2015-05-14T08:09:34-05:00 2014-06-30 990 2013-07-01 043398280 MERCY HOSPITAL INC MERC 4135392689 C/O SPHS 1221 MAIN STREET NO 213 HOLYOKE MA 010405396 THOMAS ROBERT SVP & CFO 4135392689 2015-05-14 2013 2016-02-25 16:41:14Z SEE SCHEDULE O DANIEL MOEN 271 CAREW SPRINGFIELD MA 01104 253660011 0 0928 X WWW.MERCYCARES.COM X 1898 MA MERCY HOSPITAL, INC. IS A NOT-FOR-PROFIT HOSPITAL ESTABLISHED TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. MERCY HOSPITAL OFFERS A WIDE RANGE OF PROGRAMS AND SERVICES IN ACUTE CARE, BEHAVIORAL HEALTH CARE AND REHABILITATION CARE. 19 16 1816 150 1411339 -5821 11224422 2123050 111670963 234779169 311921 276810 2558426 16372497 125765732 253551526 0 0 0 0 55625419 113917905 60422256 0 0 0 121596109 116047675 235514014 9718057 18037512 203997970 216680288 90882954 79039114 113115016 137641174 X MERCY HOSPITAL, INC., A MEMBER OF SISTERS OF PROVIDENCE HEALTH SYSTEM, INC. ("SPHS"), IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE COMMUNITIES THAT WE SERVE. WE BELIEVE IN THE SACREDNESS OF HUMAN LIFE, IN THE INNATE DIGNITY OF EACH PERSON, AND THAT IT IS IN RELATIONSHIP WITH ONE ANOTHER THAT ALL PERSONS REALIZE THEIR FULLEST POTENTIAL. IN OUR SERVICE, WE ARE SUSTAINED BY AN UNWAVERING TRUST IN GOD'S PROVIDENCE. 0 0 225792489 247481309 MERCY HOSPITAL, INC. OFFERS A WIDE RANGE OF PROGRAMS AND SERVICES IN ACUTE CARE. THE ACUTE PROGRAMS AND SERVICES INCLUDE CARDIAC CARE, MATERNITY SERVICES, CANCER TREATMENT, EMERGENCY CARE, DIAGNOSTIC IMAGING, INTENSIVE CARE, CRITICAL CARE AND SURGICAL PROCEDURES BOTH INPATIENT AND OUTPATIENT.MERCY HOSPITAL, INC.'S BEHAVORIAL HEALTH PROGRAMS AND SERVICES INCLUDE INPATIENT AND OUTPATIENT PSYCHIATRIC CARE FOR PEOPLE OF ALL AGES, SHORT-TERM RESIDENTIAL TREATMENT FOR PEOPLE WITH ACUTE PSYCHIATRIC AND/OR SUBSTANCE ABUSE PROBLEMS, AND INTENSIVE OUTPATIENT CHEMICAL DEPENDENCY PROGRAMS.MERCY HOSPITAL, INC.'S REHABILITATION PROGRAMS AND SERVICES INCLUDE INPATIENT, OUTPATIENT, DAY AND PEDIATRIC REHABILITATION SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, AUDIOLOGY AND PAIN MANAGEMENT. THE MISSION STATEMENT OF THE HOSPITAL IS AS FOLLOWS:WE, MERCY HOSPITAL AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 225792489 1 1 0 1 0 0 0 0 0 1 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 0 1 1 0 0 0 0 1 1 1 0 0 1 277 0 1 1816 1 1 1 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 MA X WILLIAM KRASIN 4135392689 C/O SPHS 1221 MAIN ST SUITE 213 HOLYOKE MA 010405396 DANIEL P MOEN TRUSTEE; PRESIDENT & CEO 24.00 31.00 X X 0 819398 40778 KATHLEEN M KANE TRUSTEE; CHAIR 1.00 4.00 X X 0 0 0 JOHN E SJOBERG TRUSTEE; VICE CHAIR 1.00 4.00 X X 0 0 0 DEAN M WHALEN ESQ TRUSTEE; SECRETARY 1.00 4.00 X X 0 0 0 CHRISTOPHER H COMEY MD TRUSTEE; PRES, MED STAFF AS OF 4/14 1.00 49.00 X 0 727734 34729 JOANNE M BEAUREGARD TRUSTEE 1.00 4.00 X 0 0 0 SR MARY GEARY CARITAS SP TRUSTEE 1.00 4.00 X 0 0 0 WILLIAM A COLLINS TRUSTEE 1.00 4.00 X 0 0 0 REV MSGR CHRISTOPHER CONNELLY TRUSTEE 1.00 4.00 X 0 0 0 SR ANN M HORGAN SP TRUSTEE 1.00 4.00 X 0 0 0 SR RUTH F MCGOLDRICK SP TRUSTEE 1.00 4.00 X 0 0 0 LEDA M MCKENRY PHD TRUSTEE 1.00 4.00 X 0 0 0 SR JOAN C MULLEN SP TRUSTEE 1.00 4.00 X 0 0 0 PAUL MANCINONE TRUSTEE 1.00 4.00 X 0 0 0 PAUL MARCHESE TRUSTEE 1.00 4.00 X 0 0 0 MARK J MULLAN MD TRUSTEE 1.00 4.00 X 0 0 0 SHIRIN NASH MD TRUSTEE 1.00 4.00 X 0 0 0 JOHN JOYCE TRUSTEE 1.00 4.00 X 0 0 0 VANESSA OTERO TRUSTEE 1.00 4.00 X 0 0 0 DAVID M CHADBOURNE MD TRUSTEE THROUGH 4/14 1.00 4.00 X 0 0 0 MOHAMED P HAMDANI MD TRUSTEE THROUGH 2/14 1.00 54.00 X 0 275461 23267 THOMAS ROBERT TREASURER/SVP & CFO 20.00 30.00 X 0 349666 36204 DANIEL KEENAN ASST SEC/SVP GOV'T RELATIONS 