STRATEGY STUDIO / PUBLIC DATA EXPLORER

SARTORI MEMORIAL HOSPITAL INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
SARTORI MEMORIAL HOSPITAL INC (EIN 42-0758901)
Tax period
2020-07-01 to 2021-06-30
Filed
2022-05-15
IRS object ID
202201359349302285
Schema version
2020v4.1
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

FieldValueIRS element (for citing)
Return2022-05-15T22:25:05-05:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN420758901EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sartori Memorial Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% TIMOTHY HUBERInCareOfNm
Business Name ControlSARTBusinessNameControlTxt
Phone3192683000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 College StreetAddressLine1Txt
CityCedar FallsCityNm
State AbbreviationIAStateAbbreviationCd
ZIP50613ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTimothy HuberPersonNm
Person TitleVP OF FINANCEPersonTitleTxt
Phone3192727607PhoneNum
Signature2022-05-15SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTimothyPersonFirstNm
Person LastHuberPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1MercyOne Cedar Falls Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerJack DusenberyPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 West Ninth StreetAddressLine1Txt
CityWaterlooCityNm
State AbbreviationIAStateAbbreviationCd
ZIP507025499ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$41,985,302GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.mercyone.org/northeastiowaWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1954FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionGeneral inpatient and outpatient acute health care services.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee263TotalEmployeeCnt
Total Volunteers265TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$1,172,331PYContributionsGrantsAmt
CY Contributions Grants$4,090,550CYContributionsGrantsAmt
PY Program Service Revenue$30,742,910PYProgramServiceRevenueAmt
CY Program Service Revenue$37,605,552CYProgramServiceRevenueAmt
PY Investment Income-$962,708PYInvestmentIncomeAmt
CY Investment Income$11,744CYInvestmentIncomeAmt
PY Other Revenue$176,329PYOtherRevenueAmt
CY Other Revenue$177,053CYOtherRevenueAmt
PY Total Revenue$31,128,862PYTotalRevenueAmt
CY Total Revenue$41,884,899CYTotalRevenueAmt
PY Grants And Similar Paid$14,212PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$33,750CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,379,343PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,071,279CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$18,225,611PYOtherExpensesAmt
CY Other Expenses$20,062,925CYOtherExpensesAmt
PY Total Expenses$30,619,166PYTotalExpensesAmt
CY Total Expenses$33,167,954CYTotalExpensesAmt
PY Revenues Less Expenses$509,696PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$8,716,945CYRevenuesLessExpensesAmt
Total Assets BOY$14,393,746TotalAssetsBOYAmt
Total Assets EOY$14,938,531TotalAssetsEOYAmt
Total Liabilities BOY$6,663,442TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,940,435TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,730,304NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,998,096NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionAS A MEMBER OF MERCYONE NORTHEAST IOWA, 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$32,582,618ExpenseAmt
Grant$33,750GrantAmt
Revenue$37,605,552RevenueAmt
DescMercyOne 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 / 2021 Charity Care: $2,2944,449. 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: $14,988,562. 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: $2,020,581. 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: $125,711. 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: $804,014. 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: $541. 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: $6,196. 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: $3,664,874. 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 2021: $24,554,928.Desc
Total Program Service Expenses$32,582,618TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee263EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
DAF Excess Business HoldingsfalseDAFExcessBusinessHoldingsInd
Taxable DistributionsfalseTaxableDistributionsInd
Distribution To DonorfalseDistributionToDonorInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonTIMOTHY HUBERPersonNm
Phone3192727607PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 WEST NINTH STREETAddressLine1Txt
CityWATERLOOCityNm
State AbbreviationIAStateAbbreviationCd
ZIP507025499ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Jack Dusenbery
Director; President1.040.0Yes (X)Yes (X)$0$556,854$42,354
Matthew Sojka
VP Medical Affairs1.040.0$0$385,976$39,280Yes (X)
Timothy Huber
Asst. Treas.; VP of Finance1.040.0Yes (X)$0$241,104$53,325
Kelly Richards
CNO1.040.0$0$213,994$42,757Yes (X)
Mary Jo Kavalier
VP Operations40.01.0$170,986$0$35,857Yes (X)
Ryan Meyer
Admin Directr; Former Key Empl1.040.0$0$156,193$32,465Yes (X)
Nermina Schultz
House Supervisor40.00.0$102,876$0$28,368Yes (X)
Alex Hansen
