2024-05-15T13:59:36-05:00 2023-06-30 861065772 Deloitte Tax LLP 111 Monument Circle Suite 4200 Indianapolis IN 46204 990 2022-07-01 237040506 Mercy Hospital Foundation MERC 3193393657 500 East Market Street Iowa City IA 52245 Thomas Clancy CEO 3193393657 2024-05-15 1 Thomas Clancy 999009999 0 Shawna M Jansons P01222873 6123974000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Thomas Clancy 500 East Market Street Iowa City IA 52245 6871975 0 X www.mercyiowacity.org X 1969 IA Generate private support for Mercy Hospital Iowa City and manage, invest and disburse funds. 11 10 0 10 0 0 274323 468864 0 0 825418 238375 0 0 1099741 707239 1350000 124301 0 0 275527 283070 0 0 239694 113994 82503 1739521 489874 -639780 217365 16632605 18337472 94401 94182 16538204 18243290 Generate private support for Mercy Hospital Iowa City ("Mercy"); manage, invest and disburse funds with regard to donor's intentions. 0 0 124301 124301 Mercy Hospital Foundation ("The Foundation") provided $124,301 in funding in fiscal year 2023 to Mercy Hospital Iowa City for assistance with purchasing medical equipment, flooring, website upgrades, nursing and health career scholarships and more to improve patient care, enhance the hospital's healing environment and provide support for specific areas. 124301 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 3 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Thomas Clancy 3193393540 500 East Market Street Iowa City IA 52245 Dawna Miller Treasurer (End 7/22) 1.00 41.00 X X 0 366748 32802 Lisa Steigleder President 40.00 0.00 X X 0 169329 29035 Jeffrey Rooney Treasurer (8/22-4/23) 1.00 41.00 X X 0 0 0 Jim Porter Treasurer (Begin 5/23) 1.00 41.00 X X 0 0 0 Lynn Skopec Chair-Elect/Chair 1.00 0.00 X X 0 0 0 Mike Trachta CEO & Administrator (End 3/23) 1.00 41.00 X X 0 0 0 Steven Anderson Secretary/Chair-Elect (Beg 10/22) 1.00 1.00 X X 0 0 0 Tom Clancy CEO & Administrator (Beg 4/23) 1.00 2.00 X X 0 0 0 Tor Nicklaus Secretary (Beg 10/22) 1.00 0.00 X X 0 0 0 Ann Perino Board Member 1.00 0.00 X 0 0 0 Denice Connell Board Member 1.00 0.00 X 0 0 0 Kim Casko Board Member 1.00 0.00 X 0 0 0 Patricia Heiden Board Member 1.00 0.00 X 0 0 0 Sarah Leonard Board Member (End 10/22) 1.00 0.00 X 0 0 0 Scott Fisher Chair (End 9/22)/Board Member 1.00 0.00 X 0 0 0 Todd Jacobson Board Member (End 10/22) 1.00 0.00 X 0 0 0 Kimberley Rossiter Assistant Treasurer (End 8/22) 1.00 41.00 X 0 208788 21185 Stuart Elkin Asst. Treas. (Beg 9/22) 1.00 40.00 X 0 170462 5733 0 915327 88755 0 0 1 0 0 468864 3869 468864 451526 451526 5951585 6164736 -213151 -213151 -213151 707239 0 0 238375 110521 110521 13780 13780 211099 69663 141436 66979 22103 44876 1743 575 1168 139 46 93 3110 1026 2084 18226 18226 30059 30059 1761 581 1180 20816 6869 13947 38 13 25 4650 4650 Misc Fundraising Exp 4826 4826 2127 2127 489874 124301 125879 239694 180464 150753 214146 146308 3970 2630 152247 147847 9050 4400 16203529 17995687 21446 37694 16632605 18337472 0 94401 94182 94401 94182 X 10627597 11870942 5910607 6372348 16538204 18243290 16632605 18337472 X 217365 1504804 -17083 X 0 0 0 X X 1 Mercy Hospital Iowa City Iowa 420680391 3 1 110521 0 1 110521 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16417674 16570 1759209 51458 18141995 20513591 37504 -2858763 1274658 16417674 16457386 47025 5088018 1078838 20513591 17144540 140115 -233782 593487 16457386 17286003 14493 377510 533466 17144540 0.84900 0.15100 0.00000 0 0 152247 147847 4400 4400 Amount Due to Mercy Hospital 91701 Sales & Use Tax 423 Gift Annuity Payable 2058 94182 Part V, Line 4: All the Restricted Endowed Funds are used for the benefit of Mercy Hospital Iowa City - capital equipment, employee grants, scholarships, etc. 1 Mercy Hospital Iowa City IA 500 East Market Street Iowa City IA 52245 420680391 501(c)(3) 110521 0 Facilities improvements, medical equipment, patient comfort items, and education materials 1 0 Health Career Scholarship 3 3000 Nursing Scholarship 10 9000 0 Part I, Line 2: Employee nursing grant applicants submit a written application, letter of acceptance from their college, and their most recent grades when applicable. This is reviewed by a sub-committee of the Foundation Board. Grants are made directly to the colleges. The Health Career Scholarship Program for high school students is administered by the Education Department. Disbursements to Mercy Hospital for medical equipment and facilities improvements are made after a copy of the invoice has been received documenting that the transaction has been made. Part II, line 1, Column (h): Name of Organization or Government: Mercy Hospital (h) Purpose of Grant or Assistance: Facility improvements, medical equipment, patient comfort items, and education materials and programs. 