MERCY HOSPITAL OF FRANCISCAN SISTERS INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MERCY HOSPITAL OF FRANCISCAN SISTERS INC (EIN 42-1178403)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-11
- IRS object ID
- 202311319349303516
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-11T11:23:45-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421178403 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mercy Hospital of Franciscan Sisters Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % TIMOTHY HUBER | InCareOfNm |
| Business Name Control | MERC | BusinessNameControlTxt |
| Phone | 3192833000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 8th Avenue SE | AddressLine1Txt |
| City | Oelwein | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50662 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Timothy Huber | PersonNm |
| Person Title | VP OF FINANCE | PersonTitleTxt |
| Phone | 3192727300 | PhoneNum |
| Signature | 2023-05-10 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Timothy | PersonFirstNm |
| Person Last | Huber | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MercyOne Oelwein Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jack Dusenbery | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3421 West Ninth Street | AddressLine1Txt |
| City | Waterloo | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 507025499 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,669,168 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.mercyone.org/northeastiowa | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | General inpatient and outpatient acute and skilled health care services. Provides 35 long-term care nursing units with a utilization rate of 69 percent. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 158 | TotalEmployeeCnt |
| Total Volunteers | 36 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,076,978 | PYContributionsGrantsAmt |
| CY Contributions Grants | $16,284 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,279,981 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,356,506 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12,419 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,222 | CYInvestmentIncomeAmt |
| PY Other Revenue | $262,112 | PYOtherRevenueAmt |
| CY Other Revenue | $295,156 | CYOtherRevenueAmt |
| PY Total Revenue | $15,631,490 | PYTotalRevenueAmt |
| CY Total Revenue | $13,669,168 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,069,929 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,740,948 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,154 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,945,346 | PYOtherExpensesAmt |
| CY Other Expenses | $7,851,699 | CYOtherExpensesAmt |
| PY Total Expenses | $14,015,275 | PYTotalExpensesAmt |
| CY Total Expenses | $15,592,647 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,616,215 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,923,479 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,687,810 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,618,301 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,777,455 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,676,785 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,910,355 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,941,516 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AS A MEMBER OF MERCY HEALTH NETWORK, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,142,375 | ExpenseAmt |
| Revenue | $13,541,410 | RevenueAmt |
| Desc | MercyOne Northeast Iowa is a faith-based 511-bed, not-for-profit, comprehensive medical/surgical health care provider offering acute levels of medical care at Covenant Medical Center in Waterloo, Sartori Memorial Hospital in Cedar Falls, and Mercy Hospital in Oelwein. Its services in the region also include Covenant Clinic with more than 100 primary care and specialty providers; Covenant Foundation, Sartori Health Care Foundation and Mercy Hospital Foundation. Areas of excellence include cardiology, orthopedics, neurosurgery, maternity and NICU, cancer treatment, minimally invasive and Bariatric surgery. The Iowa operations have been part of a 140 year system of care sponsored by the Wheaton Franciscan Sisters, formerly incorporated in 1983. In 2016, the Wheaton Franciscan Sisters transferred their Iowa operations to Mercy Health Network, an Iowa-based health care system based out of Des Moines, Iowa. Mercy Health Network (MHN) is an integrated system of member hospitals and other health and patient care facilities united into one operating organization to improve the delivery of healthcare services to the people of Iowa and adjoining states. MHN's sponsors own and operate medical centers and other services in Clinton, Des Moines, Dubuque, Mason City, and Sioux City, and community hospitals in six other locations. In addition, MHN has 27 members who participate through contracts for management and other services. Mercy Health Network (MHN) was founded in 1998 under a joint operating agreement between two of the largest Catholic, not-for-profit health organizations in the United States: Catholic Health Initiatives, based in Englewood, Colorado, and Trinity Health, based in Livonia, Michigan. Covenant Medical Center in Waterloo, Iowa was founded in 1986 when Wheaton Franciscan Services consolidated St. Francis Hospital (founded in 1912) and Schoitz Medical Center (founded in 1904). Covenant Medical Center was located in two locations until 1991 when all acute care services were combined at one site. The other site was transformed into an assisted living center and adult services center. In 1995, Wheaton Franciscan Services' Iowa region was renamed Covenant Health System and included Covenant Medical Center in Waterloo, Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, N. E. Iowa Real Estate Investments and Schoitz Health