2023-05-15T16:32:33-05:00 2022-06-30 390859910 BAKER TILLY US LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2021-07-01 362167847 JAVON BEA HOSPITAL JAVO 8159715000 2400 N ROCKTON AVE ROCKFORD IL 61103 JAVON BEA PRESIDENT/CEO 8159715000 2023-05-15 1 JAVON BEA XXX-XX-XXXX TROY MARINE CPA P00187863 6087525835 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JAVON BEA 2400 N ROCKTON AVE ROCKFORD IL 61103 424381704 0 X WWW.MERCYHEALTHSYSTEM.ORG X 1883 IL JAVON BEA HOSPITAL'S ACTIVITIES ARE TO IMPROVE AND PROTECT THE HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH OUR MISSION. THE MISSION OF JAVON BEA HOSPITAL IS "EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER". WITH A VISION OF QUALITY - EXCELLENCE IN PATIENT CARE, SERVICE - EXCEPTIONAL PATIENT AND CUSTOMER CARE, PARTNERING - BEST PLACE TO WORK AND COST - COST-EFFECTIVE CARE AND A COMMITMENT TO THE VALUES OF: HEALING IN THE BROADEST SENSE, PATIENTS COME FIRST, TREAT EACH OTHER LIKE FAMILY AND ALWAYS SEEK EXCELLENCE. 8 6 2575 208 -100852 0 21041187 19538096 395600410 388656826 4753918 2953089 3940407 3020040 425335922 414168051 179545 1019383 0 0 146978814 145769576 0 0 0 297373964 267630349 444532323 414419308 -19196401 -251257 764323993 718787941 612995444 617999239 151328549 100788702 X THE MISSION OF JAVON BEA HOSPITAL IS "EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER". WITH A VISION OF QUALITY - EXCELLENCE IN PATIENT CARE, SERVICE - EXCEPTIONAL PATIENT AND CUSTOMER CARE, PARTNERING - BEST PLACE TO WORK AND COST - COST-EFFECTIVE CARE AND A COMMITMENT TO THE VALUES OF: HEALING IN THE BROADEST SENSE, PATIENTS COME FIRST, TREAT EACH OTHER LIKE FAMILY AND ALWAYS SEEK EXCELLENCE. 0 1 189752653 8624 223335162 JAVON BEA HOSPITAL (JBH) IS A NOT-FOR-PROFIT CHARITABLE HEALTHCARE INSTITUTION THAT FUNCTIONS IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. IN THE COURSE OF OPERATIONS, JBH IS COMMITTED TO PROVIDING SUPERIOR CARE EVERY DAY FOR ALL ITS PATIENTS. JBH IS A 285 LICENSED BED, REGIONAL REFERRAL HOSPITAL WHICH INCLUDES A LEVEL 1 TRAUMA CENTER, LEVEL III NEONATAL INTENSIVE CARE UNIT AND LEVEL III REGIONAL PERINATAL CENTER. IN FISCAL YEAR 2022, PATIENT CARE WAS RENDERED TO 9,446 INDIVIDUALS WHO PRESENTED THEMSELVES FOR INPATIENT SERVICES, 877 INFANT DELIVERIES AND 1,467 INPATIENT SURGERIES ALONG WITH SUPPORTING 29,697 EMERGENCY ROOM VISITS. THE SUBACUTE LONG-TERM CARE INPATIENT DEPARTMENT PROVIDED LONG-TERM CARE TO 86 PATIENTS RELEASED FROM BASIC HOSPITAL CARE BUT NOT READY TO GO HOME OR TO MOVE ON TO A REHAB OR NURSING FACILITY. 147827070 8624 164389898 JAVON BEA HOSPITAL (JBH) IS DESIGNATED BY THE IL DEPT OF PUBLIC HEALTH AS THE DISASTER POD HOSPITAL FOR THE NORTHERN IL EMS REGION. AS A LEVEL I TRAUMA CENTER, JBH PROVIDES PATIENT CARE AND DIAGNOSTIC SERVICES 24/7 TO ALL WHO PRESENT THEMSELVES FOR SERVICE.IN FISCAL YEAR 2022, THAT INCLUDED 1,330 VISITS TO THE SLEEP LAB; 81,848 DIAGNOSTIC RADIOLOGY PROCEDURES; 5,501 RADIATION ONCOLOGY TREATMENTS; 36,209 CARDIAC PROCEDURES OR TESTS; 6,508 VISITS TO THE PAIN CLINIC; AND 124,969 RESPIRATORY THERAPY TREATMENTS.JBH HAS AN IN-HOUSE LABORATORY THAT PROVIDES TESTING FOR ALL WHO PRESENT THEMSELVES AT THE HOSPITAL FOR TREATMENT.IN FISCAL YEAR 2022, JBH PERFORMED 881,269 TESTS. 14818874 901935 874473 JBH HAS PROVIDED HEALTH EDUCATION AND OUTREACH IN A VARIETY OF FORMS WITHIN THE ELEVEN COUNTY AREA THAT INCLUDES SEVERAL SCHOOL PARTNERSHIPS, MENTORING, HEALTH PROGRAMS, TEACHING, JOB SHADOWING AND VOLUNTEERING. JBH HOSTS SUPPORT GROUPS, TRAINING CLASSES AND LECTURES SERIES FOR HEALTH AND SAFETY RELATED TOPICS. EMPLOYEES STAFF COMMUNITY HEALTH FAIRS AND OPEN HEALTH SCREENINGS. THE RONALD MCDONALD CARE MOBILE WHICH PROVIDES FREE DENTAL AND MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN IN FIVE NORTHERN COUNTIES. THE 40-FOOT, 26,000 POUND MOBILE UNIT HOUSES TWO PATIENT EXAM ROOMS, A CENTRAL WAITING ROOM , AND A STERILIZATION AREA AND HAS PROVIDED CARE TO MORE THAN 9,537 CHILDREN SINCE THE INCEPTION OF THE PROGRAM IN 2003. THIS TOTALS MORE THAN $3.03 MILLION IN FREE CARE OVER THE LIFE OF THE PROGRAM. THE CARE MOBILE IS COMPLETELY FUNDED BY PHILANTHROPY FROM THE MERCYHEALTH DEVELOPMENT FOUNDATION, JAVON BEA HOSPITAL AUXILIARY AND THE RONALD MCDONALD CHARITIES OF MADISON. JBH ALSO PROVIDES LANGUAGE ASSISTANCE TO PATIENTS AND THEIR FAMILIES WHO NEED TO COMMUNICATE WITH MEDICAL PERSONNEL FOR TREATMENT AND MEETING SPACE FOR VARIOUS MEDICAL AND SOCIAL SERVICE SUPPORT GROUPS. FUNDS WERE ALSO USED TO SUPPORT HEALTHCARE CONDITIONS THROUGHOUT THE STATE OF ILLINOIS. 110318 100200 158145 THROUGH MERCYHEALTH VOLUNTEER ASSOCIATION, JBH IS ABLE TO PROVIDE EXTRA FUNDS AND SERVICES TO SUPPORT ITS MISSION.THE VOLUNTEER ASSOCIATION HAS 150 VOLUNTEERS WHO LOGGED APPROXIMATELY 16,350 HOURS WHILE ASSISTING WITH GREETING VISITORS, TRANSPORTING PATIENTS, FLORAL OR GIFT DELIVERIES, THRIFT SHOP AND GIFT SHOP ACTIVITIES, AND OTHER SERVICES AS REQUESTED.THE VOLUNTEERS' EFFORTS PROVIDE EXTRA FUNDS AND ENHANCE THE OVERALL HOSPITAL EXPERIENCE FOR PATIENTS, VISITORS, AND STAFF. 