2024-05-15T13:59:36-05:00 2023-06-30 861065772 Deloitte Tax LLP 111 MONUMENT CIRCLE Suite 4200 INDIANAPOLIS IN 462045108 990 2022-07-01 420680391 Mercy Hospital Iowa City Iowa MERC 3193390300 500 East Market Street Iowa City IA 52245 Thomas Clancy CEO 3193390300 2024-05-15 1 Thomas Clancy 999009999 0 Shawna M Jansons P01222873 3174648600 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Thomas Clancy 500 East Market Street Iowa City IA 52245 214194860 0 0928 X www.mercyiowacity.org X 1873 IA To heal and comfort the sick and improve the health of the community in the spirit of Jesus Christ. 12 11 1310 149 4909844 0 3075832 110521 168749231 163519230 4158235 -108897 1035307 941221 177018605 164462075 14665 12000 0 0 70453482 66665626 0 0 0 123367437 126497191 193835584 193174817 -16816979 -28712742 209423313 160030077 153616891 136653461 55806422 23376616 Mercy Iowa City ("Mercy") heals and comforts the sick and works to improve the health of the community in the spirit of Jesus Christ and the Catholic tradition of the Sisters of Mercy. 0 0 124731710 12000 163656643 Hospital Services. In keeping with our mission of healing and comforting the sick, providing hospital medical services is at the heart of what we do. These services are provided in inpatient and outpatient settings, in situations that may be emergent, acute or chronic. Services include a 24 hour emergency unit, intensive and cardiovascular care. We also service a maternity unit and newborn nursery along with other surgical services, cardiac cath lab, cancer care, digestive care, telemetry monitored care, medical care, stroke care. 137092 99199 Education. The ongoing education of Mercy staff is critical in the fast changing field of health care and it necessary to meet regulations and certifications. Mercy hosts a number of professional continuing education classes each year, which is attended by it's own staff and staff from other institutions. Mercy provides a setting for students who are considering a career in health care including a class of insight to possible careers and preparation for CNA exam. 10908453 Community Benefit. Mercy's largest community benefit is the unpaid cost of Medicaid ($10.9 million). Other examples include cash donations to community non-for-profits such as the Free Medical Clinic, leadership time and skills that further the work of the non-for-profits, first aid booth provided at public events including the Johnson Co Fair. As a trusted, longtime member of the community, Mercy plays an important role not only in further community health but the general community good. 135777255 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 42 0 1 1310 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 11 1 1 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X Thomas Clancy 3193393540 500 East Market Street Iowa City IA 52245 Dawna Miller Treasurer (End 7/22) 40.00 2.00 X X 366748 0 32802 Kim Volk VP - Nursing 40.00 0.00 X X 251722 0 25884 Scott Alderman VP - Information and Tech(End 12/22) 40.00 0.00 X X 249028 0 13207 Jeffrey Rooney Treasurer (8/22-4/23) 40.00 2.00 X X 0 0 0 Jim Porter Treasurer (Beg 5/23) 40.00 2.00 X X 0 0 0 Lynn Whisler Board Member(End 3/23)/Sec(Beg 4/23) 1.00 1.00 X X 0 0 0 Madeline Windauer Vice Chair (Beg 10/22) 1.00 1.00 X X 0 0 0 Mike Trachta CEO & Administrator (End 3/23) 40.00 2.00 X X 0 0 0 Tom Clancy Chair/Sec (End 3/23)/CEO (Beg 4/23) 1.00 2.00 X X 0 0 0 Tom McLaughlin Chair (End 10/22) 1.00 1.00 X X 0 0 0 Bob Ritz Board Member (End 3/23) 1.00 1.00 X 0 0 0 Dave Vellinga Board Member (End 3/23) 1.00 0.00 X 0 0 0 Dr Chris Scott Board Member 1.00 0.00 X 0 0 0 Karin Franklin Board Member (End 10/22) 1.00 0.00 X 0 0 0 Jack Dusenbery Board Member (End 10/22) 1.00 0.00 X 0 0 0 Mary Westbrook Board Member 1.00 0.00 X 0 0 0 Peter Gardner Board Member 1.00 0.00 X 0 0 0 SR Helen Marie Burns Board Member 1.00 0.00 X 0 0 0 SR Linda Bechen Board Member 1.00 0.00 X 0 0 0 SR Rita Specht Board Member 1.00 0.00 X 0 0 0 Steven Anderson Board Member 1.00 1.00 X 0 0 0 Kimberley Rossiter Assistant Treasurer (End 8/22) 40.00 2.00 X 208788 0 21185 Stuart Elkin Assistant Treasurer (Beg 9/22) 40.00 1.00 X 170462 0 5733 Andrew Ashby Physician 40.00 0.00 X 538134 0 36461 Craig Huston Physician 40.00 0.00 X 533131 0 41185 Michael Hoffman Physician 40.00 0.00 X 498496 0 40061 Luke Brunkhorst Physician 