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MHIC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MHIC (EIN 42-0680391)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-11
IRS object ID
201231329349300803
Schema version
2010v3.4
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)
Timestamp2012-05-11T08:57:12-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line150 SOUTH SIXTH STREET STE 2800AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code554021538ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN420680391EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Hospital Iowa City IowaBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMERCNameControl
Phone3193390300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 East Market StreetAddressLine1
CityIowa CityCity
StateIAState
ZIP Code52245ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL G HEINRICHName
TitleExecutive VP of Finance & CFOTitle
Phone3193390300Phone
Date Signed2012-05-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAnne FultonName
Phone6123974000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael G HeinrichNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 East Market StreetAddressLine1
CityIowa CityCity
StateIAState
ZIP Code52245ZIPCode
FieldValueIRS element (for citing)
Gross Receipts186763232GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mercyiowacity.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1873YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionTo heal and comfort the sick and improve the health of the community in the spirit of Jesus Christ.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees1325TotalNbrEmployees
Total Nbr Volunteers461TotalNbrVolunteers
Total Gross UBI2129659TotalGrossUBI
Net Unrelated Business Txbl Income-330219NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year641893ContributionsGrantsPriorYear
Contributions Grants Current Year628872ContributionsGrantsCurrentYear
Program Service Revenue Prior Year139027638ProgramServiceRevenuePriorYear
Program Service Revenue CY139782498ProgramServiceRevenueCY
Investment Income Prior Year1412313InvestmentIncomePriorYear
Investment Income Current Year7219828InvestmentIncomeCurrentYear
Other Revenue Prior Year1710827OtherRevenuePriorYear
Other Revenue Current Year2053325OtherRevenueCurrentYear
Total Revenue Prior Year142792671TotalRevenuePriorYear
Total Revenue Current Year149684523TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year164192GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY161366GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year80458816SalariesEtcPriorYear
Salaries Etc Current Year74776974SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year61873140OtherExpensePriorYear
Other Expenses Current Year65664439OtherExpensesCurrentYear
Total Expenses Prior Year142496148TotalExpensesPriorYear
Total Expenses Current Year140602779TotalExpensesCurrentYear
Revenues Less Expenses Prior Year296523RevenuesLessExpensesPriorYear
Revenues Less Expenses CY9081744RevenuesLessExpensesCY
Total Assets BOY275560202TotalAssetsBOY
Total Assets EOY269627417TotalAssetsEOY
Total Liabilities BOY137974454TotalLiabilitiesBOY
Total Liabilities EOY122320945TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY137585748NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY147306472NetAssetsOrFundBalancesEOY
Mission DescriptionMercy Iowa City ("Mercy") heals and comforts the sick and works to improve the health of the community in the spirit of Jesus Christ and the Catholic tradition of the Sisters of Mercy.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense100143981Expense
Revenue139856081Revenue
DescriptionHospital Services. In keeping with our mission of healing and comforting the sick, providing hospital medical services is at the heart of what we do. These services are provided in inpatient and outpatient settings in situations that may be emergent, acute, or chronic. Services include a 24-hour emergency unit, intensive care, cardiovascular care and the services of a cardiac cath lab, maternity unit and newborn nursery, surgical services, cancer care, orthopedic care, telemetry monitored care, medical care, stroke care, behavioral health care, and skilled nursing.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense751892Expense
Revenue250148Revenue
DescriptionEducation. The ongoing education of Mercy staff members is critical in the fast-changing field of health care and is necessary in many cases to meet regulation and certification. In addition to the efforts designed for staff members, Mercy provides a setting for many students who are considering or pursuing health care careers. For high school students, a health careers class is offered to give students insight into possible careers and options; it also prepares students for the certified nursing assistant exam. Mercy also works with students from Kirkwood Community College, and other local colleges, offering such options as a paid summer nursing internship program, a lab student rotation opportunity, and job shadow opportunity in anesthesiology.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3569628Expense
Grants161366Grants
DescriptionCommunity Benefit. Mercy's community benefits take many forms, beginning with traditional charity care of $1.3 million, the unpaid cost of Medicaid ($1.2 million), and subsidized health services related to Mercy's provision of a community hospice facility ($58,000.) Other examples are varied; they include cash donations to community non-for-profits such as the Free Medical Clinic, free meeting space to valued community organizations, leadership time and skills that further the work of community non-for-profits, first aid booths provided at public events. These efforts are detailed in Mercy's community benefit report, prepared annually. As a trusted, longtime member of the community, Mercy plays an important role not only in furthering community heath but the general community good.Description
