2013-05-13T09:27:32-05:00 2012-06-30 990 2011-07-01 362170152 MERCY HOSPITAL AND MEDICAL CENTER MERC 3125672000 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 606162477 IRIS CHAN 3125672000 2013-05-13 2011 2016-02-24 21:20:13Z SR SHEILA LYNE RSM 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 606162477 279377943 0 0928 X WWW.MERCY-CHICAGO.ORG X 1852 IL MERCY FOSTERS AN ENVIRONMENT OF HEALING, PROVIDING ACCESS AND NEEDED CARE WITH COMPASSION AND EXCELLENCE TO THE DIVERSE COMMUNITIES IT SERVES. 14 10 2097 110 506262 0 1357728 8689694 254100071 259937696 250649 60749 1341114 10689203 257049562 279377342 40465 44752 0 0 119517048 125079290 0 0 0 124041231 135483601 243598744 260607643 13450818 18769699 174574023 332925280 106483483 137691928 68090540 195233352 X MERCY FOSTERS AN ENVIRONMENT OF HEALING, PROVIDING ACCESS AND NEEDED CARE WITH COMPASSION AND EXCELLENCE TO THE DIVERSE COMMUNITIES IT SERVES. 0 0 193391952 44752 267708044 MERCY HOSPITAL AND MEDICAL CENTER (MERCY) IS A 479 BED ACUTE CARE FACILITY PROVIDING QUALITY HEALTH CARE TO OVER 200,000 RESIDENTS EMBRACING A BROAD CULTURAL MIX. MERCY, ESTABLISHED IN 1852, STRIVES TO PROVIDE A BROAD SPECTRUM OF HEALTH CARE SERVICES, APPROPRIATED TO THE NEEDS OF AND ACCESSIBLE TO PEOPLE IN THE COMMUNITIES IT SERVES. SINCE ITS INCEPTION, MERCY HOSPITAL AND MEDICAL CENTER HAS HAD AN UNWAVERING COMMITMENT TO SERVING THE COMMUNITY, INCLUDING THE UNDER-INSURED AND UNDER-PRIVILEGED.FOUNDED IN 1852, MERCY HOSPITAL AND MEDICAL CENTER ENJOYS THE HONOR OF BEING CHICAGO'S FIRST CHARTERED HOSPITAL AND THE FIRST HOSPITAL IN ILLINOIS. FOR MORE THAN 160 YEARS, MERCY HAS BEEN AN INNOVATIVE PIONEER IN BOTH PATIENT CARE AND MEDICAL EDUCATION, AND MERCY'S LEADERSHIP LEGACY CONTINUES TODAY. RECOGNIZED NATIONALLY FOR EXCELLENCE, MERCY STANDS AT THE INTERSECTION OF PIONEERING MEDICINE AND COMPASSIONATE PATIENT CARE.OUR CENTERS OF EXCELLENCE (TWELVE IN ALL) AND SPECIALTY CARE CENTERS PROVIDE LEADING EDGE CARE WITH A PATIENT-FIRST PERSPECTIVE, AND CONTINUALLY PIONEER NEW APPROACHES IN THE FIELDS OF HEART AND ENDOVASCULAR CARE, CANCER CARE, WOMEN'S HEALTH CARE, DIABETES TREATMENT AND MINIMALLY INVASIVE SURGERY. MERCY IS ALSO HOME TO ONE OF THE CITY'S LEADING HEART & VASCULAR CENTERS AND IS CURRENTLY RECOGNIZED AS ONE OF THE NATION'S 10 TOP CARDIOVASCULAR HOSPITALS BY THOMSON HEALTHCARE.MERCY IS STEADFASTLY COMMITTED TO INVESTING IN TECHNOLOGIES THAT ALLOW OUR PROVIDERS TO DELIVER THE HIGHEST QUALITY CARE. RECENT EXAMPLES OF THIS COMMITMENT INCLUDE:-RECENT ACQUISITIONS OF STATE-OF-THE-ART LINEAR ACCELERATOR AND DIGITAL MAMMOGRAPHY EQUIPMENT.-MERCY WAS ONE OF THE FIRST HOSPITALS IN ILLINOIS TO ACQUIRE A 64-SLICE SCANNER AND REMAINS AT THE FOREFRONT OF CARDIAC TESTING AND IMAGING.-OTHER PLANS FOR MERCY INCLUDE PLANNED EXPANSION OF OUR CRITICAL CARE UNIT AND GASTROINTESTINAL LABORATORY SUITES, PROVIDING FOR ENHANCED CARE TO PATIENTS.MERCY'S MEDICAL STAFF CONSISTS OF MORE THAN 480 PROVIDERS IN 32 SPECIALTIES. OUR PROVIDERS ARE RECOGNIZED LEADERS IN THEIR FIELD, BOTH LOCALLY AND INTERNATIONALLY, AND ARE OFTEN SOUGHT FOR EXPERT ADVICE AND CONSULTATION.MERCY HAS A LONG AND PROUD TRADITION OF TEACHING, AND MEDICAL EDUCATION REMAINS CENTRAL TO OUR MISSION TODAY. MERCY MAINTAINS AFFILIATIONS WITH CHICAGO'S LEADING MEDICAL UNIVERSITIES AND OFFERS FOUR FREESTANDING RESIDENCY PROGRAMS, AS WELL AS THREE INTEGRATED RESIDENCY PROGRAMS. OUR SPONSORED RESIDENCY PROGRAMS INCLUDE INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, DIAGNOSTIC RADIOLOGY AND PODIATRY. OUR AFFILIATED RESIDENCY PROGRAMS INCLUDE SURGERY, EMERGENCY MEDICINE AND PATHOLOGY.AS A MAJOR URBAN HOSPITAL, MERCY PROVIDES RESIDENTS WITH AMPLE CASELOADS AND BROAD EDUCATION EXPERIENCE. TWO ON-SITE CLINICS, THE DOCTORS OFFICE CENTER AND THE MERCY FAMILY HEALTH CENTER, ACCOMMODATE 65,000 PATIENT VISITS PER YEAR IN ALL MAJOR SPECIALTIES AND SUB-SPECIALTIES. THERE ARE AN ADDITIONAL 100,000 PATIENT VISITS IN MERCY'S SATELLITE CLINICS LOCATED THROUGHOUT THE CHICAGO AREA.LOCATED MINUTES FROM CHICAGO'S LOOP, MERCY SERVES A DIVERSE PATIENT POPULATION, RANGING FROM UPSCALE URBAN REDEVELOPMENT AREAS TO ESTABLISHED ETHNIC NEIGHBORHOODS. MERCY'S POPULATION VIRTUALLY MIRRORS THAT OF CHICAGO, A CITY KNOWN FOR ITS ETHNIC AND SOCIOECONOMIC DIVERSITY. 