40.00 0.00 X 502463 0 32353 Steven Udelhofen Physician 40.00 0.00 X 453981 0 13306 Martin Izakovic Former VP/Physician 40.00 0.00 X 211649 0 20984 3984602 0 283161 147 1 1 0 Medefis Consolidated PO Box 5068 New York NY 100875068 Contract Nursing Labor 11508293 Allscripts Healthcare 24630 Network Place Chicago IL 60631 EHR/Help Desk Services 2243788 Medical Record Associates LLC 103 Central Street Ste A Wellesley MA 02482 Coding Services 1941943 Progressive Rehabilitation Associat 1130 Scott Blvd Ste 1 Iowa City IA 52240 Contract Rehab Services 1619677 MercyOne PO Box 74008768 Chicago IL 606748768 Management Services 1598918 66 110521 110521 Patient Serv. Revenue 621400 79029550 79029550 Medicare/Medicaid 621400 75118929 75118929 Lab Outreach 621511 4909844 4909844 ASC/DIC Income 900099 2704664 2704664 Wellmark Incentive 900099 652116 652116 1104127 1104127 163519230 -896234 -896234 1182580 985762 196818 196818 196818 49534360 48747023 787337 787337 787337 Cafeteria Income 722310 507791 507791 Emerson Point Meal Svc 722320 114202 114202 122410 122410 744403 164462075 158845998 4909844 595712 X 12000 12000 1123830 119519 1004311 55609733 44054665 11555068 135316 94302 41014 5803587 4044520 1759067 3993160 2782833 1210327 848792 848792 1073674 1073674 206535 206535 28315 28315 40213949 25617885 14596064 412397 412397 12709410 8354811 4354599 8932545 151434 8781111 2777251 113856 2663395 389127 70908 318219 4107263 1620890 2486373 9130077 6876589 2253488 2140642 2140642 Medical Supplies 18694714 18683685 11029 Pharmacy Supplies 10704804 10704804 0 Bad Debt Expense 9558655 9558655 0 Food Expense 895392 895392 0 3673649 2020507 1653142 193174817 135777255 57397562 0 5790517 9838383 133521 68269 31243280 27890458 3579601 2992970 2610445 3164673 259054727 204475259 62380441 54579468 52778600 11032514 -91318072 -109415759 142224980 159879101 209423313 160030077 35705862 37200486 70127406 69158372 2316111 1736338 45467512 28558265 153616891 136653461 X 55806422 23376616 55806422 23376616 209423313 160030077 X -28712742 -3717064 X 0 0 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 1 0 1 0 1 28315 28315 0 Part II-B, Line 1: Mercy Hospital, Iowa City, Iowa is a member of the Iowa Hospital Association (IHA) and American Hospital Association (AHA). A percentage of membership dues paid to IHA and AHA relate to Lobbying activities. 16417674 16570 1759209 51458 18141995 20513591 37504 -2858763 1274658 16417674 16457386 47025 5088018 1078838 20513591 17144539 140115 -233781 593487 16457386 17286002 14493 377510 533466 17144539 0.84900 0.15100 0 1 1 4165665 4165665 141179515 114713621 26465894 112601856 89119323 23482533 1107691 642315 465376 54579468 Beneficial Interest-Foundation 18243290 Due From Affiliates 133051398 2011/2018 Bond Fund 4235604 ROU Assets 4348809 159879101 Pension Benefit Liability 23548912 Other Long-Term Liabilities 3566988 Professional Liability Claims 1442365 28558265 Part V, Line 4: All Restricted Endowed Funds are used for the benefit of Mercy Hospital Iowa City - capital equipment, employee grants, scholarships, etc. 1 1 X 1 X 1 X 1 0 0 21617007 10708554 10908453 0.05900 21617007 10708554 10908453 0.05900 21617007 10708554 10908453 0.05900 0 2666865 0 41068574 54452970 -13384396 X 1 1 1 Iowa City Ambulatory Surgery Center LLC Outpatient Surgery Center 0.40000 0.60000 2 Corridor Radiology LLC Outpatient Radiology Services 0.51000 0.49000 3 Eastern Iowa Rehabilitation Hospital LLC Rehabilitation Services 0.51000 0.49000 1 1 Mercy Hospital 500 East Market Street Iowa City IA 52245 www.mercyiowacity.org 520074H X X X X Lab Outreach Mercy Hospital Iowa City Iowa 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V, Section C X 1 21 1 See Part V, Section C 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 5: To solicit input from community stakeholders (key informants), those individuals who have a broad interest in the health of the community, an Online Key Informant Survey also was implemented as part of this process. A list of recommended participants was compiled by Mercy Iowa City; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Final participation included representatives of the organizations outlined below.