Resources. Sartori Memorial Hospital became a part of Covenant Health System in 1996 when the system entered a long-term lease agreement with the City of Cedar Falls. In 2006, Covenant Health System was renamed Wheaton Franciscan Healthcare-Iowa, to reflect its continued commitment to an integrated health care delivery system for residents of Northeast Iowa. Today MercyOne Northeast Iowa includes Covenant Medical Center (and its unincorporated division, Covenant Clinic) and Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, Sartori Memorial Hospital and Sartori Health Care Foundation in Cedar Falls, and N. E. Iowa Real Estate Investments. MercyOne Northeast Iowa Entities: Hospitals Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic, an unincorporated division of Covenant Medical Center, Inc. Patients have access to more than 100 primary and specialty care physicians, physician assistants, nurse practitioners, and other health care professionals located throughout Northeast Iowa in 24 locations. Regional Service Lines Covenant Cardiology Covenant Cancer Treatment Center Covenant Clinic Orthopedic Services Covenant Home Health Emergency Services Imaging/Radiology Services Iowa Spine and Brain Institute Midwest Institute of Advanced Laparoscopic Surgery Maternal Child Health Occupational Medicine and Wellness Covenant Retail Pharmacies Rehabilitation Services Philanthropic Foundations Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. MERCYONE NORTHEAST IOWA COMMUNITY IMPACT IN IOWA / 2022 Charity Care: $2,624,319. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on costs, not charges, and does not include bad debt. Unreimbursed Cost of Public Programs: $13,926,783. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $2,152,780. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial Contributions: $195,981. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community groups, or nonprofit organizations for charitable purposes. Health Professions Education: $1,671,519. Health professions education is defined as direct costs incurred for accredited training and education programs for physicians, nurses, allied health professionals and technicians (does not include ongoing education for staff). Community Building Activities: $10,527. Community building activities are defined as programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental issues. Costs for these activities include cash and in-kind donations. Community Benefit Operations: $89,303. Community benefit operations are defined as costs associated with dedicated staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations. Subsidized Health Services: $3,414,557. Subsidized health services are defined as the negative margin for clinical services that are provided despite a financial loss because of an identified community need that would need to be met by the government or another not-for-profit if it was not offered. The financial losses are so significant that negative margins remain after removing the effects of charity care, bad debt, and Medicaid shortfalls. TOTAL BENEFIT TO THE COMMUNITY FOR IOWA 2022: $24,085,769. | Desc |
| Total Program Service Expenses | $15,142,375 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 158 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY HUBER | PersonNm |
| Phone | 3192727607 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3421 WEST NINTH STREET | AddressLine1Txt |
| City | WATERLOO | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 507025499 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Jack Dusenbery | |||||||||
| Director; President | 1.0 | 40.0 | Yes (X) | Yes (X) | $0 | $737,843 | $35,339 | ||
| Luis Avila MD | |||||||||
| Director thru 12/21; Phys Emp | 1.0 | 40.0 | Yes (X) | $0 | $665,118 | $47,501 | |||
| Matthew Sojka | |||||||||
| VP Medical Affairs | 1.0 | 40.0 | $0 | $479,058 | $30,612 | Yes (X) | |||
| Rachelle Makinde | |||||||||
| Director as of 1/22; Phys Emp | 1.0 | 40.0 | Yes (X) | $0 | $455,020 | $35,713 | |||
| Brian Burnett MD | |||||||||
| Director; Phys. Employee | 1.0 | 40.0 | Yes (X) | $0 | $373,059 | $47,874 | |||
| Timothy Huber | |||||||||
| Asst Treas; VP Finance | 1.0 | 40.0 | Yes (X) | $0 | $300,986 | $47,510 | |||
| Kelly Richards | |||||||||
| CNO | 1.0 | 40.0 | $0 | $264,609 | $40,507 | Yes (X) | |||
| Ryan Meyer | |||||||||
| VP Site Administrator | 1.0 | 40.0 | $0 | $201,314 | $29,632 | Yes (X) | |||
| Jill Groth | |||||||||
| VP Site Administrator | 40.0 | 0.0 | $186,354 | $0 | $28,877 | Yes (X) | |||
| Shawn Schoultz | |||||||||
| RN | 40.0 | 0.0 | $112,261 | $0 | $13,290 | Yes (X) | |||
| Nancy Schaefer | |||||||||
| Asst. Secy; Exec. Asst. | 1.0 | 40.0 | Yes (X) | $0 | $64,814 | $3,366 | |||
| David Deaver | |||||||||
| Vice Chair - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Gregory Schmitz | |||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| Shirley Dunlap | |||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| Casey McLaughlin | |||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| Bob Ritz | |||||||||
| Director, Ex Officio, MHN Pres | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| Alan Kruger | |||||||||
| Director thru 12/21 | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| James Lee | |||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| Carol Tousley | |||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $298,615 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,541,821 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $360,221 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Acute Care Inc | |||||
| 1609 N Ankeny Boulevard Suite 200 | ANKENY | IA | 50023 | Physician Services | $1,388,943 |
| Shared Medical Services Inc | |||||
| 209 Limestone Pass | COTTAGE GROVE | WI | 53527 | Medical Services | $155,235 |
| Trane US Inc | |||||
