2022-05-16T12:29:59-05:00 2021-06-30 990 2020-07-01 421264647 Covenant Medical Center Inc % TIMOTHY HUBER COVE 3192728000 3421 West Ninth Street Waterloo IA 507025499 Timothy Huber VP OF FINANCE 3192727300 2022-05-16 Timothy Huber 999009999 2 2020 2022-09-23 18:48:47Z MERCYONE WATERLOO MEDICAL CENTER Jack Dusenbery 3421 West Ninth Street Waterloo IA 507025499 321023880 false 0928 X www.mercyone.org/northeastiowa X 1985 IA General inpatient and outpatient health care services. 11 7 2615 74 2030373 478864 18858817 11246272 262739448 278619364 -747805 5386482 28867524 25683046 309717984 320935164 77966 8000 0 0 155861456 167692416 0 0 0 142383925 139640988 298323347 307341404 11394637 13593760 239485789 267916696 76410057 95241083 163075732 172675613 X AS A MEMBER OF MERCY HEALTH NETWORK, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS. false false 302048931 8000 300526227 MercyOne Northeast Iowa is a faith-based 511-bed, not-for-profit, comprehensive medical/surgical health care provider offering acute levels of medical care at Covenant Medical Center in Waterloo, Sartori Memorial Hospital in Cedar Falls, and Mercy Hospital in Oelwein. Its services in the region also include Covenant Clinic with more than 100 primary care and specialty providers; Covenant Foundation, Sartori Health Care Foundation and Mercy Hospital Foundation. Areas of excellence include cardiology, orthopedics, neurosurgery, maternity and NICU, cancer treatment, minimally invasive and Bariatric surgery. The Iowa operations have been part of a 140 year system of care sponsored by the Wheaton Franciscan Sisters, formerly incorporated in 1983. In 2016, the Wheaton Franciscan Sisters transferred their Iowa operations to Mercy Health Network, an Iowa-based health care system based out of Des Moines, Iowa. Mercy Health Network (MHN) is an integrated system of member hospitals and other health and patient care facilities united into one operating organization to improve the delivery of healthcare services to the people of Iowa and adjoining states. MHN's sponsors own and operate medical centers and other services in Clinton, Des Moines, Dubuque, Mason City, and Sioux City, and community hospitals in six other locations. In addition, MHN has 27 members who participate through contracts for management and other services. Mercy Health Network (MHN) was founded in 1998 under a joint operating agreement between two of the largest Catholic, not-for-profit health organizations in the United States: Catholic Health Initiatives, based in Englewood, Colorado, and Trinity Health, based in Livonia, Michigan. Covenant Medical Center in Waterloo, Iowa was founded in 1986 when Wheaton Franciscan Services consolidated St. Francis Hospital (founded in 1912) and Schoitz Medical Center (founded in 1904). Covenant Medical Center was located in two locations until 1991 when all acute care services were combined at one site. The other site was transformed into an assisted living center and adult services center. In 1995, Wheaton Franciscan Services' Iowa region was renamed Covenant Health System and included Covenant Medical Center in Waterloo, Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, N. E. Iowa Real Estate Investments and Schoitz Health Resources. Sartori Memorial Hospital became a part of Covenant Health System in 1996 when the system entered a long-term lease agreement with the City of Cedar Falls. In 2006, Covenant Health System was renamed Wheaton Franciscan Healthcare-Iowa, to reflect its continued commitment to an integrated health care delivery system for residents of Northeast Iowa. Today MercyOne Northeast Iowa includes Covenant Medical Center (and its unincorporated division, Covenant Clinic) and Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, Sartori Memorial Hospital and Sartori Health Care Foundation in Cedar Falls, and N. E. Iowa Real Estate Investments. MercyOne Northeast