20.00 30.00 X 0 226698 29812 LEONARD F PANSA SVP HR & ADMIN SERVICES 25.00 25.00 X 0 309483 14250 SHARON ADAMS SVP PATIENT CARE SERVICES 50.00 0.00 X 294852 0 23744 SCOTT WOLF SVP & CMO 22.00 28.00 X 0 415272 38718 HAROLD JORDAN MEDICAL DIRECTOR THRU 10/13 50.00 0.00 X 221733 0 22998 MARY TARAIL CHIEF MEDICAL OFFICER 50.00 0.00 X 280954 0 8687 NANCY DUFAULT STAFF NURSE 50.00 0.00 X 248544 0 20470 GAURAV CHAWLA CHIEF OF PSYCHIATRY 50.00 0.00 X 230583 0 35875 CHHEWANG NORSANG MEDICAL DIRECTOR 50.00 0.00 X 227400 0 17738 JAITEERTH AVADHANI RADIATION PHYSICIST 50.00 0.00 X 189421 0 30369 JOHN DIGGINS PSYCHIATRIST 50.00 0.00 X 181133 0 6502 1874620 3123712 384141 138 0 1 0 RAYMOND HOULE CONSTRUCTION 5 MILLER ST LUDLOW MA 01056 CONSTRUCTION SERVICES 2679912 SHERIDAN MORSE HEALTHCARE OF MA PO BOX 452197 SUNRISE FL 33323 ANESTHESIA SERVICES 1580968 WESTERN MASS CRITICAL CARE PC 300 STAFFORD ST STE 300 SPRINGFIELD MA 01104 PHYSICIAN FEES 1430414 ANGELICA TEXTILE SERVICES PO BOX 535122 ATLANTA GA 30353 LAUNDRY SERVICES 1105372 INPATIENT PEDIATRIC SERVICES INC 153 MUNGER HILL RD WESTFIELD MA 01085 PHYSICIAN FEES 859708 31 1253249 869801 93000 2123050 NET PATIENT SVC REV 622110 233490759 233490759 PHARMACY REVENUE 446110 1288410 22113 1266297 234779169 194235 194235 881611 0 881611 881611 881611 82575 0 82575 82575 82575 137440 108485 28955 28955 GOV'T SUBSIDY - EHR 622110 2596651 2596651 CAFETERIA REVENUE 722514 1348452 1348452 11516828 11371786 145042 15461931 253551526 247481309 1411339 2535828 852968 852968 93772773 92960642 812131 2794415 2768063 26352 9237618 9114645 122973 7260131 7136269 123862 515688 515688 20598659 19759219 839440 24765 12558 12207 3724239 3397075 327164 5473513 5247134 226379 185811 169809 16002 65471 59434 6037 1837100 1837100 9151912 7525755 1626157 1577461 1575932 1529 MEDICAL SUPPLIES 34760837 34760837 SYSTEM ASSESSMENT FEES 26056681 22669312 3387369 INTERCO LAB FEES 9422873 9422873 BAD DEBT 2318440 2318440 5882659 5057392 825267 235514014 225792489 9721525 0 83092989 9266618 321111 623834 26307783 22328800 1921 329142 3611354 3923138 879815 232181266 150863323 78135174 81317943 4342888 48677064 42525796 8184750 6808138 203997970 216680288 18597540 29786023 298042 45365670 26621702 49253091 90882954 79039114 X 111034608 135437142 1722602 1846226 357806 357806 113115016 137641174 203997970 216680288 X 18037512 112393 6376253 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 31878 0 0 0 31878 0 PART II-B, LINE 1: MERCY HOSPITAL, INC. HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED MERCY HOSPITAL, INC. WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. MERCY HOSPITAL, INC. MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 357806 357806 357806 25344 25344 357806 357806 41439 41439 357806 357806 996 996 357806 357806 35065 35065 357806 1.00000 0 0 2195837 2195837 88163374 41831973 46331401 384338 302784 81554 127027433 103486343 23541090 14410284 5242223 9168061 81317943 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 9048042 F HEDGE FUNDS 13572062 F EQUITY METHOD INVESTMENTS 19905692 C 42525796 INTERCOMPANY ACCOUNTS PAYABLE 867166 INTERCOMPANY OTHER LT LIABILITIES 1104138 INTERCOMPANY NOTES PAYABLE 44041791 OTHER CURRENT LIABILITIES 2215231 ASSET RETIREMENT OBLIGATION (FIN 47) 1024765 49253091 PART V, LINE 4: INCOME FROM ENDOWMENT FUNDS ARE USED TO PROVIDE PATIENT CARE. 1 1 X 1 X 1 X 1 1 0 1 1 5620066 1940348 3679718 0.01580 55880632 51405477 4475155 0.01920 5633877 4374007 1259870 0.00540 67134575 57719832 9414743 0.04040 1921216 1567196 354020 0.00150 100550 100550 0.00040 21110 21110 0.00010 2042876 1567196 475680 0.00200 69177451 59287028 