193391952 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 155 0 1 2097 1 1 1 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X IRIS CHAN CONTROLLER 3125676676 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 606162477 X JOHN MCCARTHY 1.00 X X 0 0 0 SUSAN GALLAGHER 1.00 X X 0 0 0 RAYMOND SPAETH II 1.00 X X 0 0 0 STEVEN POTTS DO 39.00 X 185792 0 11609 ELZIE HIGGINBOTTOM 1.00 X 0 0 0 WILLIAM KRESSE 1.00 X 0 0 0 BETSY MEISENHEIMER CCM 1.00 X 0 0 0 SR LENORE MULVIHILL RSM 1.00 X 600 0 0 MICHELLE MURPHY 1.00 X 0 0 0 SR BETTY SMITH RSM 1.00 X 0 0 0 RENEE TOGHER 1.00 X 0 0 0 DANIEL HALE 1.00 X 0 925954 106225 PIERRE NOISETTE MD 39.00 X 109841 0 14597 ROHITKUMAR VASA MD 1.00 X 11551 0 0 WILLIAM BROWN 1.00 X 0 0 0 LANGDON NEAL 1.00 X 0 0 0 SR SHEILA LYNE RSM 48.00 X X 0 0 1272 THOMAS GARVEY 48.00 X 348188 0 24338 RICHARD CERCEO 38.00 X 369560 0 22778 BARBARA TOWNSEND 38.00 X 243119 0 13193 CARLA CAMPBELL 40.00 X 186352 0 25779 JOSEPH SWEDISH 2.00 X 0 5186660 576202 KEDRICK ADKINS 2.00 X 0 1405226 117120 J RICHARD O'CONNELL 2.00 X 0 943237 118221 MICHAEL MCDONNELL 40.00 X 331811 0 22306 REUBEN NICHOLS 40.00 X 312541 0 19563 JENNIFER ANGELES 40.00 X 292267 0 9316 PHILLIP AHN 40.00 X 279111 0 19920 ANN GARCELON 40.00 X 264777 0 13335 MARTIN HEBDA 38.00 X 136349 0 10134 NANCY HILL-DAVIS 38.00 X 227141 0 15392 CONSTANCE MURPHY 20.00 X 196257 0 28723 3495257 8461077 1170023 113 1 1 0 MORRISON MANAGEMENT 200 E 5TH AVE NAPERVILLE IL 60563 FOOD SERVICE MANAGEMENT 4310292 US BANK CORPORATION TRUST 800 NICOLLET MALL MINNEAPOLIS MN 55402 FINANCIAL SERVICES 2948896 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 HEALTHCARE TECHNOLOGY SERVICES 2759820 MCKESSON TECHNOLOGIES INC ONE POST STREET SAN FRANCISCO CA 94104 HEALTHCARE TECHNOLOGY SERVICES 2444192 ARAMARK CTS INC 10510 TWIN LAKES PARKWAY CHARLOTTE NC 28269 BIOMEDICAL MANAGEMENT 1956339 53 413617 3871004 4405073 8689694 NET PATIENT SVC REV 900099 259431434 259431434 REFERENCE LAB 621500 506262 506262 259937696 46489 46489 1925762 14726 0 0 1925762 14726 1940488 1940488 14861 601 14260 14260 14260 MEANINGFUL USE 900099 5318557 5318557 JT. VENTURE REVENUE 900099 1013107 1013107 CAFETERIA REVENUE 900099 472105 472105 1944946 1944946 8748715 279377342 267708044 506262 2473342 7502 7502 37250 37250 1591226 334759 1256467 728658 104054 624604 102349001 78813146 23535855 1557327 1212725 344602 11612861 9026044 2586817 7240217 5328050 1912167 505015 505015 624264 624264 150000 150000 20814051 7502298 13311753 813004 813004 6474861 4382840 2092021 10000 10000 6298073 2255148 4042925 178554 14483 164071 392411 102244 290167 1476171 3019 1473152 10100841 2812553 7288288 11203261 11203261 MEDICAL SUPPLIES 33315848 33315848 BAD DEBT 18571436 18571436 CONTRACT LABOR 7726983 7726983 HOSPITAL PROVIDER TAX 7194747 7194747 9634081 3433562 6200519 260607643 193391952 67215691 0 8400 8450 30545012 86487426 37594923 50418457 1484238 117809 2556177 2616674 5368707 1881957 171507060 2798256 72638185 168708804 10227823 342153 11000000 13808405 11685703 174574023 332925280 32598885 64449118 1376469 125000 38613577 54293148 33894552 18824662 106483483 137691928 X 63570377 184217476 4207603 11015876 312560 0 68090540 195233352 174574023 332925280 X 18769699 108373113 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 16717 1 150000 0 0 166717 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MERCY HOSPITAL AND MEDICAL CENTER 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 AND MEDICAL CENTER WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. MERCY HOSPITAL AND MEDICAL CENTER MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 27747000 27747000 105068966 1336740 103732226 27655074 1431780 26223294 11036020 29736 11006284 168708804 INTERCOMPANY PAYABLES 1277346 OTHER CURRENT LIABILITIES 17547316 18824662 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 4103885 4103885 0.01700 60198282 69274143 -9075861 0.00000 64302167 69274143 -4971976 0.01700 1375510 1375510 0.00570 8308197 4419333 3888864 0.01610 37867667 33278617 4589050 0.01900 1537103 1537103 0.00640 49088477 37697950 11390527 0.04720 113390644 106972093 6418551 0.06420 0 6422003 0 70871507 52391073 18480434 X 1 1 1 MERCY ADVANCED MRI LLC SUB-LEASE MRI EQUIPMENT 0.65000 0.35000 2 MERCY HEART & VASCULAR LLC SUB-LEASE CT EQUIPMENT 0.51000 0.49000 1 1 MERCY HOSPITAL AND MEDICAL CENTER