Iowa Entities: Hospitals Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic, an unincorporated division of Covenant Medical Center, Inc. Patients have access to more than 100 primary and specialty care physicians, physician assistants, nurse practitioners, and other health care professionals located throughout Northeast Iowa in 24 locations. Regional Service Lines Covenant Cardiology Covenant Cancer Treatment Center Covenant Clinic Orthopedic Services Covenant Home Health Emergency Services Imaging/Radiology Services Iowa Spine and Brain Institute Midwest Institute of Advanced Laparoscopic Surgery Maternal Child Health Occupational Medicine and Wellness Covenant Retail Pharmacies Rehabilitation Services Philanthropic Foundations Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. MERCYONE NORTHEAST IOWA COMMUNITY IMPACT IN IOWA / 2021 Charity Care: $2,944,449. 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. 302048931 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true X 39 0 true 2615 true true true false false false false false false false false false false false X 11 7 false false false false true true true true true false false true true true true true true true true false X TIMOTHY HUBER 3192727607 3421 WEST NINTH STREET WATERLOO IA 507025499 X Richard Naylor MD Physician Employee 40.0 0.0 X 1290763 0 49646 Ahsan Maqsood MD Physician Employee 40.0 0.0 X 1175131 0 52778 Victor Mujica MD Physician Employee 40.0 0.0 X 1104227 0 54129 Gary Knudson Physician Employee 40.0 0.0 X 1094248 0 45438 Christopher Eagan Physician Employee 40.0 0.0 X 991550 0 52152 Jack Dusenbery Director; Pres.; Sec.; Treas. 40.0 1.0 X X 556854 0 42354 Luis Avila MD Director; Physician Employee 40.0 1.0 X 543297 0 54363 Matthew Sojka VP Medical Affairs 40.0 1.0 X 385976 0 39280 Brian Burnett MD Director; Physician Employee 40.0 1.0 X 343139 0 54283 Jeffrey Halverson VP Physician Networking 40.0 1.0 X 261901 0 49840 Timothy Huber Asst Treas; VP Finance 40.0 1.0 X 241104 0 53325 Kelly Richards CNO 40.0 1.0 X 213994 0 42757 Ryan Meyer ADMIN DIRECTR; FORMER KEY EMPL 40.0 1.0 X 156193 0 32465 Nancy Schaefer Asst. Secy; Exec. Asst. 40.0 1.0 X 63118 0 5193 David Deaver Chair 1.0 1.0 X X 0 0 0 Noreen Hermansen Director thru 12/20 1.0 1.0 X 0 0 0 Gregory Schmitz Director 1.0 1.0 X 0 0 0 Paul Stapella Director thru 12/20 1.0 1.0 X 0 0 0 Casey McLaughlin Director 1.0 1.0 X 0 0 0 Shirley Dunlap Director 1.0 1.0 X 0 0 0 Keyah Levy Director thru 04/21 1.0 1.0 X 0 0 0 Bob Ritz Director, Ex Offici, MHN Pres. 1.0 1.0 X 0 0 0 Alan Kruger Director 1.0 1.0 X 0 0 0 James Lee Director as of 06/21 1.0 1.0 X 0 0 0 Carol Tousley Director 1.0 1.0 X 0 0 0 8421495 0 628003 199 true true false Iowa Emergency Physicians LLP PO Box 674579 DETROIT MI 48267 Physician Services 1083187 Weatherby Locums Inc PO BOX 972633 DALLAS TX 753972633 Physician Services 919256 Peters Construction Company 901 Black Hawk Road WATERLOO IA 50701 Construction 1221361 Goldfish Locum Tenens 6865 Windcrest Dr Suite 300 PLANO TX 75024 Physician Services 998446 T-Psychiatry 17310 Kilmahew Place RICHMOND TX 77407 Physician Services 993540 40 12375 1543409 9622088 68400 11246272 NET PROGRAM SERVICE REVENUE 622110 44447007 43213232 1233775 MEDICARE/MEDICAID PAYMENTS 622110 225981019 225981019 RENT REVENUE 531120 8191338 8191338 278619364 5386482 5386482 0 0 298247 88716 209531 0 209531 209531 0 0 0 0 0 0 0 0 0 0 340B REVENUE 622110 12818795 12818795 CAFETERIA 722514 736125 736125 PHARMACY REVENUE 446110 10229110 9432512 796598 1689485 889331 800154 25473515 320935164 300526227 2030373 7132292 8000 8000 0 0 0 2950778 995082 1955696 325985 137326 188659 135845505 133618497 2227008 6161291 6061033 100258 14267520 14035356 232164 8141337 8044495 96842 0 245629 245629 0 20689 20689 0 0 1918352 1866986 51366 11588 10838 750 8029959 8015259 14700 0 0 8561638 8561638 144869 142688 2181 0 45094 45054 40 0 0 10321837 