Pharmacist40.00.0$107,773$0$15,965Yes (X)
Nancy Schaefer
Assistant Secretary1.040.0Yes (X)$0$63,118$5,193
James Hartel MD
Secretary - Director1.01.0Yes (X)Yes (X)$0$0$0
Sue Roberts
Director thru 12/201.01.0Yes (X)$0$0$0
Anne Hennessey DDS
Vice Chair1.01.0Yes (X)Yes (X)$0$0$0
Tim Boettger
Chair - Director1.01.0Yes (X)Yes (X)$0$0$0
Sandy Benak
Director as of 01/211.01.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$381,635TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,617,239TotReportableCompRltdOrgAmt
Total Other Compensation$295,564TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Xygent Inc
9961 Valley View RoadEDEN PRAIRIEMN55344Surgical Services$403,148
Wapiti Medical Staffing
PO BOX 1450MINNEAPOLISMN55485Physician Services$1,614,323
Health Carousel LLC
PO BOX 714216CINCINNATIOH45271Physician Services$226,305
Black Hawk County Treasurer
316 E 5th StWATERLOOIA50703Hospital Services$107,794
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Fundraising$25,881FundraisingAmt
Related Organizations$900,227RelatedOrganizationsAmt
Government Grants$3,153,285GovernmentGrantsAmt
All Other Contributions$11,157AllOtherContributionsAmt
Total Contributions$4,090,550TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICARE/MEDICAID PAYMENTS622110$23,256,679$23,256,679
RENT REVENUE531120$516,550$516,550
NET PROGRAM SERVICE REVENUE622110$13,832,323$13,832,323
FieldValueIRS element (for citing)
Total Program Service Revenue$37,605,552TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,744TotalRevenueColumnAmt
Exclusion$11,744ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$163,838RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$90,180RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$73,658RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$73,658TotalRevenueColumnAmt
Exclusion$73,658ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$27,622FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$25,881ContriRptFundraisingEventAmt
Fundraising Direct Expenses$10,223FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,399TotalRevenueColumnAmt
Exclusion$17,399ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA722514$74,986$74,986
MISCELLANEOUS622110$11,010$11,010
FieldValueIRS element (for citing)
Other Revenue Total$85,996OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,884,899TotalRevenueColumnAmt
Related Or Exempt Func Income$37,605,552RelatedOrExemptFuncIncomeAmt
Exclusion$188,797ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$33,750TotalAmt
Program Services$33,750ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$206,843TotalAmt
Management And General$206,843ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$38,555TotalAmt
Program Services$38,555ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,806,507TotalAmt
Program Services$9,578,631ProgramServicesAmt
Management And General$227,876ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$461,296TotalAmt
Program Services$451,040ProgramServicesAmt
Management And General$10,256ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,833,954TotalAmt
Program Services$1,792,509ProgramServicesAmt
Management And General$41,445ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$724,124TotalAmt
Program Services$707,904ProgramServicesAmt
Management And General$16,220ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$3,045TotalAmt
Program Services$3,045ProgramServicesAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,652,981TotalAmt
Program Services$1,652,981ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$8,093TotalAmt
Program Services$8,093ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,189,556TotalAmt
Program Services$1,171,852ProgramServicesAmt
Management And General$17,704ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,061,897TotalAmt
Program Services$1,061,897ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,147TotalAmt
Program Services$4,940ProgramServicesAmt
Management And General$207ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,395TotalAmt
Program Services$4,395ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$21,130TotalAmt
Management And General$21,130ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$925,348TotalAmt
Program Services$925,323ProgramServicesAmt
Management And General$25ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PURCHASED SERVICES$1,782,906$1,778,668$4,238
MEDICAL SUPPLIES$6,261,726$6,261,693$33
BAD DEBT EXPENSE$1,021,844$1,021,844
PARENT COMPANY ALLOCATION$5,780,681$5,780,681

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$344,176TotalAmt
Program Services$304,817ProgramServicesAmt
Management And General$39,359ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$33,167,954TotalAmt
Program Services$32,582,618ProgramServicesAmt
Management And General$585,336ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,738,291BOYAmt
EOY$3,418,933EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$341,502BOYAmt
EOY$331,009EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$16,533,859LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$5,524,557LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$11,242,284BOYAmt
