2022-05-16T16:23:46-05:00 2021-06-30 390859910 BAKER TILLY US LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2020-07-01 390816848 MERCY HEALTH SYSTEM CORPORATION MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 JAVON BEA PRESIDENT/CEO 6087566000 2022-05-16 1 JAVON BEA XXX-XX-XXXX TROY MARINE CPA P00187863 6087525835 2022-05-15 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JAVON BEA PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 727156483 0 X WWW.MERCYHEALTHSYSTEM.ORG X 1972 WI EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER. 8 6 3959 905 14058757 0 488296 329170 617700290 697858650 1511217 747027 16465135 10386752 636164938 709321599 0 0 0 0 341409652 326399372 0 0 0 246570241 300696719 587979893 627096091 48185045 82225508 660376487 776760147 349779868 376803990 310596619 399956157 X THE MISSION OF MERCY HEALTH SYSTEM CORPORATION (MHSC) IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER. 0 0 506885654 682955752 HOSPITAL DISCHARGES 7,188, NURSING HOME ADMISSIONS 203, BIRTHS 859, OUTPATIENT VISITS 1,048,718.MHSC CONTINUES ITS TRADITION OF GIVING BACK TO EACH OF THE COMMUNITIES WE SERVE IN A WIDE VARIETY OF FASHIONS. ONE OF THE LARGER AREAS OF CONTRIBUTION IS IN THE AREA OF PUBLIC HEALTH SERVICES. THIS INCLUDES EXTENSIVE DONATIONS OF TIME AND SUPPLIES TO HEALTHNET OF ROCK COUNTY, A LARGE FREE PRIMARY CARE CLINIC SERVING THE REGION. MORE THAN EIGHTY PERCENT OF THE PHYSICIAN SERVICES PROVIDED AT THE CLINIC ARE SUPPLIED THROUGH MHSC. WE HAVE A SIMILAR COMMITMENT TO OPEN ARMS FREE CLINIC THAT SERVICES LOW INCOME RESIDENTS IN WALWORTH COUNTY. ADDITIONALLY, WE PROVIDE HEALTH SCREENING AND RELATED SERVICES AT NUMEROUS EVENTS IN ROCK AND WALWORTH COUNTIES IN WISCONSIN AND MCHENRY COUNTY IN ILLINOIS.MHSC ALSO PROVIDES FINANCIAL AND IN KIND CONTRIBUTIONS TO OTHER PRIVATE AND NOT FOR PROFIT HEALTH RELATED AGENCIES AND ORGANIZATIONS IN OUR SERVICE AREA. BENEFICIARIES INCLUDED BUT ARE NOT LIMITED TO THE AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, UNITED WAY ORGANIZATIONS IN ROCK, WALWORTH, AND MCHENRY COUNTIES, YWCA CARE HOUSE, YMCA, AMERICAN LUNG ASSOCIATION, WALWORTH COUNTY ALLIANCE FOR CHILDREN, TURNING POINT WOMEN'S CENTER IN MCHENRY, OPEN ARMS FREE CLINIC, AND THE RED CROSS, TO NAME JUST A FEW RECIPIENTS.MHSC ALSO ENCOURAGES ITS PARTNERS (EMPLOYEES) TO DONATE THEIR TIME AND ENERGY TO SUPPORT A WHOLE HOST OF COMMUNITY BASED CAUSES. THOUSANDS OF HOURS EACH YEAR ARE DONATED TO NOT FOR PROFIT AND PUBLIC AGENCIES THROUGHOUT OUR SERVICE AREA. EXAMPLES OF VOLUNTEER ACTIVITIES BEING SUPPORTED INCLUDE NURSING SERVICES AT COMMUNITY AND FREE CLINICS THROUGHOUT THE REGION, MEALS ON WHEELS DELIVERY ACTIVITIES, ACTIVE INVOLVEMENT AS GOVERNING BOARD MEMBERS FOR SUCH ORGANIZATIONS AS UNITED WAY, CRIME STOPPERS, ROTARY BOTANICAL GARDENS, HEALTHNET, AND MANY OTHER ORGANIZATIONS.ANOTHER EXAMPLE OF MHSC'S COMMITMENT TO COMMUNITY IS ITS SUPPORT OF THE OPERATIONS THROUGH OFFERING SAFE RESIDENCE TO HOMELESS WOMEN AND THEIR CHILDREN AT THE HOUSE OF MERCY HOMELESS CENTER. IT OPENED IN 1996 AND SERVES ABOUT 255 INDIVIDUALS A YEAR, MANY WHO ARE CHILDREN. THE CENTER OFFERS A SAFE HARBOR FOR THESE INDIVIDUALS AS WELL AS CASE MANAGEMENT, ASSISTANCE WITH JOB SEARCHES, FINDING PERMANENT HOUSING AND EDUCATION. 506885654 1 1 1 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 267 0 1 3959 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 8 6 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 IL WI X TODD ANDERSON VP & CFO 8159716738 2400 N ROCKTON AVE ROCKFORD IL 61103 JAVON R BEA PRESIDENT & DIRECTOR (SEE PAGES 70-73) 60.00 7.00 X X 5057986 0 7074160 MARK L GOELZER MD DIRECTOR/PHYSICIAN 40.00 6.00 X 501965 0 29148 ROWLAND J MCCLELLAN CHAIR & DIRECTOR 1.00 6.00 X X 15634 0 0 WESLEY M JOST DIRECTOR 1.00 6.00 X 15557 0 0 THOMAS D BUDD TREASURER & SECRETARY 1.00 6.00 X X 15308 0 0 DAVE L SYVERSON DIRECTOR 1.00 6.00 X 15110 0 0 KATHERINE A SCHACK DIRECTOR 1.00 6.00 X 15000 0 0 THOMAS R POOL VICE CHAIR & DIRECTOR 1.00 6.00 X X 15000 0 0 TODD ANDERSON VICE PRESIDENT/CFO (AS OF 05/2020) 55.00 7.00 X 542858 0 18158 E PATRICK CRANLEY VICE-PRESIDENT 55.00 X 358650 0 54174 JOANNA BENNING VICE-PRESIDENT 55.00 X 382092 0 28148 RUTH M YARBROUGH VICE-PRESIDENT 55.00 X 388822 0 20526 JOEL PRAH VICE-PRESIDENT 55.00 X 364931 0 35811 DEBRA A POTEMPA VICE-PRESIDENT 