10321837 282096 282096 MEDICAL SUPPLIES 50699304 50699276 28 BAD DEBT EXPENSE 5575502 5575502 PARENT COMPANY ALLOCATION 37080105 37062105 18000 PURCHASED SERVICES 13629145 13598190 30955 3075181 2946984 128197 307341404 302048931 5292473 0 0 0 69759936 89816415 0 0 31611836 28765394 0 0 0 0 0 0 2500962 2273767 53958 56046 164446692 52976052 114152127 111470640 0 0 0 0 0 0 0 0 21406970 35534434 239485789 267916696 56363078 54482951 0 0 0 0 0 0 0 0 0 0 4357976 13825522 0 0 15689003 26932610 76410057 95241083 X 162685461 172274122 390271 401491 163075732 172675613 239485789 267916696 X 13593760 -3993879 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 20689 false false false 20689 false Schedule C Disclosures Schedule C Part II-B Line 1F: MercyOne Waterloo Medical Center 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 MercyOne Waterloo with an estimated percentage of dues payments which are used for lobbying activities. 6206979 6206979 91902249 19077963 72824286 65851847 33780880 32070967 485617 117209 368408 111470640 OTHER ASSETS 6862882 MISC ACCOUNTS RECEIVABLE 9762878 457B PLAN ASSETS 18908674 35534434 0 DUE TO THIRD PARTY PAYOR 1212221 REINSURANCE RECOVERY 6811715 457B PLAN LIABILITIES 18908674 26932610 X IRS Form 990 Schedule D, Part X The Company follows the provisions of ASC Subtopic 740-10, Income Taxes - Overall. ASC Subtopic 740-10 clarifies the accounting for uncertainty in tax positions and also provides guidance on when the tax positions are recognized in an entity's financial statements and how the values of these positions are determined. As of June 30, 2021, the Company did not have a liability for unrecognized tax benefits. true true X true X true X true true true false true true 2577811 2577811 0.00850 63286607 49192458 14094149 0.04670 65864418 49192458 16671960 0.05520 1569401 7071 1562330 0.00520 2429534 1674509 755025 0.00250 4918626 1457902 3460724 0.01150 106271 106271 0.00040 9023832 3139482 5884350 0.01960 74888250 52331940 22556310 0.07480 5504 5504 0.00010 5504 5504 0.00010 true 5575502 46584806 51496167 -4911361 X true true 1 1 Covenant Medical Center Inc 3421 West Ninth Street Waterloo IA 50702 http://www.mercyone.org 070137H (IA) X X X X 1 Covenant Medical Center Inc 1 false false true X X X X X X X X X X 18 true true true true X mercyone.org - full url in narrative X true 18 true mercyone.org - full url in narrative false true X 200. 400. X X X X true true X X X true X mercyone.org - full url in narrat X mercyone.org - full url in narrative X mercyone.org - full url in n X X X X X X X true X false X X X X true X false false Schedule H Supplemental Information Schedule H Part V Section B Line 3e: Covenant Medical Center included in its CHNA written report a prioritized list and description of the community's significant health needs, which were identified through the most recently conducted community health needs assessment. The following community health needs were deemed significant and were prioritized for tax year 2020 through a community-involved selection process: Social and Health Equity Healthy 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). The 2019 Online CHNA Survey to Area Agencies/Organizations included outreach to the following: University of Northern Iowa UnityPoint 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, and UnityPoint-Allen Hospital. Schedule H Part V Section B Line 6b: The CHNA was conducted in partnership with 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: https://www.mercyone.org/northeastiowa/about-us/community-benefit/communit y-health-needs-assessment Schedule H Part V Section B Line 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 operational. Clinical Care . Due to COVID-19, we expanded telehealth services throughout our eigh 59 MercyOne Kimball Outpatient Physical & O 2101 KIMBALL AVENUE WATERLOO IA 50702 Outpatient physical and occupa MercyOne Waterloo