2024-05-15T17:57:17+00:00 2023-06-30 390859910 Baker Tilly US LLP 500 Midland Court PO Box 8130 Janesville WI 535478130 990 2022-07-01 311551871 Mercy Harvard Hospital Inc MERC 8159435431 901 Grant Street Harvard IL 60033 JAVON BEA PRESIDENT AND CEO 2024-05-15 true JAVON BEA 999009999 TROY MARINE CPA P00187863 6087525835 2023-05-15 2022 2023-04-26 12:10:37Z JAVON BEA 901 Grant Street Harvard IL 60033 33647081 false X WWW.MERCYHEALTHSYSTEM.ORG X 1997 IL EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER. 8 6 215 6 0 0 181016 32871 32825531 33435721 0 26148 178489 33032695 33647081 0 0 12550369 14114906 0 0 15590739 15606118 28141108 29721024 4891587 3926057 37824048 35489631 16025853 9765379 21798195 25724252 The mission of Mercy Harvard Hospital, Inc. (MHH) is to provide exceptional health care services with a passion for making lives better. false false 23892710 33435721 HOSPITAL DISCHARGES 231, EMERGENCY VISITS 5,019, OUTPATIENT SURGERY cases 1,786, NURSING HOME DISCHARGES 51. MERCY HARVARD HOSPITAL, INC. IS LOCATED IN MCHENRY COUNTY, ILLINOIS. IT IS LICENSED FOR 25 ACUTE AND 45 LONG-TERM CARE BEDS. IT IS A CRITICAL ACCESS HOSPITAL WITH 24/7 EMERGENCY SERVICES AND OUTPATIENT SURGERY. 23892710 true true false true false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 23 0 true 215 true false false false false false false false false false false false false X 8 6 false false false false true true true true true false false false true true true true true false false false IL X JAVON BEA HOSPITAL 8159716738 8201 E Riverside Blvd Rockford IL 61114 Javon R Bea PRESIDENT/CEO (see schedule J, pages 48-49) 1.0 66.0 X X 0 11130143 430877 Rowland J McClellan Chair & Director 1.0 6.0 X X 0 19324 0 Thomas D Budd secretary & treasurer 1.0 6.0 X X 0 12086 0 Thomas R Pool Vice Chair & Director 1.0 6.0 X X 0 13500 0 Dave L Syverson Director 1.0 6.0 X 0 17334 0 Katherine A Schack Director 1.0 6.0 X 0 13500 0 Mark L Goelzer MD Director/Physician 1.0 61.0 X 0 504123 29529 Wesley M Jost Director 1.0 6.0 X 0 13955 0 Kimberly Scaccia VP - Revenue Cycle 1.0 61.0 X 0 499300 64924 Todd Anderson Vice President/CFO 1.0 61.0 X 0 828491 76813 Brenda Bote-Catacutan RN Hospital 4 50.2 0.0 X 170715 0 42139 Katherine Kus Dir. of Oper. & licensed Nursing 40.0 0.0 X 157611 0 27008 Khristine M Schrader RN Shift Coordinator 45.9 0.0 X 182195 0 32225 Susan Towne Ultrasound Radiographer 3 42.8 0.0 X 154907 0 15841 Timothy Allen Aubry PHARMACIST TEAM LEAD 40.0 0.0 X 168629 0 24921 James Davis former VICE-PRESIDENT 0.0 0.0 X 0 213871 34294 834057 13265627 778571 25 true true false AYA HEALTHCARE INC Dept 3519 PO Box 123519 Dallas TX 753123519 Purchased Labor-Nursing 374753 HARTWIG PLUMBING AND HEATING INC 20800 E Brink St Harvard IL 60033 Galvanized Water Main Replacement 138089 ONESTAFF MEDICAL LLC C/O American National Bank P O Box 3544 Omaha NE 68103 Purchased Labor-Nursing 131603 3 32871 32871 PATIENT SERVICE REVENUE 621110 33435721 33435721 0 0 0 0 33435721 58014 58014 0 58014 58014 0 0 MISCELLANEOUS 900099 6299 6299 CAFETERIA 722210 102596 102596 MEALS ON WHEELS 624210 11580 11580 0 0 0 0 120475 33647081 33435721 0 178489 X 11617979 8386565 3231414 352625 268340 84285 1166105 888093 278012 978197 744516 233681 5000 5000 7941 7941 4567869 4276523 291346 0 14131 14131 46976 36187 10789 362962 12989 349973 318561 2047 316514 62949 36110 26839 8272 6121 2151 263741 210719 53022 1608852 1285409 323443 855394 720368 135026 BAD DEBTS 3019134 3019134 DRUGS & MEDICAL SUPPLIE 2859073 2680100 178973 TAXES AND ASSESSMENTS 1007981 943483 64498 MAINTENANCE AND REPAIRS 224720 161768 62952 372562 214238 158324 0 29721024 23892710 5828314 0 25370784 4867253 2721776 1515044 0 0 0 0 1090959 1037921 38008 37428 43952100 36511805 8528693 7440295 0 0 73828 20591690 37824048 35489631 2449978 1873223 0 0 13575875 7892156 16025853 9765379 X 21798195 25724252 21798195 25724252 37824048 35489631 3926057 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7941 7941 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A percentage of the 2023 Illinois Hospital Association and American Hospital Association Dues Were Used For Lobbying. 