4A (Expenses $ 15142375 including grants of $ 0) (Revenue $ 13541410)
MercyOne Northeast Iowa is a faith-based 511-bed, not-for-profit, comprehensive medical/surgical health care provider offering acute levels of medical care at Covenant Medical Center in Waterloo, Sartori Memorial Hospital in Cedar Falls, and Mercy Hospital in Oelwein. Its services in the region also include Covenant Clinic with more than 100 primary care and specialty providers; Covenant Foundation, Sartori Health Care Foundation and Mercy Hospital Foundation. Areas of excellence include cardiology, orthopedics, neurosurgery, maternity and NICU, cancer treatment, minimally invasive and Bariatric surgery. The Iowa operations have been part of a 140 year system of care sponsored by the Wheaton Franciscan Sisters, formerly incorporated in 1983. In 2016, the Wheaton Franciscan Sisters transferred their Iowa operations to Mercy Health Network, an Iowa-based health care system based out of Des Moines, Iowa. Mercy Health Network (MHN) is an integrated system of member hospitals and other health and patient care facilities united into one operating organization to improve the delivery of healthcare services to the people of Iowa and adjoining states. MHN's sponsors own and operate medical centers and other services in Clinton, Des Moines, Dubuque, Mason City, and Sioux City, and community hospitals in six other locations. In addition, MHN has 27 members who participate through contracts for management and other services. Mercy Health Network (MHN) was founded in 1998 under a joint operating agreement between two of the largest Catholic, not-for-profit health organizations in the United States: Catholic Health Initiatives, based in Englewood, Colorado, and Trinity Health, based in Livonia, Michigan. Covenant Medical Center in Waterloo, Iowa was founded in 1986 when Wheaton Franciscan Services consolidated St. Francis Hospital (founded in 1912) and Schoitz Medical Center (founded in 1904). Covenant Medical Center was located in two locations until 1991 when all acute care services were combined at one site. The other site was transformed into an assisted living center and adult services center. In 1995, Wheaton Franciscan Services' Iowa region was renamed Covenant Health System and included Covenant Medical Center in Waterloo, Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, N. E. Iowa Real Estate Investments and Schoitz Health Resources. Sartori Memorial Hospital became a part of Covenant Health System in 1996 when the system entered a long-term lease agreement with the City of Cedar Falls. In 2006, Covenant Health System was renamed Wheaton Franciscan Healthcare-Iowa, to reflect its continued commitment to an integrated health care delivery system for residents of Northeast Iowa. Today MercyOne Northeast Iowa includes Covenant Medical Center (and its unincorporated division, Covenant Clinic) and Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, Sartori Memorial Hospital and Sartori Health Care Foundation in Cedar Falls, and N. E. Iowa Real Estate Investments. MercyOne Northeast Iowa Entities: Hospitals Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic, an unincorporated division of Covenant Medical Center, Inc. Patients have access to more than 100 primary and specialty care physicians, physician assistants, nurse practitioners, and other health care professionals located throughout Northeast Iowa in 24 locations. Regional Service Lines Covenant Cardiology Covenant Cancer Treatment Center Covenant Clinic Orthopedic Services Covenant Home Health Emergency Services Imaging/Radiology Services Iowa Spine and Brain Institute Midwest Institute of Advanced Laparoscopic Surgery Maternal Child Health Occupational Medicine and Wellness Covenant Retail Pharmacies Rehabilitation Services Philanthropic Foundations Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. MERCYONE NORTHEAST IOWA COMMUNITY IMPACT IN IOWA / 2022 Charity Care: $2,624,319. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on costs, not charges, and does not include bad debt. Unreimbursed Cost of Public Programs: $13,926,783. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $2,152,780. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial Contributions: $195,981. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community groups, or nonprofit organizations for charitable purposes. Health Professions Education: $1,671,519. Health professions education is defined as direct costs incurred for accredited training and education programs for physicians, nurses, allied health professionals and technicians (does not include ongoing education for staff). Community Building Activities: $10,527. Community building activities are defined as programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental issues. Costs for these activities include cash and in-kind donations. Community Benefit Operations: $89,303. Community benefit operations are defined as costs associated with dedicated staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations. Subsidized Health Services: $3,414,557. Subsidized health services are defined as the negative margin for clinical services that are provided despite a financial loss because of an identified community need that would need to be met by the government or another not-for-profit if it was not offered. The financial losses are so significant that negative margins remain after removing the effects of charity care, bad debt, and Medicaid shortfalls. TOTAL BENEFIT TO THE COMMUNITY FOR IOWA 2022: $24,085,769.

