2022-05-16T06:57:52-05:00 2021-06-30 861065772 Deloitte Tax LLP 111 MONUMENT CIRCLE Suite 4200 INDIANAPOLIS IN 462045108 990 2020-07-01 420680391 Mercy Hospital Iowa City Iowa MERC 3193390300 500 East Market Street Iowa City IA 52245 Dawna Miller Acting CEO 3193390300 2022-05-16 1 Dawna Miller 999009999 SHAWNA M JANSONS P01222873 3174648600 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z Mike Trachta 500 East Market Street Iowa City IA 52245 214625785 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. 15 13 1516 111 5673403 0 761447 1679077 164750687 176260217 3185800 4731889 4677058 10609055 173374992 193280238 26015 0 0 0 74419495 69704817 0 0 0 101594788 113123973 176040298 182828790 -2665306 10451448 259707250 261026318 200346271 164155664 59360979 96870654 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 120349698 185858680 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. 322791 270748 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. 8789823 Community Benefit. Mercy's community benefits take many forms, beginning with the traditional charity care of ($1.0 million) and the unpaid cost of Medicaid ($6.2 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. These efforts are detailed in Mercy's community health benefit report. As a trusted, longtime member of the community, Mercy plays an important role not only in further community health but the general community good. 129462312 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 54 0 1 1516 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Kimberley Rossiter 3193393900 500 East Market Street Iowa City IA 52245 Dawna Miller Treasurer 40.00 2.00 X X 222915 0 26174 Tom Clancy Vice Chair/Secretary 40.00 0.00 X X 82720 0 0 Sean Williams CEO & Administrator 40.00 2.00 X X 0 0 0 Bob Ritz Board Member 1.00 1.00 X 0 0 0 Dave Vellinga Board Member 1.00 1.00 X 0 0 0 Dr Chris Scott Board Member 1.00 0.00 X 0 0 0 Jack Dusenbery Board Member 1.00 0.00 X 0 0 0 Karin Franklin Board Member 1.00 0.00 X 0 0 0 Madeline Windauer Board Member 1.00 1.00 X 0 0 0 Mary Westbrook 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 Bretchen 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 0.00 X 0 0 0 Tom McLaughlin Chair 1.00 1.00 X X 0 0 0 Kimberley Rossiter Assistant Treasurer 40.00 2.00 X 170161 0 43138 Yonas Getachew Physician 40.00 0.00 X 669623 0 53182 Benjamin Green Physician 40.00 0.00 X 633225 0 53175 Andrew Ashby Physician 40.00 0.00 X 604455 0 54159 Joseph Truszowski Physician 40.00 0.00 X 542498 0 59661 James Nielsen Physician 40.00 0.00 X 567756 0 28972 Martin Izakovic Former VP/Physician 40.00 0.00 X 323073 0 59513 Luke Brunkhorst Physician 40.00 0.00 X 527354 0 50087 4343780 0 428061 113 1 1 0 MercyOne PO Box 74008768 Chicago IL 606748768 Management Services 2910931 One Neck IT Solutions PO Box 857950 Minneapolis MN 55344 IT Services 2401884 Allscripts Healthcare 24630 Network Place Chicago IL 60631 EHR/Help Desk Services 2150182 Medical Record Associates - MRA 103 Central St Ste A Wellesley MA 02482 IS Labor 1931835 Quest Diagnostics PO Box 775460 Chicago IL 60642 Lab Testing 1777576 54 1679077 1679077 Patient Serv. Revenue 621400 87367157 87367157 Medicare/Medicaid 621400 74192998 74192998 Lab Outreach 621511 5673403 5673403 ASC/DIC Income 900099 4020807 4020807 5005852 5005852 176260217 1045315 1045315 1322113 1076150 245963 245963 245963 23955971 20269397 3686574 3686574 3686574 Cafeteria Income 722210 493881 493881 Telephone 517000 121307 121307 Access 517000 3016 3016 9744888 9744888 10363092 193280238 180456025 5673403 5471733 X 637332 202896 434436 161536 161536 57343468 41545343 15798125 852959 617969 234990 6719537 4868305 1851232 3989985 2890744 1099241 2113236 2113236 295343 295343 123528 123528 26508 26508 21014959 10887559 10127400 465522 1306 464216 13042444 8397023 4645421 6404147 330750 6073397 2674902 108789 2566113 94065 48629 45436 4307004 1738978 2568026 9877995 8289764 1588231 490068 490068 Medical Supplies 16698565 16637487 61078 Pharmacy Supplies 15907663 15659954 247709 Bad Debt Expense 14040260 14040260 Food Expense 1035673 1035673 4512091 2160883 2351208 182828790 129462312 53366478 0 15778370 22087082 3626742 1593041 39104307 24230682 4628137 4404135 3348647 3167584 275795342 220875730 59534530 54919612 87664601 100105986 -64626741 -78490419 110648657 129008615 259707250 261026318 48076253 41950660 69160661 64516446 24522 1819756 83084835 55868802 200346271 164155664 X 59360979 96870654 59360979 96870654 259707250 261026318 X 10451448 9106198 -3545761 21497790 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 1 0 1 0 1 26508 26508 0 Part II-B, Line 1: Mercy Hospital, Iowa City, Iowa is a member of the Iowa Hospital Association (IHA) and America Hospital Association (AHA). A percentage of membership dues paid to IHA and AHA relate to Lobbying activites. 