- Coralville Fire Department- Iowa City- Iowa City Area Development- Iowa City Crisis Center- Iowa City Fire Department- Johnson County- Johnson County Public Health Representative- Kinze Manufacturing- Lone Tree School District- Mercy Hospital Emergency Physicians- Mercy Services- NAMI of Johnson County- Oaknoll Retirement Community- Rural Health and Safety of Eastern Iowa (RHSEI)- UI College of Public Health - United Way- University Police- Washington County Hospital and ClinicsThrough this process, input was gathered from several individuals whose organizations work with low income, minority, or other medically underserved populations. Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 7a:https://www.mercyiowacity.org/upload/docs/About%20Mercy/2021%20PRC%20CHNA%20Report%20-%20Mercy%20Iowa%20City.pdf Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 10a:https://www.mercyiowacity.org/upload/docs/About%20Mercy/2021%20CHNA%20Implementation%20Plan.pdf Mercy Hospital, Iowa City, Iowa: Part V, Section B, Line 11:The 2021 CHNA summarized 11 areas of opportunity identified through Public Health, Vital Statistics, and Benchmark Data and 6 areas of need identified by Key Informants considered to be major needs. Mercy Hospital is addressing these needs as follows:Mental Health - Access to providers and facilities:In 2022, we hired a full-time physician psychiatrist specialist to both extend our psychiatric visits on our hospital campus and also to lead an effort to evaluate the options for developing a closed psychiatric unit. In the outpatient setting, we also have hired a second therapist to increase our therapy visits. We also intend to maintain mental health related links such as "Guild to Mental Health Resources" as well as "Stress and Coping" on our website for quick and convenient educational information available to the public.Nutrition, Physical Activity & Weight - Cultural headwinds and lack of insurance covered programs for children: In 2022, we expanded our bariatric surgery program by hiring a second physician and a second dietician. Bariatric surgery is an effective treatment option especially when it is supported by a robust support program that features dieticians. We intend to maintain our posts of healthy recipes with video instruction on the Mercy website and to provide a walk-in Wellness Program which aims to increase physical activity and increase healthy eating in our community.Substance Abuse - Alcohol, meth, opioid treatment options limited: Maintained a nurse navigator service that provides callbacks to patients as well as assisting these patients and their families in obtaining counseling services, transportation, or primary care referrals. Reopen meeting rooms so the local AA chapter can resume in-person meetings once our rooms become available, provided COVID status safety concerns are met.Diabetes - Limited access to dieticians and poor insurance coverage: Offered a free pre-diabetes class taught by a registered dietician. This was offered as a virtual class in order to improve access to anyone interested. Continued to provide diabetic education to hospital based nurses so they can more directly convey the importance of managing this disease to patients. We also offered individualized diabetic education which covers nutrition management, the role of physical activity, psychosocial adjustment and healthy coping, glucose monitoring and insulin administration.Corona Virus/COVID-19 - Vaccination rate disparities: We began offering vaccinations in select clinics in 2021 and intend to continue offering those as long as the need persists. We also continued to offer tele visits which provide improved access to our providers for those in more rural settings where travel may be more difficult.Dementia/Alzheimer's - Lack of geriatric care units, adult daycare, and outpatient services focused on memory disorders: Maintained a nurse navigator service to arrange therapies and to assist in obtaining home health and/or respite care for the patients' caregivers. Primary Care Access - Cedar and Muscatine: Maintained a primary care presence in these two counties. Lung Cancer - Cedar and Muscatine:Maintained our low-dose CT screening program for long term smokers. Continue to offer smoking cessation counseling.Heart Disease - Iowa: Maintained our Primary Stroke Center designation through The Joint Commission and our recognition as a Blue Distinction Center for heart care. Maintained our Emergency Care protocols and training that have helped us