Form990
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Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 07-01-2021 , and ending 06-30-2022
BCheck if applicable:
CName of organization
MERCY HEALTH SERVICES - IOWA CORP
 
 
Doing business as
SEE SCHEDULE O FOR LIST
 
Number and street (or P.O. box if mail is not delivered to street address)
1000 4TH STREET SW
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MASON CITY, IA50401
D Employer identification number

31-1373080
E Telephone number

G Gross receipts $ 910,246,576
F Name and address of principal officer:
ROBERT RITZ
1449 NW 128TH ST BLDG 5
CLIVE,IA50325
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MERCYONE.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1993
M State of legal domicile: DE
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 5
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 4
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 6,612
6 Total number of volunteers (estimate if necessary) ............. 6 258
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 35,712,832
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 11,046,159 7,187,974
9 Program service revenue (Part VIII, line 2g) ......... 794,366,530 828,440,285
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 30,941,967 18,077,354
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 47,644,622 54,601,075
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 883,999,278 908,306,688
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,292,901 1,325,646
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 349,056,557 377,014,202
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet574,135    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 525,363,193 587,709,156
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 875,712,651 966,049,004
19 Revenue less expenses. Subtract line 18 from line 12....... 8,286,627 -57,742,316
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 983,464,486 862,272,475
21 Total liabilities (Part X, line 26)............. 498,681,036 474,798,286
22 Net assets or fund balances. Subtract line 21 from line 20..... 484,783,450 387,474,189
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
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Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: MERCYONE SERVES WITH FIDELITY TO THE GOSPEL AS A COMPASSIONATE, HEALING MINISTRY OF JESUS CHRIST TO TRANSFORM THE HEALTH OF OUR COMMUNITIES. MERCY HEALTH SERVICES-IOWA IS A MEMBER OF MERCYONE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 868,838,488 including grants of $ 1,325,646 ) (Revenue $ 843,446,096 )
MERCY HEALTH SERVICES-IOWA (MHS-IA) IS COMPRISED OF FOUR HOSPITAL DIVISIONS IN THE STATE OF IOWA THAT PROVIDED OVER 135,000 PATIENT DAYS OF HEALTH CARE SERVICES TO THEIR COMMUNITIES THROUGHOUT THE STATE OF IOWA AND SURROUNDING STATES.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS, AND AWARDS: WWW.MERCYONE.ORG
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet868,838,488
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
Yes
 
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
Click to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
619
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
53
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
6,612
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
5
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
4
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletBETH GDOWIK20555 VICTOR PARKWAY   LIVONIA,MI481527018 (734) 343-1000
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) STILIANOS EFSTRATIADIS......................................................................
PHYSICIAN, CARDIOLOGIST SIOUX CITY
50.00
.................
0.00
        X   0 2,852,548 18,434
(2) LINDA ROSS......................................................................
DIR; CHIEF LEGAL OFFICER TRINITY
1.00
.................
54.00
X           0 1,331,598 81,444
(3) YEN LIU......................................................................
PHYSICIAN, DERMATOLOGY NORTH IOWA
50.00
.................
0.00
        X   1,307,880 0 44,923
(4) MICHAEL FAUST......................................................................
PHYSICIAN, OBGYN NORTH IOWA
50.00
.................
0.00
        X   1,088,585 0 53,905
(5) GIOVANNI CIUFFO......................................................................
PHYSICIAN, CARDIOLOGIST SIOUX CITY
50.00
.................
0.00
        X   0 1,031,945 42,894
(6) THOO TAN......................................................................
PHYSICIAN, OBGYN NORTH IOWA
50.00
.................
0.00
        X   884,867 0 55,159
(7) BETH HUGHES......................................................................
PRESIDENT MERCYONE SIOUXLAND
52.00
.................
3.00
      X     0 721,607 137,605
(8) RODNEY SCHLADER......................................................................
PRESIDENT/CEO MERCYONE NORTH IOWA
55.00
.................
0.00
      X     0 720,887 63,802
(9) KAY TAKES......................................................................
PRESIDENT EASTERN IOWA REGION
29.00
.................
26.00
      X     0 620,231 58,685
(10) PAUL MANTERNACH......................................................................
SVP PHYS INTEGRATION/CMO NORTH IOWA
50.00
.................
0.00
      X     0 486,586 60,691
(11) DIANE FISCHELS......................................................................
VP COO MERCYONE NORTH IOWA
50.00
.................
0.00
      X     0 401,058 52,252
(12) JESICA HANSON......................................................................
VP FINANCE MERCYONE SIOUXLAND
46.00
.................
4.00
      X     335,650 0 43,696
(13) KIM DUWE......................................................................
VP FINANCE EASTERN IOWA REGION
27.00
.................
23.00
      X     0 277,880 46,059
(14) AMY BERENTES......................................................................
EVP COO EASTERN IOWA REGION
30.00
.................
20.00
      X     0 277,293 29,840
(15) LAWRENCE VOLZ......................................................................
CMO MERCYONE SIOUXLAND
50.00
.................
0.00
      X     0 192,068 29,769
(16) DANETTE ZOOK......................................................................
FORMER KE; SR FINANCE CONSULTANT NI
16.00
.................
0.00
          X 99,271 64,479 45,168
(17) ROBERT RITZ......................................................................
DIRECTOR; REGIONAL PRESIDENT & CEO
1.00
.................
1.00
X   X       0 0 0
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) MARY CORITA HEID RSM........................................................................
DIRECTOR; CHAIR
1.00
.......................1.00
X   X       0 0 0
(19) MILTON AVERY........................................................................
DIRECTOR
1.00
.......................1.00
X           0 0 0
(20) MAURITA SOUKUP RSM........................................................................
DIRECTOR
1.00
.......................1.00
X           0 0 0
(21) MICHAEL WEGNER........................................................................
TREAS; REG CFO THR 2/22;INT REG COO
1.00
.......................1.00
    X       0 0 0
(22) JODIE ROETTGER........................................................................
INT REG CFO AS OF 2/22; VP FINANCE
1.00
.......................1.00
    X       0 0 0
(23) HEATHER CAMPBELL........................................................................
SEC; CHIEF LEGAL OFFICER MERCYONE
1.00
.......................1.00
    X       0 0 0














1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 3,716,253 8,978,180 864,326
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet422
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
MASON CITY CLINIC PC

250 S CRESCENT DRIVE
MASON CITY,IA50401
MEDICAL SERVICES 52,140,315
AHSA AMERICAN HEALTHCARE SERVICES ASSOC

PO BOX 670529
DALLAS,TX75267
STAFFING SERVICES 5,318,775
NORTH IOWA ANESTHESIA ASSOC

1410 6TH STREET SW
MASON CITY,IA50401
MEDICAL SERVICES 4,961,932
GRAPETREE MEDICAL STAFFING LLC

2501 BOJI BEND DRIVE SUITE 100
MILFORD,IA51351
STAFFING SERVICES 4,672,735
NEUROSURGERY OF NORTH IOWA

1010 4TH ST SW SUITE 105
MASON CITY,IA50401
MEDICAL SERVICES 4,210,664
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet118
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 708,438
e Government grants (contributions)1e 6,384,938
f All other contributions, gifts, grants, and similar amounts not included above1f 94,598
g Noncash contributions included in lines 1a - 1f:$ 1g 10,000
h Total. Add lines 1a-1f.......MediumBullet 7,187,974
 Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUE 622110 750,445,804 750,445,804    
b PHARMACY REVENUE 446110 73,156,336 45,785,069 27,371,267  
c LABORATORY REVENUE 621500 4,838,145   4,838,145  
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 828,440,285
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 12,122,201     12,122,201
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   1,434,408 6a
b Less: rental expenses   916,631 6b
c Rental income or (loss)   517,777 6c
d Net rental income or (loss).......MediumBullet 517,777   1,208 516,569
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 52,194 6,013,925 7a
b Less: cost or other basis and sales expenses 110,966 0 7b
c Gain or (loss) -58,772 6,013,925 7c
d Net gain or (loss).........MediumBullet 5,955,153     5,955,153
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a 2,420,069
b Less: cost of goods sold .. 10b 912,291
c Net income or (loss) from sales of inventory..MediumBullet 1,507,778   1,387,847 119,931
Business Code Miscellaneous Revenue
11a MANAGEMENT REVENUE 541618 8,270,607 6,373,955 1,896,652  
b CAFETERIA REVENUE 722514 3,245,932     3,245,932
c INTERCOMPANY REVENUE 622110 2,676,826 2,676,826    
d All other revenue .... 38,382,155 38,164,442 217,713  
e Total. Add lines 11a–11d ...... MediumBullet 52,575,520
12 Total revenue. See instructions.....MediumBullet 908,306,688 843,446,096 35,712,832 21,959,786
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 1,272,177 1,272,177
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 53,469 53,469
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 4,470,151   4,470,151  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 208,918   208,918  
7 Other salaries and wages........ 306,518,093 283,972,978 22,227,804 317,311
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 12,088,761 11,190,818 885,438 12,505
9 Other employee benefits ....... 32,823,634 30,296,699 2,493,082 33,853
10 Payroll taxes ........... 20,904,645 19,802,161 1,079,265 23,219
11 Fees for services (non-employees):        
a Management ...... 14,462,231 14,462,231    
b Legal ......... 202,788   202,788  
c Accounting ........... 37,073   37,073  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 1,058,677   1,058,677  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 164,689,323 156,519,328 8,042,479 127,516
12 Advertising and promotion .... 1,282,040 199,897 1,075,906 6,237
13 Office expenses ....... 10,523,995 6,661,493 3,848,004 14,498
14 Information technology ...... 36,250,359 28,827,778 7,422,581  
15 Royalties ..        
16 Occupancy ........... 17,864,921 16,912,093 952,828  
17 Travel ............ 837,214 735,546 101,526 142
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 378,117 338,969 38,941 207
20 Interest ........... 9,820,182 9,820,182    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 40,855,350 30,373,967 10,480,065 1,318
23 Insurance ... 6,428,677 6,428,677    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 193,890,604 193,890,604    
b UBI TAXES 550,000   550,000  
c INTERCO. PURCHASED SVCS 50,618,555 20,060,717 30,557,838  
d BAD DEBT EXPENSE 18,098,216 18,098,216    
e All other expenses 19,860,834 18,920,488 903,017 37,329
25 Total functional expenses. Add lines 1 through 24e 966,049,004 868,838,488 96,636,381 574,135
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 2,097,733 1 1,826,675
2 Savings and temporary cash investments ......... 5,198 2 6,228
3 Pledges and grants receivable, net ...... 94,249 3  
4 Accounts receivable, net ............. 108,361,186 4 97,678,383
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ........... 2,623,126 7 2,281,709
8 Inventories for sale or use ............ 24,217,226 8 24,373,411
9 Prepaid expenses and deferred charges ...... 3,906,757 9 4,062,239
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 718,820,402
b Less: accumulated depreciation 10b 462,375,309 252,727,438 10c 256,445,093
11 Investments—publicly traded securities . 326,519,242 11 226,635,881
12 Investments—other securities. See Part IV, line 11 ..... 159,864,489 12 134,964,871
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 103,047,842 15 113,997,985
16 Total assets. Add lines 1 through 15 (must equal line 33)... 983,464,486 16 862,272,475
Liabilities 17 Accounts payable and accrued expenses ..... 74,960,125 17 76,851,765
18 Grants payable ...   18  
19 Deferred revenue ......... 825,220 19 792,504
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D 33,028 21 27,802
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22  
23 Secured mortgages and notes payable to unrelated third parties .. 3,903,475 23 3,818,238
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 418,959,188 25 393,307,977
26 Total liabilities. Add lines 17 through 25.. 498,681,036 26 474,798,286
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 484,720,168 27 387,418,651
28 Net assets with donor restrictions ........... 63,282 28 55,538
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 484,783,450 32 387,474,189
33 Total liabilities and net assets/fund balances ........ 983,464,486 33 862,272,475
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
908,306,688
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
966,049,004
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-57,742,316
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
484,783,450
5
Net unrealized gains (losses) on investments ...............
5
-47,430,505
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
7,863,560
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
387,474,189
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI
). See instructions
8  
9 Distributable amount for 2021 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2021
(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2021:
a From 2016.......  
b From 2017.......  
c From 2018.......  
d From 2019.......  
e From 2020.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2021 distributable amount  
i Carryover from 2016 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2021 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2021 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2021, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.
 
6 Remaining underdistributions for 2021. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.
 
7 Excess distributions carryover to 2022. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2017.....  
b Excess from 2018.....  
c Excess from 2019.....  
d Excess from 2020.....  
e Excess from 2021.....  
Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990) 2021


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2021)
Schedule B (Form 990) (2021) Page 2
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number
31-1373080
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 3
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 4
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2021)
Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e))
 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))
 
f Grassroots lobbying expenditures          
Schedule C (Form 990) 2021


Schedule C (Form 990) 2021
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
Yes
 
185,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
 
No
 
j
Total. Add lines 1c through 1i ....................................................................................................
185,000
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
PART II-B, LINE 1: MERCY HEALTH SERVICES - IOWA (MHS-IA) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED MHS-IA WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SIMILARLY, THESE HEALTH CARE ORGANIZATIONS WILL ARRANGE CONFERENCES AND SEMINARS FOR MEMBER ORGANIZATIONS AND THEIR EXECUTIVES WHICH INVOLVE LEGISLATORS OR OTHER POLITICAL FIGURES AS GUEST SPEAKERS. OUR 2021-2022 POLICY PRIORITIES INCLUDE: - EVERYONE SHOULD HAVE ACCESS TO HIGH-QUALITY, COMPREHENSIVE HEALTH CARE. THIS INCLUDES PROTECTING MEDICAID EXPANSION, HEALTH INSURANCE MARKETPLACE PRODUCTS, AND OTHER ACCESS CREATED BY THE AFFORDABLE CARE ACT (ACA) AS WELL AS INNOVATING RURAL HEALTH FINANCING, EXPANDING TELEHEALTH ACCESS, STRENGTHENING THE HEALTH CARE WORKFORCE AND CREATING NEW ENTRY POINTS FOR IMMIGRANTS. - AS COVID-19 DEMONSTRATES, INVESTMENT IN PUBLIC HEALTH IS CRITICAL TO OUR NATION'S SAFETY AND ECONOMIC HEALTH. ONGOING COVID-19 FINANCIAL AND REGULATORY RELIEF, NEW INVESTMENTS IN PUBLIC HEALTH AND POLICIES PROMOTING BEHAVIORAL HEALTH COORDINATION ARE CRITICAL. - IMPROVING THE HEALTH OF COMMUNITIES, INCLUDING ACHIEVING RACIAL EQUITY, IS THE RIGHT THING TO DO. ADVANCING RACIAL EQUITY, PRESERVING THE 340B DRUG SAVINGS PROGRAM, ATTENTION TO MATERNAL HEALTH, AND EXPANDING ACCESS TO HOUSING AND FOOD WILL IMPROVE HEALTH. - AFFORDABLE, HIGH-VALUE HEALTH CARE IS ACHIEVABLE WHEN WE EXPAND VALUE-BASED CARE MODELS, DEMAND COMMERCIAL PAYER FAIRNESS, ADDRESS OUTDATED REGULATIONS AND EXPAND THE PROGRAM FOR ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE). - SUSTAINING THE MINISTRY REQUIRES FAIR PAYMENT FROM MEDICARE, MEDICAID AND COMMERCIAL PAYERS; PRESERVATION OF THE 340B DRUG SAVINGS PROGRAM; ENDING SURPRISE BILLING; REGULATORY RELIEF; REALISTIC PRICE TRANSPARENCY; AN APPRECIATION FOR SOCIAL CARE; AND STRENGTHENING CYBER SECURITY.
Schedule C (Form 990) 2021


Additional Data


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SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance .... 25,000 25,000 25,000 25,000 25,000
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
         
f Administrative expenses ....          
g End of year balance ...... 25,000 25,000 25,000 25,000 25,000
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
Yes
 
(ii) Related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment)
(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   11,903,991 11,903,991
b Buildings ....   311,475,286 201,833,108 109,642,178
c Leasehold improvements   3,051,220 1,328,578 1,722,642
d Equipment ....   341,560,962 258,855,750 82,705,212
e Other .....   50,828,943 357,873 50,471,070
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 256,445,093
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3) Other
(A) COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES
33,741,218 F

(B) EQUITY METHOD INVESTMENTS
84,353,044 C

(C) HEDGE FUNDS
16,870,609 F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 134,964,871
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)INTERCOMPANY ACCOUNTS RECEIVABLE 15,155,504
(2)INTERCOMPANY LT PREPAID INFO SYSTEMS 52,736,480
(3)INVESTMENT IN AFFILIATES 15,455,237
(4)OPERATING LEASE RIGHT-OF-USE ASSETS 8,536,438
(5)OTHER ASSETS 4,648,275
(6)OTHER RECEIVABLES 17,466,051
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 113,997,985
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 393,307,977
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART IV, LINE 2B: MERCYONE NORTH IOWA MEDICAL CENTER HOLDS A BANK ACCOUNT FOR THEIR MEDICAL STAFF WHICH IS FUNDED BY DUES AND IS FOR THE BENEFIT OF THE MEDICAL STAFF. THE BALANCE OF THESE FUNDS ARE REPORTED ON FORM 990, PART X, LINE 21.
PART V, LINE 4: THE ENDOWMENT FUNDS OF MERCY HEALTH SERVICES - IOWA INCLUDE $25,000 KNOWN AS THE VIANNA HOLSCHLAG SCHOLARSHIP FUND. INTEREST INCOME FROM THE FUND IS MADE AVAILABLE FOR NURSING SCHOLARSHIPS. PART V, LINE 3A: ENDOWMENTS HELD BY DUBUQUE MERCY HEALTH FOUNDATION AND DYERSVILLE HEALTH FOUNDATION FOR THE BENEFIT OF MERCY HEALTH SERVICES - IOWA ARE REPORTED ON THE FORM 990'S OF THE RESPECTIVE FOUNDATIONS.
Schedule D (Form 990) 2021


Additional Data


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Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    6,784,753   6,784,753 0.720 %
b Medicaid (from Worksheet 3, column a) . . . . .     120,778,017 78,106,562 42,671,455 4.500 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     127,562,770 78,106,562 49,456,208 5.220 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 47 40,869 3,860,902 356,288 3,504,614 0.370 %
f Health professions education (from Worksheet 5) . . . 9 307 2,868,370 671,511 2,196,859 0.230 %
g Subsidized health services (from Worksheet 6) . . . . 19 27,338 22,410,830 11,326,079 11,084,751 1.170 %
h Research (from Worksheet 7) . 1   1,075   1,075 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 22 25,251 693,939 68,952 624,987 0.070 %
j Total. Other Benefits . . 98 93,765 29,835,116 12,422,830 17,412,286 1.840 %
k Total. Add lines 7d and 7j . 98 93,765 157,397,886 90,529,392 66,868,494 7.060 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development 2 7,130 3,670   3,670 0 %
3 Community support 2 680 9,371   9,371 0 %
4 Environmental improvements 1 97 611   611 0 %
5 Leadership development and
training for community members
           
6 Coalition building 1   80   80 0 %
7 Community health improvement advocacy 1 2,726 4,511   4,511 0 %
8 Workforce development 2 175 2,448   2,448 0 %
9 Other            
10 Total 9 10,808 20,691   20,691 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
18,098,216
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
256,811,652
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
287,969,565
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-31,157,913
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
11 FOREST PARK IMAGING LLC
 
IMAGING SERVICES 52.890 %   47.110 %
22 MAGNETIC RESONANCE SERVICES LLC
 
MRI SERVICES 49.000 %   51.000 %
33 MASON CITY AMBULATORY SURGERY CENTER LLC
 
AMBULATORY SURGICAL SERVICES 51.000 %   49.000 %
44 MERCY HEART CENTER OUTPATIENT SERVICES LLC
 
OUTPATIENT ECHOCARDIOGRAPHY AND NUCLEAR MEDICINE SERVICES 51.000 %   49.000 %
55 SURGICAL CENTER BUILDING ASSOCIATES LLC
 
OWNS AND LEASES SURGICAL CENTER BUILDING 35.000 %   65.000 %
66 SIOUXLAND SURGERY CENTER LLP (DBA DUNES SURGICAL HOSPITAL)
 
AMBULATORY SURGICAL SERVICES 29.220 %   47.540 %
77 HEALTH MANAGEMENT SERVICES LLC
 
AMBULATORY SURGICAL SVCS, OCCUPATIONAL HLTH SVCS AND PRIMARY CARE PHYS SVCS 50.000 %   50.000 %
88 PREFERRED HEALTH CHOICES LLC
 
