2017-11-14T14:00:38-06:00 2016-12-31 440160260 BKD LLP 312 Walnut Street Suite 300 Cincinnati OH 45202 990 2016-01-01 310785684 Community Mercy Health Partners COMM 9373287000 100 Medical Center Drive Springfield OH 455031832 William Kusnierz Region CFO 2017-11-07 true Aaron Hershberger P00961884 5136218300 2016 2017-02-10 21:41:12Z Springfield Regional Medical Center MATTHEW CALDWELL PRESIDENT & CEO 100 Medical Center Drive Springfield OH 455031832 303525092 false 0928 X WWW.COMMUNITY-MERCY.ORG X 1983 OH THE MISSION OF COMMUNITY MERCY HEALTH PARTNERS IS TO EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. 12 11 2640 1000 0 0 688399 640679 297008842 298370080 1818989 2000456 2835859 2513877 302352089 303525092 67236 16466 0 125855951 134612424 0 0 163912823 165936840 289836010 300565730 12516079 2959362 408504569 403949224 188278746 179133887 220225823 224815337 THE MISSION OF COMMUNITY MERCY HEALTH PARTNERS IS TO CARRY OUT THE MERCY HEALTH MISSION WITHIN OUR COMMUNITY BY PROVIDING SAFE, EFFECTIVE, PATIENT/RESIDENT CENTERED, TIMELY AND COST EFFICIENT CARE AND EDUCATION TO MEET THE HEALTH NEEDS OF ALL PEOPLE, ESPECIALLY THE POOR AND UNDER-SERVED. OUR COMMITMENT TO THIS HEALING MINISTRY WILL BE EVIDENCED BY EXCEPTIONAL CARE, COMPASSION, AND RESPECT FOR THE DIVERSE RELIGIOUS BELIEFS AND FAITH TRADITIONS OF THOSE WE SERVE. false false 263910670 16466 298370080 COMMUNITY MERCY HEALTH PARTNERS IS COMMITTED TO DELIVERING EXCEPTIONAL CARE AND COMPASSION AS IT SEEKS TO MEET THE HEALTH CARE NEEDS OF ALL PEOPLE, ESPECIALLY THE POOR AND UNDER-SERVED. DURING 2016 COMMUNITY MERCY HEALTH PARTNERS PROVIDED $12,815,116 IN NET COMMUNITY BENEFITS REPRESENTING 4.3% OF TOTAL OPERATING EXPENSES. 263910670 true true false true false false false false false false true true false false true true false true false false false false false false false false true true false false true false false false false false false false true false false false false true true false false false true 0 0 2640 true false false false false false false false false false false X 12 11 true false false false true true true true true false false true true true true true true true true true true X TRAVIS CRUM 5139525000 1701 Mercy Health Place CINCINNATI OH 45237 PIUS KURIAN MD CHAIR 1.0 1.5 X X 0 0 0 JOSEPH R JACKSON VICE CHAIR 1.0 1.5 X X 0 0 0 WENDY H DOOLITTLE Secretary 1.0 1.5 X X 0 0 0 JAMES N DOYLE TRUSTEE (OFF 2/16) 1.0 1.5 X 0 0 0 RAVI C KHANNA MD TRUSTEE 1.0 1.5 X 0 0 0 MARK B ROBERTSON TRUSTEE 1.0 1.5 X 0 0 0 REV DARRYL L GRAYSON TRUSTEE 1.0 1.5 X 0 0 0 KATHLEEN M HUGHES TRUSTEE (OFF 7/16) 1.0 1.5 X 0 0 0 WILLIAM H RAY TRUSTEE 1.0 2.5 X 0 0 0 SR CHERYL ERB RSM TRUSTEE 0.5 3.0 X 0 0 0 BRIAN SMITH TRUSTEE (BEGIN 5/16), EVP & COO, MERCY HEALTH 1.0 47.5 X 0 1036023 74867 Surender NERAVETLA MD TRUSTEE 1.0 1.5 X 0 0 0 DEANNA L BROUGHER TRUSTEE 1.0 1.5 X 0 0 0 JOHN STARCHER JR JD Trustee, President & CEO Mercy Health (END 5/16) 1.0 53.0 X 0 1685517 43882 JOSEPH MORMAN MD TRUSTEE 1.0 1.5 X 0 0 0 PAUL HILTZ Pres/CEO Springfield Region, SVP Mercy Health (END 12/16) 40.0 5.0 X 384006 0 134344 WILLIAM KUSNIERZ VP, CFO & TREASURER 40.0 1.5 X 0 329860 41142 MATTHEW CALDWELL Pres/CEO Springfield Region, SVP Mercy Health (BEGIN 12/16) 40.0 1.0 X 62805 0 3461 GARY HAGENS VP, COO - VPMA 40.0 0 X 357979 0 8312 SHERRY NELSON VP Chief Nursing Officer 40.0 0 X 261674 0 35151 DONALD B JOHNSON MD CHIEF CLINICAL OFFICER 40.0 0.5 X 298603 0 13419 JENELLE ZELINSKI ASSISTANT CFO 40.0 0 X 190675 0 35002 PAMELA ALLEN Director, Pharmacy 40.0 0 X 179650 0 20863 MICHELLE ADKINS DIRECTOR, CLINICAL SERVICES 40.0 0 X 165937 0 28983 MARYANN MCQUARRIE DIRECTOR, CLINICAL SERVICES 40.0 0 X 152955 0 17601 ELIZABETH PRICE SUPERVISOR NURSING 40.0 0 X 144923 0 18075 KATRINA ENGLISH FORMER KEY EMPLOYEE 0.0 56.5 X 0 306896 77373 2199207 3358296 552475 55 true true false 0 640679 640679 NET PATIENT SERVICE REVENUE 621990 296364137 296364137 INCOME FROM JV'S AND PARTNERSHIPS 900099 703872 703872 rental income from affiliates 531120 915840 915840 Intercompany 900099 386231 386231 0 0 0 0 298370080 547460 547460 0 0 1069030 383966 1069030 383966 1452996 1452996 CAFETERIA 722514 946132 946132 HITECH stimulus funds 900099 250630 250630 Other Revenues 900099 1317115 1317115 0 0 0 0 2513877 303525092 298370080 0 4514333 X 16466 16466 1559754 1325791 233963 108459103 92190237 16268866 5120565 4352480 768085 12095354 10281051 1814303 7377648 6271001 1106647 121918 121918 18294 18294 75947350 66450654 9496696 0 4355107 3701841 653266 7965845 6770968 1194877 565856 480978 84878 6714767 5707552 1007215 18031235 15326550 2704685 2008848 1707521 301327 Medical Supplies 37911094 37911094 state assessments 4375428 4375428 membership dues 498740 423929 74811 Dietary & laboratory supplies 5508247 5508247 1914111 1108882 805229 0 300565730 263910670 36655060 0 2908077 -47296 361987 203240 85529228 83956422 0 0 0 1642057 1824975 5819568 6486815 305039 419469 394356027 163748586 235614216 230607441 74691483 78952255 0 1632914 1545903 408504569 403949224 33717930 29982278 151171008 146907840 3389808 2243769 188278746 179133887 X 219720294 224307027 221553 224334 283976 283976 220225823 224815337 408504569 403949224 X 2959362 2676516 -1046364 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true false false false false true 1427 false false true 1775 3202 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING ACTIVITIES PERFORMED INCLUDE BOTH THE USE OF VOLUNTEERS ENCOURAGED TO WRITE LETTERS TO PUBLIC OFFICIALS ON ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE TO PROVIDE HEALTH SERVICES TO THE COMMUNITIES SERVED, AND THE USE OF PAID STAFF MEMBERS AND MANAGEMENT PERSONNEL. PAID MANAGEMENT PERSONNEL REGULARLY ISSUE MAILINGS TO LEGISLATORS ATTEMPTING TO INFLUENCE LEGISLATIVE MATTERS AND REFERENDUM, AND ORGANIZE AND HOST MEETINGS AMONG HOSPITAL EXECUTIVES AND THEIR LEGISLATORS REGARDING ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE PROVIDING HEALTHCARE SERVICES TO ITS PATIENTS AND TO CONTINUE IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. PAID STAFF MEMBERS HAVE, ON LIMITED OCCASIONS, WRITTEN TO LEGISLATORS ON SUCH ISSUES. THE PRIMARY PURPOSE FOR LOBBYING ACTIVITIES IS TO ENHANCE THE ORGANIZATION'S PUBLIC POSITION ON LEGISLATIVE AND REGULATORY ISSUES THAT IMPACT PATIENT CARE THROUGHOUT OUR SYSTEM. THE ORGANIZATION FOCUSES ON PUBLIC POLICY ISSUES THAT EXTEND OUR HEALING MINISTRY TO THOSE WHO ARE POOR AND UNDERSERVED IN THE COMMUNITIES WE SERVE. TO CARRY OUT THESE EFFORTS, THE ORGANIZATION PARTNERS WITH EXPERT CONSULTANTS AND PROFESSIONAL TRADE ASSOCIATIONS TO BUILD AWARENESS AND EXECUTE SPECIFIC STRATEGIES THAT WILL YIELD A FAVORABLE OUTCOME FOR PATIENT CARE IN THE ORGANIZATION'S FACILITIES WHERE THEY ARE TREATED. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING ACTIVITIES PERFORMED INCLUDE BOTH THE USE OF VOLUNTEERS ENCOURAGED TO WRITE LETTERS TO PUBLIC OFFICIALS ON ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE TO PROVIDE HEALTH SERVICES TO THE COMMUNITIES SERVED, AND THE USE OF PAID STAFF MEMBERS AND MANAGEMENT PERSONNEL. PAID MANAGEMENT PERSONNEL REGULARLY ISSUE MAILINGS TO LEGISLATORS ATTEMPTING TO INFLUENCE LEGISLATIVE MATTERS AND REFERENDUM, AND ORGANIZE AND HOST MEETINGS AMONG HOSPITAL EXECUTIVES AND THEIR LEGISLATORS REGARDING ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE PROVIDING HEALTHCARE SERVICES TO ITS PATIENTS AND TO CONTINUE IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. PAID STAFF MEMBERS HAVE, ON LIMITED OCCASIONS, WRITTEN TO LEGISLATORS ON SUCH ISSUES. THE PRIMARY PURPOSE FOR LOBBYING ACTIVITIES IS TO ENHANCE THE ORGANIZATION'S PUBLIC POSITION ON LEGISLATIVE AND REGULATORY ISSUES THAT IMPACT PATIENT CARE THROUGHOUT OUR SYSTEM. THE ORGANIZATION FOCUSES ON PUBLIC POLICY ISSUES THAT EXTEND OUR HEALING MINISTRY TO THOSE WHO ARE POOR AND UNDERSERVED IN THE COMMUNITIES WE SERVE. TO CARRY OUT THESE EFFORTS, THE ORGANIZATION PARTNERS WITH EXPERT CONSULTANTS AND PROFESSIONAL TRADE ASSOCIATIONS TO BUILD AWARENESS AND EXECUTE SPECIFIC STRATEGIES THAT WILL YIELD A FAVORABLE OUTCOME FOR PATIENT CARE IN THE ORGANIZATION'S FACILITIES WHERE THEY ARE TREATED. 