222604 222604 22973869 18976467 3997402 19866062 16751785 3114277 889565 783553 106012 7440295 Due from related parties 15633 Unamortized Bond Fees 23861 other receivables 309800 Due to Mercy Health System 20242396 20591690 DUE TO MERCY HEALTH CORPORATION 5733175 DUE TO OTHER RELATED PARTIES THIRD - PARTY PAYABLES 1751259 Due to Mercy Assisted Care 407722 7892156 true true X true X true X true true true false true true 65267 0 65267 0.0024 0 0 0 0.0 0 0 0 0.0 0 0 65267 0 65267 0.0024 13595 0 13595 0.0005 0 0 0 0.0 10101609 6039458 4062151 0.1521 0 0 0 0.0 5300 0 5300 0.0002 0 0 10120504 6039458 4081046 0.1528 0 0 10185771 6039458 4146313 0.1553 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 719268 145292 3866321 6417108 -2550787 X true true 1 1 MERCY HARVARD HOSPITAL 901 GRANT STREET HARVARD IL 60033 https://www.mercyhealthsystem.org/about-us/community-needs/ X X X X MERCY HARVARD HOSPITAL 1 false false true X X X X X X X X X 22 true false true true X https://www.mercyhealthsystem.org/about-us/community-needs/ true 22 true https://www.mercyhealthsystem.org/about-us/community-needs/ false true X 200.0 300.0 X X X X X true true X X X true X https://www.mercyhealthsystem.org/patientsvisitors/billing-information/financial-assistance/ X https://www.mercyhealthsystem.org/patientsvisitors/billing-information/financial-assistance/ X https://www.mercyhealthsystem.org/patientsvisitors/billing-information/financial-assistance/ X X X X X X true false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MERCY HARVARD HOSPITAL. Mercy Harvard Hospital/Mercy Health Corporation set out to gather information on the community of Harvard, Illinois as well as McHenry County as a whole. Data was gathered through on-line surveys, community leader/stakeholder surveys, and secondary data sources. To gather primary data regarding health needs in McHenry County, MHH created an online community health survey using the MachForm survey tool. The survey was translated into Spanish, and both English and Spanish versions were accessible via links and QR codes. Methods for survey distribution included social media, Mercyhealth's internal newsletter, Mercyhealth's community newsletter, and flyer placement at key community locations. The survey was distributed between January 10, 2023, and February 12, 2023. MHH received 303 survey responses. Once the survey closed, the collected data was aggregated, and visualizations were created to illustrate demographics of respondents and distributions for responses to all questions. Not sure/no answer/missing data were excluded from statistical analysis. As a qualitative supplement to survey data, primary data was also collected through virtual and in-person interviews with key informants. Key informants are stakeholders who represent community organizations and, through their roles as community leaders and organizers, possess valuable insights into health issues experienced by the populations they serve. Key informants were selected with the goal of gathering information reflective of a broad cross-section of the community, particularly those populations unlikely to respond to the survey. Seven key informant interviews were conducted between January 2023 and March 2023. Representatives from MHH participated in development of the McHenry County Department of Health's 2022 Community Health Implementation Plan (CHIP) priorities. MHH is also a member of the McHenry County Department of Health's Mobilizing for Action Through Planning and Partnerships (MAPP) Core Team. MAPP workgroups are responsible for addressing priorities outlined in the county's CHIP. Through this work, MHH has obtained input from Core Team members about resources available to address health issues in McHenry County. In late 2022, MHH solicited and received input from the McHenry County Health Department specifically regarding survey design and key informant interviews. The McHenry County Health Department shared findings from the county's 2021 McHenry County Healthy Community Study and 2022 Community Health Assessment (CHA). For purposes of comparison with this resource, MHH also added survey questions specifically focused on mental health and obesity, two of the top health concerns identified in the county's CHA. MHH also conducted a key informant interview with the Assistant Director of McHenry County Department of Health's Public Health Nursing Division/Community Health. As an initial step for the CHNA, MHH reviewed secondary data sources to define McHenry County's population and health needs. One major source of information was data gathered by the U.S. Census Bureau during the 2020 Census. A second major source of information was data included in the 2023 County Health Rankings report for Illinois. The County Health Rankings report is created through a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Secondary source data, when combined with the information gathered from the on-line surveys and key informant surveys, provided a picture of the community and its needs. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - MERCY HARVARD HOSPITAL. Mercy Harvard Hospital worked with its affiliated organization: Mercy Health System Corporation. Mercy Health System has clinic facilities in and around McHenry County. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - MERCY HARVARD HOSPITAL. When respondents were asked which health behaviors should be addressed in McHenry County, mental health, mental conditions, and suicide were most frequently identified. Among respondents who reported experiencing barriers accessing mental health care in the past 12 months, the most commonly reported barriers were wait times, affordability, and inability to locate a provider. Alcohol and substance abuse was the second-most frequently identified health behavior that survey respondents felt should be addressed in McHenry County. The third-most frequently identified health need was nutrition, physical activity, and obesity. The above findings were presented to the Mercyhealth Executive Council in April 2023. The Executive Council, which is comprised of Mercyhealth executive leaders. The Executive Council acknowledges that some of the needs identified - such as housing, childcare, and mental health - are significant needs; however, MHH as a hospital lacks the expertise necessary to appropriately address these needs, and other community providers who already offer related services are better positioned to more quickly address them. The Executive Council identified the following areas as priorities for MHH's 2023 CHNA: 1. Chronic Diseases 2. Nutrition, Physical Activity, and Obesity These priority areas address two significant health needs that hospitals like MHH may be able to impact, including for populations who experience barriers to accessing health care. Accordingly, the Executive Council believes that the action items identified in its associated implementation strategy will maintain or improve the community's health status. During the course of this tax year 2022 (fiscal year July 1, 2022- June 30, 2023), Mercy continued to participate in numerous community health fairs, provided free screenings at our clinics and in conjunction with community-based organizations/events offered screenings and education. Mercy also provides financial incentives for their employees to participate in smoking cessation programs. All of these efforts are supported through broad based marketing and advertising programs directed to audiences in both counties promoting these programs. Finally in the area of screenings, Mercy partners with community agencies and Mercy staff to offer screenings at health fairs, Mercy sponsored events, and through free and sliding fee scale primary clinics in McHenry County. Mercy provides extensive telemedicine services to increase virtual access for our patients. Mercy has providers on call that are available to assist EMS crews in the field with trauma-related emergencies and critical illnesses. 3 MERCYHEALTH CARE CENTER 901 GRANT STREET HARVARD IL 60033 NURSING HOME FACILITY MERCY HARVARD HOSPITAL CLINIC 1001 GRANT STREET HARVARD IL 60033 PHYSICIAN CLINIC MERCY HARVARD REHAB AND FITNESS CENTER 1000 N HAYES STREET HARVARD IL 60033 REHABILITATION CENTER Schedule H, Part I, Line 5b ACTUAL REVENUE WAS HIGHER THAN BUDGETED, AND AS SUCH THE ANTICIPATED CHARITY IMPACT WOULD BE HIGHER. THE ORGANIZATION STILL PROVIDED CARE REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. Schedule H, Part I, Line 3 The hospital offers a 25% self-pay discount to all uninsured patients on all medically necessary services. Eligibility for financial assistance is based on the following: individual or household income, individual or household assets, household size, and other sources of payment for services. The amount of assistance is based on the patient's ability to pay and the size of their outstanding balance. If patient income and household assets are less than 200% of the federal poverty guidelines, then Mercy will cover 100% of their outstanding balance. If the patient's income and household assets fall between 200% and 300% of the federal poverty guidelines, then a patient's remaining balance can be reduced as much as 90% and payment arrangements can be extended for as long as twenty-four (24) months or longer if there are extenuating circumstances. Schedule H, Part I, Line 6a Community benefit report prepared by related organization Mercy Health System Corp., a related organization of Mercy Harvard Hospital, prepared a community benefit report. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 3019134 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost-to-charge ratio methodology was used to determine costs associated with charity care, unreimbursed Medicaid, and other means tested government programs. The cost-to-charge ratio was derived from IRS worksheet 2: ratio of patient care cost-to charge. The cost of the other benefits referenced in the table of line 7 (community health improvement services and community benefit operations; subsidized health services; cash and in-kind contributions) were determined using actual department/service specific data and /or cost accounting derived data. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount The cost of bad debt expense was determined by applying the cost-to-charge ratio to those charges estimated and expensed as uncollectible. Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE ESTIMATE OF BAD DEBT DOLLARS THAT MAY HAVE BEEN COVERED THROUGH MERCY HARVARD HOSPITAL'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPERWORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 20.2%. THIS FIGURE WAS BASED ON THE PERCENT OF BAD DEBT ACCOUNT DOLLARS THAT ARE RECLASSIFIED FOR CHARITY AND/OR BANKRUPTCY PURPOSES. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote BAD DEBT EXPENSE IS ACCOUNTED FOR IN THE FOLLOWING MANNER (AS DETAILED IN NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH CORPORATION). Generally, patients who are covered by third-party payors are responsible for related deductibles and coinsurance, which vary in amount. The Corporation also provides services to uninsured patients, and offers those uninsured patients a discount, either by policy or law, from standard charges. The Corporation estimates the transaction price for patients with deductibles and coinsurance and for those who are uninsured based on historical experience and current market conditions. 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 patient's ability to pay are recorded as bad debt expense. Bad debt expense for the years ended June 30, 2023 and 2022, was not significant. Consistent with the Corporation's mission, care is provided to patients regardless of their ability to pay. Therefore, the Corporation has determined it has provided implicit price concessions to uninsured patients and patients with other uninsured balances (for example, copays and deductibles). The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts the Corporation expects to collect based on its collection history with those patients. The Corporation's policy is to provide a discount from established charges to uninsured patients. This policy did not change in 2023 and 2022. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs DATA FOR LINES 5 & 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MERCY HARVARD HOSPITAL'S MEDICARE COST REPORT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Patients who are self-pay, regardless of whether they qualify for Mercy Harvard Hospital's (MHH) Community Care Program, will receive a 25% discount from MHH's standard fee schedule. All self-pay patients meet with Patient Financial Counselors and discuss payment options including MHH's Community Care Program. Patients must apply for Community Care and supply Mercy with the necessary financial and other information required. Patients who qualify for Community Care benefits will receive a reduction in the balance owed, extended payment terms, or both. The amount of the Community Care benefit will be based on the patient's ability to pay and the size of the outstanding balance. Schedule H, Part V, Section B, Line 16a FAP website - MERCY HARVARD HOSPITAL: Line 16a URL: https://www.mercyhealthsystem.org/patientsvisitors/billing-information/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - MERCY HARVARD HOSPITAL: Line 16b URL: https://www.mercyhealthsystem.org/patientsvisitors/billing-information/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MERCY HARVARD HOSPITAL: Line 16c URL: https://www.mercyhealthsystem.org/patientsvisitors/billing-information/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment The hospitals of Mercyhealth Corporation, Inc. work in conjunction with the Public Health Departments of Rock (WI), Walworth (WI), McHency (IL) and Winnebago (IL) counties to complete community