HematologyOncology 200 EAST RIDGEWAY AVENUE SUITE 400 WATERLOO IA 50702 OUTPATIENT HEMATOLOGY AND ONCOLOGY SERVICES MercyOne Waterloo Sleep Lab 2710 ST FRANCIS DRIVE SUITE 409 WATERLOO IA 50702 OUTPATIENT SLEEP DISORDER DIAGNOSTICS MercyOne Waterloo Neurosurgery 2710 ST FRANCIS DRIVE SUITE 110 WATERLOO IA 50702 OP NEURO SURGERY OP PAIN MANAGEMENT OP X-RAY SERVICES MercyOne Waterloo Neurology 2710 ST FRANCIS DRIVE SUITE 201 WATERLOO IA 50702 OUTPATIENT CLINIC- NEUROLOGY SERVICES MercyOne Waterloo Urgent Care 2710 ST FRANCIS DRIVE SUITE 111 WATERLOO IA 50702 OUTPATIENT CLINIC MercyOne Waterloo Family Medicine 2710 ST FRANCIS DRIVE SUITE 210 WATERLOO IA 50702 OP FAMILY PRACTICE, GYNECOLOGY, PODIATRY, LABORATORY SERVICES MercyOne Waterloo Orthopedics Care 2710 ST FRANCIS DRIVE SUITE 319 WATERLOO IA 50702 OUTPATIENT CLINIC- ORTHOPEDIC SERVICES MercyOne Waterloo Heart Care 2710 ST FRANCIS DRIVE SUITE 320 WATERLOO IA 50702 OUTPATIENT CLINIC- CARDIOLOGY SERVICES MercyOne Waterloo Pulmonary Care 2710 ST FRANCIS DRIVE SUITE 402 WATERLOO IA 50702 OUTPATIENT CLINIC- PULMONOLOGY SERVICES MercyOne Waterloo General Surgery 2710 ST FRANCIS DRIVE SUITE 410 WATERLOO IA 50702 OP GENERAL SURGERY, WOUND CARE, VASCULAR SURGERY SERVICES MercyOne Waterloo ENTAllergy Care 2710 ST FRANCIS DRIVE SUITE 411 WATERLOO IA 50702 OUTPATIENT CLINIC - EAR, NOSE & THROAT AND ALLERGY SERVICES MercyOne Waterloo Pediatrics Care 2710 ST FRANCIS DRIVE SUITE 510A WATERLOO IA 50702 OP NEPHROLOGY, PODIATRY, AND PEDIATRIC SERVICES MercyOne Waterloo OBGYN 432 KING DRIVE WATERLOO IA 50702 OUTPATIENT MAMMOGRAPHY IMAGING SERVICES MercyOne Waterloo Behavioral Health Care 2750 ST FRANCIS DRIVE WATERLOO IA 50702 OUTPATIENT CLINIC - PSYCHIATRY SERVICES MercyOne Cedar Falls Behavioral Health C 2802 ORCHARD DRIVE CEDAR FALLS IA 50613 OUTPATIENT CLINIC- PSYCHIATRY SERVICES MercyOne Bluebell Road 226 BLUEBELL ROAD SUITE CC CEDAR FALLS IA 50613 OP FAMILY PRACTICE, PSYCHIATRY, PODIATRY, GYNECOLOGY SERVICES MercyOne Bluebell Road Ste OPT 226 BLUEBELL ROAD SUITE OPT CEDAR FALLS IA 50613 OP PHYSICAL THERAPY, OCCUPATIONAL HEALTH, RADIOLOGY SERVICES MercyOne Waterloo Physical Medicine & Re 3421 WEST NINTH STREET SUITE 100 WATERLOO IA 50702 OUTPATIENT CLINIC- PHYSIATRY SERVICES MercyOne Kimball Family Medicine Ste 400 2055 KIMBALL AVE SUITE 400 WATERLOO IA 50702 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Cedar Falls Family Medicine Ste 516 SOUTH DIVISION STREET SUITE 10 CEDAR FALLS IA 50613 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Cedar Falls General Surgery 516 SOUTH DIVISION STREET SUITE 10 CEDAR FALLS IA 50613 OUTPATIENT PHYSICIAN CLINIC - BARIATRICS SERVICES MercyOne Cedar Falls Orthopedics Care 516 SOUTH DIVISION STREET SUITE 12 CEDAR FALLS IA 50613 OUTPATIENT CLINIC - ORTHOPEDIC SERVICES MercyOne Cedar Falls Specialists 516 SOUTH DIVISION STREET SUITE 13 CEDAR FALLS IA 50613 OP CLINIC - ENT, ALLERGY, CARDIOLOGY, PAIN MANAGEMENT SERVICES MercyOne Dysart Family Medicine 501 CLARK STREET DYSART IA 52224 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Evansdale Family Medicine 3562 LAFAYETTE ROAD EVANSDALE IA 50707 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Fairbank Family Medicine 105 SOUTH WALNUT STREET FAIRBANK IA 50629 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Gladbrook Family Medicine 309 SECOND STREET GLADBROOK IA 50635 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Jesup Family Medicine 1094 220TH STREET JESUP IA 50648 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne La Porte City Family Medicine 601 HIGHWAY 218 NORTH LAPORTE CITY IA 50651 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Oelwein Family Medicine 129 8th AVENUE SE OELWEIN IA 50662 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Reinbeck Family Medicine 501 MAIN STREET REINBECK IA 50669 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Traer Family Medicine 200 