9890423 0.04240 0 902131 0 91349363 86198965 5150398 X 1 1 1 1 MERCY HOSPITAL INC 271 CAREW ST SPRINGFIELD MA 011040000 WWW.MERCYCARES.COM STATE LICEN X X X MERCY HOSPITAL INC 1 1 X X X X X X X X X 13 1 1 1 X HTTP://WWW.MERCYCARES.COM/CHNA X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 MERCY HOSPITAL, INC. PART V, SECTION B, LINE 3: FOR MERCY HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), COMMUNITY INPUT WAS GATHERED THROUGH INTERVIEWS, A COMMUNITY SURVEY, AND COMMUNITY LISTENING SESSIONS. INTERVIEWS WERE CONDUCTED WITH PUBLIC HEALTH EXPERTS, REPRESENTATIVES OF HEALTH OR OTHER DEPARTMENTS OR AGENCIES, COMMUNITY LEADERS, AND PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. THE CHNA ALSO CAPTURED MULTIPLE DATA SOURCES, INCLUDING SECONDARY DATA AND ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN RECENT YEARS.THE FOLLOWING TOPICS AND DATA SETS INFORMED THE CHNA: DEMOGRAPHICS (E.G., NUMBERS AND LOCATIONS OF VULNERABLE PEOPLE); ECONOMICS (E.G., POVERTY AND UNEMPLOYMENT RATES, IMPACTS OF HEALTH REFORM); COMMUNITY ISSUES (E.G., HOMELESSNESS, LACK OF AFFORDABLE HOUSING, ENVIRONMENTAL CONCERNS, CRIME, AVAILABILITY OF SOCIAL SERVICES); HEALTH STATUS INDICATORS (E.G., MORBIDITY RATES FOR VARIOUS DISEASES AND CONDITIONS, MORTALITY RATES FOR LEADING CAUSES OF DEATH); HEALTH ACCESS INDICATORS (E.G., UNINSURED RATES, DISCHARGES FOR AMBULATORY CARE SENSITIVE CONDITIONS, USE OF EMERGENCY DEPARTMENTS FOR NON-EMERGENT CARE); HEALTH DISPARITIES INDICATORS; AND AVAILABILITY OF HEALTHCARE FACILITIES AND RESOURCES.TO HELP DESIGN AND GATHER PRIMARY AND SECONDARY DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, MERCY MEDICAL CENTER ENGAGED VERITE HEALTHCARE CONSULTING, LLC, LOCATED IN ALEXANDRIA, VIRGINIA. THE FIRM SERVES AS A NATIONAL RESOURCE THAT HELPS HOSPITALS CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS AND DEVELOP IMPLEMENTATION STRATEGIES THAT ADDRESS PRIORITY NEEDS. THE FIRM ALSO HELPS HOSPITALS, ASSOCIATIONS, AND POLICY MAKERS WITH COMMUNITY BENEFIT REPORTING, PLANNING, PROGRAM ASSESSMENT, AND POLICY AND GUIDELINES DEVELOPMENT. THE CHNA WAS DIRECTED BY THE FIRM'S PRESIDENT AS WELL AS SENIOR-LEVEL CONSULTANTS AND ASSOCIATES. MARK RUKAVINA OF COMMUNITY HEALTH ADVISORS, LLC, BASED IN CHESTNUT HILL, MA, CONDUCTED ALL COMMUNITY INTERVIEWS. THE INTERVIEWS WERE STRUCTURED TO HELP IDENTIFY THE MOST PRESSING HEALTH STATUS AND ACCESS ISSUES IN THE COMMUNITY. KEY INFORMANT INTERVIEWS WERE CONDUCTED FACE-TO-FACE AND BY TELEPHONE. THE INTERVIEWS WERE DESIGNED TO GAIN PERSPECTIVE INTO THE HEALTH NEEDS IN THE COMMUNITY SERVED BY MERCY. A TOTAL OF 30 LOCAL KEY INFORMANTS, INCLUDING EXTERNAL AND INTERNAL (THOSE AFFILIATED WITH MERCY MEDICAL CENTER/PROVIDENCE BEHAVIORAL HEALTH HOSPITAL) STAKEHOLDERS WERE INTERVIEWED DURING DECEMBER 2012 AND FEBRUARY 2013. IN ADDITION, 10 STAFF MEMBERS FROM THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH REGIONAL OFFICE IN NORTHAMPTON, MA, ALSO WERE INTERVIEWED AS PART OF THIS ASSESSMENT. THESE INTERVIEWS WERE CONDUCTED USING A STRUCTURED QUESTIONNAIRE. INFORMANTS WERE ASKED TO DISCUSS COMMUNITY HEALTH ISSUES AND ENCOURAGED TO LOOK BROADLY AT SOCIAL DETERMINANTS OF HEALTH. INTERVIEWEES WERE ASKED ABOUT ISSUES RELATED TO HEALTH CARE ACCESS, CHANGES IN COMMUNITY POPULATION, PREVALENCE OF CHRONIC DISEASE, AND HEALTH DISPARITIES. MERCY ALSO SOUGHT INPUT FROM THE PUBLIC REGARDING THE HEALTH OF THE COMMUNITY THROUGH AN ONLINE AND PAPER-BASED SURVEY. A WEBSITE LINK TO THE SURVEY (IN BOTH ENGLISH AND SPANISH) WAS MADE AVAILABLE FROM JANUARY THROUGH FEBRUARY 2013. PAPER COPIES OF THE SURVEY WERE DISTRIBUTED AT VARIOUS LOCAL ORGANIZATIONS