| PO Box 98167 | CHICAGO | IL | 60693 | HVAC Installation | $242,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $4,044 | RelatedOrganizationsAmt |
| Government Grants | $3,837 | GovernmentGrantsAmt |
| All Other Contributions | $8,403 | AllOtherContributionsAmt |
| Total Contributions | $16,284 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 622110 | $3,776,188 | $3,776,188 |
| MEDICARE/MEDICAID PAYMENTS | 622110 | $9,580,318 | $9,580,318 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,356,506 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,034 | TotalRevenueColumnAmt |
| Exclusion | $1,034 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,201 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,201 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,201 | TotalRevenueColumnAmt |
| Exclusion | $18,201 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $188 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $188 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $188 | TotalRevenueColumnAmt |
| Exclusion | $188 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| WELLNESS CENTER | 900099 | $184,904 | $184,904 | |
| GIFT SHOP | 453220 | $22,112 | $22,112 | |
| CAFETERIA | 722514 | $44,079 | $44,079 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,860 | TotalRevenueColumnAmt |
| Exclusion | $25,860 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $276,955 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,669,168 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,541,410 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $111,474 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,230 | TotalAmt |
| Management And General | $215,230 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,674,609 | TotalAmt |
| Program Services | $5,559,360 | ProgramServicesAmt |
| Management And General | $115,249 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,697 | TotalAmt |
| Program Services | $257,080 | ProgramServicesAmt |
| Management And General | $7,617 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,157,369 | TotalAmt |
| Program Services | $1,125,379 | ProgramServicesAmt |
| Management And General | $31,990 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $429,043 | TotalAmt |
| Program Services | $410,821 | ProgramServicesAmt |
| Management And General | $18,222 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,513 | TotalAmt |
| Program Services | $1,513 | ProgramServicesAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,573,899 | TotalAmt |
| Program Services | $1,567,249 | ProgramServicesAmt |
| Management And General | $6,650 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $606,138 | TotalAmt |
| Program Services | $597,646 | ProgramServicesAmt |
| Management And General | $8,492 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $374,731 | TotalAmt |
| Program Services | $374,731 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,298 | TotalAmt |
| Program Services | $10,298 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,822 | TotalAmt |
| Program Services | $1,822 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $660,277 | TotalAmt |
| Program Services | $660,277 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PARENT COMPANY ALLOCATION | $2,262,945 | $2,262,945 | |
| PURCHASED SERVICES | $1,165,874 | $1,159,796 | $6,078 |
| MEDICAL SUPPLIES | $811,961 | $811,890 | $71 |
| BAD DEBT EXPENSE | $304,090 | $304,090 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,151 | TotalAmt |
| Program Services | $37,478 | ProgramServicesAmt |
| Management And General | $37,519 | ManagementAndGeneralAmt |
| Fundraising | $3,154 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,592,647 | TotalAmt |
| Program Services | $15,142,375 | ProgramServicesAmt |
| Management And General | $447,118 | ManagementAndGeneralAmt |
| Fundraising | $3,154 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $483,414 | BOYAmt |
| EOY | $476,230 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,583,025 | BOYAmt |
| EOY | $1,715,187 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,851 | BOYAmt |
| EOY | $94,889 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,191 | BOYAmt |
| EOY | $29,386 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,524,212 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,295,764 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,415,561 | BOYAmt |
| EOY | $4,228,448 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,768 | BOYAmt |
| EOY | $74,161 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,687,810 | BOYAmt |
| EOY | $6,618,301 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,207 | BOYAmt |
| EOY | $783,335 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,078,248 | BOYAmt |
| EOY | $893,450 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,777,455 | BOYAmt |
| EOY | $1,676,785 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,837,587 | BOYAmt |
| EOY | $4,867,355 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,768 | BOYAmt |
| EOY | $74,161 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,910,355 | BOYAmt |
| EOY | $4,941,516 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,687,810 | BOYAmt |
| EOY | $6,618,301 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,923,479 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,954,640 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $1,513 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $1,513 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C Disclosures | FormAndLineReferenceDesc |
| Explanation | Schedule C Part II-B Line 1f: Mercy Hospital of Franciscan Sisters, Inc. has made grants to other organizations for lobbying purposes. These grants have been in the form of membership dues paid to regional and national health care organizations, where the organizations have provided Mercy Hospital of Franciscan Sisters, Inc. with an estimated percentage of dues payments which are used for lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $360,000 | OtherCostOrOtherBasisAmt |