FieldValueIRS element (for citing)
Total Program Service Expense104465501TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109653NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1325NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Jean BergeBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3193393238TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 East Market StreetAddressLine1
CityIowa CityCity
StateIAState
ZIP Code52245ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Geraldine Felton
Board Member1.00X000
Scott Fisher
Board Member1.00X000
Nyle Kauffman MD
Board Member1.00X000
SR Sharon Kerrigan
Board Member1.00X000
Tim Krumm
Board Member1.00X000
Tom McLaughlin
Board Member1.00X000
SR Patricia Murphy
Board Member1.00X000
Dick Oberman
Board Member1.00X000
Mark Phillips
Board Member1.00X000
Cyndie Schmeiser
Board Member1.00X000
Mary Westabrook
Board Member1.00X000
SR Margaret Wright
Board Member1.00X000
Ronald R Reed
President & CEO40.00X497226082951X
Jean M Berge
Director, Fiscal Mgmt40.00145944039750X
Michael G Heinrich
Executive VP & CFO40.00298681055536X
Cindy Penney
VP Nursing40.00155942039674X
Andrew R Ashby MD
Physician40.00512872040774X
Martin Izakovic MD
Physician40.00339198034970X
Peter McDonnell MD
Physician40.00393734033590X
Stephen J Scheckel MD
ECU Medical Director40.00337176030780X
Eric J Stenberg MD
Physician40.00300252043400X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2981025TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation401425TotalOtherCompensation
Number Individuals GT100 K60NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Rohrbach Associates PC
325 E WashingtonIowa CityIA52244Engineering/Architecture598589
Cross Medical Laboratories
2406 Towncrest DriveIowa CityIA52244Laboratory Services365944
Deloitte & Touche LLP
50 South Sixth Street Suite 2800MinneapolisMN55402Auditing Services157398
Phelan Tucker Mullen Walker Tucker & Gel
Box 2150Iowa CityIA52244Legal Services147969
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Related Organizations564391RelatedOrganizations
Government Grants64481GovernmentGrants
Total Contributions628872TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Serv. Revenue6214008131977081319770
Medicare/Medicaid6214005195804351958043
Program Relat. Revenue621400709855709855
Purchase Discounts621400350831350831
Contract Lab Revenue621500326211326211

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column5117788TotalRevenueColumn
Related Or Exempt Function Income2988129RelatedOrExemptFunctionIncome
Unrelated Business Revenue2129659UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue139782498TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4222235TotalRevenueColumn
Exclusion$4,222,235ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2119819Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1131183Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real988636Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column988636TotalRevenueColumn
Exclusion$988,636ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities38703576Securities
Other241543Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities35833744Securities
Other113782Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2869832Securities
Other127761Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2997593TotalRevenueColumn
Exclusion$2,997,593ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Cafeteria Income722210725468$725,468
Access621400100755100755
Miscellaneous revenue9000994653846538

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column191928TotalRevenueColumn
Related Or Exempt Function Income176438RelatedOrExemptFunctionIncome
Exclusion$15,490ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1064689TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column149684523TotalRevenueColumn
Related Or Exempt Function Income137976570RelatedOrExemptFunctionIncome
Unrelated Business Revenue2129659UnrelatedBusinessRevenue
Exclusion$8,949,422ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total142325Total
Program Services142325ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total19041Total
Program Services19041ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1302296Total
Program Services588307ProgramServices
Management And General713989ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total54600710Total
Program Services42047558ProgramServices
Management And General12553152ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6271001Total
Program Services4649947ProgramServices
Management And General1621054ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8626757Total
Program Services6345478ProgramServices
Management And General2281279ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3976210Total
Program Services2999622ProgramServices
Management And General976588ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total223854Total
Management And General223854ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total150993Total
Management And General150993ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total28592Total
Management And General28592ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4037845Total
Program Services3009294ProgramServices
Management And General1028551ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1152099Total
Program Services5731ProgramServices
Management And General1146368ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total25896079Total
Program Services21605287ProgramServices