AND CLINICS IN MULTIPLE LANGUAGES. EFFORTS WERE MADE TO REACH THOSE WITHOUT INTERNET ACCESS AS WELL AS VULNERABLE POPULATIONS WITH LOW LITERACY LEVELS, AND NON-ENGLISH SPEAKERS. THE SURVEY WAS PUBLICIZED VIA FLYERS, SOCIAL MEDIA, NEWSPAPERS, EMAIL LISTS AND OTHER METHODS. A TOTAL OF 1,321 SURVEY RESPONSES WERE RECEIVED FROM RESIDENTS OF MERCY MEDICAL CENTER'S PRIMARY SERVICE AREA. SURVEY RESULTS WERE POST-STRATIFIED TO HELP ENSURE THAT THEY ACCURATELY REFLECTED THE COMMUNITY'S DEMOGRAPHICS. RESPONSES WERE ALSO ASSESSED BY RACE, INSURANCE STATUS, AND EDUCATION STATUS. A LISTENING SESSION WAS HELD DURING WHICH COMMUNITY MEMBERS REVIEWED AND DISCUSSED PRELIMINARY FINDINGS OF THIS ASSESSMENT. DISCUSSION AT THE LISTENING SESSIONS WAS HELPFUL IN THAT IT VALIDATED ASSESSMENT FINDINGS AND CONTRIBUTED TO THE PRIORITIZATION PROCESS. MERCY HOSPITAL, INC. PART V, SECTION B, LINE 4: THE HOSPITAL IS A MEMBER OF THE COALITION OF WESTERN MASSACHUSETTS HOSPITALS WHICH INCLUDES: BAYSTATE MEDICAL CENTER, BAYSTATE FRANKLIN MEDICAL CENTER, BAYSTATE MARY LANE HOSPITAL, COOLEY DICKINSON HOSPITAL, HOLYOKE MEDICAL CENTER, AND WING MEMORIAL. THE COALITION HOSPITALS COLLABORATED IN PREPARING THEIR CHNAS. MERCY HOSPITAL, INC. PART V, SECTION B, LINE 7: MERCY HOSPITAL, INC. IS COMMITTED TO ADHERING TO ITS MISSION AND REMAINING GOOD STEWARDS OF RESOURCES, SO IT CAN CONTINUE TO ENHANCE ITS CLINICAL ACTIVITIES AND TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS. THE FOLLOWING AREAS IDENTIFIED IN THE CHNA AS NEEDS ARE NOT ADDRESSED IN THE IMPLEMENTATION STRATEGY FOR THE REASONS INDICATED. LACK OF ACCESS TO DENTAL CARE: THE HOSPITAL DOES NOT OFFER ADULT DENTAL SERVICES AND THEREFORE, WILL NOT ADDRESS THIS SPECIFIC NEED. THE HOSPITAL COLLABORATES CLOSELY WITH THE CITY OF SPRINGFIELD'S HEALTH SERVICES FOR THE HOMELESS DENTAL CLINIC AND THE TWO COUNTY FQHCS - CARING HEALTH CENTER AND HOLYOKE HEALTH CENTER.HIGH RATE OF ASTHMA: THE HOSPITAL HAS THE EXPERTISE TO WORK WITH ACUTE TREATMENTS IN THE EMERGENCY DEPARTMENT BUT DOES NOT HAVE A SPECIFIC PROGRAM ADDRESSING ASTHMA. OUR COMMUNITY PARTNERS AND HOSPITALS ARE ADDRESSING THIS ISSUE.LOW EDUCATIONAL ACHIEVEMENT: THE HOSPITAL DOES NOT HAVE A SPECIFIC EDUCATIONAL PROGRAM FOR LOW EDUCATIONAL ACHIEVEMENT; HOWEVER, STRONG RELATIONSHIPS AND COLLABORATIONS EXIST WITHIN THE COMMUNITY WITH THE AREA'S REGIONAL EMPLOYMENT BOARD. MERCY HOSPITAL, INC. PART V, SECTION B, LINE 12I: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. MERCY HOSPITAL, INC. PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: MERCY HOSPITAL, INC. PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF MASSACHUSETTS. IN ADDITION, MERCY HOSPITAL, INC. REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG. IN ADDITION, MERCY HOSPITAL, INC. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $2,318,440, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY.ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: MERCY HOSPITAL, INC. USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. MERCY HOSPITAL, INC. IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, MERCY HOSPITAL, INC. IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: MERCY HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY REGIONAL HEALTH MINISTRY AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE." PART III, LINE 8: MERCY HOSPITAL, INC. DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - MERCY MEDICAL CENTER ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCY HOSPITAL, INC. IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE - BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, MERCY