MANAGEMENT SERVICES 50.000 %   50.000 %
99 SSC MOB1 LLC
 
MEDICAL OFFICE BUILDING 11.360 %   55.610 %
10
11
12
13
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?6Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 MERCYONE NORTH IOWA MEDICAL CENTER
1000 FOURTH STREET SW
MASON CITY,IA50401
WWW.MERCYONE.ORG/NORTHIOWA/
170023H
X X   X   X X      
2 MERCYONE DUBUQUE MEDICAL CENTER
250 MERCY DRIVE
DUBUQUE,IA52001
WWW.MERCYONE.ORG/DUBUQUE/
310003H
X X         X   REHAB,LAB,PHARM, X-RAY,HOME CARE  
3 MERCYONE SIOUXLAND MEDICAL CENTER
801 FIFTH STREET
SIOUX CITY,IA51101
WWW.MERCYONE.ORG/SIOUXLAND/
970112H
X X         X   EMPLOYED PHYSICIANS, SKILLED CARE UNIT  
4 DUNES SURGICAL HOSPITAL
600 N SIOUX POINT ROAD
DAKOTA DUNES,SD57049
WWW.DUNESSURGICALHOSPITAL.COM
10580
X X                
5 MERCYONE NEW HAMPTON MEDICAL CENTER
308 NORTH MAPLE AVE
NEW HAMPTON,IA50659
WWW.MERCYONE.ORG/NEWHAMPTON/
190022H
X       X   X   EMPLOYED PHYSICIANS  
6 MERCYONE DYERSVILLE MEDICAL CENTER
1111 THIRD STREET SW
DYERSVILLE,IA52040
WWW.MERCYONE.ORG/DUBUQUE/DYERSVILLE/
310181H
X X     X   X   REHAB,LAB,PHARM, X-RAY,HOME CARE  
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MERCYONE NORTH IOWA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 19
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MERCYONE NORTH IOWA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
MERCYONE NORTH IOWA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MERCYONE NORTH IOWA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MERCYONE SIOUXLAND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
3
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MERCYONE SIOUXLAND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
MERCYONE SIOUXLAND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MERCYONE SIOUXLAND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MERCYONE DUBUQUE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
2
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 20
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MERCYONE DUBUQUE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
MERCYONE DUBUQUE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MERCYONE DUBUQUE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
4
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21   No
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
DUNES SURGICAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MERCYONE NEW HAMPTON MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
5
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MERCYONE NEW HAMPTON MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
MERCYONE NEW HAMPTON MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MERCYONE NEW HAMPTON MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MERCYONE DYERSVILLE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
6
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 20
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MERCYONE DYERSVILLE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
MERCYONE DYERSVILLE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MERCYONE DYERSVILLE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
MERCYONE NORTH IOWA MEDICAL CENTER PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: MERCYONE NORTH IOWA MEDICAL CENTER (MERCYONE NORTH IOWA) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: THE FOLLOWING ARE THE PRIORTIZED SIGNIFICANT HEALTH NEEDS THAT WERE IDENTIFIED:1. ACCESS TO CARE2. EARLY CHILDHOOD ISSUES3. HOUSING
MERCYONE SIOUXLAND MEDICAL CENTER PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: MERCYONE SIOUXLAND MEDICAL CENTER (MERCYONE SIOUXLAND) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. PREVENTATIVE CARE2. SUBSTANCE MISUSE3. PHYSICAL HEALTH4. MENTAL HEALTH
MERCYONE DUBUQUE MEDICAL CENTER PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: MERCYONE DUBUQUE MEDICAL CENTER (MERCYONE DUBUQUE) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS:1. ACCESS TO HEALTH CARE 2. OBESITY3. BRAIN HEALTH
DUNES SURGICAL HOSPITAL PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: THE DUNES SURGICAL HOSPITAL (DUNES) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. PREVENTATIVE CARE2. SUBSTANCE MISUSE3. PHYSICAL HEALTH4. MENTAL HEALTH
MERCYONE NEW HAMPTON MEDICAL CENTER PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: MERCYONE NEW HAMPTON MEDICAL CENTER (MERCYONE NEW HAMPTON) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH HAVE BEEN IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS:1. ACCESS TO HEALTH CARE2. AGING POPULATION3. EMERGENCY MEDICAL SERVICES4. KNOWLEDGE OF HEALTH CARE RESOURCES/SERVICES AVAILABLE LOCALLY
MERCYONE DYERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: MERCYONE DYERSVILLE MEDICAL CENTER (MERCYONE DYERSVILLE) INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS:1. ACCESS TO HEALTH CARE 2. OBESITY3. BRAIN HEALTH
MERCYONE NORTH IOWA MEDICAL CENTER PART V, SECTION B, LINE 5: LOCAL COMMUNITY NEEDS ASSESSMENTS, STRATEGIC PLANS, AND REPORTS FROM THE PAST THREE YEARS WERE REVIEWED TO IDENTIFY COMMUNITY HEALTH NEEDS AND TO PROVIDE CONTEXT TO THE QUANTITATIVE DATA COLLECTED. ADDITIONALLY, COMMUNITY INFORMATION (QUALITATIVE DATA) WAS SOUGHT IN A VARIETY OF WAYS INCLUDING, SURVEYS, FOCUS GROUPS, MEETINGS, AND INTERVIEWS. THE QUANTITATIVE AND QUALITATIVE DATA WAS GATHERED FROM OCTOBER 2019 TO NOVEMBER 2019. THE COMMUNITY PRIORITY SESSION INCLUDED PARTICIPANTS FROM UNITED WAY OF NORTH CENTRAL IOWA, IOWA TOTAL CARE HEALTH PLAN, ELDERBRIDGE AREA ON AGING, PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTHCARE, DEPART OF HUMAN SERVICES, LUTHERAN SERVICES OF IOWA, MASON CITY POLICE DEPARTMENT, TURNING LEAF COUNSELING, HANCOCK COUNTY HEALTH SYSTEM, COMMUNITY HEALTH CENTER OF MASON CITY, NORTH IOWA COMMUNITY ACTION ORGANIZATION, CHILD CARE RESOURCE & REFERRAL, CITIZEN AT LARGE, AMERIGROUP HEALTH PLAN, DEPARTMENT OF CORRECTIONS, CRISIS INTERVENTION SERVICES, CERRO GORDO PUBLIC HEALTH, MASON CITY YOUTH TASK FORCE, FRIEND OF THE FAMILY, FAMILY WELCOME CENTERS NORTH IOWA CARES, AND PRIORITIZED SEVERAL HEALTH ISSUES AND OUTCOMES BY THE FOLLOWING FACTORS:1. SIGNIFICANT IMPACT: A HEALTH ISSUE IS IMPORTANT IN BOTH SCOPE (AFFECTS MANY PEOPLE WITHIN THE POPULATION) AND SCALE (HAS SERIOUS CONSEQUENCES FOR THOSE AFFECTED)2. BENCHMARK: NORTH IOWA LAGS COMPARED TO OTHER AREAS ON THIS HEALTH ISSUE AND/OR IS NOT ON TRACK TO ACHIEVE HEALTHY PEOPLE 2020 GOAL3. DISPARITIES IN HEALTH STATUS: A HEALTH ISSUE DISPROPORTIONATELY IMPACTS THE HEALTH STATUS OF ONE OR MORE SUBPOPULATIONS4. LINKS TO CHRONIC DISEASE: AN INDICATOR IS LINKED TO CHRONIC DISEASE AND RELATED HEALTH OUTCOMES. HIGH MORBIDITY/MORTALITY/DISABILITY/SUFFERING CONSIDERATION. ASKS: DOES THE ISSUE HAVE SERIOUS HEALTH CONSEQUENCES?5. POTENTIAL FOR CHANGE: LOCAL EFFORTS ARE LIKELY TO RESULT IN A MEANINGFUL IMPROVEMENT IN THE SCOPE AND/OR SEVERITY OF A HEALTH ISSUE6. PREVENTION OPPORTUNITY: AN INDICATOR REPRESENTS A SIGNIFICANT OPPORTUNITY TO IMPROVE HEALTH OUTCOMES USING PREVENTION-FOCUSED APPROACHESORGANIZATIONS CONTRIBUTING INPUT INTO THE CHNA INCLUDED REPRESENTATION OF MINORITY POPULATIONS, LOW-INCOME INDIVIDUALS, AND THOSE WHO ARE OTHERWISE UNDERSERVED IN OUR COMMUNITY. IN ADDITION TO THE ORGANIZATIONS THAT PARTICIPATED IN THE PRIORITY SESSION, OTHER ORGANIZATIONS PROVIDING INPUT INCLUDED: NORTH IOWA CHILDREN'S ALLIANCE CITIZEN, MARY SCHISSEL, WRIGHT COUNTY PUBLIC HEALTH, PALO ALTO COUNTY PUBLIC HEALTH, FLOYD COUNTY PUBLIC HEALTH, KOSSUTH COUNTY PUBLIC HEALTH, WINNEBAGO COUNTY PUBLIC HEALTH, CERRO GORDO COUNTY SHERIFF'S OFFICE, PRIVATE CITIZEN, MASON CITY TRANSIT, THE SALVATION ARMY, NORTH IOWA CORRIDOR, HEALTHY HARVEST OF NORTH IOWA, COMMUNITY KITCHEN, EARLY CHILDHOOD, FARMERS / GROWERS, AND MINISTERIAL GROUP.
MERCYONE SIOUXLAND MEDICAL CENTER PART V, SECTION B, LINE 5: IN 2021, THE DUNES SURGICAL HOSPITAL, MERCYONE SIOUXLAND MEDICAL CENTER, THE SIOUXLAND DISTRICT HEALTH DEPARTMENT, AND UNITYPOINT HEALTH - ST. LUKE'S PARTNERED TOGETHER TO COMPLETE THE THIRD JOINT CHNA TO DETERMINE THE COMMUNITY'S GREATEST HEALTH NEEDS AND TO COORDINATE EFFORTS TO IMPROVE POPULATION HEALTH OUTCOMES FOR THE SIOUXLAND AREA. THE YEAR-LONG PROCESS INCLUDED COLLABORATION OF REPRESENTATIVES FROM EACH ORGANIZATION, KNOWN AS THE CHNA PLANNING COMMITTEE, AS WELL AS ENGAGEMENT FROM THE COMMUNITY PARTNERS THAT ARE LISTED ON LINE 6B. ALL OF THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS WERE REPRESENTED BY THE ORGANIZATIONS THAT SERVED THEM.BEGINNING IN EARLY 2021, PRIMARY AND SECONDARY INPUT WAS COLLECTED THROUGH A COMMUNITY MEETING OF FIFTY-TWO COMMUNITY PARTNERS, AS WELL AS THE FOLLOWING SOURCES: U.S CENSUS BUREAU WEBSITE, 2021 NATIONAL COUNTY HEALTH RANKINGS, 2020 IA VITAL STATISTICS, IOWA PUBLIC HEALTH TRACKING PORTAL, 2019 CARES YOUTH SURVEY, 2020 COMPREHENSIVE STRATEGIES DATA BOOKLET, LOCAL HOSPITAL EMERGENCY ROOM DATA, POINT-IN-TIME COUNT FOR IOWA HOMELESS PROGRAMS, CDC 500 CITIES: LOCAL DATA FOR BETTER HEALTH WEBSITE, BUREAU OF LABOR STATISTICS, IOWA POISON CONTROL CENTER. THE DATA WAS ANALYZED BY THE CHNA PLANNING COMMITTEE. A COMMUNITY INPUT MEETING WAS HELD DURING THE SUMMER OF 2021, WHILE FINAL SUBMISSION OF THE CHNA OCCURRED IN 2022. A WRITTEN, COMMUNITY SURVEY WAS ALSO COMPLETED AND FOCUS GROUPS WERE HELD.THE JOINT CHNA LOOKED AT DATA FROM THE FOLLOWING SIX COUNTIES IN THE TRI-STATE SIOUXLAND AREA, AS EACH HOSPITAL SERVES A LARGER TERRITORY OUTSIDE OF JUST WOODBURY COUNTY:-UNION, SD-DAKOTA, DIXON, AND THURSTON, NE-PLYMOUTH AND WOODBURY, IA
MERCYONE DUBUQUE MEDICAL CENTER PART V, SECTION B, LINE 5: FOR THE PREVIOUS THREE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CYCLES, MERCYONE DUBUQUE MEDICAL CENTER AND MERCYONE DYERSVILLE MEDICAL CENTER JOINED THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT HEALTH IMPROVEMENT PLAN (CHNA-HIP) COALITION. THIS COALITION ASSURED BROAD INVOLVEMENT FROM MANY KEY ORGANIZATIONS ACROSS OUR SERVICE AREA. HOWEVER, DUE TO THE COVID-19 PANDEMIC, THE COALITION FOR THE FISCAL YEAR 2021 CYCLE WAS COMPRISED PRIMARILY OF MERCYONE DUBUQUE MEDICAL CENTER, MERCYONE DYERSVILLE MEDICAL CENTER, UNITY POINT FINLEY HOSPITAL, AND HILLCREST FAMILY SERVICES AS CITY OF DUBUQUE AND DUBUQUE COUNTY HEALTH DEPARTMENT REQUESTED, AND WERE GRANTED, EXTENSIONS TO COMPLETE THEIR CHNA PROCESS. WHILE PANDEMIC SPECIFIC DEMANDS IMPACTED CAPACITY FOR CITY AND COUNTY INVOLVEMENT IN THE COALITION, BOTH CITY OF DUBUQUE AND DUBUQUE COUNTY HEALTH DEPARTMENT DID PROVIDE INPUT FOR THIS CHNA SURVEY AND PLANNING, AS WELL AS INCLUDED THE CHNA SURVEY ON SAID WEBSITES TO ASSIST IN DISSEMINATION OF SURVEYS, ESPECIALLY TO VULNERABLE POPULATIONS. MERCYONE DUBUQUE MEDICAL CENTER AND MERCYONE DYERSVILLE MEDICAL CENTER PARTICIPATED IN ALL ASPECTS OF STEERING, COORDINATING AND COMPLETING THE CURRENT PROCESS. THE STEERING COMMITTEE COLLECTED INFORMATION FROM PRIMARY AND SECONDARY DATA SOURCES. DATA WAS COLLECTED THROUGH A COMMUNITY INPUT SURVEY IN DUBUQUE COUNTY, ADMINISTERED BETWEEN NOVEMBER 17, 2020 AND JANUARY 4, 2021. THE SURVEY WAS OFFERED ONLINE VIA "SURVEY MONKEY AND WAS AVAILABLE IN ENGLISH AND SPANISH LANGUAGES. PAPER COPIES OF THE SURVEY WERE ALSO AVAILABLE FOR THOSE WITHOUT COMPUTER ACCESS. THE STEERING COMMITTEE DEVELOPED A COMMUNICATIONS PLAN TO DISSEMINATE IN THE COMMUNITY AND ULTIMATELY, 1,355 COMPLETED RESPONSES WERE COLLECTED, AN INCREASE IN RESPONSE RATE FROM THE PREVIOUS CYCLE. THE STEERING COMMITTEE SOUGHT AND CONSIDERED THE NEEDS, INPUT, AND CONCERNS OF UNDERREPRESENTED PERSONS AND POPULATIONS THROUGHOUT THIS PROCESS, INCLUDING, THOSE WHO ARE MEDICALLY UNDERSERVED, IN POVERTY; AND/OR FROM MINORITY POPULATIONS. IN ADDITION, REPRESENTATIVES FROM VARIOUS AGENCIES WERE ABLE TO REPRESENT THE UNIQUE NEEDS OF THE POPULATIONS THEY SERVE WITH SPECIFIC EMPHASIS ON THOSE WHO ARE UNDERSERVED. THE STEERING COMMITTEE REVIEWED REPORTED DEMOGRAPHIC INFORMATION OF THOSE WHO COMPLETED THE SURVEY AND FOUND THAT DISTRIBUTION BY ETHNICITY, AGE, INCOME AND ZIP CODE WERE CONSISTENT WITH THE COMMUNITY'S DEMOGRAPHIC PROFILE. THE CHNA PROCESS INCLUDED GATHERING BOTH QUALITATIVE AND QUANTITATIVE DATA. THE STEERING COMMITTEE THEN REVIEWED AND COMPARED THE SURVEY RESULTS TO THE COLLECTED DATA. THE RESULTS AND DATA WERE CONSISTENT WITH EACH OTHER, VALIDATING BOTH FINDINGS. AFTER THE TOP 13 NEEDS WERE IDENTIFIED, THEY WERE PRESENTED TO THE STEERING COMMITTEE. THE STEERING COMMITTEE PRIORITIZED THE TOP HEALTH NEEDS BASED ON A NEED DIFFERENTIAL AND ON THEIR AREA OF EXPERTISE AND KNOWLEDGE OF THE COMMUNITY. THE STEERING COMMITTEE WAS INSTRUMENTAL IN IDENTIFYING THE PRIORITY AREAS SINCE THIS IS THE GROUP THAT COLLECTIVELY CAN HELP ADDRESS THE NEEDS WITH THE MAXIMUM COMMUNITY IMPACT. THE STEERING COMMITTEE FELT IT WAS BEST TO BUNDLE AREAS OF CONCERN AND ADDRESS A SMALLER NUMBER OF AREAS FOCUSING ON QUALITY AND IMMINENT PRIORITY IN PANDEMIC AND PANDEMIC RECOVERY VERSUS QUANTITY. THE TOP THREE NEEDS, BASED ON NEED DIFFERENTIAL, WERE IDENTIFIED BY THE STEERING COMMITTEE. COMMUNITY MEMBERS, EXPERTS, AND LEADERS FROM ACROSS THE COMMUNITY WERE THEN INVITED TO PARTICIPATE ON THE THREE PRIORITY TASKFORCES. EACH TASKFORCE REVIEWED THE DATA, CONDUCTED A SWOT ANALYSIS, AND MADE RECOMMENDATIONS TO THE STEERING COMMITTEE REGARDING STRATEGY FOR OUR HEALTH IMPROVEMENT PLANS. STEERING COMMITTEE MEMBERS PROVIDING INPUT INCLUDED:MALISSA SPRENGER, MICHELLE ARENSDORF, GWEN HALL DRISCOLL, (MERCYONE DUBUQUE MEDICAL CENTER & MERCYONE DYERSVILLE) CAROL CROSS (UNITY POINT FINLEY HOSPITAL)STACEY KILLIAN (UNITY POINT FINLEY HOSPITAL, VISITING NURSE ASSOCIATION)JANAE SCHMITT, MARIAH SCHRACK (HILLCREST FAMILY SERVICES)PATRICE LAMBERT (DUBUQUE COUNTY HEALTH DEPARTMENT) -ADVISORYMARY ROSE CORRIGAN (CITY OF DUBUQUE) -ADVISORY
DUNES SURGICAL HOSPITAL PART V, SECTION B, LINE 5: IN 2021, THE DUNES SURGICAL HOSPITAL, MERCYONE SIOUXLAND MEDICAL CENTER, THE SIOUXLAND DISTRICT HEALTH DEPARTMENT, AND UNITYPOINT HEALTH - ST. LUKE'S PARTNERED TOGETHER TO COMPLETE THE THIRD JOINT CHNA TO DETERMINE THE COMMUNITY'S GREATEST HEALTH NEEDS AND TO COORDINATE EFFORTS TO IMPROVE POPULATION HEALTH OUTCOMES FOR THE SIOUXLAND AREA. THE YEAR-LONG PROCESS INCLUDED COLLABORATION OF REPRESENTATIVES FROM EACH ORGANIZATION, KNOWN AS THE CHNA PLANNING COMMITTEE, AS WELL AS ENGAGEMENT FROM THE COMMUNITY PARTNERS THAT ARE LISTED ON LINE 6B. ALL OF THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS WERE REPRESENTED BY THE ORGANIZATIONS THAT SERVED THEM.BEGINNING IN EARLY 2021, PRIMARY AND SECONDARY INPUT WAS COLLECTED THROUGH A COMMUNITY MEETING OF FIFTY-TWO COMMUNITY PARTNERS, AS WELL AS THE FOLLOWING SOURCES: U.S CENSUS BUREAU WEBSITE, 2021 NATIONAL COUNTY HEALTH RANKINGS, 2020 IA VITAL STATISTICS, IOWA PUBLIC HEALTH TRACKING PORTAL, 2019 CARES YOUTH SURVEY, 2020 COMPREHENSIVE STRATEGIES DATA BOOKLET, LOCAL HOSPITAL EMERGENCY ROOM DATA, POINT-IN-TIME COUNT FOR IOWA HOMELESS PROGRAMS, CDC 500 CITIES: LOCAL DATA FOR BETTER HEALTH WEBSITE, BUREAU OF LABOR STATISTICS, IOWA POISON CONTROL CENTER. THE DATA WAS ANALYZED BY THE CHNA PLANNING COMMITTEE. A COMMUNITY INPUT MEETING WAS HELD DURING THE SUMMER OF 2021, WHILE FINAL SUBMISSION OF THE CHNA OCCURRED IN 2022. A WRITTEN, COMMUNITY SURVEY WAS ALSO COMPLETED AND FOCUS GROUPS WERE HELD.THE JOINT CHNA LOOKED AT DATA FROM THE FOLLOWING SIX COUNTIES IN THE TRI-STATE SIOUXLAND AREA, AS EACH HOSPITAL SERVES A LARGER TERRITORY OUTSIDE OF JUST WOODBURY COUNTY:-UNION, SD-DAKOTA, DIXON, AND THURSTON, NE-PLYMOUTH AND WOODBURY, IA
MERCYONE NEW HAMPTON MEDICAL CENTER PART V, SECTION B, LINE 5: MERCYONE NEW HAMPTON INITIATED THE ASSESSMENT PROCESS FOR THE 2022 CHNA, ALONG WITH A PLANNING TEAM CONSISTING OF REPRESENTATIVES FROM HOSPITAL GOVERNANCE, LEADERSHIP AND MEDICAL STAFF, AREA EMPLOYERS, SCHOOL DISTRICTS, AND AREA HEALTH PROFESSIONALS. BETWEEN SEPTEMBER 2021 AND JANUARY 2022, MERCYONE GATHERED COMMUNITY INPUT THROUGH SURVEYS, PATIENT FEEDBACK, AND SERVICE UTILIZATION DATA. DATA SOURCES INCLUDED COUNTY HEALTH RANKINGS, COMMUNITY COMMONS, NORTHEAST IOWA COMMUNITY ACTION CORPORATION CLIENT NEEDS ASSESSMENT SURVEY. IN ADDITION, FOCUS GROUPS, INTERVIEWS AND INDIVIDUAL STORIES PROVIDE A VALUABLE TOOL TO GATHER QUALITATIVE DATA FOR STRATEGIC PLANNING. MERCYONE NEW HAMPTON WAS CAREFUL TO GATHER INPUT FROM REPRESENTATIVES OF VARIOUS MINORITY AND UNDERSERVED INDIVIDUALS INCLUDING: LOW INCOME/UNDERSERVED (SALVATION ARMY, CHICKASAW COUNTY PUBLIC HEALTH, PASTORAL COMMITTEE, SCHOOL ADMINISTRATION AND NORTHEAST IOWA COMMUNITY ACTION); CHRONIC CONDITIONS (AREA NURSING HOME, MENTAL HEALTH, AND HOSPICE REPRESENTATIVES); AND RACIAL/ETHNIC MINORITY (HISPANIC MINISTER FROM HOLY FAMILY AND PUBLIC HEALTH). SEVERAL SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED WITHIN THE MERCYONE NEW HAMPTON COMMUNITY. THOSE NEEDS WERE THEN PRIORITIZED BY THE PLANNING TEAM BASED ON INFORMATION FROM ALL THE SOURCES MENTIONED WHICH WAS DISTILLED INTO A LIST OF OPPORTUNITIES ESTIMATED TO HAVE THE GREATEST POSITIVE IMPACT ON THE IDENTIFIED COMMUNITY HEALTH NEEDS.
MERCYONE DYERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 5: FOR THE PREVIOUS THREE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CYCLES, MERCYONE DUBUQUE MEDICAL CENTER AND MERCYONE DYERSVILLE MEDICAL CENTER JOINED THE DUBUQUE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT HEALTH IMPROVEMENT PLAN (CHNA-HIP) COALITION. THIS COALITION ASSURED BROAD INVOLVEMENT FROM MANY KEY ORGANIZATIONS ACROSS OUR SERVICE AREA. HOWEVER, DUE TO THE COVID-19 PANDEMIC, THE COALITION FOR THE FISCAL YEAR 2021 CYCLE WAS COMPRISED PRIMARILY OF MERCYONE DUBUQUE MEDICAL CENTER, MERCYONE DYERSVILLE MEDICAL CENTER, UNITY POINT FINLEY HOSPITAL, AND HILLCREST FAMILY SERVICES AS CITY OF DUBUQUE AND DUBUQUE COUNTY HEALTH DEPARTMENT REQUESTED, AND WERE GRANTED, EXTENSIONS TO COMPLETE THEIR CHNA PROCESS. WHILE PANDEMIC SPECIFIC DEMANDS IMPACTED CAPACITY FOR CITY AND COUNTY INVOLVEMENT IN THE COALITION, BOTH CITY OF DUBUQUE AND DUBUQUE COUNTY HEALTH DEPARTMENT DID PROVIDE INPUT FOR THIS CHNA SURVEY AND PLANNING, AS WELL AS INCLUDED THE CHNA SURVEY ON SAID WEBSITES TO ASSIST IN DISSEMINATION OF SURVEYS, ESPECIALLY TO VULNERABLE POPULATIONS. MERCYONE DUBUQUE MEDICAL CENTER AND MERCYONE DYERSVILLE MEDICAL CENTER PARTICIPATED IN ALL ASPECTS OF STEERING, COORDINATING AND COMPLETING THE CURRENT PROCESS. THE STEERING COMMITTEE COLLECTED INFORMATION FROM PRIMARY AND SECONDARY DATA SOURCES. DATA WAS COLLECTED THROUGH A COMMUNITY INPUT SURVEY IN DUBUQUE COUNTY, ADMINISTERED BETWEEN NOVEMBER 17, 2020 AND JANUARY 4, 2021. THE SURVEY WAS OFFERED ONLINE VIA "SURVEY MONKEY AND WAS AVAILABLE IN ENGLISH AND SPANISH LANGUAGES. PAPER COPIES OF THE SURVEY WERE ALSO AVAILABLE FOR THOSE WITHOUT COMPUTER ACCESS. THE STEERING COMMITTEE DEVELOPED A COMMUNICATIONS PLAN TO DISSEMINATE IN THE COMMUNITY AND ULTIMATELY, 1,355 COMPLETED RESPONSES WERE COLLECTED, AN INCREASE IN RESPONSE RATE FROM THE PREVIOUS CYCLE. THE STEERING COMMITTEE SOUGHT AND CONSIDERED THE NEEDS, INPUT, AND CONCERNS OF UNDERREPRESENTED PERSONS AND POPULATIONS THROUGHOUT THIS PROCESS, INCLUDING, THOSE WHO ARE MEDICALLY UNDERSERVED, IN POVERTY; AND/OR FROM MINORITY POPULATIONS. IN ADDITION, REPRESENTATIVES FROM VARIOUS AGENCIES WERE ABLE TO REPRESENT THE UNIQUE NEEDS OF THE POPULATIONS THEY SERVE WITH SPECIFIC EMPHASIS ON THOSE WHO ARE UNDERSERVED. THE STEERING COMMITTEE REVIEWED REPORTED DEMOGRAPHIC INFORMATION OF THOSE WHO COMPLETED THE SURVEY AND FOUND THAT DISTRIBUTION BY ETHNICITY, AGE, INCOME AND ZIP CODE WERE CONSISTENT WITH THE COMMUNITY'S DEMOGRAPHIC PROFILE. THE CHNA PROCESS INCLUDED GATHERING BOTH QUALITATIVE AND QUANTITATIVE DATA. THE STEERING COMMITTEE THEN REVIEWED AND COMPARED THE SURVEY RESULTS TO THE COLLECTED DATA. THE RESULTS AND DATA WERE CONSISTENT WITH EACH OTHER, VALIDATING BOTH FINDINGS. AFTER THE TOP 13 NEEDS WERE IDENTIFIED, THEY WERE PRESENTED TO THE STEERING COMMITTEE. THE STEERING COMMITTEE PRIORITIZED THE TOP HEALTH NEEDS BASED ON A NEED DIFFERENTIAL AND ON THEIR AREA OF EXPERTISE AND KNOWLEDGE OF THE COMMUNITY. THE STEERING COMMITTEE WAS INSTRUMENTAL IN IDENTIFYING THE PRIORITY AREAS SINCE THIS IS THE GROUP THAT COLLECTIVELY CAN HELP ADDRESS THE NEEDS WITH THE MAXIMUM COMMUNITY IMPACT. THE STEERING COMMITTEE FELT IT WAS BEST TO BUNDLE AREAS OF CONCERN AND ADDRESS A SMALLER NUMBER OF AREAS FOCUSING ON QUALITY AND IMMINENT PRIORITY IN PANDEMIC AND PANDEMIC RECOVERY VERSUS QUANTITY. THE TOP THREE NEEDS, BASED ON NEED DIFFERENTIAL, WERE IDENTIFIED BY THE STEERING COMMITTEE. COMMUNITY MEMBERS, EXPERTS, AND LEADERS FROM ACROSS THE COMMUNITY WERE THEN INVITED TO PARTICIPATE ON THE THREE PRIORITY TASKFORCES. EACH TASKFORCE REVIEWED THE DATA, CONDUCTED A SWOT ANALYSIS, AND MADE RECOMMENDATIONS TO THE STEERING COMMITTEE REGARDING STRATEGY FOR OUR HEALTH IMPROVEMENT PLANS. STEERING COMMITTEE MEMBERS PROVIDING INPUT INCLUDED:MALISSA SPRENGER, MICHELLE ARENSDORF, GWEN HALL DRISCOLL, (MERCYONE DUBUQUE MEDICAL CENTER & MERCYONE DYERSVILLE) CAROL CROSS (UNITY POINT FINLEY HOSPITAL)STACEY KILLIAN (UNITY POINT FINLEY HOSPITAL, VISITING NURSE ASSOCIATION)JANAE SCHMITT, MARIAH SCHRACK (HILLCREST FAMILY SERVICES)PATRICE LAMBERT (DUBUQUE COUNTY HEALTH DEPARTMENT) -ADVISORYMARY ROSE CORRIGAN (CITY OF DUBUQUE) -ADVISORY
MERCYONE SIOUXLAND MEDICAL CENTER PART V, SECTION B, LINE 6A: MERCYONE SIOUXLAND'S CHNA WAS CONDUCTED WITH UNITY POINT HEALTH-ST. LUKE'S AND DUNES SURGICAL HOSPITAL.
MERCYONE DUBUQUE MEDICAL CENTER PART V, SECTION B, LINE 6A: MERCYONE DUBUQUE CONDUCTED ITS CHNA WITH MERCYONE DYERSVILLE, AND UNITYPOINT HEALTH-FINLEY HOSPITAL, DUBUQUE.
DUNES SURGICAL HOSPITAL PART V, SECTION B, LINE 6A: THE DUNES SURGICAL HOSPITAL'S CHNA WAS CONDUCTED WITH MERCYONE SIOUXLAND MEDICAL CENTER AND UNITY POINT HEALTH-ST. LUKE'S.
MERCYONE DYERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 6A: MERCYONE DYERSVILLE CONDUCTED ITS CHNA WITH MERCYONE DUBUQUE, AND UNITYPOINT HEALTH-FINLEY HOSPITAL, DUBUQUE.
MERCYONE NORTH IOWA MEDICAL CENTER PART V, SECTION B, LINE 6B: MERCYONE NORTH IOWA CONDUCTED ITS CHNA WITH THE FOLLOWING NON-HOSPITAL ORGANIZATIONS:NORTH IOWA COMMUNITY ACTION ORGANIZATION, PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTHCARE, MASON CITY YOUTH TASK FORCE, NORTH IOWA CHILDREN'S ALLIANCE, TURNING LEAF COUNSELING, CITIZEN MARY SCHISSEL, CG PUBLIC HEALTH, UNITED WAY OF NORTH CENTRAL IOWA, COMMUNITY HEALTH CENTER, WRIGHT COUNTY PUBLIC HEALTH, PALO ALTO COUNTY PUBLIC HEALTH, FLOYD COUNTY PUBLIC HEALTH, KOSSUTH COUNTY PUBLIC HEALTH, AND WINNEBAGO COUNTY PUBLIC HEALTH