55.00 X 356782 0 30363 JENNIFER A HALLETT VICE-PRESIDENT 55.00 X 338657 0 39333 BARBARA J BORTNER FORMER VICE-PRESIDENT 55.00 X 319547 0 47359 SHANNON DUNPHY - ALEXANDER SR EXECUTIVE DIRECTOR 55.00 7.00 X 313241 0 15917 KIMBERLY SCACCIA VP - REVENUE CYCLE (AS OF 03/2020) 40.00 7.00 X 299091 0 21962 THOMAS R JENSEN VICE-PRESIDENT 55.00 X 232370 0 26808 LADD UDY VICE-PRESIDENT 55.00 X 200526 0 35614 KATHLEEN S HARRIS VICE-PRESIDENT 55.00 X 137287 0 11150 JAMES DAVIS VICE-PRESIDENT 40.00 X 72740 0 7312 SHAHID SHEKHANI MD PHYSICIAN 40.00 X 2135113 0 49689 DOUGLAS H BRYAN MD PHYSICIAN 40.00 X 1665738 0 22442 YASMIN HUSSAIN MD PHYSICIAN 40.00 X 1481223 0 21236 DAVID D NELSEN MD PHYSICIAN 40.00 X 1275779 0 40644 IMDAD AHMED MD PHYSICIAN 40.00 X 1225881 0 27637 PAUL T VAN DEN HEUVEL FORMER VICE PRESIDENT (THROUGH 04/2020) 0.00 0.00 X 240858 0 27557 17983746 0 7685148 516 1 1 0 COMPHEALTH ASSOCIATES PO BOX 972651 DALLAS TX 753972651 PHYSICIAN SERVICES 3943692 VJS CONSTRUCTION SERVICES INC W233 N2847 ROUNDY CIRCLE WEST PEWAUKEE WI 53072 HYBRID OR & CLINIC BUILDING EXPANSION 3493674 EPIC SYSTEMS CORP 1979 MILKY WAY VERONA WI 53593 SOFTWARE/SYSTEM MAINTENANCE 3087535 LAB CORP OF AMERICA HOLDINGS PO BOX 2240 BURLINGTON NC 272162140 LAB SERVICES 3085998 SIEMENS MEDICAL SOLUTIONS DEPT CH 14195 PALATINE IL 600554195 MAINTENANCE CONTRACTS FOR EQUIPMENT 1918495 42 197788 83906 47476 329170 PATIENT SERVICE REVENUE 621110 629693462 629693462 PHARMACY 561000 24331676 20488463 3843213 MERCYCARE EXPENSES 561000 10215544 10215544 PROVIDER RELIEF FUNDS 900099 8708791 8708791 CAFETERIA 722210 844141 844141 24065036 24065036 697858650 606760 606760 304898 76896 228002 228002 228002 17865545 32710 17718323 39665 147222 -6955 140267 140267 MERCYCARE INS OPERATIONS 900099 9137154 9137154 PREMIER REBATES 900099 1354759 1354759 MISCELLANEOUS REVENUE 900099 -333163 -333163 10158750 709321599 682955752 14058757 11977920 17816423 17816423 251252213 210476175 40776038 8755037 6549992 2205045 32964917 24662368 8302549 15610782 11637325 3973457 874494 874494 67475 67475 1112876 151794 961082 1571844 48619 1523225 4952930 2305615 2647315 2447585 920263 1527322 5584679 2677553 2907126 738612 285082 453530 142784 31372 111412 7775905 5840246 1935659 27105320 20352913 6752407 16579619 12932785 3646834 MEDICAL SUPPLIES 111889563 111538860 350703 BAD DEBTS 55406034 55406034 PURCHASED LABOR & CONTR 29409013 14681323 14727690 UNREL. BUS. INC. TAX 4157 4157 35033829 26387335 8646494 627096091 506885654 120210437 0 26314 26252 175701953 313096246 72842493 44534731 13626969 13569651 8854314 1719428 675885751 425357823 263689562 250527928 60776981 75625226 25720064 34857218 39137837 42803467 660376487 776760147 81450089 89291528 268329779 287512462 349779868 376803990 X 310596619 399956157 310596619 399956157 660376487 776760147 X 82225508 -203970 7338000 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 1 16598 16598 0 PART II-B, LINE 1: A PERCENTAGE OF THE 2021 WISCONSIN HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES WERE USED FOR LOBBYING. 27195509 27195509 336251689 188061050 148190639 4604366 4202672 401694 283611738 226308391 57303347 24222449 6785710 17436739 250527928 1147510 C DEFERRED COMPENSATION 74477716 F 75625226 OTHER RECEIVABLES 2814131 UNAMORTIZED DEBT ISSUE COSTS 1249780 PHYSICIAN LOAN RECIEVABLES 1471526 DUE FROM OTHER RELATED PARTIES 35395011 DUE FROM MERCYCARE HMO 183461 INTANGIBLE ASSETS 60750 OPERATING LEASE 1628808 42803467 DEFERRED COMPENSATION 74412067 PENSION LIABILITY -2330902 DISCRETIONARY 403B ACCRUAL 3625000 DISCRETIONARY 401K ACCRUAL 104526 DUE TO MERCY HEALTH CORPORATION 175525303 DUE TO THIRD PARTIES 4253723 ACCRUED LIABILITY UNDER SELF-INSURANCE PROGRAM 31451817 LEASE LIABILITY 470928 287512462 1 1 X 1 X 1 X 1 1 0 1 1 2352181 2352181 0.00410 67662909 35161729 32501180 0.05690 2139817 1269940 869877 0.00150 72154907 36431669 35723238 0.06250 1223687 122774 1100913 0.00190 5778718 1122117 4656601 0.00810 8084871 4899933 3184938 0.00560 0 0 271294 0 271294 0.00050 15358570 6144824 9213746 0.01610 87513477 42576493 44936984 0.07860 1 16723908 2727669 65868987 93795177 -27926190 X 1 1 2 1 MERCYHEALTH HOSPITAL AND TRAUMA CENTER-JANESVILLE 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 MERCYHEALTHSYSTEM.ORG/LOCATION/MERCYHE X X X X 2 MERCYHEALTH HOSPITAL AND