HOSPITAL, INC. HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSMERCY HOSPITAL, INC. COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE.FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE. MERCY HOSPITAL, INC. OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. MERCY HOSPITAL, INC. HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. MERCY HOSPITAL, INC. MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - MERCY MEDICAL CENTER PRIMARILY SERVES THE COMMUNITY WHICH INCLUDES ALL 51 ZIP CODES IN HAMPDEN COUNTY, MASSACHUSETTS, AND HAS A TOTAL POPULATION OF 464,416 PERSONS. HAMPDEN COUNTY CONSISTS OF THE FOLLOWING 21 CITIES AND TOWNS (POPULATIONS IN PARENTHESES): AGAWAM (28,516), BLANDFORD (1,320), BRIMFIELD (3,844), CHESTER (1,277), CHICOPEE (55,453), EAST LONGMEADOW (15,723), GRANVILLE (2,085), HAMPDEN (5,191), HOLLAND (2,512), HOLYOKE (40,073), LONGMEADOW (16,044), LUDLOW (21,197), MONSON (8,493), PALMER (12,174), RUSSELL (1,605), SOUTHWICK (9,629), SPRINGFIELD (152,998), WALES (1,691), WEST SPRINGFIELD (28,292), WESTFIELD (42,044), AND WILBRAHAM (14,255). THE HOSPITAL IS LOCATED IN SPRINGFIELD, MASSACHUSETTS, THE MOST POPULOUS CITY IN THE SERVICE AREA.THE FOLLOWING IS A BRIEF SUMMARY OF HEALTH ISSUES IN THE COMMUNITY SERVED BY MERCY MEDICAL CENTER. THE SUMMARY IS BASED ON AN ASSESSMENT OF ALL STUDY DATA SOURCES INCLUDING COMMUNITY INTERVIEWS, THE COMMUNITY SURVEY, AND THE WIDE ARRAY OF SECONDARY DATA.DEMOGRAPHICS: THE COMMUNITY IS AGING AND DIVERSIFYING, DRIVEN BY GROWTH IN ELDERLY AND IN ASIAN, BLACK, AND HISPANIC (OR LATINO) POPULATIONS. WHILE POPULATION GROWTH IN 2012-17 IS EXPECTED TO BE 1 PERCENT, THE 65+ POPULATION WILL EXPERIENCE AN 11 PERCENT INCREASE. IN 2012, ABOUT 86 PERCENT OF THE COMMUNITY'S POPULATION WAS WHITE. IT IS PROJECTED THAT 16 PERCENT WILL COMPRISE NON-WHITE BY 2017. NON-WHITE POPULATIONS ARE EXPECTED TO GROW FASTER THAN WHITE POPULATIONS IN THE COMMUNITY: ASIAN (UP 14.8%), AMERICAN INDIAN (UP 6.8%), BLACK (UP 3.7%), AND OTHER (12.5%) AND THOSE WHO IDENTIFY AS "TWO OR MORE RACES" (UP 8.5%) ARE EXPECTED TO EXPERIENCE THE FASTEST GROWTH. THE GROWING DIVERSITY OF THE COMMUNITY IS IMPORTANT TO RECOGNIZE GIVEN THE PRESENCE OF HEALTH DISPARITIES AND COMMUNITY INPUT REGARDING THE NEED TO ENHANCE CULTURAL COMPETENCY OF HEALTH PROVIDERS.HOUSEHOLD INCOME AND POVERTY: IN 2012, 28 PERCENT OF ALL HOUSEHOLDS IN THE SERVICE AREA HAD INCOMES BELOW $25,000, AN APPROXIMATION OF THE FEDERAL POVERTY LEVEL (FPL) FOR A FAMILY OF FOUR; 54 PERCENT HAD INCOMES OF LESS THAN $50,000, AN APPROXIMATION OF 200 PERCENT OF THE FPL FOR A FAMILY OF FOUR. THE CITIES OF HOLYOKE AND SPRINGFIELD REPORTED THE LOWEST AVERAGE HOUSEHOLD INCOME. SPRINGFIELD ZIP CODE 01105 REPORTED OVER 63 PERCENT OF HOUSEHOLDS EARNING LESS THAN $25,000 ANNUALLY. POVERTY RATES (PARTICULARLY IN SPRINGFIELD) OF NEARLY 17 PERCENT ARE ABOVE MASSACHUSETTS AVERAGE OF ABOUT 12 PERCENT. PEDIATRIC POVERTY AND OVERALL UNEMPLOYMENT ARE ALSO COMPARATIVELY HIGH. UNEMPLOYMENT DISPARITIES EXIST FOR BLACK, ASIAN, AND HISPANIC (OR LATINO) RESIDENTS. HAMPDEN COUNTY RESIDENTS ARE MORE RELIANT ON GOVERNMENT SUPPORT PROGRAMS SUCH AS SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM AND TEMPORARY ASSISTANCE FOR NEEDY FAMILIES THAN THE MASSACHUSETTS AVERAGE. LACK OF ACCESS TO AFFORDABLE FOOD AND HOUSING ARE ALSO CONCERNS FOR SEGMENTS OF THE COMMUNITY.INSURANCE STATUS: HEALTH REFORM IN MASSACHUSETTS HAS SIGNIFICANTLY DECREASED UNINSURANCE RATES. IN 2012 IN HAMPDEN COUNTY, 4.8 PERCENT OF OVERALL POPULATION LACKED HEALTH INSURANCE WHICH WAS HIGHER THAN MASSACHUSETTS IN GENERAL, BUT LOWER THAN THE NATIONAL AVERAGE. MEDICARE AND MASSHEALTH (MEDICAID) ARE THE MOST COMMON PAYERS IN THE COMMUNITY COMPRISING 40.9 AND 28.2 PERCENT OF PATIENT DISCHARGES, RESPECTIVELY. ONE QUARTER (25.0 PERCENT) OF ALL COMMUNITY WIDE DISCHARGES COMPRISED PRIVATE PAY. HEALTH AND SOCIAL SERVICES: HAMPDEN COUNTY HAS 17 MEDICALLY UNDERSERVED AREAS, ALL WITHIN THE MERCY MEDICAL CENTER SERVICE AREA. THE COMMUNITY HAS THREE FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) WITH 21 ADDITIONAL FQHC SITE PARTNERS. SEVERAL AREAS AND POPULATIONS IN HAMPDEN COUNTY ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS ("HPSAS"). GATEWAY/HAMPSHIRE REGIONAL IS DESIGNATED AS A PRIMARY MEDICAL CARE HPSA WHILE THE LOW-INCOME POPULATIONS IN HOLYOKE AND SPRINGFIELD ARE DESIGNATED AS MENTAL HEALTH HPSAS. THE COMMUNITY CONTAINS SIX ACUTE CARE HOSPITAL FACILITIES. A VARIETY OF COMMUNITY ORGANIZATIONS THAT FOCUS ON HEALTH AND HUMAN SERVICES ARE AVAILABLE IN THE COUNTY TO ASSIST IN MEETING HEALTH NEEDS. EDUCATION: HAMPDEN COUNTY REPORTS COMPARATIVELY LOW GRADUATION RATES AND COMPARATIVELY HIGH RATES OF DISABILITY, PARTICULARLY AMONG YOUTH. THESE FACTORS CAN CONTRIBUTE TO POVERTY, HEALTH CARE ACCESS BARRIERS, AND POOR HEALTH. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH -MERCY HOSPITAL INC.'S GOVERNING BODY IS ITS BOARD OF TRUSTEES. THE MAJORITY OF THIS BOARD RESIDES IN THE ORGANIZATION'S SERVICE AREA AND COMPRISES INDIVIDUALS WHO ARE NEITHER EMPLOYEES, NOR INDEPENDENT CONTRACTORS, NOR FAMILY MEMBERS OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS AND SPECIALTIES PROVIDED THESE PHYSICIANS MEET THE QUALIFICATIONS OUTLINED AND CERTIFIED BY THE MEDICAL CREDENTIALING OFFICE. AS MERCY IS A NON-PROFIT ENTITY ANY AND ALL EXCESS FUNDS ARE USED TO FUND IMPROVEMENTS IN PATIENT CARE AND MEDICAL EDUCATION. MERCY ALSO FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING THE FOLLOWING:HEALTH CARE FOR THE HOMELESS: MERCY MEDICAL CENTER'S DEPARTMENT OF COMMUNITY HEALTH PROVIDES CARE TO THE COMMUNITY'S HOMELESS POPULATION IN FRANKLIN, HAMPSHIRE, AND HAMPDEN COUNTIES THROUGH PRIMARY CARE SERVICES, HEALTH EDUCATION, CASE MANAGEMENT, MENTAL HEALTH SERVICES, AND FREE CLINICS TO MORE THAN 2,300 PERSONS EACH YEAR. THE VIETNAMESE HEALTH PROJECT: THIS PROGRAM PROVIDES CASE MANAGEMENT AND INTERPRETATION SERVICES TO THE REFUGEE AND IMMIGRANT VIETNAMESE POPULATION IN THE GREATER SPRINGFIELD AREA. ANNUALLY, THIS COMMUNITY HEALTH OUTREACH PROGRAM REACHES NEARLY 700 VIETNAMESE PATIENTS. ADULTS AND CHILDREN IN PSYCHIATRIC AND/OR SUBSTANCE ABUSE DISTRESS: PROVIDENCE BEHAVIORAL HEALTH HOSPITAL, OPERATING UNDER THE SAME HOSPITAL LICENSE AS MERCY MEDICAL CENTER, A 126-BED HOSPITAL LOCATED IN HOLYOKE, MASSACHUSETTS, PROVIDES BOTH INPATIENT AND OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR PEOPLE OF ALL AGES EXPERIENCING ACUTE PSYCHIATRIC DISTRESS AND/OR SEVERE SUBSTANCE ABUSE PROBLEMS.LACK OF AFFORDABLE AND ACCESSIBLE CARE: THE HOSPITAL OFFERS FINANCIAL COUNSELING TO THOSE WHO NEED ASSISTANCE. ADDITIONAL SUPPORT IS PROVIDED THROUGH COUNSELORS AND CASE MANAGERS WHO ASSIST PATIENTS WITH ACCESSING HEALTH INSURANCE THROUGH THE STATE. LACK OF AFFORDABLE AND ACCESSIBLE PRESCRIPTION MEDICATIONS: THE HOSPITAL PROVIDES PATIENT COUNSELING AND EDUCATION REGARDING PRESCRIPTION ASSISTANCE AND ALSO PROVIDES DIRECT CO-PAY ASSISTANCE THROUGH THE HEALTH CARE FOR THE HOMELESS PROGRAM. THE HOSPITAL IS ALSO REGISTERED IN THE FEDERAL 340-B PHARMACEUTICAL DRUG ACCESS PROGRAM WHICH PROVIDES DISCOUNTS TO QUALIFYING HOSPITALS ON COVERED OUTPATIENT MEDICATION AND ARE THEN PROVIDED TO THE PATIENTS AT A REDUCED COST.SUPPORT GROUPS: FOR THOSE EXPERIENCING LIFE-ALTERING CONDITIONS, MERCY MEDICAL CENTER PROVIDES A WIDE RANGE OF ONGOING, FREE, SUPPORT GROUPS FOR PATIENTS (AND THEIR FAMILIES OR CAREGIVERS) CHALLENGED BY DIAGNOSES SUCH AS CANCER, STROKE, AMPUTATIONS, APHASIA, TRAUMATIC BRAIN INJURY, MULTIPLE SCLEROSIS, AND SPINAL CORD INJURIES. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM - MERCY HOSPITAL, INC. IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES MA 0 1 0 0 0 0 0 0 0 DANIEL P MOEN TRUSTEE; PRESIDENT & CEO 0 439932 0 222386 0 157080 0 16475 0 24303 0 860176 0 0 CHRISTOPHER H COMEY MD TRUSTEE; PRES, MED STAFF AS OF 4/14 0 658946 0 28738 0 40050 0 8900 0 25829 0 762463 0 0 MOHAMED P HAMDANI MD TRUSTEE THROUGH 2/14 0 222297 0 6447 0 46717 0 3719 0 19548 0 298728 0 0 THOMAS ROBERT TREASURER/SVP & CFO 0 279271 0 68906 0 1489 0 13008 0 23196 0 385870 0 0 DANIEL KEENAN ASST SEC/SVP GOV'T RELATIONS 0 179484 0 46278 0 936 0 8058 0 21754 0 256510 0 0 LEONARD F PANSA SVP HR & ADMIN SERVICES 0 246790 0 60343 0 2350 0 8900 0 5350 0 323733 0 0 SHARON ADAMS SVP PATIENT CARE SERVICES 235093 0 58931 0 828 0 8932 0 14812 0 318596 0 0 0 SCOTT WOLF SVP & CMO 0 333576 0 80531 0 1165 0 8900 0 29818 0 453990 0 0 HAROLD JORDAN MEDICAL DIRECTOR THRU 10/13 153396 0 62000 0 6337 0 4031 0 18967 0 244731 0 0 0 MARY TARAIL CHIEF MEDICAL OFFICER 274997 0 4125 0 1832 0 7710 0 977 0 289641 0 0 0 NANCY DUFAULT STAFF NURSE 232783 0 1800 0 13961 0 3783 0 16687 0 269014 0 0 0 GAURAV CHAWLA CHIEF OF PSYCHIATRY 230223 0 0 0 360 0 7240 0 28635 0 266458 0 0 0 CHHEWANG NORSANG MEDICAL DIRECTOR 226851 0 0 0 549 0 1035 0 16703 0 245138 0 0 0 JAITEERTH AVADHANI RADIATION PHYSICIST 188970 0 0 0 451 0 6816 0 23553 0 219790 0 0 0 JOHN DIGGINS PSYCHIATRIST 180906 0 0 0 227 0 1644 0 4858 0 187635 0 0 0 PART I, LINE 3 MERCY HOSPITAL, INC.'S CEO IS PAID DIRECTLY BY A RELATED ORGANIZATION, CATHOLIC HEALTH EAST. CATHOLIC HEALTH EAST USED ONE OR MORE OF THE METHODS DESCRIBED BELOW TO ESTABLISH THE COMPENSATION OF MERCY HOSPITAL, INC.'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B PART II: THE FOLLOWING INDIVIDUAL IS VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNT IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: DANIEL MOEN - $123,551 CATUOGNO COURT REPORTING DEAN M. WHALEN, ESQ, TRUSTEE IS A KEY EMPLOYEE OF CATUOGNO COURT REPORTING 386184 MERCY HOSPITAL, INC. PAID CATUOGNO COURT REPORTING FOR MEDICAL RECORDS TRANSCRIPTION SERVICES. 0 X 1 93000 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MERCY HOSPITAL, INC. IS SISTERS OF PROVIDENCE HEALTH SYSTEM, INC. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A SISTERS OF PROVIDENCE HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF MERCY HOSPITAL, INC. SISTERS OF PROVIDENCE HEALTH SYSTEM, INC. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF MERCY HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, SISTERS OF PROVIDENCE HEALTH SYSTEM, INC. MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SISTERS OF PROVIDENCE HEALTH SYSTEM, INC. MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR MERCY HOSPITAL, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE FINANCE COMMITTEE AS WELL AS THE BOARD OF TRUSTEES. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MERCY HOSPITAL INC. HAS ADOPTED CATHOLIC HEALTH EAST'S POLICY 103, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. ANNUALLY, ALL THOSE SERVING MERCY HOSPITAL, INC. IN A FIDUCIARY CAPACITY, INCLUDING TRUSTEES, OFFICERS, AND KEY EMPLOYEES RECEIVE A COPY OF THE POLICY AND ANNUAL DISCLOSURE STATEMENT TO BE COMPLETED. DISCLOSURES OF FINANCIAL INTEREST OR OTHER REPORTABLE CIRCUMSTANCES AS DEFINED IN THE POLICY ARE SUBMITTED AND REVIEWED BY THE ORGANIZATION'S CEO AND BOARD CHAIR. SUMMARY INFORMATION IS REPORTED TO THE ENTIRE BOARD AND IS AVAILABLE TO THE BOARD THROUGHOUT THE YEAR AS BUSINESS COMES BEFORE THE BOARD OR MANAGEMENT FOR ACTION. THE POLICY CONTAINS A CONTINUING AFFIRMATIVE OBLIGATION ON ALL AFFECTED INDIVIDUALS TO DISCLOSE COMPENSATION OR OTHER CIRCUMSTANCES THROUGHOUT THE YEAR WHICH MAY RISE TO THE LEVEL OF AN ACTUAL OR APPARENT CONFLICT. THE DETERMINATION OF WHETHER A DISCLOSED FINANCIAL OR OTHER INTEREST CONSTITUTES A CONFLICT OF INTEREST IS MADE BY THE BOARD OR AN APPROPRIATE COMMITTEE THEREOF COMPRISED OF DISINTERESTED PERSONS AND WITHOUT THE PARTICIPATION OF THE AFFECTED INDIVIDUAL EXCEPT TO RESPOND TO QUESTIONS ABOUT THE DISCLOSURE. THE POLICY FURTHER ADDRESSES THE PROCEDURE FOR THE BOARD'S FURTHER CONSIDERATION OF THE PROPOSED TRANSACTION/MATTER WITHOUT THE PARTICIPATION OF THE AFFECTED PERSON AND THE DOCUMENTATION OF THE PROCEEDINGS. LASTLY, THE POLICY ADDRESSES POTENTIAL DISCIPLINARY ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15B THE COMPENSATION FOR MERCY HOSPITAL INC.'S CHIEF EXECUTIVE OFFICER IS ESTABLISHED BY CATHOLIC HEALTH EAST'S COMPENSATION COMMITTEE USING ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART III. FOR OTHER EMPLOYEES, MERCY HOSPITAL INC. HAS ADOPTED CATHOLIC HEALTH EAST'S PROCESS FOR DETERMINING COMPENSATION WHICH INCLUDES THE FOLLOWING: THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE ENGAGES WITH EXTERNAL CONSULTANTS TO PROVIDE MARKET DATA COMPARING THE ORGANIZATION'S ROLES TO SIMILARLY SIZED ORGANIZATIONS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE COMMITTEE REVIEWS THE MARKET ANALYSIS, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS WHICH ARE INCORPORATED INTO THE INCENTIVE PLAN. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 MERCY HOSPITAL, INC. IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, MERCY HOSPITAL, INC. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. MERCY HOSPITAL, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: POOLING OF INTEREST 3,574,072. NET ASSETS RELEASED FROM RESTRICTIONS 55,517. EQUITY TRANSFERS TO/FROM AFFILIATES 2,278,795. OTHER TRANSFERS 467,869. FORM 990, PART XII, LINE 2: MERCY HOSPITAL, INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY14 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE 1, DOING BUSINESS AS NAMES: MERCY MEDICAL CENTER PROVIDENCE BEHAVORIAL HEALTH HOSPITAL WELDON REHABILITATION HOSPITAL SR. MARY CARITAS CANCER CENTER @ MERCY MEDICAL CENTER HEALTHCARE FOR THE HOMELESS @ MERCY MEDICAL CENTER ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 MANAGEMENT & SUPPORT SERVICES FL 501(C)(3) LINE 11A, I CATHOLIC HEALTH EAST 1 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH 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501(C)(3) LINE 11C, III-FI CHE TRINITY INC 1 CHE TRINITY INC 20555 VICTOR PARKWAY LIVONIA MI 48152 900931907 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) LINE 11B, II N/A 0 COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK NJ 07102 262616342 INACTIVE ENTITY NJ 501(C)(3) LINE 9 SAINT MICHAELS MEDICAL CENTER 1 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 1 CONTINUING CARE MANAGEMENT SERVICES NETWORK 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 352336834 MANAGEMENT & SUPPORT SERVICES PA 501(C)(3) LINE 11B, II CATHOLIC HEALTH EAST 1 CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY MI 48098 383320699 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) LINE 11A, I TRINITY HOME HEALTH SERVICES INC 1 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) LINE 3 MOUNT CARMEL 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