1 0 0 0 0 0 0 0 0 Dawna Miller Treasurer (End 7/22) 0 207266 0 54638 0 104844 0 8332 0 24470 0 399550 0 0 Kimberley Rossiter Assistant Treasurer (End 8/22) 0 194183 0 7750 0 6855 0 5002 0 16183 0 229973 0 0 Lisa Steigleder President 0 168567 0 762 0 0 0 3150 0 25885 0 198364 0 0 Stuart Elkin Asst. Treas. (Beg 9/22) 0 170317 0 0 0 145 0 5733 0 0 0 176195 0 0 Part I, Line 3 The Foundation relied on Mercy Hospital, a related organization, to establish the compensation of the Foundation's top management official. Mercy Hospital used the following methods to establish compensation for the Foundation President: - Compensation Committee - Independent Compensation Consultant - Form 990 of Other Organizations - Compensation Survey or Study - Approval by the Board or Compensation Committee Part I, Line 4a Dawna Miller, Chief Financial Officer received severance payments amounting to $103,884 in calendar year 2022 as part of her employment contract. Form 990, Part VI, Section A, line 1a Lisa Steigleder may vote on the Full Board, but not on the Executive Committee. Stuart Elkin is not a Board Member, but fills in as Assistant Treasurer if the Treasurer/CFO is not available. Form 990, Part VI, Section A, line 2 Mike Trachta, Jeffrey Rooney and Kimberly Rossiter have a business relationship as they simultaneously serve together on the Mercy Services Iowa City, Iowa board. Form 990, Part VI, Section A, line 3 MercyOne provides certain management oversight and personnel services pursuant to a strategic management affiliation agreement. Mike Trachta, Chief Executive Officer (ending 03/23) of Mercy Hospital Foundation, is not an employee of the foundation, but rather an employee of MercyOne, a management company. For his role as Chief Executive Officer of Mercy Hospital Iowa City, Mike Trachta is compensated $582,271 by MercyOne. Jeffrey Rooney, Chief Financial Officer (beginning 08/22 and ending 04/23) of Mercy Hospital, Iowa City, Iowa is not an employee of the hospital but rather an employee of Martinville Dunn, a management company. For his role as Chief Financial Officer of Mercy Hospital Iowa City, Jeffrey Rooney was compensated $290,398 by Martinville Dunn. Form 990, Part VI, Section A, line 6 Mercy Hospital Iowa City is the sole member of the Foundation. Form 990, Part VI, Section A, line 7a Mercy Hospital Iowa City, as the sole member of the Foundation, oversees the election of the board members of the Foundation's board of directors. Form 990, Part VI, Section A, line 7b Mercy Hospital Iowa City, Iowa, as the sole member of the Foundation, approves board nominations, number of members, appointment of President and budget of the organization. It may override all decisions of the Foundation's board of directors. It may also override decisions of the Foundation's board of directors. Form 990, Part VI, Section B, line 11b The form 990 is reviewed by Mercy Hospital, Iowa City, Iowa's controller, the chief financial officer, and an outside independent accounting and tax firm prior to submitting the form 990 to the IRS. The form 990 was not reviewed by the organization's board of directors before submitting it to the IRS. Form 990, Part VI, Section B, line 12c Each board member completes the Conflict of Interest statement and Board Service Commitment Pledge yearly at the Annual Board meeting. Board Members agree to self-disclose any conflicts of interest and refrain from voting when a conflict exists. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's President, the Executive Committee of the board meets in August to review the Foundation President's performance. In the review of the compensation, the process begins with President having an opportunity to discuss the year and key highlights, and then the Executive committee goes into a private session. The Hospital President and CEO shares the results of the Foundation President's performance with Executive Committee of the board at that time. During the last review, the committee used comparative information for positions similar to and used that to adjust the Foundation President's salary to a point they felt was appropriate. During the August board meeting the board formally approves the Foundation President's continuing as the Foundation President for another year. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part XI, line 9: Contribution Revenue Not Recorded for Books -17,083. Mercy Hospital Iowa City Iowa 500 East Market Street Iowa City IA 52245 420680391 Health Care IA 501(c)(3) 3 N/A 0 Mercy Hospital Iowa City Iowa-Self Insurance Plan and Trust 500 East Market Street Iowa City IA 52245 426591803 Self Insurance IA 501(c)(3) 12A, I Mercy Hospital 1 Sisters of Mercy of the Americas West Midwest Community Inc 7262 Mercy Road Omaha NE 68124 262400800 Religious Order NE 501(c)(3) Religious Order N/A 0 Mercy Hospital Guild 500 East Market Street Iowa City IA 52245 426099912 Fundraising IA 501(c)(3) 12C, III-FI N/A 0 Iowa City Ambulatory Surgical Center LLC 2963 Northgate Drive Iowa City IA 52245 208503424 Outpatient Surgery IA N/A 0 0 Corridor Radiology LLC 2769 Heartland Drive Coralville IA 52241 460635070 Radiology Services IA N/A 0 0 Eastern Iowa Rehabilitation Hospital LLC 680 S 4th Street Louisville KY 40202 831589139 Inpatient Rehabilitation Care IA N/A 0 0 Mercy Services Iowa City Inc 500 East Market Street Iowa City IA 52245 421241044 Health Care IA N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 Mercy Hospital Iowa City Iowa B 110521 FMV