MEDICAL CENTER-WALWORTH N2950 STATE ROAD 67 LAKE GENEVA WI 53147 MERCYHEALTHSYSTEM.ORG/LOCATION/MERCYHE X X X X MERCYHEALTH HOSPITAL AND TRAUMA CENTER-J 1 0 0 1 X X X X X X X X 19 1 0 0 1 X MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 1 19 1 MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 0 1 X 200.000000000000 300.000000000000 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 X X 1 X X X X X X 1 X 0 0 MERCYHEALTH HOSPITAL AND MEDICAL CENTER- 2 0 0 1 X X X X X X X 19 1 1 1 1 X MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 1 19 1 MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS 0 1 X 200.000000000000 300.000000000000 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 X X 1 X X X X X X 1 X 0 0 MERCYHEALTH HOSPITAL AND TRAUMA CENTER-JANESVILLE PART V, SECTION B, LINE 5: MERCYHEALTH CORPORATION CONDUCTED A COMMUNITY NEEDS ASSESSMENT DESIGNED TO IDENTIFY HEALTH AND QUALITY OF LIFE ISSUES IN ROCK COUNTY. A THIRTY-FOUR QUESTION SURVEY WAS DISTRIBUTED PRINT VERSION ON OCTOBER 21, 2019, TO 2,550 RANDOM HOUSEHOLDS IN JANESVILLE AND BELOIT AND WAS ALSO DISTRIBUTED BY SEVERAL ORGANIZATION IN ROCK COUNTY. THE SURVEY COVERED VARIOUS TOPICS, INCLUDING HEALTH ISSUES IN THE COMMUNITY, UNHEALTHY BEHAVIORS IN THE COMMUNITY, WELL-BEING, ACCESSIBILITY TO HEALTHCARE, AND HEALTHY BEHAVIORS. IT INCLUDED A BAR-CODE SO THAT THE SURVEY COULD BE ACCESSED ELECTRONICALLY VIA SURVEY MONKEY. A LINK TO THE SURVEY IN BOTH SPANISH AND ENGLISH WAS ALSO INCLUDED IN THE MERCYHEALTH HEALTH NEWS ON-LINE NEWSLETTER, THE MERCYHEALTH ROCK COUNTY FACEBOOK PAGE, AND THE MERCYHEALTH WIRE. A RESPONSE WAS RECEIVED FROM 389 HOUSEHOLDS. COMMUNITY LEADERS AND STAKEHOLDERS PARTICIPATED IN KEY INFORMANT INTERVIEWS. WITH THEIR PARTICULAR KNOWLEDGE AND UNDERSTANDING, THEY COULD PROVIDE INSIGHT ON THE NATURE OF PROBLEMS AND THEREBY FURTHER ENHANCE THE VERSATILITY OF THE DATA UTILIZED IN THIS SURVEY.A DETAILED ANALYSIS OF SECONDARY DATA WAS USED TO ASSESS THE COMMUNITY PROFILE, AND ITS HEALTH STATUS. SECONDARY DATA WAS DERIVED FROM A VARIETY OF PUBLICLY AVAILABLE SOURCES, INCLUDING THE UNITED STATES CENSUS BUREAU, AMERICAN COMMUNITY SURVEY; US BUREAU OF LABOR STATISTICS; COMMUNITY COMMONS; US DEPARTMENT OF HEALTH & HUMAN SERVICES, WISCONSIN OFFICE OF RURAL HEALTH AND WISCONSIN DEPARTMENT OF HEALTH SERVICES; UNIVERSITY OF WISCONSIN, POPULATION HEALTH INSTITUTE, COUNTY HEALTH RANKINGS 2019; AND CENTERS FOR DISEASE CONTROL & PREVENTION. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, AND KEY INFORMANT SURVEYS HELPED TO IDENTIFY CONCERNS RELATING TO THE HEALTH OF THE COMMUNITY, WHILE ASSESSING AREA-BASED PROGRAMS AND ORGANIZATIONS AVAILABLE TO ADDRESS THE COMMUNITY'S NEEDS. THESE NEEDS WERE PRIORITIZED BASED ON LEVEL OF IMPORTANCE TO THE COMMUNITY; IT PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF ROCK COUNTY AND THE COMMUNITY AS A WHOLE. MERCYHEALTH HOSPITAL AND MEDICAL CENTER-WALWORTH PART V, SECTION B, LINE 5: A RANGE OF PROVIDERS, POLICY-MAKERS, AND OTHER LOCAL EXPERTS AND COMMUNITY MEMBERS ("KEY INFORMANTS") PROVIDED RANKINGS OF THE MOST IMPORTANT PUBLIC HEALTH ISSUES FOR THE COUNTY BASED ON THE FOCUS AREAS PRESENTED IN WISCONSIN'S STATE HEALTH PLAN. ALONG WITH THE RANKINGS, KEY INFORMANTS PROVIDED ADDITIONAL INFORMATION ON THESE ISSUES RANGING FROM EXISTING OR ADDITIONAL STRATEGIES NEEDED, BARRIERS AND CHALLENGES TO ADDRESSING THE ISSUE, KEY GROUPS IN THE COMMUNITY THAT HOSPITALS SHOULD PARTNER WITH, AND THE WAYS AND MEANS TO TARGET EFFORTS.THESE FINDINGS WERE A CRITICAL SUPPLEMENT TO THE WALWORTH COUNTY COMMUNITY HEALTH SURVEY CONDUCTED THROUGH A PARTNERSHIP BETWEEN THE AURORA HEALTH CARE, CHILDREN'S WISCONSIN, FORT HEALTHCARE, MERCYHEALTH AND THE WALWORTH COUNTY DIVISION OF PUBLIC HEALTH. MERCYHEALTH HOSPITAL AND TRAUMA CENTER-JANESVILLE PART V, SECTION B, LINE 6A: MHTC/JANESVILLE HOSPITAL - ROCK COUNTY RESPONSE IS NOWALWORTH HOSPITAL -WALWORTH CO RESPONSE IS YES. MERCYHEALTH HOSPITAL AND MEDICAL CENTER-WALWORTH PART V, SECTION B, LINE 6A: AURORA HEALTH CARE, CHILDREN'S WISCONSIN, AND FORT HEALTHCARE. MERCYHEALTH HOSPITAL AND TRAUMA CENTER-JANESVILLE PART V, SECTION B, LINE 6B: JANESVILLE/MHTC - NOWALWORTH HOSPITAL-YES MERCYHEALTH HOSPITAL AND MEDICAL CENTER-WALWORTH PART V, SECTION B, LINE 6B: WALWORTH COUNTY DIVISION OF PUBLIC HEALTH. MERCYHEALTH HOSPITAL AND