Management And General4290792ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2981635Total
Program Services438780ProgramServices
Management And General2542855ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2048875Total
Program Services68368ProgramServices
Management And General1980507ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total300741Total
Program Services179132ProgramServices
Management And General121609ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2378305Total
Program Services1392759ProgramServices
Management And General985546ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10404064Total
Program Services9124422ProgramServices
Management And General1279642ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1368600Total
Management And General1368600ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Bad Debt Expense5430293543029300
Pharmacy Supplies2993818299381800
Food Expense1026534102653400
Blood Bank Fees77220877220800
Collection Fees6309453236306220

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3838959Total
Program Services1626274ProgramServices
Management And General2212685ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total140602779Total
Program Services104465501ProgramServices
Management And General36137278ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7639588BOY
EOY2831957EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2258443BOY
EOY2379090EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY23982485BOY
EOY20402245EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY47498BOY
EOY54373EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3725191BOY
EOY3969188EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1992917BOY
EOY1968027EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis214990567LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec139781035LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY69174323BOY
EOY75209532EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY125823927BOY
EOY139357794EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY26335732BOY
EOY5800378EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY14580098BOY
EOY17654833EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY275560202BOY
EOY269627417EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13086521BOY
EOY15358510EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY63313168BOY
EOY62073856EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY549246BOY
EOY304211EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY61025519BOY
EOY44584368EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY137974454BOY
EOY122320945EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY137585748BOY
EOY147306472EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY137585748BOY
EOY147306472EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY275560202BOY
EOY269627417EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses9081744ReconcilationRevenueExpenses
Reconcilation Other Changes638980ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Org Belongs To Affiliated GroupXOrgBelongsToAffiliatedGroup
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$28,592OtherActivitiesAmount
Total Lobbying Expenditures IIB28592TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Other Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1i:ReturnReference
ExplanationMercy Hospital, Iowa City, Iowa is a member of the Iowa Hospital Association (IHA). A percentage of membership dues paid to IHA relate to lobbying activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance10653690BeginningOfYearBalance
Contributions451005Contributions
Investment Earnings Or Losses2031685InvestmentEarningsOrLosses
Grants Or Scholarships184488GrantsOrScholarships
End Of Year Balance12951892EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance9665745BeginningOfYearBalance
Contributions140749Contributions
Investment Earnings Or Losses1003105InvestmentEarningsOrLosses
Grants Or Scholarships155909GrantsOrScholarships
End Of Year Balance10653690EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12302591BeginningOfYearBalance
Contributions36954Contributions
Investment Earnings Or Losses-2231983InvestmentEarningsOrLosses
Grants Or Scholarships441817GrantsOrScholarships
End Of Year Balance9665745EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.82000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.18000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6379393OtherCostOrOtherBasis
Book Value6379393BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis111214319OtherCostOrOtherBasis
Depreciation70317875Depreciation
Book Value40896444BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis589029OtherCostOrOtherBasis
Depreciation555196Depreciation
Book Value33833BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis63443205OtherCostOrOtherBasis
Depreciation49641246Depreciation
Book Value13801959BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis33364621OtherCostOrOtherBasis
Depreciation19266718Depreciation
Book Value14097903BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings75209532TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Beneficial Interest-Foundation13354839
Due From Affiliates1864421
Cash Value Life Insurance351613
Deferred Financing Cost Other Assets753960
Non-Compete Agreement Value1330000
FieldValueIRS element (for citing)
Total Book Value Other Assets17654833TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Pension Benefit Liability$43,282,112
Fair Value of Interst Rate SWAP$1,302,256
FieldValueIRS element (for citing)
Total Of Amounts44584368TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:All Restricted Endowed Funds are used for the benefit of Mercy Hospital Iowa City - capital equipment, employee grants, scholarships, etc.