health needs assessment surveys for each region and work to address those needs. Collaboration varied by county and independent reports for each hospital were created to ensure it met IRS standards. Collaborative examples of Mercyhealth organizations providing care to the community include (but aren't limited to): Ronald McDonald Care Mobile: The mobile unit provides free dental and medical care to uninsured and underinsured children in five northern Illinois counties. Since its inception in 2003, it has provided $3.1 million in free care to more than 10,200 children. The care mobile is completely funded by philanthropy from the Mercyhealth Development Foundation, Javon Bea Hospital Auxiliary, and the Ronald McDonald Charities of Madison. HealthNet Free Clinic in Janesville; Family Health Partnership Clinic and Well Child Clinic in Woodstock, IL; Harvard Free Clinic in McHenry County, IL; and the Bridge Clinic of Rockford, Il., are some of the venues for uninsured or underinsured individuals to receive care. Many Mercyhealth Physicians and other healthcare providers volunteer their services at these clinics. Rockford Rescue Mission: Mercyhealth residents volunteer their time to provide care at the Rockford Rescue Mission homeless shelter. Javon Bea Hospital partners with a Silver Lining foundation to provide screening mammograms and other breast related services for uninsured or underinsured women. Red Cross: Mercyhealth hosts regular blood drives and partners in cooperative volunteer efforts. United Way: Mercyhealth hosts an annual giving fundraising campaign to raise money for United Way in all its counties. Area police and fire departments: Provide free or reduced-cost paramedic/EMT educational opportunities. Employee participation on community boards. An example: Community Action, Inc. (a not-for-profit organization offering programs to fight poverty in Rock and Walworth Counties. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance ALL UNINSURED PATIENTS ARE NOTIFIED OF MERCY'S FINANCIAL AIDE POLICY UPON REGISTRATION. INFORMATION IS ALSO AVAILABLE AT THE HEALTH SYSTEM'S WEBSITE, IN OUR EMERGENCY ROOMS, MEDICAL LABS, ADMITTING DEPARTMENTS, OUTPATIENT RADIOLOGY, REGISTRATION DESKS, PATIENT FINANCIAL SERVICES OFFICES, AND WITH THE PATIENT FINANCIAL COUNSELORS. APPROPRIATE PERSONNEL HAVE BEEN TRAINED ON HOW TO INTERACT WITH PATIENTS ABOUT FINANCIAL AID AVAILABILITY, AND HOW TO DIRECT PATIENTS TO APPROPRIATE FINANCIAL AID STAFF. THE HOSPITALS HAVE TRANSLATION SERVICES AVAILABLE AS NEEDED. Schedule H, Part VI, Line 4 Community information Mercy Harvard Hospital is located in McHenry County, Illinois. It is licensed for 25 acute and 45 long term care beds. It is a critical access hospital with 24/7 emergency services and outpatient surgery. Since 2003 and its affiliation with Mercy Health System Corp., Mercy Harvard Hospital has been able to provide a new level of care and more medical specialties. Approximately 16% of McHenry County residents live in households with income below 200% of the federal poverty level. The hospital's payor demographics include 42.02% Medicare, and 17.06% Medicaid for the fiscal year of July 1, 2022 - June 30, 2023 (as determined by charges billed). Schedule H, Part VI, Line 5 Promotion of community health MERCY HARVARD HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. MERCY HARVARD HOSPITAL HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY. Schedule H, Part VI, Line 6 Affiliated health care system Mercy Harvard Hospital provides acute care services in McHenry County, Illinois. It is part of a larger integrated healthcare system and is affiliated with other separately reported organizations known collectively as "Mercyhealth". Mercy Health Corporation is the ultimate parent company of Mercy Health System Corporation, Mercy Assisted Care Inc., and Mercy Harvard Hospital, Inc., along with Javon Bea Hospital (Rockford), Rockford Health Physicians, and Visiting Nurses Association of Rockford. Mercy Health System Corporation operates two hospitals and has community clinics located throughout six counties of Wisconsin and Illinois. Mercy Assisted Care provides home health services, hospice, and DME (durable medical equipment) services; thus, providing continuation of care to Mercyhealth patients and the community as a whole. Javon Bea Hospital provides inpatient, outpatient, and emergency care services to residents of Rockford, Illinois and the surrounding communities. The Rockford Health Physicians provide