2025-05-15T18:27:27-05:00 2024-06-30 861065772 Deloitte Tax LLP 111 MONUMENT CIRCLE Suite 4200 INDIANAPOLIS IN 462045108 990 2023-07-01 420680391 Mercy Hospital Iowa City Iowa MERC 3193390300 500 East Market Street Iowa City IA 52245 Marc Ross Liquidating Trustee Advisor 5166779740 2025-05-15 1 0 Shawna M Jansons P01222873 3174648600 2023 2025-03-06 01:10:19Z Dan Childers c/o Shuttleworth Ingersoll PLC 235 6th Street SE Cedar Rapids IA 52401 138333590 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. X 7 4 1251 60 1791420 0 110521 0 163519230 82847239 -108897 -63344408 941221 197291 164462075 19700122 12000 30000 0 0 66665626 40618329 0 0 0 126497191 83954104 193174817 124602433 -28712742 -104902311 160030077 43990746 136653461 108425111 23376616 -64434365 X 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 1 67521105 30000 82839790 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. Effective January 31, 2024, Mercy Hospital ceased providing healthcare services to the community as a result of filing for bankruptcy and the organization's assets being acquired by the University of Iowa. 135074 0 7449 Education. The ongoing education of Mercy staff is critical in the fast changing field of health care and is necessary to meet regulations and certifications. Mercy hosts a number of professional continuing education classes each year, which are 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 to provide insight to possible careers and preparation for CNA exam.These educational activities were discontinued effective January 31, 2024, when Mercy Hospital ceased operations as a result of bankruptcy and the organization's assets being acquired by the University of Iowa. 6815167 0 0 Community Benefit. Mercy's largest community benefit is the unpaid cost of Medicaid ($6.8 million). This community benefit activity ceased effective January 31, 2024, when Mercy Hospital discontinued healthcare operations as a result of bankruptcy and the acquisition of its assets by the University of Iowa. 74471346 1 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 28 0 1 1251 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 4 1 1 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X Dan Childers 5166779740 c/o Shuttleworth Ingersoll PLC Cedar Rapids IA 524062107 Tom Clancy CEO & Adminnistrator 40.00 0.00 X X 315704 0 5317 Kim Volk VP - Nursing 40.00 0.00 X X 246879 0 34341 Jim Porter Treasurer 41.00 1.00 X X 0 0 0 Lynn Whisler Secretary 1.00 0.00 X X 0 0 0 Madeline Windauer Vice Chair 1.00 0.00 X X 0 0 0 Dr Chris Scott Board Member (End 1/24) 1.00 0.00 X 0 0 0 Mary Westbrook Board Member (End 1/24) 1.00 0.00 X 0 0 0 Peter Gardner Board Member (End 1/24) 1.00 0.00 X 0 0 0 SR Helen Marie Burns Board Member (End 1/24) 1.00 0.00 X 0 0 0 SR Linda Bechen Board Member 1.00 0.00 X 0 0 0 SR Rita Specht Board Member (End 1/24) 1.00 0.00 X 0 0 0 Steven Anderson Board Member 1.00 0.00 X 0 0 0 Mark Toney Chief Restructuring Officer 40.00 0.00 X 0 0 0 Michael Hoffman Physician 40.00 0.00 X 572630 0 45557 Ali Mohammed Physician 40.00 0.00 X 483494 0 23246 Luke Brunkhorst Physician 40.00 0.00 X 457373 0 36413 Spas Kotev Physician 40.00 0.00 X 474011 0 18961 Katherine Ignacio Physician 40.00 0.00 X 464006 0 28706 Dawna Miller Former Officer (End 7/22) 0.00 0.00 X 122216 0 0 Mike Trachta Former Officer (End 03/23) 0.00 0.00 X 0 0 0 Jeffrey Rooney Former Officer (End 04/23) 0.00 0.00 X 0 0 0 3136313 0 192541 128 1 1 0 Medefis Consolidated PO Box 5068 New York NY 100875068 Contract Nursing Labor 11763317 ToneyKorf Partners LLC 80 State Street Albany NY 122072543 Management Services 5553885 McDermott Will and Emery LLC 444 West Lake Street Chicago IL 606060029 Legal Services 4589778 Altera Digital Health Inc 2429 Military Rd Suite 300 Niagara Falls NY 14304 Electronic Health Record 2801998 Revology 201 E Washington St Unit 1302 Iowa City IA 52240 Revenue Cycle Oversight 1927270 50 Patient Serv. Revenue 621400 39544783 39544783 Medicare/Medicaid 621400 37587988 37587988 ASC/DIC Income 900099 2057760 2057760 Lab Outreach 621511 1791420 1791420 Wellmark Incentive 900099 1304232 1304232 561056 561056 82847239 -1840072 -1840072 452807 570690 -117883 -117883 -117883 10030963 46527479 9676429 108386349 354534 -61858870 -61504336 -61504336 Cafeteria Income 722310 315174 315174 315174 19700122 81055819 1791420 -63147117 X 30000 30000 770966 123440 647526 34144748 27715026 6429722 395630 366929 28701 2880980 2007755 873225 2426005 1690683 735322 6003885 2585141 3418744 763656 763656 87130 87130 30105509 12966241 17139268 47562 47562 7217482 4979362 2238120 7685034 70929 7614105 1830914 72200 1758714 64325 58513 5812 4870121 1348764 3521357 4224015 3085722 1138293 1489615 1489615 Medical Supplies 9873632 9868285 5347 Pharmacy Supplies 6878882 6878882 0 Medical Director Stipen 825955 254833 571122 Food Expense 560185 560185 0 1426202 -191544 1617746 124602433 74471346 50131087 0 9838383 30953791 68269 302038 27890458 3217069 2992970 0 3164673 580000 4900047 4872291 54579468 27756 11032514 1370092 -109415759 7500000 159879101 40000 160030077 43990746 37200486 39410632 69158372 43219829 1736338 28558265 25794650 136653461 108425111 X 23376616 -64434365 23376616 -64434365 160030077 43990746 X -104902311 17091330 X 0 0 0 X 18141995 0 0 0 18141995 16417674 16570 1759209 51458 18141995 20513591 37504 -2858763 1274658 16417674 16457386 47025 5088018 1078838 20513591 17144539 140115 -233781 593487 16457386 0 1 1 1483373 1455617 27756 3416674 3416674 0 27756 Equity Investment in Joint Ventures 7500000 C 7500000 Pension Benefit Liability 23295955 Professional Liability Claims 2498695 25794650 Part V, Line 4: All restricted endowment funds were used for the benefit of Mercy Hospital, Iowa City. During the fiscal year ended June 30, 2024, the entirety of these funds were expended to support hospital operations following the organization's filing for bankruptcy in August 2023. 1 1 X 1 X 1 X 1 0 0 11708185 4893018 6815167 0.05410 11708185 4893018 6815167 0.05410 11708185 4893018 6815167 0.05410 0 0 0 19251001 24212623 -4961622 X 1 1 1 Iowa City Ambulatory Surgery Center LLC Outpatient Surgery Center 0.00400 0.00600 2 Corridor Radiology LLC Outpatient Radiology Services 0.00510 0.00490 3 Eastern Iowa Rehabilitation Hospital LLC Rehabilitation Services 0.00510 0.00490 1 1 Mercy Hospital 500 East Market Street Iowa City IA 52245 www.mercyiowacity.org 520074H X X X X Lab Outreach Mercy Hospital Iowa City Iowa 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V, Section C X 1 21 1 See Part V, Section C 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 5: To solicit input from community stakeholders (key informants), those individuals who have a broad interest in the health of the community, an Online Key Informant Survey also was implemented as part of this process. A list of recommended participants was compiled by Mercy Iowa City; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Final participation included representatives of the organizations outlined below.- Coralville Fire Department- Iowa City- Iowa City Area Development- Iowa City Crisis Center- Iowa City Fire Department- Johnson County- Johnson County Public Health Representative- Kinze Manufacturing- Lone Tree School District- Mercy Hospital Emergency Physicians- Mercy Services- NAMI of Johnson County- Oaknoll Retirement Community- Rural Health and Safety of Eastern Iowa (RHSEI)- UI College of Public Health - United Way- University Police- Washington County Hospital and ClinicsThrough this process, input was gathered from several individuals whose organizations work with low income, minority, or other medically underserved populations. Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 7a:As a result of the bankruptcy and cessation of operations effective January 31, 2024, Mercy Hospital, Iowa City, Iowa's website and all related documents, including the most recent Community Health Needs Assessment (CHNA), are no longer publicly available online. The CHNA was previously accessible at: https://www.mercyiowacity.org/upload/docs/About Mercy/2021 PRC CHNA Report - Mercy Iowa City.pdfCopies of the CHNA may be available upon request from the organization's records, subject to availability. Mercy Hospital, Iowa City, Iowa Part V, Seciton B, Line 10a:As a result of the bankruptcy and cessation of operations effective January 31, 2024, Mercy Hospital, Iowa City, Iowa's website and all related documents, including the most recent Implementation Strategy, are no longer publicly available online. The Implementation Strategy was previously accessible at:https://www.mercyiowacity.org/upload/docs/About Mercy/2021 CHNA Implementation Plan.pdfCopies of the Implementation Strategy may be available upon request from the organization's records, subject to availability. Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 11:No actions were taken during the fiscal year ended June 30, 2024, to address the needs identified in the most recent Community Health Needs Assessment (CHNA). This is due to Mercy Hospital, Iowa City, Iowa's bankruptcy filing in August 2023 and the cessation of hospital operations effective January 31, 2024. In prior years, the hospital undertook various initiatives to address identified community health needs. However, no new actions were implemented in the current fiscal year as a result of the bankruptcy and closure. Mercy Hospital, Iowa City, Iowa Part V, Section B, Line 16:As a result of the bankruptcy and cessation of operations effective January 31, 2024, Mercy Hospital, Iowa City, Iowa's website and all related documents, including the Financial Assistance Policy, Financial Assistance Application Form, and Plain Language Summary, are no longer publicly available online. These documents were previously accessible at the following URLs:Financial Assistance Policy:https://www.mercyiowacity.org/upload/docs/Patients and Visitors/Financial Assistance Docs/MercyIC Financial Assistance Policy_2021.pdfFinancial Assistance Application Form:https://www.mercyiowacity.org/upload/docs/Patients and Visitors/Financial Assistance Docs/Financial Assistance App_2021.pdfPlain Language Summary:https://www.mercyiowacity.org/upload/docs/Patients and Visitors/Financial Assistance Docs/MercyIC Plain Language Summary_2021.pdfCopies of these documents may be available upon request from the organization's records, subject to availability. 1 1 - Mercy Home Health Care 500 East Market Street Iowa City IA 52245 Home Health and Private Duty Nursing Part I, Line 3c: Mercy Hospital, Iowa City, Iowa also used asset level, medical indigency, insurance status, and underinsurance status as factors in determining eligibility for free and discounted care. Part III, Line 2: For the fiscal year ended January 31, 2024, the organization recorded a negative bad debt expense of $(1,430,512). This negative amount resulted from the reversal of previously established bad debt reserves upon cessation of operations on January 31, 2024. As a result, no bad debt expense is reported on Line 2 for the current year.Historically, the organization estimated bad debt expense by analyzing patient accounts receivable balances, applying historical collection rates, and considering current economic and operational factors. However, due to the cessation of operations and the resulting reserve true-up, no new bad debt expense was recognized for the fiscal year. Part III, Line 3: While in operation, Mercy Hospital, Iowa City, Iowa worked with those qualifying for charity care along every step of the process. Every effort was made to work with the patient to provide financial assistance when appropriate. While there were people who did not cooperate with Mercy Hospital, Iowa City, Iowa regarding payment plans, financial assistance or with those trying to get help from Government programs. For individuals that did not provide necessary information, it is impossible to know the reason for not cooperating and therefore know whether they will qualify for charity care. Mercy Hospital, Iowa City, Iowa was unable to reasonably determine whether any amount of bad debt could have been classified as charity care if the individuals did not provide the necessary information to evaluate their situation to determine qualifications with the charity care policy. Part III, Line 4: Mercy Hospital, Iowa City, Iowa did not undergo an audit for the fiscal year ended June 30, 2024, as the entity filed for voluntary bankruptcy in August 2023. As part of the bankruptcy proceedings, the organization's assets were acquired by the University of Iowa, with the transaction finalized on June 24, 2024. Effective January 31, 2024, medical services previously provided by Mercy Hospital, Iowa City, Iowa are now provided by the University of Iowa and its affiliates, and Mercy Hospital, Iowa City, Iowa no longer exists as a hospital providing health care services.As a result, the footnote describing bad debt expense is based on the most recent audited financial statements, which were issued for the