24275076 24275076 240976746 68931103 172045643 128009438 94817483 33191955 1094767 1094767 230607441 MERCY HEALTH INVESTMENT MANAGEMENT PROGRAM 78952255 F 78952255 OTHER 2243769 2243769 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE COMPANY [MERCY HEALTH AND AFFILIATED ENTITIES] COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2016 AND 2015, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2016 OR 2015. true true X true X true X true true false true true 918257 918257 0 0.0 62801367 51558947 11242420 0.0374 0 0.0 0 0 63719624 52477204 11242420 0.0374 636029 -8142 644171 0.0021 841177 841177 0.0028 418889 353314 65575 0.0002 0 0.0 21973 200 21773 0.0001 0 0 1918068 345372 1572696 0.0052 0 0 65637692 52822576 12815116 0.0426 0 0.0 0 0.0 33322 33322 0.0001 625 625 0.0000 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 33947 0 33947 0.0001 false 25874034 0 56488834 58370652 -1881818 X true true Mercy Medical Office Condominium Association Real Property Management 0.496 0.0 0.504 Northpark Condominium Association Real Property Management 0.55 0.0 0.45 2 1 SPRINGFIELD REGIONAL MEDICAL CENTER 100 Medical Center Drive SPRINGFIELD OH 45504 www.mercy.com/springfield 1122AHR X X X A 2 MERCY MEMORIAL HOSPITAL 904 SCIOTO STREET URBANA OH 43078 www.mercy.com/springfield 1121AHR X X X X A A false false true X X X X X X X X X 16 true true true true X www.mercy.com/global/about-us/community-benefit X X true 17 true www.mercy.com/gobal/about-us/community-benefit false true X 200.0 400.0 X X X X X X true true X X X true X www.mercy.com/financial-assistance X www.mercy.com/financial-assistance X www.mercy.com/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - Springfield Regional Medical Center. SPRINGFIELD REGIONAL MEDICAL CENTER ("SRMC") PARTICIPATED IN A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS COORDINATED BY THE CLARK COUNTY CHNA STAKEHOLDER GROUP ("STAKEHOLDER GROUP" OR "GROUP"). THE STAKEHOLDER GROUP CONSISTED OF SRMC, CLARK COUNTY COMBINED HEALTH DISTRICT ("CCCHD"), MENTAL HEALTH AND RECOVERY BOARD OF CLARK, GREENE, AND MADISON COUNTIES, AND ROCKING HORSE CENTER. THE GROUP WORKED TOGETHER TO GATHER DATA AND ANALYZE THE CURRENT HEALTH CARE NEEDS IN THE REGION. REGIONAL DATA WAS ACCUMULATED THROUGH RANDOM ADULT TELEPHONE SURVEYS, A YOUTH RISK BEHAVIOR SURVEY WITHIN CLARK COUNTY LOCAL SCHOOLS, AND ORGANIZATIONAL SURVEYS DISTRIBUTED WITHIN THE COMMUNITY. THE SURVEYS TOOK PLACE BETWEEN MAY 2015 TO OCTOBER 2015. THE STAKEHOLDER GROUP USED THE COMMUNITY HEALTH ASSESSMENT AND GROUP EVALUATION (CHANGE) TOOL DEVELOPED BY THE CDC TO EVALUATE THE COMMUNITY-AT-LARGE. THE CHANGE TOOL WAS CONDUCTED AMONG SEVERAL AT-RISK NEIGHBORHOODS WITH THE MOST HEALTH DISPARITIES. CCCHD COMPLETED A "YOUTH RISK SURVEY COMPARISON CLARK 2015 VS. CLARK 2011 VS. OHIO 2011 VS. US 2011" IN OCTOBER 2015. SRMC AND MERCY MEMORIAL HOSPITAL SPONSORED A HEALTH CARE SUMMIT IN OCTOBER 2015. COMMUNITY LEADERS FROM CLARK AND CHAMPAIGN COUNTIES WERE INVITED TO IDENTIFY HEALTHCARE ISSUES WITHIN THE COMMUNITY. DATA WAS PRESENTED AT A LARGE COMMUNITY MEETING IN JANUARY 2016, AND COMMUNITY PARTNERS WERE ASSIGNED A TASK FORCE TO IDENTIFY NEEDS, OBJECTIVES, AND WORK PLANS. MORE THAN 20 LARGE COMMUNITY AND TASK FORCE MEETINGS WERE HELD BETWEEN MARCH 2016 TO JUNE 2016. ATTENDEES INCLUDED THOSE WHO PREDOMINANTLY SERVE THE POOR AND THE MOST AT-RISK POPULATIONS. MEMBERS OF THE FOLLOWING ORGANIZATIONS ATTENDED THE COMMUNITY AND TASK FORCE MEETINGS: ALZHEIMBER'S ASSOCIATION OF MIAMI VALLEY, CARESOURCE, CLARK COUNTY DEPARTMENT OF JOB & FAMILY SERVICES, CLARK COUNTY EMA, CLARK COUNTY JAIL, CLARK COUNTY JUVENILE COURT, CLARK STATE UNIVERSITY, COMMUNITY HEALTH FOUNDATION, FAMILY AND CHILDREN FIRST COUNCIL, MENTAL HEALTH AND RECOVERY BOARD OF CLARK, GREEN, AND MADISON COUNTIES, NATIONAL TRAILS AND PARK DISTRICT, OHIO HOUSE OF REPRESENTATIVES, OHIO STATE UNIVERSITY EXTENSION OFFICE, PARENT ADVOCACY CONNECTION, PLANNED PARENTHOOD AND FAMILIES, ROCKING HORSE CENTER, SPRINGFIELD CITY SCHOOL DISTRICT, SPRINGFIELD FOUNDATION, SPRINGFIELD SOUP KITCHEN, SPRINGFIELD YMCA, UNITED SENIOR SERVICES, UNITED WAY, URBAN LIGHT MINISTRIES, WITTENBERG UNIVERSITY, AND WRIGHT STATE UNIVERSITY. STATISTICS THAT WERE DEEMED TO BE CAUSING THE MOST HEALTH DISPARITIES AND AFFECTING INDIVIDUAL AREAS AND POPULATIONS THE MOST WERE ANALYZED SEPARATELY. THE STATISTICS ("CONCERNING STATISTICS") WERE GROUPED BY TOPIC, FOCUS, AND MEASURE ACCORDING TO THE COUNTY HEALTH RANKINGS SYSTEM, AND SCORED BY AREA, AGE, AND POPULATION. THE OVERALL SCORES WERE CALCULATED, AND THE HEALTH NEEDS WERE PRIORITIZED ACCORDINGLY. THE MOST SERIOUS ISSUES FACING THE COMMUNITY WERE IDENTIFIED TO BE: * SUBSTANCE ABUSE * MENTAL HEALTH * CHRONIC DISEASES * HEALTHY BIRTHS AND SEXUALITY * PHYSICAL ACTIVITY * NUTRITION * SMOKING CESSATION ACCESS TO CARE IS A CRITICAL COMPONENT FOR EACH ISSUE. Schedule H, Part V, Section B, Line 5 Facility A, 2 Facility A, 2 - MERCY MEMORIAL HOSPITAL. MERCY MEMORIAL HOSPITAL, A CRITICAL ACCESS HOSPITAL, PARTICIPATED IN A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS COORDINATED BY THE CHAMPAIGN COUNTY CHNA STAKEHOLDER GROUP ("STAKEHOLDER GROUP" OR "GROUP"). THE STAKEHOLDER GROUP CONSISTED OF MERCY MEMORIAL HOSPITAL, CHAMPAIGN COUNTY HEALTH DISTRICT, CHAMPAIGN COUNTY YMCA, AND CHAMPAIGN COUNTY DRUG FREE YOUTH COALITION. REGIONAL DATA WAS ACCUMULATED THROUGH RANDOM ADULT TELEPHONE SURVEYS, A YOUTH RISK BEHAVIOR SURVEY PERFORMED IN COLLABORATION WITH CHAMPAIGN COUNTY FAMILY AND CHIDLREN FIRST COUNCIL, AND ORGANIZATIONAL SURVEYS DISTRIBUTED WITHIN THE COMMUNITY. THE SURVEYS TOOK PLACE IN THE SPRING OF 2015. THE STAKEHOLDER GROUP USED THE COMMUNITY HEALTH ASSESSMENT AND GROUP EVALUATION (CHANGE) TOOL DEVELOPED BY THE CDC TO EVALUATE THE COMMUNITY-AT-LARGE. THE CHANGE TOOL WAS CONDUCTED AMONG SEVERAL AT-RISK NEIGHBORHOODS WITH THE MOST HEALTH DISPARITIES. ADDITIONALLY, CHAMPAIGN HEALTH DISTRICT PROVIDED DATA TO IDENTIFY LOCAL HEALTH NEEDS. SPRINGFIELD REGIONAL MEDICAL CENTER AND MERCY MEMORIAL HOSPITAL SPONSORED A JOINT HEALTH CARE SUMMIT IN OCTOBER 2015. COMMUNITY LEADERS FROM CLARK AND CHAMPAIGN COUNTIES WERE INVITED TO IDENTIFY HEALTHCARE ISSUES WITHIN THE COMMUNITY. DATA WAS PRESENTED AT A LARGE COMMUNITY MEETING IN JANUARY 2016, AND COMMUNITY PARTNERS WERE ASSIGNED A TASK FORCE TO IDENTIFY NEEDS, OBJECTIVES, AND WORK PLANS. MORE THAN 20 LARGE COMMUNITY AND TASK FORCE MEETINGS WERE HELD BETWEEN MARCH 2016 TO JUNE 2016, AND INCLUDED 31 RESPRESENTATIVES ASSIGNED TO SEVEN TASK FORCES. ATTENDEES INCLUDED THOSE WHO PREDOMINANTLY SERVE THE POOR AND THE MOST AT-RISK POPULATIONS. MEMBERS OF THE FOLLOWING ORGANIZATIONS ATTENDED THE COMMUNITY AND TASK FORCE MEETINGS: CHAMPAIGN COUNTY HEALTH DISTRICT, COMMUNITY HEALTH FOUNDATION, CONSOLIDATED CARE INC., CHAMPAIGN RESIDENTIAL SERVICES, INC., CHAMPAIGN COUNTY FAMILY AND CHILDREN FIRST COUNCIL, MENTAL HEALTH, DRUG & ALCOHOL SERVICES BOARD OF LOGAN AND CHAMPAIGN COUNTIES, MERCY WELL CHILD PEDIATRICS, SUICIDE PREVENTION COALITION OF LOGAN AND CHAMPAIGN COUNTIES, UNITED WAY OF CLARK, CHAMPAIGN, AND MADISON, URBANA CITY SCHOOLS, AND CHAMPAIGN FAMILY YMCA. STATISTICS THAT WERE DEEMED TO BE CAUSING THE MOST HEALTH DISPARITIES AND AFFECTING INDIVIDUAL AREAS AND POPULATIONS THE MOST WERE ANALYZED SEPARATELY. THE STATISTICS ("CONCERNING STATISTICS") WERE GROUPED BY TOPIC, FOCUS, AND MEASURE ACCORDING TO THE COUNTY HEALTH RANKINGS SYSTEM, AND SCORED BY AREA, AGE, AND POPULATION. THE OVERALL SCORES WERE CALCULATED, AND THE HEALTH NEEDS WERE PRIORITIZED ACCORDINGLY. THE MOST SERIOUS ISSUES FACING THE COMMUNITY WERE IDENTIFIED TO BE: * MENTAL HEALTH * HEALTHY LIVING * SUBSTANCE ABUSE * YOUNG CHILD WELLNESS ACCESS TO CARE IS A CRITICAL COMPONENT FOR EACH ISSUE. Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - SPRINGFIELD REGIONAL MEDICAL CENTER. SPRINGFIELD REGIONAL MEDICAL CENTER'S CHNA WAS CONDUCTED, IN PART, WITH MERCY MEMORIAL HOSPITAL. Schedule H, Part V, Section B, Line 6a Facility A, 2 Facility A, 2 - MERCY MEMORIAL HOSPITAL. MERCY MEMORIAL HOSPITAL'S CHNA WAS CONDUCTED, IN PART, WITH SPRINGFIELD REGIONAL MEDICAL CENTER. Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - Springfield Regional Medical Center. ALZHEIMBER'S ASSOCIATION OF MIAMI VALLEY CARESOURCE CLARK COUNTY COMBINED HEALTH DISTRICT CLARK COUNTY DEPARTMENT OF JOB & FAMILY SERVICES CLARK COUNTY EMA CLARK COUNTY JAIL CLARK COUNTY JUVENILE COURT CLARK STATE UNIVERSITY COMMUNITY HEALTH FOUNDATION FAMILY AND CHILDREN FIRST COUNCIL MENTAL HEALTH AND RECOVERY BOARD OF CLARK, GREEN, AND MADISON COUNTIES NATIONAL TRAILS AND PARK DISTRICT OHIO HOUSE OF REPRESENTATIVES OHIO STATE UNIVERSITY EXTENSION OFFICE PARENT ADVOCACY CONNECTION PLANNED PARENTHOOD AND FAMILIES ROCKING HORSE CENTER SPRINGFIELD CITY SCHOOL DISTRICT SPRINGFIELD FOUNDATION SPRINGFIELD SOUP KITCHEN SPRINGFIELD YMCA UNITED SENIOR SERVICES UNITED WAY URBAN LIGHT MINISTRIES WITTENBERG UNIVERSITY WRIGHT STATE UNIVERSITY. Schedule H, Part V, Section B, Line 6b Facility A, 2 Facility A, 2 - MERCY MEMORIAL HOSPITAL. CHAMPAIGN COUNTY HEALTH DISTRICT COMMUNITY HEALTH FOUNDATION CONSOLIDATED CARE INC. CHAMPAIGN RESIDENTIAL SERVICES, INC. CHAMPAIGN COUNTY FAMILY AND CHILDREN FIRST COUNCIL MENTAL HEALTH, DRUG & ALCOHOL SERVICES BOARD OF LOGAN AND CHAMPAIGN COUNTIES MERCY WELL CHILD PEDIATRICS NORTH LEWISBURG MAYOR SUICIDE PREVENTION COALITION OF LOGAN AND CHAMPAIGN COUNTIES UNITED WAY OF CLARK, CHAMPAIGN, AND MADISON URBANA CITY SCHOOLS CHAMPAIGN FAMILY YMCA Schedule H, Part V, Section B, Line 7 Facility A, 1 Facility A, 1 - SPRINGFIELD REGIONAL MEDICAL CENTER, MERCY MEMORIAL HOSPITAL. A link to the CHNA for each hospital can also be found on the hospital website at www.mercy.com/springfield/about-us/community-benefit.aspx. Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - Springfield Regional Medical Center. Springfield Regional Medical Center (SRMC) is addressing the significant needs identified in the most recently conducted CHNA as follows: MENTAL HEALTH SRMC continues to partner with the Clark County Mental Health Task Force to work with the State in the area of medical Mental Health Homes and managed care so our focus in on prevention. A Gatekeepers Reference Card has been developed. The Resource Card is the tool used to evaluate how many persons are referred to Mercy Health and how many of those actually sought services. Additionally, physicians were surveyed to determine how many of their patients are being treated for mental illness, depression, how many are referred to Mercy Health and what triggers a referral. MHRB advocates adoption of treatment overlay; the FQHC provides mental health services; there is an array of Mercy Health providers for adults and youth (Osterlin, Catholic Charities, Well Spring, Rocking Horse-and Medicaid is available through all providers); MHRB is beginning a focus on prevention using the Good Behavior Game (GBG) in local schools, which is also embedded in the local university's education program curriculum; A Trauma informed care initiative at SRMC; Crisis intervention training done by the board on a regular basis to first responders where focus is recognition and referral. CHRONIC DISEASE MANAGEMENT Diabetes - Established an additional ADA certified education site. The Health Resources Center opened in November of 2016 to support post discharge follow up appointments for unattached patients as well as patients with a primary care physician who are unable to be seen by their physician in a timely fashion. Congestive Heart Failure (CHF) - Following the Diabetes successful protocols, a plan was developed for post discharged CHF patients, to track weight, medication compliance, and as well as the admission rates at 30, 60 and 90 days having staffing in place 1st quarter of 2017. Asthma - The Chronic Disease Task Force decreased the number of asthma attacks that required emergency room services by implementing home-based environmental assessments/interventions. There was a 22% decrease in ER visits for asthma between 2015 and 2016. There was a 70% decrease in asthma admissions to inpatient through the ER, from 134 in 2015 to 40 admissions in 2016. Oral Health - In 2016 the first steps to decrease the number of Clark County residents with poor oral health by fluoridation of the public water supply. This included data collection, developing infographic and fact sheets, as well as discussion with local business for support. Next step in 2017 to place a fluoridation ordinance to the city commission for approval. Education and group support for patients with chronic disease will be available to all in the community. SUBSTANCE ABUSE Clark County, like many communities in the country, is experiencing an increase in the use of heroin among other substance abuse trends. The community determined that the primary barrier to improving substance abuse prevention strategies is the overall lack of capacity in the County. In 2016, Community Mercy Health Partners continued the Vivitrol program. This program offers medication assistance treatment (MAT) to our Springfield clients of Mercy REACH, Outpatient Drug, Alcohol and Tobacco rehab program. The Vivitrol Company offers the first injection free to our clients. In partnership with the Substance Abuse task force, through McKinley Hall grant, clients are offered a free NARCAN medication. An inpatient Detox Program was established in the 3rd quarter with 39 self-referrals and 20 completed detox; 15 left AMA. In the 4th quarter we had 46 self-referrals with 35 completing detox and 12 leaving AMA. With the increase of clients in 2016, Mercy REACH hired an additional therapist in the 3rd quarter reducing the client wait from 4 weeks to a 2 week wait period. Identified needs that are not being addressed specifically by SRMC OBESITY As identified in the 2013 CHNA and 2014 Implementation plan, the Obesity Task Force's strategic plan was to implement a child health, multi-dimensional, school-wide, evidence-based program in Lincoln Elementary as a pilot program to determine what works then scale up to additional schools. The Obesity Task Force determined that a core criterion for their decision was prevention, and therefore their focus is on youth in schools, which also engages parents, via a multidimensional, school-wide, child health evidence-based program. Due to the number of school based prevention programs available, the Task Force preferred to present the various programs to school representatives and allow them to select the program that best suits their needs. Although SRMC chose not to specifically address childhood obesity, SRMC recognizes that one third of Americans are overweight. SRMC opened the Springfield Regional Weight Management Solutions due to the challenges associated with weight loss. A weight management solution program was designed specifically for individuals, including Sleeve Gastrectomy, Gastric Bypass, Adjustable Gastric Banding, Robotic Bariatric Surgery and Revision Surgery. In addition to providing surgical weight loss options, we also offer counseling, support group programs, meal planning and fitness programs to guide our patients to become healthier individuals. In 2016, SRMC added 163 new patients to our surgical program, 50 new patients to our non-surgical program, and 91 patients attended support groups throughout the year. Total lbs. lost for our surgical program - 4574 lbs., Total lbs. lost for our non-surgical program - 845 lbs. In 2016, 12 unduplicated individuals qualified for assistance with 48 cases of ensure health supplement. HEALTHY BIRTHS/SEXUALITY Strategic plan - To identify and engage pregnant women in first trimester prenatal care. Partnering Agencies are Clark County Combined Health District including its WIC program, the Community Foundation, the Pregnancy Resource Center, Clark County Department of Job and Family Services, and Springfield's Women's Network. The gap analysis uncovered the need for better outreach to pregnant women to get them to the FQHC's OB program. A concerning proportion