2012-11-15T13:50:09-06:00 2011-12-31 861065772 Deloitte Tax LLP 1700 Market Street 25th Floor Philadelphia PA 191033984 990 2011-01-01 010211534 Mercy Hospital MERC 2078793000 144 State Street Portland ME 041013795 Michael Hachey 2078793000 2012-11-15 1 Pamela L Heist P00294236 2152462300 2011 2016-02-24 21:20:13Z Eileen Skinner 144 State Street Portland ME 041013795 203435458 0 X www.mercyhospital.com X 1945 ME Mercy Hospital carries out the healing work of Christ by providing clinically excellent, compassionate healthcare for all, with special concern for the poor and disadvantaged. 28 22 1978 463 0 0 1100877 1608779 186573567 199595175 1153624 558497 1536041 1434405 190364109 203196856 0 0 0 0 102903247 112207570 0 0 658714 104122902 106971762 207026149 219179332 -16662040 -15982476 206185828 197985033 119849704 129071451 86336124 68913582 Mercy Hospital carries out the healing work of Christ by providing clinically excellent, compassionate healthcare for all, with special concern for the poor and disadvantaged. 0 0 188607202 199595175 Provide access to healthcare for all people through direct patient care at Mercy's various hospital, clinical and physician locations. In providing these services, the organization absorbs significant costs that are not reimbursed through Medicare, Medicaid or other programs. In addition, as part of our mission, we maintain a charity care program that exceeds the Federal Poverty Guidelines. The Company also provides and sponsors a number of socially responsible activities and events that have a positive impact on the lives of the residents of the Greater Portland Community. 188607202 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 142 0 1 1978 1 0 0 0 0 0 1 1 0 0 0 0 X 28 22 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X X Douglas W Libby 2078793000 144 State Street Portland ME 041013795 X William Demicco 37.50 X 269716 0 28648 Eileen Skinner 37.50 X X 0 573327 39246 Thomas W Yoder Jr 5.00 X X 0 0 0 Joseph R Foley 5.00 X X 0 0 0 Karen Hart 5.00 X X 0 0 0 Paul Bloch MD 2.50 X 0 0 0 Sr Barbara Brennan RSM 2.50 X 0 0 0 Sr Patricia Flynn RSM PhD 2.50 X 0 0 0 Joseph Gray 2.50 X 0 0 0 Margaret Hourigan 2.50 X 0 0 0 Lois Lengyel 2.50 X 0 0 0 Cheryl Libby 2.50 X 0 0 0 Paul Lones 2.50 X 0 0 0 Sr Michele Aronica RSM 2.50 X 0 0 0 Brenda Miley 2.50 X 0 0 0 Lisa Miller 2.50 X 0 0 0 Jon Jennings 2.50 X 0 0 0 Thimi Mina 2.50 X 0 0 0 Sr Mary Morey RSM 2.50 X 0 0 0 Mary Louise Norton 2.50 X 0 0 0 Gregg Otterbein 2.50 X 0 0 0 Sr Patricia Pora RSM 2.50 X 0 0 0 David Small 2.50 X 0 0 0 Sr Kathleen M Smith RSM 2.50 X 0 0 0 Nelson A Toner 2.50 X X 0 0 0 Isabella Thurston MD 2.50 X 0 0 0 Sr Janice Turner RSM 2.50 X 0 0 0 Bruce Wagner 2.50 X 0 0 0 Daniel Merson DO 2.50 X 0 0 0 William Schirmer MD 2.50 X 0 0 0 Daniel P Sheridan PhD 2.50 X 0 0 0 John Walters 2.50 X 0 0 0 Anthony Marple Sch O 37.50 X 0 226069 21118 Michael Hachey Sch O 37.50 X 0 328003 36743 Robert Nutter 37.50 X 0 272290 36366 Scott Rusk 37.50 X 0 314823 30546 James Shrum 37.50 X 0 203292 29537 Gregory Pomeroy 40.00 X 708145 0 37108 Marc Hodroff 40.00 X 469925 0 28241 Gregory Adey 40.00 X 468651 0 32800 Adam Owen 40.00 X 512860 0 23923 Christopher Kleeman 40.00 X 448377 0 24814 Edward Ted McCarthy 37.50 X 198697 0 27987 3076371 1917804 397077 131 1 1 0 General Electric Medical Systems 8200 West Tower Avenue Milwaukee WI 53223 Equipment Service & Maintenance 2328837 Synernet Inc 110 Free Street Portland ME 04101 Transcription; Equip. Svcs & Maintenance 2032637 Quest Diagnostics 5763 Collection Center Drive Chicago IL 60693 Patient Lab Tests 1202923 Seabreeze Property Services PO Box 617 Portland ME 04102 Grounds Management & Maintenance 997636 BCA Financial Services Inc 18001 Old Cutler Road Suite 462 Miami FL 33157 Collections 661900 44 98497 760268 750014 30234 1608779 Patient Service Revenu 621110 198238159 198238159 All Other Program Serv 621110 1357016 1357016 199595175 13249 13249 411096 0 411096 411096 411096 508732 171179 0 134663 508732 36516 545248 545248 212225 98497 103939 108286 108286 Cafeteria Income 722210 915023 915023 915023 203196856 199595175 0 1992902 2539738 2405131 134607 87472343 82611600 4637482 223261 3592420 3393431 185347 13642 12529326 11438108 1046413 44805 6073743 5597696 459633 16414 233217 16326 216891 319838 319838 119000 119000 22566802 15504950 6864225 197627 898684 2142 879122 17420 41112479 38330587 2642485 139407 5604979 5604979 6134026 5731939 402087 169715 135422 32702 1591 5644 5594 50 3175992 3175992 10705940 8117051 2585151 3738 2991685 2719842 271843 Bad Debt 12049563 12049563 Dues and Subscriptions 697670 393193 303668 809 Auxiliary 129627 129627 Amortization 56901 25000 31901 219179332 188607202 29913416 658714 0 4257240 5729864 0 25219266 29729152 0 0 0 4283233 4672245 2425062 1094317 193405442 88894838 107321903 104510604 27264472 19206682 0 246167 124167 35168485 32918002 206185828 197985033 19100602 19399735 0 1150377 1890248 73886719 73170121 0 0 303963 0 57846 30530 25350197 34580817 119849704 129071451 X 84203259 66899973 1080540 971663 1052325 1041946 86336124 68913582 206185828 197985033 X -15982476 -1440066 X X 0 0 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 500 0 0 1 102200 0 1 16300 119000 0 Explanation of Lobbying Activities: Part II-B, Line 1: Percentage of dues paid to Maine Hospital Association (MHA) and American Hospital Association (AHA) used by MHA and AHA for lobbying purposes. 