2525 SOUTH MICHIGAN AVENUE CHICAGO IL 606162477

X X X X MERCY HOSPITAL AND MEDICAL CENTER 1 1 1 200.000000000000 1 600.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 14 MERCY MEDICAL ON PULASKI - NORTH

5525 SOUTH PULASKI CHICAGO IL 60629

CLINIC - PRIMARY AND SPECIALTY PHYSICIANS MERCY MEDICAL AT DEARBORN

47 WEST POLK CHICAGO IL 60605

INTEGRATIVE MEDICINE, PRIMARY AND SPECIALTY PHYSICIANS MERCY MEDICAL AT 43RD STREET

4321 SOUTH PULASKI CHICAGO IL 60632

CLINIC - PRIMARY CARE PHYSICIANS MERCY MEDICAL ON MICHIGAN

2930 SOUTH MICHIGAN CHICAGO IL 60616

PHYSICAL THERAPY, HAND REHABILITATION & PRIMARY CARE PHYSICIANS MERCY WORKS ON ASHLAND

3316 SOUTH ASHLAND CHICAGO IL 60608

CLINIC - OCCUPATIONAL MEDICINE MERCY MEDICAL IN CHATHAM

8541 SOUTH STREET CHICAGO IL 60619

CLINIC - PHYSICIAN OFFICES MERCY MEDICAL AT 2600

2600 SOUTH MICHIGAN AVENUE CHICAGO IL 60616

CLINIC - OCCUPATIONAL MEDICINE MERCY HEART AND VASCULAR LLC

2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616

SUB-LEASE CT EQUIPMENT MERCY ADVANCED MRI LLC

2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616

SUB-LEASE MRI EQUIPMENT MERCY MEDICAL IN BRIDGEPORT

2837 SOUTH HALSTED CHICAGO IL 60608

CLINIC - PRIMARY CARE AND SPECIALTY PHYSICIANS MERCY MEDICAL IN CHINATOWN

2323 SOUTH WENTWORTH CHICAGO IL 60616

CLINIC - PRIMARY CARE PHYSICIANS MERCY WORKS AT CUMBERLAND

4900 NORTH CUMBERLAND CHICAGO IL 60706

CLINIC - OCCUPATIONAL MEDICINE MERCY MEDICAL IN BRIDGEPORT

3700 SOUTH WALLACE CHICAGO IL 60609

CLINIC - PRIMARY CARE PHYSICIANS MERCY MEDICAL

2850 SOUTH WABASH CHICAGO IL 60609

CLINIC - PRIMARY CARE PHYSICIANS PART I, LINE 6A: MERCY HOSPITAL AND MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF ILLINOIS. MERCY HOSPITAL AND MEDICAL CENTER ALSO WILL REPORT ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, MERCY HOSPITAL AND MEDICAL CENTER WILL INCLUDE 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, L7 COL(F): THE FOLLOWING NUMBER, $18,571,436, 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 4: MERCY HOSPITAL AND MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH FOR APRIL 1, 2012 THROUGH JUNE 30, 2012. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM THOSE STATEMENTS: "SUBSTANTIALLY ALL OF THE CORPORATION'S RECEIVABLES ARE RELATED TO PROVIDING HEALTHCARE SERVICES TO PATIENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. THE CORPORATION'S ESTIMATE FOR ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS BY PAYOR."COSTING METHODOLOGY FOR LINES 2 AND 3: AMOUNTS ARE CALCULATED ON LINE 2 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.ALTHOUGH MERCY RESPONDED TO PART III, LINE 3 AS $0, THE RESPONSE WOULD BE ACCURATELY NOTED AS UNKNOWN. WE STRONGLY BELIEVE, DESPITE SIGNIFICANT PROACTIVE MEASURES, THERE ARE A PERCENTAGE OF BAD DEBTS THAT COULD BE CONSIDERED COMMUNITY BENEFIT. HOWEVER AT THIS TIME WE DO NOT BELIEVE WE HAVE THE APPROPRIATE TOOLS TO DETERMINE THIS PERCENTAGE. PART III, LINE 8: MERCY HOSPITAL AND MEDICAL CENTER 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: COLLECTION POLICIES ARE THE SAME FOR ALL MERCY HOSPITAL AND MEDICAL CENTER PATIENTS. PATIENTS ARE NOTIFIED OF MERCY HOSPITAL AND MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY AT THE TIME OF REGISTRATION VIA POSTED NOTIFICATIONS AND ON EVERY ACCOUNT STATEMENT THAT IS SENT. ON RECEIPT OF THE INFORMATION, MERCY HOSPITAL AND MEDICAL CENTER WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT AS QUICKLY AS POSSIBLE. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS WHO ARE BEING REVIEWED FOR FINANCIAL ASSISTANCE ELIGIBILITY OR WHO ARE DETERMINED TO QUALIFY FOR CHARITY CARE. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW.IN ADDITION, ALL PATIENTS HAVING DIFFICULTY PAYING THEIR BILLS ARE DIRECTED TO FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS WILL WORK WITH PATIENTS TO QUALIFY THEM FOR CHARITY CARE OR GOVERNMENT PROGRAMS SUCH AS MEDICAID. AFTER A PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS EITHER PARTIALLY OR ENTIRELY WRITTEN OFF IN ACCORDANCE WITH OUR FINANCIAL ASSISTANCE POLICY. IF THERE IS ANY REMAINING BALANCE, ONLY THAT BALANCE WOULD BE SUBJECT TO OUR DEBT COLLECTION POLICY. MERCY HOSPITAL AND MEDICAL CENTER PART V, SECTION B, LINE 19D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL (FPL), ADJUSTED FOR FAMILY SIZE, ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH ELIGIBLE ASSETS AND INCOMES ABOVE 200% BUT NOT EXCEEDING 600% OF THE FPL, ADJUSTED FOR FAMILY SIZE, RECEIVE A PERCENTAGE DISCOUNT ON MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. PART VI, LINE 2: NEEDS ASSESSMENT - MERCY HOSPITAL & MEDICAL CENTER PERFORMS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE (3) YEARS. A COMMUNITY HEALTH NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR MERCY HOSPITAL & MEDICAL CENTER'S STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY HEALTH NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.THE MERCY HOSPITAL & MEDICAL CENTER COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE MERCY HOSPITAL & MEDICAL CENTER COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES. THE MERCY HOSPITAL & MEDICAL CENTER COMMUNITY HEALTH NEEDS ASSESSMENT IS CURRENT AS OF 2010. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE ASSISTANCE OF THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCY HOSPITAL & MEDICAL CENTER 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 (AHA) RECOMMENDATIONS, MERCY HOSPITAL & MEDICAL CENTER 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 OBLIGATIONS.MERCY HOSPITAL & MEDICAL CENTER 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. IN ACCORDANCE WITH AHA RECOMMENDATIONS, MERCY HOSPITAL & MEDICAL CENTER 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 PAYMENT OBLIGATIONSMERCY HOSPITAL & MEDICAL CENTER PROVIDES EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING THEIR 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. WHILE EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE. PATIENTS WITH INCOME AT, OR BELOW, 200% OF THE FEDERAL POVERTY LEVEL (FPL) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE-OFF FOR CHARGES FOR MEDICALLY NECESSARY SERVICES THAT HAVE BEEN PROVIDED FOR THEM. PATIENTS WITH ELIGIBLE ASSETS AND INCOME ABOVE 200% OF THE FPL, BUT NOT EXCEEDING 600%, ADJUSTED FOR FAMILY SIZE, WILL RECEIVE A DISCOUNT ON MEDICALLY NECESSARY SERVICES, BASED ON A SLIDING SCALE ESTABLISHED BY HOSPITAL POLICY. WHEN CHARITY CARE IS REQUESTED OR INDICATED, A FINANCIAL COUNSELOR WILL MEET WITH THE PATIENT IN PERSON OR BY PHONE, TO EXPLAIN THE HOSPITAL POLICY AND IF INDICATED, TO BEGIN THE APPLICATION PROCESS. FINANCIAL COUNSELORS ASSIST ELIGIBLE PATIENTS IN APPLYING FOR STATE AND/OR FEDERAL PROGRAMS, SUCH AS MEDICAID AND MEDICARE. INFORMATION REGARDING OTHER COMMUNITY RESOURCES WILL ALSO BE PROVIDED, IF APPROPRIATE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING INFORMATION ON FINANCIAL ASSISTANCE POLICIES (ON HOW TO APPLY OR OBTAIN FURTHER INFORMATION) ARE POSTED IN KEY PUBLIC AREAS OF THE HOSPITAL, INCLUDING EMERGENCY DEPARTMENT, OUTPATIENT REGISTRATION, CASHIER AND OTHER KEY AREAS OF THE HOSPITAL. INFORMATION IS AVAILABLE IN ENGLISH AS WELL AS SPANISH, POLISH AND CHINESE, WHICH REFLECTS THE PATIENT POPULATION SERVED BY MERCY. INFORMATION IS ALSO AVAILABLE ON MERCY'S WEBSITE AND IT IS PRINTED ON HOSPITAL BILLING STATEMENTS THAT ARE SENT TO PATIENTS. MERCY HOSPITAL & MEDICAL CENTER HAS ESTABLISHED A WRITTEN POLICY FOR BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. MERCY HOSPITAL & MEDICAL CENTER 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. MERCY HOSPITAL & MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING STAFF WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES, WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. PERSONNEL FROM PATIENT FINANCIAL SERVICES AND KEY