WALNUT STREET TRAER IA 50675 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Tripoli Familiy Medicine 602 7TH AVENUE SW TRIPOLI IA 50676 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Waverly Family Medicine 217 20TH STREET NW WAVERLY IA 50677 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Arlington Family Medicine 751 Main Street Arlington IA 50606 OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES MercyOne Waterloo Home Health Care 2101 Kimball Ave Suite 140 Waterloo IA 50702 Home Health Care MercyOne Waterloo Pain Management 2710 Saint Francis Drive Suite 419 Waterloo IA 50702 Outpatient Clinic - Pain Management MercyOne Waterloo Internal Medicine 2710 Saint Francis Drive Suite 300 Waterloo IA 50702 Outpatient Clinic - Internal Medicine Services MercyOne Cedar Falls Family Medicine Sui 516 S Division St Ste 100 Cedar Falls IA 50613 Outpatient Clinic- Family Prac MercyOne Cedar Falls Heart Care 515 College Street Suite 2000 Cedar Falls IA 50613 Outpatient Clinic - Cardiology Services MercyOne Kimball Family Medicine Ste 330 2055 Kimball Avenue Suite 330 Waterloo IA 50702 Outpatient Clinic MercyOne Traer Physicial Therapy 549 2nd Street Traer IA 50675 Physical Therapy Services MercyOne Parkersburg Family Medicine 1306 Highway 57 Unit A Cedar Falls IA 50665 Outpatient Clinic - Family Practice Services MercyOne Waterloo Urology Care 3410 Kimball Avenue Waterloo IA 50702 Outpatient Clinic - Urological Services MercyOne Oelwein Urgent Care & Occupatio 201 8th Ave SE Ste 411 Oelwein IA 506622447 OUTPATIENT CLINIC OCCUPATIONAL HEALTH MercyOne Independence Family Medicine 2004 Enterprise Ct Independence IA 50644 Outpatient Clinic Family Practice MercyOne Allison Family Medicine 502 Locust St Allison IA 50602 Outpatient Clinic Family Practice Services MercyOne Waterloo Podiatry Care 2710 Saint Francis Dr Ste 510B Waterloo IA 50702 Outpatient Clinic- Podiatry Se MercyOne Waterloo Gastroenterology Care 2710 St Francis Dr Ste 104 Waterloo IA 50702 Outpatient Clinic- Gastroenter MercyOne Cedar Falls Weight Loss Center 515 College St Ste 2800 Cedar Falls IA 50613 Outpatient Clinic- Bariatrics MercyOne Waterloo Home Medical Equipment 441 San Marnan Dr Waterloo IA 50702 Home Health Care MercyOne La Porte City Pharmacy 601 Highway 218 N LaPorte City IA 50651 Pharmacy MercyOne Jesup Pharmacy 1094 220th Street Jesup IA 50648 Pharmacy MercyOne Waterloo Pharmacy 2710 St Francis Dr Ste 101 Waterloo IA 50702 Pharmacy MercyOne Grand Crossing 220 Franklin Street Waterloo IA 50703 Outpatient Clinic Family Practice Services MercyOne Waterloo Radiation Oncology 200 EAST RIDGEWAY AVENUE SUITE CTC WATERLOO IA 50702 OUTPATIENT CANCER TREATMENT MercyOne Waverly Physical Therapy 211 20th St NW Waverly IA 50677 Physical Therapy Services MercyOne Evansdale Physical Therapy 110 S Evans Rd Ste 110 Evansdale IA 50707 Physical Therapy Services Pt VI Supplemental Information Schedule 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 $5,575,502 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 1-3: In determining bad debt amounts, the Iowa organizations use a two-level scoring process as follows: First, for any patient account that is categorized as having no insurance, when the amount becomes 60 days overdue or greater, the patient's account is reviewed for financial assistance qualification. If the patient is found to qualify for financial assistance, the necessary steps are taken to apply, and the needed adjustments are made to treat as charity care and not as bad debt. A similar scoring process is completed for those patients who do have insurance, but after 120 days or greater, still have not paid the patient responsibility portion. Again, these patient accounts are reviewed for financial assistance, and if they qualify, similar steps are taken to remove from bad debt. As a result of these scoring procedures, Iowa's position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, or