schedule H supplemental Information
Schedule H Part V Section B Line 3e: MercyOne Oelwein Medical Center 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 for tax year 2021 through a community-involved selection process: Prevention Mental Health Nutrition Schedule H Part V Section B Line 3j: Iowa's Community Health Needs Reports provide additional detailed information in response to many of the Schedule H questions on our Community Health Needs Assessments (CHNA) and Implementation Plans. These reports are accessible at under the Community Health tab at: www.mercyone.org/about-us/community-health-and-well-being under Oelwein and Waterloo/Cedar Falls. The MercyOne team wrote a joint CHNA and an Implementation Plan for MercyOne Waterloo Medical Center and MercyOne Cedar Falls Medical Center (Black Hawk County); as well as one for MercyOne Oelwein Medical Center (Fayette County). The Community Health Needs Assessments were board approve and posted on June 24th, 2022. This 2022 assessment covered the FY23-FY25 time frame. Black Hawk County conducted a joint Community Health Needs Assessment and Implementation Plan. Due to not aligning with due dates in Fayette County, MercyOne Oelwein Medical Center conducted their own survey and completed the assessment with information obtained in the survey and in collaboration with Health Fayette County Coalition. The Community Health Needs Assessment Implementation Plans for both Fayette and Black Hawk County were board approved and posted on October 31st, 2022. Schedule H Part V Section B Line 5: MercyOne Oelwein Medical Center Community Health Needs Assessment was approved and posted June 24, 2022, to reflect the findings of Fayette County for FY23-FY25. The Community Health Needs Implementation Plan was board approved and posted on October 31, 2022. MercyOne Oelwein Medical Center and Gundersen Palmer Hospital are the two critical access hospitals in the county. The Fayette County Health Department is located within Gundersen Palmer Hospital, in West Union, Iowa. MercyOne Oelwein Medical Center collaborated with both Gundersen Palmer Hospital and Fayette County Health Department throughout the assessment and implementation process. In addition, Healthy Fayette County Coalition assisted with the development of the CHNA and the Implementation Plan for FY23-FY25. Healthy Fayette County Coalition had already identified three areas in which to target and collaborate to have the most impact countywide. This was based on the past county assessment. Due to timing and differences in the assessment cycle, MercyOne Oelwein Medical Center conducted their own survey in April 2022 to have up to date data for the assessment and implementation plan, focusing on the 3 previously identified key areas, Mental Health, Prevention and Nutrition. Postcards were sent out to all Fayette County residents with information and the QR code to access the online survey. Fayette County Public Health advertised this on their Facebook page. In addition, flyers and paper copy surveys were distributed to 16 different locations throughout Fayette County as well as during the mobile food pantry. A few residents reached out to participate in the survey via phone. A total of 260 residents participated in the survey. Schedule H Part V Section B Line 6a-b: The CHNA was conducted by MercyOne Oelwein Medical center in collaboration with Fayette County Public Health, Gunderson Palmer Hospital and Healthy Fayette County Coalition. Due to MercyOne Oelwein Medical Center being on a different cycle schedule, they conducted their own survey and gathered new data surrounding the 3 focused areas of Healthy Fayette County, Mental Health, Prevention & Nutrition. Survey results and data were shared. Schedule H Part V Section B Line 7a: https://www.mercyone.org/northeastiowa/_assets/documents/about-us/chna/oel wein-chna-fy22-fy24-final.pdf Schedule H Part V Section B Line 10a: https://www.mercyone.org/northeastiowa/_assets/documents/fayette-county-im plementation-strategy-final.pdf Schedule H Part V Section B Line 11 Using the CHNA completed in