16457386 47025 5088018 1078838 20513591 17144539 140115 -233781 593487 16457386 17286002 14493 377510 533466 17144539 16775239 456231 744957 690425 17286002 15365728 123098 1673119 386706 16775239 0.86600 0.13400 0 1 1 4165665 4165665 141731846 108514696 33217150 127879592 111747526 16132066 2018239 613508 1404731 54919612 Beneficial Interest-Foundation 20720179 Due From Affiliates 100002769 2011/2018 Bond Fund 4060689 ROU Assets 4224978 129008615 Pension Benefit Liability 46515763 Other Long-Term Liabilities 8637269 Professional Liability Claims 715770 55868802 X Part V, Line 4: All Restricted Endowed Funds are used for the benefit of Mercy Hospital Iowa City - capital equipment, employee grants, scholarships, etc. Part X, Line 2: As a result of the implementation of ASC 740, "As of June 30 2021 and 2020, the company recorded no liabilities for unrecognized tax benefits. 1 1 1 X 1 X 1 1 0 1 1 505886 505886 0.00300 18571753 10287816 8283937 0.04910 19077639 10287816 8789823 0.05210 531661 531661 0.00310 1272351 1120961 151390 0.00090 1804012 1120961 683051 0.00400 20881651 11408777 9472874 0.05610 509965 509965 0.00300 509965 509965 0.00300 0 3542358 0 48654714 50684825 -2030111 X 1 1 1 Iowa City Ambulatory Surgery Center LLC Outpatient Surgery Center 0.51000 0.49000 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 X X X Lab Outreach Mercy Hospital Iowa City Iowa 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X https://www.mercyiowacity.org/community_health X 1 18 1 https://www.mercyiowacity.org/community_health 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X https://www.mercyiowacity.org/patient-financial-assistance X https://www.mercyiowacity.org/patient-financial-assistance X https://www.mercyiowacity.org/patient-financial-assistance 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: The Hospital conducted two focus groups with participants from these organizations, representing broad and deep knowledge of community health needs.- 4Cs of Community Coordinated Child Care- City of Coralville- Clear Creek Amana Schools- Coralville Police Dept.- Iowa City Area of Chamber of Commerce- Iowa City Area Development- Iowa City Community Schools- Iowa City Free Medical and Dental Clinic- Iowa City Police Dept.- Johnson Co Ambulance Service- Johnson Co Public Health- Johnson Co Public Services- Mercy Hospital ECU- Mercy Hospital & Clinics- National Alliance on Mental Illness Johnson Co- Rural Health and Safety Clinic of Eastern Iowa- United Action for Youth- United Way- United Way of Johnson & Washington Counties Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 11: The 2018 CHNA summarized 12 areas of opportunity for Community Health Improvement. Mercy Hospital is addressing these needs as follows:Mental Health - Depression and Social Support:Mercy continues to invest in outpatient psychiatric services. While traditional primary care visits fell throughout the COVID pandemic, the visit volume to our mental health clinic grew significantly. We accommodated the growth in demand by initiating telehealth capability at our mental health clinic. We employ four full time providers which includes one therapist. Our providers also staff the emergency room of our hospital in Johnson county where many patients present with mental health conditions. In addition, our affiliate MercyOne will be rolling out a new ambulatory social service this year that will dedicate a social worker to serve as the primary contact for patients with mental health or emotional needs. Their focus is to manage transitions in care following hospital discharges, emergency department use and post-acute stays where mental illness or substance abuse was a primary reason for the admission or visit. Nutrition, Physical Activity, Diabetes:We will continue to offer a 12 week program to the public taught by registered dieticians that focuses on behavioral modifications to achieve long-term lifestyle changes to improve overall health.Substance Abuse - Binge Drinking:Our community is home to a major university and excessive drinking has long been an issue. Our Vice President of Population Health attends the Partnership for Alcohol Safety, A joint project of The University of Iowa and the City of Iowa City. Its mission is to identify and advocate for strategies that reduce high-risk drinking and related harms.Access Primary Care Physicians:Mercy will continue to operate primary care clinics in each of our 5 primary care counties. This is the most direct way to address access, along with a financial aid policy that reduces the financial barriers for the uninsured. Mercy will also continue support of the Free Medical Clinic in Johnson county. This is an important health care access point for those with limited ability to payCancer - Cancer incidence:Mercy intends to more widely advertise the low dose lung cancer screening program that screens for at-risk patients, especially former heavy smokers. The existing program has resulted in the early identification and treatment of lung cancers, although