2015-05-14T09:10:43-05:00 2014-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2013-07-01 390816848 MERCY HEALTH SYSTEM CORPORATION MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 JAVON BEA CEO 6087566000 2015-05-11 1 BRADLEY S MCGUIRE CPA P00643763 6087525835 2015-05-11 X 2013 2016-03-07 17:11:31Z JAVON BEA PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 564694255 0 X WWW.MERCYHEALTHSYSTEM.ORG X 1972 WI THE MISSION OF MERCY HEALTH SYSTEM IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES RESULTING IN HEALING IN THE BROADEST SENSE. 9 8 3868 0 10145886 0 192379 263821 482875091 515758827 906429 293559 4487239 2856252 488461138 519172459 0 0 0 0 283427073 297341530 0 0 0 186769727 206767003 470196800 504108533 18264338 15063926 460754384 497525602 305574103 303051697 155180281 194473905 X THE MISSION OF MERCY HEALTH SYSTEM IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES RESULTING IN HEALING IN THE BROADEST SENSE. 0 0 405273227 505367904 HOSPITAL DISCHARGES 8,416, NURSING HOME ADMISSIONS 319, BIRTHS 1,006, OUTPATIENT VISITS 1,181,947MERCY HEALTH SYSTEM 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 MERCY HEALTH SYSTEM. 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. IN FACT, IN 2014, MORE THAN 138,000 PARTICIPANTS FROM THESE COUNTIES RECEIVED SERVICES DURING OUR WELLNESS CLINICS.IN THAT SAME PERIOD OF TIME, MERCY ALSO PROVIDED MORE THAN $416,000 IN FINANCIAL AND IN KIND CONTRIBUTIONS TO OTHER PRIVATE NOT FOR PROFIT HEALTH RELATED AGENCIES AND ORGANIZATION 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.MERCY 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 MERCY'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. SINCE ITS OPENING IN 1996, THE CENTER HAS SERVED MORE THAN 5500 PERSONS, MOST OF WHOM ARE UNDER THE AGE OF 18 AT THE CENTER. THE CENTER OFFERS A SAFE HARBOR FOR THESE INDIVIDUALS AS WELL AS CASE MANAGEMENT, ASSISTANCE WITH JOB SEARCHES, FINDING PERMANENT HOUSING AND EDUCATION. 405273227 1 1 0 0 0 0 0 0 0 0 1 1 0 0 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 0 0 0 1 382 0 1 3868 1 1 1 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IL WI X SHANNON DUNPHY-ALEXANDER 6087566642 1000 MINERAL POINT JANESVILLE WI 535475003 ROWLAND MCCLELLAN CHAIRPERSON & DIRECTOR 1.00 X 1097 0 0 THOMAS POOL VICE-CHAIRPERSON & DIRECTO 1.00 X 15000 0 0 LARRY SQUIRE TREASURER & DIRECTOR 1.00 X 3718 0 0 ELIZABETH HANSCH DIRECTOR 1.00 X 0 0 0 DAVE SYVERSON DIRECTOR 1.00 X 15000 0 0 MARK GOELZER MD DIRECTOR/PHYSICIAN 55.00 X 433237 0 28418 ROBERT CONSIGNY DIRECTOR 1.00 X 0 0 0 KATHERINE SCHACK DIRECTOR 1.00 X 2205 0 0 MARK KOPP DIRECTOR 1.00 X 0 0 0 BARB BORTNER VICE-PRESIDENT 55.00 X 198844 0 34313 DAN COLBY VICE-PRESIDENT 55.00 X 266553 0 28819 DAVID KURTZ VICE-PRESIDENT 55.00 X 209510 0 28280 JOHN COOK VICE-PRESIDENT 55.00 X 378933 0 37682 KATHY HARRIS VICE-PRESIDENT 55.00 X 137243 0 27926 RUTH YARBROUGH VICE-PRESIDENT 55.00 X 255040 0 23432 RICHARD GRUBER VICE-PRESIDENT 55.00 X 207379 0 27888 RALPH TOPINKA VICE-PRESIDENT 55.00 X 286672 0 15725 JOSEPH NEMETH VICE-PRESIDENT 55.00 X 212999 0 25731 SUE RIPSCH VICE-PRESIDENT 55.00 X 375874 0 32971 JENNIFER HALLATT VICE-PRESIDENT 1.00 X 225038 0 37244 PAUL VAN DEN HEUVEL VICE-PRESIDENT 1.00 X 101778 0 4809 JAVON BEA PRESIDENT & DIRECTOR 55.00 X X 5220365 0 36645 VIKRAM KHANNA PHYSICIAN 