MERCYONE SIOUXLAND MEDICAL CENTER PART V, SECTION B, LINE 6B: THROUGHOUT 2021 THE CHNA PLANNING COMMITTEE, MADE UP OF REPRESENTATIVES FROM THE AFOREMENTIONED HOSPITALS, AS WELL AS THE FOLLOWING ORGANIZATIONS; BRIAR CLIFF UNIVERSITY, GROWING COMMUNITY CONNECTIONS, SIOUXLAND COMMUNITY HEALTH CENTER, SIOUXLAND DISTRICT HEALTH DEPARTMENT, AND SOURCE FOR SIOUXLAND, CONDUCTED THE JOINT CHNA IN COLLABORATION WITH: BOYS AND GIRLS HOME AND FAMILY SERVICES, DAKOTA COUNTY JUVENILE DIVERSION, DEPARTMENT OF CORRECTIONAL SERVICES, GIRLS INC., INSTITUTE FOR COMMUNITY ALLIANCE, IOWA POISON CONTROL, IOWA STATE UNIVERSITY EXTENSION, JUNE E. NYLEN CANCER CENTER, MORNINGSIDE UNIVERSITY, NAACP, NORM WAITT SR. YMCA, ONE SIOUXLAND, PROTEUS, ROSECRANCE JACKSON RECOVERY CENTER, SIOUXLAND CARES, SIOUXLAND COMMUNITY HEALTH CENTER, SIOUXLAND HUMAN INVESTMENT PARTNERSHIP, SIOUXLAND MENTAL HEALTH CENTER, THE WARMING SHELTER, AND UNITED WAY OF SIOUXLAND.
MERCYONE DUBUQUE MEDICAL CENTER PART V, SECTION B, LINE 6B: MERCYONE DUBUQUE CONDUCTED ITS CHNA WITH THE FOLLOWING NON-HOSPITAL ORGANIZATIONS:CITY OF DUBUQUE HEALTH SERVICES, DUBUQUE COUNTY HEALTH DEPARTMENT, CRESCENT COMMUNITY HEALTH CENTER, GRAND RIVER MEDICAL GROUP, HILLCREST FAMILY SERVICES, VISITING NURSE ASSOCIATION, MEDICAL ASSOCIATES CLINIC, RIVERBEND FOOD BANK, DUBUQUE FOOD POLICY COUNCIL, CONVIVIUM URBAN FARMSTEAD, PROJECT ROOTED, BRAIN HEALTH NOW, ZTM SOBER LIVING, AND SUBSTANCE ABUSE SERVICES CENTER.
DUNES SURGICAL HOSPITAL PART V, SECTION B, LINE 6B: THROUGHOUT 2021 THE CHNA PLANNING COMMITTEE, MADE UP OF REPRESENTATIVES FROM THE AFOREMENTIONED HOSPITALS, AS WELL AS THE FOLLOWING ORGANIZATIONS; BRIAR CLIFF UNIVERSITY, GROWING COMMUNITY CONNECTIONS, SIOUXLAND COMMUNITY HEALTH CENTER, SIOUXLAND DISTRICT HEALTH DEPARTMENT, AND SOURCE FOR SIOUXLAND, CONDUCTED THE JOINT CHNA IN COLLABORATION WITH: BOYS AND GIRLS HOME AND FAMILY SERVICES, DAKOTA COUNTY JUVENILE DIVERSION, DEPARTMENT OF CORRECTIONAL SERVICES, GIRLS INC., INSTITUTE FOR COMMUNITY ALLIANCE, IOWA POISON CONTROL, IOWA STATE UNIVERSITY EXTENSION, JUNE E. NYLEN CANCER CENTER, MORNINGSIDE UNIVERSITY, NAACP, NORM WAITT SR. YMCA, ONE SIOUXLAND, PROTEUS, ROSECRANCE JACKSON RECOVERY CENTER, SIOUXLAND CARES, SIOUXLAND COMMUNITY HEALTH CENTER, SIOUXLAND HUMAN INVESTMENT PARTNERSHIP, SIOUXLAND MENTAL HEALTH CENTER, THE WARMING SHELTER, AND UNITED WAY OF SIOUXLAND.
MERCYONE DYERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 6B: MERCYONE DYERSVILLE CONDUCTED ITS CHNA WITH THE FOLLOWING NON-HOSPITAL ORGANIZATIONS:CITY OF DUBUQUE HEALTH SERVICES, DUBUQUE COUNTY HEALTH DEPARTMENT, CRESCENT COMMUNITY HEALTH CENTER, GRAND RIVER MEDICAL GROUP, HILLCREST FAMILY SERVICES, VISITING NURSE ASSOCIATION, MEDICAL ASSOCIATES CLINIC, RIVERBEND FOOD BANK, DUBUQUE FOOD POLICY COUNCIL, CONVIVIUM URBAN FARMSTEAD, PROJECT ROOTED, BRAIN HEALTH NOW, ZTM SOBER LIVING, AND SUBSTANCE ABUSE SERVICES CENTER.
MERCYONE NORTH IOWA MEDICAL CENTER PART V, SECTION B, LINE 11: MERCYONE NORTH IOWA ADOPTED A NEW CHNA IN FISCAL YEAR 2020, WHICH IDENTIFIED THE FOLLOWING NEEDS: ACCESS TO CARE, EARLY CHILDHOOD ISSUES, AND HOUSING. THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE ADDRESSED WITHIN FISCAL YEAR 2022 (FY22): ACCESS TO CARE:MERCYONE NORTH IOWA SUCCESSFULLY EXPANDED ITS PRIMARY HEALTH CARE SERVICES TO SOUTHERN MINNESOTA BY THE DEVELOPMENT, OPENING AND STAFFING OF A PRIMARY HEALTH CARE CLINIC IN ALBERT LEA, MN. TO ADDRESS THE LACK OF MENTAL HEALTH PROVIDERS IN THE COMMUNITY, SUPPORT FOR RECRUITMENT OF PROVIDERS AND MENTAL HEALTH SERVICES CONTINUED TO BE A PRIORITY. MERCYONE NORTH IOWA'S BEHAVIORAL HEALTH UNIT EXPERIENCED AN INCREASE OVERALL FOR DETOX TREATMENT OR COMORBID MENTAL HEALTH/MEDICAL DIAGNOSES ON MEDICAL FLOORS. MERCYONE NORTH IOWA CONTINUES TO SPONSOR THE SENIOR HEALTH INSURANCE INFORMATION PROGRAM (SHIIP) TO ADDRESS THE HIGH COST OF SENIOR MEDICATIONS. COUNSELORS OFFERED SESSIONS TO SENIORS TO ACCESS UNBIASED COUNSELING FOR DRUG PLAN COVERAGE AND PUBLIC BENEFIT ENROLLMENT. COUNSELORS HOSTED WELCOME TO MEDICARE SEMINARS, VIRTUAL AND IN PERSON COUNSELING SESSIONS SERVING AN INCREASED NUMBER OF CLIENTS FROM THE PREVIOUS YEAR. AN ADDITIONAL TWO COUNSELORS WERE ADDED FOR A TOTAL OF SIX. MERCY ONE NORTH IOWA HAS CONTINUED TO PARTNER WITH NORTH IOWA COMMUNITY ACTION ORGANIZATION (NICAO) FOR COMMUNITY TRANSPORTATION. WHILE THE COVID-19 PANDEMIC DRASTICALLY CHANGED THE NEED FOR TRANSPORTATION, NICAO PROVIDED CASE MANAGEMENT, MEANS TESTING FOR SUBSIDIZED RIDES AND HELP FOR THOSE WITH TRANSPORTATION BENEFITS TO NAVIGATE THE SYSTEM. THEY PROVIDED 41 RIDES IN FY22. DESPITE MERCYONE NORTH IOWA'S ROBUST RECRUITMENT ACTIVITIES, WE SAW VACANCIES ESCALATE IN FY22. CONTRIBUTING FACTORS INCLUDE THE COVID-19 PANDEMIC, FEAR OF THE VIRUS, EARLY RETIREMENT, AND ATTRITION. IN FY22, MERCYONE NORTH IOWA RECRUITED 37 NEW PROVIDERS.MERCYONE NORTH IOWA CONTINUED TO ADVOCATE FOR, AND PARTICIPATE IN, THE 340B PROGRAM, SERVING A 10% INCREASE IN THE NUMBER OF PATIENTS SEEKING ASSISTANCE. MERCYONE NORTH IOWA CONTINUED TO SUPPORT MENTAL HEALTH AND SUBSTANCE USE RECOVERY PROGRAMS VIA THE 340B PROGRAM IN THE COMMUNITY PARTNERING WITH THE COMMUNITY HEALTH CENTER OF MASON CITY, BEJE CLARK, SECOND JUDICIAL DISTRICT PROBATION/PAROLE AND PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTH CARE. HOUSING:MERCYONE NORTH IOWA ADDRESSED HOMELESSNESS BY SUPPORTING THE ALLIANCE FOR THE HOMELESS SHELTERS (MEN/WOMEN AND CHILDREN). MERCYONE NORTH IOWA PARTICIPATED IN COMMUNITY WIDE IMPACT MEETINGS CONCERNING DEVELOPMENT OF COMMUNITY LOW BARRIER WARMING SHELTER. MERCYONE NORTH IOWA DID NOT DIRECTLY ADDRESS THE FOLLOWING NEED IN THIS CHNA CYCLE DUE TO COMPETING PRIORITIES, LACK OF RESOURCES, AND BECAUSE OTHER AGENCIES ARE ALREADY ADDRESSING THESE ISSUES.EARLY CHILDHOOD ISSUES:THOUGH IT WAS NOT A DIRECT FOCUS IN FY22, MERCYONE NORTH IOWA CONTINUED ITS COLLABORATION WITH THE NORTH IOWA FOOD COALITION IN SUPPORT OF HEALTHY HARVEST OF NORTH IOWA, TO INCREASE THE AVAILABILITY OF FRESH, WHOLE, HEALTHY FOODS AND ASSISTING FAMILIES WITH CHILDREN AND THEIR NUTRITIONAL NEEDS. PARTNERSHIPS FURTHER DEVELOPED WITH CG PUBLIC HEALTH, FMC DECAT (DHS) AND FLOYD COUNTY CULTURAL EQUITY BOARD TO EXTEND THE VEGGIE VOUCHER PROJECT INTO FLOYD AND CERRO GORDO COUNTIES. THE PROGRAM DISTRIBUTED VOUCHERS AND CSA BOXES IN CERRO GORDO AND IN FLOYD COUNTY. HEALTHY HARVEST OF NORTH IOWA PROVIDED COMMUNITY EDUCATION VIA THEIR WEBSITE, FACEBOOK AND IN PERSON DEMONSTRATIONS WITH SAMPLES AND RECIPE CARDS. THEY SAFELY HOSTED 30 IN-PERSON DEMONSTRATIONS IN ELEVEN DIFFERENT COMMUNITIES WITH 1,600 SAMPLES AND 54 ADDITIONAL RECIPE CARDS DISTRIBUTED. DOUBLE UP FOOD BUCKS REDEEMED AT TWO LOCAL FARMERS MARKETS TOTALED $4,366 WHILE $3,887 WAS REDEEMED AT FARWAY/HYVEE. MERCYONE NORTH IOWA WILL FURTHER INVESTIGATE HOW IT CAN PARTNER WITH OTHER COMMUNITY AGENCIES CURRENTLY ADDRESSING EARLY CHILDHOOD ISSUES IN FISCAL YEAR 2023. MERCYONE NORTH IOWA CONTINUED PARTICIPATION WITH PARTNERS 4 CHILDREN DECATEGORIZATION PROJECT AND EYES (EMPOWERING YOUTH WITH EDUCATION AND SUPPORT) COALITIONS.
MERCYONE SIOUXLAND MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING FOUR NEEDS WERE IDENTIFIED IN THE 2022 CHNA FOR THE SIOUXLAND AREA: MENTAL HEALTH, PHYSICAL HEALTH, PREVENTATIVE CARE, AND SUBSTANCE MISUSE. MENTAL HEALTH: IN FY22, RECRUITMENT CONTINUED FOR ADDITIONAL MENTAL HEALTH PROVIDERS FOR THE SIOUXLAND AREA. TELEMEDICINE WAS USED AT MERCYONE SIOUXLAND TO IMPROVE ACCESS FOR MENTAL HEALTH CARE. MERCYONE SIOUXLAND ALSO OPENED A SECOND INPATIENT MENTAL HEALTH UNIT DURING THIS YEAR TO BETTER SERVE THE NEEDS OF THE COMMUNITY. CONTINUED MENTAL HEALTH SERVICES WERE PROVIDED AT THE MERCYONE CHILD ADVOCACY CENTER TO CHILDREN WHO HAD BEEN ABUSED. MERCYONE SIOUXLAND FINANCIALLY SUPPORTED MENTAL HEALTH SERVICES PROVIDED AT CATHOLIC CHARITIES TO VULNERABLE POPULATIONS. IN ADDITION, THE BOYS AND GIRLS HOME AND FAMILY SERVICES AND THE WARMING SHELTER WERE SUPPORTED TO ASSIST IN AIDING THOSE WITH MENTAL HEALTH NEEDS. MERCYONE SIOUXLAND CONTINUED TO COLLABORATE WITH OTHER MENTAL HEALTH PROVIDERS TO COORDINATE MENTAL HEALTH CARE. MERCYONE SIOUXLAND PARTICIPATED IN THE MENTAL HEALTH ROUNDTABLE WHICH WAS COMPRISED OF 18 MENTAL HEALTH COMMUNITY PARTNERS AND PROVIDING ORGANIZATIONS. IN ADDITION, MERCYONE SIOUXLAND PROVIDERS CONTINUED TO SCREEN AND EDUCATE COMMUNITY MEMBERS ABOUT MENTAL HEALTH, AND MADE REFERRALS TO MENTAL HEALTH PROFESSIONALS AS NEEDED. PHYSICAL HEALTH:IN FY22, MERCYONE SIOUXLAND CONTINUED TO PROVIDE HEALTH COACHING, EDUCATION ON HEALTHY CHOICES, AND THE IMPORTANCE OF MAINTAINING A HEALTHY WEIGHT. MERCYONE SIOUXLAND PROVIDERS CONTINUED TO MEASURE BMIS FOR HEALTHY WEIGHT MONITORING AND COUNSELING. IN ADDITION, THE MERCYONE SIOUXLAND DIETITIANS COMPLETED EDUCATION TO PROMOTE HEALTHY FOOD CHOICES. PHYSICIAN RESIDENTS IN THE COMMUNITY WERE EDUCATED BY THE MERCYONE SIOUXLAND DIETITIANS TO INCREASE FUTURE PHYSICIAN SUPPORT FOR THE COMMUNITY IN THE AREA OF PHYSICAL HEALTH. THE CARDIAC PROGRAM ALSO PROVIDED VASCULAR AND CHOLESTEROL SCREENINGS TO PROMOTE HEALTHY LIFESTYLE CHOICES. IN AN EFFORT TO CURB THE PREVALENCE OF OBESITY IN FY22, MERCYONE SIOUXLAND CONTINUED COLLABORATING WITH THE SIOUXLAND YMCA BY REFERRING PRE-DIABETIC PERSONS TO THE DIABETES PREVENTION PROGRAM (DPP). DPP COURSES WERE HELD, AND PARTICIPANTS DEMONSTRATED SUCCESS IN COMBATING OBESITY. MERCYONE SIOUXLAND ALSO PROVIDED SUPPORT FOR THE BOARD OF DIRECTORS AT THE FOOD BANK OF SIOUXLAND, A SOURCE OF HEALTHY FOODS FOR THE VULNERABLE POPULATION IN THE COMMUNITY.PREVENTATIVE CARE:MERCYONE SIOUXLAND AIDED COMMUNITY MEMBERS WHO WERE UNABLE TO OBTAIN PRESCRIPTIONS NECESSARY TO MAINTAIN THEIR HEALTH STATUS AND AVOID HOSPITALIZATIONS. TRANSPORTATION WAS ALSO PROVIDED WHEN COMMUNITY MEMBERS WERE UNABLE TO AFFORD BUS OR TAXI SERVICES TO ACCESS HEALTH MAINTENANCE SERVICES. DURING THE PANDEMIC, MERCYONE SIOUXLAND PROVIDED INFECTION CONTROL SUPPLIES TO THE LOCAL HOMELESS SHELTER. ENROLLMENT ASSISTANCE FOR MEDICAID WAS ALSO PROVIDED TO ASSIST THOSE IN LOW-INCOME CATEGORIES. IN ADDITION, THE LOCAL HOMELESS SHELTER WAS FINANCIALLY SUPPORTED TO OFFER SHELTERED HOUSING DURING THE WINTER MONTHS AND DAY SHELTER SERVICES THROUGHOUT THE YEAR. MERCYONE SIOUXLAND ALSO CONTINUED THEIR FINANCIAL ASSISTANCE PROGRAM TO ASSIST WITH ACCESS TO NECESSARY PREVENTATIVE CARE FOR THOSE WHO QUALIFY. PREVENTATIVE TELEMONITORING WAS PROVIDED FOR THE VULNERABLE CONGESTIVE HEART FAILURE POPULATION. SUBSTANCE MISUSE:MERCYONE SIOUXLAND PROVIDED SUPPORT TO THE HOPE STREET SOBER LIVING FACILITY. MERCYONE SIOUXLAND PARTICIPATED IN COMMUNITY EFFORTS OF THE SMOKEFREE SIOUXLAND COALITION. ADDITIONAL SMOKE-FREE AREAS WERE ACHIEVED. MERCYONE SIOUXLAND PROVIDERS AND HEALTH COACHES CONTINUED TO EDUCATE COMMUNITY MEMBERS ON HEALTHY LIFESTYLE CHOICES, INCLUDING THE CESSATION OF SMOKING AND ELIMINATING SUBSTANCE MISUSE. MERCYONE SIOUXLAND, THROUGH MERCYONE SIOUXLAND BUSINESS HEALTH, CONTINUED TO PROVIDE HEALTH COACHING FOR TOBACCO CESSATION.
MERCYONE DUBUQUE MEDICAL CENTER PART V, SECTION B, LINE 11: THE SIGNIFICANT NEEDS THAT WERE ADDRESSED IN FY22 WERE ACCESS TO HEALTH CARE, OBESITY, AND BRAIN HEALTH.MERCYONE DUBUQUE WAS INVOLVED IN THE FOLLOWING PROJECTS DURING FY22 TO ADDRESS ACCESS TO HEALTH CARE:MERCYONE DUBUQUE AND MERCYONE DYERSVILLE PURCHASED A 31-FOOT WINNEBAGO AND HIRED A VENDOR TO CUSTOMIZE THE UNIT WITH A WAITING ROOM, INTAKE AREA, TWO EXAM ROOMS AND A HANDICAP ACCESSIBLE LIFT. THE UNIT LAUNCHED IN NOVEMBER 2022 WITH THE VISION OF REACHING ANYONE EXPERIENCING A BARRIER TO HEALTH CARE ACCESS. INITIAL FOCUS WAS ON ADULT, ADOLESCENT, AND PEDIATRIC COVID-19 VACCINE DISTRIBUTION.THROUGH THE MOBILE MEDICAL UNIT, THE FOLLOWING OUTREACH EVENTS WERE HELD: - TWENTY-THREE VACCINE CLINICS, RESULTING IN 1,425 COVID-19 VACCINATIONS AND BOOSTER SHOTS GIVEN TO COMMUNITY MEMBERS. THE CLINICS WERE HELD IN STRATEGIC LOCATIONS, INCLUDING ELEMENTARY, MIDDLE, AND HIGH SCHOOLS IN HIGH PRIORITY ZIP CODES, TO ASSIST IN DECREASING BARRIERS TO ACCESSING THE VACCINES. VACCINE FAQS WERE TRANSLATED INTO MARSHALLESE AND SPANISH TO ASSIST WITH LANGUAGE BARRIERS RELATED TO VACCINE HESITANCY. -TUBERCULOSIS SCREENINGS (BLOOD DRAWS) TO MARSHALLESE POPULATION, AT VARIOUS LOCATIONS, IN PARTNERSHIP WITH THE IOWA DEPARTMENT OF PUBLIC HEALTH AND THE DUBUQUE COUNTY HEALTH DEPARTMENT, TO MAKE IT MORE ACCESSIBLE. THE TUBERCULOSIS SCREENINGS YIELDED 16 POSITIVE RESULTS REQUIRING X-RAYS AND PHYSICIAN FOLLOW UP. -OUTREACH TO THOSE EXPERIENCING HOMELESSNESS INCLUDING BLOOD PRESSURES, A1C'S, BRAIN HEALTH SCREENINGS, IMMUNIZATIONS, VACCINATIONS, AND CONNECTION TO MEDICATIONS. THE TEAM ALSO PROVIDED HYGIENE PRODUCTS, NUTRIENT DENSE FOOD, HYDRATION, BLANKETS, CLOTHING, COATS, AND GLOVES. -PREVENTIVE CARE AND VACCINATIONS TO ACTIVE MILITARY, VETERANS, AND FAMILIES AT THE VETERANS FREEDOM CENTER AND TO RURAL COMMUNITIES IN THE SURROUNDING AREA. -HEAD INJURY PREVENTION EDUCATION TO 47 CHILDREN AND THEIR FAMILIES AT A LOCAL SKI RESORT. -PARTNERED WITH CRESCENT COMMUNITY HEALTH CENTER TO PROVIDE SCHOOL REQUIRED IMMUNIZATIONS TO 4 AND 5 YEAR OLD AND 7TH GRADE STUDENTS IN HIGH PRIORITY POVERTY ZIP CODES.MERCYONE DUBUQUE WAS INVOLVED IN THE FOLLOWING PROJECT DURING FY22 TO ADDRESS OBESITY:- MERCYONE DUBUQUE CONTINUED TO WORK IN PARTNERSHIP WITH RIVERBEND FOOD BANK AND OUR LADY OF THE MISSISSIPPI ABBEY SISTERS TO MAINTAIN A FOOD PANTRY ONSITE AT MERCYONE DUBUQUE TO HELP ALLEVIATE FOOD INSECURITY. THE FOOD PANTRY STOCKED 50,662 POUNDS OF FOOD IN FY22, THE EQUIVALENT OF 42,219 MEALS, SERVING 3,855 COLLEAGUES AND PATIENTS (1,272 CHILDREN AND 382 SENIORS). -THE MOBILE MEDICAL UNIT WAS PRESENT AT FARMERS MARKETS IN DUBUQUE AND DYERSVILLE TO PROMOTE HEALTHY EATING. DIETICIANS JOINED THE INTERDISCIPLINARY MOBILE MEDICAL UNIT TEAM TO MEET WITH COMMUNITY MEMBERS AND PROVIDE TEACHING ON NUTRIENT DENSE FOOD CHOICES AND PHYSICAL ACTIVITY.MERCYONE DUBUQUE WAS INVOLVED IN THE FOLLOWING PROJECTS DURING FY22 TO ADDRESS BRAIN HEALTH:- PARTICIPATED IN A MONTHLY BRAIN HEALTH STAKEHOLDERS TEAM TO ASSIST IN COORDINATING AND LEVERAGING BRAIN HEALTH SPECIFIC RESOURCES WITHIN THE COMMUNITY.-PARTICIPATED IN A LOCAL BRAIN HEALTH SUMMIT PROMOTING BRAIN HEALTH LANGUAGE AND PARTNERING TO IMPROVE TIMELY ACCESS FOR CHILDREN, ADOLESCENTS, AND ADULTS IN OUR COMMUNITIES RELATED TO BRAIN HEALTH. - MERCYONE DUBUQUE PHARMACY CONTINUED TO STOCK NALOXONE (NARCAN) AND EDUCATED COMMUNITY MEMBERS WHO PRESENTED FOR A NARCAN KIT. THE MOBILE MEDICAL UNIT PROVIDED THREE NARCAN TRAININGS TO THE COMMUNITY.- MAINTAINED A COLLEAGUE CARE CIRCLE TO ASSIST IN FOSTERING COLLEAGUE MENTAL WELL-BEING SECONDARY TO PANDEMIC IMPACT. DEVELOPED A COLLEAGUE CARE SUSTAINMENT MODEL USING CHAPLAINS, THERAPISTS, AND A MISSION LEADER TO ASSURE A SKILLED EMBEDDED PRESENCE THROUGHOUT DUBUQUE & DYERSVILLE ORGANIZATIONS. PROVIDED WEEKLY COLLEAGUE CARE ROUNDING DURING ALL SHIFTS.
DUNES SURGICAL HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING FOUR NEEDS WERE IDENTIFIED IN THE 2022 CHNA FOR THE SIOUXLAND AREA: MENTAL HEALTH, PHYSICAL HEALTH, PREVENTATIVE CARE, AND SUBSTANCE MISUSE. SUBSTANCE MISUSE:THE PROVIDERS AT THE DUNES SURGICAL HOSPITAL (DUNES) CONTINUED TO EDUCATE PATIENTS ON THE HEALTH RISKS OF SMOKING AND USING ALCOHOL. WRITTEN MATERIALS ON SMOKING/VAPING CESSATION WERE DISSEMINATED TO THE COMMUNITY THROUGH DUNES. PHYSICAL HEALTH:DUNES CONTINUED TO PROVIDE PATIENT EDUCATION ON HEALTHY CHOICES, AND THE IMPORTANCE OF MAINTAINING A HEALTHY WEIGHT. THE PROVIDERS AT DUNES CONTINUED TO MEASURE PATIENT'S HEALTH RISK USING BODY MASS INDEX (BMI) FOR HEALTHY WEIGHT MONITORING. POST-SURGICAL EDUCATION WAS PROVIDED TO PATIENTS EMPHASIZING THE IMPORTANCE OF PHYSICAL EXERCISE AND PROPER NUTRITION. ADDITIONALLY, A FOOD DRIVE WAS HELD AT THE HOSPITAL FOR THE VULNERABLE POPULATION IN THE COMMUNITY.MENTAL HEALTH:DUNES PROVIDERS CONTINUED TO SCREEN AND EDUCATE COMMUNITY MEMBERS ABOUT MENTAL HEALTH. REFERRALS WERE MADE TO MENTAL HEALTH PROFESSIONALS AS NEEDED. RECRUITMENT CONTINUED FOR ADDITIONAL MENTAL HEALTH PROVIDERS FOR THE SIOUXLAND AREA. PREVENTATIVE CARE:DUNES INCREASED ACCESS TO CARE WITHIN THE COMMUNITY DURING FY22 BY CONTINUING TO OFFER A FINANCIAL ASSISTANCE PROGRAM, WHICH ALLOWED THOSE WHO MET THE FINANCIAL NEED CRITERIA TO RECEIVE ASSISTANCE FOR NECESSARY SERVICES. SUCCESS WAS ACHIEVED IN REDUCING THE PERCENT OF UNINSURED ADULTS IN ALL SIX COUNTIES WITHIN THE PRIMARY SERVICE AREA (WOODBURY IA, PLYMOUTH IA, UNION SD, DAKOTA NE, DIXON NE, AND THURSTON NE). AT THE TIME OF PATIENTS' DISMISSAL, THE HOSPITAL STAFF MADE FOLLOW UP APPOINTMENTS WITH PRIMARY CARE PHYSICIANS TO AID IN THE MAINTENANCE OR IMPROVEMENT OF OVERALL HEALTH STATUS.
MERCYONE NEW HAMPTON MEDICAL CENTER PART V, SECTION B, LINE 11: MERCYONE NEW HAMPTON RESOURCES, AND OVERALL ALIGNMENT WITH THE HOSPITAL'S MISSION, GOALS AND STRATEGIC PRIORITIES WERE TAKEN INTO CONSIDERATION OF THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE MOST RECENT CHNA PROCESS. IN FY22, MERCYONE NEW HAMPTON DEVELOPED AND/OR SUPPORTED INITIATIVES AND MEASURED THEIR EFFECTIVENESS, TO IMPROVE THE FOLLOWING HEALTH NEEDS:ACCESS TO HEALTH CARE - MERCYONE NEW HAMPTON IDENTIFIED THAT AREA RESIDENTS WOULD DESIRE MORE LOCAL ACCESS TO SPECIALISTS, TREATMENTS/PROCEDURES, AND FAMILY PHYSICIANS. IN FY22, MERCYONE NEW HAMPTON FAMILY MEDICINE WORKED WITH OPION TO PROVIDE ONLINE REGISTRATION FOR APPOINTMENTS, WHICH LAUNCHED IN FALL 2022. EMERGENCY MEDICAL SERVICES - IN FY22, MERCYONE NEW HAMPTON COLLABORATED WITH CHICKASAW COUNTY BOARD OF SUPERVISORS, CHICKASAW COUNTY AMBULANCE COUNCIL AND CHICKASAW EMS ADVISORY COMMITTEE TO ASSIST WITH THE ESTABLISHMENT OF NEW COUNTY OWNED AND OPERATED EMS, IN RESPONSE TO THE RECENT LOSS OF THE ONLY LOCAL EMS PROVIDER. MERCYONE NEW HAMPTON'S EMERGENCY DEPARTMENT NURSE LEADER CONTINUES TO SERVE ON THE ADVISORY COMMITTEE. MERCYONE NEW HAMPTON'S CEO AND PUBLIC RELATIONS MANAGER PARTICIPATED AND OFFERED ASSISTANCE WITH DATA COLLECTION, EDUCATING THE PUBLIC, MARKETING, AND RECRUITMENT. MERCYONE NEW HAMPTON DEVELOPED A PARTNERSHIP WITH NORTHEAST IOWA COMMUNITY COLLEGE AND NEW HAMPTON COMMUNITY SCHOOLS TO OFFER EMT EDUCATION TO SENIORS IN HIGH SCHOOL. OVER THE NEXT 3 YEARS, MERCYONE NEW HAMPTON WILL CONTINUE TO SUPPORT THE NEW EMS MODEL AND WORK TO DECREASE WAIT TIME FOR PARAMEDIC TRANSFERS OUT OF THE ER AND INCREASE AMBULANCE TRANSFER ACCESS FOR MEDICAID PATIENTS AND OTHER UNDER-INSURED PATIENTS. MERCYONE NEW HAMPTON ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH ARE THE MOST PRESSING, UNDER- ADDRESSED AND WITHIN ITS ABILITY TO INFLUENCE. MERCYONE NEW HAMPTON DOES NOT INTEND TO ADDRESS THE FOLLOWING HEALTH NEEDS:KNOWLEDGE OF HEALTH CARE RESOURCES/SERVICES AVAILABLE LOCALLY, WHILE NOT INCLUDED FOR INTERVENTION IN THE IMPLEMENTATION STRATEGY, MERCYONE NEW HAMPTON WILL CONTINUE TO PROMOTE AND EDUCATE OUR COMMUNITY ABOUT RESOURCES AVAILABLE THROUGH MERCYONE NEW HAMPTON, COUNTY AND STATE AGENCIES. MERCYONE NEW HAMPTON LAUNCHED AN ONLINE COMMUNITY RESOURCE DIRECTORY WHICH WILL HELP PEOPLE FIND LOCAL PROGRAMS, RESOURCES, AND SUPPORT. AGING POPULATION, WHILE NOT ADDRESSED IN FY22, STRATEGIES WERE DETERMINED, AND WILL BE IMPLEMENTED OVER THE NEXT 3 YEARS. PARTNERSHIPS WITH CHICKASAW COUNTY PUBLIC HEALTH, SENIOR LIFE SOLUTIONS, NORTHEAST IOWA AREA AGENCY ON AGING, AMERICAN HEART ASSOCIATION, HOSPICE AGENCIES AND CHICKASAW COUNTY MINISTERIAL ASSOCIATION HAVE BEEN ESTABLISHED TO ASSIST MERCYONE NEW HAMPTON WITH OUR STRATEGY IMPLEMENTATION.
MERCYONE DYERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 11: THE SIGNIFICANT NEEDS THAT WERE ADDRESSED IN FY22 WERE ACCESS TO HEALTH CARE, OBESITY, AND BRAIN HEALTH.MERCYONE DYERSVILLE WAS INVOLVED IN THE FOLLOWING PROJECT DURING FY22 TO ADDRESS ACCESS TO HEALTH CARE:- MERCYONE DUBUQUE AND MERCYONE DYERSVILLE PURCHASED A 31-FOOT WINNEBAGO AND HIRED A VENDOR TO CUSTOMIZE THE UNIT WITH A WAITING ROOM, INTAKE AREA, TWO EXAM ROOMS AND A HANDICAP ACCESSIBLE LIFT. THE UNIT LAUNCHED IN NOVEMBER 2022 WITH THE VISION OF REACHING ANYONE EXPERIENCING A BARRIER TO HEALTH CARE ACCESS. WITH INITIAL FOCUS ON ADULT, ADOLESCENT, AND PEDIATRIC COVID-19 VACCINE DISTRIBUTION.MERCYONE DYERSVILLE WAS INVOLVED IN THE FOLLOWING PROJECT DURING FY22 TO ADDRESS OBESITY:-THE MOBILE MEDICAL UNIT WAS PRESENT AT FARMERS MARKETS IN DUBUQUE AND DYERSVILLE TO PROMOTE HEALTHY EATING. DIETICIANS JOINED THE INTERDISCIPLINARY MOBILE MEDICAL UNIT TEAM TO MEET WITH COMMUNITY MEMBERS AND PROVIDE TEACHING ON NUTRIENT DENSE FOOD CHOICES.MERCYONE DYERSVILLE WAS INVOLVED IN THE FOLLOWING PROJECTS DURING FY22 TO ADDRESS BRAIN HEALTH:- PARTICIPATED IN A MONTHLY BRAIN HEALTH STAKEHOLDERS TEAM TO ASSIST IN COORDINATING AND LEVERAGING BRAIN HEALTH SPECIFIC RESOURCES WITHIN THE COMMUNITY.- MAINTAINED A COLLEAGUE CARE CIRCLE TO ASSIST IN FOSTERING COLLEAGUE MENTAL WELL-BEING SECONDARY TO PANDEMIC IMPACT. DEVELOPED A COLLEAGUE CARE SUSTAINMENT MODEL USING CHAPLAINS, THERAPISTS, AND A MISSION LEADER TO ASSURE A SKILLED EMBEDDED PRESENCE THROUGHOUT DUBUQUE & DYERSVILLE ORGANIZATIONS. PROVIDED WEEKLY COLLEAGUE CARE ROUNDING DURING ALL SHIFTS.
MERCYONE NORTH IOWA MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCYONE SIOUXLAND MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCYONE DUBUQUE MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
DUNES SURGICAL HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCYONE NEW HAMPTON MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCYONE DYERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.
MERCYONE NORTH IOWA MEDICAL CENTER - PART V, SECTION B, LINE 7A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE NORTH IOWA MEDICAL CENTER - PART V, SECTION B, LINE 10A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE SIOUXLAND MEDICAL CENTER - PART V, SECTION B, LINE 7A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE SIOUXLAND MEDICAL CENTER - PART V, SECTION B, LINE 10A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE DUBUQUE MEDICAL CENTER - PART V, SECTION B, LINE 7A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE DUBUQUE MEDICAL CENTER - PART V, SECTION B, LINE 10A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
