/deductible. where medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from medicare allowable costs because the amounts are typically immaterial. MRMC believes that excluding Medicare losses makes the overall community benefit report more credible for these reasons. Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit Hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as a community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as \"subsidized health services.\" Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states afford to pay.","subsidized_health_services":"To the extent that an organization includes any costs associated with physician clinics as subsidized health services in Part I, line 7g it must describe that it has done so and report in Part VI such costs included in part I, line 7g, line 1. There are no physician clinics included in subsidized health services."}},"ScheduleI":{"grant_records_maintained":true,"reported_domestic_org_grants":19679,"reported_domestic_individual_grants":0,"reported_domestic_org_grants_program_services":19679,"total_501c3_and_government_organizations":1,"grants":[{"ein":840902211,"irc_section":"501(c)(3)","cash":6600,"purpose":"Program Support","address_line1":"1010 Three Springs Blvd","city":"DURANGO","state":"CO","zip":"81301","name":"Mercy Health Foundation","address":"1010 Three Springs Blvd, DURANGO, CO, 81301"}],"total_domestic_grants":19679,"total_domestic_program_services":19679,"detail_org_grants_total":6600,"detail_domestic_grants_total":6600,"supplemental_information":[{"identifier":"procedures for monitoring the use of grant funds","form_and_line_reference":"schedule i, part i, q.2","explanation":"THE GRANTS MADE BY MERCY REGIONAL MEDICAL CENTER OF DURANGO (\"MRMCD\") TO MERCY HEALTH FOUNDATION (\"MHF\"), A RELATED TAX-EXEMPT ORGANIZATION, WERE MONITORED BY THE BOARD OF DIRECTORS OF MRMCD TO BE CONSISTENT WITH THE EXEMPT PURPOSES OF MRMCD."}],"grant_monitoring":{"claims_monitoring_procedures":false,"requires_financial_reports":false,"requires_narrative_reports":false,"conducts_site_visits":false,"conducts_field_audits":false,"requires_grant_agreements":false,"may_suspend_future_funding":false,"may_require_repayment":false}},"ScheduleF":{"reported_foreign_grants":0},"ScheduleJ":{"benefits_and_procedures":{"tax_indemnification_and_gross_up_payments":true,"substantiation_required":true,"written_policy_travel_and_entertainment":true},"compensation_arrangements":{"compensation_based_on_revenue_filing_org":false,"compensation_based_on_revenue_related_orgs":false,"compensation_based_on_net_earnings_filing_org":false,"compensation_based_on_net_earnings_related_orgs":false,"nonfixed_payments":true,"initial_contract_exception":false,"severance_payment":false,"supplemental_nonqualified_retirement_plan":true,"equity_based_compensation_arrangement":false},"compensation":[{"person_name":"JOHN BOYD","base_compensation_filing_org":191777,"nontaxable_benefits_filing_org":27828,"other_compensation_filing_org":674,"total_compensation_filing_org":220278,"name":"JOHN BOYD"},{"person_name":"GREGORY DEEM","base_compensation_filing_org":356447,"bonus_filing_org":4000,"nontaxable_benefits_filing_org":41064,"other_compensation_filing_org":357,"total_compensation_filing_org":401868,"name":"GREGORY DEEM"},{"person_name":"Kirk Dignum","bonus_related_orgs":78131,"compensation_based_on_related_orgs":279673,"comp_report_prior_990_related_orgs":33078,"deferred_compensation_related_orgs":15271,"nontaxable_benefits_related_orgs":43795,"other_compensation_related_orgs":62791,"total_compensation_related_orgs":479661,"name":"Kirk