40.00 X 1820022 0 49172 BRADLEY FIDELER PHYSICIAN 40.00 X 1308704 0 41515 CHRISTOPHER STURM PHYSICIAN 40.00 X 1186786 0 39311 ROBB WHINNEY PHYSICIAN 40.00 X 1255377 0 31733 DANIEL HOFFMAN PHYSICIAN 40.00 X 1056481 0 36899 15173855 0 588513 19 0 1 0 MAGILL CONSTRUCTION COMPANY 977 KOOPMAN LANE ELKHORN WI 53121 CONSTRUCTION 5222884 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 SOFTWARE/SYSTEM MAINTENANCE 3697926 WALSH CONSTRUCTION COMPANY II LLC 929 WEST ADAMS CHICAGO IL 60607 CONSTRUCTION 2732097 HAYES LOCUMS LLC 6700 N ANDREWS AVE STE 600 FORT LAUDERDALE FL 33309 PHYSICIAN LOCUM 1322393 BABCOCK OUTDOOR ADVERTISING 966 CENTER AVE JANESVILLE WI 53546 ADVERTISING 1105491 49 129080 114899 19842 263821 PATIENT SERVICE REVENUE 621110 504383272 504383272 UNRELATED BUSINESS INCOME 561000 10145886 10145886 CAFETERIA 722210 1229669 1229669 515758827 383643 383643 45322056 109656 45407916 113880 -85860 -4224 -90084 -90084 OTHER INVESTMENTS 900099 2830329 2830329 MISCELLANEOUS 900099 25923 25923 2856252 519172459 504383272 10145886 4379480 8829156 8829156 236176326 192939869 43236457 7398033 5494816 1903217 31012904 21722276 9290628 13925111 10459254 3465857 686837 686837 44300 44300 37457 37457 27182292 15822770 11359522 3646504 17662 3628842 83798512 78905551 4892961 1238001 408239 829762 8946478 8025617 920861 1092350 465864 626486 1660793 1063586 597207 9358292 8395043 963249 25842703 23065719 2776984 4506889 3109737 1397152 BAD DEBTS 28097312 28097312 EQUIPMENT REPAIRS & MAI 7254669 4825185 2429484 WI MEDICAID & OTHER TAX 6701005 6701005 INTER-ENTITY TRANSACTIO -5837201 -4861877 -975324 2509810 615599 1894211 504108533 405273227 98835306 0 22285 24990 9996299 19975876 78130447 87097875 10104452 10737552 5603206 5824521 533925660 245335466 291762282 288590194 50226624 73661949 14908789 11612645 460754384 497525602 56498293 60162338 7084631 7104728 241991179 235784631 305574103 303051697 X 155180281 194473905 155180281 194473905 460754384 497525602 X 15063926 370495 23859203 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27078424 27078424 296003827 106255768 189748059 5259189 3882255 1376934 193247672 130155230 63092442 12336548 5042213 7294335 288590194 INVEST. - FUTURE REPLACE OF PROP, PLANT & EQUIPMENT 32812437 C ASSETS UNDER BOND INDENTURE AGREEMENT 4344304 C DEFERRED COMPENSATION 9969659 C INVESTMENT IN MERCYCARE 21815602 C INVESTMENTS - OTHER 4719947 C 73661949 DEFERRED COMPENSATION 9969659 PENSION LIABILITY 23773000 CAPITAL LEASES PAYABLE 195658 DUE TO RELATED PARTY 201846314 235784631 1 1 X 1 X 1 X 1 1 1 0 1 1 4303830 4303830 0.00850 66562299 35208378 31353921 0.06220 5766020 3311063 2454957 0.00490 76632149 38519441 38112708 0.07560 1563349 204853 1358496 0.00270 5304291 782389 4521902 0.00900 10626742 8332172 2294570 0.00460 506780 506780 0.00100 18001162 9319414 8681748 0.01730 94633311 47838855 46794456 0.09290 53040 53040 0.00010 32640 32640 0.00010 20400 20400 0.00000 34680 34680 0.00010 140760 140760 0.00030 1 11493404 1517129 56735174 74331057 -17595883 X 1 1 2 1 MERCY HOSPITAL 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 X X X X 2 MERCY WALWORTH HOSPITAL AND MEDICAL CENT N2950 STATE ROAD 67 LAKE GENEVA WI 53147 X X X X MERCY HOSPITAL AND TRAUMA CENTER 1 1 X X X X X X X X 13 1 1 1 X MERCYHEALTHSYSTEM.ORG X X X X X X X X X 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X 