TRAUMA CENTER-JANESVILLE PART V, SECTION B, LINE 11: CONSISTENT WITH THE ROCK AND WALWORTH COUNTY COMMUNITY NEEDS ASSESSMENT ACTION PLANS, MHSC CONTINUES TO ROLL OUT ITS IMPLEMENTATION PLANS. MHSC'S PLAN IN ROCK COUNTY IS TO IMPROVE THE HEALTH OF PATIENTS WITH MENTAL HEALTH, SUBSTANCE ABUSE, AND ALCOHOL ABUSE ISSUES THROUGH INCREASED ACCESS TO EDUCATION AND CARE FOR THESE PATIENTS. TO THIS END, MHSC CONTINUES TO DEVELOP AND OFFER VARIOUS ACCESS SITES, MONITORS ITS CURRENT PROGRAMS, AND PARTNERS WITH LOCAL AGENCIES TO PROVIDE EDUCATION AND SUPPORT FOR PATIENTS AND THEIR FAMILIES. MHSC IS WORKING TO REDUCE THE LIKELIHOOD OF OPIOID ADDITION BEGINNING AND/OR CONTINUING. MHSC'S PLAN IS TO IMPROVE THE PHYSICAL HEALTH OF PATIENTS THROUGH EDUCATION AND SUPPORT/SPONSORSHIP OF ATHLETIC EVENTS OR PROGRAMS THAT PROMOTE PHYSICAL ACTIVITY IN THE COMMUNITY. MHSC ESTABLISHED A PROJECT SEARCH PROGRAM THAT PROVIDES JOB TRAINING AND EMPLOYMENT OPPORTUNITIES TO DISABLED YOUNG ADULT COMMUNITY MEMBERS.IN RESPONSE TO COVID-19 AND TO EFFECTIVELY CARE FOR THE NEEDS OF THE COMMUNITY, MHSC PROVIDED ALTERNATIVE EDUCATION TO EMERGENCY MEDICAL SERVICE (EMS) PERSONNEL FOR ENHANCED SAFETY AND TREATMENT PROTOCOLS. MHSC EXPANDED TELEMEDICINE SERVICES TO INCREASE VIRTUAL ACCESS FOR OUR PATIENTS AND ALLOW EMS CREWS TO BE AVAILABLE FOR THOSE WITH CRITICAL ILLNESSES. MHSC PROVIDED COMMUNITY EDUCATION VIDEOS ADDRESSING COVID-19 QUESTIONS AND CONCERNS ALONG WITH HOW TO SAFELY WEAR A MASK.MHSC PARTNERS WITH MULTIPLE COMMUNITY BASED ORGANIZATIONS IN ROCK AND WALWORTH COUNTY TO ACCOMPLISH SUCCESSFUL IMPLEMENTATION OF THESE STRATEGIES. DURING THE COURSE OF THIS TAX YEAR 2020 (FISCAL YEAR JULY 1, 2020-JUNE 30, 2021), AND THE PRIOR TAX YEARS, MHSC PARTICIPATED IN NUMEROUS COMMUNITY HEALTH FAIRS, PROVIDED FREE SCREENINGS AT OUR CLINICS AND IN CONJUNCTION WITH COMMUNITY BASED ORGANIZATIONS, OFFERED SCREENINGS TO FREE AND SLIDING FEE SCHEDULE PRIMARY CARE CLINICS, AND SCHOOL DISTRICTS IN BOTH COUNTIES. MHSC 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. MERCYHEALTH HOSPITAL AND MEDICAL CENTER-WALWORTH PART V, SECTION B, LINE 11: CONSISTENT WITH THE ROCK AND WALWORTH COUNTY COMMUNITY NEEDS ASSESSMENT ACTION PLANS, MHSC CONTINUES TO ROLL OUT ITS IMPLEMENTATION PLANS. IN RESPONSE TO COVID-19 AND TO EFFECTIVELY CARE FOR THE NEEDS OF THE COMMUNITY, MHSC PROVIDED ALTERNATIVE EDUCATION TO EMERGENCY MEDICAL SERVICE (EMS) PERSONNEL FOR ENHANCED SAFETY AND TREATMENT PROTOCOLS. MHSC EXPANDED TELEMEDICINE SERVICES TO INCREASE VIRTUAL ACCESS FOR OUR PATIENTS AND ALLOW EMS CREWS TO BE AVAILABLE FOR THOSE WITH CRITICAL ILLNESSES. MHSC PROVIDED COMMUNITY EDUCATION VIDEOS ADDRESSING COVID-19 QUESTIONS AND CONCERNS ALONG WITH HOW TO SAFELY WEAR A MASK.WALWORTH COUNTY'S PLAN IS TO IMPROVE THE GENERAL HEALTH OF INDIVIDUALS LIVING IN WALWORTH COUNTY. MHSC CONTINUES TO DEVELOP AND OFFER VARIOUS ACCESS SITES FOR PRIMARY AND SPECIALTY CARE SERVICES, PROACTIVELY MANAGES MEDICARE POPULATION THROUGH ACO INITIATIVES FOCUSED ON PREVENTIVE CARE, AND PROVIDES HEALTH EDUCATION AND AWARENESS (WITH EMPHASIS TOWARD SCREENING, IMMUNIZATIONS, AND VACCINATIONS). IT IS MHSC'S PLAN TO IMPROVE THE HEALTH STATUS OF INDIVIDUALS WITH CHRONIC ILLNESS AND PROMOTE HEALTHY LIFESTYLES AND TO IMPROVE THE HEALTH OF PATIENTS WITH SPECIFIC NEEDS, SUCH AS GERIATRIC SERVICES AND ALCOHOL AND SUBSTANCE ABUSE. AS IN ROCK COUNTY, MHSC IS LOOKING TO REDUCE THE LIKELIHOOD OF OPIOID ADDICTION BEGINNING AND/OR CONTINUING. IT WILL MONITOR AND INCREASE TESTING, PROVIDE SMOKING CESSATION MATERIALS AND PROGRAMS, PROVIDE FREE BLOOD PRESSURE CHECKS, AND PROMOTE SERVICES FOR SPECIAL NEEDS OF ELDERLY OR THOSE SUFFERING FROM ABUSE ISSUES.MHSC PARTNERS WITH MULTIPLE COMMUNITY BASED ORGANIZATIONS IN ROCK AND WALWORTH COUNTY TO ACCOMPLISH SUCCESSFUL IMPLEMENTATION OF THESE STRATEGIES. DURING THE COURSE OF THIS TAX YEAR 2020 (FISCAL YEAR JULY 1, 2020-JUNE 30, 2021), AND THE PRIOR TAX YEARS, MHSC PARTICIPATED IN NUMEROUS COMMUNITY HEALTH FAIRS, PROVIDED FREE SCREENINGS AT OUR CLINICS AND IN CONJUNCTION WITH COMMUNITY BASED ORGANIZATIONS, OFFERED SCREENINGS TO FREE AND SLIDING FEE SCHEDULE PRIMARY CARE CLINICS, AND SCHOOL DISTRICTS IN BOTH COUNTIES. MHSC 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. 