Description of Uncertain Tax Positions Under FIN 48:Part X:Mercy adopted the provisions of FIN No. 48 in fiscal 2008. As a result of the implementation of FIN No. 48, and as of June 30, 2011, Mercy recorded no liabilities for unrecognized tax benefits.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1259008TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense1259008NetCommunityBenefitExpense
Percent Of Total Expense0.00930PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5942936TotalCommunityBenefitExpense
Direct Offsetting Revenue3994649DirectOffsettingRevenue
Net Community Benefit Expense1948287NetCommunityBenefitExpense
Percent Of Total Expense0.01440PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense18146TotalCommunityBenefitExpense
Direct Offsetting Revenue10993DirectOffsettingRevenue
Net Community Benefit Expense7153NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7220090TotalCommunityBenefitExpense
Direct Offsetting Revenue4005642DirectOffsettingRevenue
Net Community Benefit Expense3214448NetCommunityBenefitExpense
Percent Of Total Expense0.02380PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1069191TotalCommunityBenefitExpense
Direct Offsetting Revenue96416DirectOffsettingRevenue
Net Community Benefit Expense972775NetCommunityBenefitExpense
Percent Of Total Expense0.00720PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense136628TotalCommunityBenefitExpense
Direct Offsetting Revenue19976DirectOffsettingRevenue
Net Community Benefit Expense116652NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense3030019TotalCommunityBenefitExpense
Direct Offsetting Revenue2485961DirectOffsettingRevenue
Net Community Benefit Expense544058NetCommunityBenefitExpense
Percent Of Total Expense0.00400PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense364265TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense364265NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4600103TotalCommunityBenefitExpense
Direct Offsetting Revenue2602353DirectOffsettingRevenue
Net Community Benefit Expense1997750NetCommunityBenefitExpense
Percent Of Total Expense0.01480PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11820193TotalCommunityBenefitExpense
Direct Offsetting Revenue6607995DirectOffsettingRevenue
Net Community Benefit Expense5212198NetCommunityBenefitExpense
Percent Of Total Expense0.03860PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense52402TotalCommunityBuildingExpense
Net Community Building Expense52402NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense80025TotalCommunityBuildingExpense
Net Community Building Expense80025NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense1047TotalCommunityBuildingExpense
Net Community Building Expense1047NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense133474TotalCommunityBuildingExpense
Net Community Building Expense133474NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,915,264BadDebtExpenseAmount
Amount Attributable To30546AmountAttributableTo
Amount Reimbursed By Medicare39319291AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare54653475CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-15334184MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 Iowa City Ambulatory Surgery CenterBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityOutpatient Surgery CenterDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.62500OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.37500PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1500 East Market StreetAddressLine1
CityIowa CityCity
StateIAState
ZIP Code52245ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherSkilled Nursing and Lab OutreachOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Mercy Hospital Iowa City IowaBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Home Health CareBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1500 East Market StreetAddressLine1
CityIowa CityCity
StateIAState
ZIP Code52245ZIPCode
FieldValueIRS element (for citing)
Facility TypeHome Health & Private Duty NursingFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 7: Amounts in the table were derived using a cost accounting system that addresses all patient segments. A cost to charge ratio derived from completing IRS worksheet 2 was used to determine the amounts in Part I, Line 7a, 7b, 7c, and 7g.
Part I, L7 Col(f): Bad debt expense of $5,430,293 was subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f).
