2024-05-15T15:30:57-05:00 2023-06-30 420714325 RSM US LLP 4650 EAST 53RD STREET DAVENPORT IA 528073479 990 2022-07-01 510233180 MERCY HOSPITALCEDAR RAPIDSIA ENDOWMENT FOUNDATION INC MERC 3193986105 701 10TH ST SE CEDAR RAPIDS IA 52403 NATHAN VAN GENDEREN EXECUTIVE VP/CFO 3193986105 2024-05-14 1 NATHAN VAN GENDEREN 999009999 0 JENIFER L CHASE P01306883 5638884000 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MERCY MEDICAL CENTER FOUNDATION NATHAN VAN GENDEREN 701 10TH ST SE CEDAR RAPIDS IA 52403 28449149 0 X WWW.MERCYCARE.ORG/WAYS-TO-GIVE/ X 1977 IA TO FOSTER, SUPPORT, AND ENCOURAGE THE MISSION AND ACTIVITIES OF MERCY MEDICAL CENTER. 11 10 7 15 0 1974 10785402 6871949 0 0 7563974 4976238 -413783 -521374 17935593 11326813 6327285 16449469 0 0 718957 813989 98135 0 487632 423005 545372 7567382 17808830 10368211 -6482017 138946347 132829882 2872129 2764278 136074218 130065604 EXCLUSIVELY ORGANIZED TO FOSTER, SUPPORT, AND ENCOURAGE THE MISSION AND ACTIVITES OF MERCY MEDICAL CENTER. 0 0 16449469 16449469 TO FOSTER, SUPPORT, AND ENCOURAGE THE MISSION AND ACTIVITIES OF MERCY MEDICAL CENTER. 16449469 1 1 0 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 0 0 1 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 X 13 0 1 7 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 AL AR CA FL GA HI IL KS KY MA MD MI MN MS NC NH NJ NM NY OR PA RI SC TN VA WI WV X KIM GRADY 3193986105 701 10TH ST SE CEDAR RAPIDS IA 52403 X TIMOTHY L CHARLES FORMER SECRETARY 3.00 X X 0 910163 81633 A JAMES TINKER FORMER DIRECTOR 1.00 X 0 116035 7399 STACY CATALDO DIRECTOR 1.00 X 0 0 0 CHRIS DEWOLF DIRECTOR 1.00 X 0 0 0 BARRIE ERNST DIRECTOR 1.00 X 0 0 0 BRUCE MCGRATH DIRECTOR 1.00 X 0 0 0 JANET MERFELD DIRECTOR 1.00 X 0 0 0 CHERYLE MITVALSKY CHAIRMAN 1.00 X X 0 0 0 DARREL MORF VICE CHAIRMAN 1.00 X X 0 0 0 JOHN RIFE DIRECTOR 1.00 X 0 0 0 CHARLES ROHDE DIRECTOR 1.00 X 0 0 0 AL RUFFALO FORMER DIRECTOR 1.00 X 0 0 0 EMMETT J SCHERRMAN TREASURER 1.00 X X 0 0 0 TIMOTHY QUINN MD SECRETARY 3.00 X X 0 718980 72933 NATHAN VAN GENDEREN EXECUTIVE VP/COO/CFO/ASSISTANT TREASURER 1.00 X 0 474578 65896 LORRIE M ERUSHA PRESIDENT 40.00 X 180854 0 25220 180854 2219756 253081 1 0 1 0 0 497541 967344 5407064 115272 6871949 5178809 5178809 15965857 16168428 -202571 -202571 -202571 432534 497541 953908 -521374 -521374 11326813 0 0 4454864 16386219 16386219 63250 63250 214396 160797 53599 434886 304258 130628 15411 11521 3890 106657 79736 26921 42639 31877 10762 130 130 41698 41698 206985 206985 112787 112787 8988 8988 41950 41950 1 1 138 138 11489 11489 PRINTING & PUBLICATIONS 51451 51451 DONOR CULTIVATION 26880 26880 MISCELLANEOUS EXPENSE 25738 25738 DUES AND SUBCRIPTIONS 5072 5072 12065 12065 17808830 16449469 871729 487632 4465431 2857554 10830602 9628059 7809215 118344 118344 0 0 122782165 111657306 868149 