48 1 - MERCYHEALTH TRANSITION CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 SKILLED NURSING/SUB-ACUTE CARE FACILITY 2 - MERCYHEALTH REGIONAL CANCER CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 RADIATION ONCOLOGY CLINIC/RADIATION THERAPY FACILITY 3 - HOUSE OF MERCY HOMELESS CENTER 320 LINCOLN STREET JANESVILLE WI 53548 HOMELESS CENTER 4 - MERCYHEALTH ALGONQUIN 2401 HARNISH DRIVE SUITE 101 ALGONQUIN WI 60102 OUTPATIENT PHYSICIAN CLINIC 5 - MERCYHEALTH BARRINGTON 500 WEST HIGHWAY 22 BARRINGTON IL 60010 OUTPATIENT PHYSICIAN CLINIC 6 - MERCYHEALTH BELOIT 2825 PRAIRIE AVENUE BELOIT WI 53511 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY 7 - MERCYHEALTH BRODHEAD 2310 FIRST CENTER AVENUE BRODHEAD WI 53520 OUTPATIENT PHYSICIAN CLINIC 8 - MERCYHEALTH MCHENRY EYE CENTER 406 N FRONT ST SUITE C MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC 9 - MERCYHEALTH EAST 3524 EAST MILWAUKEE STREET JANESVILLE WI 53546 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY 10 - MERCYHEALTH EAST PHARMACY 3524 EAST MILWAUKEE STREET JANESVILLE WI 53546 RETAIL PHARMACY 11 - MERCYHEALTH SOUTH 849 KELLOGG AVENUE JANESVILLE WI 53546 RESIDENCY PROGRAM / OUTPATIENT PHYSICIAN CLINIC 12 - MERCYHEALTH WEST 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC & MEDICAL ONCOLOGY 13 - MERCYHEALTH WEST PHARMACY 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 RETAIL PHARMACY 14 - MERCYHEALTH CRYSTAL LAKE CHIROPRACTIC 330 W TERRA COTTA ROAD RTE 176 CRYSTAL LAKE IL 60014 CHIROPRACTOR 15 - MERCYHEALTH CRYSTAL LAKE EAST 390 CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC 16 - MERCYHEALTH CRYSTAL LAKE OBGYN 750 E TERRA COTTA STE B CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC 17 - MERCYHEALTH CRYSTAL LAKE SOUTH 415-A CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC 18 - MERCYHEALTH DELAVAN 1038 E GENEVA STREET DELAVAN WI 53115 OUTPATIENT PHYSICIAN CLINIC 19 - MERCYHEALTH EDGERTON 217 N MAIN STREET EDGERTON WI 53534 OUTPATIENT PHYSICIAN CLINIC 20 - MERCYHEALTH EVANSVILLE 300 UNION STREET EVANSVILLE WI 53536 OUTPATIENT PHYSICIAN CLINIC 21 - MERCYHEALTH HARVARD SOUTH 348 S DIVISION HARVARD IL 60033 OUTPATIENT PHYSICIAN CLINIC 22 - MERCYHEALTH MALL 1010 NORTH WASHINGTON JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY 23 - MERCYHEALTH MALL PHARMACY 1010 NORTH WASHINGTON JANESVILLE WI 53548 RETAIL PHARMACY 24 - MERCYHEALTH LAKE GENEVA 350 PELLER ROAD LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC 25 - MERCYHEALTH LAKESIDE ORTHOPEDICS 352 PELLER ROAD LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC 26 - MERCYHEALTH MCHENRY 3922 MERCY DRIVE MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC 27 - MERCYHEALTH MILTON 725 SOUTH JANESVILLE STREET MILTON WI 53563 OUTPATIENT PHYSICIAN CLINIC 28 - MERCYHEALTH MILTON PHARMACY 725 SOUTH JANESVILLE STREET MILTON WI 53563 RETAIL PHARMACY 29 - MERCYHEALTH NORTHWEST WOMEN'S GROUP 47 WEST ACORN LANE LAKE IN THE HILLS IL 601564804 OUTPATIENT PHYSICIAN CLINIC 30 - MERCYHEALTH BEHAVIORAL HEALTH CLINIC 903 MINERAL POINT AVENUE JANESVILLE WI 53548 PHYSICIAN & THERAPIST SERVICES: MENTAL HEALTH & ADDICTION TREATMENT 31 - MERCYHEALTH DIALYSIS CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 DIALYSIS CENTER 32 - MERCYHEALTH LUNG CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 PHYSICIANS CLINIC & SLEEP DISORDER CENTER 33 - MERCYHEALTH RICHMOND 9715 PRAIRIE RIDGE RICHMOND IL 60071 OUTPATIENT PHYSICIAN CLINIC 34 - MERCYHEALTH SPORTS MEDICINE AND REHAB 557 NORTH WASHINGTON JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC AND REHABILITATION FACILITY 35 - MERCYHEALTH TERRACE 510 N TERRACE STREET JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC 36 - MERCYHEALTH WHITEWATER 507 WEST MAIN STREET WHITEWATER WI 53190 OUTPATIENT PHYSICIAN CLINIC 37 - MERCYHEALTH SPORTS MEDICINE & REHAB 519 WEST MAIN STREET WHITEWATER WI 53190 OUTPATIENT PHYSICIAN CLINIC AND REHABILITATION FACILITY 38 - MERCYHEALTH WOODSTOCK 2000 LAKE AVENUE WOODSTOCK IL 60098 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY 39 - MERCYHEALTH WOODSTOCK PHARMACY 2000 LAKE AVENUE WOODSTOCK IL 60098 RETAIL PHARMACY 40 - MERCYHEALTH ELKHORN 839 N WISCONSIN STREET ELKHORN WI 53121 OUTPATIENT PHYSICIAN CLINIC 41 - MERCYCARE BUILDING 580 N WASHINGTON STREET JANESVILLE WI 53548 AUTISM PROGRAM/EMS TRAINING 42 - MERCYHEALH SLEEP DISORDERS CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC/SLEEP