many more eligible patients have not yet been screened.Heart Disease and Stroke Mortality rates:Two additional cardiologists will begin treating patients in 2019 and should result in at least a 25% increase in patient contacts with our cardiologists. Mercy is also certified as a primary stroke center and intends to maintain that certification.Infant Health - Teen Births:Mercy has budgeted to maintain our Muscatine county clinic staffing levels for the next year. This should maintain patients' ability to access health care resources directly from this clinic. Additionally, we partner with independent OBGYN groups to assess the market needs in this county.Injury & Violence - Violent Crime Rate:We intend to take no action as reducing the crime rate is not within the scope of our health care delivery system.Oral Health - Regular Dental Care:We intend to take no action regular dental care is not within the scope of our health care delivery system.Respiratory Disease:We have employed 2 nurse navigators in 2018 that are focused on reducing hospitalization readmissions and avoidable emergency room visits, especially from patients with chronic conditions. They contact patients after they return home after hospital encounters to ensure that patients have follow-up visits with their normal primary care provider and that they understand and are following the medical advice prescribed for them.Sexually Transmitted Disease & Chlamydia Incidence:Mercy is continuing to monitor chlamydia incidence rates and has seen recent high rates in the eastern portion of our service area. Our Infection Prevention Coordinator plans to provide staff education in the clinic and identify opportunities for community outreach. He will then track the incidence rates to see if those efforts have a significant impact on reducing incidence.Tobacco Use:We continue to provide smoking cessation counseling to a high percentage (85%) of adult smokers who are seen in our clinics. 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 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: Amounts in the table were derived using a cost accounting system that addresses all patient segments. A cost to charge ratio derived from completing IRS worksheet 2 was used to determine the amounts in Part I, Line 7a, 7b, 7c. and 7g. Part I, Ln 7 Col(f): The bad debt expense included on Form 990, Part IX, Line 25(A), but subtracted for purposes of calculating the percentage in this column is $14,040,260 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 .2523 to that amount. Part III, Line 3: Mercy Hospital 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 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 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 II, Community Building Activities: Economic Development:Mercy works with such groups as the Iowa City Area Chamber of Commerce and Iowa City Area Development Group to support the business community, welcome innovation to the area, and develop the workforce. Mercy continues to partner with the 40-bed Mercy Inpatient Rehabilitation Hospital that employs approximately 100 health care professionals.Community Support:Mercy is proud to continue our dedicated annual support that we provide to our community. For this fiscal year those supports include the impact of the Covid-19 pandemic as well as the derecho that struck in August 2020. Mercy has provided support to the following community organizations in financial support, promotional collaboration and/or colleague volunteer time:Through the Iowa City Free Medical Clinic, Mercy provided mammograms and radiology exams at no charge to community members. Mercy holds a high emphasis for the importance of preventative care and wants to ensure access to mammograms for all community members, regardless of financial means. Mercy Iowa City is pleased to continue our partnership with Iowa City Hospice; often accepting patients for acute care and/or respite care. Mercy accommodates subsidies for Hospice patients as needed and is proud to continue to promote the value Iowa City Hospice in our community. Continued collaboration with Team Breast Friends, Breast Cancer Awareness Association through promotional materials offered in cancer care bags provided to Mercy cancer patients purchased by the Mercy Guild. The Mercy Hospital Foundation works with Team Breast Friends to offer in annual support to women in need who were unable to pay for mammography services at the hospital.Rural Health and Safety of Eastern Iowa Partnership providing free COVID-19 testing, rural health screenings, and farm safety campaigns in their efforts to increase health care outreach and reduce injury prevention in the agricultural areas that make up most of its service area. Physical and mental health screenings, injury prevention education and general health information activities continue in Johnson and five contiguous counties. Mercy continues to