EOY$11,009,302EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$71,669BOYAmt
EOY$179,287EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,393,746BOYAmt
EOY$14,938,531EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,242,680BOYAmt
EOY$2,409,425EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,420,762BOYAmt
EOY$3,531,010EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,663,442BOYAmt
EOY$5,940,435EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,730,304BOYAmt
EOY$8,998,096EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,730,304BOYAmt
EOY$8,998,096EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,393,746BOYAmt
EOY$14,938,531EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$8,716,945ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$7,449,153OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$3,045GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$3,045TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C DisclosuresFormAndLineReferenceDesc
ExplanationSchedule C Part II-B Line 1f: Sartori Memorial Hospital, 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 Sartori Memorial Hospital, Inc. with an estimated percentage of dues payments which are used for lobbying activities.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,300,000OtherCostOrOtherBasisAmt
Book Value$4,300,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,881,595OtherCostOrOtherBasisAmt
Depreciation$663,920DepreciationAmt
Book Value$2,217,675BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,352,264OtherCostOrOtherBasisAmt
Depreciation$4,860,637DepreciationAmt
Book Value$4,491,627BookValueAmt
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$11,009,302TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescOTHER LIABILITIESDesc
Amt$3,531,010Amt
FieldValueIRS element (for citing)
Total Liability$3,531,010TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceIRS Form 990 Schedule D, Part XFormAndLineReferenceDesc
ExplanationThe 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, 2021, the Company did not have a liability for unrecognized tax benefits.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1fstvl of treesEvent1Nm
Gross Receipts Event1$44,218GrossReceiptsEvent1Amt
Charitable Contri Event1$16,596CharitableContriEvent1Amt
Gross Revenue Event1$27,622GrossRevenueEvent1Amt
Rent Facility Costs Event1$578RentFacilityCostsEvent1Amt
Other Direct Expenses Event1$9,645OtherDirectExpensesEvent1Amt
Event2may breakfastEvent2Nm
Gross Receipts Event2$9,285GrossReceiptsEvent2Amt
Charitable Contri Event2$9,285CharitableContriEvent2Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$53,503GrossReceiptsTotalAmt
Charitable Contributions Tot$25,881CharitableContributionsTotAmt
Gross Revenue Total Events$27,622GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$578RentFcltyCostsTotalEventsAmt
Oth Direct Expnss Total Events$9,645OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$10,223DirectExpenseSummaryEventsAmt
Net Income Summary$17,399NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$162,078TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$162,078NetCommunityBenefitExpnsAmt
Total Expense0.00500TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,941,770TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,962,393DirectOffsettingRevenueAmt
Net Community Benefit Expns$979,377NetCommunityBenefitExpnsAmt
Total Expense0.03050TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,103,848TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,962,393DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,141,455NetCommunityBenefitExpnsAmt
Total Expense0.03550TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$263,580TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$263,580NetCommunityBenefitExpnsAmt
Total Expense0.00820TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$37,325TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$37,325NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$117,543TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$117,543NetCommunityBenefitExpnsAmt
Total Expense0.00370TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,618TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,618NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$430,066TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$430,066NetCommunityBenefitExpnsAmt
Total Expense0.01350TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,533,914TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,962,393DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,571,521NetCommunityBenefitExpnsAmt
Total Expense0.04900TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,021,844BadDebtExpenseAmt
Reimbursed By Medicare$6,746,006ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,158,363CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$2,412,357MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sartori Memorial Hospital IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 College StreetAddressLine1Txt
CityCedar FallsCityNm
State AbbreviationIAStateAbbreviationCd
ZIP50613ZIPCd