877748 138946347 132829882 99236 173947 156804 295890 2616089 2294441 2872129 2764278 X 63156424 51778318 72917794 78287286 136074218 130065604 138946347 132829882 -6482017 473403 0 X X 0 1 X 1 0 X X 1 MERCY MEDICAL CENTER 420698295 3 1 16386219 0 1 16386219 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PART IV, SECTION C, LINE 1: PER THE MERCY HOSPITAL, CEDAR RAPIDS, IA ENDOWMENT FOUNDATION'S (FOUNDATION) GOVERNING BYLAWS, A MAJORITY OF THE DIRECTORS SHALL ALSO BE MEMBERS OF THE MERCY HOSPITAL, CEDAR RAPIDS, IOWA BOARD OF TRUSTEES. IN THE EVENT, WHETHER BY DEATH, RESIGNATION OR OTHERWISE, LESS THAN A MAJORITY OF THE BOARD OF DIRECTORS SHALL BE MEMBERS OF THE BOARD OF TRUSTEES OF MERCY HOSPITAL, CEDAR RAPIDS, IOWA, A SPECIAL MEETING OF THE BOARD OF DIRECTORS SHALL BE CALLED FOR THE PURPOSE OF RE-ELECTING MEMBERS OF THE BOARD OF DIRECTORS, A MAJORITY OF WHICH SHALL BE MEMBERS OF THE BOARD OF TRUSTEES OF MERCY HOSPITAL, CEDAR RAPIDS, IOWA. FURTHERMORE, (1) THE PRESIDENT AND CEO AND BOARD MEMBER OF THE SUPPORTED ORGANIZATION (MERCY HOSPITAL) IS ALSO A BOARD MEMBER AND OFFICER OF THE SUPPORTING ORGANIZATION (FOUNDATION), (2) THE VICE CHAIRMAN AND BOARD MEMBER OF THE SUPPORTED ORGANIZATION IS ALSO A BOARD MEMBER OF THE SUPPORTING ORGANIZATION, (3) THE TREASURER AND BOARD MEMBER OF THE SUPPORTED ORGANIZATION IS ALSO THE TREASURER AND BOARD MEMBER OF THE SUPPORTING ORGANIZATION, AND (4) THE CFO OF THE SUPPORTED ORGANIZATION IS ALSO THE CFO OF THE SUPPORTING ORGANIZATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 81579640 65958 3287666 -129890 14026719 71036435 82365623 5693080 -2715364 716834 3046863 81579642 65433553 6112026 10511350 -812952 504258 82365623 34140867 30594750 1101466 232175 171355 65433553 33874605 146716 389112 140348 129218 34140867 0.53910 0.46090 0.00000 0 0 118344 118344 0 0 BENEFICIAL INTEREST IN PERPETUAL TRUST 3848858 F MUTUAL FUNDS 102969396 F MONEY MARKET FUNDS & CASH EQUIV 4839052 F 111657306 ANNUITY PAYABLE 170400 DUE TO MERCY MEDICAL CENTER 2124041 2294441 X 12690989 473403 143850 617253 12073736 -746923 -746923 11326813 18699603 143850 953908 1097758 17601845 206985 206985 17808830 PART III, LINE 1A: THE ORGANIZATION HAS TWELVE PIECES OF ARTWORK IN ITS COLLECTION. THE COLLECTION IS ON DISPLAY FOR PUBLIC VIEWING. THE FOUNDATION HAS ELECTED NOT TO CAPITALIZE THEIR COLLECTION AS PERMITTED BY STATEMENT OF FINANCIAL ACCOUNTING STANDARDS (SFAS) NO. 116, ACCOUNTING FOR CONTRIBUTIONS RECEIVED AND CONTRIBUTIONS MADE. THE FOUNDATION'S COLLECTIONS THAT HAVE BEEN DONATED ARE NOT RECOGNIZED AS ASSETS ON THE BALANCE SHEET. NONE OF THE ARTWORK HAS BEEN SOLD TO RAISE FUNDS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR THE HALL-PERRINE CANCER CENTER AND CANCER CENTER PROGRAMS, HALL RADIATION CENTER, OLDORF HOSPICE HOUSE, HOSPICE OF MERCY