Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (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 | |||||
| (A)
SISTERS OF MERCY OF THE AMERICAS WEST MIDWEST COMMUNITY INC |
262400800 | 1 | Yes | 0 | 0 | |
|
Total 1
|
0 | 0 | ||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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.).. | ||||||
| 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 | ||||
| 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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. 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 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 3 | MHIC, F/K/A MERCY HOSPITAL, IOWA CITY, IOWA FILED FOR VOLUNTARY BANKRUPTCY IN AUGUST 2023. AS PART OF THE BANKRUPTCY PROCEEDINGS, THE ORGANIZATION'S ASSETS WERE ACQUIRED BY THE UNIVERSITY OF IOWA, WITH THE TRANSACTION FINALIZED ON JUNE 24, 2024. AS A RESULT, EFFECTIVE JANUARY 31, 2024, MERCY HOSPITAL CEASED PROVIDING HEALTHCARE SERVICES TO THE COMMUNITY. THE ORGANIZATION REMAINS IN EXISTENCE SOLELY TO MANAGE THE WINDING DOWN OF OPERATIONS, INCLUDING THE COLLECTION OF RECEIVABLES AND SETTLEMENT OF OUTSTANDING OBLIGATIONS. NO PROGRAM SERVICES OR HEALTHCARE OPERATIONS HAVE BEEN CONDUCTED BY THE ORGANIZATION SINCE JANUARY 31, 2024. |
| FORM 990, PART VI, SECTION A, LINE 3 | SHUTTLEWORTH & INGERSOLL PROVIDED CERTAIN MANAGEMENT OVERSIGHT AND WINDDOWN SERVICES PURSUANT TO THE DEBTOR'S FIRST AMENDED COMBINED DISCLOSURE STATEMENT AND JOINT PLAN OF LIQUIDATION DATED APRIL 3, 2024, AS MODIFIED BY THE FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER CONFIRMING DEBTORS' JOINT CHAPTER 11 PLAN OF LIQUIDATION DATED JUNE 7, 2024. DAN CHILDERS, TRUSTEE OF THE MERCY HOSPITAL LIQUIDATION TRUST, IS NOT AN EMPLOYEE OF MHIC, BUT RATHER AN EMPLOYEE OF SHUTTLEWORTH & INGERSOLL, A MANAGEMENT COMPANY. FOR HIS ROLE AS TRUSTEE OF MHIC, DAN CHILDERS WAS COMPENSATED BY SHUTTLEWORTH & INGERSOLL. |
| FORM 990, PART VI, SECTION A, LINE 4 | DURING THE TAX YEAR, THE ORGANIZATION ADOPTED AMENDED AND RESTATED BYLAWS THAT REFLECT A COMPREHENSIVE RESTRUCTURING OF ITS PURPOSE, GOVERNANCE, AND OPERATIONS IN CONNECTION WITH ITS TRANSITION FROM OPERATING A HEALTHCARE FACILITY TO ADMINISTERING A COURT-APPROVED PLAN OF LIQUIDATION. THE ORGANIZATION ADOPTED AMENDED AND RESTATED BYLAWS EFFECTIVE APRIL 3, 2025, REPLACING ITS PRIOR BYLAWS (LAST REVISED JANUARY 21, 2020). THE RESTATEMENT REFLECTS SIGNIFICANT CHANGES TO THE ORGANIZATION'S PURPOSE AND GOVERNANCE STRUCTURE IN CONNECTION WITH ITS TRANSITION UNDER A CONFIRMED CHAPTER 11 PLAN OF LIQUIDATION. KEY CHANGES INCLUDE: CHANGE IN ORGANIZATIONAL PURPOSE/MISSION: THE BYLAWS WERE REVISED TO PROVIDE THAT THE ORGANIZATION'S SOLE PURPOSE IS TO CARRY OUT THE ACTIVITIES DESCRIBED IN THE CONFIRMED CHAPTER 11 PLAN OF LIQUIDATION, REPLACING THE PRIOR PURPOSE OF OPERATING A HOSPITAL AND PROVIDING HEALTHCARE SERVICES. CONSISTENT WITH THIS CHANGE IN PURPOSE, THE ORGANIZATION WILL REPORT ON FORM 990, SCHEDULE A, PART I AS A TYPE I SUPPORTING ORGANIZATION DESCRIBED IN LINE 12A (SUPPORTING THE SISTERS OF MERCY OF THE AMERICAS WEST MIDWEST COMMUNITY, INC.), RATHER THAN AS A HOSPITAL ORGANIZATION DESCRIBED IN LINE 3. CHANGES TO THE GOVERNING BODY (BOARD COMPOSITION