achieve interventions "faster than the national average".Births to Adolescents - Muscatine and Washington: Maintained our primary care clinic in Muscatine and continue to provide support by linking prospective mothers to our OBGYN affiliates, our pediatric outpatient clinic, our breastfeeding support classes, and to provide access to our financial counselors. Maintained our website support including a free pregnancy tracker app. STI - Johnson: Continued to staff the infectious disease position. This person will monitor chlamydia incidence and maintained relationships with the public health departments at the county and state levels. Mercy Hospital, Iowa City, Iowa Part V, line 16a, FAP website:https://www.mercyiowacity.org/upload/docs/Patients%20and%20Visitors/Financial%20Assistance%20Docs/MercyIC%20Financial%20Assistance%20Policy_2021.pdf Mercy Hospital, Iowa City, Iowa Part V, line 16b, FAP Application website:https://www.mercyiowacity.org/upload/docs/Patients%20and%20Visitors/Financial%20Assistance%20Docs/Financial%20Assistance%20App_2021.pdf Mercy Hospital, Iowa City, Iowa Part V, line 16c, FAP Plain Language Summary Website:https://www.mercyiowacity.org/upload/docs/Patients%20and%20Visitors/Financial%20Assistance%20Docs/MercyIC%20Plain%20Language%20Summary_2021.pdf 1 1 - Mercy Home Health Care 500 East Market Street Iowa City IA 52245 Home Health and Private Duty Nursing Part I, Line 3c: Mercy Hospital, Iowa City, Iowa also uses asset level, medical indigency, insurance status, and underinsurance status as factors in determining eligibility for free and discounted care. Part I, Line 7, Column (f): 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 is $ 9,558,655. Part III, Line 2: The amount of bad debt expense reported on line 2 was derived from taking actual bad debt write-offs and applying the cost to charge ratio of .2790 to that amount. Part III, Line 3: Mercy Hospital, Iowa City, Iowa works with those qualifying for charity care along every step of the process. Every effort is made to work with the patient to provide financial assistance when appropriate. While there are people who do not cooperate with Mercy Hospital, Iowa City, Iowa regarding payment plans, financial assistance or with those trying to get help from Government programs. For individuals not providing necessary information, it is impossible to know the reason for not cooperating and therefore know whether they will qualify for charity care. Mercy Hospital, Iowa City, Iowa is unable to reasonably determine whether any amount of bad debt could have been classified as charity care if the individuals do not provide the necessary information to evaluate their situation to determine qualifications with the charity care policy. Part III, Line 4: Mercy Hospital, Iowa City, Iowa did not undergo an audit for the fiscal year ended June 30, 2023 as the entity filed a voluntary petition for relief under chapter 11 of title 11 of the United States Code in the United States Bankruptcy Court for the Northern District of Iowa on August 7, 2023. Mercy Hospital, Iowa City, Iowa has entered into an agreement with the State of Iowa, on behalf of the University of Iowa pursuant to which the State of Iowa, on behalf of the University of Iowa, has agreed to purchase substantially all of the assets of Mercy Hospital, Iowa City, Iowa. Following the acquisition, the medical services previously provided by Mercy Hospital, Iowa City, Iowa will be provided by the University of Iowa and its affiliates, and Mercy Hospital, Iowa City, Iowa will no longer exist as a hospital providing health care services. As a result, the footnote that describes bad debt expense is based on the most recent audited financial statements issued for the fiscal year ended June 30, 2022.Mercy Hospital, Iowa City, Iowa's audited financial statements includes a footnote for the provision of uncollectible accounts on Page 12 of the audited financial statements. Part III, Line 8: Total revenue was determined using charges per the CMS Provider Statistical Reimbursement System reports for Fee Reimbursed Services for the fiscal year ended 6/30/23. Costs calculated using the Cost to Charge Ratio for the appropriate services from the submitted Medicare Cost Report Form 2552-96 for the fiscal year ended 06/30/23. Part III, Line 9b: Mercy Hospital, Iowa City, Iowa has two policies