FieldValueIRS element (for citing)
Website Addresshttp://www.mercyone.orgWebsiteAddressTxt
State License070059H (IA)StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Sartori Memorial Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
OtherYes (X)OtherInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLmercyone.org - full url in narrativeOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt18ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLmercyone.org - full url in narrativeStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLmercyone.org - full url in narratFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLmercyone.org - full url in narrativeFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLmercyone.org - full url in nFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule H Supplemental InformationFormAndLineReferenceDesc
ExplanationSchedule H Part V Section B Line 3e: Sartori Hospital 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 2020 through a community-involved selection process: Social and Health Equity Health Behaviors Social and Economic Factors Clinical Care 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 www.mercyone.com under the About Us page or at this link: https://www.mercyone.org/northeastiowa/about-us/community-benefit/communit y-health-needs-assessment. 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). All reports and plans were board approved and posted online June 30, 2019. This 2019 assessment covered the FY20-FY22 time frame, however because hospital and health department assessment deadlines did not align, an Amendment was completed July 1, 2020. This amendment included new data/information obtained through the Black Hawk County Health Departments for their Community Health Improvement Plan (CHIP) and included a Community Health Status Assessment; Forces of Change Assessment; Community Themes and Strengths Assessment; and a Local Public Health System Assessment - all leading to a CHIP Executive Summary and approved by the Black Hawk County Board of Health on April 29, 2020. Schedule H Part V Section B Line 5: The report - compiled in calendar year 2019 covered a three-year period (FY20-FY22) by MercyOne, representing both Waterloo Medical Center and Cedar Falls Medical Center, in partnership with Unity Point Health (representing Allen Hospital), the Black Hawk County Health Department and other community organizations - outlined findings throughout Black Hawk County and surrounding counties by all three hospitals and their network of clinics. At the time of the research project, representatives from the listed entities above included Amy Hetherton, Director of Marketing and Communications for MercyOne; Jim Waterbury, VP of Institutional Advancement for Unity Point Health - Allen; and Nafissa Cisse Egbuonye, PhD, MPH, Director of Public Health for the Black Hawk County Health Department, including other groups such as Peoples Clinic, Cedar Valley United Way, the University of Northern Iowa, Black Hawk County Gaming Commission and Success Link. The survey was developed collaboratively and was made available to the public online and in paper form. Publicity, websites, and emails invited the public to take the survey any time before March 30, 2019. Paper surveys were available at the hospitals and clinics, and other non-profit agencies, seeking client, business and non-profit leader input (list below). Information and promotion on how to access the link for the online survey was available to both internal and external audiences. The partners received more than 1,500 electronic and paper surveys with additional ongoing efforts through December 2019 to capture input from minority and immigrant groups to ensure a cross-section of residents provided input (see details within the Amendment). MercyOne updated its Community Health Needs Assessment website page to include a link to additional assessment data collected by the Black Hawk County Health Department in preparation of their Community Health Improvement Plan (CHIP) due to a later timeline. MercyOne has continued to collaborate with partners every year for ongoing data collection from various groups for use in the FY23-25 assessment period for use in its next CHNA (to be posted June 30, 2022). 2019 Online CHNA Survey to Area Agencies/Organizations University of Northern Iowa Unity Point Family Children Council Big Brothers Big Sisters Amerigroup Aspire Operation Threshold Quakerdale Bertch Cabinets Exceptional Persons Success Link United Healthcare Riverview Center Four Oaks Amani Community Services Pathways Peoples Community Health Clinic MercyOne YWCA YMCA Iowa State Extension Office Girl Scouts Jesse Cosby Center Waterloo/Cedar Falls Schools Mid-Iowa Therapy Clinic Salvation Army Black Hawk County Supervisors Volunteer Center of the Cedar Valley Four Oaks Iowa Courts House of Hope Lutheran Services in Iowa Department of Human Services Qwest Ethnic and Minorities of Burma Advocacy and Resource Center (EMBARC) Mayors - City of Evansdale, Waterloo and Cedar Falls Chamber of Commerce - Waterloo/Cedar Falls, Oelwein, etc. Iowa Workforce Development