later with the timing of the scoring procedures mentioned above. Bad debt is therefore only determined for each organization at the time the amount due is truly determined to be uncollectible, after financial assistance has been determined, and after many months of collection efforts. Additionally, the organization followed guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommends that no bad debt amounts be included in community benefit amounts. For these reasons, Part III Section A Line 3 is reported at zero. Schedule H Part III Section A Line 4: Covenant Medical Center, Inc. is included in the consolidated financial statements of MercyOne Northeast Iowa, Inc. The following is the text of the footnote from the financial statements which addresses the allowance for doubtful accounts. This footnote can be found on page 14 of the attached consolidated financial statements. The Company estimates the transaction price for patients with deductibles and coinsurance and for those who are uninsured and underinsured based on historical experience and current market conditions, using the portfolio approach. The initial estimate of the transaction price is determined by reducing the standard charge by any contractual adjustments, discounts, and implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payor of the patient's ability to pay are recorded as bad debt expense in other expenses in the statement of operations and changes in net assets. Schedule H Part III Section B Line 6-8: Schedule H Part III Section B Line 6 reports allowable costs of care as taken from the most recently filed Medicare cost report available at the time of publishing the Community Benefit Report. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid costs are determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Iowa Hospital Association, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b: Iowa organizations follow a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Please also see Schedule H Part III Section A Lines 1-4 narrative response. Schedule H Part V Section A and Section C: Affiliates of the Iowa region have defined and reported hospital facilities to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Iowa state law required for hospital licensing. Although there may be other facilities within our system built to hospital specifications, performing hospital-based billing, and conforming to other hospital standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part VI Line 2: Iowa assesses the needs of the communities it serves by reviewing admission and discharge data, analyzing information from the community health departments and other community leaders, and by aligning our services with the Healthy People 2030 and other current year initiatives. The Iowa hospital organizations complete a Community Health Needs Assessment and Implementation Plan every three years. Please reference Schedule H Part V Section B Lines 1-12 for additional information. Schedule H Part VI Line 3: Iowa provides its patients with several opportunities to gain knowledge and awareness of its Community Care true Covenant Foundation Inc 3421 West 9th St Waterloo IA 507025499 421295784 501(c)(3) 8000 General support 1 Schedule I Disclosures Schedule I Part I Line 2: Donations made by Covenant Medical Center, 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. X X X X false false false false false false false false false Luis Avila MD Director; Physician Employee 539964 2100 1233 17100 37263 597660 0 Jack Dusenbery Director; Pres.; Sec.; Treas. 