2026-05-15T15:07:00-05:00 2025-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2024-07-01 426591803 MERCY HOSPITAL IOWA CITY IOWA SELF INSURANCE PLAN AND TRUST MERC 3193390300 500 EAST MARKET STREET IOWA CITY IA 52245 MARC ROSS LIQUIDATING TRUSTEE ADVISOR 5166779740 2026-05-15 1 1 SHAWNA M JANSONS P01222873 3174648600 2024 2025-03-06 01:10:19Z DAN CHILDERS C/O SHUTTLEWORTH INGERSOLL PLC 235 6TH STREET SE CEDAR RAPIDS IA 52401 0 0 X MERCYIOWACITY.ORG X 1998 IA A TRUST TO PROTECT ASSETS CONTRIBUTED FOR MEDICAL MALPRACTICE & LIABILITY RESERVES. 1 0 0 0 0 0 30000 0 0 0 31345 0 0 0 61345 0 0 0 0 0 0 0 0 0 0 275424 0 275424 0 -214079 0 0 0 0 0 0 0 X THE TRUST WAS ESTABLISHED TO PROTECT MONEY, PROPERTY, AND OTHER ASSETS CONTRIBUTED BY PARTICIPANTS TO PROVIDE MEDICAL MALPRACTICE AND LIABILITY RESERVES. 0 1 0 0 0 MERCY HOSPITAL IOWA CITY IOWA SELF INSURANCE PLAN AND TRUST ("THE TRUST") IS A SELF INSURANCE PROGRAM FOR THE BENEFIT OF MHIC. THE TRUST WAS ESTABLISHED TO PROTECT MONEY, PROPERTY, AND OTHER ASSETS CONTRIBUTED BY PARTICIPANTS TO PROVIDE MEDICAL MALPRACTICE AND LIABILITY RESERVES. MERCY HOSPITAL SELF INSURANCE PLAN & TRUST WAS FULLY LIQUIDATED TO SUPPORT THE OPERATIONS OF MHIC AS IT NAVIGATED THE BANKRUPTCY PROCESS AND THEREFORE HAS NO PROGRAM ACTIVITY TO REPORT. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 X 1 0 0 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X DAN CHILDERS 5166779740 C/O SHUTTLEWORTH AND INGERSOLL PLC CEDAR RAPIDS IA 524062107 X DAN CHILDERS PRESIDENT/SECRETARY/TREASURER 1.00 14.00 X X 0 0 0 MARC ROSS FINANCIAL ADVISOR TO MHLT 1.00 20.00 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 0 X 0 0 0 X X 1 MHIC 420680391 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FORM 990, PART III, LINE 3 MERCY HOSPITAL SELF INSURANCE PLAN & TRUST WAS FULLY LIQUIDATED TO SUPPORT THE OPERATIONS OF MHIC AS IT NAVIGATED THE BANKRUPTCY PROCESS. FORM 990, PART VI, SECTION A, LINE 3 SHUTTLEWORTH & INGERSOLL PROVIDED CERTAIN MANAGEMENT OVERSIGHT AND WINDDOWN SERVICES PURSUANT TO THE DEBTOR'S FIRST AMENDED COMBINED DISCLOSURE STATEMENT AND JOINT PLAN OF LIQUIDATION DATED APRIL 3, 2024, AS MODIFIED BY THE FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER CONFIRMING DEBTORS' JOINT CHAPTER 11 PLAN OF LIQUIDATION DATED JUNE 7, 2024. DAN CHILDERS, TRUSTEE OF THE MERCY HOSPITAL LIQUIDATION TRUST, IS NOT AN EMPLOYEE OF MERCY HOSPITAL IOWA CITY IOWA SELF INSURANCE PLAN AND TRUST, BUT RATHER AN EMPLOYEE OF SHUTTLEWORTH & INGERSOLL, A MANAGEMENT COMPANY. FOR HIS ROLE AS TRUSTEE OF MERCY HOSPITAL IOWA CITY IOWA SELF INSURANCE PLAN AND TRUST, DAN CHILDERS WAS COMPENSATED BY SHUTTLEWORTH & INGERSOLL. FORM 990, PART VI, SECTION A, LINE 7A MHIC, AS A PARTICIPANT OF THE TRUST, MAY APPOINT TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B MHIC, AS THE PARTICIPANT OF THE TRUST, MAY APPROVE DECISIONS OF THE TRUST'S TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY MERCY HOSPITAL LIQUIDATION TRUST'S FINANCIAL ADVISOR AND AN OUTSIDE INDEPENDENT ACCOUNTING AND TAX FIRM PRIOR TO SUBMISSION TO THE IRS. THE FORM 990 WAS NOT REVIEWED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE SUBMISSION, AS THE ORGANIZATION IS NO LONGER OPERATING AND HAS EMERGED FROM BANKRUPTCY. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST CHECK IS PERFORMED BY THE SOLE BOARD MEMBER AND ALL PROFESSIONALS UTILIZED BY MHIC ON A REGULAR BASIS. FORM 990, PART VI, SECTION B, LINE 15 THERE ARE NO LONGER ANY COMPENSATED EMPLOYEES AS OF FEBRUARY 2024, FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. MHIC 500 EAST MARKET STREET IOWA CITY IA 52245 420680391 HEALTH CARE IA 501(C)(3) 3 N/A 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 IOWA CITY AMBULATORY SURGICAL CENTER LLC 2963 NORTHGATE DRIVE IOWA CITY IA 52245 208503424 OUTPATIENT SURGERY 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 MERCY HOSPITAL LIQUIDATION TRUST 235 6TH ST SE CEDAR RAPIDS CA 52401 996633146 DISSOLUTION IA N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0