related to debt collection. The Financial Assistance Policy provides guidelines for forgiving all or part of a patient's financial responsibility for healthcare services received at Mercy Hospitals. Patient may be given a financial assistance application at the time of service, be offered financial assistance during the normal collection process or learn of the option on the Hospital website. All patients with no insurance are offered financial assistance via billing statements & follow-up telephone calls. Any patient that is known to qualify for financial assistance is provided assistance. The payment plan policy enables those who qualify for patient financial assistance to establish payment plans of the remaining balance of their bill. Part VI, Line 2: The most recent community health needs assessment was conducted in December 2021. The organization engaged Professional Research Consultants to conduct the assessment. The community health survey is a systematic, data-driven approach to determining the health status, behaviors, and needs of residents in the communities the organization serves. The survey instrument used for the assessment is based largely on the Centers for Disease Control (CDC), Behavioral Risk Factor Surveillance System (BRFS), as well as various other public health surveys and customized questions addressing gaps in indicator data, relative to nation health promotion and disease prevention objectives and other recognized health issues. Part VI, Line 3: If a patient is deemed to not have insurance coverage (self-pay) or is under-insured, a referral is made to our third-party vendor to screen the patient for Medicaid eligibility. They can also assist with marketplace products and social security applications. If they are not eligible for Medicaid/Emergency Medicaid, our third-party eligibility vendor notifies the patient of the financial counselors and places a referral to the financial counselor to assist the patient. In order to be eligible for financial assistance the patients must complete the Medicaid, Medicare, and/or insurance exchange review process. The level of assistance is based on where the patient falls on the federal poverty level. The financial counselors provide/assist the patient with completion of the financial aid application and noting the account according to the outcome. Part VI, Line 4: Mercy Hospital, Iowa City, Iowa is located in the community of Iowa City, Iowa, in Johnson County along the east central part of the state. The county's population in 2022 was approximately 156,420. Mercy Hospital, Iowa City, Iowa services 10 counties in southeast Iowa, with the primary service area being Johnson County. The secondary service areas includes: Cedar, Iowa, Muscatine and Washington counties. The tertiary service area includes Henry, Jefferson, Keokuk, Lee and Louisa counties. The population of the service area is approximately 340,200. Iowa City is home to the University of Iowa, which has an enrollment of approximately 31,317 for the 2022-2023 academic year. Johnson County is well-educated, of individuals 25 and older, 95.3 percent are high school graduates and 54 percent hold a bachelors degree or higher. The University of Iowa also provides the foundation for an economy that has particular strengths in education, health care, services, technology, agribusiness and manufacturing. According to the U.S. Census Bureau, 14.7 percent of the Johnson County population lived below the poverty line between 2017 and 2021, compared to 11.1 percent for the entire state. Part VI, Line 5: Mercy Hospital, Iowa City, Iowa is faith-based institution that provides services based on the ethical and religious directives of the Catholic Church. An important part of Mercy's mission is to improve the health of the community. Mercy Hospital, Iowa City, Iowa does so by: Ensuring that the medical staff is open to all qualified physicians; ensuring that the hospital is accredited and in good standing with the Joint Commission; ensuring that the board of directors is comprised of diverse, independent individuals, not employees of the hospital, representing the community and also providing necessary expertise; establishing and carrying out a conflict of interest policy; providing a site for clinical experience for a variety of health care professionals; providing charity care and