of pregnant women delay prenatal care, and this trend is especially evident among the growing Spanish speaking-only households, where it is not uncommon for pregnant women to get a confirmation of pregnancy at 4-6 months. An SRMC Mother Baby educator participated in the Clark County Healthy Births/Sexuality Task Force in support of the needs as follows: * Decrease in the teen birthrate 15-17 year olds for Clark County * Increase in percent of infants born to pregnant women receiving prenatal care beginning in the first trimester * Minority populations and other vulnerable populations have increased access to sexual health information and services. Schedule H, Part V, Section B, Line 11 Facility A, 2 Facility A, 2 - MERCY MEMORIAL HOSPITAL. Mercy Memorial Hospital is addressing the significant needs identified in the most recently conducted CHNA as follows: MENTAL HEALTH The goal to provide a safe room in the Emergency Department at Mercy Memorial Hospital was met in 2015. The room is fully enclosed and specially designed to remove all potentially dangerous objects. There is a monitoring system that provides safety for the staff in the case of violent patients and also eliminates the need for a "sitter" which upholds the dignity of the patient. A Precision Medicine program was started in 2016 to support appropriate medication for mental health patients. Using the patient's DNA, the prescriber can tell which anti-depressant, anti-psychotic or ADHD medication will be likely to work. While no guarantee, it has cut down on moving through multiple medications with an average cost savings just in pharmaceuticals to consumers of approximately $1,000.00 annually. This also can reduce the cost of treatment for side effects, added visits to the healthcare provider or testing that may not be needed. MMH's NP is meeting with outpatient mental health once a month, with a focus on streamlining the process and support all mental health collaborative issues. NUTRITION AND EXERCISE A fitness center was opened for employees at Mercy Memorial Hospital in 2015 to promote wellness for employees. Employees are taking advantage to the fitness center noting the opportunity to use before or after work, eliminating an extra stop at a community gym and eliminating the cost of membership. Continue to operate the fitness center. Mercy Memorial Hospital partnered with the YMCA beginning in 2016 to develop and execute a 12 week community diabetes prevention program. In 2016, 44 persons were served. Other actions taken by MMH in 2016 include: * A Healthy Kids Day event promoting the 5-2-1 Almost None program. 325 children served * A Go Red for Women program focused on heart health and healthy eating. Served 45 persons * A health fair event with the Champaign County Health Department program on Healthy Eating served 41 persons. CHRONIC DISEASE MANAGEMENT The Chronic Care Clinic at MMH, opened in May of 2015 provides post discharge, follow up appointments for patients without a primary care physician, medication reconciliation and support in finding a medical home. The recent reduction in readmissions in 2015 has been attributed to the clinic. The Chronic Care Clinic continued focus on patients without a primary care physician, to provide follow up visits after discharge from the ED and inpatient setting in 2016. MMH also established an additional ADA certified education site at MMH to provide education for diabetic patients in Champaign County. The Chronic Care Clinic at mercy Memorial Hospital continued focus on patients without a primary care physician, to provide follow up visits after discharge from the ED and inpatient setting. Identified needs that are not being addressed specifically by Mercy Memorial Hospital: YOUTH SUBSTANCE ABUSE AND WELLNESS: Other community agencies are specifically designed and better prepared to address this health need. MMH continues to support groups such as Champaign County Drug Free Youth Coalition, Champaign County Family and Children First Council, Triad Local Schools North Lewisburg, Ohio and Mercy Well Child Pediatrics, Urbana Ohio. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - Springfield Regional Medical Center, Mercy Memorial Hospital. Mercy Health's financial assistance policy requires a patient or family member to complete an application including gross income for a minimum of 3 months (up to 12 months) prior to the date of application or date of service. Proof of income is required with the exceptions of patients discharged to a skilled nursing facility, patients who are deceased with no estate, and patients who have documented homelessness. Third party income scoring may be used to verify income in situations where income verification is unable to be obtained through other methods. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - Springfield Regional Medical Center, Mercy Memorial Hospital. Mercy Health's financial assistance policy requires proof that Health Savings Account and/or Medical Savings Account funds be depleted prior to providing healthcare financial assistance. Schedule H, Part V, Section B, Line 13 Facility A, 2 Facility A, 2 - Springfield Regional Medical Center, Mercy Memorial Hospital. Patients who live in the community served by a Mercy Health hospital will be offered healthcare financial assistance. For those patients living outside of the geographic area, extenuating circumstances must be documented and approved by the PFS Manager. A list of the zip codes of the community served for each Mercy Health hospital is maintained in a separate document and readily available via the contact list at the end of Mercy Health's financial assistance policy. Schedule H, Part V, Section B, Line 13 Facility A, 3 Facility A, 3 - Springfield Regional Medical Center, Mercy Memorial Hospital. Mercy Health's financial assistance policy requires a patient to apply for health insurance coverage and/or enter the marketplace/exchange before financial assistance may be extended. Exceptions to this policy include patients discharged to a SNF, patients who are deceased with no estate, and patients who have documented homelessness. 9 CARDIOLOGISTS OF CLARK AND CHAMPAIGN COUNTIES - SPRINGFIELD 100 W MCCREIGHT AVE FIRST FLOOR SPRINGFIELD OH 45504 SPECIALIST DOCTORS COMMUNITY MERCY FOUNDATION 100 W MCCREIGHT AVE SUITE 200 SPRINGFIELD OH 45504 SPECIALIST DOCTORS MITCHELL THOMAS CENTER - ADMINISTRATION 100 W MCCREIGHT AVE SUITE 4 4TH FLO OR SPRINGFIELD OH 45505 OTHER COMMUNITY MERCY HOME CARE 1111 N PLUM STREET SUITE 4 SPRINGFIELD OH 45504 SPECIALIST DOCTORS SPRINGFELD REGIONAL IMAGING CENTER 1343 N FOUNTAIN BLVD SPRINGFIELD OH 45504 IMAGING SPRINGFIELD HEALTH RESOURCE CENTER 1343 N FOUNTAIN BLVD SUITE 205 SPRINGFIELD OH 45504 OTHER EXCEL PEDIATRIC REHABILITATION 1345 N FOUNTAIN BLVD SPRINGFIELD OH 45504 SPECIALIST DOCTORS SPRINGFIELD REGIONAL CANCER CENTER 148 W NORTH STREET SPRINGFIELD OH 45504 SPECIALIST DOCTORS OAKWOOD VILLAGE 1500 VILLA ROAD SPRINGFIELD OH 45503 SENIOR LIVING EAST SPRINGFIELD FAMILY MEDICINE 160 SOUTH TUTTLE ROAD SPRINGFIELD OH 45505 PRIMARY CARE DOCTORS COMMUNITY MERCY HOME MEDICAL EQUIPMENT 1702 N LIMESTONE STREET SPRINGFIELD OH 45504 SPECIALIST DOCTORS NORTH FAMILY MEDICINE - WITTENBERG HEALTH CLINIC 200 W WARD STREET ROOM 003 SPRINGFIELD OH 45504 PRIMARY CARE DOCTORS SOUTH SPRINGFIELD FAMILY MEDICINE 2055 S LIMETONE STREET SPRINGFIELD OH 45504 PRIMARY CARE DOCTORS EAST SPRINGFIELD INTERNAL MEDICINE 2105 E HIGH STREET SPRINGFIELD OH 45505 PRIMARY CARE DOCTORS NORTHPARKE INTERNAL MEDICINE 211 NORTHPARKE DRIVE SPRINGFIELD OH 45503 PRIMARY CARE DOCTORS SPRINGFIELD PHYSICAL MEDICINE - OUTPATIENT 211 NORTHPARKE DRIVE SPRINGFIELD OH 45503 SPECIALIST DOCTORS SOUTH BURNETT FAMILY MEDICINE 247 SOUTH BURNETT ROAD SUITE 220 SPRINGFIELD OH 45505 PRIMARY CARE DOCTORS COMMUNITY MERCY OCCUPATIONAL HEALTH - SPRINGFIELD 2501 E HIGH STREET SPRINGFIELD OH 45505 SPECIALIST DOCTORS EXCEL SPORTS MEDICINE AND REHAB - SPRINGFIELD 2600 N LIMESTONE STREET SPRINGFIELD OH 45503 SPECIALIST DOCTORS SPRINGFIELD REGIONAL OUTPATIENT