PROGRAMS, HALLMAR, WATTS LIBRARY, CAREGIVERS CENTER, ESPECIALLY FOR YOU RACE AGAINST BREAST CANCER, MERCY MEDICAL CENTER OPERATING AND CAPITAL PROJECTS, AND GENERAL ENDOWMENT FUNDS TO BE USED AT THE BOARD OF DIRECTOR'S DISCRETION. PART X, LINE 2: THE INTERNAL REVENUE SERVICE (IRS) HAS RECOGNIZED MERCY MEDICAL CENTER FOUNDATION (FOUNDATION) AS EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE FOUNDATION FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO NOT-FOR-PROFIT ENTITIES INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2023 AND 2022, THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY. THE FORM 990 FILED BY THE FOUNDATION IS SUBJECT TO EXAMINATION BY THE IRS UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES INCLUDED WITH EXPENSES ON REPORT -953,908. INVESTMENT EXPENSES NOT INCLUDED ON FORM 990, PART VIII, LINE 3 206,985. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES INCLUDED WITH EXPENSES ON REPORT 953,908. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES NOT INCLUDED ON FORM 990, PART VIII, LINE 3 206,985. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 39121515 0 0 0 0 0 0 39121515 0 39121515 1 0 1 1 1 0 PART III ACCOUNTING METHOD: WALK (EFY) 930075 497541 432534 953908 930075 497541 432534 953908 953908 -521374 1 MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 1132008 2531 FMV IN KIND(MEALS AND GIFT CARDS) MERCY MEDICAL CENTER PROJECTS & OPERATIONS MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 13818252 0 EQUIPMENT MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 524153 0 HALL RADIATION CENTER MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 205173 0 CANCER SERVICES & HALL-PERRINE CANCER CENTER MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 278398 0 FAMILY CAREGIVERS CENTER MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 298472 0 HOSPICE HOUSE AND HOSPICE PROGRAMS MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 501(C)(3) 127232 0 NURSING SCHOLARSHIPS & EDUCATIONAL PROGRAMS 1 0 EMPLOYEE ASSISTANCE 125 63250 PART I, LINE 2: AT THE END OF THE FISCAL YEAR, THE RECIPIENTS OF THE MAJOR GRANTS FOR CAPITAL PROJECTS AND OPERATIONS ATTEND THE ANNUAL BOARD MEETING OF THE FOUNDATION. THE HEADS OF THESE DEPARTMENTS PROVIDE A REPORT OF HOW THE MONEY WAS USED, MAJOR ACCOMPLISHMENTS, AND FUTURE PLANS. THE SMALLER GRANTS ARE INITIALLY PAID BY MERCY MEDICAL CENTER. ON A QUARTERLY BASIS, THE FOUNDATION REIMBURSES MERCY MEDICAL CENTER FOR THE GRANTS. BEFORE REIMBURSEMENT, THE FOUNDATION ACCOUNTANT REVIEWS THE INFORMATION, CHECKS INVOICES TO ENSURE THE PROPER USAGE OF THE FUNDS PROVIDED, AND MAKES SURE NECESSARY DOCUMENTATION IS PROVIDED. ONCE THE INFORMATION HAS BEEN VERIFIED, A REIMBURSEMENT CHECK IS ISSUED. THE MERCY MEDICAL CENTER FOUNDATION INITIATED THE EMPLOYEE RELIEF FUND TO