DUNES SURGICAL HOSPITAL - PART V, SECTION B, LINE 7A WWW.DUNESSURGICALHOSPITAL.COM/COMMUNITY-BENEFIT
DUNES SURGICAL HOSPITAL - PART V, SECTION B, LINE 10A WWW.DUNESSURGICALHOSPITAL.COM/COMMUNITY-BENEFIT
MERCYONE NEW HAMPTON MEDICAL CENTER - PART V, SECTION B, LINE 7A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE NEW HAMPTON MEDICAL CENTER - PART V, SECTION B, LINE 10A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE DYERSVILLE MEDICAL CENTER - PART V, SECTION B, LINE 7A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE DYERSVILLE MEDICAL CENTER - PART V, SECTION B, LINE 10A WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/
MERCYONE NEW HAMPTON MEDICAL CENTER - PART V, SECTION B, LINE 9 AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.
MERCYONE NORTH IOWA MEDICAL CENTER - PART V, SECTION B, LINE 9 AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.
MERCYONE SIOUXLAND MEDICAL CENTER - PART V, SECTION B, LINE 7B WWW.DUNESSURGICALHOSPITAL.COM/COMMUNITY-BENEFITWWW.SIOUXLANDDISTRICTHEALTH.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-AND-STATISTICSWWW.UNITYPOINT.ORG/SIOUXCITY/ABOUT-COMMUNITY-BENEFIT.ASPX
DUNES SURGICAL HOSPITAL - PART V, SECTION B, LINE 7B WWW.MERCYONE.ORG/ABOUT-US/COMMUNITY-HEALTH-AND-WELL-BEING/WWW.SIOUXLANDDISTRICTHEALTH.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-AND-STATISTICSWWW.UNITYPOINT.ORG/SIOUXCITY/ABOUT-COMMUNITY-BENEFIT.ASPX
MERCYONE DUBUQUE MEDICAL CENTER - PART V, SECTION B, LINE 9 AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.
MERCYONE DYERSVILLE MEDICAL CENTER - PART V, SECTION B, LINE 9 AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.
MERCYONE NORTH IOWA MEDICAL CENTER, PART V, LINE 16A, FAP WEBSITE: WWW.MERCYONE.ORG/NORTHIOWA/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/
MERCYONE DUBUQUE MEDICAL CENTER, PART V, LINE 16A, FAP WEBSITE: WWW.MERCYONE.ORG/DUBUQUE/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
DUNES SURGICAL HOSPITAL, PART V, LINE 16A, FAP WEBSITE: WWW.DUNESSURGICALHOSPITAL.COM/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE
MERCYONE DYERSVILLE MEDICAL CENTER, PART V, LINE 16A, FAP WEBSITE: WWW.MERCYONE.ORG/DUBUQUE/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
MERCYONE NORTH IOWA MEDICAL CTR, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MERCYONE.ORG/NORTHIOWA/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/
MERCYONE DUBUQUE MEDICAL CENTER, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MERCYONE.ORG/DUBUQUE/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
DUNES SURGICAL HOSPITAL, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.DUNESSURGICALHOSPITAL.COM/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE
MERCYONE DYERSVILLE, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MERCYONE.ORG/DUBUQUE/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
MERCYONE NORTH IOWA MEDICAL CENTER, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MERCYONE.ORG/NORTHIOWA/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/
MERCYONE SIOUXLAND MEDICAL CENTER, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MERCYONE.ORG/SIOUXLAND/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
MERCYONE DUBUQUE MEDICAL CENTER, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MERCYONE.ORG/DUBUQUE/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
DUNES SURGICAL HOSPITAL, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.DUNESSURGICALHOSPITAL.COM/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE
MERCYONE NEW HAMPTON MEDICAL CENTER, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MERCYONE.ORG/NEWHAMPTON/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/
MERCYONE DYERSVILLE MEDICAL CENTER, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MERCYONE.ORG/DUBUQUE/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
MERCYONE NEW HAMPTON MEDICAL CENTER, PART V, LINE 16A, FAP WEBSITE: WWW.MERCYONE.ORG/NEWHAMPTON/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/
MERCYONE NEW HAMPTON MEDICAL CTR, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MERCYONE.ORG/NEWHAMPTON/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/
MERCYONE SIOUXLAND MEDICAL CENTER, PART V, LINE 16A, FAP WEBSITE: WWW.MERCYONE.ORG/SIOUXLAND/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
MERCYONE SIOUXLAND MEDICAL CTR, PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MERCYONE.ORG/SIOUXLAND/FOR-PATIENTS/BILLING-AND-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?16
Name and address Type of Facility (describe)
1 1 - MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001
OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
2 2 - MEDICAL ASSOCIATES CLINIC
1240 BIG JACK ROAD
PLATTEVILLE,WI53818
X-RAY, LAB, EMPLOYED PHYSICIANS
3 3 - TRI-STATE OCCUPATIONAL HEALTH
1920 ELM STREET
DUBUQUE,IA52001
PHYS THERAPY,EMPLOYED PHYSICIANS
4 4 - MEDICAL ASSOCIATES CLINIC
10988 BARTELL BLVD
GALENA,IL61036
HOME CARE,LAB, EMPLOYED PHYSICIANS
5 5 - MERCYONE DYERSVILLE MEDICAL CENTER
1121 THIRD STREET SW
DYERSVILLE,IA52040
CLINIC
6 6 - MEDICAL ASSOCIATES CLINIC
208 N 12TH STREET
BELLEVUE,IA52031
CLINIC
7 7 - MEDICAL ASSOCIATES CLINIC
911 NW CARTER
ELKADER,IA52043
CLINIC
8 8 - CASCADE FAMILY HEALTH CENTER
805 JOHNSON STREET SW
CASCADE,IA52033
EMPLOYED PHYSICIANS, LAB, X-RAY, PT
9 9 - MEDICAL ASSOCIATES CLINIC
117 SOUTH MADISON
CUBA CITY,WI53807
X-RAY, LAB, EMPLOYED PHYSICIANS
10 10 - MEDICAL ASSOCIATES CLINIC
560 PLEASANT ST
ELIZABETH,IL61028
CLINIC
11 11 - MEDICAL ASSOCIATES CLINIC
107 S PAGE
MONONA,IA52159
CLINIC
12 12 - MEDICAL ASSOCIATES EAST CAMPUS
1000 LANGWORTHY
DUBUQUE,IA52001
OCC. HEALTH, PHYSICAL THERAPY
13 13 - MERCYONE DAKOTA DUNES MEDICAL LAB
101 TOWER RD SUITE 220
DAKOTA DUNES,SD57049
REFERENCE LABORATORY
14 14 - MASON CITY SURGERY CENTER
990 4TH STREET
MASON CITY,IA50401
AMBULATORY SURGERY
15 15 - MERCY FAMILY CLINIC - BUFFALO CENTER
115 NORTH MAIN
BUFFALO CENTER,IA50424
X-RAY, LAB, EMPLOYED PHYSICIANS
16 16 - TRI-STATE SURGERY CENTER
1500 ASSOCIATES DRIVE
DUBUQUE,IA52002
OUTPATIENT CLINIC, OPHTHALMOLOGY, ORTHOPEDICS
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS.
PART I, LINE 6A: MERCY HEALTH SERVICES-IOWA (MHS-IA) REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, THE HOSPITAL DIVISIONS OF MHS-IA INCLUDE A COPY OF THEIR MOST RECENT SCHEDULE H ON THEIR RESPECTIVE WEBSITES. TRINITY HEALTH ALSO INCLUDES MHS-IA'S MOST RECENTLY FILED SCHEDULE H ON ITS WEBSITE.
PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITALS' COST ACCOUNTING SYSTEMS.
PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $18,098,216, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F).
PART II, COMMUNITY BUILDING ACTIVITIES: MERCYONE NORTH IOWA MEDICAL CENTER (MERCYONE NORTH IOWA) SPONSORED THE NORTH IOWA FOOD COALITION, A COALITION AIMING TO HELP CITIZENS OBTAIN AFFORDABLE FRESH, WHOLE, HEALTHY FOODS WITHIN OUR COMMUNITY.MERCYONE DUBUQUE MEDICAL CENTER (MERCYONE DUBUQUE) PROVIDED COMMUNITY SUPPORT BY PROVIDING EMS TRAINING, WHICH INCLUDED VARIOUS ACTIVITIES THAT SUPPORT THE EDUCATION OF EMERGENCY MEDICAL SERVICE PERSONNEL IN THE TRI-STATE AREA. MERCYONE NEW HAMPTON MEDICAL CENTER (MERCYONE NEW HAMPTON):ECONOMIC DEVELOPMENT: AS ONE OF THE LARGEST EMPLOYERS IN THE AREA, MERCYONE NEW HAMPTON TAKES ITS CIVIC RESPONSIBILITY VERY SERIOUSLY. SUPPORT OF, AND CONTRIBUTIONS TO, COMMUNITY ORGANIZATIONS, EVENTS, AND PROGRAMS, SUCH AS NEW HORIZONS-CHAMBER, AND THE INDUSTRIAL DEVELOPMENT CORPORATION HELP IMPROVE THE ECONOMY OF MERCYONE NEW HAMPTON'S CATCHMENT COUNTIES. BY PROMOTING ECONOMIC DEVELOPMENT, MERCYONE NEW HAMPTON HELPS CREATE A COMMUNITY THAT CONTINUES TO BUILD ITSELF THROUGH THE LEADERS WHO WORK AND VOLUNTEER AT THE HOSPITAL. ECONOMIC STABILITY IS INTRINSICALLY LINKED TO THE PREVENTION OF HEALTH PROBLEMS ASSOCIATED WITH POVERTY, HOMELESSNESS, AND ENVIRONMENTAL CHALLENGES, AND IS CRUCIAL IF THE COMMUNITY HOPES TO MAINTAIN A VIABLE HOSPITAL COMPLEX WITH A BROAD SPECTRUM OF ESSENTIAL SERVICES. IN FISCAL YEAR 2022 (FY22), MERCYONE NEW HAMPTON SUPPORTED THE INDUSTRIAL DEVELOPMENT CORPORATION WITH THE EXPANSION OF A LOCAL NON-PROFIT DAYCARE TO DOUBLE THEIR CAPACITY. MERCYONE NEW HAMPTON'S INVOLVEMENT INCLUDED DONATIONS OF IN-KIND PRODUCTS FOR OPEN HOUSES, WORKDAYS, AND FUNDRAISERS. WE ALSO WROTE LETTERS OF SUPPORT FOR GRANTS.COMMUNITY SUPPORT: FY22 BROUGHT MANY CHALLENGES TO OUR COMMUNITY AS WE FACED LOSING THE ONLY EMERGENCY MEDICAL SERVICES PROVIDER. MERCYONE NEW HAMPTON, WITH THE SUPPORT OF TWO MEMBERS OF THE COUNTY BOARD OF SUPERVISORS, WORKED TO RESEARCH OPTIONS FOR EMS AND SUPPORTED THE CREATION OF A COUNTY OWNED AND OPERATED AMBULANCE SERVICE. MERCYONE NEW HAMPTON ADMINISTRATORS WERE ACTIVE PARTICIPANTS IN DISCUSSIONS WITH THE CHICKASAW AMBULANCE COUNCIL, CITY COUNCILS AND CHICKASAW COUNTY BOARD OF SUPERVISORS. MERCYONE NEW HAMPTON ADVOCATED FOR AN AMBULANCE SERVICE THAT WOULD ACCEPT MEDICAID, AS THE PREVIOUS SERVICE DID NOT. MERCYONE NEW HAMPTON HAS A COMMITMENT TO THOSE WHO ARE POOR, AND IT WAS IMPORTANT THAT OUR MOST VULNERABLE PATIENTS HAVE ACCESS TO TIMELY AMBULANCE TRANSFERS WHEN A HIGHER LEVEL OF CARE IS NEEDED.ENVIRONMENTAL IMPROVEMENTS: MERCYONE NEW HAMPTON CONTINUES TO ADDRESS THE NEED FOR MEMBERS OF THE COMMUNITY TO SAFELY DISPOSE OF THEIR SHARPS AND CONTAINERS TO REDUCE ENVIRONMENTAL HAZARDS. THE HOSPITAL COLLABORATES WITH PHARMACIES IN NEW HAMPTON TO COLLECT THEIR CONTAINERS AS WELL.ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT: IN SEPTEMBER 2021, AN INITIATIVE WAS STARTED TO RENOVATE A CURRENT, RUN-DOWN PARK INTO AN INCLUSIVE PLAYGROUND. MERCYONE NEW HAMPTON HAS THREE COLLEAGUES ON THE PLANNING AND FUNDRAISING COMMITTEE. AS WE ALL KNOW, PLAY IS A VITAL PART OF CHILDREN'S DEVELOPMENT, NOT JUST PHYSICALLY BUT SOCIALLY AND EMOTIONALLY. THE INCLUSIVE PLAYGROUND WILL BRING TOGETHER CHILDREN AND FAMILIES IN PLAY. THE PLAYGROUND WILL HELP THOSE WITH DISABILITIES HAVE FUN PLAYING ALONGSIDE THEIR FRIENDS, FURTHERING THEIR DEVELOPMENT AND SENSE OF BELONGING. FOR OTHER CHILDREN, IT WILL TEACH THEM TO EMBRACE DIVERSITY AND INCLUSION OF CHILDREN DIFFERENT FROM THEM.WORKFORCE DEVELOPMENT: MERCYONE NEW HAMPTON SUCCESSFULLY RECRUITED TWO PHYSICIANS IN FY22 WITH ONE STARTING IMMEDIATELY AND THE OTHER BEGINNING AFTER THEIR RESIDENCY IS COMPLETE IN THE SUMMER OF 2023.MERCYONE NEW HAMPTON PARTNERS WITH NORTHEAST IOWA COMMUNITY COLLEGE AND AREA SCHOOLS TO PROMOTE CAREER EXPLORATION. CAREER EXPLORATION IS AN IMPORTANT STEP IN HELPING STUDENTS FULFILL LONG TERM EMPLOYMENT GOALS. MERCYONE NEW HAMPTON WELCOMES JOB SHADOW STUDENTS AND HOLDS AN ANNUAL HEALTH CARE CAREER DAY FOR HIGH SCHOOL STUDENTS. ALL AREA 8TH GRADE STUDENTS TOUR MERCYONE NEW HAMPTON TO LEARN ABOUT HEALTH CARE CAREERS AND PARTICIPATE IN MOCK INTERVIEWS. MERCYONE NEW HAMPTON ADMINISTRATION IS ALSO A MEMBER OF THE NORTHEAST IOWA REGIONAL CAREER AND TECHNICAL EDUCATION PLANNING PARTNERSHIP.
PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.
PART III, LINE 3: MHS-IA USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, MHS-IA IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, MHS-IA IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL.
PART III, LINE 4: MHS-IA IS IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 13 OF THOSE STATEMENTS: "AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE.THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED."PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE ONE PERCENT SEQUESTRATION REDUCTION FOR THE PERIOD APRIL 1, 2022 THROUGH JUNE 30, 2022.
PART III, LINE 8: MHS-IA DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT.
PART III, LINE 9B: MHS-IA'S FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN EACH HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE HOSPITALS HAVE IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS.
PART VI, LINE 2: NEEDS ASSESSMENT - MHS-IA HOSPITALS ASSESS THE HEALTH STATUS OF THEIR COMMUNITIES, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORT TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THEIR COMMUNITIES, OUR HOSPITALS MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH AREAS OF UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED.MERCYONE NORTH IOWA AND MERCYONE NEW HAMPTON EACH HAVE A LOCAL BOARD OF GOVERNANCE COMPOSED OF AREA RESIDENTS, EMPLOYERS, AND REPRESENTATIVES OF DEMOGRAPHIC GROUPS. THESE HOSPITALS ALSO COMMUNICATE WITH OTHER AGENCIES ABOUT WHAT SERVICES ARE NEEDED LOCALLY. IN PARTICULAR OUR PRIMARY CARE PHYSICIANS HAVE A STRONG AWARENESS OF PATIENT NEEDS. A COMMITTEE MEETS QUARTERLY THAT IS COMPRISED OF COMMUNITY MEMBERS AND HOSPITAL PERSONNEL THAT WORK DIRECTLY WITH THE UNINSURED, UNDERINSURED AND UNDERSERVED. THE COMMUNITY BENEFIT MINISTRY OFFICER INTERFACES REGULARLY WITH COMMUNITY HUMAN SERVICE AGENCIES AND COALITIONS.THE STAFF OF MERCYONE SIOUXLAND MEDICAL CENTER (MERCYONE SIOUXLAND) ROUTINELY MET WITH VARIOUS COMMUNITY AGENCIES AND SCHOOLS IN SEARCH OF OPPORTUNITIES TO FURTHER COLLABORATE TO ADDRESS PHYSICAL HEALTH, SUBSTANCE MISUSE, MENTAL HEALTH, AND PREVENTATIVE CARE.
PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MHS-IA HOSPITALS COMMUNICATE EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. THE HOSPITALS OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITALS. THE HOSPITALS HAVE ESTABLISHED WRITTEN POLICIES FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. THE HOSPITALS MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND ARE COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER.
PART VI, LINE 4: COMMUNITY INFORMATION -MERCYONE NORTH IOWA'S SERVICE AREA IS COMPRISED OF 15 COUNTIES IN NORTH-CENTRAL IOWA AND SOUTHERN MINNESOTA. THE PRIMARY SERVICE AREA INCLUDES CERRO GORDO AND WORTH COUNTIES, AND THE SECONDARY SERVICE AREA INCLUDES BUTLER, CHICKASAW, FLOYD, FRANKLIN, FREEBORN, HANCOCK, HARDIN, HOWARD, KOSSUTH, MITCHELL, PALO ALTO, WINNEBAGO, AND WRIGHT COUNTIES. THE NORTH-CENTRAL IOWA REGION HAS A POPULATION OF APPROXIMATELY 200,000, INCLUDING ABOUT 42,600 RESIDENTS WHO LIVE WITHIN CERRO GORDO, THE LARGEST COUNTY AND 7,500 RESIDENTS WHO LIVE WITHIN WORTH, THE SMALLEST COUNTY, AS WELL AS ONE FEDERALLY QUALIFIED HEALTH CENTER. REGIONALLY, THE POPULATION IS APPROXIMATELY 96% WHITE ALONE, 1.8% BLACK ALONE AND 4.6% LATINO (STATE AVERAGES ARE: 90.7%, 4%, AND 6.2% RESPECTIVELY). THIS AREA IS AMONG THE LEAST DIVERSE NATIONALLY; HOWEVER, IN IOWA, RACIAL AND ETHNIC MINORITY POPULATIONS ARE INCREASING. THIS POPULATION COMPRISES 2.1% OF THE POPULATION IN BUTLER COUNTY (THE LOWEST) TO 12.6% IN FRANKLIN COUNTY (THE HIGHEST). IOWA HAS AN OLDER POPULATION THAT IS AMONG THE HIGHEST IN THE NATION. REGIONALLY, INDIVIDUALS AGED 65 YEARS AND OLDER ACCOUNT FOR 21.8% OF THE POPULATION AND PERSONS UNDER AGE 18 YEARS ACCOUNT FOR 22.5% OF THE POPULATION. STATEWIDE, THE AVERAGES ARE 17.1% AND 23.2% RESPECTIVELY. IN DUBUQUE COUNTY, ONE OTHER HOSPITAL IS PRESENT AND ONE FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER. THE PRIMARY SERVICE AREA OF MERCYONE DUBUQUE AND MERCYONE DYERSVILLE MEDICAL CENTER (MERCYONE DYERSVILLE) IS DUBUQUE COUNTY, IOWA, WHICH IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA.THE MAJOR SERVICE AREA FOR MERCYONE DUBUQUE IS DUBUQUE COUNTY, BUT ALSO INCLUDES JACKSON, CLAYTON, LAFAYETTE, AND DELAWARE COUNTIES IN IOWA, GRANT COUNTY, WISCONSIN, AND JO DAVIESS COUNTY, ILLINOIS. THE SERVICE AREA IS RELATIVELY HOMOGENOUS, WITH A WHITE NON-HISPANIC POPULATION OF 92.5% AND VERY LOW OVERALL POPULATION GROWTH. MERCYONE SIOUXLAND AND DUNES SURGICAL HOSPITAL: SIOUX CITY, IOWA SERVES AS THE REGIONAL HUB FOR BUSINESS, EMPLOYMENT, INDUSTRY, RETAIL TRADE, MEDICAL CARE, AND EDUCATIONAL OPPORTUNITIES. SIX COUNTIES IN THE TRI-STATE AREA OF NORTHWESTERN IOWA, NORTHEASTERN NEBRASKA, AND SOUTHWESTERN SOUTH DAKOTA WERE INCLUDED IN THE SIOUXLAND COMMUNITY HEALTH NEEDS ASSESSMENT. INDIVIDUALS RESIDING IN THESE COUNTIES LIVED WITHIN A 40-MILE RADIUS OF SIOUX CITY. THE AREA INCLUDED THE IOWA COUNTIES OF WOODBURY AND PLYMOUTH; THE NEBRASKA COUNTIES OF DAKOTA, DIXON, AND THURSTON; AND THE SOUTH DAKOTA COUNTY OF UNION. THE TOTAL AREA FOR THESE COUNTIES IS 3,355 SQUARE MILES, WITH WOODBURY AND PLYMOUTH REPRESENTING 52% OF THE TOTAL AREA. THE SIOUXLAND REGION HAS A TOTAL CURRENT POPULATION OF 177,000. ABOUT 26% OF THE POPULATION WAS UNDER THE AGE OF 18 YEARS AND 16% OF THE POPULATION WAS OVER THE AGE OF 65 YEARS. THE RACE/ETHNICITY DISTRIBUTION IN THE AREA WAS 84% WHITE, 4% AMERICAN INDIAN, 3% BLACK, 2% ASIAN, 3% TWO OR MORE RACES, AND 4% OTHER. EIGHTY FOUR PERCENT ARE NON-HISPANIC WHILE 16% WERE HISPANIC/LATINO.IN THE AREA, OVERALL POVERTY RATE IS 13%, WITH AMERICAN INDIAN/ALASKA NATIVE AND BLACK OR AFRICAN AMERICAN POPULATIONS HAVING THE HIGHEST POVERTY RATE. THIRTY PERCENT OF HOUSEHOLDS FALL UNDER THE 200% POVERTY RATE AND THE MEDIAN HOUSEHOLD INCOME FOR THE AREA IS $61,393.THE REGIONAL ECONOMY IS BASED ON FOOD MANUFACTURING/PROCESSING, AGRICULTURE, HEALTH CARE AND SOCIAL ASSISTANCE, EDUCATION, AND THE FOOD SERVICE INDUSTRIES. THE JUNE 2021 UNEMPLOYMENT RATE FOR THE LARGEST COUNTIES IN THE REGION WOODBURY, PLYMOUTH, AND DAKOTA WAS 4.9%, 3.5%, AND 3.4%, RESPECTIVELY.WOODBURY COUNTY, IA HAS A POPULATION OF 103,107, WHICH REPRESENTS 58% OF THE SIOUXLAND REGIONAL TOTAL. THE RESIDENTS OF SIOUX CITY AND SERGEANT BLUFF REPRESENT NEARLY 90% OF THE WOODBURY COUNTY POPULATION. PLYMOUTH COUNTY, IA HAS A POPULATION OF 25,177, OR 14% OF THE SIOUXLAND REGIONAL TOTAL. THE LARGEST COMMUNITY IN THE COUNTY IS LE MARS WITH A POPULATION OF 10,081. DAKOTA COUNTY, NE HAS A POPULATION OF 20,026. SOUTH SIOUX CITY AND DAKOTA CITY TOTAL RESIDENTS REPRESENT 73% OF THE COUNTY POPULATION. UNION COUNTY, SD HAS A POPULATION OF 15,932 WHICH REPRESENTS 9% OF THE REGIONAL TOTAL. NORTH SIOUX CITY AND DAKOTA DUNES' TOTAL RESIDENTS REPRESENT 34% OF THE COUNTY POPULATION. THURSTON COUNTY, NE HAS A POPULATION OF 7,224. DIXON COUNTY, NE HAS A POPULATION OF 5,636, REPRESENTING 7% OF THE REGIONAL TOTAL.MERCYONE NEW HAMPTON SERVES THE CHICKASAW AREA AND SURROUNDING COUNTIES WITHIN A 20-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM NEW HAMPTON. THE PRIMARY SERVICE AREA CONSISTS OF THE TOWNS OF NEW HAMPTON, FREDERICKSBURG, ALTA VISTA, IONIA, ELMA, WAUCOMA, LAWLER AND NASHUA. THE ESTIMATED POPULATION OF THIS AREA IS 13,000. ACCORDING TO THE U.S. CENSUS BUREAU, CHICKASAW COUNTY HAD AN ESTIMATED POPULATION OF 12,012 IN 2020. CHICKASAW COUNTY EXPERIENCED AN ESTIMATED 3.5% DECLINE IN POPULATION FROM 2010 TO 2020. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER-THAN-AVERAGE PROPORTION OF ELDERLY INDIVIDUALS IN THE AREA. OF THE CHICKASAW POPULATION, 21.4% WERE OVER AGE 65 IN 2020, COMPARED TO 17.7% FOR THE STATE AND 16.8% FOR THE NATION. THIS LARGE PERCENTAGE FOR THIS AGE GROUP PRESENTS SPECIAL CHALLENGES TO HEALTH CARE PROVIDERS, BECAUSE THIS AGE GROUP HAS THE HIGHEST INCIDENCE OF DISEASE AND MORTALITY IN MOST CATEGORIES, AND CORRESPONDINGLY, REPRESENTS THE BIGGEST USERS OF HEALTH CARE SERVICES. IN ADDITION, MEDICARE PAYMENT SHORTFALLS PRESENT AN ADDITIONAL BURDEN FOR RURAL HEALTH PROVIDERS. APPROXIMATELY 53% OF MERCYONE NEW HAMPTON'S REVENUES (HOSPITAL INPATIENT AND OUTPATIENT) WERE GENERATED FROM MEDICARE PATIENTS. THE MEDIAN HOUSEHOLD INCOME IN CHICKASAW COUNTY WAS ESTIMATED AT $61,239 IN 2020. PERSONS IN POVERTY COMPRISE 8.3% OF THE POPULATION. THE FISCAL YEAR 2020 PAYER MIX AT POINT OF REGISTRATION INCLUDES 53% COVERED BY MEDICARE, 11.8% COVERED BY MEDICAID AND 1.5% SELF-PAY.