financial assistance with medical bills as needed to community members; participating in such programs as Medicare, Medicaid, and Hawk-i, an insurance program for needy Iowa children; absorbing unreimbursed costs for such government programs; ensuring that account collections are carried out in compliance with state and federal guidelines; providing emergency room services and working with local and state officials in community preparedness issues; treating emergency patients according to EMTALA guidelines and service all patients regardless of their ability to pay; investing surplus funds in services, technology, and personnel that will further the benefit of the community. Part VI, Line 7, Reports Filed With States IA 1 Iowa City Area Development Group Inc 136 S Dubuque Street Iowa City IA 52240 421234837 501(c)(6) 12000 0 General Support 0 1 Part I, Line 2: All organizations Mercy provides assistance to are local organizations. Therefore, Mercy is in frequent contact with the organizations and is generally aware of their use of Mercy's assistance. However, there is no formal mechanism in place to track specific uses of the assistance. Mercy Hospital offers a Temporary Assistance Program (TAP) for emergency financial needs that employees may have. This confidential program offers crisis assistance and health benefit assistance. X X X X X 1 0 0 0 0 0 0 1 0 Andrew Ashby Physician 517684 0 2000 0 18450 0 7175 0 29286 0 574595 0 0 0 Craig Huston Physician 488131 0 45000 0 0 0 10213 0 30972 0 574316 0 0 0 Michael Hoffman Physician 482196 0 2400 0 13900 0 10675 0 29386 0 538557 0 0 0 Luke Brunkhorst Physician 500063 0 2000 0 400 0 5125 0 27228 0 534816 0 0 0 Steven Udelhofen Physician 415781 0 38000 0 200 0 6429 0 6877 0 467287 0 0 0 Dawna Miller Treasurer (End 7/22) 207266 0 54638 0 104844 0 8332 0 24470 0 399550 0 0 0 Kim Volk VP - Nursing 239038 0 12150 0 534 0 4523 0 21361 0 277606 0 0 0 Scott Alderman VP - Information and Tech(End 12/22) 237140 0 11788 0 100 0 6187 0 7020 0 262235 0 0 0 Martin Izakovic Former VP/Physician 173495 0 19865 0 18289 0 4928 0 16056 0 232633 0 0 0 Kimberley Rossiter Assistant Treasurer (End 8/22) 194183 0 7750 0 6855 0 5002 0 16183 0 229973 0 0 0 Stuart Elkin Assistant Treasurer (Beg 9/22) 170317 0 0 0 145 0 5733 0 0 0 176195 0 0 0 Part I, Line 4a Dawna Miller, Chief Financial Officer received severance payments amounting to $103,884 in calendar year 2022 as part of her employment contract. Part I, Line 7 Non-fixed payments were provided to administrators and physicians who met stated criteria that included meeting certain RVU (Relative Value Unit), productivity levels, specified CMS/JACHO performance core indicators and certain patient satisfaction and/or nursing satisfaction survey scores. A City of Hills Iowa 420920947 000000000 2018-05-10 40501771 Refund Bonds issued 04/29/08 0 0 0 B City of Hills Iowa 420920947 431669AW0 2011-11-30 44742571 Build and Equip Facility; Refund Bonds issued 7/16/1998 0 0 0 A 3885000 40501771 4050177 2131594 34320000 2018 1 0 1 1 B 20345000 44743882 589874 20002570 24151438 2012 1 0 1 1 A 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 1 0 0 0 1 1 A 1 B 1 Schedule K, Part II, Line 3: Differences between the issue price (Part I) and total proceeds (Part II, line 3) are due to investment earnings. Schedule K, Part IV, Line 2c, Column A: The organization is in bankruptcy; no rebate calculation has been performed. Schedule K, Part IV, Line 2c, Column B: Rebate calculation was performed 11/30/21. Schedule K, Part IV, Line 6, Column B: Such amounts were appropriately yield restricted. Form 990, Part VI, Section A, line 2 Sister Helen Marie Burns, board member; Sister Rita Specht, board member; and Sister Linda Bechen, Board Member are members of the Sisters of Mercy of the Americas West Midwest Community, Inc. Mike Trachta, Jeff Rooney, Stuart Elkin, Dawna Miller, and Kimberly Rossiter have a business relationship as they simultaneously serve together on the Mercy Services Iowa City, Iowa board. Form 990, Part VI, Section A, line 3 MercyOne provided certain management oversight and personnel services pursuant to a strategic management affiliation agreement through March 2023. Mike Trachta, Chief Executive Officer (ending 3/23) of Mercy Hospital, Iowa City, Iowa is not an employee of the hospital, but rather an employee of MercyOne, a