Part II: Mercy provides cash donations to area organizations at work in the areas of economic development, community support, environmental improvements, and leadership development and training for community members (community building activities). The majority of these amounts are listed in Part I, line 7i as cash and in-kind contributions.Economic developmentMercy works extensively with such groups at the Iowa City Area Chamber of Commerce and the Iowa City Area Development Group to support the business community, welcome innovation to the area, and develop the workforce. Mercy's own growth benefits the community as well, particularly when Mercy's recruiting efforts attract new professionals to the area.Community supportMercy has provided extensive support for many years to United Way of Johnson County. Mercy holds its own campaign for employees each autumn (typically raising more than $120,000) and provides much staff time and support to the local United Way organization. For example, in 2008 Mercy President and CEO Ronald R. Reed served as co-chair of the county-wide United Way campaign, which raised more than $2.6 million. Environmental improvementsMercy has been a good neighbor for its closest neighbors by maintaining its buildings and landscaping at a high level. Mercy also pursues recycling and programs that reduce energy consumption, primarily as cost saving measures, but these programs benefit the entire community.Leadership development and training for community membersMercy is involved on a regular basis with the Iowa City Area Chamber of Commerce annual Community Leadership Program. In this nine-month program, 24 members of the civic community receive an in-depth look at the workings of local government, public works, education system, health care, arts community, and more. This program gives participants a better understanding and appreciation of the entire community and develops fellowship among members from diverse backgrounds and settings.Mercy is also involved with the Chamber's similar Youth Leadership Program.Coalition buildingMercy is involved in many ways with local citizens and groups that are working to afford all members of our community a good quality of life and to improve the overall quality of life. Mercy is a cosponsor of and provides leadership for the 17-year-old Johnson County Safe Kids Coalition, a grass-roots effort to reduce unintentional injuries to children from birth to age 14. Since its inception, the coalition has been active in promoting bike helmet sales and bike safety and safety education events. The coalition is particularly active in providing free car seat check clinics to parents.Mercy staff members also participate in local coalitions Johnson County Liveable Communities and Johnson County Consortium on Successful Aging (focused on elderly living issues).Community health improvement advocacyHealthy Kids Community Care is a school-based clinic that provides health care to children who have no other access to it. Mercy made a large cash donation to this initiative and provided key leadership as the program developed. In 2010 the clinic served 271 unduplicated patients/students during the 2009-2010 school year.Mercy also provides financial support to the Free Medical Clinic, which saw 2,600 unduplicated patients in 2010. Those who seek care of the Free Medical Clinic typically have no other access to health care services. Workforce developmentKirkwood Foundation, Workplace Learning Connection
Part III, Line 4: We do not currently have a footnote to our financial statements that describes bad debt expense. The amount on line 2 was derived from taking actual bad debt write-offs and applying the cost to charge ratio of .3527 to that amount. Mercy Hospital does not include bad debt amounts as part of community benefit.An estimate of bad debt attributable to patients eligible for charity care has been estimated to be $30,546. This estimate was derived by using the outstanding patient balance of accounts recommended for presumptive charity at cost that were reviewed and denied. The presumptive charity program was implemented on October 1, 2010.
Part III, Line 8: Mercy Hospital does not include Medicare shortfalls as part of it's community benefit. Total revenue was determined using charges per the CMS Provider Statistical Reimbursement System reports for Fee Reimbursed Services for the fiscal year ended 6/30/11. Costs calculated using the Cost to Charge Ratio for the appropriate services from the submitted Medicare Cost Report form 2552-96 for the fiscal year ended 6/30/11.
Part III, Line 9b: Mercy Hospital has two policies related to debt collection. The Financial Assistance Policy provides guidelines for forgiving all or part of a patient's financial responsibility for healthcare services received at Mercy Hospital. Patients may be given a financial assistance application at the time of service, be offered financial assistance during the normal collection process or learn of the option on the Hospital website. All patients with no insurance are offered financial assistance via billing statements & follow up telephone calls. Any patient that is known to qualify for financial assistance is provided assistance. The payment plan policy enables those who qualify for partial financial assistance to establish payment plans of the remaining balance of their bill.