physician and ambulatory care services at several Illinois sites. Mercy Health System Corp. works with the Mercyhealth Development Foundation, Inc. to operate a homeless shelter in Janesville, WI: The House of Mercy Homeless Center provides shelter, support, and training to women, children, and families to help fight homelessness. It opened in 1996 and provided 8,135 shelter nights for 193 individuals in FY2023 (July 1, 2022 -June 30, 2023). Mercy Hospital Association of Volunteers, Inc. is the organization/tax entity of Mercy's volunteers. Volunteers numbered 234 in calendar year 2023. This organization not only supports Mercy's services, but provides benefits to the community as a whole. In conjunction with Mercy Health System's meal preparation, the volunteers participate in and oversee a Meals-on-Wheels program: participant/nutrition specific meals are prepared and delivered to the elderly needing assistance in Janesville. The volunteer association runs a hospitality house in which family members of patients are offered free housing during their loved ones extended hospital stay and rehabilitation. Schedule H, Part VI, Line 7 State filing of community benefit report IL true true false false false false false false false Javon R Bea PRESIDENT/CEO (see schedule J, pages 48-49) 0 2193820 0 1660233 0 7276090 0 413098 0 17779 0 11561020 0 4953609 Mark L Goelzer MD Director/Physician 0 312319 0 187404 0 4400 0 12200 0 17329 0 533652 0 0 James Davis former VICE-PRESIDENT 0 79369 0 0 0 134502 0 4471 0 29823 0 248165 0 0 Kimberly Scaccia VP - Revenue Cycle 0 314004 0 147040 0 38256 0 21669 0 43255 0 564224 0 0 Todd Anderson Vice President/CFO 0 564084 0 252851 0 11556 0 40746 0 36067 0 905304 0 0 Khristine M Schrader RN Shift Coordinator 151479 0 3741 0 26975 0 7484 0 24741 0 214420 0 0 0 Brenda Bote-Catacutan RN Hospital 4 160089 0 3476 0 7150 0 7150 0 34989 0 212854 0 0 0 Timothy Allen Aubry PHARMACIST TEAM LEAD 145655 0 5663 0 17311 0 6878 0 18043 0 193550 0 0 0 Katherine Kus Dir. of Oper. & licensed Nursing 112923 0 20959 0 23729 0 4972 0 22036 0 184619 0 0 0 Susan Towne Ultrasound Radiographer 3 134595 0 4615 0 15697 0 6279 0 9562 0 170748 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment James Davis received 26 weeks severance pay $119,025 in 2022. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $4,953,609 Todd Anderson participated in the 457(f) plan during Calendar year 2022. However, he did not receive a payout during calendar year 2022. Schedule J, Part I, Line 3 THE CEO IS PAID FROM A RELATED ORGANIZATION, MERCY HEALTH SYSTEM CORPORATION (MHSC). MHSC USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATION, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE MERCY COMPENSATION COMMITTEE OF MHSC IS COMPRISED OF THE BOARD CHAIRPERSON, VICE CHAIR, AND SECRETARY/TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED BY INDEPENDENT LEGAL COUNSEL AND AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE, LEGAL COUNSEL, AND THE COMPENSATION CONSULTANT MEET THROUGHOUT THE YEAR AND REPORT DIRECTLY TO THE BOARD OF DIRECTORS ANNUALLY. THIS PROCESS WAS COMPLETED FOR 2022. Schedule J, Part II PART II, LINE 1 JJAVON R. BEA - DEFERRED COMPENSATION PAYMENT MR. BEA HAS BEEN EMPLOYED BY MHSC AS PRESIDENT AND CEO OVER THE PAST 30 YEARS. DURING THIS TIME, MR. BEA HAS LED AN INCREDIBLE TRANSFORMATION TAKING A SMALL, SINGLE, STAND-ALONE COMMUNITY HOSPITAL AND CREATING A VERTICALLY INTEGRATED HEALTH SYSTEM WITH 85 FACILITIES IN 50 COMMUNITIES THROUGHOUT SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INCREASING GROSS REVENUE FROM $33 MILLION TO OVER $3.6 BILLION IN FY2023. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 1.8 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,500+ PARTNERS IN HEALTH CARE. TODAY, MHSC HAS BECOME THE LARGEST EMPLOYER IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. THIS GROWTH CAN BE ATTRIBUTED TO MR. BEA'S VISIONARY LEADERSHIP. LEADERSHIP THAT HAS LED TO MHSC RECEIVING NUMEROUS NATIONAL RECOGNIZED AWARDS INCLUDING BEING NAMED THE FIRST FULLY INTEGRATED HEALTH SYSTEM TO RECEIVE THE MALCOLM BALDRIGE NATIONAL QUALITY AWARD, THE MAGNET RECOGNITION AWARD, BEING RANKED #1 AND #2 ON AARP'S TOP 100 BEST PLACES TO WORK FOR WORKERS OVER 50 AND BEING RANKED IN THE TOP 25 ON THE TOP 100 INTEGRATED HEALTHCARE NETWORKS LIST BY MODERN HEALTHCARE FOR OVER 12 STRAIGHT YEARS. THE TURNAROUND OF THE MHSC IMPLEMENTED BY MR. BEA IS UNPARALLELED. BY PIONEERING A "PARTNERSHIP MODEL" OF COMPENSATION AND DESIGNING