1 X 0 1 X 0 0 MERCY WALWORTH HOSPITAL AND MEDICAL CENT 2 1 X X X X X X X X 13 1 1 1 X MERCYHEALTHSYSTEM.ORG X X X X X X X X X 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X 1 X 0 1 X 0 0 MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 3: MERCY HEALTH SYSTEM (MHS) SET OUT TO GATHER INFORMATION ON THE COMMUNITY OF ROCK COUNTY, WISCONSIN. MHS COLLABORATED WITH BELOIT HEALTH SYSTEM, ROCK COUNTY HEALTH DEPARTMENT, UNIVERSITY OF WISCONSIN- EXTENSION ROCK COUNTY, ROCK COUNTY, HEALTHNET OF ROCK COUNTY, EDGERTON HOSPITAL AND HEALTH SERVICES, SSM HEALTHCARE OF WISCONSIN. THE GROUP GATHERED INFORMATION THROUGH HOUSEHOLD SURVEYS AND SECONDARY DATA SOURCES.MERCY HEALTH SYSTEM DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF ROCK COUNTY RESIDENTS. THE FIFTY QUESTION SURVEY WAS DISTRIBUTED TO 2,000 MEMBERS OF THE COMMUNITY AND COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. A RESPONSE WAS RECEIVED FROM 32.8% OF HOUSEHOLDS THAT RECEIVED THE SURVEY. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, MERCY HEALTH SYSTEM ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING WISCONSIN COUNTY HEALTH RANKINGS, WISCONSIN DEPARTMENT OF TRANSPORTATION, DEPARTMENT OF EDUCATION, WISCONSIN DEPARTMENT OF HEALTH SERVICES, U.S. CENSUS BUREAU, AND OTHERS. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, 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. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 3: MERCY HEALTH SYSTEM DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF WALWORTH COUNTY RESIDENTS. THE SURVEY, DISTRIBUTED TO 2000 MEMBERS OF THE COMMUNITY, COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. A RESPONSE WAS RECEIVED FROM 14.4% OF HOUSEHOLDS THAT RECEIVED THE SURVEY (288 SURVEYS). ONCE THE SURVEY RESPONSES WERE TABULATED, THE SURVEY RESULTS WERE EVALUATED AND ANALYZED FOR HEALTH AND DEMOGRAPHIC TRENDS. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, MERCY HEALTH SYSTEM ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTES COUNTY HEALTH RANKINGS, WISCONSIN DEPARTMENT OF PUBLIC HEALTH, AND THE UNITED STATES CENSUS BUREAU. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF WALWORTH COUNTY. MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 4: BELOIT, EDGERTON, ST MARY'S JANESVILLE MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 4: AURORA LAKELAND MEDICAL CENTER MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 14G: AVAILABLE THROUGH PATIENT FINANCIAL COUNSELORS WHO DO PRE- OR POST-FOLLOW UP WITH SELF-PAY PATIENTS. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 14G: AVAILABLE THROUGH PATIENT FINANCIAL COUNSELORS WHO DO PRE- OR POST-FOLLOW UP WITH SELF-PAY PATIENTS. MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE COMMERCIAL CHARGE. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE COMMERCIAL CHARGE. 