110318 100200 158145 352508915 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 218 0 1 2575 1 1 1 1 BD 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 IL X TODD ANDERSON 8159716738 2400 N ROCKTON AVE ROCKFORD IL 61103 JAVON R BEA PRESIDENT & CEO (PAGES 71-74) 1.00 66.00 X X 0 11908792 619061 MARK L GOELZER MD DIRECTOR/PHYSICIAN 1.00 45.00 X 0 444609 28511 ROWLAND J MCCLELLAN CHAIR & DIRECTOR 1.00 6.00 X X 0 14276 0 THOMAS R POOL VICE CHAIR & DIRECTOR 1.00 6.00 X X 0 13500 0 THOMAS D BUDD SECRETARY & TREASURER 1.00 6.00 X X 0 13691 0 DAVE L SYVERSON DIRECTOR 1.00 6.00 X 0 15306 0 KATHERINE A SCHACK DIRECTOR 1.00 6.00 X 0 13500 0 WESLEY M JOST DIRECTOR 1.00 6.00 X 0 13693 0 TODD ANDERSON VP & CFO 1.00 56.00 X 0 767925 45782 JOHN DORSEY VP CLINICAL INTERGRATION 40.00 0.00 X 690353 0 40592 ROBERT WALTERS VP HOME CARE 40.00 0.00 X 339133 0 45764 WENDI AUBRY REGIONAL PHARMACY MANAGER 40.00 0.00 X 214312 0 53033 MATTHEW PYCIOR PERFUSIONIST 40.00 0.00 X 210458 0 36172 REBEKA BAUER MANAGER OF INPATIENT SERVICES 40.00 0.00 X 194390 0 25106 SHANNON DUNPHY-ALEXANDER SR EXECUTIVE DIRECTOR 1.00 56.00 X 0 319804 16364 1648646 13525096 910385 137 1 1 0 ARX AN ASPIRION COMPANY PO BOX 1437 COLUMBUS GA 31902 ACCOUNTS RECEIVABLE MANAGEMENT 3424857 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 100875068 CLINICAL PURCHASED LABOR 2567453 SJOSTROM & SONS INC 1129 HARIISON AVENUE ROCKFORD IL 61104 CONSTRUCTION 2145635 LABORATORY CORP OF AMER HLDNG PO BOX 12140 BURLINGTON NC 272162140 LABORATORY SERVICES 1326491 MED ONE CAPITAL FUNDING LLC PO BOX 271128 SALT LAKE CITY UT 84127 CAPITAL FUNDING 1221609 50 297420 19240676 19538096 MEDICARE/MEDICAID 621110 174818973 174818973 OUTPATIENT & EMERGENCY 621400 109472624 109573476 -100852 INPATIENT ROUTINE & AN 621110 82868855 82868855 ALL OTHER PROGRAM REVE 900099 19032315 19032315 DIAGNOSTIC & MEDICAL L 621500 2464059 2464059 388656826 608434 608434 231637 416033 -184396 -184396 -184396 7388269 4754006 4935495 4862125 2452774 -108119 2344655 2344655 CAFETERIA/FOOD SERVICE 722210 1449829 1449829 CLINICAL FLIGHT CREW A 621990 1265961 1265961 INTEREST ON IL MEDICAI 621110 346185 346185 142461 142461 3204436 414168051 388757678 -100852 5973129 1019383 1019383 119883700 93509286 26374414 6252802 5002242 1250560 11310511 9048409 2262102 8322563 6824502 1498061 706419 143039 563380 7417 7417 129561 129561 435356 87071 348285 1619504 323901 1295603 10285302 5656916 4628386 8902663 7122130 1780533 7582997 4331025 3251972 253473 139410 114063 263326 236993 26333 18910961 15128769 3782192 34838184 24386729 10451455 21225064 20056963 1168101 SUPPLIES/DRUGS 61876626 61542492 334134 HEALTHCARE SERVICES 54167179 53796200 370979 BAD DEBT EXPENSE 24114986 24114986 MEDICAID ASSESSMENT TAX 13629014 13629014 8682317 6409455 2272862 414419308 352508915 61910393 0 23379433 46688280 24493806 23292910 2895787 432818 26824907 8576684 2733516 6212590 11580220 11907864 2349269 3306482 864016866 416946638 474488247 447070228 172459455 148625663 12844829 11757503 10274524 10916919 764323993 718787941 43784637 38090316 655440 655440 568555367 579253483 612995444 617999239 X 138466567 88234214 12861982 12554488 151328549 100788702 764323993 718787941 X -251257 -26367760 -23920830 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 89175 89175 0 PART II-B, LINE 1: A PERCENTAGE OF THE 2022 ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES WERE USED FOR LOBBYING. TWO CONSULTING FIRMS WERE ENGAGED TO REVIEW LEGISLATION AFFECTING HOSPITALS. APPROXIMATELY 50% OF TOTAL PAYMENTS TO THE CONSULTANTS WERE ALLOCABLE TO LOBBYING ACTIVITIES. 12271344 -544633 74653 796 11651262 11197286 200 1182560 107994 708 12271344 10816953 37162 359599 15545 883 11197286 10051014 3382 1190683 423923 4203 10816953 9434350 2045 861213 232378 14217 10051014 0.04200 0.40100 0.55700 0 1 1 65484 8103281 8168765 582164541 204636246 377528295 13569572 8684947 4884625 259746611 203625445 56121166 367377 367377 447070228 ACCRUED PENSION 3974962 ACCRUED POST RETIREMENT MEDICAL BENEFITS 3700725 DUE TO THIRD PARTY PAYORS 25786488 DUE TO MERCY HEALTH CORPORATION 505484496 ACCRUED LIABILITY, SELF INSURANCE LESS CURRENT 33890259 OTHER LIABILITIES 5861360 CAPITAL LEASE 555193 579253483 PART V, LINE 4: FUNDS WERE USED TO PROVIDE A LECTURE SERIES, FOR CONTINUING EDUCATION FOR EMPLOYEES WANTING TO IMPROVE THEIR CREDENTIALS OR TO FOCUS ON A NEW SKILL OR SOME TECHNOLOGY NOT CURRENTLY AVAILABLE IN THE ROCKFORD COMMUNITY. THERE WERE ALSO MISCELLANEOUS PROJECTS DESIGNATED BY THE FOUNDATION BOARD IN ACCORDANCE WITH THE SPECIFIC ENDOWMENT. ALL FUNDS WERE EXPENDED PER THE SPECIFIC DIRECTION OF EACH ENDOWMENT. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 3930839 0 0 0 0 0 0 3930839 0 3930839 0 0 1 0 0 0 PART III ACCOUNTING METHOD: SCHEDULE F, PART I: METHOD USED TO REPORT ENDING BALANCE: EQUITY METHOD. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 2075320 2075320 0.00530 68348534 63771722 4576812 0.01170 70423854 63771722 6652132 0.01700 1116732 236786 879946 0.00230 12321114 501001 11820113 0.03030 19235920 15709307 3526613 0.00900 726633 726633 0.00190 33400399 16447094 16953305 0.04350 103824253 80218816 23605437 0.06050 1 24114986 60751583 62204379 -1452796 X 1 1 2 1 JAVON BEA HOSPITAL 2400 N ROCKTON AVE ROCKFORD IL 61103 HTTPS://MERCYHEALTHSYSTEM.ORG/ 0002048 X X X X X 2 VANMATRE HEALTH SOUTH 950 S MULFORD RD ROCKFORD IL 61108 HTTPS://MERCYHEALTHSYSTEM.ORG/LOCATION 0005215 X REHABILITATION JAVON BEA HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 1 19 1 MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 0 1 X 200.000000000000 600.000000000000 X X X X X 1 1 X X X 1 X MERCYHEALTHSYSTEM.ORG/FINANCIAL-POLICIES X MERCYHEALTHSYSTEM.ORG/FINANCIAL-POLICIES X MERCYHEALTHSYSTEM.ORG/FINANCIAL-POLICIES X X X X X X 1 0 X X X X 1 X 0 0 VANMATRE HEALTH SOUTH 2 0 0 1 X X X X X X X X X 19 1 0 1 1 X MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS X 1 19 1 MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 0 1 X 200.000000000000 400.000000000000 1 1 X X X 1 X WWW.ENCOMPASSHEALTH.COM/LOCATIONS/VANMATREREHAB/FINANCIAL-ASSISTANCE X WWW.ENCOMPASSHEALTH.COM/LOCATIONS/VANMATREREHAB/FINANCIAL-ASSISTANCE X WWW.ENCOMPASSHEALTH.COM/LOCATIONS/VANMATREREHAB/FINANCIAL-ASSISTANCE X X X X 1 0 X X 0 X X 0 0 JAVON BEA HOSPITAL PART V, SECTION B, LINE 5: JAVON BEA HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT THAT COLLABORATED WITH AND REFERENCED A VARIETY OF SOURCES TO BETTER UNDERSTAND COMMUNITY NEEDS. ONE EXTENSIVE DATA SOURCE REFERENCED WAS THE ROCKFORD REGIONAL HEALTH COUNCIL 2020 HEALTHY COMMUNITY STUDY. THIS STUDY COMPLEMENTED OTHER DATA SOURCES AND LED TO A STRATEGIC PLAN WITH IDENTIFIED GOALS AND PRIORITIES. THE ROCKFORD REGIONAL HEALTH COUNCIL IS A NON-PARTISAN ORGANIZATION THAT FOCUSES ON IMPROVING THE QUALITY OF OUR REGION'S HEALTH. THE FOCUS OF THE COUNCIL IS ON IMPROVING THE QUALITY OF OUR REGION'S HEALTH THROUGH DATA GATHERING AND ANALYSIS, EDUCATION, ACTION AND ADVOCACY. THE COUNCIL WORKED WITH A STEERING COMMITTEE CONSISTING OF BOONE COUNTY HEALTH DEPARTMENT, MERCYHEALTH (JAVON BEA HOSPITAL), OSF HEALTHCARE, SWEDISHAMERCIAN HEALTH SYSTEM, UNITED WAY OF ROCK RIVER VALLEY, UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE ROCKFORD, DEPARTMENT OF FAMILY & COMMUNITY MEDICINE AND THE DIVISION OF HEALTH POLICY AND SOCIAL SCIENCE RESEARCH TO PLAN, COMPLETE, AND ANALYZE THE RESULTS OF THE 2020 HEALTHY COMMUNITY STUDY. THIS WIDE ARRAY OF ORGANIZATIONS WHO SPECIALIZE IN HEALTHCARE AND MEETING COMMUNITY NEEDS COVERS A LARGE PORTION OF THE WINNEBAGO COUNTY COMMUNITY WHO PARTNERED TOGETHER TO CONDUCT THIS STUDY AND TO COLLECTIVELY IDENTIFY AREAS OF THE COMMUNITY WHERE THERE ARE PUBLIC HEALTH CONCERNS. SUBSEQUENTLY, JAVON BEA HOSPITAL COMPLETED AN INDIVIDUAL REPORT BASED ON THESE FINDINGS AND INPUT. JAVON BEA HOSPITAL ALSO CREATED AN IMPROVEMENT PLAN SPECIFIC TO THE HOSPITAL'S EFFORTS. THE HEALTHY COMMUNITY STUDY INCLUDED A COMMUNITY SURVEY WHICH RECEIVED 1,677 ANONYMOUS RESPONSES FROM INDIVIDUALS. THE SURVEY WAS AVAILABLE IN ENGLISH AND SPANISH, AND WAS DISTRIBUTED VIA EMAIL, SOCIAL MEDIA, AND A PAPER SURVEY. TO ENCOURAGE INPUT FROM MEDICALLY UNDERSERVED POPULATIONS, THE PAPER SURVEY WAS DISTRIBUTED AT SITES INCLUDING ELEMENTARY SCHOOLS, PUBLIC HOUSING PROVIDERS, FEDERALLY QUALIFIED HEALTH CENTER CLINICS, AND A FOOD PANTRY.THE HEALTHY COMMUNITY STUDY ALSO INCLUDED A FACILITATED DISCUSSION WITH 38 LOCAL ORGANIZATIONS REPRESENTING THE LOCAL COMMUNITY TO EXAMINE THE STRENGTHS, WEAKNESSES, AND OPPORTUNITIES FOR GROWTH IN THE LOCAL PUBLIC HEALTH SYSTEM. THESE ORGANIZATIONS INCLUDED BOONE COUNTY HEALTH DEPARTMENT, CITY OF ROCKFORD HEAD START, CRUSADER CLINIC, HARLEM SCHOOL DISTRICT #122, ILLINOIS DEPARTMENT OF PUBLIC HEALTH, NAMI NORTHERN ILLINOIS, PECATONICA COMMUNITY SCHOOL DISTRICT, ROCKFORD RESCUE MISSION, ROCKFORD PUBLIC SCHOOLS, ROSECRANCE, ROCKFORD FIRE DEPARTMENT, AND THE WINNEBAGO COUNTY HEALTH DEPARTMENT. VANMATRE HEALTH SOUTH PART V, SECTION B, LINE 5: VAN MATRE SOUTH COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT THAT COLLABORATED WITH AND REFERENCED A VARIETY OF SOURCES TO BETTER UNDERSTAND COMMUNITY NEEDS. ONE EXTENSIVE DATA SOURCE REFERENCED WAS THE ROCKFORD REGIONAL HEALTH COUNCIL 2020 HEALTHY COMMUNITY STUDY. THIS STUDY COMPLEMENTED OTHER DATA SOURCES AND LED TO A STRATEGIC PLAN WITH IDENTIFIED GOALS AND PRIORITIES. THE ROCKFORD REGIONAL HEALTH COUNCIL IS A NON-PARTISAN ORGANIZATION THAT FOCUSES ON IMPROVING THE QUALITY OF OUR REGION'S HEALTH. THE FOCUS OF THE COUNCIL IS ON IMPROVING THE QUALITY OF OUR REGION'S HEALTH THROUGH DATA GATHERING AND ANALYSIS, EDUCATION, ACTION AND ADVOCACY. THE COUNCIL WORKED WITH A STEERING COMMITTEE CONSISTING OF BOONE COUNTY HEALTH