537053 0 19801 17100 25254 599208 0 Christopher Eagan Physician Employee 987178 1650 2722 17100 35052 1043702 0 Jeffrey Halverson VP Physician Networking 244115 0 17786 19416 30424 311741 0 Ahsan Maqsood MD Physician Employee 1169961 1575 3595 17100 35678 1227909 0 Ryan Meyer ADMIN DIRECTR; FORMER KEY EMPL 153737 0 2456 7334 25131 188658 0 Richard Naylor MD Physician Employee 1281906 1275 7582 17100 32546 1340409 0 Timothy Huber Asst Treas; VP Finance 235288 0 5816 19097 34228 294429 0 Matthew Sojka VP Medical Affairs 383254 0 2722 12825 26455 425256 0 Victor Mujica MD Physician Employee 1094850 1050 8327 21375 32754 1158356 0 Brian Burnett MD Director; Physician Employee 335725 6667 747 21375 32908 397422 0 Gary Knudson Physician Employee 1087584 1575 5089 21375 24063 1139686 0 Kelly Richards CNO 209485 0 4509 16735 26022 256751 0 Tatum Bedard Tammy Bedard Daughter 16497 Employment false Denise Huber Spouse of Tim Huber 48822 Employment false Cassandra Kennedy Kerri Wilson Step Daughter 72007 Employment false Schedule O Disclosures IRS Form 990 Part I Line 6: Covenant Medical Center, Inc. received donated services through volunteers assisting in a variety of areas which include the information desk, escorts, medical runner, nursing units, ambulatory surgery, Cancer Treatment Center, rehabilitation therapies, and volunteer transportation services. 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 and top 5 independent contractors reported. IRS Form 990 Part VI Section A Lines 6-7b: Covenant Medical Center, Inc. has one member which holds several reserved powers over Covenant Medical Center, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Lines 11a and 11b: Affiliates of MercyOne Northeast Iowa during the fiscal year ending June 30, 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 MercyOne Northeast Iowa 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, 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: Covenant Medical Center, Inc. has adopted a Conflict of Interest policy which applies to all "interested persons" of Covenant Medical Center, 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 Covenant Medical Center, 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 Covenant Medical Center, Inc. (or a delegated committee of the board) on a yearly basis. Interested persons are required to make full disclosure to Covenant Medical Center, 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 Covenant Medical Center, 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 Covenant Medical Center, 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: 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, 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 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, made available, 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 balances to zero. For the fiscal year ended June 30, 2021, this resulted in a decrease in net assets or fund balances of $3,993,879. WF Healthcare - Iowa Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421177001 HOLDING CO IA 501(c)(3) 12 - III-FI MHN true Covenant Foundation Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421295784 FOUNDATION IA 501(c)(3) 10 COV MED CTR true Mercy Hospital of Fran Sisters Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421178403 HOSPITAL IA 501(c)(3) 3 WFH-IOWA true NE Iowa Real Estate Invsts 3421 WEST NINTH STREET WATERLOO IA 50702 421207432 HOLDING CO IA 501(c)(2) N/A WFH-IOWA true Sartori Health Care Foundation Inc 3421 WEST NINTH STREET WATERLOO IA 50702 421240996 FOUNDATION IA 501(c)(3) 12 - I SARTORI HOSP true Sartori Memorial Hospital Inc 515 COLLEGE STREET CEDAR FALLS IA 50613 420758901 HOSPITAL IA 501(c)(3) 3 WFH-IOWA true Mercy Health Network 1111 6th Avenue Des Moines IA 50314 421478417 PARENT DE 501(C)(3) 12 - III-FI NA true false true true false false false false false true true true true true true true true false false Covenant Foundation Inc C 1543409 Book Value Mercy Hospital of Franciscan Sisters Inc O 240286 Book Value Sartori Memorial Hospital Inc O 920613 Book Value Wheaton Franciscan Healthcare - Iowa Inc M 37070209 Book Value Northeast Iowa Real Estate Investments Ltd K 116766 Book Value