50 MERCY MANOR TRANSITION CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 SKILLED NURSING/SUB-ACUTE CARE FACILITY MERCY REGIONAL CANCER CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 RADIATION ONCOLOGY CLINIC/RADIATION THERAPY FACILITY HOUSE OF MERCY HOMELESS SHELTER 320 LINCOLN STREET JANESVILLE WI 53548 HOMELESS CENTER MERCY ALGONQUIN MEDICAL CENTER 2401 HARNISH DRIVE SUITE 101 ALGONQUIN WI 60102 OUTPATIENT PHYSICIAN CLINIC MERCY BARIATRIC WELLNESS CENTER 250 E CENTER DRIVE SUITE 201 VERNON HILLS WI 60061 OUTPATIENT PHYSICIAN CLINIC MERCY BARRINGTON MEDICAL CENTER 500 WEST HIGHWAY 22 BARRINGTON WI 60010 OUTPATIENT PHYSICIAN CLINIC MERCY BELOIT MEDICAL CENTER 2825 PRAIRIE AVENUE BELOIT WI 53511 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY BRODHEAD MEDICAL CENTER 2310 FIRST CENTER AVENUE BRODHEAD WI 53520 OUTPATIENT PHYSICIAN CLINIC MERCY CENTER FOR CORRECTIVE EYE SURGERY 5400 W ELM STREET SUITE 120 MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC MERCY CENTER FOR CORRECTIVE EYE SURGERY 8780 W GOLF ROAD STE 304 NILES IL 60714 OUTPATIENT PHYSICIAN CLINIC MERCY CLINIC EAST 3524 EAST MILWAUKEE STREET JANESVILLE WI 53546 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY CLINIC EAST PHARMACY 3524 EAST MILWAUKEE STREET JANESVILLE WI 53546 RETAIL PHARMACY MERCY CLINIC SOUTH 849 KELLOGG AVENUE JANESVILLE WI 53546 RESIDENCY PROGRAM / OUTPATIENT PHYSICIAN CLINIC MERCY CLINIC WEST 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC & MEDICAL ONCOLOGY MERCY CLINIC WEST PHARMACY 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 RETAIL PHARMACY MERCY CRYSTAL LAKE CHIROPRACTIC AND REHA 330 W TERRA COTTA ROAD RTE 176 CRYSTAL LAKE IL 60014 CHIROPRACTOR MERCY CRYSTAL LAKE MEDICAL CENTER EAST 390 CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY CRYSTAL LAKE MEDICAL CENTER WEST 350 CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY CRYSTAL LAKE OBGYN 750 E TERRA COTTA STE B CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY CRYSTAL LAKE MEDICAL CENTER SOUTH 415-A CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY DELAVAN MEDICAL CENTER 1038 E GENEVA ST DELAVAN WI 53115 OUTPATIENT PHYSICIAN CLINIC MERCY EDGERTON MEDICAL CENTER 217 N MAIN STREET EDGERTON WI 53534 OUTPATIENT PHYSICIAN CLINIC MERCY EVANSVILLE MEDICAL CENTER 300 UNION STREET EVANSVILLE WI 53536 OUTPATIENT PHYSICIAN CLINIC MERCY HARVARD CLINIC SOUTH 348 S DIVISION HARVARD IL 60033 OUTPATIENT PHYSICIAN CLINIC MERCY HEALTH MALL 1010 NORTH WASHINGTON JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY HEALTH MALL PHARMACY 1010 NORTH WASHINGTON JANESVILLE WI 53548 RETAIL PHARMACY MERCY LAKE GENEVA MEDICAL CENTER 350 PELLER ROAD LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC MERCY LAKESIDE ORTHOPAEDICS 352 PELLER ROAD LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC MERCY MCHENRY INTERNAL MEDICINE CENTER 633 RIDGEVIEW DRIVE MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC MERCY MCHENRY MEDICAL CENTER 3922 MERCY DRIVE MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC MERCY MILTON MEDICAL CENTER 725 SOUTH JANESVILLE STREET MILTON WI 53563 OUTPATIENT PHYSICIAN CLINIC MERCY MILTON PHARMACY 725 SOUTH JANESVILLE STREET MILTON WI 53563 RETAIL PHARMACY MERCY NORTHWEST WOMEN'S GROUP 47 WEST ACORN LANE LAKE IN THE HILLS IL 601564804 OUTPATIENT PHYSICIAN CLINIC MERCY OPTIONS-COOPERATIVE CHILDCARE INST 20 EAST COURT STREET JANESVILLE WI 53548 TREATMENT FACILITY FOR ADOLESCENTS MERCY OPTIONS-JANESVILLE 903 MINERAL POINT AVENUE JANESVILLE WI 53548 PHYSICIAN & THERAPIST SERVICES: MENTAL HEALTH & ADDICTION TREATMENT MERCY REGIONAL DIALYSIS CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 DIALYSIS CENTER MERCY REGIONAL LUNG CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 PHYSICIANS CLINIC & SLEEP DISORDER CENTER MERCY RICHMOND MEDICAL CENTER 9715 