DEPARTMENT, MERCYHEALTH (JAVON BEA HOSPITAL), OSF HEALTHCARE, SWEDISHAMERCIAN HEALTH SYSTEM, UNITED WAY OF ROCK RIVER VALLEY, UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE ROCKFORD, DEPARTMENT OF FAMILY & COMMUNITY MEDICINE AND THE DIVISION OF HEALTH POLICY AND SOCIAL SCIENCE RESEARCH TO PLAN, COMPLETE, AND ANALYZE THE RESULTS OF THE 2020 HEALTHY COMMUNITY STUDY. THIS WIDE ARRAY OF ORGANIZATIONS WHO SPECIALIZE IN HEALTHCARE AND MEETING COMMUNITY NEEDS COVERS A LARGE PORTION OF THE WINNEBAGO COUNTY COMMUNITY WHO PARTNERED TOGETHER TO CONDUCT THIS STUDY AND TO COLLECTIVELY IDENTIFY AREAS OF THE COMMUNITY WHERE THERE ARE PUBLIC HEALTH CONCERNS. SUBSEQUENTLY, VAN MATRE SOUTH COMPLETED AN INDIVIDUAL REPORT BASED ON THESE FINDINGS AND INPUT. VAN MATRE SOUTH ALSO CREATED AN IMPROVEMENT PLAN SPECIFIC TO THE HOSPITAL'S EFFORTS.THE HEALTHY COMMUNITY STUDY INCLUDED A COMMUNITY SURVEY WHICH RECEIVED 1,677 ANONYMOUS RESPONSES FROM INDIVIDUALS. THE SURVEY WAS AVAILABLE IN ENGLISH AND SPANISH, AND WAS DISTRIBUTED VIA EMAIL, SOCIAL MEDIA, AND A PAPER SURVEY. TO ENCOURAGE INPUT FROM MEDICALLY UNDERSERVED POPULATIONS, THE PAPER SURVEY WAS DISTRIBUTED AT SITES INCLUDING ELEMENTARY SCHOOLS, PUBLIC HOUSING PROVIDERS, FEDERALLY QUALIFIED HEALTH CENTER CLINICS, AND A FOOD PANTRY.THE HEALTHY COMMUNITY STUDY ALSO INCLUDED A FACILITATED DISCUSSION WITH 38 LOCAL ORGANIZATIONS REPRESENTING THE LOCAL COMMUNITY TO EXAMINE THE STRENGTHS, WEAKNESSES, AND OPPORTUNITIES FOR GROWTH IN THE LOCAL PUBLIC HEALTH SYSTEM. THESE ORGANIZATIONS INCLUDED BOONE COUNTY HEALTH DEPARTMENT, CITY OF ROCKFORD HEAD START, CRUSADER CLINIC, HARLEM SCHOOL DISTRICT #122, ILLINOIS DEPARTMENT OF PUBLIC HEALTH, NAMI NORTHERN ILLINOIS, PECATONICA COMMUNITY SCHOOL DISTRICT, ROCKFORD RESCUE MISSION, ROCKFORD PUBLIC SCHOOLS, ROSECRANCE, ROCKFORD FIRE DEPARTMENT, AND THE WINNEBAGO COUNTY HEALTH DEPARTMENT. JAVON BEA HOSPITAL PART V, SECTION B, LINE 6B: ROCKFORD REGIONAL HEALTH COUNCIL VANMATRE HEALTH SOUTH PART V, SECTION B, LINE 6B: ROCKFORD REGIONAL HEALTH COUNCIL AND WINNEBAGO COUNTY HEALTH DEPARTMENT JAVON BEA HOSPITAL PART V, SECTION B, LINE 11: JAVON BEA HOSPITAL CREATED AN INDEPENDENT IMPLEMENTATION PLAN TO MEET COMMUNITY NEEDS BASED ON THE RESULTS OF THE 2020 HEALTHY COMMUNITY STUDY AND OTHER DATA SOURCES. THE RESULT WAS A MULTIFACETED COMMUNITY BENEFIT PLAN TO IMPROVE THE HEALTH AND WELLBEING OF RESIDENTS IN THE PRIMARY SERVICE AREA.THE SURVEY IDENTIFIED MULTIPLE NEEDS WITHIN THE COMMUNITY. THE NEEDS IDENTIFIED INCLUDED ALCOHOL, OPIOID & OTHER SUBSTANCE ABUSE ISSUES, CHRONIC DISEASE, MATERNAL/PRENATAL/EARLY CHILDHOOD HEALTH, GERIATRIC HEALTH NEEDS, HEALTH EQUITY, AND A SHORTAGE OF MENTAL HEALTH SERVICES, JOB TRAINING AND EMPLOYMENT FOR PEOPLE WITH DISABILITIES.THE IMPLEMENTATION PLAN FOCUSES ON MANY OF THE AREAS IDENTIFIED TO HELP TO IMPROVE THE GENERAL HEALTH OF INDIVIDUALS LIVING IN THE PRIMARY SERVICE AREA INCLUDING:1. IMPROVE HEALTH CARE ACCESS BY DEVELOPING AND OFFERING VARIOUS ACCESS SITES AND VENUES FOR PRIMARY CARE MEDICAL SERVICES. 2. ESTABLISH PHYSICIAN RESIDENCY PROGRAMS IN ROCKFORD. 3. SUPPORT BRIDGE CLINIC SERVICES AND THE RONALD MCDONALD CARE MOBILE FOR NON- AND UNDER-INSURED PATIENTS AND CHILDREN.4. SAFE CARE COMMITMENT - IN RESPONSE TO COVID-19 TO EFFECTIVELY CARE FOR THE NEEDS OF OUR COMMUNITY AND TO ENSURE UP-TO-DATE EDUCATION AND PREPAREDNESS DURING A PANDEMIC, COORDINATE WITH LOCAL, REGIONAL, AND STATE ORGANIZATIONS REGARDING EMS SURGE PLANNING, RESPONSE AND INFORMATION SHARING. PROVIDE ALTERNATIVE EDUCATION FOR EMERGENCY MEDICAL SERVICES, INCLUDING: - ENHANCED SAFETY AND TREATMENT PROTOCOLS BY OUR EMS SYSTEM AND THE REACT AIR MEDICAL CRITICAL CARE TRANSPORT PROGRAM. - EXPAND TELEMEDICINE SERVICES TO INCREASE VIRTUAL ACCESS FOR OUR PATIENTS. HAVE PROVIDERS ON CALL THAT ARE AVAILABLE TO ASSIST EMS CREWS IN THE FIELD WITH TRAUMA-RELATED EMERGENCIES AND CRITICAL ILLNESSES. - EXPAND COVID 19 RESPONSE, SCREENING, AND EFFECTIVE TRANSPORT OF PATIENTS SUSPECTED OR CONFIRMED FOR COVID-19. - REASSURE PATIENTS OF EXTRA SAFETY PRECAUTIONS TAKEN TO ENSURE THE HEALTH AND SAFETY OF OUR PATIENTS INCLUDING ENHANCED CLEANING, MASKING, SCREENING AND SOCIAL DISTANCING.THE IMPLEMENTATION PLAN DOES NOT ADDRESS ISSUES AROUND VIOLENCE IN THE COMMUNITY, AS THIS NEED IS BETTER ADDRESSED BY ORGANIZATIONS MORE VERSED IN THE MULTIDIMENSIONAL FACTORS AFFECTING COMMUNITY VIOLENCE & CRIME. VANMATRE HEALTH SOUTH PART V, SECTION B, LINE 11: JAVON BEA HOSPITAL CREATED AN INDEPENDENT IMPLEMENTATION PLAN TO MEET COMMUNITY NEEDS BASED ON THE RESULTS OF THE 2020 HEALTHY COMMUNITY STUDY AND OTHER DATA SOURCES. THE RESULT WAS A MULTIFACETED COMMUNITY BENEFIT PLAN TO IMPROVE THE HEALTH AND WELLBEING OF RESIDENTS IN THE PRIMARY SERVICE AREA.THE SURVEY IDENTIFIED MULTIPLE NEEDS WITHIN THE COMMUNITY. THE NEEDS IDENTIFIED INCLUDED ALCOHOL, OPIOID & OTHER SUBSTANCE ABUSE ISSUES, CHRONIC DISEASE, MATERNAL/PRENATAL/EARLY CHILDHOOD HEALTH, GERIATRIC HEALTH NEEDS, HEALTH EQUITY, AND A SHORTAGE OF MENTAL HEALTH SERVICES, JOB TRAINING AND EMPLOYMENT FOR PEOPLE WITH DISABILITIES.THE IMPLEMENTATION PLAN FOCUSES ON MANY OF THE AREAS IDENTIFIED TO HELP TO IMPROVE THE GENERAL HEALTH OF INDIVIDUALS LIVING IN THE PRIMARY SERVICE AREA INCLUDING:1. ENHANCE QUALITY OF CARE BY FOCUSING ON CARE COORDINATION BETWEEN HOSPITAL, PRIMARY CARE, AND INPATIENT REHAB FACILITY. 