fiscal year ended June 30, 2022. Mercy Hospital, Iowa City, Iowa's audited financial statements include a footnote for the provision of uncollectible accounts on page 12 of the audited financial statements. Part III, Line 8: Total revenue was determined using charges reported in the CMS Provider Statistical Reimbursement System reports for fee-reimbursed services for the fiscal year ended June 30, 2024. Costs were calculated using the cost-to-charge ratio for the appropriate services, as reported in the submitted Medicare Cost Report (Form 2552-96) for the fiscal year ended June 30, 2024. These amounts reflect services provided through January 30, 2024, the date on which the organization ceased providing patient care. Part III, Line 9b: Mercy Hospital, Iowa City, Iowa had two policies related to debt collection. The Financial Assistance Policy provided guidelines for forgiving all or part of a patient's financial responsibility for healthcare services received at Mercy Hospitals. A Patient may have been provided with a financial assistance application at the time of service, been offered financial assistance during the normal collection process or learned of the option on the Hospital website. All patients with no insurance were offered financial assistance via billing statements & follow-up telephone calls. Any patient that was known to qualify for financial assistance was provided assistance. The payment plan policy enabled those who qualified for patient financial assistance to establish payment plans of the remaining balance of their bill. Part VI, Line 2: The most recent community health needs assessment was conducted in December 2021. The organization engaged Professional Research Consultants to conduct the assessment. The community health survey is a systematic, data-driven approach to determining the health status, behaviors, and needs of residents in the communities the organization serves. The survey instrument used for the assessment is based largely on the Centers for Disease Control (CDC), Behavioral Risk Factor Surveillance System (BRFS), as well as various other public health surveys and customized questions addressing gaps in indicator data, relative to nation health promotion and disease prevention objectives and other recognized health issues. Part VI, Line 3: If a patient was deemed to not have insurance coverage (self-pay) or was under-insured, a referral was made to Mercy's third-party vendor to screen the patient for Medicaid eligibility. They can also assist with marketplace products and social security applications. If they are not eligible for Medicaid/Emergency Medicaid, our third-party eligibility vendor notifies the patient of the financial counselors and places a referral to the financial counselor to assist the patient. In order to be eligible for financial assistance the patients must complete the Medicaid, Medicare, and/or insurance exchange review process. The level of assistance is based on where the patient falls on the federal poverty level. The financial counselors provide/assist the patient with completion of the financial aid application and noting the account according to the outcome. Part VI, Line 4: Mercy Hospital, Iowa City, Iowa is located in the community of Iowa City, Iowa, in Johnson County along the east central part of the state. The county's population in 2022 was approximately 156,420. Mercy Hospital, Iowa City, Iowa served 10 counties in southeast Iowa, with the primary service area being Johnson County. The secondary service areas include: Cedar, Iowa, Muscatine and Washington counties. The tertiary service area includes Henry, Jefferson, Keokuk, Lee and Louisa counties. The population of the service area is approximately 340,200. Iowa City is home to the University of Iowa, which has an enrollment of approximately 31,317 for the 2022-2023 academic year. Johnson County is well-educated, of individuals 25 and older, 95.3 percent are high school graduates and 54 percent hold a bachelors degree or higher. The University of Iowa also provides the foundation for an economy that has particular strengths in education, health care, services, technology, agribusiness and manufacturing. According to the U.S. Census Bureau, 14.7 percent of the Johnson County population lived below the poverty line between 2017 and 2021, compared to 11.1 