PRAIRIE RIDGE RICHMOND IL 60071 OUTPATIENT PHYSICIAN CLINIC MERCY SHARON MEDICAL CENTER 118 PLAIN STREET SHARON WI 53585 OUTPATIENT PHYSICIAN CLINIC MERCY SPORTS MEDICINE AND REHABILITATION 557 NORTH WASHINGTON JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC AND REHABILITATION FACILITY MERCY TERRACE 510 N TERRACE STREET JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC MERCY WALWORTH PHARMACY N2950 STATE ROAD 67 LAKE GENEVA WI 53147 RETAIL PHARMACY MERCY WHITEWATER MEDICAL CENTER 507 WEST MAIN STREET WHITEWATER WI 53190 OUTPATIENT PHYSICIAN CLINIC MERCY WHITEWATER SPORTS MEDICINE & REHAB 519 WEST MAIN STREET WHITEWATER WI 53190 OUTPATIENT PHYSICIAN CLINIC AND REHABILITATION FACILITY MERCY WOODSTOCK MEDICAL CENTER 2000 LAKE AVENUE WOODSTOCK IL 60098 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY WOODSTOCK PHARMACY 2000 LAKE AVENUE WOODSTOCK IL 60098 RETAIL PHARMACY MERCY WOMEN'S HEALTHCARE CENTER - ALCONQ 2230 N HUNTINGTON DR ALGONQUIN IL 60102 OUTPATIENT PHYSICIAN CLINIC MERCY WOMEN'S HEALTHCARE CENTER - ELGIN 750 FLETCHER DR STE 206 ELGIN IL 60123 OUTPATIENT PHYSICIAN CLINIC WOMEN'S HEALTH CENTER - HOFFMAN ESTATES 1555 BARRINGTON RD STE 2300A HOFFMAN ESTATES IL 60169 OUTPATIENT PHYSICIAN CLINIC MERCY ELKHORN MEDICAL CENTER 839 N WISCONSIN ST ELKHORN WI 53121 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 6A: MERCY HEALTH SYSTEM, CORP. (MHS) SUBMITS AN ANNUAL COMMUNITY BENEFIT STATEMENT TO THE WISCONSIN HOSPITAL ASSOCIATION. 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). MHS ISSUED A PRESS RELEASE RELATING TO THE HEALTH SYSTEM'S PRIOR YEAR'S COMMUNITY BENEFITS AND HAS THE SAME ON ITS WEBSITE; IT FURTHER REFERENCES THE AVAILABILITY OF WHA'S REPORT. 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, LINE 7G: THE SUBSIDIZED HEALTH CARE LINE INCLUDES $3,306,659 OF EXPENSES (COLUMN C) AND $1,447,230 OF NET EXPENSES (COLUMN E) ATTRIBUTABLE TO THE COSTS OF TRAUMA SURGEONS. THESE SURGEONS STAFF THE LEVEL II TRAUMA PROGRAM OF MERCY HEALTH SYSTEM CORPORATION 24/7. MERCY SOUTH - FAMILY PRACTICE CLINIC WAS ALSO INCLUDED IN THIS LINE: EXPENSES IN COLUMN C TOTALED $3,573,088 AND COLUMN E HAD $259,487 OF NET EXPENSES. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $28,097,312 INCLUDED ON FORM 990, PART IX, LINE 25, WAS EXCLUDED FROM EXPENSES WHEN CALCULATING THE PERCENTAGE IN THIS COLUMN. PART II, COMMUNITY BUILDING ACTIVITIES: MERCY'S MANY HEALTH IMPROVEMENT AND BENEFIT SERVICES/OPERATIONS WERE THE RESULT OF MERCY FILLING A COMMUNITY NEED. MERCY'S COLLABORATIVE EFFORTS AND THE EFFORTS OF ITS RELATED ENTITIES HAVE BROUGHT ASSISTANCE TO THE AREA'S UNDERSERVED (AS DETAILED IN #2 ABOVE). 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 SYSTEM CORPORATION AND SUBSIDIARIES). PATIENT ACCOUNTS RECEIVABLE ARE RECORDED. . . NET OF CONTRACTUAL ADJUSTMENTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH REFLECTS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. . . IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, MHSC ANALYZES HISTORICAL LOSS EXPERIENCE ON REVENUE FOR ALL PAYORS. USING THE LOSS EXPERIENCE RATE, MHSC ESTIMATES THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. 