emphasize the importance of its support in this area as rural farming is key in our community and ensuring the health and safety of our farmers, and other rural community members, is highly valued. Mercy Hospital is a partner in the community-wide initiative called Honoring Your Wishes. Mercy helps community members talk about long-term health care wishes and desires. Mercy offers to create a written plan of those wishes and desires referred to as Advanced Directives. This service is highly educational to community members and is provided at no charge through the Mercy Pastoral Care Department. Mercy's Pastoral Care Department provides clothing to discharged patients who lack appropriate attire, often because what they had worn when they were admitted was cut off in the Emergency Room to provide immediate care. Transportation is also provided via paid taxi for discharged patients and/or their family members as needed due to lack of financial means for required transportation.Mercy's 24-hour Mercy On-Call service provides medical triage and health information, scheduling of provider appointments, and refers callers to local supporting services as appropriate at no charge to the community member. This is a valued service and often complimented by community members such as new mothers seeking guidance on potential medical needs for their newborn or community members who are new to our community and unsure of existing resources. SHIIP (Senior Health Insurance Information Program) Volunteers assist seniors navigate through Medicare insurance enrollment with emphasis on the annual Medicare Open Enrollment Period for Part D coverage. 478 community members realized savings during Open Enrollment for Part D in FY 21' for our community members served through Mercy Iowa City. TRAIL of Johnson County (Tools and Resources for Active Independent Living) Colleagues volunteer time to promote this non-profit organization's goal of keeping seniors independent in their own homes - offering numerous services including light maintenance, appointment assistance, grocery delivery, and more. NAMI (National Association for Mental Illness) Mercy supports the annual NAMI walk in efforts to bring awareness and assistance for mental illness.AHA (American Heart Association) Mercy Iowa City supports the AHA Go Red For Women Luncheon to help bring awareness, early detection for heart disease to women.Mercy donated goods in support of a virtual walk fund raiser for local parks and recreation services to ensure continued support of overall community health and staying active, with emphasis during the Covid-19 pandemic when many sources of exercise were closed such as local gyms. To provide community support after the derecho in August of 2020, Mercy donated linens and bedding to a local Animal Shelter. Shelters were overwhelmed with pets while attempting to reunite them with their families after the devastation the derecho had on our community. Mercy continues to be a donation site for the Toys-for-Tots annual toy drive, providing toys over the holiday season for children in need. Toys delivered to Mercy Iowa City are then delivered to the designated drop off area for final collection by Toys-for-Tots through Mercy colleague volunteered time. Environmental Improvements:Mercy has been a good neighbor by maintaining its buildings and landscaping at a quality level. Mercy also continues to pursue extensive recycling (including newspapers, office paper, magazines, plastic, batteries, cooking oil, construction materials and more) and pursues equipment that reduce energy consumption as equipment requires replacement.Leadership Development and Training of Community Members:Mercy obtains a clear understanding of the importance in leadership development and training of community members and is excited to offer room space on-site at no charge in the future to local community groups for educational and developmental purposes, once safety able to resume, pending the Covid-19 pandemic. Despite the Covid-19 pandemic, Mercy was successful in continuing to support this overall cause in other ways. Coalition Building:Mercy is involved in many ways with local citizens and groups that are working to afford all members of our community a good quality of life and to improve overall quality of life.Mercy is a lead partner in Rural Health and Safety of Eastern Iowa initiative which works to reduce preventable injuries in the agricultural community such as heavy equipment, large animal, pesticides and more. This partnership also seeks to increase health screenings and referrals to primary and specialty care for this population and provide education to improve overall health. Some of this is accomplished through youth safety camps, FFA (Future Farmers of America) and 4-H programs, county fairs, community events and in cooperation with churches. (Also see Community Support above).Mercy is a lead partner of Safety Village, a two-week summer safety camp for children aged 5-7 held in a miniature village on the grounds of one of our local elementary schools. Each summer, 200+ children participate in safety education with local EMS, police, sheriffs, and others. Due to Covid-19 this has been put on hold, but plans are in place for the program to resume FY 22' in which Mercy will be a proud continuing supporter. Part III, Line 4: Mercy Hospital's Audited Financial Statements includes a footnote for the Provision of Uncollectible Accounts on page 11 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 6/30/21. 