AND AUTHORITY): THE PRIOR BOARD STRUCTURE OF BETWEEN 5 AND 15 DIRECTORS WAS ELIMINATED AND REPLACED WITH A SINGLE DIRECTOR, WHO SERVES AS THE LIQUIDATION TRUSTEE. AUTHORITY FOR MANAGEMENT OF THE ORGANIZATION IS NOW VESTED IN THIS SOLE DIRECTOR, CONSISTENT WITH THE LIQUIDATION PLAN. CHANGES TO OFFICERS: THE PRIOR OFFICER STRUCTURE (INCLUDING CHAIRMAN, VICE CHAIRMAN, PRESIDENT/CEO, ADMINISTRATOR, AND OTHER OFFICERS) WAS SIMPLIFIED. UNDER THE AMENDED BYLAWS, THE SOLE DIRECTOR SERVES SIMULTANEOUSLY AS PRESIDENT, SECRETARY, AND TREASURER, AND OFFICER ROLES, DUTIES, AND SUCCESSION PROVISIONS WERE REVISED ACCORDINGLY. CHANGES TO COMMITTEES: THE PRIOR STANDING COMMITTEE STRUCTURE (INCLUDING EXECUTIVE, FINANCE, AUDIT, QUALITY, AND MISSION COMMITTEES) WAS ELIMINATED AND REPLACED WITH A MORE LIMITED FRAMEWORK PERMITTING THE BOARD (I.E., THE SOLE DIRECTOR) TO ESTABLISH COMMITTEES AS NEEDED, REFLECTING THE ORGANIZATION'S STREAMLINED OPERATIONS. CHANGES TO MEMBER AND GOVERNANCE PROVISIONS: WHILE MEMBERS CONTINUE TO BE DESIGNATED BY THE SISTERS OF MERCY, GOVERNANCE PROVISIONS WERE CONFORMED TO THE REVISED STRUCTURE UNDER THE LIQUIDATION PLAN, INCLUDING THE ROLE OF MEMBERS IN RATIFYING THE APPOINTMENT OF THE DIRECTOR. CHANGES TO FISCAL AND OPERATIONAL PROVISIONS: CERTAIN OPERATIONAL PROVISIONS WERE UPDATED TO REFLECT THE ORGANIZATION'S CURRENT STATUS, INCLUDING A CHANGE IN THE FISCAL YEAR (FROM JULY 1-JUNE 30 TO A CALENDAR YEAR) AND REMOVAL OF PROVISIONS RELATED TO HOSPITAL ADMINISTRATION, MEDICAL STAFF, AND HEALTHCARE OPERATIONS. CHANGES TO AMENDMENT PROVISIONS: THE BYLAWS AMENDMENT PROVISIONS WERE REVISED, INCLUDING UPDATES TO NOTICE REQUIREMENTS AND PROCEDURES FOR APPROVAL BY THE DIRECTOR AND MEMBERS. THESE CHANGES COLLECTIVELY REFLECT A FUNDAMENTAL RESTRUCTURING OF THE ORGANIZATION'S GOVERNANCE, MANAGEMENT, AND PURPOSE IN CONNECTION WITH ITS TRANSITION FROM OPERATING A HEALTHCARE FACILITY TO ADMINISTERING AND IMPLEMENTING A PLAN OF LIQUIDATION AS A SUPPORTING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | MHIC'S SOLE MEMBER IS THE SISTERS OF MERCY OF THE AMERICAS WEST MIDWEST COMMUNITY, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | MHIC'S SOLE MEMBER, SISTERS OF MERCY OF THE AMERICAS WEST MIDWEST COMMUNITY, INC., MAINTAINS A NUMBER OF "RESERVED POWERS" INCLUDING BUT NOT LIMITED TO APPROVAL OF AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS AND APPROVAL OF BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BY MERCY HOSPITAL LIQUIDATION TRUST'S FINANCIAL ADVISOR AND AN OUTSIDE INDEPENDENT ACCOUNTING AND TAX FIRM PRIOR TO SUBMISSION TO THE IRS. THE FORM 990 WAS NOT REVIEWED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE SUBMISSION, AS THE ORGANIZATION IS NO LONGER OPERATING AND HAS EMERGED FROM BANKRUPTCY. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CONFLICT OF INTEREST CHECK IS PERFORMED BY THE SOLE BOARD MEMBER AND ALL PROFESSIONALS UTILIZED BY MHIC ON A REGULAR BASIS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THERE ARE NO LONGER ANY EMPLOYEES OF MHIC |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF CASH TO MERCY HOSPITAL LIQUIDATION TRUST -8,528,576. CHANGE IN UNRECOGNIZED PENSION -4,204,045. |
| Software ID: | |
| Software Version: |