2. REDUCE LIKELIHOOD OF OPIOID ADDICTION BEGINNING AND/OR CONTINUING. 3. INCREASE ACCURACY OF DISPOSITION TO ENSURE CARE IS DELIVERED IN THE RIGHT SETTING.4. SAFE CARE COMMITMENT - IN RESPONSE TO COVID-19 TO EFFECTIVELY CARE FOR THE NEEDS OF OUR COMMUNITY AND TO ENSURE UP-TO-DATE EDUCATION AND PREPAREDNESS DURING A PANDEMIC, COORDINATE WITH LOCAL, REGIONAL, AND STATE ORGANIZATIONS REGARDING SURGE PLANNING, RESPONSE, AND INFORMATION SHARING, INCLUDING:- ENHANCED SAFETY AND TREATMENT PROTOCOLS. EXPAND COVID 19 RESPONSE, SCREENING, AND EFFECTIVE TRANSPORT OF PATIENTS SUSPECTED OR CONFIRMED FOR COVID-19. - REASSURE PATIENTS OF EXTRA SAFETY PRECAUTIONS TAKEN TO ENSURE THE HEALTH AND SAFETY OF OUR PATIENTS INCLUDING ENHANCED CLEANING, MASKING, SCREENING, AND SOCIAL DISTANCING. PART V, SECTION B, LINE 22D: JAVON BEA HOSPITALTHE HOSPITAL FACILITY USED A LOOK-BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12-MONTH PERIOD. PART I, LINE 7: THE HOSPITAL UTILIZED BOTH THE MEDICARE COST REPORT CCR (COST-TO-CHARGE RATIO) AND OUR COST ACCOUNTING SYSTEM TO DETERMINE THE COST OF CHARGES, BAD DEBT AND CHARITY CARE EXPENSE INCLUDED IN LINE 7. THE SUBSIDIZED PROGRAMS ALSO INCLUDE THE COSTS (BASED ON A CALCULATED CCR) FROM THE RELATED COMPANY ROCKFORD HEALTH PHYSICIANS (RHPH) BECAUSE THERE ARE NO PHYSICIANS COSTS INCLUDED IN THE HOSPITAL COST ACCOUNTING ANALYSIS. BAD DEBT AND CHARITY AT COST HAVE BEEN REMOVED FROM LINES 7A/7F/7G SINCE THOSE COSTS WERE PREVIOUSLY INCLUDED. PART III, LINE 2: ALL CHARGES FOR ANY SERVICE PROVIDED BY JAVON BEA HOSPITAL ARE THE VERY SAME FOR EVERY INDIVIDUAL, REGARDLESS OF WHETHER IT IS FOR EMERGENCY OR STANDARD CARE AND REGARDLESS OF THE PATIENT'S ABILITY TO PAY. EACH PATIENT IS THEN ASSESSED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BASED ON PREDEFINED CRITERIA OF FINANCIAL STATUS AND INCOME LEVEL. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE EXPECTED REIMBURSEMENT IS BASED ON CHARITY CARE POLICY GUIDELINES. THE ORGANIZATION MAINTAINS A BAD DEBT RESERVE ON THE BALANCE SHEET. ANY BAD DEBT WRITE-OFFS OF PATIENT ACCOUNTS WILL GO AGAINST THE BED DEBT RESERVE. AT EACH MONTH END BASED ON THE ACCOUNTS RECEIVABLE BY FINANCIAL CLASS AND AGING BUCKET, THE RESERVE AMOUNT IS RE-EVALUATED. THE AMOUNT NEEDED TO MAINTAIN THE APPROPRIATE RESERVE LEVEL IS THE BAD DEBT EXPENSE. ANY PAYMENTS RECEIVED ON PATIENT ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBT WILL OFFSET THE BAD DEBT EXPENSE. PART III, LINE 4: 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 FROM 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, 2022 AND 2021, 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 2022 AND 2021. PART III, LINE 8: REPORTED ON LINE 6 ARE ALLOWABLE MEDICARE COSTS PROVIDED BY THE COST REPORT. MEDICARE COSTS ARE ELIMINATED FROM THE SUBSIDIZED PROGRAMS ON PART 1, LN 7G AS CALCULATED BY OUR COST ACCOUNTING ANALYSIS. A COMBINATION OF COST ACCOUNTING AND THE MEDICARE CCR WAS USED FOR THE COMPUTATION OF SUBSIDIZED PROGRAMS. PART III, LINE 9B: JAVON BEA HOSPITAL HAS A STRONG COMMITMENT TO PROVIDE QUALITY PATIENT CARE FOR ALL INDIVIDUALS. OUR MISSION IS TO PROVIDE HEALTH CARE TO EVERYONE WHO COMES TO OUR DOOR, REGARDLESS OF THEIR ABILITY TO PAY. WE HELP PATIENTS APPLY FOR INSURANCE ASSISTANCE INCLUDING: AUTOMOBILE ACCIDENTS, CRIME VICTIMS, WORKERS COMPENSATION, MEDICAID, COBRA, LOCAL ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE, AND COPAY ASSISTANCE PROGRAMS. IF PATIENTS DO NOT QUALIFY FOR ANY OF THESE, WE MAY EXTEND PAYMENT OPTIONS SUCH AS MONTHLY PAYMENTS, CREDIT CARD PAYMENTS OR FINANCIAL ASSISTANCE. PER OUR POLICY, MERCYHEALTH WILL SUSPEND ANY EFFORT TO COLLECT PAYMENT FOR CARE WHEN A PATIENT SUBMITS AN APPLICATION FOR FINANCIAL ASSISTANCE UNTIL EITHER (I) MERCYHEALTH HAS DETERMINED WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON A COMPLETE APPLICATION; OR (II) IN THE CASE OF AN INCOMPLETE APPLICATION, THE INDIVIDUAL HAS FAILED TO RESPOND TO REQUESTS FOR ADDITIONAL INFORMATION AND/OR DOCUMENTATION WITHIN A REASONABLE PERIOD OF TIME GIVEN TO RESPOND TO SUCH REQUESTS. IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, MERCYHEALTH WILL: (I) REFUND TO THE PATIENT ANY AMOUNT HE OR SHE HAS PAID FOR CARE THAT EXCEEDS THE PATIENT'S CALCULATED PERSONAL RESPONSIBILITY; (II) PROVIDE THE PATIENT A BILLING STATEMENT THAT INDICATES THE AMOUNT THE PATIENT OWES FOR THE CARE AS A FINANCIAL ASSISTANCE ELIGIBLE PATIENT AND AN EXPLANATION OF HOW THE AMOUNT WAS CALCULATED, INCLUDING A DESCRIPTION