June 2022, the hospital developed, adopted, and is working on executing the first year of a three-year Implementation Strategy to address priority community health needs. The Implementation Strategy was board approved on October 31, 2022. The following summarizes how the hospitals will address priority health needs in the community in FY23-FY25 (July 1, 2022- June 30, 2025): MercyOne Oelwein Medical Center is focused on impacting health issues identified within the community health needs assessment, aligning with Fayette County Public Health, Gundersen Palmer Lutheran Health, and Healthy Fayette County Coalition. Based on the Community Health Needs assessment, the overall ranking of the priority issues are as follows: . Prevention . Mental Health . Nutrition FY22 MercyOne Oelwein Medical Center was focused on impacting health issues identified within the community health needs assessment conducted in 2019 and the implementation plan. Health Behaviors: . MercyOne Oelwein Medical Center continued to partner with Northeast Iowa Food Bank to continue to provide the Mobile Food Pantry to ensure access to food. The hospital continued to provide funds to support and volunteers each month during the food distribution, addressing food insecurity. . MercyOne entered a memorandum of understanding with Plentiful Pantry. . MercyOne continues to run a wellness center in cooperation with the Oelwein School and the City of Oelwein. . MercyOne continues to refer residents and patients to Quit Line Iowa. . Educating patients and the community on the resource guide, Find Help. . Active participant in Health Fayette County Coalition. Clinical Care: . Continued to offer FREE mammography program for the poor/underserved in conjunction with the Care for Yourself Program and Check the Girls. . Continue with telehealth services to ensure patients have access to care. . Kicked off a Military/Vet program within the hospitals and clinics. For FY23-25, MercyOne Oelwein Medical Center will not focus on the following priorities, but will support initiatives related to these areas by other partners when possible: . Social and economic factors related to unemployment, income inequity, poverty, crime, and death rates. . Physical environment, such as air pollution, housing, and commute driving. Schedule H Part V Section B Line 16: Organizations in the Iowa region take several proactive approaches to make our patients aware of our financial assistance policy. In addition to our policy being posted on our website there is abundant signage and brochures throughout our facility explaining the financial assistance policy and how to obtain a copy. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as in patient admitting and registration areas (both inpatient and outpatient settings), physician offices, and emergency departments. Brochures describing the policy are available in the same locations, and the policy is reviewed at the time of registration or pre-registration, admission, discharge, and with billing for those identified with a need. Patients who call and express a financial hardship in paying their bill are assisted by a customer service representative who will assist the patient in setting up an appointment to meet with a financial advocate to review the financial assistance policy in detail, get the application process started, and answer any questions. Our patient statements also include notifications about the availability of financial assistance and a phone number to call for more information. Additionally, the policy and brochure summarizing our Community Care Program (financial assistance) is available on our website with applications in English, Spanish, Bosnian and French, found here: https://www.mercyone.org/northeastiowa/for-patients/billing-and-financial- information/financial-assistance. Additionally, there are other helpful aides, including our Billing and Collections policy, a summary of Community Care Program Requirements, and Payment for Services Brochures; many of these are again available in all three languages, English, Spanish, and Bosnian.