PROVIDE FINANCIAL ASSISTANCE TO MERCY EMPLOYEES WHO HAVE BEEN IMPACTED BY THE COVID-19 CRISIS AND OTHER POTENTIAL DISASTERS. THE EMPLOYEE RELIEF FUND IS MAINTAINED THROUGH THE SUPPORT OF THE MERCY MEDICAL CENTER FOUNDATION AND OTHER DONATIONS. THE MAXIMUM AMOUNT OF ASSISTANCE ALLOWED MAY BE UP TO $750, UNLESS OTHERWISE DETERMINED BY THE EMPLOYEE RELIEF FUND COMMITTEE AND BASED ON FUNDS AVAILABLE. TO REQUEST FUNDS, AN APPLICATION IS SUBMITTED INCLUDING APPROPRIATE DOCUMENTATION FOR THE BILLS/EXPENSES THEY ARE REQUESTING ASSISTANCE WITH. EACH REQUEST IS THEN REVIEWED INDEPENDENTLY BY THE EMPLOYEE RELIEF FUND COMMITTEE TO DETERMINE ELIGIBILITY. FUNDS ARE PAID BY CHECK FOR ACCEPTED APPLICATIONS. DUE TO THE SCREENING OF THE APPLICATIONS ON THE FRONT END OF THE PROCESS, NO FOLLOW-UP IS NEEDED AFTER THE FUNDS ARE DISBURSED. X 1 1 0 1 0 0 0 0 0 0 0 TIMOTHY L CHARLES FORMER SECRETARY 0 788159 0 109006 0 12998 0 63189 0 18444 0 991796 0 0 TIMOTHY QUINN MD SECRETARY 0 551922 0 161997 0 5061 0 46778 0 26155 0 791913 0 0 NATHAN VAN GENDEREN EXECUTIVE VP/COO/CFO/ASSISTANT TREAS 0 424421 0 47462 0 2695 0 37262 0 28634 0 540474 0 0 LORRIE M ERUSHA PRESIDENT 175919 0 0 0 4935 0 2337 0 22883 0 206074 0 0 0 PART I, LINE 1A IN TAX YEAR 2022, THE MERCY MEDICAL CENTER FOUNDATION PROVIDED CLUB DUES TO LORRIE ERUSHA. THE AMOUNT IS INCLUDED IN REPORTABLE COMPENSATION IN PART VII AND SCHEDULE J. PART I, LINE 3 MERCY HOSPITAL, CEDAR RAPIDS, IA ENDOWMENT FOUNDATION RELIES ON MERCYCARE SERVICE CORPORATION, A RELATED ORGANIZATION, TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS, AND KEY EMPLOYEES, AS APPLICABLE. MERCYCARE SERVICE CORPORATION UTILIZES A HUMAN RESOURCES COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE SUCH COMPENSATION. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN SPONSORED BY MERCY MEDICAL CENTER, A RELATED ORGANIZATION: TIMOTHY L. CHARLES - $55,564, TIMOTHY QUINN, M.D. - $39,153, AND NATHAN VAN GENDEREN - $29,637. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY MERCY MEDICAL CENTER ON BEHALF OF THE INDIVIDUAL TO THE PLAN IN 2022. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. X 3 115272 FMV 0 0 1 1 PART I, COLUMN (B): MERCY MEDICAL CENTER FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS. PART I, LINE 32B: MERCY MEDICAL CENTER FOUNDATION USES WELLS FARGO TO SELL STOCK CONTRIBUTIONS RECEIVED. FORM 990, PART I, LINE 4 & PART VI, SECTION A, LINE 1B: THE FOLLOWING MERCY HOSPITAL, CEDAR RAPIDS, IA, ENDOWMENT FOUNDATION, INC. DIRECTOR IS NOT INDEPENDENT DUE TO TRANSACTIONS DISCLOSED ON FORM 990, SCHEDULE L OF MERCY MEDICAL CENTER, A RELATED TAX-EXEMPT ORGANIZATION: BARRIE ERNST. FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE COMMITTEE OF MERCYCARE SERVICE CORPORATION, A RELATED ORGANIZATION, REVIEWS THE FORM 990 