STUDY CENTER 43 - MERCYHEALTH WALWORTH N2950 STATE ROAD 67 LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC 44 - MERCYHEALTH WALWORTH PHARMACY N2950 STATE ROAD 67 LAKE GENEVA WI 53147 RETAIL PHARMACY 45 - MERCYHEALTH BEHAVIORAL HEALTH CLINIC N2846 STATE ROAD 67 WILLIAMS BAY WI 53191 OUTPATIENT PHYSICIAN CLINIC 46 - MERCYHEALTH NORTH 3400 DEERFIELD DR JANESVILLE WI 53546 OUTPATIENT PHYSICIAN CLINIC 47 - MERCY CRYSTAL LAKE PHYSICAL THERAPY 741 MCHENRY AVE STE E CRYSTAL LAKE IL 60014 OUTPATIENT THERAPY CLINIC 48 - MERCYHEALTH CHILD & ADOLESCENT TREATMENT 2600 HUMES RD STE 100 JANESVILLE WI 53545 CHILD AND ADOLESCENT DAY TREATMENT/MENTAL HEALTH CENTER PART I, LINE 3C: MERCY HOSPITALS 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. PART I, LINE 6A: MERCY HEALTH SYSTEM, CORP (MHS) SUBMITS AN ANNUAL COMMUNITY BENEFIT STATEMENT TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). PERIODICALLY, IT PUBLISHES A PAMPHLET EXPLAINING THE COMMUNITY BENEFITS THAT MERCY HEALTH SYSTEM CORP, AND THE RELATED ORGANIZATIONS OF MHS PROVIDE TO THE COMMUNITIES THEY SERVE. MHS HAS SUPPLIED SUPPLEMENTAL COMMUNITY BENEFIT STATEMENT INFORMATION WITH ITS 990 TAX RETURN SINCE FISCAL YEAR 2006 (TAX FORM 2005). PART I, LINE 7: 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; HEALTH PROFESSIONS EDUCATION; SUBSIDIZED HEALTH SERVICES; CASH AND IN-KIND CONTRIBUTIONS) WERE DETERMINED USING ACTUAL DEPARTMENT/SERVICE SPECIFIC DATA AND /OR COST ACCOUNTING DERIVED DATA. PART I, LN 7 COL(F): BAD DEBT OF $55,406,034 WAS NOT INCLUDED AS AN EXPENSE WHEN CALCULATING THE PERCENTAGE IN THIS COLUMN. PART III, LINE 2: THE COST OF BAD DEBT ON LINE 2, PART III, WAS DETERMINED BY APPLYING THE COST-TO-CHARGE RATIO TO THOSE CHARGES ESTIMATED AND EXPENSED AS UNCOLLECTIBLE. PART III, LINE 3: THE ESTIMATE OF BAD DEBT DOLLARS THAT MAY HAVE BEEN COVERED THROUGH MERCY HEALTH SYSTEM CORP.'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 16.31%. THIS FIGURE WAS BASED ON THE PERCENT OF BAD DEBT ACCOUNT DOLLARS THAT ARE RECLASSIFIED FOR CHARITY AND/OR BANKRUPTCY PURPOSES. 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, INC. MERCY HEALTH CORPORATION, INC. IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORP.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 ADJUSTMENT, 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.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 2021 AND 2020.THE CORPORATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. PART III, LINE 8: DATA FOR LINES 5 & 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MERCY HEALTH SYSTEM CORP'S TWO MEDICARE COST REPORTS (MERCY HOSPITAL AND TRAUMA CENTER-JANESVILLE, AND MERCY WALWORTH HOSPITAL). PART III, LINE 9B: PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MERCY HEALTH SYSTEM'S (MHS) COMMUNITY CARE PROGRAM, WILL RECEIVE A 25% DISCOUNT FROM MHS'S STANDARD FEE SCHEDULE. ALL SELF-PAY PATIENTS MEET WITH PATIENT FINANCIAL COUNSELORS AND DISCUSS PAYMENT OPTIONS INCLUDING MHS'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. PART VI, LINE 2: THE HOSPITALS OF MERCYHEALTH CORPORATION, INC. WORK IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF ROCK (WI), WALWORTH (WI), MCHENRY (IL) AND WINNEBAGO (IL) COUNTIES TO COMPLETE. COLLABORATIVE EXAMPLES OF MERCYHEALTH ORGANIZATIONS PROVIDING CARE TO THE COMMUNITY INCLUDE (BUT AREN'T LIMITED TO):I) THE COMMUNITY HEALTH CENTER AT MERCY CLINIC SOUTH: PARTNERSHIP WITH THE COMMUNITY HEALTH CENTER, INC. OF BELOIT, WI IN 2006. MERCY PARTNERED WITH COMMUNITY HEALTH CENTER, INC TO OPEN THIS CLINIC IN JANESVILLE. IT PROVIDES FREE AND LOW-COST CARE TO LOW-INCOME, UNINSURED AND UNDERINSURED PATIENTS.II) RONALD MCDONALD CARE MOBILE PROVIDES FREE DENTAL AND MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN IN FIVE NORTHERN ILLINOIS COUNTIES. SINCE ITS INCEPTION IN 2003, IT HAS PROVIDED CARE TO MORE THAN 7,500 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.III) 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 MERCY PHYSICIANS AND OTHER HEALTH CARE PROVIDERS VOLUNTEER THEIR SERVICES. IV) FAMILY HEALTH PARTNERSHIP CLINIC: MCHENRY COUNTY DEPARTMENT OF HEALTH COLLABORATION TO PROVIDE MAMMOGRAMS AT MERCY FACILITIES FOR WOMEN WHO CANNOT OTHERWISE AFFORD THE SERVICE. JAVON BEA HOSPITAL CONTINUES TO PARTNER WITH A SILVER LINING FOUNDATION TO PROVIDE SCREENING