PART VI, LINE 5: OTHER INFORMATION -MERCYONE NORTH IOWA HAS PROVIDED MANAGEMENT SERVICES FOR RURAL HOSPITALS SINCE 1978. THESE COMMUNITY HOSPITALS OFFER QUALITY HEALTH CARE AND YET ARE STILL ABLE TO TAKE ADVANTAGE OF ALL THE RESOURCES WE HAVE TO OFFER AS A MAJOR REFERRAL CENTER. WE EXTEND MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTH CARE PROVIDERS TO MEET THE NEEDS OF THOSE WHO LIVE IN OUR COMMUNITIES. MERCYONE NORTH IOWA IS INTENTIONAL IN DEVELOPING TRIPLE-AIM ACCOUNTABLE CARE ORGANIZATION RELATIONSHIPS AND COLLABORATING WITH COMMUNITY HEALTH PROVIDERS AND SOCIAL SERVICE AGENCIES, IN CREATING A SYSTEM OF CARE COORDINATION PROCESSES. AS A TEACHING HOSPITAL, WE HOST A THREE-YEAR FAMILY PRACTICE RESIDENCY PROGRAM, PHARMACY RESIDENCY, INTERNAL MEDICINE RESIDENCY, CARDIOLOGY FELLOWSHIP, HOSPICE AND PALLIATIVE CARE FELLOWSHIP, NURSE RESIDENCY, AND A SCHOOL OF RADIOLOGIC TECHNOLOGY. THE HOSPITAL SERVES AS A CLINICAL SITE FOR MULTIDISCIPLINARY STUDENTS. AS A COMMUNITY PROVIDER, SPECIALIZED SERVICES INCLUDE A HEART & VASCULAR INSTITUTE, CANCER, DIABETES, STROKE, BARIATRIC, VASCULAR, AND WOUND, LEVEL II BIRTH, AND LEVEL II EMERGENCY CENTERS. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. MERCYONE NORTH IOWA FURTHER INVESTS IN THE COMMUNITY TO ENHANCE THE HEALTH OF RESIDENTS BY:-PROVIDING NO COST MEDICATION NAVIGATION ASSISTANCE TO THOSE WHO HAVE NON-COVERED LONG-TERM MEDICATIONS-PARTICIPATING WITH THE AGING SERVICES COALITION TO ADVOCATE AND CONNECT ELDERLY TO COMMUNITY RESOURCES-PARTICIPATING WITH THE NCI COMMUNITY COLLABORATIONS HOUSING COALITION -PARTICIPATING WITH NORTH IOWA ADDICTION PREVENTION ALLIANCE TO ADDRESS UNDERAGE DRINKING, TOBACCO & NICOTINE PREVENTION, PRESCRIPTION & OPIOID MISUSE PREVENTION-OFFERING SOCIAL CARE OUTREACH FOR FOOD, EMERGENCY SUPPLIES, AND CONNECTION TO COMMUNITY -PROVIDING SUPPORT FOR THOSE WHO ARE HOMELESS -PROVIDING THE MERCY FAMILY HEALTH LINE, A 24-HOUR/7-DAY A WEEK TELEPHONE MEDICAL TRIAGE/COVID-19 EMERGENT TESTING AND RESOURCES AND SOCIAL SUPPORT SERVICE-PARTICIPATING AND ASSISTING IN DELIVERY OF MEALS ON WHEELS, INCLUDING TO THOSE IN COVID-19 QUARANTINE-PARTICIPATED IN LOCAL BLOOD DRIVES-PARTICIPATED IN HEALTHY YOU RESOURCE FAIR WITH NUMEROUS COMMUNITY-BASED AGENCIES ON EXERCISE, STRESS REDUCTION, NICOTINE CESSATION, EMPLOYMENT, MENTAL HEALTH, PREGNANCY, CHILDCARE RESOURCES, EDUCATION, FOOD AND NUTRITION, GENERAL HEALTH, HOUSING ASSISTANCE, PARENTING RESOURCES AND SEXUAL HEALTH-COLLABORATING AND PARTICIPATING WITH COMMUNITY-BASED ORGANIZATIONS LOCAL BUILD AND LAUNCH OF AUNT BERTHA COMMUNITY RESOURCE DIRECTORY FOR FREE REDUCED PROGRAMING -COLLABORATING WITH HEALTHY HARVEST, CERRO GORDO PUBLIC HEALTH, HY-VEE, FARMERS MARKET MASON CITY AND CLEAR LAKE, COMMUNITY PARTNERSHIPS FOR PROTECTING CHILDREN, AND UNIVERSITY OF NORTHERN IOWA TO EXTEND VEGGIE VOUCHER PROGRAM WITH COMMUNITY SUPPORTED AGRICULTURE BOXES-SCREENING INDIVIDUALS FOR SOCIAL INFLUENCERS OF HEALTH IN THE EMERGENCY DEPARTMENT, INPATIENT UNITS, AND CLINICS, AND CONNECTING THOSE IDENTIFIED WITH SOCIAL NEEDS TO COMMUNITY RESOURCES -FACILITATE A WEEKLY VIRTUAL COMMUNITY HUDDLE TO INCLUDE THE CERRO GORDO DEPARTMENT OF PUBLIC HEALTH, NORTH IOWA COMMUNITY ACTION ORGANIZATION, LUTHERAN SERVICES IOWA, COUNTY SOCIAL SERVICES, VA CLINIC, AND CICS, PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTH CARE, TO ENABLE THE SHARING OF COMMUNITY RESOURCES, EVENTS AND EDUCATION -BABY FRIENDLY INITIATIVES INCLUDED IMPLEMENTING INFANT FEEDING POLICY, PROVIDING EDUCATION TO ALL NEW STAFF AND ANNUALLY THEREAFTER, PROMOTING 10 STEPS TO SUCCESSFUL BREASTFEEDING, PROVIDING A SECURE LACTATION AREA INCLUSIVE OF A HOSPITAL GRADE PUMP FOR ALL STAFF TO USE, INITIATING OUTPATIENT BREASTFEEDING APPOINTMENTS WITH OUR CLC STAFF, AND PROVIDING DONOR MILK FOR ALL NICU BABIES, AS WELL AS OTHER NEWBORNS NEEDING DONOR'S MILK IN FY22, MERCYONE NORTH IOWA COLLABORATED ON ADVOCACY EFFORTS WITH OUR MERCYONE AND TRINITY HEALTH COLLEAGUES TO SUPPORT POLICIES SUCH AS FUNDING FOR PUBLIC HEALTH AND PREVENTION EFFORTS, HOUSING, RACIAL DISPARITIES, EXPANSION OF HEALTH CARE ACCESS, MEDICAID EXPANSION, 340B, AND INCREASED FUNDING FOR BEHAVIORAL/MENTAL HEALTH SERVICES. IN 1879, THE SISTERS OF MERCY ARRIVED IN DUBUQUE AT THE REQUEST OF BISHOP JOHN HENNESSY TO LAUNCH A HEALING MINISTRY NOW KNOWN AS MERCYONE DUBUQUE MEDICAL CENTER. TODAY, MERCYONE DUBUQUE IS THE LEADING HOSPITAL IN THE TRI-STATES, WITH THE MOST COMPREHENSIVE CARDIOLOGY CENTER IN THE AREA AND THE ONLY LEVEL II REGIONAL NEONATAL INTENSIVE CARE UNIT. OTHER SERVICES INCLUDE A TRAUMA CENTER, A CARF-ACCREDITED INPATIENT REHABILITATION UNIT, HOME HEALTH CARE, ORTHOPEDICS, CANCER CARE, RETAIL PHARMACIES, PALLIATIVE CARE, AND A WIDE RANGE OF OUTPATIENT AND COMMUNITY SERVICES. MERCYONE DUBUQUE OPERATES TWO HOSPITAL-BASED SKILLED NURSING UNITS AND A 40-BED NURSING HOME. IN RECOGNITION OF THE STRENGTH OF ITS NURSING SERVICE AND THE OVERALL QUALITY OF PATIENT CARE, MERCYONE DUBUQUE HAS BEEN DESIGNATED A MAGNET HOSPITAL FOUR CONSECUTIVE TIMES - THE NATION'S MOST PRESTIGIOUS AWARD FOR NURSING EXCELLENCE.MERCYONE DYERSVILLE IS A 20-BED CRITICAL ACCESS HOSPITAL SERVING 17 RURAL COMMUNITIES IN WESTERN DUBUQUE COUNTY, OFFERING THE FOLLOWING SERVICES: EMERGENCY/TRAUMA, ACUTE AND SKILLED CARE, REHABILITATION SERVICES (PT/OT/SPEECH), AMBULATORY SURGERY, HOME CARE, AND A SPECIALTY CLINIC.MERCYONE DUBUQUE AND MERCYONE DYERSVILLE ARE ADVISED BY LOCAL BOARDS AND OPERATE EMERGENCY ROOMS, WHICH ARE AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY. MERCYONE DUBUQUE ALSO PROVIDED SEVERAL SERVICES THAT WERE UNIQUE TO THE COMMUNITY, INCLUDING OPEN-HEART SURGERY, NEONATAL INTENSIVE CARE, AND INPATIENT COMMUNITY PSYCHIATRIC SERVICES. THROUGHOUT FY22, MERCYONE DUBUQUE AND MERCYONE DYERSVILLE CONTINUED INCIDENT COMMAND MEETINGS TO MITIGATE THE SURGE RISK OF COVID-19 PATIENTS WITHIN THE HOSPITALS AND THE COMMUNITIES. INCIDENT COMMAND MEETINGS WERE FACILITATED TO ENHANCE COMMUNICATION AND OVERALL EMERGENCY PREPAREDNESS TOWARDS ADDRESSING THE COVID-19 PANDEMIC. THE WEEKLY INCIDENT COMMAND MEETINGS INCLUDED SECTION CHIEFS FOR OPERATIONS, LOGISTICS/SUPPLIES, DIGITAL SUPPORT, VISITOR/STAFF SCREENING, TESTING, VACCINE, PLANNING, FINANCE, HOSPITAL LIAISON, SAFETY, PUBLIC INFORMATION, EMERGENCY PREPAREDNESS/ED, MISSION/SPIRITUAL CARE, AND BUSINESS RECOVERY, AS WELL AS OTHER MEDICAL CENTER LEADERS. INCIDENT COMMAND MEMBERS COLLABORATED WITH LOCAL ENTITIES TO INFORM OUR DECISION MAKING, SUCH AS OTHER HOSPITALS, FEDERAL QUALIFIED COMMUNITY HEALTH CENTER, DUBUQUE COUNTY HEALTH DEPARTMENT, CITY OF DUBUQUE PUBLIC HEALTH NURSE SPECIALIST, DUBUQUE COUNTY EMERGENCY MANAGEMENT, LONG TERM CARE FACILITIES, AND LOCAL COLLEGES AND UNIVERSITIES. INCIDENT COMMAND MEETINGS STARTED IN MARCH 2020 AND CONTINUED THROUGH 2022 (BUT WITH LESS FREQUENCY IN 2022).SCREENING STATIONS CONTINUED AT MERCYONE DUBUQUE AND MERCYONE DYERSVILLE ENTRANCES TO SCREEN COLLEAGUES, PATIENTS, AND VISITORS FOR FEVER AND COVID-19 SYMPTOMS. ALL ENTERING BOTH MEDICAL CENTERS WERE PROVIDED A FACE MASK. AT TIMES OF HIGH COMMUNITY PREVALENCE, WITH VISITOR RESTRICTIONS IN PLACE, MISSION LEADER ASSISTED FAMILIES OF PATIENTS TO CONNECT VIA PHONE AND VIDEO CONFERENCING. ...CONTINUED AFTER PART VI, LINE 6.
PART VI, LINE 6: MHS-IA IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH'S COMMUNITY HEALTH AND WELL-BEING (CHWB) STRATEGY PROMOTES OPTIMAL HEALTH FOR PEOPLE EXPERIENCING POVERTY AND OTHER VULNERABILITIES IN THE COMMUNITIES WE SERVE BY CONNECTING SOCIAL AND CLINICAL CARE, ADDRESSING SOCIAL NEEDS, DISMANTLING SYSTEMIC RACISM, AND REDUCING HEALTH INEQUITIES. WE DO THIS BY: 1. INVESTING IN OUR COMMUNITIES, 2. ADVANCING SOCIAL CARE, AND 3. IMPACTING SOCIAL INFLUENCERS OF HEALTH.TO FURTHER OUR STRATEGY IN FISCAL YEAR 2022 (FY22), CHWB LAUNCHED TWO TRAINING SERIES TO ADVANCE HEALTH AND RACIAL EQUITY IN OUR COMMUNITIES.1. CHWB LEADER SERIES TO ADVANCE HEALTH AND RACIAL EQUITY: A YEAR-LONG PEER LEARNING SERIES TO BUILD THE CAPACITY OF OUR CHWB LEADERS TO DELIVER ON OUR CHWB STRATEGY WITH A FOCUS ON COMMUNITY LEADERSHIP AND ENGAGEMENT, AND THE USE OF A RACIAL EQUITY LENS IN ALL OF OUR DECISION MAKING. 2. COMMUNITY ENGAGEMENT TO ADVANCE RACIAL JUSTICE - PREPARING FOR IMPLEMENTATION STRATEGY: A FOUR-PART SERIES ON ENGAGING OUR COMMUNITIES IN MEANINGFUL WAYS USING A HEALTH EQUITY AND RACIAL EQUITY LENS TO BUILD LASTING PARTNERSHIPS AND IMPACTFUL IMPLEMENTATION STRATEGIES.INVESTING IN OUR COMMUNITIES - TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FY22, TRINITY HEALTH CONTRIBUTED $1.37 BILLION IN COMMUNITY BENEFIT SPENDING TO AID THOSE WHO ARE VULNERABLE AND LIVING IN POVERTY, AND TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES IN WHICH WE SERVE. SOME EXAMPLES OF THESE INVESTMENTS INCLUDE: TRINITY HEALTH AWARDED OVER $1.6 MILLION IN COMMUNITY GRANTS THAT DIRECTLY ALIGN WITH INTERVENTIONS AND LOCAL PARTNERSHIPS IDENTIFIED IN ITS MEMBER HOSPITALS' COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IMPLEMENTATION STRATEGIES, INCLUDING ACCESS TO HEALTH CARE, MENTAL HEALTH, TRANSPORTATION, COMMUNITY ENGAGEMENT, FOOD ACCESS, AND HOUSING SUPPORTS. WITH A $1.2 MILLION INITIAL INVESTMENT, TRINITY HEALTH LAUNCHED ROUND 2 OF THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), A FIVE-YEAR, INNOVATIVE FUNDING AND TECHNICAL ASSISTANCE INITIATIVE, PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS AND RESIDENTS TO ADVANCE HEALTH AND RACIAL EQUITY IN NINE OF OUR COMMUNITIES EXPERIENCING HIGH POVERTY AND OTHER VULNERABILITIES. HEALTH MINISTRIES RECEIVING TCI FUNDING ARE COLLABORATING WITH A LOCAL MULTI-SECTOR COLLABORATIVE TO DEVELOP AND IMPLEMENT EVIDENCE-BASED STRATEGIES THAT ADVANCE HEALTH AND RACIAL EQUITY THROUGH ADDRESSING AT LEAST ONE ROOT CAUSE OF POOR HEALTH IDENTIFIED IN THE DEVELOPMENT OF THEIR MOST RECENT CHNA IMPLEMENTATION STRATEGY. TRINITY HEALTH AWARDED OVER $1 MILLION IN COVID-19 FUNDING TO SUPPORT NEW AND ONGOING COMMUNITY ENGAGEMENT AND MOBILIZATION EFFORTS AROUND MAKING THE COVID-19 VACCINATION ACCESSIBLE TO ALL ELIGIBLE POPULATIONS. THIS FUNDING WAS DESIGNED TO SUPPORT ALL COMMUNITIES TO ENSURE EASY AND EQUITABLE ACCESS TO THE VACCINE BY REMOVING BARRIERS FOR ALL PEOPLE TO RECEIVE THE VACCINE, ESPECIALLY COMMUNITIES THAT HAVE LESS THAN A 75% VACCINATION RATE. WITH THIS FUNDING, HEALTH MINISTRIES FACILITATED 3,200 COVID-19 VACCINE EVENTS, ADMINISTERED 80,000 COVID-19 VACCINE DOSES, AND REACHED 874,000 PEOPLE WITH EDUCATIONAL MATERIALS ON COVID-19 AND THE BENEFITS OF VACCINATION.IN ADDITION TO THE $1.37 BILLION IN COMMUNITY BENEFIT SPENDING, OUR COMMUNITY INVESTING PROGRAM HAD THE MOST ROBUST YEAR OF LENDING SINCE THE PROGRAM'S INCEPTION OVER 20 YEARS AGO: $17.8 MILLION IN NEW LOANS AND $8.3 MILLION IN LOAN RENEWALS WERE APPROVED, FOCUSING ON BUILDING AFFORDABLE HOUSING AND INCREASING ACCESS TO EDUCATION IN PARTNERSHIP WITH OUR HEALTH MINISTRIES. ADVANCING SOCIAL CARE - TRINITY HEALTH'S SOCIAL CARE PROGRAM WAS DEVELOPED TO ADDRESS SOCIAL NEEDS, SUCH AS ACCESS TO TRANSPORTATION, CHILDCARE, OR AFFORDABLE MEDICATIONS BY FACILITATING CONNECTIONS BETWEEN OUR PATIENTS, HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS THAT PROMOTE HEALTHY BEHAVIORS. HIGHLIGHTS FROM FY22 INCLUDE THE FOLLOWING SUCCESSES:- LAUNCHED TRINITY HEALTH COMMUNITY HEALTH WORKER (CHW) CERTIFICATION PROGRAM, TRAINING 86 CHWS WITH 40+ HOURS OF TRAINING, AND INCREASED CHW STAFF ACROSS MOST HEALTH MINISTRIES- LAUNCHED A SYSTEM-WIDE ASSESSMENT OF LANGUAGE ACCESS SERVICES TO RECOMMEND SYSTEM STANDARDS THAT ENSURE CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES FOR ALL OF OUR PATIENTS, THEIR COMPANIONS, AND CAREGIVERS- ENGAGED OVER 1,100 PARTICIPANTS IN THE NATIONAL DIABETES PREVENTION PROGRAM, EXCEEDING OUR PROGRAM YEAR 5 GOAL- INCREASED THE NUMBER OF ACTIVE COMMUNITY PARTNER ORGANIZATIONS ON THE COMMUNITY RESOURCE DIRECTORY BY 120% FROM FISCAL YEAR 2021- ENGAGED 5,300+ PATIENTS WHO ARE DUALLY ENROLLED IN MEDICARE AND MEDICAID IN A SOCIAL CARE OR MEDICAL CARE ACTIVITY, IN SUPPORT OF REDUCING PREVENTABLE HOSPITALIZATIONS (SUCH AS DIABETES AND ASTHMA)IMPACTING SOCIAL INFLUENCERS OF HEALTH - LEVERAGING INVESTOR POWER TO CATALYZE CORPORATE SOCIAL RESPONSIBILITY, TRINITY HEALTH'S SHAREHOLDER ADVOCACY WORK FOCUSES ON DISMANTLING RACISM ACROSS FIVE STRATEGIC FOCUS AREAS BY HOLDING CORPORATIONS ACCOUNTABLE FOR THE HUMAN RIGHTS VIOLATIONS THOSE COMPANIES PERPETUATE IN THE U.S. AND BEYOND. IN FY22, TRINITY HEALTH FACILITATED OVER 135 SHAREHOLDER ADVOCACY ENGAGEMENTS, WITH GREAT SUCCESS:- FIVE BELOW COMMITTED TO ASSESS AND MANAGE THE RISKS/HAZARDS ASSOCIATED WITH CHEMICALS OF HIGH CONCERN CONTAINED IN THEIR PRIVATE LABEL PRODUCTS- UNILEVER AGREED TO STOP FOOD AND BEVERAGE MARKETING TO CHILDREN UNDER AGE 16, AND WILL ADOPT NEW TARGETS TO REDUCE SALT, ADDED SUGARS AND CALORIES, AND INCREASE SALES OF THEIR HEALTHIER PRODUCTS- PEPSICO SET GOALS TO INCREASE POSITIVE NUTRIENTS IN THEIR PRODUCTS- PDC ENERGY ACCELERATED ITS GOAL TO END ROUTINE FLARING OF METHANE, FROM 2030 TO 2025, THUS REDUCING ENVIRONMENTAL HEALTH RISKS AND GREENHOUSE GAS EMISSIONSADDITIONALLY, TRINITY HEALTH AND OTHER MEMBERS OF THE INTERFAITH CENTER ON CORPORATE RESPONSIBILITY GUN SAFETY GROUP SUBMITTED A SHAREHOLDER RESOLUTION ASKING STURM RUGER, ONE OF THE NATION'S LEADING MANUFACTURERS OF FIREARMS, TO CONDUCT AND PUBLISH AN INDEPENDENT HUMAN RIGHTS IMPACT ASSESSMENT OF ITS POLICIES, PRACTICES AND PRODUCTS, AND MAKE RECOMMENDATIONS FOR IMPROVEMENT. THE RESOLUTION RECEIVED A 68.5% VOTE IN FAVOR, WELL ABOVE THE THRESHOLD REQUIRED FOR THE RESOLUTION TO BE RESUBMITTED IN 2023, INDICATING A LARGE MAJORITY OF STURM RUGER INVESTORS BELIEVE THE COMPANY HAS TO ADDRESS ITS HUMAN RIGHTS IMPACTS. TRINITY HEALTH AND TRINITY HEALTH OF NEW ENGLAND ARE CITED AS PART OF THE GROUP WHO MOVED FORWARD THIS RESOLUTION.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG.
PART VI, LINE 5 CONTINUED: MERCYONE DUBUQUE CONTINUED TO SERVE ON A LOCAL PACIFIC ISLANDERS HEALTH ADVISORY TEAM. THE MARSHALLESE POPULATION WAS DISPROPORTIONATELY IMPACTED BY COVID-19 OFTENTIMES DUE TO THEIR COMORBIDITIES AND CONGREGATE LIVING ARRANGEMENTS. THE TEAM GENERATED SOLUTIONS TO ASSIST THIS VULNERABLE POPULATION, INCLUDING INCREASED PUBLIC HEALTH EDUCATION, COVID-19 TESTING, DISTRIBUTION OF MASKS, AND LUNCH AND DINNER DELIVERIES. THE MOBILE MEDICAL UNIT WAS PRESENT AT THE MARSHALLESE CHURCH AND REPUBLIC OF THE MARSHALL ISLANDS CONSTITUTIONAL DAYS TO PROVIDE COVID-19 EDUCATION AND VACCINATIONS. TO DECREASE VACCINE HESITANCY, VACCINE FAQS WERE TRANSLATED INTO MARSHALLESE.MERCYONE DUBUQUE CONTINUED TO ENDORSE AND PARTICIPATE IN AN #ALLOFUSDUBUQUE CAMPAIGN. MERCYONE DUBUQUE AND MERCYONE DYERSVILLE WORKED COLLABORATIVELY WITH THE CITY OF DUBUQUE, CLARKE UNIVERSITY, COMMUNITY FOUNDATION OF GREATER DUBUQUE, CRESCENT COMMUNITY HEALTH CENTER, DIVINE WORD COLLEGE, DOMINICAN SISTERS OF SINSINAWA, DUBUQUE AREA CONGREGATIONS UNITED, DUBUQUE COLLEGE ACCESS NETWORK, DUBUQUE COMMUNITY SCHOOL DISTRICT, DUBUQUE COMMUNITY YMCA/YWCA, DUBUQUE FOR REFUGEE CHILDREN, THE DUBUQUE PACIFIC ISLANDER HEALTH PROJECT, DUBUQUE PARADISE CHURCH, ASSEMBLY OF GOD, EPIC HEALTH AND WELLNESS, FOUNTAIN OF YOUTH, LORAS COLLEGE, MCGRAW HILL, MEDICAL ASSOCIATES CLINIC AND HEALTH PLANS, THE MULTICULTURAL FAMILY CENTER, NAACP-DUBUQUE CHAPTER, NORTHEAST IOWA COMMUNITY COLLEGE, PRESENTATION LANTERN CENTER (IMMIGRANTS), RADIO DUBUQUE, RIVER BEND FOODBANK, SISTERS OF CHARITY OF THE BLESSED VIRGIN MARY, SISTERS OF ST. FRANCIS, SISTERS OF THE PRESENTATION OF DUBUQUE, THE TELEGRAPH HERALD, TRI-STATE VETS, UNITARIAN UNIVERSALIST FELLOWSHIP OF DUBUQUE, UNITYPOINT HEALTH, AND UNIVERSITY OF DUBUQUE.MERCYONE DUBUQUE CONTINUED SUPPORT OF THE DUBUQUE COMMUNITY QUARANTINE SHELTER BY PROVIDING BLESSING BAGS, THERMAL BLANKETS, AND FOOD AND WATER. THE BLESSING BAGS CONTAINED EATING UTENSILS, TOILETRIES, BATH TOWELS, WASH CLOTHS, FACE MASKS, AND HAND SANITIZER. MERCYONE DUBUQUE CASE MANAGEMENT TEAM AND POPULATION HEALTH SERVICES ORGANIZATION CONTINUED TO FACILITATE CALLS TO PATIENTS AND COLLEAGUES DIAGNOSED WITH COVID-19. THE TEAMS ALSO FOLLOWED UP WITH PERSONS UNDER INVESTIGATION TO ASSURE THEY HAD WHAT THEY NEEDED WHILE QUARANTINING, SUCH AS FOOD, MEDICATIONS, FOLLOW UP, ETC.MERCYONE DUBUQUE CONTINUED TO FACILITATE A TRIAGE TEAM OF NINE ANONYMOUS PHYSICIANS TO TRIAGE SCARCE RESOURCES SUCH AS VENTILATORS, CRITICAL CARE BEDS, AND THERAPEUTICS IN THE EVENT OF A COVID-19 SURGE. MISSION LEADER FACILITATED MULTIPLE ZOOM MEETINGS WITH THIS TEAM TO REVIEW TRIAGE GUIDELINES AND SOLIDIFY PROCESS FOR TRIAGING SCARCE RESOURCES IN THE EVENT OF A COVID-19 SURGE. MERCYONE DUBUQUE AND MERCYONE DYERSVILLE RECOGNIZED THE IMPORTANCE OF SCREENING FOR AND ADDRESSING SOCIAL INFLUENCERS OF HEALTH, SUCH AS AFFORDABLE HOUSING, ACCESS TO EDUCATION, PUBLIC SAFETY, AVAILABILITY OF HEALTHY FOODS, LOCAL EMERGENCY/HEALTH SERVICES, AND ENVIRONMENTS FREE OF LIFE-THREATENING TOXINS.SPECIFIC EFFORTS FOCUSED ON COLLABORATIONS TO BRING SOLUTIONS RELATED TO FOOD INSECURITY NEEDS OF PATIENTS AND COLLEAGUES. MERCYONE DUBUQUE CONTINUED TO WORK IN PARTNERSHIP WITH RIVERBEND FOOD BANK AND OUR LADY OF THE MISSISSIPPI ABBEY SISTERS TO MAINTAIN A FOOD PANTRY ONSITE AT MERCYONE DUBUQUE. IN ADDITION, NUTRIENT DENSE FOOD TOTE BAGS WERE DISTRIBUTED, USING OUR MOBILE MEDICAL UNIT, TO IDENTIFIED FOOD DESERT AREAS.IN FY22, SIGNIFICANT ENERGY WENT INTO PLANNING AND LAUNCHING A MOBILE MEDICAL UNIT WITH THE VISION OF MAKING HEALTH CARE MORE ACCESSIBLE FOR POPULATIONS THAT HAVE BARRIERS SUCH AS NO TRANSPORTATION, NO INSURANCE, AND/OR HAVE HISTORICALLY NOT TRUSTED HEALTH CARE. THE MOBILE MEDICAL UNIT PLANNING INVOLVED MUCH COLLABORATION WITH COMMUNITY PARTNERS, POLICY WRITING, SECURING SUPPLIES TO OUTFIT THE UNIT, WORKING WITH THE INTERIOR DESIGN TEAM, TRAINING THE TEAM/ASSESSING COMPETENCY, AND DEVELOPING A ROBUST MARKETING STRATEGY HIGHLIGHTING OUR MISSION DRIVEN GROWTH. THE MOBILE MEDICAL UNIT HAS A PHASED IN DELIVERY APPROACH FOR MERCYONE'S EASTERN IOWA REGION; PHASE 1-PREVENTIVE CARE, PHASE 2-PRIMARY CARE, AND PHASE 3-SPECIALTY CARE. A MERCYONE EASTERN IOWA ADVISORY TEAM WAS ESTABLISHED TO FURTHER DEVELOP THE VISION AND CREATE A "DAY IN THE LIFE OF THE BUS". MERCYONE SIOUXLAND REMAINS FOCUSED ON IMPROVING THE HEALTH OF OUR COMMUNITY. MERCYONE SIOUXLAND IS HOME TO THE ONLY LEVEL II TRAUMA CENTER IN WESTERN IOWA AND PROVIDES A VITAL, LIFESAVING LINK TO RURAL AREAS VIA HELICOPTER AMBULANCE SERVICE. WE ARE INVOLVED IN SEVERAL COMMUNITY COLLABORATIONS. MERCYONE SIOUXLAND CONTINUES TO HAVE AN OPEN MEDICAL STAFF. IN ADDITION, MERCYONE SIOUXLAND COLLABORATES WITH HEALTH EDUCATION PROGRAMS IN THE AREA INCLUDING ST. LUKE'S COLLEGE OF NURSING, WESTERN IOWA TECH COMMUNITY COLLEGE SCHOOL OF NURSING, NORTHEAST COMMUNITY COLLEGE, NORTHWESTERN COLLEGE, NORTHWEST IOWA COMMUNITY COLLEGE, AND BRIAR CLIFF UNIVERSITY SCHOOL OF NURSING. MERCYONE SIOUXLAND CONTINUES TO SUPPORT THE COMMUNITY BY HAVING LEADERS ACTIVELY PARTICIPATE IN LOCAL COMMUNITY BOARDS.IN FY22, EXTENSIVE COMMUNITY EMERGENCY PLANNING CONTINUED RELATED TO COVID-19. CONTINGENCY PLANNING AND PREPARATION REQUIRED RESOURCES WITHIN THE HOSPITAL AND THE COMMUNITY. INCIDENT COMMAND MEETINGS AND DRILLS CONTINUES THROUGHOUT THE YEAR. OTHER EMERGENCY DISASTER PLANNING WITH COMMUNITY PARTNERS WAS ALSO COMPLETED THROUGHOUT FY22. DUNES SURGICAL HOSPITAL CONTINUED TO SUPPORT THE HEALTH AND WELL-BEING OF THE COMMUNITY BY SUPPORTING HEALTH EDUCATION IN THE AREAS OF NURSING AND RESPIRATORY THERAPY IN COLLABORATION WITH BRIAR CLIFF UNIVERSITY, MORNINGSIDE UNIVERSITY, WESTERN IOWA TECH COMMUNITY COLLEGE SCHOOL OF NURSING, AND UNIVERSITY OF SOUTH DAKOTA. IN ADDITION, EXTENSIVE EMERGENCY MEDICAL PREPAREDNESS WORK WAS COMPLETED WITH THE SOUTH DAKOTA HEALTH CARE COALITION. POINT OF DISTRIBUTION PLANNING WAS COMPLETED. THE DUNES SURGICAL HOSPITAL SUPPORTED COMMUNITY COVID-19 EFFORTS.MERCYONE NEW HAMPTON IS THE SOLE COMMUNITY PROVIDER OFFERING A RANGE OF SPECIALIZED SERVICES, FAMILY HEALTH, DIABETES AND NUTRITION EDUCATION, AND AN EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. EMERGENCY SERVICES ARE PROVIDED AT A FINANCIAL LOSS BUT IS A CRITICALLY NEEDED SERVICE. WE COLLABORATE WITH OTHER AGENCIES TO IMPROVE OVERALL COMMUNITY HEALTH AND WELL-BEING. WE EXTEND MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTH CARE PROVIDERS, TO MEET THE NEEDS OF OUR NORTHEAST IOWA COMMUNITIES.MERCYONE NEW HAMPTON PRIDES ITSELF ON BEING COMMUNITY HEALTH IMPROVEMENT ADVOCATES. OUR COMMUNITY WELLNESS PROGRAM CONTINUES TO EXPAND, AND IN FY22 WAS ACTIVE IN THE WALKING SCHOOL BUS PROGRAM, TOBACCO FREE COALITION, COMMUNITY FOOD & FITNESS INITIATIVE, AND THE LOCAL FARMER'S MARKET. WE PROVIDE SUPPORT AND EXPERTISE TO CHICKASAW CONNECTIONS, A COALITION AGAINST UNDERAGE DRINKING AND DRUG USE. WE WORK CLOSELY WITH NEW HAMPTON COMMUNITY SCHOOLS TO EDUCATE STUDENTS ABOUT HEALTH AND WELLNESS. HANDWASHING LESSONS ARE TAUGHT TO ALL PRE-SCHOOL AND KINDERGARTEN CLASSES.
Schedule H (Form 990) 2021
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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number
31-1373080
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) AMERICAN CANCER SOCIETY
3380 CHASTAIN MEADOWS PKWY NO 2
KENNESAW,IA30144
13-1788491 501(C)(3) 10,000 0     RELAY FOR LIFE PROGRAM
(2) CATHOLIC CHARITIES OF THE ARCHDIOCESE OF DUBUQUE
1229 MT LORETTA AVE
DUBUQUE,IA52003
42-0680493 501(C)(3) 7,500 0     TELEHEALTH COUNSELING SERVICES
(3) COMMUNITY FOUNDATION GREATER DUBUQUE
700 LOCUST ST SUITE 195
DUBUQUE,IA52001
42-1526614 501(C)(3) 10,000 0     BEN PAKES SCHOLARSHIP AND HARDSHIP FUND
(4) CRESCENT COMMUNITY HEALTH CENTER
1789 ELM ST SUITE A
DUBUQUE,IA52001
48-1302204 501(C)(3) 12,500 0     PACIFIC ISLANDER HEALTH PROJECT STAFFING
(5) DUBUQUE COMMUNITY SCHOOLS
2300 CHANEY ROAD
DUBUQUE,IA52001
42-6001531 PUBLIC SCHOOL 15,000 0     SUPPORT OF ATHLETIC TRAINER PROGRAM FOR TWO HIGH SCHOOLS
(6) DUBUQUE FOR REFUGEE CHILDREN
1199 MAIN STREET
DUBUQUE,IA52004
47-3092234 501(C)(3) 7,000 0     MEDICAL AND DENTAL CARE FOR YOUNG IMMIGRANTS
(7) DUBUQUE RESCUE MISSION
398 MAIN ST
DUBUQUE,IA52001
42-0844836 501(C)(3) 6,000 0     SUPPORT FOR MISSION SCHOOL OF PRESERVATION
(8) GREATER DUBUQUE DEVELOPMENT
900 JACKSON ST SUITE 109
DUBUQUE,IA52001
42-1263173 501(C)(6) 18,000 0     COMMUNITY SUPPORT
(9) ST JOHN'S EVANGELICAL LUTHERAN CHURCH
1296 WHITE ST
DUBUQUE,IA52001
23-7421408 501(C)(3) 9,800 0     SUPPORT OF THE ALMOST HOME PROGRAM
(10) DUBUQUE MERCY HEALTH FOUNDATION
250 MERCY DRIVE
DUBUQUE,IA52001
26-2227941 501(C)(3) 493,536 0     FUNDING SUPPORT
(11) DYERSVILLE HEALTH FOUNDATION INC
1111 3RD STREET SW
DYERSVILLE,IA52040
20-5383271 501(C)(3) 40,434 0     FUNDING SUPPORT
(12) HEALTHY HARVEST OF NORTH IA
PO BOX 52
HAMPTON,IA50441
47-2868649 501(C)(3) 47,013 0     COOKING UP A HEALTHIER NORTH IOWA PROGRAM
(13) MASON CITY COMMUNITY SCHOOLS
1515 SOUTH PENNSYLVANIA
MASON CITY,IA50401
42-6002616 PUBLIC SCHOOL 75,000 0     FIELD HOUSE AND PLAYGROUND PROJECTS
(14) NORTH IOWA AREA COMMUNITY COLLEGE FOUNDATION
500 COLLEGE DR
MASON CITY,IA50401
23-7023677 501(C)(3) 6,500 0     PERFORMING ARTS SERIES
(15) NORTH IOWA COMMUNITY ACTION
PO BOX 1627
MASON CITY,IA50401
42-0921505 501(C)(3) 135,000 0     COPA PROGRAM AND TRANSPORTATION SUPPORT
(16) NORTHERN LIGHTS ALLIANCE FOR THE HOMELESS
202 1ST ST NW
MASON CITY,IA50401
42-1501295 501(C)(3) 61,140 0     COMMUNITY SUPPORT
(17) NORTH IOWA CORRIDOR EDC
9 N FEDERAL
MASON CITY,IA50401
75-3190471 506(C)(6) 22,000 0     COMMUNITY SUPPORT
(18) MASON CITY YOUTH HOCKEY
PO BOX 311
MASON CITY,IA50401
42-1083935 501(C)(3) 20,000 0     FUNDING SUPPORT
(19) MITCHELL COUNTY REGIONAL HEALTH CTR
616 N 8TH ST
OSAGE,IA50461
42-6006380 GOVERNMENT ORG 7,143 0     RISE UP CAMPAIGN
(20) NORTHEAST IOWA COMMUNITY ACTION CORP
305 MONTGOMERY ST
DECORAH,IA52101
42-6092713 501(C)(3) 6,000 0     SUPPORT CHICKASAW CO RESIDENTS FACING HOMELESSNESS OR LOSS OF UTILITIES
(21) THE WARMING SHELTER INC
601 PIERCE STREET
SIOUX CITY,IA51101
47-1257560 501(C)(3) 6,000 0     SUPPORT FOR PROVIDING SHELTER TO HOMELESS
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
19
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
2
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients
(c) Amount of
cash grant
(d) Amount of
noncash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of noncash assistance
(1) SCHOLARSHIPS 1 1,000      
(2) TRANSPORTATION ASSISTANCE 757 15,427      
(3) HOUSING 6 2,964      
(4) MEDICAL BILLS AND MEDICATION ASSISTANCE 143 26,921      
(5) CAR REPAIR AND CAR NOTE ASSISTANCE 5 3,643      
(6) FOOD ASSISTANCE 15 141      
(7) UTILITIES 50 1,328      
(8) OTHER SERVICES/ITEMS 12 2,045      
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: DONATIONS MADE BY MERCY HEALTH SERVICES - IOWA TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H.
Schedule I (Form 990) 2021



Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1STILIANOS EFSTRATIADIS
PHYSICIAN, CARDIOLOGIST SIOUX CITY
(i)

(ii)
0
-------------
2,849,014
0
-------------
0
0
-------------
3,534
0
-------------
4,350
0
-------------
14,084
0
-------------
2,870,982
0
-------------
0
2LINDA ROSS
DIR; CHIEF LEGAL OFFICER TRINITY
(i)

(ii)
0
-------------
734,738
0
-------------
428,274
0
-------------
168,586
0
-------------
13,050
0
-------------
68,394
0
-------------
1,413,042
0
-------------
0
3YEN LIU
PHYSICIAN, DERMATOLOGY NORTH IOWA
(i)

(ii)
1,226,910
-------------
0
0
-------------
0
80,970
-------------
0
18,886
-------------
0
26,037
-------------
0
1,352,803
-------------
0
0
-------------
0
4MICHAEL FAUST
PHYSICIAN, OBGYN NORTH IOWA
(i)

(ii)
481,995
-------------
0
0
-------------
0
606,590
-------------
0
27,290
-------------
0
26,615
-------------
0
1,142,490
-------------
0
0
-------------
0
5GIOVANNI CIUFFO
PHYSICIAN, CARDIOLOGIST SIOUX CITY
(i)

(ii)
0
-------------
1,027,430
0
-------------
0
0
-------------
4,515
0
-------------
13,050
0
-------------
29,844
0
-------------
1,074,839
0
-------------
0
6THOO TAN
PHYSICIAN, OBGYN NORTH IOWA
(i)

(ii)
506,049
-------------
0
0
-------------
0
378,818
-------------
0
21,750
-------------
0
33,409
-------------
0
940,026
-------------
0
0
-------------
0
7BETH HUGHES
PRESIDENT MERCYONE SIOUXLAND
(i)

(ii)
0
-------------
492,831
0
-------------
173,810
0
-------------
54,966
0
-------------
98,558
0
-------------
39,047
0
-------------
859,212
0
-------------
41,367
8RODNEY SCHLADER
PRESIDENT/CEO MERCYONE NORTH IOWA
(i)

(ii)
0
-------------
458,613
0
-------------
162,576
0
-------------
99,698
0
-------------
21,750
0
-------------
42,052
0
-------------
784,689
0
-------------
25,861
9KAY TAKES
PRESIDENT EASTERN IOWA REGION
(i)

(ii)
0
-------------
412,343
0
-------------
144,096
0
-------------
63,792
0
-------------
21,750
0
-------------
36,935
0
-------------
678,916
0
-------------
0
10PAUL MANTERNACH
SVP PHYS INTEGRATION/CMO NORTH IOWA
(i)

(ii)
0
-------------
397,050
0
-------------
81,200
0
-------------
8,336
0
-------------
21,750
0
-------------
38,941
0
-------------
547,277
0
-------------
0
11DIANE FISCHELS
VP COO MERCYONE NORTH IOWA
(i)

(ii)
0
-------------
327,022
0
-------------
66,000
0
-------------
8,036
0
-------------
21,750
0
-------------
30,502
0
-------------
453,310
0
-------------
0
12JESICA HANSON
VP FINANCE MERCYONE SIOUXLAND
(i)

(ii)
278,022
-------------
0
57,200
-------------
0
428
-------------
0
13,050
-------------
0
30,646
-------------
0
379,346
-------------
0
0
-------------
0
13KIM DUWE
VP FINANCE EASTERN IOWA REGION
(i)

(ii)
0
-------------
227,390
0
-------------
47,000
0
-------------
3,490
0
-------------
12,842
0
-------------
33,217
0
-------------
323,939
0
-------------
0
14AMY BERENTES
EVP COO EASTERN IOWA REGION
(i)

(ii)
0
-------------
229,746
0
-------------
46,000
0
-------------
1,547
0
-------------
16,752
0
-------------
13,088
0
-------------
307,133
0
-------------
0
15LAWRENCE VOLZ
CMO MERCYONE SIOUXLAND
(i)

(ii)
0
-------------
150,500
0
-------------
40,500
0
-------------
1,068
0
-------------
0
0
-------------
29,769
0
-------------
221,837
0
-------------
0
16DANETTE ZOOK
FORMER KE; SR FINANCE CONSULTANT NI
(i)

(ii)
90,299
-------------
37,853
8,680
-------------
26,040
292
-------------
586
8,014
-------------
5,205
25,368
-------------
6,581
132,653
-------------
76,265
0
-------------
0
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 3 MERCY HEALTH SERVICES - IOWA (MHS-IA) IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MHS-IA HOSPITAL CEO'S ARE PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MHS-IA CEO'S: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2021. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. PARTICIPANTS' VESTED BENEFITS WERE PAID OUT IN 2021, AND THEIR NON-VESTED BENEFITS FOR 2021 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2021 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: BETH HUGHES - $41,367 LINDA ROSS - $124,913 RODNEY SCHLADER - $84,330 KAY TAKES - $51,462 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUAL FOR 2021 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: BETH HUGHES - $85,508 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($290,000 FOR 2021). THE FOLLOWING PAYOUTS FOR 2021 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: DIANE FISCHELS - $1,532 PAUL MANTERNACH - $3,852 THE FOLLOWING ARE PARTICIPANTS IN A MHS-IA NON-QUALIFIED ELECTIVE DEFERRED COMPENSATION PLAN. THE FOLLOWING DEFERRALS FOR 2021 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: YEN LIU - $71,107 MICHAEL FAUST - $39,225
Schedule J (Form 990) 2021

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA (MHS-IA) IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION.
FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF MHS-IA. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MHS-IA.
FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS AND MODIFICATIONS TO GOVERNING DOCUMENTS.
FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR MHS-IA IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C MHS-IA HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF MHS-IA, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF MHS-IA AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO THE INTEGRITY AND COMPLIANCE OFFICER. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE INTEGRITY AND COMPLIANCE OFFICER SHARES THE DISCLOSURES WITH INTERNAL LEGAL COUNSEL, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF MHS-IA (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MHS-IA OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MHS-IA (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF MHS-IA. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MHS-IA IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND VICE PRESIDENT FINANCE COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE HOSPITAL CEO'S AND VICE PRESIDENTS FINANCE OF MHS-IA ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FOR OTHER EXECUTIVES WHO ARE NOT PART OF THE REBUTTABLE PRESUMPTION PROCESS, TRINITY HEALTH USES A MARKET ANALYSIS TO DETERMINE THE APPROPRIATENESS OF THE EXECUTIVE'S COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19 MHS-IA IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, MHS-IA INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE. MHS-IA'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 70,092. MANAGEMENT AND GENERAL EXPENSES 106,110. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 176,202. LAUNDRY AND LINEN SERVICES: PROGRAM SERVICE EXPENSES 487,087. MANAGEMENT AND GENERAL EXPENSES 188. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 487,275. BILLING SERVICES: PROGRAM SERVICE EXPENSES 222,865. MANAGEMENT AND GENERAL EXPENSES 118,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 340,923. MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 62,726,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,726,500. RECRUITING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 606,819. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 606,819. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 15,467,464. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,467,464. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 60,501,813. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 60,501,813. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 17,043,507. MANAGEMENT AND GENERAL EXPENSES 7,211,304. FUNDRAISING EXPENSES 127,516. TOTAL EXPENSES 24,382,327.
FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS TO/FROM AFFILIATES 4,960,326. OTHER TRANSACTIONS 692,999. EQUITY GAIN IN UNCONSOLIDATED AFFILIATES 2,203,719. INDIGENT CARE AGREEMENT REVENUE, NET OF CONTRIBUTIONS 6,516.
FORM 990, PART XII, LINE 2: MHS-IA'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY22 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM.
FORM 990, PAGE 1, DOING BUSINESS AS NAMES: DUNES MEDICAL LABORATORIES, FOREST PARK PHARMACY, HEALTHWORKS, MARIAN HEALTH CENTER, MERCY FAMILY PHARMACY, MERCY HEALTH CENTER-DUBUQUE (ST. JOSEPH'S), MERCY HEALTH CENTER-DYERSVILLE (ST. MARY'S),MERCY HEART CENTER & VASCULAR INSTITUTE, MERCY HOME CARE-NORTH IOWA, MERCY HOME HEALTHCARE DUBUQUE, MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER-DYERSVILLE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA, MERCY MEDICAL CENTER-SIOUX CITY, MERCY VASULAR MEDICINE CLINIC, MHC ANESTHESIA SERVICES, NORTH IOWA MERCY CLINICS, NORTH IOWA MERCY HEALTH CENTER, NORTH IOWA MERCY HOME HEALTHCARE, NORTH IOWA TEXTILE SERVICES, SHEFFIELD PHARMACY, SIOUXLAND PATHOLOGY GROUP-SMHC, SIOUXLAND RADIOLOGY-SMHC, ST. JOSEPH COMMUNITY HOSPITAL, MERCY SOFT GOODS, MERCYONE DUBUQUE MEDICAL CENTER, MERCYONE DYERSVILLE MEDICAL CENTER, MERCYONE NEW HAMPTON MEDICAL CENTER, MERCYONE NORTH IOWA CLINICS, MERCYONE NORTH IOWA MEDICAL CENTER, MERCYONE SIOUXLAND MEDICAL CENTER
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity

(1) MHN ACO LLC
1449 NW 128TH ST BLDG 5 STE 200
CLIVE,IA50325
42-1521367
ACCOUNTABLE CARE ORGANIZATION IA 0 0 MERCY HEALTH SERVICES-IOWA CORP
 










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP
200 JEFFERSON AVE SE

GRAND RAPIDS,MI49503
27-2491974
HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN
 
Yes
 
(2)ALLEGANY FRANCISCAN MINISTRIES INC
33920 US HIGHWAY 19 NORTH SUITE 269

PALM HARBOR,FL34684
58-1492325
GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION
 
Yes
 
(3)ASYLUM HILL FAMILY MEDICINE CENTER INC
114 WOODLAND STREET

HARTFORD,CT06105
06-1450170
HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(4)BAUM HARMON MERCY HOSPITAL
255 NORTH WELCH AVENUE

PRIMGHAR,IA51245
42-1500277
HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(5)BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION
255 NORTH WELCH AVENUE

PRIMGHAR,IA51245
26-2973307
FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL
 
Yes
 
(6)BEECHWOOD INC
2212 BURDETT AVE

TROY,NY12180
14-1651563
TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC
 
Yes
 
(7)BETHLEHEM HAVEN OF PITTSBURGH
905 WATSON STREET

PITTSBURGH,PA15219
25-1436685
HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC
 
Yes
 
(8)BEVERWYCK INC
40 AUTUMN DRIVE

SLINGERLANDS,NY12159
14-1717028
SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(9)BRIGHTSIDE INC
114 WOODLAND STREET

HARTFORD,CT06105
04-2182395
HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC
 
Yes
 
(10)CAPITAL REGION GERIATRIC CENTER INC
421 WEST COLUMBIA STREET

COHOES,NY12047
14-1701597
LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(11)CATHERINE MCAULEY HEALTH SERVICES CORP
5315 ELLIOTT DR 102

YPSILANTI,MI48197
38-2507173
HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN
 
Yes
 
(12)CATHOLIC HEALTH MINISTRIES
20555 VICTOR PARKWAY

LIVONIA,MI48152
GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A
 
No
(13)DILEY RIDGE MEDICAL CENTER
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
34-2032340
HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM
 
Yes
 
(14)DUBUQUE MERCY HEALTH FOUNDATION
250 MERCY DRIVE

DUBUQUE,IA52001
26-2227941
FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(15)DYERSVILLE HEALTH FOUNDATION INC
1111 3RD STREET SW

DYERSVILLE,IA52040
20-5383271
FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(16)EAST NORRITON PHYSICIANS SERVICES INC
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2515999
HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK
 
Yes
 
(17)EDDY LICENSED HOME CARE AGENCY
433 RIVER ST SUITE 3000

TROY,NY12180
14-1818568
HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC
 
Yes
 
(18)EMBRACING AGE INC
333 BUTTERNUT DRIVE

DEWITT,NY13214
46-1051881
PACE PROGRAM NY 501(C)(3) LINE 12B, II ST JOSEPH'S HEALTH INC
 
Yes
 
(19)EMPIRE HOME INFUSION SERVICE INC
10 BLACKSMITH DRIVE

MALTA,NY12020
14-1795732
HOME HEALTH SERVICES NY 501(C)(3) LINE 10 HOME AIDE SERVICE OF EASTERN NEW YORK INC
 
Yes
 
(20)FARREN CARE CENTER INC
114 WOODLAND STREET

HARTFORD,CT06105
04-2501711
LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC
 
Yes
 
(21)FRANCISCAN ELDERCARE CORPORATION
PO BOX 2500

WILMINGTON,DE19805
22-3008680
LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL INC
 
Yes
 
(22)GLACIER HILLS FOUNDATION
1200 EARHART RD

ANN ARBOR,MI48105
20-8072723
FOUNDATION MI 501(C)(3) LINE 12A, I GLACIER HILLS INC
 
Yes
 
(23)GLACIER HILLS INC
1200 EARHART RD

ANN ARBOR,MI48105
38-1891500
SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES
 
Yes
 
(24)GLEN EDDY INC
1 GLEN EDDY DRIVE

NISKAYUNA,NY12309
14-1794150
SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(25)GLOBAL HEALTH MINISTRY
20555 VICTOR PARKWAY

LIVONIA,MI48152
42-1253527
HEALTH CARE SERVICES MI 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION
 
Yes
 
(26)GOOD SAMARITAN HOSPITAL INC
5401 LAKE OCONEE PARKWAY

GREENSBORO,GA30642
26-1720984
HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 TRINITY HEALTH GEORGIA INC
 
Yes
 
(27)GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
701 W NORTH AVE

MELROSE PARK,IL60160
36-3332852
HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM
 
Yes
 
(28)GOTTLIEB MEMORIAL FOUNDATION
701 WEST NORTH AVENUE

MELROSE PARK,IL60160
74-3260011
FOUNDATION IL 501(C)(3) LINE 12D, III-O N/A
 
No
(29)GOTTLIEB MEMORIAL HOSPITAL
701 W NORTH AVE

MELROSE PARK,IL60160
36-2379649
HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM
 
Yes
 
(30)HAWTHORNE RIDGE INC
30 COMMUNITY WAY

EAST GREENBUSH,NY12061
80-0102840
SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(31)HEART CENTER OF GREATER WATERBURY INC
114 WOODLAND STREET

HARTFORD,CT06105
83-0416893
MANAGEMENT CT 501(C)(3) LINE 12A, I N/A
 
No
(32)HERITAGE HOUSE NURSING CENTER INC
2920 TIBBITS AVE

TROY,NY12180
14-1725101
LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(33)HOLY CROSS CARENET INC
PO BOX 9184

FARMINGTON HILLS,MI48152
52-1945054
LONG TERM CARE MD 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES
 
Yes
 
(34)HOLY CROSS HEALTH FOUNDATION INC
1500 FOREST GLEN ROAD

SILVER SPRING,MD20910
20-8428450
FOUNDATION MD 501(C)(3) LINE 7 HOLY CROSS HEALTH INC
 
Yes
 
(35)HOLY CROSS HEALTH INC
1500 FOREST GLEN ROAD

SILVER SPRING,MD20910
52-0738041
HEALTH CARE AND HOSPITAL SERVICES MD 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
Yes
 
(36)HOLY CROSS HOSPITAL INC
4725 NORTH FEDERAL HIGHWAY

FT LAUDERDALE,FL33308
59-0791028
HEALTH CARE AND HOSPITAL SERVICES FL 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
Yes
 
(37)HOLY CROSS OUTPATIENT SERVICES INC
4725 NORTH FEDERAL HIGHWAY

FT LAUDERDALE,FL33308
46-5421068
HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC
 
Yes
 
(38)HOLY CROSS PRIMARY CARE INC
4725 NORTH FEDERAL HIGHWAY

FT LAUDERDALE,FL33308
81-2531495
HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC
 
Yes
 
(39)HOLY CROSS SENIOR SERVICES INC
4725 NORTH FEDERAL HIGHWAY

FT LAUDERDALE,FL33308
83-2256461
HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC
 
Yes
 
(40)HOME AIDE SERVICE OF EASTERN NEW YORK INC
433 RIVER ST SUITE 3000

TROY,NY12180
14-1514867
HOME HEALTH SERVICES NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(41)HOSPICE OF NORTH IOWA
232 SECOND STREET SE

MASON CITY,IA50401
42-1173708
HOSPICE SERVICES IA 501(C)(3) LINE 10 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(42)HOSPICE OF SIOUXLAND
4300 HAMILTON BLVD

SIOUX CITY,IA51104
38-3320710
HOSPICE SERVICES IA 501(C)(3) LINE 12A, I N/A
 
No
(43)IHA HEALTH SERVICES CORPORATION
24 FRANK LLOYD WRIGHT DR LOBBY J

ANN ARBOR,MI48106
38-3316559
HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN
 
Yes
 
(44)JOHNSON MEMORIAL HOSPITAL INC
114 WOODLAND STREET

HARTFORD,CT06105
47-5676956
HEALTH CARE AND HOSPITAL SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(45)LANGHORNE MRI INC
1201 LANGHORNE-NEWTOWN ROAD

LANGHORNE,PA19047
23-2519529
HEALTH CARE SERVICES (INACTIVE) PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER
 
Yes
 
(46)LANGHORNE PHYSICIAN SERVICES INC
1201 LANGHORNE-NEWTOWN ROAD

LANGHORNE,PA19047
23-2571699
HEALTH CARE SERVICES PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER
 
Yes
 
(47)LIFE AT LOURDES INC
2475 MCCLELLAN AVENUE

PENNSAUKEN,NJ08109
26-1854750
PACE PROGRAM NJ 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(48)LIFE AT ST FRANCIS HEALTHCARE INC
1072 JUSTISON STREET

WILMINGTON,DE19801
45-2569214
PACE PROGRAM DE 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(49)LIFE ST FRANCIS CORPORATION
7500 K JOHNSON BOULEVARD

BORDENTOWN,NJ08505
22-2797282
PACE PROGRAM NJ 501(C)(3) LINE 10 ST FRANCIS MEDICAL CENTER TRENTON NJ
 
Yes
 
(50)LIFE ST JOSEPH OF THE PINES INC
4900 RAEFORD ROAD

FAYETTEVILLE,NC28304
27-2159847
PACE PROGRAM NC 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(51)LIFE ST MARY
2500 NORTHGATE ROAD

TREVOSE,PA19053
26-2976184
PACE PROGRAM PA 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(52)LOYOLA MEDICINE TRANSPORT LLC
905 W NORTH AVE

MELROSE PARK,IL60160
47-4147171
TRANSPORTATION SERVICES IL 501(C)(3) LINE 10 LOYOLA UNIVERSITY MEDICAL CENTER
 
Yes
 
(53)LOYOLA UNIVERSITY HEALTH SYSTEM
2160 SOUTH FIRST AVENUE

MAYWOOD,IL60153
36-3342448
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IL 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(54)LOYOLA UNIVERSITY MEDICAL CENTER
2160 SOUTH FIRST AVENUE