Part VI, Line 2: Historically, a community health needs assessment is conducted every 5-10 years. The most recent assessment was conducted in 2008. The organization engaged Professional Research Consultants to conduct the assessment. The community health survey is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in the communities the organization serves. The survey instrument used for the assessment is based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to national health promotion and disease prevention objectives and other recognized health issues. The results of the survey are used to improve health status, elevate overall quality of life, reduce health disparities, and increase accessibility to preventive services for all community residents. Examples of areas of opportunity for community health improvement included diabetes (an area where Mercy offers a support group), heart disease and stroke (support groups and education provided), nutrition and overweight (cooking demonstrations and public access televised cooking show), barriers to accessing healthcare services (Mercy provides support to the local Free Medical Clinic and Healthy Kids Community Care school-based clinics), and bicycle safety (Mercy provides much support to the Johnson County SAFE KIDS Coalition).
Part VI, Line 3: Evaluation for Medicaid, disability, & other types of coverage is provided for uninsured patients. This service is provided for inpatient stays as well as high dollar outpatient services. The evaluation is conducted during the patient stay or by a phone call to the patients home. Financial Assistance information & applications are available at the point of registration in the hospital as well as at Mercy affiliated clinics. The first statement sent to patients with no insurance explains that financial assistance is available & provides information about how to inquire about financial assistance. Subsequent statements also contain infomation about who to contact for financial assistance. Financial assistance is offered to all patients with no insurance on the first telephone contact. During the collection process for insured patients, if the patient expresses concern about payment they are offered financial assistance and/or payment plan options. Full or partial assistance is available. If partial assistance is received the balance may be set up on a payment plan if needed.
Part VI, Line 4: Mercy Hospital is located in the community of Iowa City, Iowa, in Johnson County in the east central part of the state. The county's population is approximately 128,000. From 2000 to 2008 Johnson County experienced strong population growth of 15.4 percent, compared to 2.6 percent for the entire state. Johnson County's population is projected to increase by another 9.5 percent by the year 2014.Mercy Hospital serves 10 counties in southeast Iowa, with the primary service area being Johnson County. The secondary service area includes Cedar, Iowa, Muscatine and Washington counties. The tertiary service area includes Henry, Jefferson, Keokuk, Lee and Louisa counties. The population of the service area is approximately 325,168.Iowa City is home to the University of Iowa, which has an enrollment of 30,893 for the 2011-2012 academic year. Johnson County is well-educated; of individuals 25 and older, 93.7 are high school graduates and 47.6 percent hold a bachelor's degree or higher.The University of Iowa also provides the foundation for an economy that has particular strengths in education, health care, services, technology, agribusiness, and manufacturing.University of Iowa Hospitals and Clinics and the Iowa City VA Medical Center are also located in Iowa City. UIHC is a 700-bed comprehensive academic medical center that draws patients from the entire region. ICVAMC cares for more than 40,000 military veterans in eastern Iowa and western Illinois. According to the U.S. Census Bureau, 15.5 percent of the Johnson County population lived below the poverty line in 2007.
Part VI, Line 6: Mercy Iowa City is a faith-based institution that provides services based on the ethical and religious directives of the Catholic Church. An important part of Mercy's mission is to improve the health of the community. Mercy does so by: Ensuring that the medical staff is open to all qualified physicians; ensuring that the hospital is accredited and in good standing with The Joint Commission; ensuring that the board of directors is comprised of diverse, independent individuals, not employees of the hospital, representing the community and also providing necessary expertise; establishing and carrying out a conflict of interest policy; providing a site for clinical experience for a variety of health care professionals; providing charity care and financial assistance with medical bills as needed to community members; participating in such programs as Medicare, Medicaid, and hawk-i, an insurance program for needy Iowa children; absorbing unreimbursed costs for such government programs; ensuring that account collections are carried out in compliance with state and federal guidelines; providing emergency room services and working with local and state officials in community prepardness issues; treating emergency patients according to EMTALA guidelines and serving all patients regardless of their ability to pay; investing surplus funds in services, technology, and personnel that will further the benefit of the community.