OF HOW THE PATIENT CAN GET INFORMATION REGARDING THE AMOUNT GENERALLY BILLED (AS DEFINED IN MERCYHEALTH HOSPITAL FINANCIAL ASSISTANCE POLICY); AND (III) TAKE ALL REASONABLY AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS (ECAS) (EXCEPT THE SALE OF DEBT) TAKEN AGAINST THE PATIENT TO OBTAIN PAYMENT FOR THE CARE. PART VI, LINE 2: IN ADDITION TO THE HEALTH NEEDS ASSESSMENT - MERCY HEALTH IS WORKING TO: - WORK WITH OTHER COMMUNITY SERVICES AND THROUGH MEDICARE ACO TO PROACTIVELY MANAGE AND IMPROVE THE CHRONIC DISEASE STATE OF OUR PATIENTS, AND TO CONTINUE MEDICARE ACO WELLNESS VISITS TO PROACTIVELY MANAGE THE HEALTH OF MEDICARE PATIENTS. - MAINTAIN CLINICAL TEAMS TO WORK WITH SELECTED NURSING HOME PATIENTS TO ENSURE APPROPRIATE TRANSITIONAL CARE AND MANAGE AND PROVIDE INTERVENTIONS AS NECESSARY FOR VARIOUS ACUTE AND CHRONIC DISEASES. - IN ADDITION, SUB-ACUTE CARE WAS ADDED TO ALLOW PATIENTS TO TRANSITION AFTER A MAJOR ILLNESS OR INJURY AND MAINTAIN A HEALTHY LIFESTYLE.- MAINTAIN MULTIDISCIPLINARY PALLIATIVE CARE SERVICES FOR ADULTS TO FORMULATE PLANS OF CARE, IDENTIFY RESOURCES, AND PROVIDE SUPPORT FOR BOTH PATIENTS AND FAMILIES FOR VARIOUS CHRONIC AND ACUTE DISEASES.- IMPROVE THE HEALTH OF PATIENTS WITH SPECIFIC NEEDS, INCLUDING GERIATRIC HEALTH NEEDS AND SUBSTANCE ABUSE BY OFFERING A WIDE ARRAY OF COMMUNITY EDUCATIONAL HEALTH & SCREENING PROGRAMS.- REDUCE THE LIKELIHOOD OF OPIOID ADDICTION BEGINNING OR CONTINUING BY MONITORING OPIOID PRESCRIPTIONS AMONG PHYSICIANS, OFFERING PROVIDER EDUCATION, AND OFFERING ADDICTION COUNSELING.- MAINTAIN OUR COMMITMENT TO THE WOMEN AND CHILDREN OF THE COMMUNITY AS A PROVIDER OF COMPREHENSIVE TERTIARY SERVICES AND TO ENSURE EXCELLENT OUTCOMES FOR MOTHERS AND INFANTS BY REMAINING THE STATE OF IL REGIONAL PERINATAL CENTER FOR 11 COUNTIES AND PARTICIPATING IN ILPQC (ILLINOIS PERINATAL QUALITY COLLABORATIVE) INITIATIVES LIKE PROMOTING VAGINAL BIRTH FOR LOW RISK FIRST PREGNANCY WOMEN, MAINTAINING THE HYPERTENSION BUNDLE TO ASSESS QUICK RESPONSE TO INCREASED BLOOD PRESSURES OF PERIPARTUM MOTHERS, AND THE NEONATAL ABSTINENCE SYNDROME (NAS) BUNDLE FOCUSING ON INTERVENTION FOR BABIES OF ADDICTED MOTHERS.- PROVIDE JOB TRAINING AND EMPLOYMENT OPPORTUNITIES TO DISABLED YOUNG ADULT COMMUNITY MEMBERS IN COLLABORATION WITH RAMP AND THE ILLINOIS DEPARTMENT OF HUMAN SERVICES BY ESTABLISHING PROJECT SEARCH. PART VI, LINE 3: ALL UNINSURED PATIENTS ARE NOTIFIED OF MERCY'S FINANCIAL ASSISTANCE POLICY UPON REGISTRATION. INFORMATION IS ALSO AVAIABLE AT THE HEALTH SYSTEMS' WEBSITE, IN OUR EMERGENCY ROOMS, FINANCIAL ASSISTANCE 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. PART VI, LINE 4: JAVON BEA HOSPITAL IS LOCATED IN ROCKFORD, IL (WINNEBAGO COUNTY). ACCORDING TO THE US CENSUS BUREAU FROM THE 2020 CENSUS THE POPULATION OF WINNEBAGO COUNTY WAS MEASURED AT 285,350. LOCATED IN NORTHERN ILLINOIS, THE COUNTY IS CHARACTERIZED AS LARGELY RURAL AND POPULATED WITH VERY SMALL COMMUNITIES WITH THE EXCEPTION OF THE NEIGHBORING CITIES OF ROCKFORD, LOVES PARK, AND MACHESNEY PARK WHICH COMPRISE APPROXIMATELY 195,000 INDIVIDUALS. THE VAST MAJORITY OF THE POPULATION RESIDE IN URBAN AREAS AND THE MAJORITY OF PATIENTS RESIDE IN WINNEBAGO COUNTY. AS A COMMUNITY THAT RELIES HEAVILY ON MANUFACTURING COMPANIES AND SMALL BUSINESSES, THE AREA WAS PARTICULARLY HARD HIT IN RECENT YEARS. CURRENTLY, THE LARGEST EMPLOYERS INCLUDE THE ROCKFORD PUBLIC SCHOOLS AND THE THREE ROCKFORD HEALTH CARE PROVIDERS. THE MOST RECENT MEDIAN HOUSEHOLD INCOMES IN WINNEBAGO COUNTY WERE $57,779 COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $72,563 AND THE NATIONAL MEDIAN INCOME OF $69,021. THESE DISPARITIES ARE ALSO REFLECTED IN EDUCATION AND POVERTY RATES. UNEMPLOYMENT RATES AS OF JUNE 30, 2022 FIGURES FOR WINNEBAGO COUNTY AT 6.6% BUT ARE HIGH IN COMPARISON TO THE STATE AT 4.5% AND THE NATION AT 3.6%. ONLY 23.3% OF WINNEBAGO COUNTY RESIDENTS ATTAIN A BACHELOR'S DEGREE OR HIGHER COMPARED WITH THOSE IN THE STATE AT 36.2% AND 33.7% IN THE NATION. MORE THAN 14.2% OF THE RESIDENTS IN WINNEBAGO COUNTY LIVE BELOW THE POVERTY LINE COMPARED TO STATE LEVELS OF 11.6% AND NATIONAL LEVELS OF 12.1%. THIS IS IMPORTANT BECAUSE POVERTY CREATES BARRIERS TO ACCESS INCLUDING HEALTH SERVICES, HEALTHY FOOD, AND OTHER NECESSITIES THAT CONTRIBUTE TO POOR HEALTH STATUS AS WELL THE LACK OF INTERNET ACCESS FOR AN ESTIMATED 14.5% OF THE HOUSEHOLDS IN WINNEBAGO COUNTY. PART VI, LINE 5: LED BY A GOVERNING BODY COMPRISED OF A MAJORITY OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY, JAVON BEA HOSPITAL (JBH) AND ITS AFFILIATES ARE VERY INVOLVED IN PROMOTING A HEALTHIER COMMUNITY. AS ONE OF ROCKFORD'S LARGEST EMPLOYERS, THE ORGANIZATION TAKES A LEADING ROLE IN FINANCIALLY SUPPORTING NOT ONLY HEALTH-RELATED INITIATIVES, BUT ALSO COMMUNITY-BUILDING ACTIVITIES ACROSS THE REGION. THIS INCLUDES PROVIDING FINANCIAL SUPPORT AND TALENT FOR ECONOMIC DEVELOPMENT AND BUSINESS RELATED ACTIVITIES. AS