MAYWOOD,IL60153
36-4015560
HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM
 
Yes
 
(55)LTC (EDDY) INC
2212 BURDETT AVE

TROY,NY12180
22-2564710
MANAGEMENT SERVICES FOR LONG TERM CARE NY 501(C)(3) LINE 12B, II ST PETER'S HEALTH PARTNERS
 
Yes
 
(56)MAXIS HEALTH SYSTEM
20555 VICTOR PARKWAY

LIVONIA,MI48152
91-1940902
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT PA 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION
 
Yes
 
(57)MCAULEY CENTER INC
275 STEELE ROAD

WEST HARTFORD,CT06117
06-1058086
SENIOR LIVING COMMUNITY CT 501(C)(3) LINE 10 MERCY COMMUNITY HEALTH INC
 
Yes
 
(58)MCAULEY MINISTRIES
3333 FIFTH AVENUE

PITTSBURGH,PA15213
94-3436142
GRANT MAKING PA 501(C)(3) LINE 12B, II PITTSBURGH MERCY HEALTH SYSTEM INC
 
Yes
 
(59)MERCY CARE CENTER
3753 SOUTH COTTAGE GROVE AVE

CHICAGO,IL60653
85-3904921
HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
Yes
 
(60)MERCY CARE FOUNDATION INC
424 DECATUR STREET

ATLANTA,GA30312
58-1448522
FOUNDATION GA 501(C)(3) LINE 7 SAINT JOSEPH'S HEALTH SYSTEM INC
 
Yes
 
(61)MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PENNSYLVANIA
3805 W CHESTER PIKE STE 100

NEWTOWN SQUARE,PA19073
23-1352191
HEALTH CARE AND HOSPITAL SERVICES PA 501(C)(3) LINE 3 TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(62)MERCY COMMUNITY HEALTH INC
2021 ALBANY AVENUE

WEST HARTFORD,CT06117
06-1492707
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT CT 501(C)(3) LINE 12B, II TRINITY CONTINUING CARE SERVICES
 
Yes
 
(63)MERCY FAMILY SUPPORT
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2325059
HOME HEALTH SERVICES PA 501(C)(3) LINE 10 MERCY HOME HEALTH SERVICES
 
Yes
 
(64)MERCY FOUNDATION INC
2525 SOUTH MICHIGAN AVENUE

CHICAGO,IL60616
36-3227350
FOUNDATION IL 501(C)(3) LINE 7 MERCY HEALTH SYSTEM OF CHICAGO
 
Yes
 
(65)MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE
888 TERRACE STREET

MUSKEGON,MI49440
38-3321856
HOME HEALTH SERVICES MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES
 
Yes
 
(66)MERCY HEALTH FOUNDATION OF SOUTHEASTERN PENNSYLVANIA
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2829864
FOUNDATION PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(67)MERCY HEALTH NETWORK INC
1449 NW 128TH ST BLDG 5

CLIVE,IA50325
42-1478417
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT DE 501(C)(3) LINE 12C, III-FI N/A
 
No
(68)MERCY HEALTH PARTNERS
1500 E SHERMAN BLVD

MUSKEGON,MI49444
38-2589966
HEALTH CARE AND HOSPITAL SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN
 
Yes
 
(69)MERCY HEALTH PLAN
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
22-2483605
MEDICAID MANAGED CARE PLAN PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(70)MERCY HEALTH SERVICES - IOWA CORP
1000 4TH STREET SW

MASON CITY,IA50401
31-1373080
HEALTH CARE AND HOSPITAL SERVICES DE 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
 
No
(71)MERCY HEALTH SYSTEM OF CHICAGO
2525 SOUTH MICHIGAN AVENUE

CHICAGO,IL60616
36-3163327
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IL 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(72)MERCY HEALTHCARE FOUNDATION - CLINTON
1410 N 4TH ST

CLINTON,IA52732
42-1316126
FOUNDATION IA 501(C)(3) LINE 7 MERCY MEDICAL CENTER - CLINTON INC
 
Yes
 
(73)MERCY HOME HEALTH
20555 VICTOR PARKWAY

LIVONIA,MI48152
23-1352099
HOME HEALTH SERVICES PA 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES
 
Yes
 
(74)MERCY HOME HEALTH SERVICES
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2325058
MANAGEMENT SERVICES FOR HOME HEALTH PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(75)MERCY HOSPITAL AND MEDICAL CENTER
2160 SOUTH FIRST AVENUE

MAYWOOD,IL60153
36-2170152
HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 MERCY HEALTH SYSTEM OF CHICAGO
 
Yes
 
(76)MERCY HOSPITAL CADILLAC FOUNDATION
318 RIVER RIDGE DR NW SUITE 100

WALKER,MI49544
20-3357131
FOUNDATION MI 501(C)(3) LINE 12A, I TRINITY HEALTH-MICHIGAN
 
Yes
 
(77)MERCY LIFE (FKA ST AGNES CONTINUING CARE CENTER)
1930 SOUTH BROAD STREET

PHILADELPHIA,PA19145
23-2840137
PACE PROGRAM PA 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(78)MERCY LIFE CENTER CORPORATION
1200 REEDSDALE STREET

PITTSBURGH,PA15233
25-1604115
COMMUNITY OUTREACH PA 501(C)(3) LINE 10 PITTSBURGH MERCY HEALTH SYSTEM INC
 
Yes
 
(79)MERCY LIFE OF ALABAMA
PO BOX 7957

MOBILE,AL36670
27-3163002
PACE PROGRAM AL 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(80)MERCY LIFE INC
200 HILLSIDE CIRCLE

WEST SPRINGFIELD,MA01089
45-3086711
PACE PROGRAM MA 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(81)MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2627944
HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK
 
Yes
 
(82)MERCY MEDICAL CENTER - CLINTON INC
1410 NORTH 4TH ST

CLINTON,IA52732
42-1336618
HEALTH CARE AND HOSPITAL SERVICES DE 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(83)MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION
801 5TH STREET

SIOUX CITY,IA51102
14-1880022
FOUNDATION IA 501(C)(3) LINE 7 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(84)MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA
1000 4TH STREET SW

MASON CITY,IA50401
42-1229151
FOUNDATION IA 501(C)(3) LINE 7 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(85)MERCY MEDICAL CORPORATION
PO BOX 7957

MOBILE,AL36670
63-6002215
PACE PROGRAM AL 501(C)(3) LINE 10 TRINITY HEALTH CORPORATION
 
Yes
 
(86)MERCY MEDICAL GROUP INC
114 WOODLAND STREET

HARTFORD,CT06105
45-4884805
HEALTH CARE SERVICES MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC
 
Yes
 
(87)MERCY SENIOR CARE INC
424 DECATUR STREET

ATLANTA,GA30312
58-1366508
COMMUNITY OUTREACH GA 501(C)(3) LINE 7 SAINT JOSEPH'S HEALTH SYSTEM INC
 
Yes
 
(88)MERCY SERVICES DOWNTOWN INC
424 DECATUR STREET

ATLANTA,GA30312
27-2046353
TITLE HOLDING COMPANY GA 501(C)(3) LINE 12B, II SAINT JOSEPH'S HEALTH SYSTEM INC
 
Yes
 
(89)MERCY SERVICES FOR AGING NONPROFIT HOUSING CORPORATION
PO BOX 9184

FARMINGTON HILLS,MI48333
38-2719605
LONG TERM CARE MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES
 
Yes
 
(90)MERCY SPECIALIST PHYSICIANS INC
114 WOODLAND STREET

HARTFORD,CT06105
26-4033168
HEALTH CARE SERVICES MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC
 
Yes
 
(91)MERCY SUBURBAN HOSPITAL
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-1396763
HEALTH CARE AND HOSPITAL SERVICES PA 501(C)(3) LINE 3 TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(92)MOUNT CARMEL COLLEGE OF NURSING
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
31-1308555
COLLEGE OF NURSING OH 501(C)(3) LINE 2 MOUNT CARMEL HEALTH SYSTEM
 
Yes
 
(93)MOUNT CARMEL HEALTH INSURANCE COMPANY
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
25-1912781
HEALTH INSURANCE OH 501(C)(4) N/A MOUNT CARMEL HEALTH SYSTEM
 
Yes
 
(94)MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
87-3948434
MEDICARE HMO CT 501(C)(4) N/A MOUNT CARMEL HEALTH PLAN INC
 
Yes
 
(95)MOUNT CARMEL HEALTH PLAN OF IDAHO INC
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
83-1422704
MEDICARE HMO ID 501(C)(4) N/A MOUNT CARMEL HEALTH PLAN INC
 
Yes
 
(96)MOUNT CARMEL HEALTH PLAN OF NEW YORK INC
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
83-3278543
MEDICARE HMO NY 501(C)(4) N/A MOUNT CARMEL HEALTH PLAN INC
 
Yes
 
(97)MOUNT CARMEL HEALTH PLAN INC
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
31-1471229
MEDICARE HMO OH 501(C)(4) N/A MOUNT CARMEL HEALTH SYSTEM
 
Yes
 
(98)MOUNT CARMEL HEALTH SYSTEM
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
31-1439334
HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
Yes
 
(99)MOUNT CARMEL HEALTH SYSTEM FOUNDATION
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
31-1113966
FOUNDATION OH 501(C)(3) LINE 12A, I MOUNT CARMEL HEALTH SYSTEM
 
Yes
 
(100)MOUNT SINAI HOSPITAL FOUNDATION INC
114 WOODLAND STREET

HARTFORD,CT06105
22-2584082
FOUNDATION CT 501(C)(3) LINE 12C, III-FI N/A
 
No
(101)MOUNT SINAI REHABILITATION HOSPITAL INC
114 WOODLAND STREET

HARTFORD,CT06105
06-1422973
HEALTH CARE AND HOSPITAL SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(102)MOUNT ST JOSEPH
20555 VICTOR PARKWAY

LIVONIA,MI48152
01-0274998
LONG TERM CARE ME 501(C)(3) LINE 3 MERCY COMMUNITY HEALTH INC
 
Yes
 
(103)MUSKEGON COMMUNITY HEALTH PROJECT
565 W WESTERN AVENUE

MUSKEGON,MI49440
91-1932918
COMMUNITY OUTREACH MI 501(C)(3) LINE 7 MERCY HEALTH PARTNERS
 
Yes
 
(104)NAZARETH HOSPITAL
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2794121
HEALTH CARE AND HOSPITAL SERVICES PA 501(C)(3) LINE 3 TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(105)NAZARETH PHYSICIAN SERVICES INC
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
20-3261266
HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK
 
Yes
 
(106)NE PHYSICIAN SERVICES INC
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2497355
HEALTH CARE SERVICES (INACTIVE) PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK
 
Yes
 
(107)OAKLAND MERCY HOSPITAL
PO BOX 203

SIOUX CITY,IA51102
20-8072234
HEALTH CARE AND HOSPITAL SERVICES NE 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(108)OAKLAND MERCY HOSPITAL FOUNDATION
PO BOX 203

SIOUX CITY,IA51102
31-1678345
FOUNDATION NE 501(C)(3) LINE 12A, I OAKLAND MERCY HOSPITAL
 
Yes
 
(109)OSUMOUNT CARMEL HEALTH ALLIANCE
3100 EASTON SQUARE PL STE 300

COLUMBUS,OH43219
31-1654603
COOPERATIVE HEALTH CARE DELIVERY SYSTEM OH 501(C)(3) LINE 12A, I N/A
 
No
(110)OUR LADY OF MERCY LIFE CENTER
2 MERCYCARE LANE

GUILDERLAND,NY12084
14-1743506
LONG TERM CARE NY 501(C)(3) LINE 3 LTC (EDDY) INC
 
Yes
 
(111)PIONEER VALLEY CARDIOLOGY ASSOCIATES INC
114 WOODLAND STREET

HARTFORD,CT06105
45-4208896
HEALTH CARE SERVICES MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC
 
Yes
 
(112)PITTSBURGH MERCY HEALTH SYSTEM INC
3333 5TH AVENUE

PITTSBURGH,PA15213
25-1464211
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT PA 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(113)PROBILITY THERAPY SERVICES
2058 S STATE STREET

ANN ARBOR,MI48104
20-2020239
HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN
 
Yes
 
(114)PROFESSIONAL MED TEAM
965 FORK STREET

MUSKEGON,MI49442
38-2638284
HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MERCY HEALTH PARTNERS
 
Yes
 
(115)RIVERBEND MEDICAL GROUP INC
114 WOODLAND STREET

HARTFORD,CT06105
81-1807730
HEALTH CARE SERVICES MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC
 
Yes
 
(116)SJ MANAGEMENT COMPANY OF SYRACUSE INC
301 PROSPECT AVENUE

SYRACUSE,NY13203
27-1763712
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT NY 501(C)(3) LINE 12A, I ST JOSEPH'S HOSPITAL HEALTH CENTER
 
Yes
 
(117)SAINT AGNES MEDICAL CENTER
1303 EAST HERNDON AVE

FRESNO,CA93720
94-1437713
HEALTH CARE AND HOSPITAL SERVICES CA 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
Yes
 
(118)SAINT AGNES MEDICAL FOUNDATION
1303 EAST HERNDON AVE

FRESNO,CA93720
94-2839324
HEALTH CARE SERVICES CA 501(C)(3) LINE 12A, I SAINT AGNES MEDICAL CENTER
 
Yes
 
(119)SAINT ALPHONSUS DIVERSIFIED CARE INC
1055 NORTH CURTIS RD

BOISE,ID83706
94-3028978
HEALTH CARE SYSTEM SUPPORT ID 501(C)(3) LINE 12A, I SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
 
Yes
 
(120)SAINT ALPHONSUS FOUNDATION-BAKER CITY INC
3325 POCAHONTAS ROAD

BAKER CITY,OR97814
94-3164869
FOUNDATION OR 501(C)(3) LINE 7 SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY INC
 
Yes
 
(121)SAINT ALPHONSUS FOUNDATION-ONTARIO INC
351 SW 9TH STREET

ONTARIO,OR97914
20-2683560
FOUNDATION OR 501(C)(3) LINE 7 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO INC
 
Yes
 
(122)SAINT ALPHONSUS HEALTH SYSTEM INC
1055 N CURTIS ROAD

BOISE,ID83706
27-1929502
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT ID 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(123)SAINT ALPHONSUS MEDICAL CENTER ONTARIO VOLUNTEERS
351 SW 9TH STREET

ONTARIO,OR97914
94-3059469
VOLUNTEER SERVICE AUXILIARY OR 501(C)(3) LINE 10 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO INC
 
Yes
 
(124)SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY INC
3325 POCAHONTAS ROAD

BAKER CITY,OR97814
27-1790052
HEALTH CARE AND HOSPITAL SERVICES OR 501(C)(3) LINE 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
Yes
 
(125)SAINT ALPHONSUS MEDICAL CENTER-NAMPA HEALTH FOUNDATION INC
4300 E FLAMINGO AVENUE

NAMPA,ID83687
26-1737256
FOUNDATION ID 501(C)(3) LINE 7 SAINT ALPHONSUS MEDICAL CENTER-NAMPA INC
 
Yes
 
(126)SAINT ALPHONSUS MEDICAL CENTER-NAMPA INC
4300 E FLAMINGO AVENUE

NAMPA,ID83687
82-0200896
HEALTH CARE AND HOSPITAL SERVICES ID 501(C)(3) LINE 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
Yes
 
(127)SAINT ALPHONSUS MEDICAL CENTER-ONTARIO INC
351 SW 9TH STREET

ONTARIO,OR97914
27-1789847
HEALTH CARE AND HOSPITAL SERVICES OR 501(C)(3) LINE 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
Yes
 
(128)SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
1055 NORTH CURTIS RD

BOISE,ID83706
82-0200895
HEALTH CARE AND HOSPITAL SERVICES ID 501(C)(3) LINE 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
Yes
 
(129)SAINT FRANCIS EMERGENCY MEDICAL GROUP INC
114 WOODLAND STREET

HARTFORD,CT06105
45-1994612
HEALTH CARE SERVICES CT 501(C)(3) LINE 12B, II TRINITY HEALTH OF NEW ENGLAND PNO INC
 
Yes
 
(130)SAINT FRANCIS HOSPITAL AND MEDICAL CENTER
114 WOODLAND STREET

HARTFORD,CT06105
06-0646813
HEALTH CARE AND HOSPITAL SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(131)SAINT FRANCIS HOSPITAL AND MEDICAL CENTER FOUNDATION INC
114 WOODLAND STREET

HARTFORD,CT06105
06-1008255
FOUNDATION CT 501(C)(3) LINE 7 SAINT FRANCIS HOSPITAL AND MEDICAL CENTER
 
Yes
 
(132)SAINT JOSEPH PACE INC
20555 VICTOR PARKWAY

LIVONIA,MI48152
47-3129127
PACE PROGRAM IN 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(133)SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC
PO BOX 670

PLYMOUTH,IN46563
35-1142669
HEALTH CARE AND HOSPITAL SERVICES IN 501(C)(3) LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
Yes
 
(134)SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC
5215 HOLY CROSS PARKWAY

MISHAWAKA,IN46545
35-0868157
HEALTH CARE AND HOSPITAL SERVICES IN 501(C)(3) LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
Yes
 
(135)SAINT JOSEPH REGIONAL MEDICAL CENTER INC
5215 HOLY CROSS PARKWAY

MISHAWAKA,IN46545
35-1568821
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) LINE 12C, III-FI TRINITY HEALTH CORPORATION
 
Yes
 
(136)SAINT JOSEPH'S HEALTH SYSTEM INC
424 DECATUR STREET

ATLANTA,GA30312
58-1744848
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT GA 501(C)(3) LINE 12C, III-FI TRINITY HEALTH CORPORATION
 
Yes
 
(137)SAINT JOSEPH'S MERCY CARE SERVICES INC
424 DECATUR STREET

ATLANTA,GA30312
58-1752700
HEALTH CARE SERVICES GA 501(C)(3) LINE 7 SAINT JOSEPH'S HEALTH SYSTEM INC
 
Yes
 
(138)SAINT JOSEPH'S TOWER INC
PO BOX 9184

FARMINGTON HILLS,MI48333
31-1040468
SENIOR LIVING COMMUNITY IN 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES - INDIANA INC
 
Yes
 
(139)SAINT MARY HOME INCORPORATED
2021 ALBANY AVENUE

WEST HARTFORD,CT06117
06-0646843
LONG TERM CARE CT 501(C)(3) LINE 3 MERCY COMMUNITY HEALTH INC
 
Yes
 
(140)SAINT MARY'S AMICARE HOME HEALTHCARE
1430 MONROE NW STE 120

GRAND RAPIDS,MI49505
38-3320700
HOME HEALTH SERVICES MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES
 
Yes
 
(141)SAINT MARY'S FOUNDATION
200 JEFFERSON ST SE

GRAND RAPIDS,MI49503
38-1779602
FOUNDATION MI 501(C)(3) LINE 7 TRINITY HEALTH-MICHIGAN
 
Yes
 
(142)SAINT MARY'S HOSPITAL FOUNDATION INC
114 WOODLAND STREET

HARTFORD,CT06105
22-2528400
FOUNDATION CT 501(C)(3) LINE 7 SAINT MARY'S HOSPITAL INC
 
Yes
 
(143)SAINT MARY'S HOSPITAL INC
114 WOODLAND STREET

HARTFORD,CT06105
06-0646844
HEALTH CARE AND HOSPITAL SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(144)SAMARITAN CHILD CARE CENTER INC
2215 BURDETT AVE

TROY,NY12180
14-1710225
CHILD CARE SERVICES NY 501(C)(3) LINE 10 ST PETER'S HEALTH PARTNERS
 
Yes
 
(145)SAMARITAN HOSPITAL
2215 BURDETT AVE

TROY,NY12180
14-1338544
HEALTH CARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS
 
Yes
 
(146)SAMARITAN HOSPITAL AND THE EDDY FOUNDATION
310 SOUTH MANNING BLVD

ALBANY,NY12208
22-2743478
FOUNDATION NY 501(C)(3) LINE 7 ST PETER'S HEALTH PARTNERS
 
Yes
 
(147)SENIOR CARE CONNECTION INC
1938 CURRY ROAD

SCHENECTADY,NY12303
14-1708754
PACE PROGRAM NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(148)SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE
ONE ABELE BLVD

CLIFTON PARK,NY12065
14-1756230
LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(149)SIOUXLAND PARAMEDICS INC
PO BOX 3349

SIOUX CITY,IA51102
42-1185707
MEDICAL TRANSPORTATION SERVICES IA 501(C)(3) LINE 12A, I N/A
 
No
(150)SISTERS OF PROVIDENCE CARE CENTERS INC
114 WOODLAND STREET

HARTFORD,CT06105
22-2541103
LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC
 
Yes
 
(151)SJHSJOC HOLDINGS INC
424 DECATUR STREET

ATLANTA,GA30312
47-2299757
HEALTH CARE SYSTEM SUPPORT GA 501(C)(3) LINE 12B, II SAINT JOSEPH'S HEALTH SYSTEM INC
 
Yes
 
(152)ST FRANCIS HOSPITAL INC
PO BOX 2500

WILMINGTON,DE19805
51-0064326
HEALTH CARE AND HOSPITAL SERVICES DE 501(C)(3) LINE 3 TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(153)ST FRANCIS MEDICAL ASSOCIATES PA
601 HAMILTON AVENUE

TRENTON,NJ08629
83-2199054
HEALTH CARE SERVICES NJ 501(C)(3) LINE 3 ST FRANCIS MEDICAL CENTER TRENTON NJ
 
Yes
 
(154)ST FRANCIS MEDICAL CENTER FOUNDATION INC
601 HAMILTON AVENUE

TRENTON,NJ08629
52-1025476
FOUNDATION NJ 501(C)(3) LINE 7 ST FRANCIS MEDICAL CENTER TRENTON NJ
 
Yes
 
(155)ST FRANCIS MEDICAL CENTER TRENTON NJ
601 HAMILTON AVENUE

TRENTON,NJ08629
22-3431049
HEALTH CARE AND HOSPITAL SERVICES NJ 501(C)(3) LINE 3 MAXIS HEALTH SYSTEM
 
Yes
 
(156)ST JAMES MERCY HEALTH SYSTEM INC
20555 VICTOR PARKWAY

LIVONIA,MI48152
22-3127184
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT (INACTIVE) NY 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION
 
Yes
 
(157)ST JOSEPH MERCY CHELSEA INC
775 SOUTH MAIN ST

CHELSEA,MI48118
82-4757260
HEALTH CARE AND HOSPITAL SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN
 
Yes
 
(158)ST JOSEPH OF THE PINES INC
100 GOSSMAN DRIVE

SOUTHERN PINES,NC28387
56-0694200
LONG TERM CARE NC 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES
 
Yes
 
(159)ST JOSEPH'S COLLEGE OF NURSING AT ST JOSEPH'S HOSPITAL HEALTH CENTER
206 PROSPECT AVENUE

SYRACUSE,NY13203
20-2497520
COLLEGE OF NURSING NY 501(C)(3) LINE 2 ST JOSEPH'S HOSPITAL HEALTH CENTER
 
Yes
 
(160)ST JOSEPH'S HEALTH AT HOME INC
7246 JANUS PARK

LIVERPOOL,NY13088
87-1012253
HOME HEALTH SERVICES NY 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES
 
Yes
 
(161)ST JOSEPH'S HEALTH CENTER PROPERTIES INC
301 PROSPECT AVENUE

SYRACUSE,NY13203
23-7219294
BUILDING MANAGEMENT SERVICES NY 501(C)(3) LINE 12B, II ST JOSEPH'S HEALTH INC
 
Yes
 
(162)ST JOSEPH'S HEALTH INC
301 PROSPECT AVENUE

SYRACUSE,NY13203
47-4754987
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT NY 501(C)(3) LINE 12C, III-FI TRINITY HEALTH CORPORATION
 
Yes
 
(163)ST JOSEPH'S HOSPITAL HEALTH CENTER
301 PROSPECT AVENUE

SYRACUSE,NY13203
15-0532254
HEALTH CARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 ST JOSEPH'S HEALTH INC
 
Yes
 
(164)ST JOSEPH'S HOSPITAL HEALTH CENTER FOUNDATION INC
301 PROSPECT AVENUE

SYRACUSE,NY13203
22-2149775
FOUNDATION NY 501(C)(3) LINE 12B, II ST JOSEPH'S HEALTH INC
 
Yes
 
(165)ST JOSEPH'S MEDICAL PC
301 PROSPECT AVENUE

SYRACUSE,NY13203
27-3899821
HEALTH CARE SERVICES NY 501(C)(3) LINE 12A, I ST JOSEPH'S HOSPITAL HEALTH CENTER
 
Yes
 
(166)ST JOSEPH'S PHYSICIAN HEALTH PC
301 PROSPECT AVENUE

SYRACUSE,NY13203
16-1516863
HEALTH CARE SERVICES NY 501(C)(3) LINE 12A, I ST PETER'S HEALTH PARTNERS
 
Yes
 
(167)ST MARY BUILDING AND DEVELOPMENT
1201 LANGHORNE-NEWTOWN ROAD

LANGHORNE,PA19047
46-1827502
TITLE HOLDING COMPANY PA 501(C)(2) N/A ST MARY MEDICAL CENTER
 
Yes
 
(168)ST MARY EMERGENCY MEDICAL SERVICES
1201 LANGHORNE-NEWTOWN ROAD

LANGHORNE,PA19047
46-5354512
HEALTH CARE SERVICES PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER
 
Yes
 
(169)ST MARY MEDICAL CENTER
1201 LANGHORNE-NEWTOWN ROAD

LANGHORNE,PA19047
23-1913910
HEALTH CARE AND HOSPITAL SERVICES PA 501(C)(3) LINE 3 TRINITY HEALTH OF THE MID-ATLANTIC REGION
 
Yes
 
(170)ST MARY'S FOUNDATION INC
1230 BAXTER STREET

ATHENS,GA30606
58-2544232
FOUNDATION GA 501(C)(3) LINE 12A, I TRINITY HEALTH GEORGIA INC
 
Yes
 
(171)ST MARY'S GOOD SAMARITAN FOUNDATION INC
1230 BAXTER STREET

ATHENS,GA30606
81-1660088
FOUNDATION GA 501(C)(3) LINE 12A, I TRINITY HEALTH GEORGIA INC
 
Yes
 
(172)ST MARY'S HEALTH CARE SYSTEM INC
1230 BAXTER STREET

ATHENS,GA30606
58-0566223
HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 TRINITY HEALTH GEORGIA INC
 
Yes
 
(173)ST MARY'S HIGHLAND HILLS INC
1230 BAXTER STREET

ATHENS,GA30606
02-0576648
SENIOR LIVING COMMUNITY GA 501(C)(3) LINE 3 TRINITY HEALTH GEORGIA INC
 
Yes
 
(174)ST MARY'S MEDICAL GROUP INC
1230 BAXTER STREET

ATHENS,GA30606
26-1858563
HEALTH CARE SERVICES GA 501(C)(3) LINE 3 TRINITY HEALTH GEORGIA INC
 
Yes
 
(175)ST MARY'S SACRED HEART HOSPITAL INC
367 CLEAR CREEK PARKWAY

LAVONIA,GA30553
47-3752176
HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 TRINITY HEALTH GEORGIA INC
 
Yes
 
(176)ST PETER'S HEALTH PARTNERS
315 SOUTH MANNING BLVD

ALBANY,NY12208
45-3570715
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT NY 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(177)ST PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES PC
315 SOUTH MANNING BLVD

ALBANY,NY12208
46-1177336
HEALTH CARE SERVICES NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS
 
Yes
 
(178)ST PETER'S HOSPITAL
315 SOUTH MANNING BLVD

ALBANY,NY12208
14-1348692
HEALTH CARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS
 
Yes
 
(179)ST PETER'S HOSPITAL FOUNDATION INC
310 SOUTH MANNING BLVD

ALBANY,NY12208
22-2262982
FOUNDATION NY 501(C)(3) LINE 7 ST PETER'S HEALTH PARTNERS
 
Yes
 
(180)SUNNYVIEW HOSPITAL AND REHABILITATION CENTER
1270 BELMONT AVENUE

SCHENECTADY,NY12308
14-1338386
HEALTH CARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS
 
Yes
 
(181)SUNNYVIEW HOSPITAL AND REHABILITATION CENTER FOUNDATION INC
1270 BELMONT AVE

SCHENECTADY,NY12308
22-2505127
FOUNDATION NY 501(C)(3) LINE 7 SUNNYVIEW HOSPITAL AND REHABILITATION CENTER
 
Yes
 
(182)THE AUXILIARY OF ST JOSEPH'S HOSPITAL HEALTH CENTER INC
301 PROSPECT AVENUE

SYRACUSE,NY13203
20-3018640
VOLUNTEER SERVICE AUXILIARY NY 501(C)(3) LINE 10 ST JOSEPH'S HOSPITAL HLTH CTR FOUNDATION INC
 