management company. For his role as Chief Executive Officer of Mercy Hospital Iowa City, Mike Trachta is compensated $582,271 by MercyOne. Martinville Dunn provided certain management oversight and personnel services pursuant to a strategic management affiliation agreement. Jeffrey Rooney, Chief Financial Officer (beginning 9/22 and ending 4/23) of Mercy Hospital, Iowa City, Iowa is not an employee of the hospital but rather an employee of Martinville Dunn, a management company. For his role as Chief Financial Officer of Mercy Hospital Iowa City, Jeffrey Rooney was compensated $290,398 by Martinville Dunn. Form 990, Part VI, Section A, line 6 Mercy's sole member is the Sisters of Mercy of the Americas West Midwest Community, Inc. Form 990, Part VI, Section A, line 7b Mercy's sole member, Sisters of Mercy of the Americas West Midwest Community, Inc., maintains a number of "reserved powers" including but not limited to approval of annual budgets, approval of amendments to the articles of incorporation and bylaws, approval of real property transactions and approval of long term borrowing. Form 990, Part VI, Section B, line 11b The form 990 is reviewed by Mercy Hospital, Iowa City, Iowa's controller, the chief financial officer, and an outside independent accounting and tax firm prior to submitting the form 990 to the IRS. The form 990 was not reviewed by the organization's board of directors before submitting it to the IRS. Form 990, Part VI, Section B, line 12c A conflict of interest statement is signed at the beginning of Board members term and on an annual basis there after. Any abstention from a vote is recorded in Board minutes. After the fiscal year end a "look back" questionnaire is distributed to all Board members to disclose any conflicts of interest that may have taken place in the previous year. Form 990, Part VI, Section B, line 15 Compensation for all executives and other key employees is determined based on national or regional market data for comparable positions at comparatively sized hospitals. The Executive Committee of the Board of Directors uses this market-based information to set the President and CEO's compensation. In turn, the CEO uses this same information to set compensation for officers and key employees, which is also approved by the board. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part IX, line 11g Outside Services: Program service expenses 25,617,885. Management and general expenses 14,596,064. Fundraising expenses 0. Total expenses 40,213,949. Form 990, Part XI, line 9: Change in Unrecognized Pension Actuarial Gain 14,178,927. Change in Beneficial Interest in Foundation 1,705,086. Change in Beneficial Interest of Services -17,361,627. Pension Cost -1,264,450. Transfer to Self-Insured Trust -975,000. Mercy Foundation 500 East Market Street Iowa City IA 52245 237040506 Foundation/Fundraising IA 501(c)(3) 12A, I Mercy Hospital 1 Mercy Hospital Iowa City Iowa Self Insurance Plan and Trust 500 East Market Street Iowa City IA 52245 426591803 Self Insurance IA 501(c)(3) 12A, I Mercy Hospital 1 Sisters of Mercy of the Americas West Midwest Community Inc 7262 Mercy Road Omaha NE 68124 262400800 Religious Order NE 501(c)(3) Religious Order N/A 0 Mercy Hospital Guild 500 East Market Street Iowa City IA 52245 426099912 Fundraising IA 501(c)(3) 12C, III-FI N/A 0 Iowa City Ambulatory Surgical Center LLC 2963 Northgate Drive Iowa City IA 52245 208503424 Outpatient Surgery IA Mercy Hospital Related 2828785 1622733 0 1 0.40000 Corridor Radiology LLC 2769 Heartland Drive Suite 307 Coralville IA 52241 430635070 Radiology Services IA Mercy Hospital Related 192489 -55239 0 0 0.51000 Eastern Iowa Rehabilitation Hospital LLC 680 S 4th Street Louisville KY 40202 831589139 Inpatient Rehabilitation Care IA Mercy Hospital Related -801558 7942126 0 0 0.51000 Mercy Services Iowa City Inc 500 East Market Street Iowa City IA 52245 421241044 Medical Clinic Services IA Mercy Hospital C 21944593 20776448 1.00000 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 Mercy Foundation C 110521 Cost Mercy Services Iowa City Inc A 670990 Cost Mercy Services Iowa City Inc R 6850000 Cost Mercy Services Iowa City Inc S 2700000 Cost Mercy Hospital Iowa City Iowa Self Insurance Plan and Trust B 975000 Cost Mercy Services Iowa City Inc Q 6841576 Cost Mercy Services Iowa City Inc O 4917795 Cost