| Book Value | $360,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,478,225 | OtherCostOrOtherBasisAmt |
| Depreciation | $598,958 | DepreciationAmt |
| Book Value | $1,879,267 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,684,577 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,696,236 | DepreciationAmt |
| Book Value | $1,988,341 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,410 | OtherCostOrOtherBasisAmt |
| Depreciation | $570 | DepreciationAmt |
| Book Value | $840 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,228,448 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER LIABILITIES | Desc |
| Amt | $893,450 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $893,450 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | IRS Form 990 Schedule D, Part X | FormAndLineReferenceDesc |
| Explanation | The Company follows the provisions of ASC Subtopic 740-10, Income Taxes - Overall. ASC Subtopic 740-10 clarifies the accounting for uncertainty in tax positions and also provides guidance on when the tax positions are recognized in an entity's financial statements and how the values of these positions are determined. As of June 30, 2022, the Company did not have a liability for unrecognized tax benefits. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $150,317 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $150,317 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,036,544 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,277,836 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,186,861 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,277,836 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $150,317 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01000 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $190,851 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $190,851 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01200 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,564 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $63,564 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00420 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $102,837 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $102,837 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00670 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,613 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,613 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $377,865 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $377,865 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02420 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,564,726 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,277,836 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $528,182 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03420 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $304,090 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,422,824 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,371,674 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $51,150 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MercyOne Oelwein Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 315 8th Avenue SE | AddressLine1Txt |
| City | Oelwein | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50662 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.mercyone.org | WebsiteAddressTxt |
| State License | 330141H (IA) | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MercyOne Oelwein Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | mercyone.org - full url in narrative | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | mercyone.org - full url in narrative | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | mercyone.org-full url in narra | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | mercyone.org-FULL URL IN NARRATIV | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | mercyone.org-FULL URL IN N | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | schedule H supplemental Information | FormAndLineReferenceDesc |
| Explanation | Schedule H Part V Section B Line 3e: MercyOne Oelwein Medical Center included in its CHNA written report a prioritized list and description of the community's significant health needs, which were identified through the most recently conducted community health needs assessment. The following community health needs were deemed significant and were prioritized for tax year 2021 through a community-involved selection process: Prevention Mental Health Nutrition Schedule H Part V Section B Line 3j: Iowa's Community Health Needs Reports provide additional detailed information in response to many of the Schedule H questions on our Community Health Needs Assessments (CHNA) and Implementation Plans. These reports are accessible at under the Community Health tab at: www.mercyone.org/about-us/community-health-and-well-being under Oelwein and Waterloo/Cedar Falls. The MercyOne team wrote a joint CHNA and an Implementation Plan for MercyOne Waterloo Medical Center and MercyOne Cedar Falls Medical Center (Black Hawk County); as well as one for MercyOne Oelwein Medical Center (Fayette County). The Community Health Needs Assessments were board approve and posted on June 24th, 2022. This 2022 assessment covered the FY23-FY25 time frame. Black Hawk County conducted a joint Community Health Needs Assessment and Implementation Plan. Due to not aligning with due dates in Fayette County, MercyOne Oelwein Medical Center conducted their own survey and completed the assessment with information obtained in the survey and in collaboration with Health Fayette County Coalition. The Community Health Needs Assessment Implementation Plans for both Fayette and Black Hawk County were board approved and posted on October 31st, 