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. THE MERCY MEDICAL CENTER FOUNDATION BOARD SECRETARY AND FINANCIAL CHAIRMAN SIT ON THIS COMMITTEE. THE COMMITTEE IS PROVIDED WITH GENERAL BACKGROUND INFORMATION REGARDING THE FORM 990, AND THE FORM ITSELF (INCLUDING ATTACHMENTS) IS REVIEWED. UPON REQUEST, THE TAX RETURN WILL BE AVAILABLE FOR REVIEW BY THE MERCY MEDICAL CENTER BOARD OF TRUSTEES AND THE FOUNDATION BOARD OF DIRECTORS. MEMBERS OF THE EXECUTIVE COMMITTEES AND MANAGEMENT ARE AVAILABLE TO ANSWER QUESTIONS FROM THE TRUSTEES ON THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES, AS WELL AS EACH EMPLOYEE IN SELECT AREAS TO DISCLOSE ANY INTEREST IN, OBLIGATION OR DUTY TO, OR ACTIVITY FOR ANY CONCERN IN WHICH A DIRECTOR, OFFICER, KEY EMPLOYEE, OR EMPLOYEE OR THEIR FAMILY MEMBER MAY BE INVOLVED THAT: MIGHT CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OR MIGHT HAVE THE APPEARANCE OF ADVERSELY AFFECTING THE DIRECTOR'S, OFFICER'S, KEY EMPLOYEE'S, OR EMPLOYEE'S JUDGMENT OR ACTIONS IN PERFORMING HIS/HER DUTIES TOWARDS MERCY. ALL SUCH DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES SHALL FILE AN INITIAL CONFLICT OF INTEREST REPORT UPON HIRE AND SHALL BE REQUIRED TO FILE AN UPDATED REPORT IMMEDIATELY IF ANY CHANGES OCCUR WHICH RESULT IN A CONFLICT OF INTEREST OR FINANCIAL INTEREST. ALL SUCH DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES (SUPERVISOR AND ABOVE), PHYSICIANS, AND ANY EMPLOYEE IN A POSITION TO INFLUENCE A PURCHASE DECISION SHALL RE-SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WITH ANY NECESSARY CHANGES, EACH YEAR AND IMMEDIATELY IF ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. ALL BOARD MEMBERS SHALL SUBMIT IN WRITING A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND CONFLICTING INTERESTS. THE STATEMENT SHALL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR AND AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS WITH A MERCY MEDICAL CENTER FOUNDATION BOARD MEMBER: -UPON DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, THE BOARD MEMBER, THE CORPORATE OFFICER, OR THE CEO MAKING SUCH DISCLOSURE MAY BE ASKED TO LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. -THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. -IN THE CASE OF DISCLOSURE BY A MEDICAL STAFF MEMBER, PHYSICIAN, EXECUTIVE STAFF MEMBER, DEPARTMENT DIRECTOR, SUPERVISOR, OR OTHER INDIVIDUAL, THE PRESIDENT/CEO OF ENTITY SHALL DETERMINE, BASED ON THE FACTS AND CIRCUMSTANCES DISCLOSED, IF A CONFLICT OF INTEREST EXISTS. -THE PRESIDENT/CEO OF ENTITY SHALL REPORT THE RESULTS OF ALL DETERMINATIONS, WITH REGARD TO CONFLICT OF INTEREST, TO THE CHAIR OF THE BOARD. PENALTIES FOR NON-COMPLIANCE: FAILURE TO COMPLY WITH THIS POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL FROM OFFICE AND, IN THE CASE OF MERCY MEDICAL CENTER FOUNDATION KEY