IAReports Filed With StatesPart VI, Line 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Iowa City Free Medical Clinic
2440 Towncrest DriveIowa CityIA52240420960955501(c)(3)15500General Support
American Heart Association-Midwest Affiliate
PO Box 4002902Des MoinesIA503402902135613797501(c)(3)13000Iowa City Events Sponsor 10-11
Community Foundation of Johnson County
325 East Washington StreetIowa CityIA52240421508117501(c)(3)100000Healthy Kids Fund
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantTemporary Assistance ProgramTypeOfGrant
Number Of Recipients33NumberOfRecipients
Amount Of Cash Grant19041AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: All organizations Mercy provides assistance to are local organizations. Therefore, Mercy is in frequent contact with the organizations and is generally aware of their use of Mercy's assistance. However, there is no formal mechanism in place to track specific uses of the assistance. Mercy Hospital offers a Temporary Assistance Program (TAP) for emergency financial needs that employees may have. This confidential program offers crisis assistance and health benefit assistance.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Ronald R Reed
3997320009749403721204573905801770761850
Jean M Berge
14212800038160217020180480185694000
Michael G Heinrich
2631830003549801379004174603542170294400
Cindy Penney
1542380001704081520315220195616000
Andrew R Ashby MD
29771802148940260000407740553646000
Martin Izakovic MD
2807300582480220049490300210374168000
Peter McDonnell MD
3924240001310000335900427324000
Stephen J Scheckel MD
31586302000001313000307800367956000
Eric J Stenberg MD
299925000327000434000343652000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aHealth club membership dues were paid for Mercy's CEO, Ronald Reed in the amount of $898.80 and were included as taxable income on his W-2.
Part I, Line 4bMercy established an IRC Section 457(f) plan as a way of retaining executives, officers and select groups of highly compensated employees with supplemental retirement benefits. The following individuals participated in and received payments from the plan. - Michael Heinrich - $29,440 - Ronald Reed - $76,185 - Cindy Penney - $0

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Hills IowaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN420920947IssuerEIN
CUSIP Number431669AA8CUSIPNumber
Date Issued2008-04-29DateIssued
Issue Price39235000IssuePrice
Description Of PurposeRefund 2005 Bonds & Certain Issuance Costs (10/19/05)DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds39235000TotalProceeds
Issuance Costs From Proceeds375139IssuanceCostsFromProceeds
Other Spent Proceeds38859861OtherSpentProceeds
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate1ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
Michael G Heinrich
Split Dollar Life Insurance PolicyX$16,08116081000
Ronald R Reed
Split Dollar Life Insurance PolicyX$38,29238292000
FieldValueIRS element (for citing)
Total Balance Due54373TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 2Sister Sharon Kerrigan, boardmember; Sister Patricia Murphy, board member; and Sister Margaret Wright, board member are all members of the Sisters of Mercy of the Americas West Midwest Community.
Form 990, Part VI, Section A, line 6Mercy's sole member is the Sisters of Mercy of the Americas West Midwest Community, Inc.
Form 990, Part VI, Section A, line 7bMercy's sole member, Sisters of Mercy of the Americas West Midwest Community, Inc., maintains a number of "reserved powers" including but not limited to approval of annual budgets, approval of amendments to the articles of incorporation and bylaws, approval of real property transactions and approval of long term borrowing.
Form 990, Part VI, Section B, line 11The Form 990 is prepared and reviewed by Mercy Hospital management and is also reviewed by Deloitte Tax LLP. The Audit Committee reviews the 990 and their review process shall be intended to reasonably verify that the Form 990 has been fully and accurately completed, including but not limited to, all inquiries therein relating to corporate governance. After completing it's review, the Audit Committee, on the Board's behalf, shall have the authority to authorize the filing of the annual Form 990. A copy of the Form 990 is made available to all board members.