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. THE ESTIMATE OF BAD DEBT DOLLARS THAT MAY HAVE BEEN COVERED THROUGH MERCY'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 13.2%. THIS FIGURE WAS BASED ON THE PERCENT OF BAD DEBT ACCOUNT DOLLARS THAT ARE RECLASSIFIED FOR CHARITY AND/OR BANKRUPTCY PURPOSES. PART III, LINE 8: DATA FOR LINES 5 & 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MERCY'S TWO HOSPITALS' MEDICARE COST REPORTS. PART III, LINE 9B: PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MERCY'S COMMUNITY CARE PROGRAM, WILL RECEIVE A 20% DISCOUNT FROM MERCY'S STANDARD FEE SCHEDULE. ALL SELF-PAY PATIENTS MEET WITH PATIENT FINANCIAL COUNSELORS AND DISCUSS PAYMENT OPTIONS INCLUDING MERCY'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: MERCY HEALTH SYSTEM CORPORATION DOES COMMUNITY NEEDS ASSESSMENTS IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF WALWORTH (WI), ROCK (WI), AND MCHENRY (IL) COUNTIES EVERY 18 MONTHS. MERCY HAS DEDICATED STAFF THAT WORKS WITH VARIOUS AGENCIES/PROGRAMS OF NEARBY COMMUNITIES TO ASSESS HEALTH NEEDS. COLLABORATIVE EXAMPLES OF MERCY AND MERCY'S RELATED ENTITIES INCLUDE: 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. THIS FIRST-OF-ITS-KIND PARTNERSHIP IS THE RESULT OF YEARS OF WORK WITH LOCAL PARTNERS AND THE FEDERAL GOVERNMENT TO DESIGN AND DEBUT A NEW MODEL OF CARE FOR THE UNDERSERVED. THE CLINIC SEES OVER 200 NEW PATIENTS EACH MONTH, HAS SIGNIFICANTLY IMPROVED PATIENT OUTCOMES, AND HAS SAVED MILLIONS IN UNNECESSARY EMERGENCY DEPARTMENT COSTS. II) HEALTHNET FREE CLINIC IN JANESVILLE: MERCY PHYSICIANS VOLUNTEER THEIR SERVICES. MERCY ALSO DONATES LAB, RADIOLOGY AND OTHER ANCILLARY SERVICES TO PATIENTS. III) FAMILY HEALTH PARTNERSHIP CLINIC AND WELL CHILD CLINIC IN WOODSTOCK, IL AND HARVARD FREE CLINIC IN MCHENRY COUNTY, IL: MERCY PHYSICIANS 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. V) ROCK COUNTY HEALTH DEPARTMENT: BIOTERRORISM READINESS PROJECT. VI) RED CROSS: BLOOD DRIVE AND COOPERATIVE VOLUNTEER EFFORTS. VII) UNITED WAY: FUND RAISING CAMPAIGN AND ROCK COUNTY NEEDS ASSESSMENT SURVEY CONTRIBUTOR VIII) AREA POLICE AND FIRE DEPARTMENTS: PROVIDE PORTABLE DEFIBRILLATORS FOR POLICE VEHICLES AND FREE OR REDUCED-COST PARAMEDIC/EMT EDUCATIONAL OPPORTUNITIES. IX) COMMUNITY ACTION, INC.: MERCY LEADERSHIP SERVES ON STRATEGIC PLANNING COMMITTEE AND COMMUNITY ACTION DEVELOPMENT BOARD. 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, 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 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 (2013) WAS AT 8.6% WHILE THE STATE (WI) AND THE NATION WERE AT 7.0% AND 7.5%, RESPECTIVELY. MEDIAN HOUSEHOLD INCOME (2012) WAS $50,316 IN ROCK COUNTY, WHICH IS LOWER THAN BOTH THE STATES $52,627 AND NATIONAL MEDIAN OF $53,046. IN 2012, 13.5% OF ROCK COUNTY RESIDENTS LIVED BELOW THE POVERTY LEVEL; THIS IS LARGER THAN THE STATES AVERAGE OF 12.5%, BUT LESS THAN THE NATIONAL AVERAGE OF 14.9%. OVER 50% OF STUDENTS IN THE JANESVILLE SCHOOL DISTRICT WERE ECONOMICALLY DISADVANTAGED STUDENTS (SCHOOL YEAR 2012-2013).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. MERCY HEALTH SYSTEM DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF WALWORTH COUNTY RESIDENTS. THE SURVEY, DISTRIBUTED TO 2000 MEMBERS OF THE COMMUNITY, COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. A RESPONSE WAS RECEIVED FROM 14.4% OF HOUSEHOLDS THAT RECEIVED THE SURVEY (288 SURVEYS). ONCE THE SURVEY RESPONSES WERE TABULATED, THE SURVEY RESULTS WERE EVALUATED AND ANALYZED FOR HEALTH AND DEMOGRAPHIC TRENDS. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, MERCY HEALTH SYSTEM ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTES COUNTY HEALTH RANKINGS, WISCONSIN DEPARTMENT OF PUBLIC HEALTH, AND THE UNITED STATES CENSUS BUREAU. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF WALWORTH COUNTY. UNEMPLOYMENT IN WALWORTH COUNTY (2013) WAS AT 7.0%; THIS MATCHED THE STATES (WI) RATE AND WAS BETTER THAN THE NATIONAL AVERAGE OF 7.5%. APPROXIMATELY 50% OF STUDENTS IN THE LAKE GENEVA J1 SCHOOL DISTRICT WERE ECONOMICALLY DISADVANTAGED STUDENTS (SCHOOL YEAR 2012-2013).MERCY HEALTH SYSTEM CORPS PAYOR DEMOGRAPHICS FOR ITS HOSPITALS INCLUDE 39.6% MEDICARE, AND 14.4% MEDICAID FOR THE FISCAL YEAR OF JULY 1, 2013 JUNE 30, 2014 (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 ALLIANCE INC. IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORPORATION, MERCY HARVARDHOSPITAL, INC., AND MERCY ASSISTED CARE INC. MERCY HARVARD HOSPITAL PROVIDES ACUTE CARE SERVICES IN MCHENRY COUNTY, ILLINOIS. 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.MERCY HEALTH SYSTEM CORP. WORKS WITH THE MERCY 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 290 INDIVIDUALS PER YEAR THE LAST THREE YEARS.MERCY HOSPITAL ASSOCIATION OF VOLUNTEERS, INC. IS THE ORGANIZATION/TAX ENTITY OF MERCYS VOLUNTEERS. VOLUNTEERS NUMBERED 1,470 IN CALENDAR YEAR 2013. THIS ORGANIZATION NOT ONLY SUPPORTS MERCYS SERVICES, BUT PROVIDES BENEFITS TO THE COMMUNITY AS A WHOLE. IN CONJUNCTION WITH MERCY HEALTH SYSTEMS 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 X X X X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 MARK GOELZER MD DIRECTOR/PHYSICIAN 428028 0 0 0 5209 0 15576 0 12842 0 461655 0 0 0 BARB BORTNER VICE-PRESIDENT 135533 0 62671 0 640 0 13029 0 21284 0 233157 0 0 0 DAN COLBY VICE-PRESIDENT 179806 0 68085 0 18662 0 16851 0 11968 0 295372 0 0 0 DAVID KURTZ VICE-PRESIDENT 136730 0 62671 0 10109 0 13111 0 15169 0 237790 0 0 0 JOHN COOK VICE-PRESIDENT 258028 0 115445 0 5460 0 16851 0 20831 0 416615 0 0 0 KATHY HARRIS VICE-PRESIDENT 87296 0 40977 0 8970 0 8056 0 19870 0 165169 0 0 0 RUTH YARBROUGH VICE-PRESIDENT 167541 0 74487 0 13012 0 16223 0 7209 0 278472 0 0 0 RICHARD GRUBER VICE-PRESIDENT 136675 0 62153 0 8551 0 13329 0 14559 0 235267 0 0 0 RALPH TOPINKA VICE-PRESIDENT 183819 0 91483 0 11370 0 13026 0 2699 0 302397 0 0 0 JOSEPH NEMETH VICE-PRESIDENT 140908 0 63877 0 8214 0 13602 0 12129 0 238730 0 0 0 SUE RIPSCH VICE-PRESIDENT 247499 0 111778 0 16597 0 16851 0 16120 0 408845 0 0 0 JENNIFER HALLATT VICE-PRESIDENT 151395 0 69829 0 3814 0 14830 0 22414 0 262282 0 0 0 JAVON BEA PRESIDENT & DIRECTOR 1005629 0 883870 0 3330866 0 16851 0 19794 0 5257010 0 0 0 VIKRAM KHANNA PHYSICIAN 1819662 0 0 0 360 0 15576 0 33596 0 1869194 0 0 0 BRADLEY FIDELER PHYSICIAN 1307876 0 0 0 828 0 15576 0 25939 0 1350219 0 0 0 CHRISTOPHER STURM PHYSICIAN 1186246 0 0 0 540 0 15576 0 23735 0 1226097 0 0 0 ROBB WHINNEY PHYSICIAN 1255017 0 0 0 360 0 15576 0 16157 0 1287110 0 0 0 DANIEL HOFFMAN PHYSICIAN 1005821 0 0 0 50660 0 15576 0 21323 0 1093380 0 0 0 PART I, LINE 1A RESIDENCE FOR PERSONAL USE - THE CEO IS PROVIDED WITH A RESIDENCE. THE COST OF RENTING THE RESIDENCE IS TREATED AS TAXABLE COMPENSATION. PAYMENTS FOR BUSINESS USE OF PERSONAL RESIDENCE - THE CEO IS REIMBURSED FOR INTERNET ACCESS