Iowa Legal Aid Waterloo Community Foundation Families First Counseling Center Cedar Valley United Way Sisters of St. Francis Cedar Valley Hospice Dubuque Archdiocese Black Hawk County Health Department Black Hawk County Sheriff's Office Waterloo Visitors Bureau Way Point Services Northeast Iowa Food Bank Salvation Army Life Connections Domestic/Sexual Assault Outreach Center Commission on Human Rights Veridian Credit Union Grout Museum Tri-County Child and Family Hawkeye Community College Community Foundation Eastside Ministerial Alliance Area Education Agency 7 Upper Iowa University Sing Me to Heaven The Job Foundation Veteran Affairs Silos and Smokestacks Otto Schoitz Foundation McElroy Trust Schedule H Part V Section B Line 6a: The CHNA was conducted in partnership with MercyOne Waterloo Medical Center, MercyOne Cedar Falls Medical Center, UnityPoint-Allen Hospital, People's Community Health Clinic, Black Hawk County Health Department, Cedar Valley United Way, Black Hawk County Gaming Commission, University of Northern Iowa, and Success Link. Schedule H Part V Section B Line 6b: The CHNA was conducted in partnership with MercyOne Waterloo Medical Center, MercyOne Cedar Falls Medical Center, UnityPoint-Allen Hospital, People's Community Health Clinic, Black Hawk County Health Department, Cedar Valley United Way, Black Hawk County Gaming Commission, University of Northern Iowa, and Success Link. Schedule H Part V Section B Line 7a, 10a: https://www.mercyone.org/northeastiowa/about-us/community-benefit/communit y-health-needs-assessment Schedule H Part V Section B Line 11: Using the CHNA completed in June 2019, the hospital developed, adopted, and worked on executing the final year of a three-year Implementation Strategy to address priority community health needs. The following summarizes how the hospitals addressed priority health needs in the community in FY 20-22 (July 1, 2019 - June 30, 2022): MercyOne was focused on impacting health issues identified within the community health needs assessment in alignment with the health department's Community Health Improvement Plan (CHIP). These include Social and Health Equity; Health Behaviors; Social and Economic factors; and Clinical Care. Social and Health Equity . We continue to participate in Black Hawk County Health Department's Community Health Improvement Plan (CHIP) including ongoing assessments of which we financially supported; participation in formulating the CHIP for board of health approval, and leadership of the Healthy Behaviors Team . Participation in the Core Team planning Mental Health and Trauma . Participation in the Systems Thinking planning team through Leveraging workshops over the past several years . Annual, ongoing FREE MAMMOGRAPHY program for the poor/underserved in conjunction with the Black Hawk County Health Department's Care for Yourself Program, the MercyOne Waterloo Foundation and Check the Girls. Health Behaviors . In 2020, we co-led the leadership of the Healthy Behaviors Team to support the Black Hawk County CHIP. In 2021, a staff member of the Northeast Iowa Food Bank took over leadership; however, MercyOne maintains committee participation . MercyOne Community Health Coordinator served on the Advisory Board for the Rooted Carrot Food Coop in Cedar Falls to assist in developing and opening the coop in 2022; however due to COVID-19 and city approval of operations has delayed it's opening until 2023-2024. . Continued partnership with the UNI Local Food Program to continue to offer the free Fruit Vegetable Voucher Program (FVVP) in its pediatric office so families could meet with a dietician and access vouchers to redeem at local farmers' markets; expanded to Waterloo Schools. . Ongoing financial support of the Northeast Iowa Food Bank including food drives/donations Social and Economic Issues . Continuation of the Care-A-Van service providing free transportation to/from appointments for the underserved/uninsured in Black Hawk County . Ongoing contributions to cover rides home for patients in need when Care-A-Van not operExplanationTxt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule H Supplemental InformationFormAndLineReferenceDesc
ExplanationSchedule H Part 1 Line 6a: MercyOne Northeast Iowa strives to post a one-page Community Benefit Report summarizing the totals for the region. These reports can be accessed on the website under Commitment to Community at this link: https://www.mercyone.org/northeastiowa/about-us/community-benefit/commitme nt-to-community 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 $1,021,844 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 $26,328,958 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 $51,198,680. Schedule H Part 1 Line 7g: In the 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 the 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 subsidized health services reported on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-4: 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: Sartori Memorial Hospital, 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 payorpatient's ability to pay are recorded as bad debt expense in other expense 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 (CharitExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Sartori Healthcare Foundation IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 West 9th StAddressLine1Txt