OUTPATIENT DEPARTMENTS RECEIVE INSTRUCTION REGARDING MERCY'S CHARITY CARE POLICES AND ON THE PROCESS FOR SHARING THIS INFORMATION WITH PATIENTS IN KEEPING WITH MERCY VALUES AND BEHAVIORS. PART VI, LINE 4: COMMUNITY INFORMATION- MERCY HOSPITAL & MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL ESTABLISHED IN 1852, IS CHICAGO'S FIRST HOSPITAL. ITS MISSION IS TO PROVIDE A BROAD SPECTRUM OF HEALTH CARE SERVICES APPROPRIATE TO THE NEEDS OF AND ACCESSIBLE TO PEOPLE IN THE COMMUNITIES IT SERVES. FROM ITS VERY INCEPTION, MERCY HOSPITAL, SPONSORED BY THE RELIGIOUS SISTERS OF MERCY, HAS HAD AN UNWAVERING COMMITMENT TO SERVING THE COMMUNITY, INCLUDING THE UNDERINSURED AND UNDERPRIVILEGED. IN 2012, MERCY BECAME A PART OF THE TRINITY HEALTH SYSTEM, LOCATED IN LIVONIA, MICHIGAN. TRINITY IS THE 10TH LARGEST HEALTH SYSTEM IN THE NATION AND THE FOURTH LARGEST CATHOLIC HEALTH CARE SYSTEM IN THE COUNTRY. THE SYSTEM SERVES THROUGH A NETWORK OF 47 ACUTE-CARE HOSPITALS, 432 OUTPATIENT FACILITIES, 32 LONG-TERM CARE FACILITIES AND NUMEROUS HOME HEALTH OFFICES AND HOSPICE PROGRAMS IN TEN STATES. TRINITY HEALTH DRAWS ON A RICH AND COMPASSIONATE HISTORY OF CARE EXTENDING BEYOND 140 YEARS. AS A TEACHING HOSPITAL AFFILIATED WITH THE UNIVERSITY OF ILLINOIS, MERCY HOSPITAL PROVIDES A PHYSICIAN RESIDENCY PROGRAM THAT TRAINS OVER A HUNDRED RESIDENTS EACH YEAR. THE HOSPITAL SPONSORS TWO INDEPENDENT MEDICAL RESIDENCIES - IN INTERNAL MEDICINE AND OBSTETRICS/GYNECOLOGY. CLINICAL EDUCATION IS ALSO OFFERED FOR NURSES, ALLIED HEALTH PROFESSIONALS AND OTHERS SEEKING TO PROVIDE SERVICE TO THE HEALTH CARE INDUSTRY. THE HOSPITAL IS PART OF MERCY HEALTH SYSTEM OF CHICAGO THAT ALSO INCLUDES: - MERCY FOUNDATION, INC., THE PHILANTHROPIC ARM OF THE HEALTH SYSTEM.- TWO SCHOOL-BASED HEALTH CENTERS IN WENDELL PHILLIPS AND PERCY DUNBAR VOCATIONAL CAREER ACADEMIES ON THE NEAR SOUTH SIDE OF CHICAGO. BOTH CLINICS ARE HIGHLY REGARDED IN THE COMMUNITY FOR THEIR ROLE IN REDUCING THE BARRIERS ADOLESCENTS FACE IN SEEKING HEALTH CARE SERVICES.- A NETWORK OF SATELLITE FACILITIES.EIGHTEEN CHICAGO ZIP CODES MAKE UP MERCY HOSPITAL'S PRIMARY SERVICE AREA. FOUR CORE ZIP CODES - 60616, 60608, 60609 AND 60653 - MAKE UP APPROXIMATELY 50% OF MERCY'S INPATIENT ADMISSIONS. TEN ZIP CODES ARE LOCATED TO THE SOUTH AND WEST OF THE CORE MARKET AND FOUR ARE TO THE NORTH.MERCY'S PRIMARY SERVICE AREA (PSA) IS THE NEAR-SOUTH SIDE AND MID-SOUTHSIDE OF CHICAGO. MERCY SERVICES THE ETHNICALLY DIVERSE NEIGHBORHOODS OF CHINATOWN, PILSEN, ARMOR SQUARE, DOUGLAS, OAKLAND, FULLER PARK, GRAND BOULEVARD, AND KENWOOD, WHICH TOGETHER EXTEND FROM ROOSEVELT ROAD ON THE NORTH, LAKE MICHIGAN ON THE EAST, 51ST/55TH STREETS ON THE SOUTH AND AS FAR WEST AS WESTERN AVENUE. IN EXAMINING PAYOR MIX, HOSPITAL DISCHARGES FOR FY 2012 WERE: 38% MEDICARE, 36% MEDICAID, 22% MANAGED CARE AND, 4% ALL OTHERS. THE 2000 U.S. CENSUS REPORTS THE INCOME FOR RESIDENTS IN THE PSA AS FOLLOWS: 60% LESS THAN $35,000, 17% $35,000 - $49,999, 14% $50,000 - $74,999, 5% $75,000 - $100,000 AND 4% $100,000 PLUS. PART VI, LINE 5: OTHER INFORMATION - THE HOSPITAL SERVES ALL AGES, MEN AND WOMEN, CHILDREN AND INFANTS, AND THE PHYSICALLY AND MENTALLY CHALLENGED.IN ORDER TO MEET THE COMMUNITY'S HEALTH CARE NEEDS AND TO MAINTAIN MERCY'S STATUS AS A VIABLE TEACHING HOSPITAL, IT IS CONSTANTLY EVALUATING AND STRENGTHENING ITS CLINICAL PROGRAMS ON THE MAIN HOSPITAL CAMPUS AND AT SATELLITE FACILITIES LOCATED THROUGHOUT THE CITY OF CHICAGO. AS AN ACTIVE PARTICIPANT IN THE HEALTH AND WELLNESS OF ITS COMMUNITY, MERCY IS DEDICATED TO PARTNERING WITH RESIDENTS, COMMUNITY LEADERS, AREA BUSINESSES AND OTHER HEALTH PROVIDERS TO SUPPORT THE HEALTH NEEDS AND FOSTER THE ECONOMIC GROWTH OF THE DIVERSE COMMUNITIES SERVED BY THE INSTITUTION. MERCY IS RELENTLESS IN ITS EFFORTS TO MAKE CERTAIN THAT RESIDENTS HAVE ACCESS TO APPROPRIATE PROGRAMS AND SERVICES, INCLUDING HEALTH EDUCATION PROGRAMS ON DIABETES, OBESITY, SMOKING