A conflict of interest statement is signed at the beginning of Board members term and on an annual basis there after. Any abstention from a vote is recorded in Board minutes. After the fiscal year end a "look back" questionnaire is distributed to all Board members to disclose any conflicts of interest that may have taken place in the previous year. Form 990, Part VI, Section B, Line 13: Per IRS guidance, because the board had not formally adopted the whistleblower policy as of 6/30/11, the organization has answered "No" to this question. Mercy has an Administrative team "A Team" which is made up of Vice Presidents and the CEO that has been delegated by the board of directors to manage and approve policies. The A Team has approved the whistleblowers policy.Form 990, Part VI, Section B, line 12c
Compensation for all executives and other key employees is determined based on national or regional market data for comparable positions at comparatively sized hospitals. The Executive Committee of the Board of Directors uses this market-based information to set the President and CEO's compensation. In turn, the CEO uses the same information to set compensation for officers and key employees, which is also approved by the board.Form 990, Part VI, Section B, line 15
An annual statement of "Financial Highlights" is published in Mercy's annual report. It provides annual Funds Available and Funds Applied in the form of percentages of Mercy's total budget. The annual report is produced in print form and appears on Mercy's Website, www.mercyiowacity.org, as a PDF. Mercy's governing documents and conflict of interest policy are not available to the public.Form 990, Part VI, Section C, line 19
The following individuals held positions at both Mercy Hospital and the Mercy Hospital, Iowa City, Iowa Self Insurance Plan and Trust. The hours listed on Part VII are the average hours per week these individuals devoted to the Hospital during the year. In addition, these individuals also devoted the following average hours per week to the Trust. - Ronald R. Reed - 1.0 hour - Michael Heinrich - 1.0 hour The following individuals held positions at both Mercy Hospital and Mercy Foundation. The hours listed on Part VII are the average hours per week these individuals devoted to the Hospital during the year. In addition, these individuals also devoted the following average hours per week to Mercy Foundation. - Ronald R. Reed - 2.0 hours - Michael Heinrich - 2.0 hours - Jean Berge - 1.0 hour - Scott Fisher - 1.0 hourForm 990, Part VII:
Changes in Net Assets or Fund Balances:Net unrealized gains on investments: 11,347,305. Change in Unrecognized Pension Actuarial Loss 13,329,269. Change in Beneficial Interest in Foundation 2,149,925. Transfer to Mercy Hospital Self Insurance Plan & Trust -712,500. Change in Beneficial Interest in Services -25,475,019. Total to Form 990, Part XI, Line 5: 638,980.Form 990, Part XI, line 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Mercy Foundation
500 East Market StreetIowa CityIA52245237040506Foundation/FundraisingIA501(c)(3)11-IN/A1
Mercy Hospital Iowa City Iowa Self Insurance Plan & Trust
500 East Market StreetIowa CityIA52245426591803Self InsuranceIA501(c)(3)11-IN/A1
Sisters of Mercy of the Americas West Midwest Community Inc
7262 Mercy RoadOmahaNE68124262400800Religious OrderNE501(c)(3)N/A0
Mercy Hospital Guild
500 East Market StreetIowa CityIA52245426099912FundraisingIA501(c)(3)11-III-FIN/A0

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
Cancer Care of Iowa City LLC
613 East Bloomington Suite 100Iowa CityIA52245421460774Oncology ServicesIAN/ARelated-204499801215000.58550
Iowa City Ambulatory Surgical Center LLC
2963 Northgate DriveIowa CityIA52245208503424Outpatient SurgeryIAN/ARelated37520877203159010.62500

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Mercy Services Iowa City IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 East Market StreetAddressLine1
CityIowa CityCity
StateIAState
ZIP Code52245ZIPCode
FieldValueIRS element (for citing)
EIN421241044EIN
Primary ActivityMedical Clinic ServicesPrimaryActivity
Legal Domicile StateIALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income-3876665ShareOfTotalIncome
Share Of EOY Assets8294006ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
MERCY SERVICES IOWA CITY
A709495Cost
CANCER CARE OF IOWA CITY
A124472Cost
MERCY FOUNDATION
C564391Cost
MERCY HOSPITAL SELF INSURANCE PLAN & TRUST
B712500Cost
MERCY SERVICES IOWA CITY
P1485300Cost
CANCER CARE OF IOWA CITY
P669190Cost
MERCY FOUNDATION
P366936Cost
MERCY SERVICES IOWA CITY
D800000Cost