2024-12-16T20:00:55-06:00 2024-01-23 861065772 Deloitte Tax LLP 111 Monument Circle Suite 4200 Indianapolis IN 46204 990 2023-07-01 237040506 Mercy Hospital Foundation MERC 5166779740 500 East Market Street Iowa City IA 52245 Marc Ross Liquidating Trustee Advisor 5166779740 2024-12-16 1 1 Shawna M Jansons P01222873 6123974000 2023 2024-10-15 13:58:12Z X Dan Childers c/o Shuttleworth Ingersoll PLC 235 6th St SE Cedar Rapids IA 524062107 21651298 0 X www.mercyiowacity.org X 1969 IA Generate private support for Mercy Hospital, Iowa City and manage, invest and disburse funds. X 9 6 0 6 0 0 468864 34140 0 0 238375 1773523 0 0 707239 1807663 124301 0 0 0 283070 150972 0 0 0 82503 300251 489874 451223 217365 1356440 18337472 0 94182 0 18243290 0 X Generate private support for Mercy Hospital, Iowa City ("Mercy"); manage, invest and disburse funds with regard to donor's intentions. 0 1 0 0 0 Mercy Hospital Foundation ("The Foundation") supported the operations of Mercy Hospital, Iowa City as it navigated the bankruptcy process. 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Dan Childers 5166779740 c/o Shuttleworth Ingersoll PLC Cedar Rapids IA 524062107 Tom Clancy CEO & Administrator (End 10/23) 1.00 40.00 X X 0 315704 5317 Kim Volk Board Member (Beg 10/23) 1.00 40.00 X 0 251722 34341 Lisa Steigleder President 40.00 0.00 X X 0 172486 32649 Denice Connell Board Member/Treasurer (Beg 10/23) 1.00 0.00 X X 0 0 0 Jim Porter Treasurer (End 10/23) 1.00 40.00 X X 0 0 0 Steven Anderson Chair (Beg 10/23) 1.00 0.00 X X 0 0 0 Todd Jacobson Secretary (Beg 10/23) 1.00 0.00 X X 0 0 0 Tor Nicklaus Secretary/Chair-Elect (Beg 10/23) 1.00 0.00 X X 0 0 0 Ann Perino Board Member 1.00 0.00 X 0 0 0 Kim Casko Board Member (End 10/23) 1.00 0.00 X 0 0 0 Lynn Skopec Chair (End 10/23)/Board Member 1.00 0.00 X X 0 0 0 Patricia Heiden Board Member (End 10/23) 1.00 0.00 X 0 0 0 Scott Fisher Board Member (End 10/23) 1.00 0.00 X 0 0 0 Stephen Scheckel Board Member (End 10/23) 1.00 0.00 X 0 0 0 Dawna Miller Treasurer 1.00 41.00 X X 0 122216 0 Stuart Elkin Asst. Treas. (End 5/23) 1.00 40.00 X 0 86167 7879 0 948295 80186 0 0 1 0 0 34140 34140 253293 253293 21363865 19843635 1520230 1520230 1520230 1807663 0 0 1773523 113580 113580 21277 21277 309 309 6797 6797 9009 9009 209935 209935 2035 2035 343 343 20816 20816 1822 1822 Miscellaneous 65300 65300 451223 0 451223 0 150753 0 146308 0 2630 0 0 0 0 0 0 0 0 4400 0 17995687 0 0 0 0 37694 0 18337472 0 94182 0 94182 0 X 11870942 0 6372348 0 18243290 0 18337472 0 X 1356440 -1435643 -18164087 X 0 0 0 X X 1 Mercy Hospital Iowa City Iowa 420680391 3 1 18164087 0 1 18164087 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 18141995 0 0 0 18141995 16417674 16570 1759209 51458 18141995 20513591 37504 -2858763 1274658 16417674 16457386 47025 5088018 1078838 20513591 17144540 140115 -233782 593487 16457386 0.00000 0.00000 0.00000 0 0 0 Part V, Line 4: All remaining Restricted Endowed Funds in FY24 were used for the benefit of Mercy Hospital Iowa City - to fund operations. 1 0 0 0 0 0 0 0 0 Tom Clancy CEO & Administrator (End 10/23) 0 315704 0 0 0 0 0 5317 0 0 0 321021 0 0 Kim Volk Board Member (Beg 10/23) 0 251451 0 0 0 271 0 10494 0 23847 0 286063 0 0 Lisa Steigleder President 0 172206 0 0 0 280 0 3500 0 29149 0 205135 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 During 2023, Dawna Miller received a severance payment in the amount of $122,216 Transfer of Assets, Liabilities, and Net Assets to Mercy Hospital Iowa City, Iowa 18164087 Book value 420680391 Mercy Hospital Iowa City Iowa 500 E Market St Iowa City IA 52245 501(c)(3) 0 0 0 0 1 1 1 1 0 Form 990, Part III, line 3 Mercy Hospital Foundation was dissolved on 1/23/24. Form 990, Part VI, Section A, line 1a Lisa Steigleder was allowed to vote on the Full Board, but not on the Executive Committee. Stuart Elkin is not a Board Member but filled in as Assistant Treasurer if the Treasurer/CFO is not availiable. Form 990, Part VI, Section A, line 3 ToneyKorf Partners provided certain management oversight and personnel services pursuant to a strategic management agreement. 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, oversaw 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, approved 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 was reviewed by Mercy Hospital, Iowa City, Iowa's former controller, 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 as the organization has been dissolved. Form 990, Part VI, Section B, line 12c Each board member completed 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 existed. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's President, the Executive Committee of the board met 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 shared 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 approved 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: Transfer of net assets to mercy hospital, Iowa city, iowa upon dissolution -18,164,087. 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 0 0 0 0