Schedule H Supplemental Information
Schedule H Part 1 Line 6a: MercyOne Northeast Iowa's Community Benefit totals as of tax year 2021 are posted in total with the rest of MercyOne Iowa. The annual report can be accessed at the following link: https://www.mercyone.org/assets/documents/about-us/community-health/srvc_c hwb_fy22-annual-report_111522_v8.pdf Schedule H Part 1 Line 7: Community Benefit amounts are reported using total actual costs per the hospital's managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information is published. Amounts are summarized using a software application recommended by the Catholic Health Association in conjunction with the Iowa Hospital Association, because it can provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the Iowa organization. After amounts are verified and approved, community benefit amounts become finalized. Finally, the information is compiled with the assistance of CBISA software for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. The Iowa hospital facilities are not required to report community benefit information to the State of Iowa but do make the information readily available on certain websites and report the information to the Iowa Hospital Association. Schedule H Part 1 Line 7 Column f: Iowa Hospitals follow guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommend that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $304,090 has not been included in the denominator of the calculation that determines the percentages reported on Schedule H Line 7 Column f. In addition to the community benefit described above, MercyOne Northeast Iowa also provides care to Medicare and Medicare HMO patients that is not fully reimbursed by the government. According to the most recently filed Medicare cost report, we provided $17,595,605 in unreimbursed Medicare services. We are not including the gap in Medicare reimbursement in accordance with the Catholic Health Association Community Benefit Guidelines. If we included the Medicare shortfall, our total would be $41,681,374. Schedule H Part 1 Line 7g: In Iowa region, clinic operations are included as a department of the hospital, MercyOne Medical Centers (Waterloo, Cedar Falls, and Oelwein), DBA Covenant Medical Center, Inc. Clinic operations for MercyOne clinics in the northeast Iowa regions are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, costs related to physician clinics are not included in the subsidized health services report on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-3: In determining bad debt amounts, the Iowa organizations use a two-level scoring process as follows: First, for any patient account that is categorized as having no insurance, when the amount becomes 60 days overdue or greater, the patient's account is reviewed for financial assistance qualification. If the patient is found to qualify for financial assistance, the necessary steps are taken to apply, and the needed adjustments are made to treat as charity care and not as bad debt. A similar scoring process is completed for those patients who do have insurance, but after 120 days or greater, still have not paid the patient responsibility portion. Again, these patient accounts are reviewed for financial assistance, and if they qualify, similar steps are taken to remove from bad debt. As a result of these scoring procedures, Iowa's position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, or later with the timing of the scoring procedures mentioned above. Bad debt is therefore only determined for each organization at the time the amount due is truly determined to be uncollectible, after financial assistance has been determined, and after many months of collection efforts. Additionally, the organization followed guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommends that no bad debt amounts be included in community benefit amounts. For these reasons, Part III Section A Line 3 is reported at zero. Schedule H Part III Section A Line 4: Mercy Hospital of Franciscan Sisters, Inc. is included in the consolidated financial statements of MercyOne Northeast Iowa. The following is the text of the footnote from the financial statements which addresses the allowance for doubtful accounts. This footnote can be found on page 14 of the attached consolidated financial statements. The Company estimates the transaction price for patients with deductibles and coinsurance and for those who are uninsured and underinsured based on historical experience and current market conditions, using the portfolio approach. The initial estimate of the transaction price is determined by reducing the standard charge by any contractual adjustments, discounts, and implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payor of the patient's ability to pay are recorded as bad debt expense in other expenses in the statement of operations and changes in net assets. Schedule H Part III Section B Line 6-8: Schedule H Part III Section B Line 6 reports allowable costs of care as taken from the most recently filed Medicare cost report available at the time of publishing the Community Benefit Report. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid costs are determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Iowa Hospital Association, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b: Iowa organizations follow a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Please also see Schedule H Part III Section A Lines 1-4 narrative response. Schedule H Part V Section A and Section C: Affiliates of the Iowa region have defined and reported hospital facilities to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Iowa state law required for hospital licensing. Although there may be other facilities within our system built to hospital specifications, performing hospital-based billing, and conforming to other hospital standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part VI Line 2: Iowa assesses the needs of the communities it serves by reviewing admission and discharge data, analyzing information from the community health departments and other community leaders, and by aligning our services with the Healthy People 2030 and other current year initiatives. The Iowa hospital organizations complete a Community Health Needs Assessment and Implementation Plan every three years. Please reference Schedule H Part V Section B Lines 1-12 for additional information. Schedule H Part VI Line 3: Iowa provides its patients with several opportunities to gain knowledge and awareness of its Community Care (C