CityWaterlooCityNm
State AbbreviationIAStateAbbreviationCd
ZIP507025499ZIPCd
FieldValueIRS element (for citing)
Recipient EIN421240996RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$33,750CashGrantAmt
Valuation Method UsedBookValuationMethodUsedDesc
Purpose Of GrantSupportPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule I DisclosuresFormAndLineReferenceDesc
ExplanationDonations made by Sartori Memorial Hospital, Inc. to charitable organizations are made in furtherance of the recipient organization's exempt purpose. Donations are included in community benefits in schedule H if the contribution has been formally restricted to a community benefit activity that meets the criteria to be reported on schedule H.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt
Jack Dusenbery
Director; President$537,053$0$19,801$17,100$25,254$599,208$0
Mary Jo Kavalier
VP Operations$169,420$0$1,566$13,394$22,463$206,843$0
Ryan Meyer
Admin Directr; Former Key Empl$153,737$0$2,456$7,334$25,131$188,658$0
Timothy Huber
Asst. Treas.; VP of Finance$235,288$0$5,816$19,097$34,228$294,429$0
Matthew Sojka
VP Medical Affairs$383,254$0$2,722$12,825$26,455$425,256$0
Kelly Richards
CNO$209,485$0$4,509$16,735$26,022$256,751$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule J DisclosuresFormAndLineReferenceDesc
ExplanationSchedule J Part I Line 3 Sartori Memorial Hospital, Inc. is a subsidiary in the Mercy Health Network system. Sartori Memorial Hospital, 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 Sartori Memorial Hospital, Inc.'s President/CEO: -independent compensation consultant -written employment contract -compensation survey or study, and -approval by Mercy Health Network board of directorsExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule O DisclosuresFormAndLineReferenceDesc
ExplanationIRS Form 990 Part I Line 6 Sartori Memorial Hospital, Inc. received donated services through volunteers assisting in such areas as surgical waiting area, information desk, ambulatory surgery, medical records, engineering, occupational health, dietary, community screenings, materials, laundry, surgery, administration, human resources, public relations, wellness, and medical runner. 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 Sartori Memorial Hospital, Inc. has one member which holds several reserved powers over Sartori Memorial Hospital, 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 MHN during the fiscal year ending June 30, 2021 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: Sartori Memorial Hospital, Inc. has adopted a Conflict of Interest policy which applies to all "interested persons" of Sartori Memorial Hospital, 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 Sartori Memorial Hospital, 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 Sartori Memorial Hospital, Inc. (or a delegated committee of the Board) on a yearly basis. Interested persons are required to make full disclosure to Sartori Memorial Hospital, 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 Sartori Memorial Hospital, 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 Sartori Memorial Hospital, 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 Sartori Memorial Hospital, 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 In establishing other officer and key employee compensation, Sartori Memorial Hospital, 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 Mercy Health Network, during the fiscal year ending June 30, 2021, 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 Mercy Health Network during the fiscal year ending June 30, 2021 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 MHN 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, 2021 this resulted in a decrease in net assets or fund balances of $7,449,153.ExplanationTxt

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
WF Healthcare - Iowa Inc
3421 WEST NINTH STREETWATERLOOIA50702421177001HOLDING COIA501(c)(3)12 - III-FIMHNYes (true)
Covenant Foundation Inc
3421 WEST NINTH STREETWATERLOOIA50702421295784FOUNDATIONIA501(c)(3)10COV MED CTRYes (true)
Covenant Medical Center Inc
3421 WEST NINTH STREETWATERLOOIA50702421264647HOSPITALIA501(c)(3)3WFH-IOWAYes (true)
Mercy Hospital of Fran Sisters Inc
3421 WEST NINTH STREETWATERLOOIA50702421178403HOSPITALIA501(c)(3)3WFH-IOWAYes (true)
NE Iowa Real Estate Invsts
3421 WEST NINTH STREETWATERLOOIA50702421207432HOLDING COIA501(c)(2)N/AWFH-IOWAYes (true)
Sartori Health Care Foundation Inc
3421 WEST NINTH STREETWATERLOOIA50702421240996FOUNDATIONIA501(c)(3)12 - ISARTORI HOSPYes (true)
Mercy Health Network
1111 6th AvenueDes MoinesIA50314421478417PARENTDE501(C)(3)12 - III-FINAYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Sartori Health Care Foundation Inc
C$900,227Book value
Wheaton Franciscan Healthcare - Iowa Inc
m$5,780,681Book value
Covenant Medical Center Inc
o$920,613Book value