percent for the entire state. Part VI, Line 5: Mercy Hospital, Iowa City, Iowa is a faith-based institution that provides services based on the ethical and religious directives of the Catholic Church. An important part of Mercy's mission is to improve the health of the community. Mercy Hospital, Iowa City, Iowa does so by: Ensuring that the medical staff is open to all qualified physicians; ensuring that the hospital is accredited and in good standing with the Joint Commission; ensuring that the board of directors is comprised of diverse, independent individuals, not employees of the hospital, representing the community and also providing necessary expertise; establishing and carrying out a conflict of interest policy; providing a site for clinical experience for a variety of health care professionals; providing charity care and financial assistance with medical bills as needed to community members; participating in such programs as Medicare, Medicaid, and Hawk-i, an insurance program for needy Iowa children; absorbing unreimbursed costs for such government programs; ensuring that account collections are carried out in compliance with state and federal guidelines; providing emergency room services and working with local and state officials in community preparedness issues; treating emergency patients according to EMTALA guidelines and service all patients regardless of their ability to pay; investing surplus funds in services, technology, and personnel that will further the benefit of the community. Part VI, Line 7, Reports Filed With States IA 1 Mercy Hospital Iowa City Iowa Self Insurance Plan and Trust 500 East Market Street Iowa City IA 52245 426591803 501(c)(3) 30000 0 General Support 1 0 Part I, Line 2: The organization maintains records to substantiate the amount of grants or assistance provided, For the fiscal year ended June 30, 2024, the only grant awarded was to a related 501(c)(3) entity. X X X X X 1 0 0 0 0 0 0 1 0 Michael Hoffman Physician 521350 0 38511 0 12769 0 10193 0 35364 0 618187 0 0 0 Ali Mohammed Physician 466730 0 16626 0 138 0 6600 0 16646 0 506740 0 0 0 Luke Brunkhorst Physician 455929 0 1000 0 444 0 5625 0 30788 0 493786 0 0 0 Spas Kotev Physician 444641 0 16625 0 12745 0 1535 0 17426 0 492972 0 0 0 Katherine Ignacio Physician 429760 0 29700 0 4546 0 10396 0 18310 0 492712 0 0 0 Tom Clancy CEO & Adminnistrator 315704 0 0 0 0 0 5317 0 0 0 321021 0 0 0 Kim Volk VP - Nursing 246608 0 0 0 271 0 10494 0 23847 0 281220 0 0 0 Dawna Miller Former Officer (End 7/22) 0 0 0 0 122216 0 0 0 0 0 122216 0 0 0 Part I, Line 4a Dawna Miller, former Chief Financial Officer received severance payments amounting to $122,216 in calendar year 2023 as part of her employment contract. Part I, Line 7 Non-fixed payments were provided to administrators and physicians who met stated criteria that included meeting certain RVU (Relative Value Unit), productivity levels, specified CMS/JACHO performance core indicators and certain patient satisfaction and/or nursing satisfaction survey scores. A City of Hills Iowa 420920947 000000000 2018-05-10 40501771 Refund Bonds issued 04/29/08 0 0 0 B City of Hills Iowa 420920947 431669AW0 2011-11-30 44742571 Build and Equip Facility; Refund Bonds issued 7/16/1998 0 0 0 A 20679237 40501771 2131594 34320000 2018 1 0 1 1 B 22695000 44743882 589874 20002570 24151438 2012 1 0 1 1 A 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 1 0 0 0 1 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: City of Hills Iowa Date the Rebate Computation was Performed: 11/30/2021 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 6, Column B: Such amounts were appropriately yield restricted. Schedule K, Part IV, Line 2c, Column A: The organization is in bankruptcy; no rebate calculation has been performed. Class IV Inventory and Class V Assets 2024-01-31 46527479 Outstanding Offers 426004813 University of Iowa 500 E Market Street Iowa city IA 52245 Gov't Entity 0 1 0 0 Part II, Line 2e: Explanation of Involvement: Kim Volk was the Chief Nursing Officer of Mercy Hospital and became an employee of the University of Iowa. Form 990, Part III, line 3 Mercy Hospital, Iowa City, Iowa filed for voluntary bankruptcy in August 2023. As part of the bankruptcy proceedings, the organization's assets were acquired by the University of Iowa, with the transaction finalized