CENTER 2610 N LIMESTONE STREET SPRINGFIELD OH 45503 SPECIALIST DOCTORS SPRINGFIELD FAMILY PRACTICE 2665 DERR ROAD SPRINGFIELD OH 45503 PRIMARY CARE DOCTORS SPRINGFIELD REGIONAL SLEEP CENTER 30 W MCCREIGHT AVE SUITE 201 SPRINGFIELD OH 45504 SPECIALIST DOCTORS NORTH FAMILY MEDICINE 30 W MCCREIGHT AVE SUITE 208 SPRINGFIELD OH 45503 PRIMARY CARE DOCTORS CLARK COUNTY GASTROENTEROLGY 30 W MCCREIGHT AVE SUITE 211 SPRINGFIELD OH 45504 SPECIALIST DOCTORS SPRINGFIELD WEIGHT MANAGEMENT SOLUTIONS 30 W MCCREIGHT AVE SUTIE 209 SPRINGFIELD OH 45504 SPECIALIST DOCTORS COMMUNITY MERCY REACH DRUG ALCOHOL AND TOBACCO CESSATION 30 W MCCREIGHT AVENUE SPRINGFIELD OH 45504 SPECIALIST DOCTORS SPRINGFIELD GYNECOLOGY 30 W MCCREIGHT AVENUE SPRINGFIELD OH 45004 SPECIALIST DOCTORS COMMUNITY MERCY MED ASSIST 30 W MCCREIGHT SUITE 011 SPRINGFIELD OH 45504 SPECIALIST DOCTORS SPRINGFIELD AND URBANA GENERAL AND LAPAROSCOPIC SURGEONS 30 W MCREIGHT AVE SUITE 106 SPRINGFIELD OH 45504 SPECIALIST DOCTORS SPRINGFIELD REGIONAL MEDICAL GROUP - WOUND CARE - SPRINGFIELD 362 SOUTH BURNETT ROAD SPRINGFIELD OH 45505 SPECIALIST DOCTORS SOUTH URBANA FAMILY MEDICINE 1300 US SOUTH 68 URBANA OH 43078 PRIMARY CARE DOCTORS SPRINGFIELD REGIONAL MEDICAL GROUP - WOUND CARE - URBANA 1430 US HIGHWAY 36 EAST SUITE B URBANA OH 43078 SPECIALIST DOCTORS EXCEL SPORTS MEDICINE AND REHABILITATION - URBANA 1450 E US HIGHWAY 36 URBANA OH 43078 SPECIALIST DOCTORS URBANA FAMILY MEDICINE AND PEDIATRICS 204 PATRICK AVENUE URBANA OH 43078 SPECIALIST DOCTORS CARDIOLOGISTS OF CLARK AND CHAMPAIGN COUNTIES - URBANA 900 EAST COURT STREET URBANA OH 43078 SPECIALIST DOCTORS SPRINGFIELD REGIONAL MEDICAL GROUP - ORTHOPEDIC AND SURGICAL SPECIALISTS 900 SCIOTO STREET SUITE 1 URBANA OH 43078 SPECIALIST DOCTORS URBANA FAMILY AND INTERNAL MEDICINE 900 SCIOTO STREET SUITE 1 URBANA OH 43078 PRIMARY CARE DOCTORS URBANA INTERNAL MEDICINE 900 SCIOTO STREET SUITE 4 URBANA OH 43078 PRIMARY CARE DOCTORS COMMUNTY MERCY OCCUPATIONAL HEALTH - URBANA 904 SCIOTO STREET URBANA OH 43078 SPECIALIST DOCTORS MERCY MCCAULEY CENTER 906 SCIOTO STREET URBANA OH 43078 SENIOR LIVING Schedule H, Part I, Line 6a Community benefit report prepared by related organization Mercy Health Schedule H, Part I, Line 7g Subsidized Health Services COMMUNITY MERCY HEALTH PARTNERS (CMHP) OPERATES THE DPM Reach Program substance abuse and COPD CLINIC. THE AMOUNT OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO THE PHYSICIAN CLINIC IS $95,597. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance COST OF CHARITY CARE WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 2. THE COST RELATED TO MEDICAID PATIENTS WAS DETERMINED USING THE HOSPITAL COST ACCOUNTING SYSTEM AND INCLUDED BOTH INPATIENTS AND OUTPATIENTS FOR TRADITIONAL MEDICAID AND MEDICAID MANAGED CARE PLANS. FOR SUBSIDIZED SERVICES THE HOSPITAL'S COST ACCOUNTING SYSTEM IS USED TO DETERMINE COST RELATED TO THE SPECIFIC SERVICE EXCLUDING TRADITIONAL MEDICAID AND MEDICAID MANAGED CARE PATIENTS. COSTS FOR CHARITY AND BAD DEBT ACCOUNTS ARE DEDUCTED USING A RATIO OF COST TO CHARGE SPECIFIC TO THAT SUBSIDIZED SERVICE. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS. Schedule H, Part II Community Building Activities COMMUNITY MERCY HEALTH PARTNERS (CMHP) ENSURES ACCESS TO HEALTH SERVICES BY RECRUITING AND PROVIDING TRANSITIONAL SUPPORT TO PHYSICIANS TO ATTRACT THEM TO THE COMMUNITY FOR SPECIALTIES WHERE THERE IS A DEMONSTRATED NEED. AN APPROPRIATE SUPPLY OF PHYSICIANS IS NECESSARY TO ENSURE THAT RESIDENTS HAVE ACCESS TO ADEQUATE AND TIMELY DIAGNOSIS AND TREATMENT FOR ALL HEALTH CONDITIONS. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Net patient accounts are reduced by an allowance for doubtful receivables based upon the hospital's historical collection experience adjusted for current environmental risks and trends for each major payor source. Significant provision is made for self-pay patient accounts in the period of service based on past collection experience. The hospital's concentration of credit risk related to net patient accounts is limited due to the diversity of patients and payors. Net patient accounts consist of amounts due from governmental programs (primarily Medicare and Medicaid), private insurance companies, managed care programs and patients themselves. Net patient service revenue for services provided to patients who have third-party payor coverage is recognized based on contractual rates for services rendered. The hospital recognizes a significant amount of patient service revenue at the time services are rendered even though it does not assess the patient's ability to pay. As a result, the provision for bad debts is presented as a deduction from patient service revenue (net of contractual provisions and discounts). Amounts recognized are subject to adjustment upon review by third-party payors. For uninsured patients that do not qualify for charity care, the hospital recognizes revenue when services are provided. Based on historical experience, a significant portion of the hospital's uninsured patients will be unable or unwilling to pay for services provided. Thus, the hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided. Any discounts applied to self-pay patients would be deemed either Charity or a contractual adjustment. Bad debt would be based on the balance after the charity or contractual adjustment that is deemed uncollectable following a reasonable collection effort. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The hospital's financial assistance policy does not permit the cost of patients who are uncooperative or unable to be located to be reclassified from bad debt to financial assistance. The hospital's financial assistance policy requires an application and supporting documentation. Therefore, zero dollars are being reported on Part III, Line 3 as amounts included in bad debt that could be attributable to patients eligible under the hospital's financial assistance policy. The hospital follows the Catholic Health Association of the United States policy document, Community Benefit Program, A Revised Resource for Social Accountability ("CHA guidelines") for determining community benefit. The CHA guidelines recommend that hospitals not include bad debt expense as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The hospital's audited financial statements do not contain a footnote that describes bad debt expense. The hospital elected to early adopt ASU 2011-07. Accordingly, bad debt expense is reflected as a deduction from revenue rather than an operating expense. Notes to Consolidated Financial Statements, B. Significant Accounting Policies, Net Patient accounts and Net Patient Service Revenue (page 13) states net patient accounts are reduced by an allowance for doubtful receivables based upon the historical collection experience of each regional affiliate adjusted for current environmental risks and trends for each major payor source. Significant provision is made for self-pay patient accounts in the period of service based upon past collection experience. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The hospital follows the Catholic Health Association of the United States policy document, Community Benefit Program, A Revised Resource for Social Accountability ("CHA guidelines") for determining community benefit. The CHA guidelines recommend that hospitals not include Medicare losses as community benefit. The hospital's cost accounting system was used to determine the Medicare amounts in Part III. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Patients known to qualify for charity care or financial assistance are not sent to a collection agency. The organization repeatedly offers patients access to financial help during their hospital stays and after, as well as with each billing notice. Bills are sent to a collection agency as a last resort and only: when patients have the ability to pay some portion of their healthcare expenses but refuse to do so; when patients refuse to work with the organization to determine if they qualify for free or discounted care via federal, state, local or hospital assistance programs; when the organization is unable to locate the patient or person responsible for the bill. Schedule H, Part V, Section B, Line 16a FAP website A - SPRINGFIELD REGIONAL MEDICAL CENTER: Line 16a URL: www.mercy.com/financial-assistance; A - MERCY MEMORIAL HOSPITAL: Line 16a URL: www.mercy.com/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website A - SPRINGFIELD REGIONAL MEDICAL CENTER: Line 16b URL: www.mercy.com/financial-assistance; A - MERCY MEMORIAL HOSPITAL: Line 16b URL: www.mercy.com/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - SPRINGFIELD REGIONAL MEDICAL CENTER: Line 16c URL: www.mercy.com/financial-assistance; A - MERCY MEMORIAL HOSPITAL: Line 16c URL: www.mercy.com/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment COMMUNITY MERCY HEALTH PARTNERS (CMHP) HOSPITALS ASSESS AND CONTINUALLY RESPOND TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. CMHP HOSPITALS JOIN AN EXISTING COMMUNITY-BASED NEEDS ASSESSMENT EVERY THREE YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. MERCY HEALTH HOSPITALS INCORPORATE PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. CMHP HOSPITALS RECOGNIZE THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS OF UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. CMHP HAS A DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT EFFORT. CMHP'S COMMUNITY BENEFITS COMMITTEES MEET TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. CMHP HOSPITALS WORK CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES TO AVOID DUPLICATION. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Community Mercy Health Partners (CMHP) posts its charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency departments and other areas of the organization's facilities in which eligible patients are likely to be present. CMHP provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process and with discharge materials. Additionally, a copy of the policy or a summary along with financial assistance contact information is included in patient bills. CMHP discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. The Hospital Eligibility Link Program (HELP) is a free referral service provided by CMHP. The purpose of HELP is to assist patients in obtaining medical benefits through federal, state, and hospital programs. HELP representatives will provide the following services at no cost to the patient: * Explore eligibility under public assistance programs * File applications on patient's behalf * Schedule and attend appointments * Provide transportation when necessary * Provide medical documentation to Social Security Administration for disability claims. Through HELP, patients and their counselors look at what options are available. CMHP understands that not everyone can pay for healthcare services. HELP is here to offer options and assistance for those who are uninsured or underinsured. HELP is an extension of CHMP's mission to improve the health of our community with emphasis on the poor and underserved. Meeting the needs of those with limited resources has always been the heart of our mission. CMHP is proud to make our financial assistance information available to the public through our website, which can be found at www.community-mercy.org Other patient education information that is provided for eligibility of assistance is as follows: * A bilingual representative is available in our HELP Program. Two bilingual representatives are available in our customer service department. Each of these representatives are in our regional office in Cincinnati. * Staff training on Hospital Care Assurance Program (HCAP) and Hospital Financial Assistance (HFA) was provided in 2009 by a private auditing company. Training included a manual and in-depth information regarding the preparation of the cost report logs, accurate completion of the HCAP application, as well as an overview of the FAQ's provided by the Ohio Hospital Association. * Financial assistance counselors work with case managers to expedite the transfer of patients to extended care facilities. * Federal poverty guidelines are posted on our website as well as a copy of our charity application. * Consistent review of self pay patients for retroactive Medicaid coverage. * Services provided by vendor to reach out to patients in bad debt to screen for HCAP eligibility. Schedule H, Part VI, Line 4 Community information Community Mercy Health Partners's (CMHP) primary service area includes Clark and Champaign counties, which have a total population of approximately 209,700. According to the most recent Community Health Assessment reports from the two counties, residents of the CMHP primary service area are generally older, poorer and have worse health statistics than state and national averages. Unemployment has also risen in our community during the last several years, and we serve a growing number of uninsured and underinsured patients. CMHP owns two of the three hospitals in this geographic area. The third hospital (not owned by CMHP) is a limited-service for-profit hospital that specializes in outpatient and short-stay surgery, and it does not have an emergency department. Part of the city of Springfield has been federally designated as a medically underserved area. Other demographics of our service area include: * Percentage of adults who have not achieved at least a high school diploma is higher that both the state and national averages * Higher percentage of residents living in poverty than in the state and nationwide * Unemployment rate is higher than both the state and national rates * Median household income is below the state median and US median * The population of the service area consists of 3.3% non-English speaking people. * The population of the service area that is 65 years or older is 17%. * The occupation classification in the community consists of 29% blue collar, 51% white collar and 20% service and farm workers. The major health problems and/or leading causes of death in our service area are Cardiovascular disease, Diabetes, Emphysema and Cancer. Most of these are preventable through proper care and maintaining control of the illness/disease, as well as choosing healthier lifestyles. In our service area 28% of the population are smokers, 40% have high cholesterol, and 30-40% are overweight or at risk for becoming overweight. Schedule H, Part VI, Line 5 Promotion of community health Community Mercy Health Partners (CMHP) operates emergency rooms open to all regardless of ability to pay. In addition to providing emergency services, CMHP also provides minor emergency and urgent care services to all regardless of ability to pay. CMHP participates in Medicaid, Medicare, Champus and/or other government sponsored health programs. CMHP operates skilled nursing units, ICU, newborn nursery, wound care, diabetes management, outpatient pediatrics, substance abuse, prescription assistance and a critical access hospital. CMHP has an open medical staff with privileges available to all qualified physicians in the area. The majority of the governing body consists of independent persons representative of the community served by CMHP. CMHP participates in Medicaid, Medicare, CHAMPUS, and/or other government -sponsored health care programs. CMHP furthers its exempt purpose by providing the following community benefit programs in the communities in which it serves: Community Mercy Med Assist helps area residents who cannot afford their prescription medications. Community Mercy REACH offers outpatient treatment for chemical dependency by licensed professionals who have master's-level education. REACH also offers an innovative and effective smoking cessation program that incorporates exercise and nutrition/weight control to promote an overall healthy lifestyle. Mercy Well Child Pediatrics is a pediatric clinic that identifies and addresses potential health and developmental concerns in children. The clinic promotes quality pediatric care with a holistic approach to