Dignum"},{"person_name":"ROGER HIRST","base_compensation_filing_org":359322,"nontaxable_benefits_filing_org":36749,"other_compensation_filing_org":562,"total_compensation_filing_org":396633,"name":"ROGER HIRST"},{"person_name":"NANCY HOYT","base_compensation_filing_org":178018,"nontaxable_benefits_filing_org":28109,"other_compensation_filing_org":241,"total_compensation_filing_org":206368,"name":"NANCY HOYT"},{"person_name":"David Goode","bonus_related_orgs":120573,"compensation_based_on_related_orgs":453182,"comp_report_prior_990_related_orgs":410385,"deferred_compensation_related_orgs":126,"nontaxable_benefits_related_orgs":43341,"other_compensation_related_orgs":459299,"total_compensation_related_orgs":1076521,"name":"David Goode"},{"person_name":"MICHAEL MCCALLUM","base_compensation_filing_org":382336,"nontaxable_benefits_filing_org":34135,"other_compensation_filing_org":391,"total_compensation_filing_org":416862,"name":"MICHAEL MCCALLUM"},{"person_name":"STEVEN MOROZOWICH","base_compensation_filing_org":358061,"nontaxable_benefits_filing_org":38746,"other_compensation_filing_org":356,"total_compensation_filing_org":397163,"name":"STEVEN MOROZOWICH"},{"person_name":"JOSEPH PEDLEY","base_compensation_filing_org":112684,"bonus_filing_org":31246,"compensation_based_on_related_orgs":49898,"nontaxable_benefits_filing_org":37866,"other_compensation_filing_org":9227,"other_compensation_related_orgs":604,"total_compensation_filing_org":191022,"total_compensation_related_orgs":50502,"name":"JOSEPH PEDLEY"},{"person_name":"ALBERT WHITESELL","base_compensation_filing_org":364571,"bonus_filing_org":10000,"nontaxable_benefits_filing_org":37323,"other_compensation_filing_org":561,"total_compensation_filing_org":412454,"name":"ALBERT WHITESELL"}],"supplemental_information":[{"identifier":"Tax Indemnification and gross-up payments","form_and_line_reference":"schedule J, PART I, Q. 1A","explanation":"THE CFO, JOSEPH PEDLEY, RECEIVED GROSSED-UP MOVING EXPENSES ASSOCIATED WTIH HIS CHANGE OF EMPLOYMENT."},{"identifier":"METHODS USED TO ESTABLISH CEO COMPENSATION","form_and_line_reference":"SCHEDULE J, PART I, Q. 3","explanation":"COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF MERCY REGIONAL MEDICAL CENTER OF DURANGO WAS ESTABLISHED AND PAID BY A RELATED ORGANIZATION, CATHOLIC HEALTH INITIATIVES (\"CHI\"). CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACT; (4) COMPENSATION SURVEY OR STUDY; AND (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE."},{"identifier":"POST TERMINATION PAYMENTS","form_and_line_reference":"SCHEDULE J, PART I, Q. 4A","explanation":"POST-TERMINATION PAYMENTS ARE ADDRESSED IN THE EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVE'S MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM CHI DURING THE 2009 CALENDAR YEAR."},{"identifier":"SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN","form_and_line_reference":"SCHEDULE J, PART I, Q. 4B","explanation":"DURING THE 2009 CALENDAR YEAR, CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: KIRK DIGNUM AND DAVID GOODE. for the 2009 calendar year contributions were made on behalf of; KIRK DIGNUM; $15,271 AND DAVID GOODE; $126. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN DURING THE 2009 CALENDAR YEAR, AND THE FOLLOWING AMOUNTS WERE INCLUDED IN THE INDIVIDUAL'S REPORTABLE COMPENSATION ON SCHEDULE J: Kirk Dignum; $33,078 AND DAVID GOODE; $423,784."