CESSATION, HEALTHY EATING, HEART HEALTH, AGE-APPROPRIATE HEALTH SCREENING SCHEDULES (FOR MEN AND WOMEN) AND OTHER HEALTH, WELLNESS AND MEDICAL CARE PROGRAMS AND SERVICES. THESE PROGRAMS ARE OFFERED ON THE HOSPITAL CAMPUS AND AT THE NETWORK OF MERCY SATELLITES. MERCY IS COMMITTED TO UTILIZING ITS RESOURCES TO MAXIMIZE THE NUMBER OF COMMUNITY RESIDENTS WHO ARE ABLE TO ACCESS PROGRAMS AND SERVICES PROVIDED AT MERCY. COMMUNITY BUILDING ACTIVITIES - MERCY HOSPITAL & MEDICAL CENTER IS ENGAGED IN THE COMMUNITY IN MANY WAYS. MENTAL HEALTH CENTER CHRISTMAS BASKETS:EACH YEAR MERCY STAFF COLLABORATES WITH SANTA FOR THE VERY POOR, A COMMUNITY GROUP THAT PROVIDES CLOTHING, TOYS AND OTHER GIFTS FOR 80 FAMILIES OF PATIENTS SEEN IN THE MERCY OUTPATIENT MENTAL HEALTH CENTER. THE FAMILIES CHOSEN USUALLY HAVE YOUNG CHILDREN AND ALL HAVE VERY LIMITED FINANCIAL RESOURCES. NEARLY ALL ARE DEALING WITH SERIOUS PROBLEMS RELATED TO MENTAL HEALTH ISSUES IN THE FAMILY. THE DONATIONS (TOYS, CLOTHING, HOUSEHOLD ITEMS AND CHRISTMAS TREATS) ARE BROUGHT TO THE HOSPITAL AND THE FAMILIES PICK THEM UP IN THE MENTAL HEALTH CENTER. FOR MANY OF THESE FAMILIES, THESE ARE THE ONLY CHRISTMAS GIFTS THEY WILL RECEIVE. THERE ARE ALSO EIGHTY $50 GIFT CERTIFICATES TO LOCAL GROCERY CHAINS THAT CAN BE USED THROUGHOUT THE YEAR FOR FOOD, MEDICINE OR PERSONAL PRODUCTS. THIS IS ONE OF MANY ACTIVITIES THAT HELPS BUILD TRUST BETWEEN MENTAL HEALTH PATIENTS, MERCY STAFF AND PHYSICIANS, THEREBY INCREASING THE PROBABILITY OF PATIENTS HAVING SUCCESSFUL OUTCOMES AND IMPROVED QUALITY OF LIFE.HEALTH PROFESSION FOR THE FUTURE:THIS IS A PIPELINE PROGRAM THAT COLLABORATES WITH THE CHICAGO PUBLIC SCHOOLS, THE CHICAGO WORKFORCE BOARD, THE MICHAEL REESE HEALTH TRUST AND OTHER CHICAGO-AREA HOSPITALS TO ASSIST HIGH SCHOOL STUDENTS WHO HAVE AN IDENTIFIED INTEREST IN SEEKING CAREERS IN HEALTHCARE. THESE STUDENTS PARTICIPATE IN LECTURES, CLASSES AND INTERNSHIP EXPERIENCES AT MERCY HOSPITAL AND MERCY SATELLITES, AS WELL AS THE OTHER AREA HOSPITALS INVOLVED IN THIS PROGRAM. THEY WORK UNDER THE DIRECTION OF HEALTHCARE PROFESSIONALS, WHO ACT AS MENTORS AND COACHES. THE GOAL IS TO WORK COLLABORATIVELY WITH AREA SCHOOLS, HOSPITALS AND OTHER ORGANIZATIONS, TO STRENGTHEN OUR COMMUNITIES BY PROVIDING OPPORTUNITIES FOR YOUNG PEOPLE TO OBTAIN MEANINGFUL AND LUCRATIVE EMPLOYMENT. PATIENT RELATIONS PROGRAM ANNUAL CHRISTMAS BASKETS: MERCY'S PATIENT RELATIONS PROGRAM SERVES THE NEEDS OF ELDERLY PATIENTS WHO RECEIVE CARE AT MERCY. MOST OF THESE PATIENTS HAVE MULTIPLE MEDICAL PROBLEMS AND CHRONIC ILLNESSES. STAFF MEMBERS ACT AS ADVOCATES AND PATIENTS ARE MONITORED IN ALL LEVELS OF CARE (INPATIENT AND OUTPATIENT). PATIENTS ARE ROUTINELY VISITED IN THEIR HOME TO PROVIDE SUPPORT AND TO DIRECT RESOURCES IN AN EFFORT TO IMPROVE OR MAINTAIN THEIR HEALTH STATUS. EACH YEAR FOR THE PAST 38 YEARS, MERCY HAS DELIVERED CHRISTMAS BASKETS TO THE HOMES OF THESE ELDERLY PATIENTS. THIS PAST YEAR (2012) MERCY EMPLOYEES AND VOLUNTEERS DELIVERED OVER 1,000 BASKETS. THE BASKETS INCLUDE THE FOOD ITEMS NEEDED FOR A CHRISTMAS DINNER AND ADDITIONAL FOOD ITEMS AS WELL. PATIENTS ARE EXTREMELY THANKFUL FOR THESE GIFTS AND HAVE EXPRESSED THEIR APPRECIATION NUMEROUS TIMES TO PATIENT RELATIONS STAFF AND OTHER HOSPITAL PERSONNEL. BECAUSE MANY OF THE PATIENTS ARE SHUT-IN, THEY OFTEN EXPRESS THEIR THANKS AND PLEASURE AT HAVING SOMEONE VISIT AT THE HOLIDAY TIME TO BRING THIS SPECIAL GIFT.LUNCH VOUCHERS:LUNCH VOUCHERS ARE OFTEN PROVIDED FOR OUTPATIENTS WHO MAY NOT HAVE MONEY FOR FOOD AND WHO ARE BEING SEEN FOR EXTENSIVE TESTING (THAT MAY REQUIRE THEM TO REMAIN AT THE HOSPITAL FOR SEVERAL HOURS). VOUCHERS ARE ALSO PROVIDED FOR VOLUNTEERS, MANY OF WHOM ASSIST PATIENTS IN HOSPITAL PROGRAMS AND DEPARTMENTS SUCH AS MERCY'S WOMEN'S HEALTH CENTER, THE MERCY FAMILY HEALTH CENTER AND AT INFORMATION/WELCOMING CENTERS (WHICH ARE LOCATED AT FACILITY ENTRY POINTS). THESE VOLUNTEERS ALSO ACT AS PATIENT VISITORS, TAKING BOOKS AND MAGAZINES TO INPATIENTS ON THE HOSPITAL FLOORS.ENVIRONMENTAL BUILDING ACTIVITIES:ACTIVITIES INCLUDE:- A GREEN ROOF, PLANTED TO IMPROVE AIR QUALITY IN THE COMMUNITY AND TO DECREASE CONSUMPTION OF GAS AND OTHER RESOURCES NEEDED TO HEAT AND COOL THE HOSPITAL CAMPUS.