meet the health, social and emotional needs of children and families. Mercy Well Child Pediatrics serves children from infants to age 21, regardless of the families' income or insurance status. CMHP's emergency department treats an increasing number of patients who use the facility for primary care needs. Patient demographics reflect the changing community. As in other communities, some area physicians place limits on their acceptance of Medicaid patients. In addition, some primary care physicians refer patients with after-hours needs directly to area emergency rooms. Community groups and individuals are very supportive of CMHP. For the past decade, the Rocking Horse Center has been a key partner with CMHP in making basic healthcare more accessible, especially for the poor and underserved. Early in 2009, Rocking Horse was granted status as a Federally Qualified Health Center, which will provide higher levels of Medicaid reimbursement. In addition, CMHP and Rocking Horse collaborated to develop an ER referral process, to identify patients who did not have a medical home and to provide follow-up care. Schedule H, Part VI, Line 6 Affiliated health care system Community Mercy Health Partners (CMHP) is a member of Community Mercy Health Systems. CMHP is sponsored by the Sisters of Mercy and has been an integral part of the community since 1950. CMHP includes an acute care hospital and a critical care access hospital with approximately 641 licensed beds combined. Community Mercy Health System community benefit for 2016 per the audit footnote is as follows: Total 2016 Community Benefit: $14.9 Million Benefits to the Broader Community: $1.1 million Unreimbursed Care for Those Who Are Poor and Qualify for Medicaid: $13.3 million Support for Other Programs for Those Who are Poor: $0.5 million Community Benefit as Percent of Total Expense: 4.9 percent CMHP is a member of Mercy Health, which is the largest health system in Ohio, the state's fourth largest employer and one of the largest Catholic health systems in the United States. Mercy Health is sponsored by Partners in Catholic Health Ministries (PCHM). PCHM is a public juridic person of the Roman Catholic Church. Mercy Health continues the healthcare ministries begun by its founders in urban and rural areas across Ohio and Kentucky more than 150 years ago. Mercy Health provides integrated health services via acute care hospitals, physician practices, long-term care residences, housing sites for the elderly, home health agencies, hospice programs, outreach services and wellness centers. Mercy Health hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Mercy Health's mission calls it to extend the healing ministry of Jesus by improving the health of the communities it serves with special emphasis on people who are poor and under-served. In addition to providing programs and services designed to enhance the health of entire communities, Mercy Health cares for everyone who comes to its facilities, regardless of their ability to pay. Mercy Health's home office in Cincinnati, Ohio provides services and support to the entire system. Its governance practices have been nationally recognized for quality. System leadership provides strategic vision and management oversight in support of the ministry by directing resources, providing access to lower cost debt financing, improving clinical outcomes and reducing operating costs. System-wide community benefit for 2016 per the audit footnote is as follows: Total 2016 Community Benefit: $346.7 Million Benefits to the Broader Community: $80.3 million Unreimbursed Care for Those Who Are Poor and Qualify for Medicaid: $242.7 million Cost of Care for Those Who Could Not Afford to Pay: $4.7 million Support for Other Programs for Those Who are Poor: $19.0 million Community Benefit as Percent of Total Expense: 7.8 percent X X true true X X X X X true true false false false false false true false BRIAN SMITH TRUSTEE (BEGIN 5/16), EVP & COO, MERCY HEALTH 0 771014 0 0 0 265009 0 35344 0 39523 0 1110890 0 67437 JOHN STARCHER JR JD Trustee, President & CEO Mercy Health (END 5/16) 0 1206522 0 225000 0 253995 0 16731 0 27151 0 1729399 0 0 PAUL HILTZ Pres/CEO Springfield Region, SVP Mercy Health (END 12/16) 378385 0 0 0 5621 0 105041 0 29303 0 518350 0 0 0 WILLIAM KUSNIERZ VP, CFO & TREASURER 0 275404 0 13678 0 40778 0 29778 0 11364 0 371002 0 0 KATRINA ENGLISH FORMER KEY EMPLOYEE 0 302867 0 1112 0 2917 0 46937 0 30436 0 384269 0 0 GARY HAGENS VP, COO - VPMA 73040 0 0 0 284939 0 2216 0 6096 0 366291 0 548 0 SHERRY NELSON VP Chief Nursing Officer 246009 0 0 0 15665 0 15062 0 20089 0 296825 0 0 0 DONALD B JOHNSON MD CHIEF CLINICAL OFFICER 267694 0 12000 0 18909 0 12068 0 1351 0 312022 0 0 0 JENELLE ZELINSKI ASSISTANT CFO 189761 0 0 0 914 0 33292 0 1710 0 225677 0 0 0 PAMELA ALLEN Director, Pharmacy 175912 0 0 0 3738 0 10841 0 10022 0 200513 0 0 0 MICHELLE ADKINS DIRECTOR, CLINICAL SERVICES 146602 0 17737 0 1598 0 13789 0 15194 0 194920 0 0 0 MARYANN MCQUARRIE DIRECTOR, CLINICAL SERVICES 149878 0 0 0 3077 0 8628 0 8973 0 170556 0 0 0 ELIZABETH PRICE SUPERVISOR NURSING 143820 0 0 0 1103 0 8111 0 9964 0 162998 0 0 0 Schedule J, Part I, Line 4b The Mercy Health SERP Plan The Mercy Health SERP plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. It provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 50%, 75%, and 100% in their accounts after 5, 6, and 7 years of service, respectively, vesting occurs earlier for death or total disability or reaching age 60 while employed, or involuntary termination of employment within 24 months after a change in control of the organization or due to position elimination, payments during employment are made for required tax withholdings. Payment of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: John Starcher, Jr. JD $230,539; Brian Smith $119,659. Schedule J, Part I, Line 4b Terms and conditions of the Cincinnati Market SERP The Cincinnati Market SERP is a deferred compensation plan which provides employment continuation incentives to all executive council members. The plan is no longer accepting new participants and the cessation of contributions has occurred. Participants must complete a two tiered vesting provision. Participants must be vested under the base qualified plan and must count 24 months after termination during which they do not compete with Mercy Health Cincinnati LLC. Amounts includible as taxable compensation for listed individuals due to executive benefit plan participation in the reporting year were as follows: Paul Hiltz $0. Schedule J, Part I, Line 4b Terms and conditions of the Mercy Health System SERP The Mercy Health System SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Paul Hiltz $0; Matthew Caldwell $0; Gary Hagens $4,445; Donald B. Johnson MD $14,069; Sherry Nelson $12,552; William Kusnierz $0; Katrina English $0. Schedule J, Part I, Line 4b Terms and conditions of the Lima MArket SERP THE LIMA MARKET 457(F) PLAN PROVIDES A FLEXIBLE BENEFIT ALLOWANCE TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. THIS ALLOWANCEMAY BE ALLOCATED AMONG VARIOUS INSURANCE AND DEFERRED COMPENSATION BENEFIT OPTIONS. THE PLAN IS NO LONGER ACCEPTING NEW PARTICIANTS AND THE CESSATION OF CONTRIBUTIONS HAS OCCURRED. AMOUNTS INCLUDIBLE IN TAXABLE COMPENSATION FOR LISTED PARTICIPATING INDIVIDUALS IN THE REPORTING YEAR WERE AS FOLLOWS: BRIAN SMITH $67,437. Schedule J, Part I, Line 1a Tax indemnification and gross-up payments A tax indemnification benefit to cover the income tax incurred on moving expenses was paid to the following listed individual: Matthew Caldwell. The entire benefit was treated as taxable compensation. Schedule J, Part I, Line 1a Housing allowance or residence for personal use A housing allowance was provided to the following listed individual as a result of employment by Community Mercy Health Partners: Matthew Caldwell. The entire amount was treated as taxable compensation. Schedule J, Part I, Line 4a Severance or change-of-control payment Severance Benefits consisting of continuation of base salary and insurance benefits were provided to a listed individual for a specified period. The listed individual executed a release and waiver of claims in exchange for the severance benefits. The salary continuation amount provided during the reporting year to the listed individual were as follows: Gary Hagens $275,340. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The Community Mercy Health Partners SERP plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the CMHP Committee. The plan is no longer accepting new participants and cessation of contributions has occurred. Participants vest the later of five years of active service or the second anniversary of his or her separation from service with the employer. Vesting occurs earlier for death or total disability. Payments during employment are made for required tax withholding. Payment of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Gary Hagens $0; Katrina English $0; Donald B. Johnson, MD $0. Schedule J, Part I, Line 7 Non-fixed payments The organization provides annual incentive compensation for listed individuals. The organization's Board of Trustees establishes objective thresholds for quality, community benefit, and financial performance which must be achieved for incentives to be awarded. The Board also establishes threshold, target and maximum levels for incentive awards. Within these established parameters, the Board determines the CEO's incentive award and incentive awards for other listed individuals are determined by the listed individual's supervisor and disclosed to the Board. The Board may authorize modified incentive awards when appropriate in its judgment. SPRINGFIELD HEART SURGEONS SURENDER NERAVETLA, M.D. (BOARD MEMBER) HAS A REPORTABLE OWNERSHIP INTEREST 964367 INDEPENDENT CONTRACTOR false Form 990, Part IV, Line 14a Consolidated audited financial statements The filing organization does not have separate, independent audited financial statements. The organization is included in Mercy Health's consolidated audited financial statements, which are prepared in accordance with Generally Accepted Accounting Principles. Mercy Health's Audit and Corporate Responsibility Committee has responsibility for oversight of the audit and the selection of an independent accountant. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons JOSEPH R. JACKSON, JAMES N. DOYLE - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders COMMUNITY MERCY HEALTH SYSTEM IS THE MEMBER OF COMMUNITY MERCY HEALTH PARTNERS. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Mercy Health elects all board members who have full voting rights. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Certain matters require approval of the Mercy Health Corporate Member, Mercy Health Governing body, or Mercy Health CEO. The regulations of the organization describe the level of approval required for various decisions. Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 is prepared by Mercy Health's Tax Department and reviewed by an independent accounting firm. A copy of the Form 990 is then reviewed by management. Once the Form 990 is reviewed by all applicable parties a copy of the final version is provided to all members of the governing body prior to filing. Form 990, Part VI, Line 12c Conflict of interest policy ALL BOARD MEMBERS ARE COVERED BY THE Mercy Health CONFLICT OF INTEREST POLICY WHICH REQUIRES DISCLOSURE ON AN ANNUAL BASIS. ALL POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY Mercy Health CORPORATE COMPLIANCE OFFICER. AT THE BEGINNING OF EACH BOARD MEETING ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. BOARD MEMBERS DETERMINED TO HAVE A CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISION-MAKING FOR THE TRANSACTION IN WHICH THE CONFLICT EXISTS. Form 990, Part VI, Line 15a Process to establish compensation of top management official The organization's formal process for determining total compensation for the CEO and other officers and key employees is intended to provide reasonable compensation for accomplishing the organization's mission, to recognize performance, and to operate in keeping with the organization's obligations as a tax-exempt charitable organization. The Compensation & Evaluation Committee of the organization's Board of Trustees conducts an annual review of the compensation and performance of the CEO and other officers and key employees. In doing so, the Committee retains a qualified independent compensation consultant to conduct a competitive market analysis annually of the market ranges of base, incentive, and total cash compensation. The Committee utilizes that analysis and other appropriate information in connection with its annual review and adjustment of compensation ranges. It also reviews and recommends to the full board the threshold, target, and maximum incentive awards for which the listed individuals may be eligible, based upon the organization's performance results for community benefit, quality, and financial performance. The committee's recommendations concerning salary range adjustments and incentive awards go to the full board for approval. The committee, with full board approval, determines the adjustment to the ceo's base compensation and incentive award, within such established parameters. For the coo, cao, evp, and svp positions, adjustments and incentive awards are approved by the organization's ceo within such parameters. Adjustments and awards for other listed individuals are recommended by the supervising executive. Base salary adjustments and incentive awards are disclosed to the committee. A formal performance appraisal process is incorporated in the compensation adjustment and award process. It utilizes a multi-perspective approach and performance measures which are linked to the organization's long-term strategic plan, achievement of annual system objectives, and personal objectives. Form 990, Part VI, Line 15b Process to establish compensation of other employees Compensation-related determinations are conducted in accordance with applicable requirements of the Internal Revenue Code and regulations to qualify for the presumption that the compensation is reasonable, including but not limited to approval by an authorized body composed of individuals who do not have a conflict of interest, obtaining and relying on appropriate data as to comparability, and concurrent documentation of the basis for the compensation determinations. Form 990, Part VI, Line 19 Required documents available to the public THE CONFLICT OF INTEREST POLICY and financial statements are POSTED ON THE Mercy Health WEBSITE. Form 990, Part IX, Line 11g Other Fees Medical Professional fees - Total Expense: 12636037, Program Service Expense: 12636037, Management and General Expenses: , Fundraising Expenses: ; Consulting - Total Expense: 674029, Program Service Expense: 572925, Management and General Expenses: 101104, Fundraising Expenses: ; Affiliate Purchased services - Total Expense: 40062835, Program Service Expense: 34053410, Management and General Expenses: 6009425, Fundraising Expenses: ; Other purchased services - Total Expense: 22574449, Program Service Expense: 19188282, Management and General Expenses: 3386167, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Intercompany Eliminations - -432551; Loss on discontinued operations - -613813; SPRINGFIELD REGIONAL CANCER CENTER 148 W NORTH STREET SPRINGFIELD OH 45502 352216018 CANCER CENTER OH 3360323 8109138 COMMUNITY MERCY HEALTH PARTNERS MERCY HEALTH 1701 Mercy Health Place CINCINNATI OH 45237 311161086 HEALTHCARE SYSTEM PARENT OH 501(c)(3) 3 NA false MERCY HEALTH FOUNDATION 1701 Mercy Health Place CINCINNATI OH 45237 201072726 FUNDRAISING OH 501(c)(3) 7 MERCY HEALTH false MERCY HEALTH RETIREMENT TRUST 1701 Mercy Health Place CINCINNATI OH 45237 316046304 RETIREMENT TRUST OH 501(c)(3) 7 MERCY HEALTH false COMMUNITY HEALTH PARTNERS PHYSICIANS OFFICE BUILDINGS 3700 KOLBE ROAD LORAIN OH 44053 341268828 MEDICAL OFFICE RENTAL OH 501(c)(3) 10 MERCY HEALTH - 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