WELL AS QUALITY OF LIFE AND EDUCATIONAL INITIATIVES. EMPLOYEES PARTICIPATE ON COMMUNITY BOARDS AND ARE ACTIVELY INVOLVED IN PROMOTING THE REGION AND ITS ASSETS. BASED ON THE RESULTS OF THE ROCKFORD HEALTH COUNCILS 2020 HEALTHY COMMUNITY STUDY, THE COMMUNITY BENEFIT IMPLEMENTATION PLAN IDENTIFIED SEVERAL KEY AREAS TO FOCUS EFFORTS. FOR EXAMPLE, AS THE PREDOMINANT PROVIDER OF PEDIATRIC SERVICES, JBH MAINTAINS ITS COMMITMENT TO THE CHILDREN OF OUR COMMUNITY. THIS IS EVIDENT IN OUR SUPPORT OF THE RONALD MCDONALD CARE MOBILE WHICH PROVIDES FREE DENTAL AND MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN IN FIVE NORTHERN COUNTIES. THE 40-FOOT, 26,000 POUND MOBILE UNIT HOUSES TWO PATIENT EXAM ROOMS, A CENTRAL WAITING ROOM, AND A STERILIZATION AREA AND HAS PROVIDED CARE TO MORE THAN 9,537 CHILDREN SINCE THE INCEPTION OF THE PROGRAM IN 2003. THIS TOTALS MORE THAN $3.03 MILLION IN FREE CARE OVER THE LIFE OF THE PROGRAM. THE CARE MOBILE IS COMPLETELY FUNDED BY PHILANTHROPY FROM THE MERCYHEALTH DEVELOPMENT FOUNDATION, JAVON BEA HOSPITAL AUXILIARY AND THE RONALD MCDONALD CHARITIES OF MADISON. THE BRIDGE CLINIC IS YET ANOTHER VENUE FOR UN- AND UNDER-INSURED ADULTS TO RECEIVE FREE MEDICAL TREATMENT FOR CHRONIC MEDICAL ISSUES. SINCE ITS OPENING IN 2008, HUNDREDS OF PEOPLE FROM OUR COMMUNITY HAVE RECEIVED CARE. MANY PHYSICIANS AND OTHER HEALTH CARE PROVIDERS GIVE FREELY OF THEIR TIME TO PROVIDE THESE SERVICES TO THE LESS FORTUNATE INDIVIDUALS IN OUR COMMUNITY TO BETTER MANAGE THEIR CHRONIC CONDITIONS. SINCE 2012, JBH CONTINUES TO PARTNER WITH A SILVER LINING FOUNDATION TO PROVIDE FREE BREAST HEALTH SERVICES TO THE UN- UNDER-INSURED WOMEN IN THE COMMUNITY. OVER 620 WOMEN HAVE RECEIVED FREE SCREENING MAMMOGRAMS AND OTHER BREAST RELATED SERVICES AND PROCEDURES SINCE THE PROGRAM'S INCEPTION. THESE ARE ONLY SOME OF THE MANY CONTRIBUTIONS THAT JBH MAKES TO PROMOTE AND IMPROVE THE HEALTH OF THE COMMUNITY. JBH REMAINS COMMITTED TO EDUCATING THE PUBLIC ABOUT VARIOUS HEALTH CARE ISSUES AND INITIATIVES AND IMPROVING THE LIVES OF OUR CITIZENS. JBH DOES NOT RESTRICT ADMISSION OF PROVIDERS AND PROVIDES AN OPEN MEDICAL STAFF. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 AMERICAN CANCER SOCIETY 255 N MICHIGAN AVE STE 1200 CHICAGO IL 60601 131788491 501(C)(3) 5000 0 PROGRAM SUPPORT GROWTH DIMENSIONS 401 WHITNEY BLVD BELVIDERE IL 610083799 363196645 501(C)(3) 5000 0 PROGRAM SUPPORT ROCK RIVER DEVELOPMENT PARTNERSHIP 124 N WATER ST ROCKFORD IL 611073960 271153597 501(C)(3) 60000 0 PROGRAM SUPPORT ROCKFORD AREA CONVENTION & VISITOR'S BUREAU CHARITABLE FOUNDATION 102 N MAIN STREET ROCKFORD IL 61101 474742025 501(C)(3) 7500 0 PROGRAM SUPPORT REMEDIES RENEWING LIVES 220 EASTON PARKWAY ROCKFORD IL 61108 362464898 501(C)(3) 10000 0 PROGRAM SUPPORT ROCKFORD REGIONAL HEALTH COUNCIL 1601 PARKVIEW AVE ROCKFORD IL 61107 363229371 501(C)(3) 24250 0 PROGRAM SUPPORT ROCKFORD UNIVERSITY 5050 E STATE ST ROCKFORD IL 61107 362167842 501(C)(3) 10000 0 PROGRAM SUPPORT UNIVERSITY OF IL FOUNDATION 1305 W GREEN ST URBANA IL 618012900 376006007 501(C)(3) 50000 0 PROGRAM SUPPORT ILLINOIS HEALTH AND HOSPITAL ASSOCIATION FKA METROPOLITAN CHICAGO HEALTHCAR 1151 EAST WARRENVILLE ROAD NAPERVILLE IL 605639339 362352486 501(C)(3) 23715 0 PROGRAM SUPPORT DISCOVERY CENTER MUSEUM 711 N MAIN STREET ROCKFORD IL 611036990 363292135 501(C)(3) 21500 0 PROGRAM SUPPORT THE HAVEN NETWORK 124 N WATER ST STE 201 ROCKFORD IL 611073959 200620800 501(C)(3) 5000 0 PROGRAM SUPPORT SALVATION ARMY ROCKFORD 1720 18TH AVENUE ROCKFORD IL 61104 362167912 501(C)(3) 0 26910 VARIOUS DONATIONS PROGRAM SUPPORT FRIENDS OF MCHENRY COUNTY COLLEGE FOUNDATION 8900 US HIGHWAY 14 CRYSTAL LAKE IL 60012 217418071 501(C)(3) 10000 0 PROGRAM SUPPORT MERCY HEALTH DEVELOPMENT FOUNDATION 2400 ROCKTON AVE ROCKFORD IL 61103 363197918 501(C)(3) 50000 432865 PURCHASE PRICE MEDICAL SUPPLIES AND PRINTERS PROGRAM SUPPORT 14 0 PART I, LINE 2: APPLICATIONS ARE SUBMITTED TO THE HOSPITAL VERIFYING A NEED FOR FUNDS OR PRODUCTS (IE AUTOMATIC ELECTRONIC DEFIBRILLATORS-AED). A DETERMINATION IS MADE THROUGH A PREDETERMINED SCORING METHOD AS TO WHAT ORGANIZATIONS WILL BE RECIPIENTS OF THE FUNDS OR PRODUCTS. CASH CONTRIBUTIONS ARE MADE ONLY TO RECOGNIZED CHARITIES FOR WHICH GOOD FAITH REGARDING FUND USE HAS BEEN ESTABLISHED. THE CONTRIBUTION IS ONLY FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. USABLE EXPIRED MEDICAL INVENTORY WAS DONATED. 0 1 0 0 0 0 0 0 0 JAVON R BEA PRESIDENT & CEO (PAGES 71-74) 0 1570273 0 1475763 0 8862756 0 602150 0 16911 0 12527853 0 5837133 TODD ANDERSON VP & CFO 0 545321 0 211257 0 11347 0 11600 0 34182 0 813707 0 0 JOHN DORSEY VP CLINICAL INTERGRATION 463224 0 222732 0 4397 0 31319 0 9273 0 730945 0 0 0 MARK L GOELZER MD DIRECTOR/PHYSICIAN 0 324023 0 116186 0 4400 0 11600 0 16911 0 473120 0 0 ROBERT WALTERS VP HOME CARE 227161 0 110566 0 1406 0 12717 0 33047 0 384897 0 0 0 SHANNON DUNPHY-ALEXANDER SR EXECUTIVE DIRECTOR 0 244896 0 74682 0 226 0 11600 0 4764 0 336168 0 0 WENDI AUBRY REGIONAL PHARMACY MANAGER 193978 0 20058 0 276 0 32850 0 20183 0 267345 0 0 0 MATTHEW PYCIOR PERFUSIONIST 198689 0 10829 0 940 0 32194 0 3978 0 246630 0 0 0 REBEKA BAUER MANAGER OF INPATIENT SERVICES 173837 0 16779 0 3774 0 21658 0 3448 0 219496 0 0 0 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 ORGANIZATIONS, 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 2021. PART I, LINE 4B INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $5,837,133. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING FY2022 THAT WAS SPONSORED BY THE ORGANIZATION: CAROLYN BENGSTON, JOHN DORSEY, MICHELLE LIPPERT AND SUE SCHRIEBER. THERE WERE NO AMOUNTS PAID TO ANY PARTICIPANTS DURING THE YEAR UNDER THE PLAN. PART II, LINE 2: JAVON 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 $3.4 BILLION IN FY2022. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 1.9 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,000+ 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 11 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 TWO 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 III, LINE 3 MANY INPATIENT PROGRAMS WERE COMBINED INTO ONE LOCATION RATHER THAN OFFERING THE SAME SERVICES AT 2 LOCATIONS WITHIN THE SAME CITY. COVID HAD A LARGE IMPACT IN REDUCING SERVICES AS WELL. FORM 990, PART VI, SECTION A, LINE 1A THE VOTING MEMBERS OF THE EXECUTIVE COMMITTEE CONSISTS OF SEVEN INDIVIDUALS, EACH OF WHOM SHALL HAVE A VOTE, INCLUDING THE CEO, THE CHAIRMAN, VICE-CHAIRMAN, IMMEDIATE PAST CHAIRMAN, TREASURER, AND TWO 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, SECTION A, LINE 6 MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF JAVON BEA HOSPITAL (JBH). THE SOLE MEMBER SHALL HAVE POWERS AND VOTING RIGHTS TO DO THE FOLLOWING: (A) APPOINT ALL THE DIRECTORS OF THE CORPORATION (B) NOMINATE TO CORPORATION'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION PRESIDENT (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATIONS 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 CORPORATIONS 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, SECTION A, LINE 7A SEE NARRATIVE FOR PART VI, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE NARRATIVE FOR PART VI, LINE 6 FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C 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 VICE PRESIDENT, LEGAL SERVICES/GENERAL COUNSEL 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 JBH 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, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART XI, LINE 9: CHANGES IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE -4,985,442. POST RETIREMENT MEDICAL BENEFIT ADJUSTMENT -32,137. NET TRANSFERS TO AFFILIATES -20,410,403. UPMIFA 99,262. MISCELLANEOUS ADJUSTMENT -40,208. RHIL TRANSFER 608,434. COST OF GOODS SOLD 839,664. ROCKFORD HEALTH SYSTEM VENTURES LLC 2400 N ROCKTON AVE ROCKFORD IL 61103 364366881 HEALTHCARE IL 3546157 9985058 JAVON BEA HOSPITAL MERCYHEALTH VISITING NURSES ASSOCIATION 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(C)(3) LINE 10 MERCY HEALTH CORPORATION 0 MERCYHEALTH DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 363197918 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 12A, I MERCY HEALTH CORPORATION 0 ROCKFORD HEALTH PHYSICIANS 2300 N ROCKTON AVE ROCKFORD IL 61103 363907436 HEALTHCARE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCY HEALTH CORPORATION 2400 N ROCKTON AVE ROCKFORD IL 61103 472158680 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 12B, II N/A 0 MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT AVE JANESVILLE WI 53548 390912682 SUPPORT OF HEALTHCARE WI 501(C)(3) LINE 12C, III-FI MERCY HEALTH SYSTEM CORPORATION 0 MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT AVE JANESVILLE WI 53548 390816848 HEALTHCARE WI 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCY ASSISTED CARE INC 901 MINERAL POINT AVE JANESVILLE WI 53548 391035110 HEALTHCARE WI 501(C)(3) LINE 10 MERCY HEALTH CORPORATION 0 MERCY HARVARD HOSPITAL INC 901 GRANT STREET HARVARD IL 60033 311551871 HEALTHCARE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 200 LAKE AVE WOODSTOCK IL 60098 201673011 NONE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 ROCKFORD HEALTH INSURANCE LTD WELLESLEY HOUSE SO 2ND FL PEMBROKE HM BD INSURANCE BD JAVON BEA HOSPITAL C 237583 3814380 1.00000 1 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT AVE JANESVILLE WI 53548 391520130 MANAGEMENT OF UNION EMPLOYEES WI N/A C 0 MERCYCARE INSURANCE COMPANY 580 N WASHINGTON ST JANESVILLE WI 53546 391768192 INSURANCE WI N/A C 0 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 580 N WASHINGTON ST JANESVILLE WI 53546 201482553 INSURANCE WI N/A C 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 1 1 1 1 0 ROCKFORD HEALTH INSURANCE LTD R 761495 NET BOOK VALUE ROCKFORD HEALTH INSURANCE LTD R 1878000 AMOUNTS PAID