MAMMOGRAMS AND OTHER BREAST RELATED SERVICES.V) RED CROSS: BLOOD DRIVE AND COOPERATIVE VOLUNTEER EFFORTS.VI) UNITED WAY: FUNDRAISING CAMPAIGNVII) AREA POLICE AND FIRE DEPARTMENTS: PROVIDE FREE OR REDUCED-COST PARAMEDIC/EMT EDUCATIONAL OPPORTUNITIES.VIII) 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.) PART VI, LINE 3: 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. PART VI, LINE 4: MERCY HOSPITAL AND TRAUMA CENTER:MERCY HOSPITAL AND TRAUMA CENTER IS LOCATED IN JANESVILLE, WI: ROCK COUNTY. IT IS ONE OF TWO ACUTE CARE HOSPITALS IN JANESVILLE, WI. IT IS LICENSED FOR 240 ACUTE BEDS. IT HAS 24/7 EMERGENCY SERVICES, WITH A TRAUMA II DESIGNATION. IT IS A TEACHING HOSPITAL WITH A RESIDENCY PROGRAM.UNEMPLOYMENT IN ROCK COUNTY (2018) WAS AT 3.2% WHILE THE STATE (WI) AND THE NATION WERE AT 3% AND 3.9%, RESPECTIVELY. MEDIAN HOUSEHOLD INCOME (2018) WAS $57,037 IN ROCK COUNTY, WHICH IS LOWER THAN BOTH THE STATE'S $60,773 AND NATIONAL MEDIAN OF $61,937. IN 2018, 13.6% OF ROCK COUNTY RESIDENTS LIVED BELOW THE POVERTY LEVEL; THIS IS LARGER THAN THE STATE'S AVERAGE OF 11.9%, BUT LESS THAN THE NATIONAL AVERAGE OF 14.1%. MERCY WALWORTH HOSPITAL:MERCY WALWORTH HOSPITAL IS LOCATED IN LAKE GENEVA WI WHICH IS IN WALWORTH COUNTY, WI. IT IS A CRITICAL ACCESS HOSPITAL LICENSED FOR 25 ACUTE BEDS THAT PROVIDES 24/7 EMERGENCY SERVICES. PER THE US CENSUS, MEDIAN HOUSEHOLD INCOME FOR WALWORTH COUNTY (IN 2019 DOLLARS) 2015-2019 WAS $63,776; PERSONS IN POVERTY 9.5%. BOTH THESE INDICATORS ARE BETTER THAN THE STATE'S AVERAGE OF $61,747 AND 10.4%, RESPECTIVELY. HOWEVER, WALWORTH HAS A 8.2% RATE OF PERSONS WITHOUT HEALTH INSURANCE (UNDER AGE 65) WHEREAS THE STATE'S AVERAGE IS 6.8%.MERCY HEALTH SYSTEM CORP'S PAYOR DEMOGRAPHICS FOR ITS HOSPITALS INCLUDE 52.07% MEDICARE, AND 12.76% MEDICAID FOR THE FISCAL YEAR OF JULY 1, 2020 - JUNE 30, 2021 (AS DETERMINED BY CHARGES BILLED). PART VI, LINE 5: MERCY HEALTH SYSTEM CORP HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREAS. MERCY HEALTH SYSTEM CORP. HAS A GOVERNING BODY COMPRISED OF A MAJORITY OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY. PART VI, LINE 6: MERCY HEALTH SYSTEM CORPORATION HAS TWO HOSPITALS THAT PROVIDE ACUTE CARE SERVICES IN ROCK AND WALWORTH COUNTIES OF WISCONSIN. MERCY HEALTH SYSTEM CORP ALSO OPERATES COMMUNITY CLINICS LOCATED THROUGHOUT SIX COUNTIES OF WISCONSIN AND ILLINOIS. IT IS PART OF A LARGER INTEGRATED HEALTHCARE SYSTEM AND IS AFFILIATED WITH OTHER SEPARATELY REPORTED ORGANIZATIONS.MERCY HEALTH CORPORATION IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORPORATION, MERCY HARVARD HOSPITAL, INC., AND MERCY ASSISTED CARE INC. MERCY HARVARD HOSPITAL PROVIDES ACUTE CARE SERVICES IN MCHENRY COUNTY, ILLINOIS, ALONG WITH JAVON BEA HOSPITAL (ROCKFORD), ROCKFORD HEALTH PHYSICIANS, AND MERCYHEALTH VISITING NURSES ASSOCIATION. MERCY ASSISTED CARE PROVIDES HOME HEALTH SERVICES, HOSPICE, AND DME (DURABLE MEDICAL EQUIPMENT) SERVICES; THUS PROVIDING CONTINUATION OF CARE TO MERCY HEALTH SYSTEM 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 NOW SHELTERS AN AVERAGE OF 243 INDIVIDUALS PER YEAR, BASED ON THE PRIOR THREE YEARS.MERCY HOSPITAL ASSOCIATION OF VOLUNTEERS, INC. IS THE ORGANIZATION/TAX ENTITY OF MERCY'S VOLUNTEERS. VOLUNTEERS NUMBERED 905 IN CALENDAR YEAR 2020; THOUGH MANY WERE FURLOUGHED DUE TO COVID. 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. PART VI, LINE 7, REPORTS FILED WITH STATES WI,IL LINE 6 MHSC FILES A COMMUNITY BENEFIT REPORT WITH IN WI WITH THE WISCONSIN HOSPITAL ASSOCIATION. X X X X X 1 1 0 0 0 0 0 0 0 JAVON R BEA PRESIDENT & DIRECTOR (SEE PAGES 70-73) 1471858 0 0 0 3586128 0 7056412 0 17748 0 12132146 0 0 0 SHAHID SHEKHANI MD PHYSICIAN 2089613 0 0 0 45500 0 0 0 49689 0 2184802 0 0 0 DOUGLAS H BRYAN MD PHYSICIAN 1620238 0 0 0 45500 0 0 0 22442 0 1688180 0 0 0 YASMIN HUSSAIN MD PHYSICIAN 1435723 0 0 0 45500 0 0 0 21236 0 1502459 0 0 0 DAVID D NELSEN MD PHYSICIAN 1249529 0 0 0 26250 0 0 0 40644 0 1316423 0 0 0 IMDAD AHMED MD PHYSICIAN 1186881 0 0 0 39000 0 0 0 27637 0 1253518 0 0 0 TODD ANDERSON VICE PRESIDENT/CFO (AS OF 05/2020) 355005 0 182313 0 5540 0 0 0 18158 0 561016 0 0 0 MARK L GOELZER MD DIRECTOR/PHYSICIAN 355312 0 142289 0 4364 0 11400 0 17748 0 531113 0 0 0 E PATRICK CRANLEY VICE-PRESIDENT 252694 0 94267 0 11689 0 17762 0 36412 0 412824 0 0 0 JOANNA BENNING VICE-PRESIDENT 