2022. Schedule H Part V Section B Line 5: MercyOne Oelwein Medical Center Community Health Needs Assessment was approved and posted June 24, 2022, to reflect the findings of Fayette County for FY23-FY25. The Community Health Needs Implementation Plan was board approved and posted on October 31, 2022. MercyOne Oelwein Medical Center and Gundersen Palmer Hospital are the two critical access hospitals in the county. The Fayette County Health Department is located within Gundersen Palmer Hospital, in West Union, Iowa. MercyOne Oelwein Medical Center collaborated with both Gundersen Palmer Hospital and Fayette County Health Department throughout the assessment and implementation process. In addition, Healthy Fayette County Coalition assisted with the development of the CHNA and the Implementation Plan for FY23-FY25. Healthy Fayette County Coalition had already identified three areas in which to target and collaborate to have the most impact countywide. This was based on the past county assessment. Due to timing and differences in the assessment cycle, MercyOne Oelwein Medical Center conducted their own survey in April 2022 to have up to date data for the assessment and implementation plan, focusing on the 3 previously identified key areas, Mental Health, Prevention and Nutrition. Postcards were sent out to all Fayette County residents with information and the QR code to access the online survey. Fayette County Public Health advertised this on their Facebook page. In addition, flyers and paper copy surveys were distributed to 16 different locations throughout Fayette County as well as during the mobile food pantry. A few residents reached out to participate in the survey via phone. A total of 260 residents participated in the survey. Schedule H Part V Section B Line 6a-b: The CHNA was conducted by MercyOne Oelwein Medical center in collaboration with Fayette County Public Health, Gunderson Palmer Hospital and Healthy Fayette County Coalition. Due to MercyOne Oelwein Medical Center being on a different cycle schedule, they conducted their own survey and gathered new data surrounding the 3 focused areas of Healthy Fayette County, Mental Health, Prevention & Nutrition. Survey results and data were shared. Schedule H Part V Section B Line 7a: https://www.mercyone.org/northeastiowa/_assets/documents/about-us/chna/oel wein-chna-fy22-fy24-final.pdf Schedule H Part V Section B Line 10a: https://www.mercyone.org/northeastiowa/_assets/documents/fayette-county-im plementation-strategy-final.pdf Schedule H Part V Section B Line 11 Using the CHNA completed in June 2022, the hospital developed, adopted, and is working on executing the first year of a three-year Implementation Strategy to address priority community health needs. The Implementation Strategy was board approved on October 31, 2022. The following summarizes how the hospitals will address priority health needs in the community in FY23-FY25 (July 1, 2022- June 30, 2025): MercyOne Oelwein Medical Center is focused on impacting health issues identified within the community health needs assessment, aligning with Fayette County Public Health, Gundersen Palmer Lutheran Health, and Healthy Fayette County Coalition. Based on the Community Health Needs assessment, the overall ranking of the priority issues are as follows: . Prevention . Mental Health . Nutrition FY22 MercyOne Oelwein Medical Center was focused on impacting health issues identified within the community health needs assessment conducted in 2019 and the implementation plan. Health Behaviors: . MercyOne Oelwein Medical Center continued to partner with Northeast Iowa Food Bank to continue to provide the Mobile Food Pantry to ensure access to food. The hospital continued to provide funds to support and volunteers each month during the food distribution, addressing food insecurity. . MercyOne entered a memorandum of understanding with Plentiful Pantry. . MercyOne continues to run a wellness center in cooperation with the Oelwein School and the City of Oelwein. . MercyOne continues to refer residents and patients to Quit Line Iowa. . Educating patients and the community on the resource guide, Find Help. . Active participant in Health Fayette County Coalition. Clinical Care: . Continued to offer FREE mammography program for the poor/underserved in conjunction with the Care for Yourself Program and Check the Girls. . Continue with telehealth services to ensure patients have access to care. . Kicked off a Military/Vet program within the hospitals and clinics. For FY23-25, MercyOne Oelwein Medical Center will not focus on the following priorities, but will support initiatives related to these areas by other partners when possible: . Social and economic factors related to unemployment, income inequity, poverty, crime, and death rates. . Physical environment, such as air pollution, housing, and commute driving. Schedule H Part V Section B Line 16: Organizations in the Iowa region take several proactive approaches to make our patients aware of our financial assistance policy. In addition to our policy being posted on our website there is abundant signage and brochures throughout our facility explaining the financial assistance policy and how to obtain a copy. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as in patient admitting and registration areas (both inpatient and outpatient settings), physician offices, and emergency departments. Brochures describing the policy are available in the same locations, and the policy is reviewed at the time of registration or pre-registration, admission, discharge, and with billing for those identified with a need. Patients who call and express a financial hardship in paying their bill are assisted by a customer service representative who will assist the patient in setting up an appointment to meet with a financial advocate to review the financial assistance policy in detail, get the application process started, and answer any questions. Our patient statements also include notifications about the availability of financial assistance and a phone number to call for more information. Additionally, the policy and brochure summarizing our Community Care Program (financial assistance) is available on our website with applications in English, Spanish, Bosnian and French, found here: https://www.mercyone.org/northeastiowa/for-patients/billing-and-financial- information/financial-assistance. Additionally, there are other helpful aides, including our Billing and Collections policy, a summary of Community Care Program Requirements, and Payment for Services Brochures; many of these are again available in all three languages, English, Spanish, and Bosnian. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Outpatient Rehab Therapy | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 317 8TH AVENUE SE | AddressLine1Txt |
| City | OELWEIN | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50662 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | PHYSICAL THERAPY OCCUPATIONAL/SPEECH THERAPY | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule H Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Schedule H Part 1 Line 6a: MercyOne Northeast Iowa's Community Benefit totals as of tax year 2021 are posted in total with the rest of MercyOne Iowa. The annual report can be accessed at the following link: https://www.mercyone.org/assets/documents/about-us/community-health/srvc_c hwb_fy22-annual-report_111522_v8.pdf Schedule H Part 1 Line 7: Community Benefit amounts are reported using total actual costs per the hospital's managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information is published. Amounts are summarized using a software application recommended by the Catholic Health Association in conjunction with the Iowa Hospital Association, because it can provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the Iowa organization. After amounts are verified and approved, community benefit amounts become finalized. Finally, the information is compiled with the assistance of CBISA software for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. The Iowa hospital facilities are not required to report community benefit information to the State of Iowa but do make the information readily available on certain websites and report the information to the Iowa Hospital Association. Schedule H Part 1 Line 7 Column f: Iowa Hospitals follow guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommend that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $304,090 has not been included in the denominator of the calculation that determines the percentages reported on Schedule H Line 7 Column f. In addition to the community benefit described above, MercyOne Northeast Iowa also provides care to Medicare and Medicare HMO patients that is not fully reimbursed by the government. According to the most recently filed Medicare cost report, we provided $17,595,605 in unreimbursed Medicare services. We are not including the gap in Medicare reimbursement in accordance with the Catholic Health Association Community Benefit Guidelines. If we included the Medicare shortfall, our total would be $41,681,374. Schedule H Part 1 Line 7g: In Iowa region, clinic operations are included as a department of the hospital, MercyOne Medical Centers (Waterloo, Cedar Falls, and Oelwein), DBA Covenant Medical Center, Inc. Clinic operations for MercyOne clinics in the northeast Iowa regions are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, costs related to physician clinics are not included in the subsidized health services report on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-3: In determining bad debt amounts, the Iowa organizations use a two-level scoring process as follows: First, for any patient account that is categorized as having no insurance, when the amount becomes 60 days overdue or greater, the patient's account is reviewed for financial assistance qualification. If the patient is found to qualify for financial assistance, the necessary steps are taken to apply, and the needed adjustments are made to treat as charity care and not as bad debt. A similar scoring process is completed for those patients who do have insurance, but after 120 days or greater, still have not paid the patient responsibility portion. Again, these patient accounts are reviewed for financial assistance, and if they qualify, similar steps are taken to remove from bad debt. As a result of these scoring procedures, Iowa's position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, or later with the timing of the scoring procedures mentioned above. Bad debt is therefore only determined for each organization at the time the amount due is truly determined to be uncollectible, after financial assistance has been determined, and after many months of collection efforts. Additionally, the organization followed guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommends that no bad debt amounts be included in community benefit amounts. For these reasons, Part III Section A Line 3 is reported at zero. Schedule H Part III Section A Line 4: Mercy Hospital of Franciscan Sisters, Inc. is included in the consolidated financial statements of MercyOne Northeast Iowa. The following is the text of the footnote from the financial statements which addresses the allowance for doubtful accounts. This footnote can be found on page 14 of the attached consolidated financial statements. The Company estimates the transaction price for patients with deductibles and coinsurance and for those who are uninsured and underinsured based on historical experience and current market conditions, using the portfolio approach. The initial estimate of the transaction price is determined by reducing the standard charge by any contractual adjustments, discounts, and implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payor of the patient's ability to pay are recorded as bad debt expense in other expenses in the statement of operations and changes in net assets. Schedule H Part III Section B Line 6-8: Schedule H Part III Section B Line 6 reports allowable costs of care as taken from the most recently filed Medicare cost report available at the time of publishing the Community Benefit Report. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid costs are determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Iowa Hospital Association, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b: Iowa organizations follow a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Please also see Schedule H Part III Section A Lines 1-4 narrative response. Schedule H Part V Section A and Section C: Affiliates of the Iowa region have defined and reported hospital facilities to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Iowa state law required for hospital licensing. Although there may be other facilities within our system built to hospital specifications, performing hospital-based billing, and conforming to other hospital standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part VI Line 2: Iowa assesses the needs of the communities it serves by reviewing admission and discharge data, analyzing information from the community health departments and other community leaders, and by aligning our services with the Healthy People 2030 and other current year initiatives. The Iowa hospital organizations complete a Community Health Needs Assessment and Implementation Plan every three years. Please reference Schedule H Part V Section B Lines 1-12 for additional information. Schedule H Part VI Line 3: Iowa provides its patients with several opportunities to gain knowledge and awareness of its Community Care (C | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Luis Avila MD | ||||||||||||||
| Director thru 12/21; Phys Emp | $663,242 | $0 | $1,876 | $8,700 | $38,801 | $712,619 | $0 | |||||||
| Jack Dusenbery | ||||||||||||||
| Director; President | $549,954 | $169,330 | $18,559 | $8,700 | $26,639 | $773,182 | $0 | |||||||
| Ryan Meyer | ||||||||||||||
| VP Site Administrator | $166,778 | $33,364 | $1,172 | $3,114 | $26,518 | $230,946 | $0 | |||||||
| Timothy Huber | ||||||||||||||
| Asst Treas; VP Finance | $243,354 | $51,146 | $6,486 | $13,050 | $34,460 | $348,496 | $0 | |||||||
| Matthew Sojka | ||||||||||||||
| VP Medical Affairs | $395,284 | $80,466 | $3,308 | $4,350 | $26,262 | $509,670 | $0 | |||||||
| Brian Burnett MD | ||||||||||||||
| Director; Phys. Employee | $371,728 | $0 | $1,331 | $13,050 | $34,824 | $420,933 | $0 | |||||||
| Jill Groth | ||||||||||||||
| VP Site Administrator | $154,173 | $28,218 | $3,963 | $5,880 | $22,997 | $215,231 | $0 | |||||||
| Kelly Richards | ||||||||||||||
| CNO | $215,723 | $45,032 | $3,854 | $12,340 | $28,167 | $305,116 | $0 | |||||||
| Rachelle Makinde | ||||||||||||||
| Director as of 1/22; Phys Emp | $454,081 | $0 | $939 | $2,328 | $33,385 | $490,733 | $0 | |||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J Disclosures | FormAndLineReferenceDesc |
| Explanation | Schedule J Part I Line 3 Mercy Hospital of Franciscan Sisters, Inc. is a subsidiary of the Mercy Health Network system. Mercy Hospital of Franciscan Sisters, Inc.'s President/CEO is paid directly by a related entity, Covenant Medical Center, Inc. Covenant Medical Center, Inc. used the following methods to establish the compensation of Mercy Hospital of Franciscan Sisters, Inc.'s President/CEO: -independent compensation consultant -written employment contract -compensation survey or study -approval by Mercy Health Network board of directors. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule O Disclosures | IRS Form 990 Part I Line 6 Mercy Hospital of Franciscan Sisters, Inc. received donated services through volunteers assisting in such areas as the gift shop, x-ray, Mercy clinic, dietary, emergency room, 2nd floor, long-term care, and auxiliary events. Part V Line 1a and Part VII Section B Line 1-2 MercyOne Northeast Iowa streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC are now reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. IRS Form 990 Part VI Section A Lines 6-7b Mercy Hospital of Franciscan Sisters, Inc. has one member which holds several reserved powers over Mercy Hospital of Franciscan Sisters, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Lines 11a and 11b Affiliates of MercyOne Northeast Iowa during the fiscal year ending June 30, 2022 used a multiple-level review process on all IRS Forms 990 to ensure accurate and timely filing for all organizations. Under the direction of the Chief Financial Officer, the Accounting Department prepares Forms 990 and any applicable 990-T and associated state filings. When complete, the return is first reviewed by a Senior-Level (or higher) associate in the Finance Department, who focuses on the income statement and balance sheet items, and schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Finance, the return is provided to the Tax Department of the MHN sponsor organization, where the Tax Director concentrates primarily on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule H or Schedule J may be reviewed by committees, such as the Community Benefit Team or the Compensation Committee in selected years. The board has asked for formal presentations on various 990 topics over the years. This decision will vary from year to year, again based on many factors. Once all levels of review have been completed, a designated finance and accounting employee will schedule an appointment with the signer of the 990. The signer, the Vice President-Finance and CFO, will perform an additional, normally high level review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors, who at a later date but prior to efiling, are provided access to