A CUSTOM CULTURE OF EXCELLENCE, MR. BEA IS VITAL TO THE DECADES-LONG AND CONTINUING GROWTH AT MHSC. THIS SUCCESS HAS MADE MR. BEA A HIGHLY SOUGHT AFTER SPEAKER AND CONSULTANT AS HE IS NOW WELL-RENOWNED FOR HIS INNOVATIONS IN THE AREAS OF INTEGRATED HEALTHCARE AND PHYSICIAN PARTNERSHIP MODELS. THE TREMENDOUS SUCCESS OF MHSC UNDER THE LEADERSHIP OF MR. BEA HAS ALLOWED HIM TO RECEIVE PAYOUTS FROM A DEFERRED COMPENSATION PACKAGE WHICH MHSC HAS BEEN PAYING INTO OVER MANY YEARS. THESE PAYMENTS ONLY BECAME PAYABLE IF MHSC ATTAINED CERTAIN DEFINED FINANCIAL AND STRATEGIC GOALS AND THE AMOUNTS ARE AT RISK EVERY SINGLE YEAR. AS INDICATED ABOVE, MANY OF THESE GOALS WERE ACHIEVED WITHIN THE PAST FEW YEARS RESULTING IN A RELEASE OF THESE DEFERRED PAYMENTS WHICH IMPACTED MR. BEA'S COMPENSATION REPORTING. THE SETTING OF THESE GOALS WERE LAID OUT BY THE BOARD OF DIRECTORS IN COOPERATION WITH NATIONALLY RECOGNIZED COMPENSATION ATTORNEYS AND CONSULTANTS TO MAKE SURE ALL FACTORS WERE TAKEN INTO CONSIDERATION. MR. BEA'S COMPENSATION HAS ALSO BEEN SCRUTINIZED BY NUMEROUS OUTSIDE ORGANIZATIONS AND MOST IMPORTANTLY, THE INTERNAL REVENUE SERVICE; AND HAS PASSED INSPECTION IN EACH CASE. TOTAL COMPENSATION IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OF MHSC. Form 990, Part VI, Line 1a Delegate broad authority to a committee THE VOTING MEMBERS OF THE EXECUTIVE COMMITTEE CONSISTS OF EIGHT INDIVIDUALS, EACH OF WHOM SHALL HAVE A VOTE, INCLUDING THE CEO, THE CHAIRMAN, VICE-CHAIRMAN, IMMEDIATE PAST CHAIRMAN, TREASURER, AND THREE ADDITIONAL DIRECTORS OF THE BOARD. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE A PHYSICIAN. THE EXECUTIVE COMMITTEE SHALL IN ALL INSTANCES BE COMPRISED OF AT LEAST 51% COMMUNITY MEMBERS. IN THE EVENT THAT ONE OR MORE OF THE AFOREMENTIONED VOTING MEMBERS OF THE EXECUTIVE COMMITTEE IS UNABLE TO SERVE IN SUCH CAPACITY, THEN THE CHAIRMAN OF THE CORPORATION SHALL DESIGNATE A REPLACEMENT FROM AMONG THE BOARD MEMBERS. THE EXECUTIVE COMMITTEE SHALL MEET AS NEEDED. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS, DUTIES, RESPONSIBILITIES AND AUTHORITY OF THE BOARD, EXCEPT AS PROHIBITED BY LAW. Form 990, Part VI, Line 6 Classes of members or stockholders MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF MERCY HARVARD HOSPITAL, INC. (MHH). THE SOLE MEMBER SHALL HAVE POWERS AND VOTING RIGHTS TO DO THE FOLLOWING: (A) APPOINT ALL THE DIRECTORS OF THE CORPORATION (B) NOMINATE TO the CORPORATION'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION PRESIDENT (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS (D) APPROVE ANNUAL BUDGETS, AND STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS OF THE CORPORATION (E) Require the corporation's board of directors to take any action (including authorizing the pledge or transfer of assets to MHC or as directed by MHC, or the execution of contracts) which would improve the credit worthiness or otherwise result in financial benefit to MHC and its tax-exempt Affiliated Corporations (provided that under no circumstances may MHC require transfer of assets in violation of law or the terms of any charitable trust or donation) (F) APPROVE ALL CONTRACTS OF INDEBTEDNESS EFFECTIVE FOR LONGER THAN EIGHTEEN MONTHS (G) APPROVE ALL PLANS OF MERGER OR CONSOLIDATION (H) APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION (I) APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION (J) APPROVE MATERIAL AMENDMENTS TO THE CORPORATION'S STANDARD FORM OF PHYSICIAN EMPLOYMENT AGREEMENT, provided the corporation shall have the authority to negotiate the terms and conditions of individual physician employment agreements so long as the negotiated terms and conditions are consistent with the requirements of applicable law and the strategic, long-range and health manpower development plans approved by MHC (K) APPROVE MATERIAL AMENDMENTS TO THE STANDARD COMPENSATION SYSTEM USED BY THE CORPORATION TO ESTABLISH INDIVIDUAL PHYSICIAN COMPENSATION (L) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AMENDING THE ARTICLES OF INCORPORATION OR BYLAWS), OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, IF MHC DETERMINES THAT FAILURE TO TAKE THE ACTION, OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, MAY RESULT IN THE CORPORATIONS FAILURE TO OBTAIN OR MAINTAIN ITS EXEMPTION AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body SEE NARRATIVE FOR PART VI, LINE 6 Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders SEE NARRATIVE FOR PART VI, LINE 6 Form 990, Part VI, Line 11b Review of