Yes
 
(183)THE COMMUNITY HOSPICE FOUNDATION INC
445 NEW KARNER RD

ALBANY,NY12205
22-2692940
FOUNDATION NY 501(C)(3) LINE 7 THE COMMUNITY HOSPICE INC
 
Yes
 
(184)THE COMMUNITY HOSPICE INC
445 NEW KARNER RD

ALBANY,NY12205
14-1608921
HOSPICE SERVICES NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS
 
Yes
 
(185)THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER INC
707 EAST CEDAR STREET STE 100

SOUTH BEND,IN46617
35-1654543
FOUNDATION IN 501(C)(3) LINE 7 SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
Yes
 
(186)THE JAMES A EDDY MEMORIAL GERIATRIC CENTER INC
2256 BURDETT AVE

TROY,NY12180
22-2570478
LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(187)THE MARJORIE DOYLE ROCKWELL CENTER INC
421 WEST COLUMBIA ST

COHOES,NY12047
14-1793885
LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC
 
Yes
 
(188)THE MERCY HOSPITAL INC
114 WOODLAND STREET

HARTFORD,CT06105
04-3398280
HEALTH CARE AND HOSPITAL SERVICES MA 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(189)THE WOMEN'S AUXILIARY OF ST FRANCIS HOSPITAL & MEDICAL CENTER
114 WOODLAND STREET

HARTFORD,CT06105
06-0660403
VOLUNTEER SERVICE AUXILIARY CT 501(C)(3) LINE 12B, II N/A
 
No
(190)THHS OAKLAND FKA CRANBROOK HOSPICE CARE
20555 VICTOR PARKWAY

LIVONIA,MI48152
38-3320699
HOSPICE SERVICES (INACTIVE) MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES
 
Yes
 
(191)TRI-HOSPITAL EMERGENCY MEDICAL SERVICES
309 GRAND RIVER

PORT HURON,MI48060
38-2485700
HEALTH CARE SERVICES MI 501(C)(3) LINE 12A, I N/A
 
No
(192)TRINITY CONTINUING CARE SERVICES
PO BOX 9184

FARMINGTON HILLS,MI48333
38-2559656
LONG TERM CARE MI 501(C)(3) LINE 10 TRINITY HEALTH CORPORATION
 
Yes
 
(193)TRINITY CONTINUING CARE SERVICES - INDIANA
PO BOX 9184

FARMINGTON HILLS,MI48333
93-0907047
LONG TERM CARE IN 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES
 
Yes
 
(194)TRINITY CONTINUING CARE SERVICES - MASSACHUSETTS
PO BOX 9184

FARMINGTON HILLS,MI48333
82-4005577
LONG TERM CARE MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES
 
Yes
 
(195)TRINITY HEALTH - MICHIGAN
20555 VICTOR PARKWAY

LIVONIA,MI48152
38-2113393
HEALTH CARE AND HOSPITAL SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION
 
Yes
 
(196)TRINITY HEALTH CORPORATION
20555 VICTOR PARKWAY

LIVONIA,MI48152
35-1443425
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) LINE 12B, II CATHOLIC HEALTH MINISTRIES
 
Yes
 
(197)TRINITY HEALTH GEORGIA INC
1230 BAXTER STREET

ATHENS,GA30606
88-0878641
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT GA 501(C)(3) LINE 12C, III-FI TRINITY HEALTH CORPORATION
 
Yes
 
(198)TRINITY HEALTH LIFE PENNSYLVANIA INC
PO BOX 9184

FARMINGTON HILLS,MI48333
47-5244984
PACE PROGRAM PA 501(C)(3) LINE 10 TRINITY HEALTH PACE
 
Yes
 
(199)TRINITY HEALTH OF NEW ENGLAND CORPORATION INC
114 WOODLAND STREET

HARTFORD,CT06105
06-1491191
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT CT 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(200)TRINITY HEALTH OF NEW ENGLAND EMERGENCY MEDICAL SERVICES INC
114 WOODLAND STREET

HARTFORD,CT06105
83-3546613
HEALTH CARE SERVICES CT 501(C)(3) LINE 10 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(201)TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC
114 WOODLAND STREET

HARTFORD,CT06105
06-1450168
HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC
 
Yes
 
(202)TRINITY HEALTH OF THE MID-ATLANTIC REGION
3805 WEST CHESTER PIKE SUITE 100

NEWTOWN SQUARE,PA19073
23-2212638
HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT PA 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(203)TRINITY HEALTH PACE
PO BOX 9184

FARMINGTON HILLS,MI48333
47-3073124
PACE PROGRAM MI 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION
 
Yes
 
(204)TRINITY HEALTH WELFARE BENEFIT TRUST
20555 VICTOR PARKWAY

LIVONIA,MI48152
20-8151733
RETIREE MEDICAL AND RETIREE LIFE INSURANCE MI 501(C)(9) N/A TRINITY HEALTH CORPORATION
 
Yes
 
(205)TRINITY HOME HEALTH SERVICES
PO BOX 9184

FARMINGTON HILLS,MI48333
38-2621935
MANAGEMENT SERVICES FOR HOME HEALTH SYSTEM MI 501(C)(3) LINE 10 TRINITY HEALTH CORPORATION
 
Yes
 
(206)VILLA MARY IMMACULATE
301 HACKETT BLVD

ALBANY,NY12208
14-1438749
LONG TERM CARE NY 501(C)(3) LINE 3 ST PETER'S HOSPITAL
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) ADVENT REHABILITATION LLC

607 DEWEY AVENUE SUITE 300
GRAND RAPIDS,MI49504
38-3306673
REHABILITATION THERAPY SERVICES MI N/A
        No   Yes    
(2) BH VENTURE ONE LP

905 WATSON STREET
PITTSBURGH,PA15219
38-4098074
REAL ESTATE PA N/A
        No   Yes    
(3) BIG RUN MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP

3100 EASTON SQ STE 300
COLUMBUS,OH43219
31-1608125
MEDICAL OFFICE BUILDING RENTAL OH N/A
        No   Yes    
(4) CENTER FOR DIGESTIVE CARE LLC

5300 ELLIOTT DRIVE
YPSILANTI,MI48197
03-0447062
PROVIDE GASTROINTESTINAL SERVICES MI N/A
        No     No  
(5) CENTRAL NEW JERSEY HEART SERVICES LLC

45 SAPPHIRE DRIVE
PRINCETON,NJ08550
20-8525458
CARDIAC PROGRAM NJ N/A
        No     No  
(6) CLINTON IMAGING SERVICES LLC

1410 N 4TH STREET
CLINTON,IA52732
41-2044739
MRI DIAGNOSTIC SERVICES IA N/A
        No     No  
(7) CONVENIENT CARE LLC

10319 JEFFERSON HIGHWAY
BATON ROUGE,LA70809
72-1439481
URGENT CARE CENTER LA N/A
        No   Yes    
(8) DIAGNOSTIC IMAGING OF SOUTHBURY LLC

385 MAIN STREET SOUTH
SOUTHBURY,CT06488
06-1487582
IMAGING CENTER CT N/A
        No   Yes    
(9) EVERETT ROAD ASC LLC

30 CENTURY HILL DRIVE
LATHAM,NY12110
83-3542382
MEDICAL SERVICES NY N/A
        No   Yes    
(10) FOREST PARK IMAGING LLC

1000 4TH STREET SW
MASON CITY,IA50401
13-4365966
X-RAY AND MAMMOGRAPHY SERVICES IA MERCY HEALTH SERVICES-IOWA CORP
 
RELATED 1,587,781 879,105   No   Yes   52.890 %
(11) FRANCES WARDE MEDICAL LABORATORY

300 WEST TEXTILE ROAD
ANN ARBOR,MI48104
38-2648446
LABORATORY MI N/A
        No   Yes    
(12) GATEWAY HEALTH PLAN LP

444 LIBERTY AVE SUITE 2100
PITTSBURGH,PA15222
25-1691945
MEDICAID & MEDICARE/ SPECIAL NEEDS MANAGED CARE ORGANIZATION PA N/A
        No   Yes    
(13) HAWARDEN REGIONAL HEALTH CLINICS LLC

1122 AVENUE L
HAWARDEN,IA51023
20-1444339
MEDICAL CLINIC IA N/A
        No   Yes    
(14) INTERMOUNTAIN MEDICAL IMAGING LLC

877 WEST MAIN ST STE 603
BOISE,ID83702
82-0514422
IMAGING CENTER ID N/A
        No   Yes    
(15) LAKE CHARLES URGENT CARE LLC

10319 JEFFERSON HIGHWAY
BATON ROUGE,LA70809
27-2272979
URGENT CARE CENTER LA N/A
        No   Yes    
(16) LCMC URGENT CARE LLC

10319 JEFFERSON HIGHWAY
BATON ROUGE,LA70809
30-0951534
URGENT CARE CENTER DE N/A
        No   Yes    
(17) LOURDES AFTER HOURS LLC

7777 HENNESSY BLVD SUITE 1004-202
BATON ROUGE,LA70809
20-1367299
URGENT CARE CENTER LA N/A
        No   Yes    
(18) LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP

569 BROOKWOOD VILLAGE901
BIRMINGHAM,AL35209
36-4119522
SURGICAL SERVICES IL N/A
        No   Yes    
(19) MAGNETIC RESONANCE SERVICES PARTNERSHIP

1416 SIXTH STREET SW
MASON CITY,IA50401
42-1328388
MRI SERVICES IA MERCY HEALTH SERVICES-IOWA CORP
 
RELATED 934,572 114,232   No   Yes   49.000 %
(20) MASON CITY AMBULATORY SURGERY CENTER LLC

990 4TH STREET SW
MASON CITY,IA50401
20-1960348
SURGERY-SAME DAY IA MERCY HEALTH SERVICES-IOWA CORP
 
RELATED 2,770,938 3,791,410   No   Yes   51.000 %
(21) MCE MOB IV LIMITED PARTNERSHIP

3100 EASTON SQUARE PL STE 300
COLUMBUS,OH43219
42-1544707
MEDICAL OFFICE BUILDING RENTAL OH N/A
        No   Yes    
(22) MEDILUCENT MOB I

3100 EASTON SQUARE PL STE 300
COLUMBUS,OH43219
20-4911370
MEDICAL OFFICE BUILDING RENTAL OH N/A
        No   Yes    
(23) MERCYONE-HFH HOME MEDICAL SHOP LLC

1000 4TH STREET SW
MASON CITY,IA50401
85-4007472
MEDICAL EQUIPMENT SALES IA MERCY HEALTH SERVICES-IOWA CORP
 
RELATED 7,099 68,881   No     No 51.000 %
(24) MEDWORKS LLC

375 EAST CEDAR STREET
NEWINGTON,CT06111
06-1490483
REHABILITATION SERVICES CT N/A
        No     No  
(25) MERCY HEART CTR OP SERVICES LLC

1000 4TH STREET SW
MASON CITY,IA50401
13-4237594
CARDIOVASCULAR SERVICES IA MERCY HEALTH SERVICES-IOWA CORP
 
RELATED 151,550 -82,794   No     No 51.000 %
(26) MERCYMANOR PARTNERSHIP

PO BOX 10086
TOLEDO,OH43699
52-1931012
NURSING HOME PA N/A
        No   Yes    
(27) MERCYUSP HEALTH VENTURES LLC

14201 DALLAS PARKWAY
DALLAS,TX75254
47-1290300
OUTPATIENT SURGERY IA MERCY HEALTH SERVICES-IOWA CORP
 
RELATED 13,672,399 22,897,975   No     No 55.710 %
(28) MOUNT CARMEL EAST POB III LIMITED PARTNERSHIP

3100 EASTON SQ STE 300
COLUMBUS,OH43219
31-1369473
MEDICAL OFFICE BUILDING RENTAL OH N/A
        No   Yes    
(29) NAUGATUCK VALLEY MRI LLC

385 MAIN STREET SOUTH
SOUTHBURY,CT06488
06-1239526
IMAGING CENTER CT N/A
        No     No  
(30) NAZARETH MEDICAL OFFICE BUILDING ASSOCIATES LP

2601 HOLME AVE
PHILADELPHIA,PA19152
23-2388040
MEDICAL OFFICE BUILDING PA N/A
        No   Yes    
(31) OSWEGO HEALTH HOME CARE LLC

510 SOUTH 4TH STREET
FULTON,NY13069
47-2463736
HOME HEALTH CARE NY N/A
        No   Yes    
(32) PHYSICIANS OUTPATIENT SURGERY CENTER LLC

1000 NE 56TH STREET
OAKLAND PARK,FL33334
35-2325646
AMBULATORY SURGERY CENTER FL N/A
        No   Yes    
(33) PREMIER HEALTH HOLDINGS LLC

10319 JEFFERSON HIGHWAY
BATON ROUGE,LA70809
47-2665226
URGENT CARE CENTERS DE N/A
        No   Yes    
(34) PRIMARY CARE PHYSICIAN CENTER LLC

2160 SOUTH FIRST AVENUE
MAYWOOD,IL60153
36-4038505
OFFICE BUILDING RENTAL IL N/A
        No   Yes    
(35) RADISSON SJH PROPERTIES LLC

100 MADISON STREET SUITE 1200
SYRACUSE,NY13202
46-1892799
MEDICAL OFFICE BUILDING NY N/A
        No   Yes    
(36) RAPIDES AFTER HOURS CLINIC LLC

10319 JEFFERSON HIGHWAY
BATON ROUGE,LA70809
45-1772383
URGENT CARE CENTER LA N/A
        No   Yes    
(37) SAINT AGNESDIGNITYUSP SURGERY CENTERS LLC

15305 DALLAS PKWY STE 1600
ADDISON,TX75001
84-3522377
OUTPATIENT SURGERY CA N/A
        No     No  
(38) SAINT AGNESUSP SURGERY CENTERS LLC

14201 DALLAS PARKWAY
DALLAS,TX75254
36-4896811
MEDICAL SERVICES CA N/A
        No     No  
(39) SIXTY FOURTH STREET LLC

2373 64TH ST STE 2200
BYRON CENTER,MI49315
20-2443646
PROVIDE OUTPATIENT SURGICAL CARE MI N/A
        No     No  
(40) SJLS LLC

920 WINTER ST
WALTHAM,MA02451
20-1796650
DIALYSIS SERVICES NY N/A
        No     No  
(41) SMMC MOB II LP

1201 LANGHORNE-NEWTOWN ROAD
LANGHORNE,PA19047
36-4559869
INVESTMENT AND OPERATION OF A MEDICAL BUILDING PA N/A
        No     No  
(42) ST AGNES LONG-TERM INTENSIVE CARE LLP

3805 WEST CHESTER PIKE SUITE 100
NEWTOWN SQUARE,PA19073
20-0984882
LONG TERM INTENSIVE CARE PA N/A
        No   Yes    
(43) ST ALPHONSUS CALDWELL CANCER CTR LLC

3123 MEDICAL DR
CALDWELL,ID83605
82-0526861
HEALTH CARE SERVICES ID N/A
        No   Yes    
(44) ST ANN'S MEDICAL OFFICE BLDG II LIMITED PARTNERSHIP

3100 EASTON SQ STE 300
COLUMBUS,OH43219
31-1603660
MEDICAL OFFICE BUILDING RENTAL OH N/A
        No   Yes    
(45) ST JOSEPH'S IMAGING ASSOCIATES PLLC

104 UNION AVE SUITE 905
SYRACUSE,NY13203
16-1104293
RADIOLOGY SERVICES NY N/A
        No   Yes    
(46) ST MARY REHABILITATION HOSPITAL LLP

680 SOUTH FOURTH STREET
LOUISVILLE,KY40202
27-3938747
HEALTH CARE SERVICES DE N/A
        No     No  
(47) ST PETER'S AMBULATORY SURGERY CENTER LLC

1375 WASHINGTON AVE 201
ALBANY,NY12206
46-0463892
OUTPATIENT SURGERY NY N/A
        No   Yes    
(48) THE AMBULATORY SURGERY CENTER AT ST MARY LLC

1203 LANGHORNE-NEWTOWN ROAD
LANGHORNE,PA19047
27-2871206
OUTPATIENT SURGERY PA N/A
        No   Yes    
(49) THPH URGENT CARE LLC

20555 VICTOR PARKWAY
LIVONIA,MI48152
85-2464958
URGENT CARE CENTERS DE N/A
        No     No  
(50) WOODLAND IMAGING CENTER LLC

5301 E HURON RIVER DR
ANN ARBOR,MI48106
76-0820959
RADIOLOGY/ IMAGING MI N/A
        No     No  
(51) WOODLAND PARTNERS REAL ESTATE LLC

129 WOODLAND STREET
HARTFORD,CT06105
83-3371094
REAL ESTATE CT N/A
        No     No  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CATHERINE HORAN BUILDING CORPORATION

114 WOODLAND STREET
HARTFORD,CT06105
04-2938160
BUILDING MANAGEMENT MA N/A
C       Yes  
(2) CENTRAL VALLEY HEALTH PLAN INC

1303 E HERNDON AVE
FRESNO,CA93720
61-1846844
HEALTH INSURANCE CA N/A
C       Yes  
(3) FHS SERVICES INC

333 BUTTERNUT DRIVE SUITE 100
DEWITT,NY13214
27-2995699
MEDICAL SERVICES NY N/A
C       Yes  
(4) FRANCISCAN ASSOCIATES INC

333 BUTTERNUT DRIVE SUITE 100
DEWITT,NY13214
20-2991688
MEDICAL SERVICES NY N/A
C       Yes  
(5) FRANCISCAN HEALTH SUPPORT INC

333 BUTTERNUT DRIVE SUITE 100
DEWITT,NY13214
16-1236354
MEDICAL SERVICES NY N/A
C       Yes  
(6) FRANCISCAN MANAGEMENT SERVICES INC

333 BUTTERNUT DRIVE SUITE 100
DEWITT,NY13214
16-1351193
MANAGEMENT SERVICES NY N/A
C       Yes  
(7) FRANKLIN MEDICAL GROUP PC

114 WOODLAND STREET
HARTFORD,CT06105
06-1470493
PHYSICIAN OFFICE CT N/A
C       Yes  
(8) HACKLEY HEALTH VENTURES INC

318 RIVER RIDGE DR NW SUITE 100
WALKER,MI49544
38-2589959
OTHER MEDICAL SERVICES MI N/A
C       Yes  
(9) HACKLEY PROFESSIONAL PHARMACY INC

318 RIVER RIDGE DR NW SUITE 100
WALKER,MI49544
38-2447870
PHARMACY MI N/A
C       Yes  
(10) HEALTH CARE MANAGEMENT ADMINISTRATORS INC

333 BUTTERNUT DRIVE SUITE 100
DEWITT,NY13214
16-1450960
HEALTH CARE MANAGEMENT NY N/A
C       Yes  
(11) HURON ARBOR CORPORATION

5301 EAST HURON RIVER DR
ANN ARBOR,MI48106
38-2475644
PROVIDES OFFICE RENTAL SPACE MI N/A
C       Yes  
(12) IHA AFFILIATION CORPORATION

24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3188895
MEDICAL MANAGEMENT MI N/A
C       Yes  
(13) LABORATORY ASSOCIATES OF MICHIGAN INC

300 W TEXTILE ROAD
ANN ARBOR,MI48104
38-2637870
LAB SERVICES MI N/A
C       Yes  
(14) LANGHORNE SERVICES II INC

1201 LANGHORNE-NEWTOWN ROAD
LANGHORNE,PA19047
26-3795549
GENERAL PARTNER OF LMOB PARTNERS, II PA N/A
C       Yes  
(15) LANGHORNE SERVICES INC

1201 LANGHORNE-NEWTOWN ROAD
LANGHORNE,PA19047
23-2625981
GENERAL PARTNER OF LMOB PARTNERS PA N/A
C       Yes  
(16) MACNEAL HEALTH PROVIDERS INC

750 PASQUINELLI DRIVE SUITE 216
WESTMONT,IL60059
36-3361297
MEDICAL SERVICES IL N/A
C       Yes  
(17) MARYLAND CARE GROUP INC

1500 FOREST GLEN RD
SILVER SPRING,MD20910
52-1815313
HEALTH CARE HOLDING MD N/A
C       Yes  
(18) MCMC EASTWICK INC

3805 WEST CHESTER PIKE SUITE 100
NEWTOWN SQUARE,PA19073
23-2184261
MEDICAL OFFICE BUILDINGS PA N/A
C       Yes  
(19) MEDNOW INC

4300 E FLAMINGO AVE
NAMPA,ID83687
82-0389927
MEDICAL SERVICES ID N/A
C       Yes  
(20) MERCY INPATIENT MEDICAL ASSOCIATES INC

114 WOODLAND STREET
HARTFORD,CT06105
04-3029929
MEDICAL SERVICES MA N/A
C       Yes  
(21) MERCY MEDICAL SERVICES

801 5TH STREET
SIOUX CITY,IA51101
42-1283849
PRIMARY CARE PHYSICIANS IA MERCY HEALTH SERVICES-IOWA CORP
 
C -4,529,176 5,590,895 100.000 % Yes  
(22) MOUNT CARMEL HEALTHPROVIDERS INC

3100 EASTON SQUARE PL STE 300
COLUMBUS,OH43219
31-1382442
MEDICAL SERVICES OH N/A
C       Yes  
(23) NURSING NETWORK INC

4725 NORTH FEDERAL HIGHWAY
FORT LAUDERDALE,FL33308
59-1145192
MEDICAL SERVICES FL N/A
C       Yes  
(24) SAINT ALPHONSUS HEALTH ALLIANCE INC

1055 NORTH CURTIS ROAD
BOISE,ID83706
82-0524649
ACCOUNTABLE CARE ORGANIZATION ID N/A
C       Yes  
(25) SAINT ALPHONSUS PHYSICIANS PA

1055 NORTH CURTIS ROAD
BOISE,ID83706
33-1078261
HEALTH CARE SERVICES (INACTIVE) ID N/A
C       Yes  
(26) SAINT FRANCIS BEHAVIORAL HEALTH GROUP PC

114 WOODLAND STREET
HARTFORD,CT06105
06-1384686
MEDICAL SERVICES CT N/A
C       Yes  
(27) SAINT FRANCIS CARE MEDICAL GROUP PC

114 WOODLAND STREET
HARTFORD,CT06105
06-1432373
MEDICAL SERVICES CT N/A
C       Yes  
(28) SAMARITAN MEDICAL OFFICE BUILDING INC

2212 BURDETT AVENUE
TROY,NY12180
14-1607244
REAL ESTATE NY N/A
C       Yes  
(29) SCOVILL STREET MEDICAL BUILDING ASSOCIATION INC

114 WOODLAND STREET
HARTFORD,CT06105
06-1232868
PROPERTY MANAGEMENT CT N/A
C       Yes  
(30) SJM PROPERTIES INC

20555 VICTOR PARKWAY
LIVONIA,MI48152
16-1294991
PROPERTY HOLDINGS NY N/A
C       Yes  
(31) SJPE PRACTICE MANAGEMENT SERVICES INC

301 PROSPECT AVE
SYRACUSE,NY13203
45-4164964
MANAGEMENT SERVICES NY N/A
C       Yes  
(32) SJRMC HOLDINGS INC

5215 HOLY CROSS PARKWAY
MISHAWAKA,IN46545
47-4763735
PROPERTY HOLDINGS IN N/A
C       Yes  
(33) ST ELIZABETH HEALTH SUPPORT SERVICES INC

333 BUTTERNUT DRIVE SUITE 100
DEWITT,NY13214
16-1540486
MEDICAL SERVICES NY N/A
C       Yes  
(34) SYSTEM COORDINATED SERVICES INC

114 WOODLAND STREET
HARTFORD,CT06105
04-2938161
LAB SERVICES MA N/A
C       Yes  
(35) THRE SERVICES LLC

20555 VICTOR PARKWAY
LIVONIA,MI48152
45-2603654
REAL ESTATE BROKERAGE SERVICES MI N/A
C       Yes  
(36) TRINITY ASSURANCE LTD

PO BOX 1159 GRAND CAYMAN
GRAND CAYMAN    
CJ
98-0453602
SELF-INSURANCE CJ N/A
C       Yes  
(37) TRINITY HEALTH ACO INC

20555 VICTOR PARKWAY
LIVONIA,MI48152
47-3794666
ACCOUNTABLE CARE ORGANIZATION DE N/A
C       Yes  
(38) TRINITY HEALTH EMPLOYEE BENEFIT TRUST

20555 VICTOR PARKWAY
LIVONIA,MI48152
38-3410377
GRANTOR TRUST MI N/A
T       Yes  
(39) TRINITY SENIOR SERVICES MANAGEMENT INC

PO BOX 9184
FARMINGTON HILLS,MI48333
37-1572595
SENIOR SERVICES PA N/A
C       Yes  
(40) WORKPLACE HEALTH OF GRAND HAVEN INC

318 RIVER RIDGE DR NW SUITE 100
WALKER,MI49544
38-3112035
OCCUPATIONAL HEALTH MI N/A
C       Yes  
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) BAUM HARMON MERCY HOSPITAL

L 312,569 PER BOOKS
(2) BAUM HARMON MERCY HOSPITAL

M 167,518 PER BOOKS
(3) BAUM HARMON MERCY HOSPITAL

P 107,285 PER BOOKS
(4) BAUM HARMON MERCY HOSPITAL

Q 238,567 PER BOOKS
(5) DUBUQUE MERCY HEALTH FOUNDATION

B 493,536 PER BOOKS
(6) DUBUQUE MERCY HEALTH FOUNDATION

C 246,957 PER BOOKS
(7) DYERSVILLE HEALTH FOUNDATION INC

C 54,133 PER BOOKS
(8) FOREST PARK IMAGING LLC

A 104,243 PER BOOKS
(9) FOREST PARK IMAGING LLC

C 1,213,080 PER BOOKS
(10) FOREST PARK IMAGING LLC

L 145,665 PER BOOKS
(11) FOREST PARK IMAGING LLC

Q 952,478 PER BOOKS
(12) HOSPICE OF NORTH IOWA

L 268,694 PER BOOKS
(13) MAGNETIC RESONANCE SERVICES PARTNERSHIP

C 917,320 PER TAX RETURN
(14) MASON CITY AMBULATORY SURGERY CENTER LLC

C 2,405,558 PER BOOKS
(15) MASON CITY AMBULATORY SURGERY CENTER LLC

L 2,534,140 PER BOOKS
(16) MASON CITY AMBULATORY SURGERY CENTER LLC

Q 209,515 PER BOOKS
(17) MERCY HEALTH NETWORK

P 10,857,269 PER BOOKS
(18) MERCY HEART CTR OP SERVICES LLC

C 162,935 PER BOOKS
(19) MERCY HEART CTR OP SERVICES LLC

L 153,030 PER BOOKS
(20) MERCY HEART CTR OP SERVICES LLC

Q 105,340 PER BOOKS
(21) MERCY MEDICAL CENTER - CLINTON INC

L 371,132 PER BOOKS
(22) MERCY MEDICAL CENTER - CLINTON INC

P 457,937 PER BOOKS
(23) MERCY MEDICAL CENTER - CLINTON INC

Q 899,655 PER BOOKS
(24) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION

A 3,512 PER BOOKS
(25) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION

C 396,134 PER BOOKS
(26) MERCY MEDICAL SERVICES

A 24,159 PER BOOKS
(27) MERCY MEDICAL SERVICES

L 4,521,001 PER BOOKS
(28) MERCY MEDICAL SERVICES

M 8,487,718 PER BOOKS
(29) MERCY MEDICAL SERVICES

P 7,387,397 PER BOOKS
(30) MERCY MEDICAL SERVICES

Q 90,520 PER BOOKS
(31) MERCY MEDICAL SERVICES

R 97,674 PER BOOKS
(32) MERCYUSP HEALTH VENTURES LLC

C 12,067,655 PER BOOKS
(33) MOUNT CARMEL HEALTH SYSTEM

M 99,817 PER BOOKS
(34) TRINITY CONTINUING CARE SERVICES

M 254,134 PER BOOKS
(35) TRINITY HEALTH CORPORATION

B 12,685,805 PER BOOKS
(36) TRINITY HEALTH CORPORATION

E 70,000,000 PER BOOKS
(37) TRINITY HEALTH CORPORATION

M 82,339,116 PER BOOKS
(38) TRINITY HEALTH CORPORATION

P 31,036,128 PER BOOKS
(39) TRINITY HEALTH CORPORATION

Q 4,511,665 PER BOOKS
(40) TRINITY HEALTH CORPORATION

R 10,851,556 PER BOOKS
(41) TRINITY HEALTH CORPORATION

S 1,222,824 PER BOOKS
(42) TRINITY HOME HEALTH SERVICES

A 29,396 PER BOOKS
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

Additional Data


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