on June 24, 2024. As a result, effective January 31, 2024, Mercy Hospital ceased providing healthcare services to the community. The organization remains in existence solely to manage the winding down of operations, including the collection of receivables and settlement of outstanding obligations. No program services or healthcare operations have been conducted by the organization since January 31, 2024. Form 990, Part VI, Section A, line 2 Sister Helen Marie Burns, board member; Sister Rita Specht, board member; and Sister Linda Bechen, Board Member are members of the Sisters of Mercy of the Americas West Midwest Community, Inc. Form 990, Part VI, Section A, line 3 MercyOne, Martinville Dunn, and ToneyKorf Partners provided certain management oversight and personnel services pursuant to a strategic management agreement. Mike Trachta, Former Officer (ending 03/23) of Mercy Hospital, Iowa City, Iowa, is not an employee of the hospital, but rather an employee of MercyOne, a management company. For his role as a Former Officer of Mercy Hospital Iowa City, Mike Trachta was compensated $135,980 by MercyOne. Jeffrey Rooney, Former Officer (ending 04/23) of Mercy Hospital, Iowa City, Iowa is not an employee of the hospital but rather an employee of Martinville Dunn, a management company. For his role as a Former Officer of Mercy Hospital Iowa City, Jeffrey Rooney was compensated $201,871 by Martinville Dunn. Jim Porter, Treasurer of Mercy Hospital, Iowa City, Iowa, is not an employee of the hospital, but rather an employee of ToneyKorf Partners, a management company. For his role as treasurer of Mercy Hospital Iowa City, Jim Porter was compensated by ToneyKorf Partners. Mark Toney, Chief Restructuring Officer of Mercy Hospital, Iowa City, Iowa, is not an employee of the hospital, but rather an employee of ToneyKorf Partners, a management company. For his role as Chief Restructuring Officer of Mercy Hospital Iowa City, Mark Toney was compensated by ToneyKorf Partners. 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 was reviewed by Mercy Hospital, Iowa City, Iowa's former controller and an outside independent accounting and tax firm prior to submission to the IRS. The Form 990 was not reviewed by the organization's board of directors before submission, as the organization is no longer operating and has emerged from bankruptcy. 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 is determined based on national or regional market data for comparable positions at comparatively sized hospitals. The current President/CEO is provided under a management agreement with ToneyKorf Partners. 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 12,966,241. Management and general expenses 17,139,268. Fundraising expenses 0. Total expenses 30,105,509. Form 990, Part XI, line 9: Transfer of net liabilities from Mercy Hospital SIT -1,072,757. Transfer of net assets from Mercy Hospital Foundation 18,164,087. Sisters of Mercy of the Americas West Midwest Community Inc 7262 Mercy Road Omaha NE 68124 262400800 Religious Order NE 501(c)(3) Religious Order N/A 0 Mercy Foundation 500 East Market Street Iowa City IA 52245 237040506 Foundation/Fundraising IA 501(c)(3) 12A, I Mercy Hospital 1 Mercy Hospital Guild 500 East Market Street Iowa City IA 52245 426099912 Fundraising IA 501(c)(3) 12C, III-FI N/A 0 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 Iowa City Ambulatory Surgical Center LLC 2963 Northgate Drive Iowa City IA 52245 208503424 Outpatient Surgery IA Mercy Hospital Related 2430986 1470374 0 1 0.40000 Corridor Radiology LLC 2769 Heartland Drive Suite 307 Coralville IA 52241 460635070 Radiology Services IA Mercy Hospital Related 207808 -27604 0 0 0.51000 Eastern Iowa Rehabilitation Hospital LLC 680 S 4th Street Louisville KY 40202 831589139 Inpatient Rehabilitation Care IA Mercy Hospital Related -2853800 0 0 0.51000 Mercy Services Iowa City Inc 500 East Market Street Iowa City IA 52245 421241044 Health Care IA N/A C 19710652 2148292 1.00000 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 Mercy Services Iowa City Inc A 412427 Cost Mercy Services Iowa City Inc R 300000 Cost Mercy Services Iowa City Inc O 4298623 Cost Mercy Services Iowa City Inc Q 2948299 Cost Mercy Hospital Foundation R 18164087 Book Value Mercy Hospital Iowa City Self Insurance Plan and Trust R -1072757 Book Value