},{"identifier":"NON-FIXED PAYMENTS","form_and_line_reference":"SCHEDULE J, PART I, Q.7","explanation":"UNDER AN INCENTIVE PLAN APPROVED BY THE EXECUTIVE COMMITTEE, THE EXECUTIVE OFFICERS OF MRMCD WERE ELIGIBLE FOR CERTAIN DISCRETIONARY BONUSES BASED ON MEETING PERFORMANCE CRITERIA UNDER EACH OF MRMCD'S STRATEGIC GOALS (PEOPLE, QUALITY, STEWARDSHIP, AND INDIVIDUAL PERFORMANCE) AT THE CLOSE OF THE FISCAL YEAR. UNDER A BOARD-APPROVED INCENTIVE PLAN, DISCRETIONARY BONUSES WERE PAID TO CERTAIN INDIVIDUALS AS REFLECTED ON SCH. J, PART II."}]},"ScheduleL":{"business_transactions_involving_interested_persons":[{"person_name":"Carolyn Newbold","relationship":"Family member","description":"COMPENSATION","amount":103505,"sharing_of_revenues":false,"name":"Carolyn Newbold"},{"person_name":"FOUR CORNERS HEART CLINIC","relationship":"DUAL BOARD MEMBER","description":"CONTRACT MEDICAL SERVICES","amount":147494,"sharing_of_revenues":true,"name":"FOUR CORNERS HEART CLINIC"},{"person_name":"FOUR CORNERS REGIONAL HEART CLINIC","relationship":"GREATER THAN 5% OWNER","description":"CARDIAC CATHETERIZATION","amount":5327283,"sharing_of_revenues":true,"name":"FOUR CORNERS REGIONAL HEART CLINIC"},{"person_name":"MARK STERN SURGICAL SERCVICES PLCC","relationship":"SOLE OWNER","description":"MEDICAL STAFF PRESIDENT","amount":48000,"sharing_of_revenues":true,"name":"MARK STERN SURGICAL SERCVICES PLCC"},{"person_name":"SOUTHWEST SURGICAL ASSOCIATION","relationship":"DUAL BOARD MEMBER","description":"TRAUMA SERVICES","amount":352200,"sharing_of_revenues":true,"name":"SOUTHWEST SURGICAL ASSOCIATION"},{"person_name":"PEDIATRIC PARTNERS","relationship":"DUAL BOARD MEMBER","description":"CONTRACT MEDICAL SERVICES","amount":336257,"sharing_of_revenues":true,"name":"PEDIATRIC PARTNERS"},{"person_name":"DURANGO ORTHOPEDICS","relationship":"DUAL BOARD MEMBER","description":"CONTRACT MEDICAL SERVICES","amount":108225,"sharing_of_revenues":true,"name":"DURANGO ORTHOPEDICS"}]},"ScheduleR":{"tax_exempt_organizations":[{"ein":710897107,"business_name_line1":"St Joseph Community Health Services","primary_activities":"Community","exempt_code_section":"501(c)(3)","public_charity_status":"11a","legal_domicile_state":"NM","direct_controlling_business_name_line1":"CHI","address_line1":"300 Central SW Suite 300","city":"Albuquerque","state":"NM","zip":"87102","name":"St Joseph Community Health Services","address":"300 Central SW Suite 300, Albuquerque, NM, 87102"},{"ein":850253087,"business_name_line1":"St Joseph Community Health Foundation","primary_activities":"Foundation","exempt_code_section":"501(c)(3)","public_charity_status":"7","legal_domicile_state":"NM","direct_controlling_business_name_line1":"SJCHS","address_line1":"300 Central SW Suite 300","city":"Albuquerque","state":"NM","zip":"87102","name":"St Joseph Community Health Foundation","address":"300 Central SW Suite 300, Albuquerque, NM, 87102"},{"ein":930412495,"business_name_line1":"St Francis of Baker City","primary_activities":"Hospital","exempt_code_section":"501(c)(3)","public_charity_status":"3","legal_domicile_state":"OR","direct_controlling_business_name_line1":"CHI","address_line1":"3325 Pocahontas Road","city":"Baker City","state":"OR","zip":"97814","name":"St Francis of Baker City","address":"3325 Pocahontas Road, Baker City, OR, 97814"},{"ein":943164869,"business_name_line1":"St Elizabeth Health Care 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