AND COMMUNICATION COSTS USED FOR BUSINESS PURPOSES AT HIS PERSONAL RESIDENCE. THE REIMBURSEMENT IS TREATED AS TAXABLE COMPENSATION. HEALTH CLUB DUES - THE CEO IS REIMBURSED FOR HEALTH CLUB DUES. THIS IS TREATED AS TAXABLE COMPENSATION. PERSONAL SERVICES - THE CEO IS REIMBURSED FOR INCOME TAX PREPARATION SERVICES. THIS IS TREATED AS TAXABLE COMPENSATION. KRISTEN GOELZER FAMILY MEMBER OF MARK GOELZER, DIRECTOR 297025 EMPLOYMENT - PHYSICIAN 0 JAMIE KURTZ FAMILY MEMBER OF DAVID KURTZ, OFFICER 35854 EMPLOYMENT - PATIENT ACCOUNT REPRESENTATIVE 0 JOANNA BENNING FAMILY MEMBER OF JAVON BEA, PRESIDENT & DIRECTOR 142126 EMPLOYMENT - DIRECTOR 0 MEGAN KRAUSE FAMILY MEMBER OF SUE RIPSCH, OFFICER 90815 EMPLOYMENT - MANAGER 0 LAUREN GRUBER FAMILY MEMBER OF RICHARD GRUBER, OFFICER 48641 EMPLOYMENT - RN/HIB 0 FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING.THE FORM 990 IS AVAILABLE TO THE BOARD FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO REPORT ALL CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR INVESTIGATING ALL CONFLICTS AND REPORTING TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE MERCY ALLIANCE COMPENSATION COMMITTEE IS COMPRISED OF THE BOARD CHAIRPERSON, SECRETARY, AND THE TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED BY INDEPENDENT LEGAL COUNCIL AND AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE, LEGAL COUNCIL, AND THE COMPENSATION CONSULTANT MEET THROUGHOUT THE YEAR AND REPORT DIRECTLY TO THE BOARD OF DIRECTORS ANNUALLY. THIS PROCESS WAS COMPLETED FOR 2012. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: NET AFFILIATES TRANSFER 23,600,000. CHANGES IN PENSION OBLIGATIONS 195,000. OTHER 64,203. MERCY ALLIANCE INC 1000 MINERAL POINT JANESVILLE WI 535475003 391679859 MANAGEMENT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) 11A N/A 0 MERCY FOUNDATION INC 1000 MINERAL POINT JANESVILLE WI 535475003 237275336 TO SUPPORT MERCY HEALTH SYSTEM & THE HOUSE OF MERCY WI 501(C)(3) 11A MERCY HEALTH SYSTEM CORPORATION 1 MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT JANESVILLE WI 535475003 390912682 TO SUPPORT MERCY HEALTH SYSTEM CORPORATION WI 501(C)(3) 11C MERCY HEALTH SYSTEM CORPORATION 1 MERCY ASSISTED CARE INC 901 MINERAL POINT JANESVILLE WI 535475003 391035110 HOME HEALTH CARE & SERVICES WI 501(C)(3) 9 MERCY ALLIANCE INC 0 MERCY ALLIANCE INC 901 GRANT STREET HARVARD IL 60033 311551871 MEDICAL HEALTHCARE IL 501(C)(3) 3 MERCY ALLIANCE INC 0 HARVARD MEMORIAL HOSPITAL FOUNDATION 901 GRANT STREET HARVARD IL 60033 364308662 TO SUPPORT MERCY HARVARD HOSPITAL, INC. IL 501(C)(3) 11A MERCY HARVARD HOSPITAL INC 0 MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 1000 MINERAL POINT JANESVILLE WI 535475003 201673011 NONE IL 501(C)(3) 3 MERCY ALLIANCE INC 0 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 535475003 391520130 MANAGEMENT ENTITY OF UNION EMPLOYEES WI MERCY HEALTH SYSTEM CORPORATION C 68984 1.00000 1 MERCYCARE INSURANCE COMPANY 3430 PALMER DRIVE JANESVILLE WI 53545 391768192 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 111471679 50097627 1.00000 1 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 3430 PALMER DRIVE JANESVILLE WI 53545 201482553 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 1.00000 1 1 0 0 0 1 0 0 0 0 1 1 0 0 1 1 0 1 1 0 MERCYCARE INSURANCE COMPANY Q 7477970 COST OF SERVICES PROVIDED