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 06/30/21. Part III, Line 9b: Mercy Hospital 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: Evaluation for Medicaid, disability, and other types of coverage is provided for uninsured patients for inpatient stays as well as high dollar outpatient services. Part VI, Line 4: Mercy Hospital 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 2019 was approximately 152,850. Mercy Hospital 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 31,200 for the 2020-2021 academic year. Johnson County is well-educated, of individuals 25 and older, 95.3 percent are high school graduates and 53 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, 16.0 percent of the Johnson County population lived below the poverty line between 2018 and 2019, compared to 11.2 percent for the entire state. Part VI, Line 5: Mercy Iowa City 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 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 X X X X X 0 0 0 0 0 0 0 1 0 Yonas Getachew Physician 626452 0 30000 0 13171 0 16125 0 37057 0 722805 0 0 0 Benjamin Green Physician 622170 0 2500 0 8555 0 16625 0 36550 0 686400 0 0 0 Andrew Ashby Physician 585463 0 0 0 18992 0 16625 0 37534 0 658614 0 0 0 Joseph Truszowski Physician 540208 0 1000 0 1290 0 19250 0 40411 0 602159 0 0 0 James Nielsen Physician 507478 0 49901 0 10377 0 9000 0 19972 0 596728 0 0 0 Luke Brunkhorst Physician 526884 0 0 0 470 0 14675 0 35412 0 577441 0 0 0 Martin Izakovic Former VP/Physician 254529 0 44170 0 24374 0 19550 0 39963 0 382586 0 0 0 Dawna Miller Treasurer 184065 0 38850 0 0 0 6677 0 19497 0 249089 0 0 0 Kimberley Rossiter Assistant Treasurer 149776 0 20000 0 385 0 11295 0 31843 0 213299 0 0 0 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 2035000 40501771 4050177 2131594 34320000 2018 1 0 1 1 B 15945000 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 1 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 B: Rebate calculation was performed 5/21/14. 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 Bretchen, Board Member are members of the Sister of Mercy of the Americas West Midwest Community, Inc. Dawna Miller and Kimberley Rossiter have a business relationship as all three simultaneously serve together on the Mercy Services Iowa City, Iowa board. 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 prepared and reviewed by Mercy Hospital management and is also reviewed by Deloitte Tax LLP. In addition, a board resolution was established that provides that each board member be (i) provided a copy of the Form 990 as it is intended to be filed, and (ii) given a reasonable opportunity before filing to provide to the Audit Committee any comments, corrections, concerns or other inputs on the proposed Form. The Audit Committee's review process shall be intended to reasonably verify that the Form 990 has been fully and accurately completed, including but not limited to, all inquiries therein relating to corporate governance. After completing its review, the Audit Committee, on the Board's behalf, shall have the authority to authorize the filing of the annual Form 990. 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 10,887,559. Management and general expenses 10,127,400. Fundraising expenses 0. Total expenses 21,014,959. Form 990, Part XI, line 9: Change in Unrecognized Pension Actuarial Gain 32,097,687. Change in Beneficial Interest in Foundation 4,009,149. Change in Beneficial Interest of Services -13,773,991. Transfer to Self Insured Trust -835,055. 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) 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 3747603 1962909 0 1 0.51000 Corridor Radiology LLC 2769 Heartland Drive Suite 307 Coralville IA 52241 430635070 Radiology Services IA Mercy Hospital Related 444655 343972 0 0 0.51000 Eastern Iowa Rehabilitation Hospital LLC 680 S 4th Street Louisville KY 40202 831589139 Inpatient Rehabilitation Care IA Mercy Hospital Related -2150007 2033900 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 -14283185 4036149 1.00000 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 Mercy Foundation C 1679077 Cost Mercy Services Iowa City Inc A 892095 Cost Mercy Services Iowa City Inc R 300000 Cost Mercy Hospital Iowa City Iowa Self Insurance Plan and Trust R 280000 Cost Mercy Services Iowa City Inc Q 306568 Cost