PERSONNEL, EMPLOYEES, OR OTHER AFFECTED PARTIES, TERMINATION OF EMPLOYMENT. RETENTION PERIOD: ALL CERTIFICATES AND DISCLOSURE SUMMARY DOCUMENTS OF CURRENT OR FORMER EMPLOYEES (AND RELATED CORRESPONDENCE) WILL BE RETAINED IN ACCORDANCE WITH MERCY'S RECORD RETENTION POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS SET BY THE HUMAN RESOURCES COMMITTEE OF MERCYCARE SERVICE CORPORATION, A RELATED ORGANIZATION. THE COMMITTEE USES MERCER (US) INC. FOR THE REVIEW OF SALARIES AND COMPARES THEM TO COMPARABLE ENTITIES IN THE REGION. THIS PROCESS WAS LAST COMPLETED AND DOCUMENTED ON FEBRUARY 23, 2022. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR REVIEW UPON REQUEST. FORM 990, PART VII, LINE 1A: MERCYCARE SERVICE CORPORATION, MERCY MEDICAL CENTER AND MERCY CARE MANAGEMENT, INC. AND SUBSIDIARIES ARE RELATED ORGANIZATIONS OF MERCY MEDICAL CENTER FOUNDATION. FOR THOSE INDIVIDUALS WHO PROVIDE SERVICES TO MULTIPLE ORGANIZATIONS, THE HOURS REPORTED ON FORM 990, PART VII, REFLECT TOTAL HOURS RENDERED ON BEHALF OF ALL THE ORGANIZATIONS. IT WOULD BE ADMINISTRATIVELY IMPRACTICABLE FOR MEMBERS OF THE GOVERNING BOARD AND EXECUTIVE TEAM TO BREAK OUT HOURS AMONG EACH ORGANIZATION. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. MERCY MEDICAL CENTER 701 10TH STREET SE CEDAR RAPIDS IA 52403 420698295 HEALTH CARE IA 501(C)(3) LINE 3 MERCYCARE SERVICE CORPORATION 1 MERCYCARE SERVICE CORPORATION 701 10TH STREET SE CEDAR RAPIDS IA 52403 421199429 HEALTHCARE OVERSIGHT IA 501(C)(3) LINE 12B, II N/A 0 MERCY-PHS SENIOR HOUSING INC 701 10TH STREET SE CEDAR RAPIDS IA 52403 843118573 APPROPRIATE AND DEVELOP SENIOR HOUSING PROJECT IA 501(C)(3) LINE 10 MERCY MEDICAL CENTER 1 MR ASSOCIATES LLP 1455 SHERMAN ROAD HIAWATHA IA 52233 421260463 MEDICAL IMAGING IA N/A 0 0 EASTERN IOWA SLEEP CENTER 600 7TH STREET CEDAR RAPIDS IA 52401 260310416 SLEEP STUDIES IA N/A 0 0 CEDAR RAPIDS PHYSICIANS-HOSP ORG LC 722 5TH AVENUE SE CEDAR RAPIDS IA 42401 421445014 PHYSICIAN CREDENTIALING IA N/A 0 0 USRC EASTERN IOWA LLC 5851 LEGACY CIRCLE STE 900 PLANO TX 75024 844628073 DIALYSIS TX N/A 0 0 MERCY SURGERY CENTER LLC 701 10TH STREET SE CEDAR RAPIDS IA 52403 841875159 OUTPATIENT SURGERY CENTER IA N/A 0 0 MERCY CARE MANAGEMENT INC & SUBSIDIARIES PO BOX 786 CEDAR RAPIDS IA 52406 421198970 MEDICAL CLINICS IA N/A C 0 MERCY PHYSICIANS ASSOCIATES (SUB OF MERCY CARE MANAGEMENT INC) PO BOX 786 CEDAR RAPIDS IA 52406 421442443 MEDICAL SERVICES IA N/A C 0 MERCY PHYSICIAN SERVICES (SUB OF MERCY CARE MANAGEMENT INC) PO BOX 786 CEDAR RAPIDS IA 52406 421442442 SUPPORT SERVICES IA N/A C 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 MERCY MEDICAL CENTER B 16386219 FAIR MARKET VALUE MERCY MEDICAL CENTER C 967344 FAIR MARKET VALUE MERCY MEDICAL CENTER D 8068947 FAIR MARKET VALUE MERCY MEDICAL CENTER P 845774 FAIR MARKET VALUE