271387 0 110017 0 688 0 18521 0 9627 0 410240 0 0 0 RUTH M YARBROUGH VICE-PRESIDENT 268706 0 96454 0 23662 0 11400 0 9126 0 409348 0 0 0 JOEL PRAH VICE-PRESIDENT 279643 0 84075 0 1213 0 17407 0 18404 0 400742 0 0 0 DEBRA A POTEMPA VICE-PRESIDENT 260032 0 91132 0 5618 0 15855 0 14508 0 387145 0 0 0 JENNIFER A HALLETT VICE-PRESIDENT 242696 0 91636 0 4325 0 11400 0 27933 0 377990 0 0 0 BARBARA J BORTNER FORMER VICE-PRESIDENT 228599 0 89963 0 985 0 10800 0 36559 0 366906 0 0 0 SHANNON DUNPHY - ALEXANDER SR EXECUTIVE DIRECTOR 237151 0 75861 0 229 0 11400 0 4517 0 329158 0 0 0 KIMBERLY SCACCIA VP - REVENUE CYCLE (AS OF 03/2020) 227500 0 67625 0 3966 0 0 0 21962 0 321053 0 0 0 PAUL T VAN DEN HEUVEL FORMER VICE PRESIDENT (THROUGH 04/2020) 141873 0 66244 0 32741 0 17847 0 9710 0 268415 0 0 0 THOMAS R JENSEN VICE-PRESIDENT 167701 0 59774 0 4895 0 9454 0 17354 0 259178 0 0 0 LADD UDY VICE-PRESIDENT 154028 0 46378 0 120 0 8563 0 27051 0 236140 0 0 0 PART I, LINE 3 THE MHSC COMPENSATION COMMITTEE 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 2020. PART I, LINES 4A-B PAUL VAN DEN HEUVEL RECEIVED SEVERANCE OF $27,693 IN 2020 FROM THE ORGANIZATION. INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $2,627,335. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING FY2021 THAT WAS SPONSORED BY THE ORGANIZATION: JOANNA BENNING, E. PATRICK CRANLEY, DEBRA POTEMPA AND PAUL VAN DEN HEUVEL. THERE WERE NO AMOUNTS PAID TO ANY PARTICIPANTS DURING THE YEAR UNDER THE PLAN. PART II, LINE 1: 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 $3.3 BILLION IN FY2021. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 2.1 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,300+ 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 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. KRISTEN GOELZER FAMILY MEMBER OF MARK GOELZER, DIRECTOR 462967 EMPLOYMENT - PHYSICIAN 0 MADELINE BLOMGREN FAMILY MEMBER OF BARBARA J. BORTNER, VICE PRESIDENT 13077 EMPLOYMENT - MARKETING PR SPECIALIST 0 FORM 990, PART VI, SECTION A, LINE 1 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, SECTION A, LINE 2 FAMILY RELATIONSHIP: JAVON R. BEA (FATHER) & JOANNA BEA BENNING (DAUGHTER) FORM 990, PART VI, SECTION A, LINE 6 MERCY HEALTH CORPORATION (MHC) IS THE SOLE MEMBER OF MERCY HEALTH SYSTEM CORPORATION (MHSC). 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, 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 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 2020, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2019 CONFLICTS IDENTIFIED. MHC AND MHSC 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 B, LINE 15 THE MHCS COMPENSATION COMMITTEE 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 2020. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: OTHER PENSION RELATED CHANGES -1,755,000. CHANGES IN PENSION OBLIGATIONS OTHER THAN PENSION EXPENSE 9,093,000. 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 1 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 MERCY HEALTH CORPORATION 2400 N ROCKTON AVE ROCKFORD IL 61103 472158680 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 12B, II N/A 0 JAVON BEA HOSPITAL 2400 N ROCKTON AVE ROCKFORD IL 61103 362167847 HEALTHCARE IL 501(C)(3) LINE 3 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 MERCYHEALTH VISITING NURSES ASSOCIATION 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(C)(3) LINE 10 MERCY HEALTH CORPORATION 0 ROCKFORD HEALTH PHYSICIANS 2400 N ROCKTON AVE ROCKFORD IL 61103 363907436 HEALTHCARE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT AVE JANESVILLE WI 53548 391520130 MANAGEMENT OF UNION EMPLOYEES WI MERCY HEALTH SYSTEM CORPORATION C 11116 1.00000 1 MERCYCARE INSURANCE COMPANY 580 N WASHINGTON ST JANESVILLE WI 53546 391768192 INSURANCE WI MERCY HEALTH SYSTEM CORPORATION C 88241189 1.00000 1 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 580 N WASHINGTON ST JANESVILLE WI 53546 201482553 INSURANCE WI MERCY HEALTH SYSTEM CORPORATION C 1.00000 1 ROCKFORD HEALTH INSURANCE LTD WELLESLEY HOUSE SO 2ND FL PEMBROKE HM BD INSURANCE BD N/A C 0 1 0 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 1 MERCYCARE INSURANCE COMPANY Q 10215544 COST OF SERVICES PROVIDED MERCY ASSISTED CARE INC A 101815 COST OF PROPERTY PROVIDED MERCYCARE INSURANCE COMPANY A 117316 COST OF PROPERTY PROVIDED