all 990's throughout their assigned region. IRS Form 990 Part VI Section B Lines 12a - 12c Mercy Hospital of Franciscan Sisters, Inc. has adopted a Conflict of Interest policy which applies to all "interested persons" of Mercy Hospital of Franciscan Sisters, Inc. including directors, principal officers, key employees, and members of committees with Board-delegated powers. Interested persons are expected to discharge their duties in a manner the person reasonably believes to be in the best interests of Mercy Hospital of Franciscan Sisters, Inc. and to avoid situations involving a conflict of interest. On an annual basis, interested persons are required to complete a conflict of interest disclosure statement and to affirm their receipt of the conflict of interest policy, compliance with its requirements, and agree to notify the organization of changes impacting their annual disclosure in accordance with the policy. The annual disclosures are provided to internal Legal Counsel and the Integrity and Compliance Officer, from which Legal Counsel prepares a report for the Board Chair and CEO. A summary of potential conflicts is reviewed with the Board of Directors of Mercy Hospital of Franciscan Sisters, Inc. (or a delegated committee of the Board) on a yearly basis. Interested persons are required to make full disclosure to Mercy Hospital of Franciscan Sisters, Inc. of any financial or business interests that might result in or have the appearance of a conflict of interest. The Board of Directors of Mercy Hospital of Franciscan Sisters, Inc. (or a delegated committee of the Board) is responsible for the review of transactions to determine whether an actual conflict of interest exists. In the event of an actual conflict, the Board (or a delegated committee of the Board) will either avoid the conflict or appropriately scrutinize the transaction to ensure it is in the best interests of Mercy Hospital of Franciscan Sisters, Inc. Interested persons are required to recuse themselves from discussion and voting on matters involving a conflict of interest. The policy further addresses the proper documentation of the proceedings and potential disciplinary and corrective action for violations of the policy. The policy is available to the public upon request. IRS Form 990 Part VI Section B Line 15a Question 15a is answered "No" because the compensation for the CEO of Mercy Hospital of Franciscan Sisters, Inc. is established and paid by a related entity, Covenant Medical Center, Inc. In establishing CEO compensation, Covenant Medical Center, Inc. follows a process which includes the following: Use of an independent compensation consultant and compensation study, use of a written employment contract, and review and approval by the Mercy Health Network board of directors. This process is performed annually. IRS Form 990 Part VI Section B Line 15b Question 15b is answered "No" because the compensation for the other officers and key employees of Mercy Hospital of Franciscan Sisters, Inc. is established and paid by a related entity, Covenant Medical Center, Inc. In establishing other officer and key employee compensation, Covenant Medical Center, Inc. follows a process which includes the following: Use of an independent compensation consultant and compensation study, use of a written employment contract, and review and approval by the Covenant Medical Center, Inc. and MercyOne Northeast Iowa CEO, authorized to act on behalf of the board with respect to certain compensation matters. This process is performed annually. IRS Form 990 Part VI Section C Line 19 Affiliates of MHN during the fiscal year ending June 30, 2022 provided upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. IRS Form 990 Part VII Column B Affiliates of MHN during the fiscal year ending June 30, 2022 operated as a controlled group of related healthcare organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where MercyOne has common boards and other overlaps in committee representations, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. IRS Form 990 Part XI Line 9 Certain related organizations utilize receivable/payable accounts throughout the year. These intercompany balances were settled through the equity account at the end of the fiscal year to bring the receivable/payable balance to zero. For the fiscal year ended June 30, 2022 this resulted in an increase in net assets or fund balances of $1,954,640. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1573899 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| WF Healthcare - Iowa Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421177001 | HOLDING CO | IA | 501(c)(3) | 12 - III-FI | MHN | Yes (true) |
| Covenant Foundation Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421295784 | FOUNDATION | IA | 501(c)(3) | 10 | COV MED CTR | Yes (true) |
| Covenant Medical Center Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421264647 | HOSPITAL | IA | 501(c)(3) | 3 | WFH-IOWA | Yes (true) |
| NE Iowa Real Estate Invsts | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421207432 | HOLDING CO | IA | 501(c)(2) | N/A | WFH-IOWA | Yes (true) |
| Sartori Health Care Foundation Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421240996 | FOUNDATION | IA | 501(c)(3) | 12 - I | SARTORI HOSP | Yes (true) |
| Sartori Memorial Hospital Inc | ||||||||||
| 515 COLLEGE STREET | CEDAR FALLS | IA | 50613 | 420758901 | HOSPITAL | IA | 501(c)(3) | 3 | WFH-IOWA | Yes (true) |
| Mercy Health Network | ||||||||||
| 1111 6th Avenue | Des Moines | IA | 50314 | 421478417 | PARENT | DE | 501(C)(3) | 12 - III-FI | NA | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Covenant Medical Center Inc | ||
| o | $423,701 | Book Value |
| Sartori Memorial Hospital Inc | ||
| o | $83,614 | Book Value |
| Wheaton Franciscan Healthcare - Iowa Inc | ||
| m | $2,262,945 | Book Value |
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