- CONSTRUCTION OF A COMMUNITY GARDEN SPACE, TO PROVIDE HEALTHY FOOD FOR COMMUNITY RESIDENTS. THE PROGRAM TEACHES GARDENING SKILLS AND HEALTHY COOKING TO PROMOTE THE CONSUMPTION OF MORE NUTRITIOUS FOOD AND TO IMPROVE THE HEALTH STATUS OF COMMUNITY RESIDENTS AND EMPLOYEES. PART VI, LINE 6: MERCY HOSPITAL & MEDICAL CENTER IS A MEMBER ORGANIZATION OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE SYSTEMS IN THE COUNTRY. BASED IN LIVONIA, MICHIGAN, TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEVELOP - AND ARE HELD ACCOUNTABLE FOR ACHIEVING - COMMUNITY BENEFIT GOALS THAT INCLUDE DEVELOPING 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 TO SERVE THE POOR AND UNINSURED, MANAGE CHRONIC CONDITIONS LIKE DIABETES, HEALTH EDUCATION AND PROMOTION INITIATIVES, AND OUTREACH FOR THE ELDERLY. IN FISCAL YEAR 2012, THIS INCLUDED OVER $615 MILLION IN SUCH COMMUNITY BENEFITS. THEREFORE, TRINITY HEALTH TAKES A SYSTEM APPROACH IN ITS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION, AND IS CONSEQUENTLY ABLE TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ARE HELPING PROMOTE AND ADDRESS THE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. REPORTS FILED WITH STATES PART VI, LINE 7 IL 1 MERCY DIAGNOSTIC AND TREATMENT CENTER 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 363720708 501(C)(3) 7502 MATERNAL/CHILD HEALTH 1 0 EMPLOYEE SCHOLARSHIP PROGRAM 6 37250 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY MERCY HOSPITAL AND MEDICAL CENTER TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS. X X 0 1 0 0 0 0 0 0 0 STEVEN POTTS DO 185411 0 0 0 381 0 3752 0 7857 0 197401 0 0 0 DANIEL HALE 0 479340 0 186340 0 260274 0 87640 0 18585 0 1032179 0 155414 THOMAS GARVEY 315657 0 31899 0 632 0 9463 0 14875 0 372526 0 0 0 RICHARD CERCEO 333841 0 33699 0 2020 0 8262 0 14516 0 392338 0 0 0 BARBARA TOWNSEND 218627 0 22191 0 2301 0 4791 0 8402 0 256312 0 0 0 CARLA CAMPBELL 168873 0 17342 0 137 0 5727 0 20052 0 212131 0 0 0 JOSEPH SWEDISH 0 1279458 0 677642 0 3229560 0 548602 0 27600 0 5762862 0 2698342 KEDRICK ADKINS 0 743978 0 316652 0 344596 0 103857 0 13263 0 1522346 0 143708 J RICHARD O'CONNELL 0 571942 0 230946 0 140349 0 85919 0 32302 0 1061458 0 0 MICHAEL MCDONNELL 241493 0 90000 0 318 0 4728 0 17578 0 354117 0 0 0 REUBEN NICHOLS 308855 0 0 0 3686 0 5834 0 13729 0 332104 0 0 0 JENNIFER ANGELES 171761 0 120398 0 108 0 5117 0 4199 0 301583 0 0 0 PHILLIP AHN 181564 0 97304 0 243 0 5123 0 14797 0 299031 0 0 0 ANN GARCELON 168211 0 93600 0 2966 0 5562 0 7773 0 278112 0 0 0 MARTIN HEBDA 134470 0 0 0 1879 0 4129 0 6005 0 146483 0 0 0 NANCY HILL-DAVIS 205995 0 20984 0 162 0 6231 0 9161 0 242533 0 0 0 CONSTANCE MURPHY 177485 0 18569 0 203 0 4961 0 23762 0 224980 0 0 0 PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2011). THE FOLLOWING ACCRUALS FOR 2011 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $91,607 DANIEL HALE - $42,034 J. RICHARD O'CONNELL - $66,279 JOSEPH SWEDISH - $255,902 PART I, LINE 4B: THE FOLLOWING IS A PARTICIPANT IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUAL FOR 2011 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: JOSEPH SWEDISH - $265,000 PART II: THE FOLLOWING INDIVIDUALS BECAME VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) DURING CALENDAR 2011. AS A RESULT, THE VESTED AMOUNTS WERE INCLUDED IN THEIR 2011 TAXABLE INCOMES. THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JOSEPH SWEDISH - $2,740,000 KEDRICK ADKINS - $220,648 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. KIMBERLY TOWNSEND-SCOTT FAMILY MEMBER OF BARBARA TOWNSEND, KEY EMPLOYEE 104054 EMPLOYMENT ARRANGEMENT 0 CONSTANCE MURPHY FAMILY MEMBER OF MICHELLE MURPHY, BOARD DIRECTOR 229113 EMPLOYMENT ARRANGEMENT 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MERCY HOSPITAL AND MEDICAL CENTER IS MERCY HEALTH SYSTEM OF CHICAGO. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH SYSTEM OF CHICAGO IS THE SOLE MEMBER OF MERCY HOSPITAL AND MEDICAL CENTER. MERCY HEALTH SYSTEM OF CHICAGO MUST APPROVE ALL CANDIDATES ELECTED AS BOARD MEMBERS OR OFFICERS OF MERCY HOSPITAL AND MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, MERCY HEALTH SYSTEM OF CHICAGO MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. MERCY HEALTH SYSTEM OF CHICAGO 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 AND MEDICAL CENTER 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 DIRECTORS. 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 AND MEDICAL CENTER HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF MERCY HOSPITAL AND MEDICAL CENTER, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH MERCY HOSPITAL AND MEDICAL CENTER'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCY HOSPITAL AND MEDICAL CENTER OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MERCY HOSPITAL AND MEDICAL CENTER IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO MERCY HOSPITAL AND MEDICAL CENTER. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF DIRECTORS OF MERCY HOSPITAL AND MEDICAL CENTER ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 MERCY HOSPITAL AND MEDICAL CENTER USES AN EXECUTIVE COMPENSATION SURVEY COMPILED BY SULLIVAN COTTER & ASSOCIATES. THE VICE PRESIDENT OF HUMAN RESOURCES REVIEWS THE SALARY SURVEY DATA EACH YEAR AND PRESENTS THE RESULTS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE REVIEWS THE DATA AND MAKES A RECOMMENDATION TO ADJUST THE CEO'S SALARY, WHEN SUPPORTED BY THE DATA, TO THE FULL BOARD OF DIRECTORS. MINUTES OF ALL BOARD OF DIRECTOR MEETINGS ARE RECORDED. MERCY HOSPITAL DOES NOT HAVE A FORMAL COMPENSATION COMMITTEE; HOWEVER, THE EXECUTIVE COMMITTEE ASSUMES THIS FUNCTION. NO OUTSIDE COMPENSATION CONSULTANTS ARE USED. FORM 990, PART VI, SECTION C, LINE 19 EFFECTIVE APRIL 1, 2012, MERCY HOSPITAL AND MEDICAL CENTER 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 ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, MERCY HOSPITAL AND MEDICAL CENTER WILL BE INCLUDING A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. FORM 990, PART VII, SECTION A, LINE 1: SR. SHEILA LYNE IS A MEMBER OF THE CONGREGATION OF THE RELIGIOUS SISTERS OF MERCY. HAVING TAKEN A VOW OF POVERTY, SR. SHEILA DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HOSPITAL AND MEDICAL CENTER EXCEPT FOR INSURANCE BENEFITS OF $1,272. INSTEAD, A TOTAL OF $566,365 WAS PAID BY MERCY HOSPITAL AND MEDICAL CENTER TO THE RELIGIOUS SISTERS OF MERCY FOR SR. SHEILA'S SERVICES. ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: KEDRICK ADKINS - 53 HOURS RICHARD CERCEO - 2 HOURS THOMAS GARVEY - 2 HOURS DANIEL HALE - 49 HOURS MARTIN HEBDA - 2 HOURS NANCY HILL-DAVIS - 2 HOURS SR. SHEILA LYNE, RSM - 2 HOURS CONSTANCE MURPHY - 20 HOURS PIERRE NOISETTE, MD - 1 HOUR J. RICHARD O'CONNELL - 53 HOURS STEVEN POTTS, DO - 1 HOUR JOSEPH SWEDISH - 53 HOURS BARBARA TOWNSEND - 2 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: EQUITY TRANSFER FROM AFFILIATE 681,052. PURCHASE ACCOUNTING ADJUSTMENTS DUE TO ACQUISITION BY TRINITY HEALTH CORP. 107,973,910. TEMPORARILY RESTRICTED NET ASSETS RELEASED FOR OPERATIONS -19,071. CHANGE IN HOSPITAL INTEREST IN NET ASSETS OF THE FOUNDATION -262,778. TOTAL TO FORM 990, PART XI, LINE 5: 108,373,113. FORM 990, PART XII, LINE 2: MERCY HOSPITAL AND MEDICAL CENTER'S FINANCIAL STATEMENTS FOR APRIL 1, 2012 THROUGH JUNE 30, 2012 WERE INCLUDED IN THE FY12 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PART X, BALANCE SHEET: CERTAIN BEGINNING BALANCE SHEET AMOUNTS HAVE BEEN RECLASSIFIED TO CONFORM TO THE ENDING BALANCE SHEET PRESENTATION. 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