form 990 by governing body MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. Form 990, Part VI, Line 12c Conflict of interest policy BY WRITTEN POLICY, MHC SENDS OUT, ON AN ANNUAL BASIS, THE CORPORATE CONFLICT AND DUALITY OF INTEREST POLICY TO ALL BOARD MEMBERS, CORPORATE OFFICERS AND OTHER KEY INDIVIDUALS (THOSE HAVING RESPONSIBILITY AND AUTHORITY TO MAKE FINAL DECISIONS REGARDING THE ACQUISITION OF PRODUCTS OR SERVICES). EACH RECIPIENT IS REQUIRED TO COMPLETE A FINANCIAL INTEREST DISCLOSURE STATEMENT, WHICH IS SUBMITTED TO THE MHC compliance department FOR REVIEW. WITH RESPECT TO PHYSICIANS AND MANAGERS WHO ARE KEY INDIVIDUALS, ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE APPROPRIATE EXECUTIVE STAFF MEMBER FOR FOLLOW UP WITH THE DISCLOSING PARTY IN ORDER TO REVIEW THE MATTER IN MORE DETAIL. THIS INCLUDES EMPHASIZING THAT THE DISCLOSING PARTY IS NOT PERMITTED TO PARTICIPATE IN ANY NEGOTIATIONS FOR THE PURCHASE OF ANY PRODUCTS OR SERVICES WHERE THE CONFLICT IS DEEMED MATERIAL, OR AUTHORIZE THE SUBSEQUENT PURCHASE OF RELATED GOODS AND SERVICES. THE DISCLOSING PARTY IS ALSO REQUIRED TO IDENTIFY EACH AND EVERY INSTANCE OF A POTENTIAL CONFLICT AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. A SIMILAR PROCESS IS FOLLOWED FOR THE BOARD OF DIRECTORS, EXCEPT THAT ANY POTENTIAL CONFLICT IS REVIEWED BY THE BOARD'S GOVERNANCE COMMITTEE. BOARD MEMBERS MAY COMMENT ON TRANSACTIONS WHERE THERE IS A POTENTIAL CONFLICT, BUT CANNOT VOTE ON THE RELATED MATTER AND MAY BE REQUIRED TO LEAVE ANY MEETING WHERE THE POTENTIAL CONFLICT IS REVIEWED BY THE BOARD OR WHERE THE BOARD TAKES ACTION TO EITHER APPROVE OR NOT APPROVE THE PROPOSED TRANSACTION. A BOARD MEMBER ALSO HAS A CONTINUING DUTY TO REPORT ANY CONFLICTS AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. IN THE EVENT THAT A POTENTIAL CONFLICT OF INTEREST IS REPORTED OR DISCOVERED OUTSIDE THE ESTABLISHED PROCESS, APPROPRIATE REVIEW AND ACTION WOULD BE TAKEN. THIS PROCESS WAS LAST COMPLETED IN 2022, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2021 CONFLICTS IDENTIFIED. MHC AND MHH HAVE THE SAME BOARD, AND THEREFORE THE MHC QUESTIONNAIRE IS USED TO ALSO ADDRESS POTENTIAL AND ACTUAL CONFLICTS FOR THE FILING ORGANIZATION. THE MHC CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. Form 990, Part VI, Line 19 Required documents available to the public NO DOCUMENTS AVAILABLE TO THE PUBLIC. Form 990, Part IX, Line 11g Other Fees OTHER FEES FOR SERVICES - Total Expense: 1230277, Program Service Expense: 938931, Management and General Expenses: 291346, Fundraising Expenses: ; PHYSICIAN LOCUM SERVICES - Total Expense: 3337592, Program Service Expense: 3337592, Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT AVE JANESVILLE WI 53548 390912682 SUPPORT OF HEALTHCARE WI 501(c)(3) Type III-FI MERCY HEALTH SYSTEM CORPORATION false MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT AVE JANESVILLE WI 53548 390816848 HEALTHCARE WI 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCY ASSISTED CARE INC 901 MINERAL POINT AVE JANESVILLE WI 53548 391035110 HEALTHCARE WI 501(c)(3) 10 MERCY HEALTH CORPORATION false MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 200 LAKE AVE WOODSTOCK IL 60098 201673011 healthcare IL 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCY HEALTH CORPORATION 8201 E Riverside Blvd ROCKFORD IL 61114 472158680 SUPPORT OF HEALTHCARE IL 501(c)(3) Type I NA false JAVON BEA HOSPITAL 8201 E Riverside Blvd ROCKFORD IL 61114 362167847 HEALTHCARE IL 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCYHEALTH DEVELOPMENT FOUNDATION 8201 E Riverside Blvd ROCKFORD IL 61114 363197918 SUPPORT OF HEALTHCARE IL 501(c)(3) Type I MERCY HEALTH CORPORATION false MERCYHEALTH VISITING NURSES ASSOCIATION 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(c)(3) 10 MERCY HEALTH CORPORATION false ROCKFORD HEALTH PHYSICIANS 8201 E Riverside Blvd ROCKFORD IL 61114 363907436 HEALTHCARE IL 501(c)(3) 3 MERCY HEALTH CORPORATION false JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 53548 391520130 MANAGEMENT OF UNION EMPLOYEES WI NA C Corporation false MERCYCARE INSURANCE COMPANY 580 N WASHINGTON ST JANESVILLE WI 53546 391768192 INSURANCE WI NA C Corporation false MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 580 N WASHINGTON ST JANESVILLE WI 53546 201482553 INSURANCE WI NA C Corporation false ROCKFORD HEALTH INSURANCE LTD INSURANCE BD NA C Corporation false false false false false true false false false false true true false false true true true true true false