1052325 1850 -12229 1041946 983424 4188 64713 1052325 873360 31500 78564 983424 1086370 1500 -214510 873360 1.00000 0 0 6251723 6251723 102939507 35077707 67861800 2844314 1114510 1729804 77808259 51819351 25988908 3561639 883270 2678369 104510604 Marketable Equity Securities 11353286 F Marketable Debt Securities 3215627 F Alternative Investments 4637769 F 19206682 Due from Third-Party Payors 22162231 Other Accounts Receivable 3673747 Unamortized Financing 677323 Other Assets 594510 Market Value Swap Asset 204191 Insurance Recoveries 5606000 32918002 Market Value Swap Liability 1193577 Workers Compensation Reserve 3132000 Accrued Pension Liability 2499012 AR Credit Balances 1783497 Due to Third Party Payors 6672265 Health Claim Reserves 1177997 Due to Related Companies 9822369 Other Reserves 1076774 Professional Liability Reserve 6540900 Deferred Compensation 682426 34580817 203196856 219179332 -15982476 -2087863 647797 -1440066 -17422542 Description of Intended Use of Endowment Funds: Part V, Line 4: Endowment funds restricted uses include funding operations, educational programs, hospice and Alzheimer's screening. Part XI, Line 8 - Other Adjustments: Transfers to/from Affliliates 647,797. Gary's House Golf 197136 70000 127136 0 2000 1000 15928 0 43233 McAuley Auction 39824 0 39824 0 0 500 3818 250 5649 2 73762 28497 45265 0 1018 1790 3299 400 25054 310722 98497 212225 3018 3290 23045 650 73936 103939 108286 1 1 1 X 1 X 1 1 1 0 1 1 7087418 7087418 0.03420 33599117 24346098 9253019 0.04470 40686535 24346098 16340437 0.07890 1090471 621424 469047 0.00230 97717 12 97705 0.00050 1188188 621436 566752 0.00280 41874723 24967534 16907189 0.08170 103596 103596 0.00050 103596 103596 0.00050 1 6695041 223770 66258482 79299887 -13041405 X 1 1 1 1 Mercy Hospital

144 State Street Portland ME 04101

X X X Mercy Hospital 1 0 1 1 200.000000000000 1 250.000000000000 1 X X X X X X 0 1 X X X X 1 0 1 X 0 1 Part I, Line 6a: The organization's community benefit activities are included in Catholic Health East's Community Benefit Report. Part I, Line 7: The method used was a cost-to-charge ratio derived from the most recent Medicare Cost Report data. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 12049563. Part II: See attachment for narrative to be added here. Part III, Line 4: Mercy Hospital provides an allowance for doubtful accounts for estimated losses resulting from the unwillingness of patients or third-party payors to make payments for services. The allowance is determined by analyzing historical data and trends. Accounts receivable are written off against the allowance for doubtful accounts when managment determines that recovery is unlikely and refers collection efforts to a third-party collector under contract. Recoveries of bad debt write-offs reduce bad debt expense. The costing methodology used for determining Mercy Hospital's bad debt expense at cost is applying a cost-to-charge ratio on the value of the organizations bad debt expense. To determine the estimated amount of bad debt expense (at cost) attributable to patients eligible under the organizations's charity care policy, the calculated percentage of total charity care to total gross patient revenue was applied to the total bad debt expense. The resulting amount was multiplied by the Medicare cost to charge ratio. Although our charity care policies and procedures make every effort to indentify thoses patients who are eligible for charity care before the billing process begins, often it is not possible to make an appropriate determination until after the billing and collection cycle has commenced. The rationale for including bad debt amounts in community benefits would be to account for those patients who were classified as bad debt expense, but would have qualified for charity care if sufficient information had been availiable to make a determination of their eligibility.Discounts on patient accounts are not considered to be bad debts. Part III, Line 8: The costing methodology to determine Mercy Hospital's Medicare shortfall is calculated by applying a cost-to-charge ratio on the value of gross Medicare revenue to determine an estimate of total revenue received from Medicare and comparing this amount to allowable costs of care. Part III, Line 9b: Mercy Hospital's written charity care policy clearly states that patients who are known to qualify for charity care or financial assistance are covered under Mercy Hospital's charity care policy. The charity care policy outlines specific parameters for collection practices for charity care patients. Mercy Hospital Part V, Section B, Line 19d: Patients qualifying under the Financial Assistance Plan, FAP, are not charged differently than patients who do not qualify. However, the bills for patients who qualify are adjusted for the amount of financial assistance granted based on the patient's income and family size. Part VI, Line 2: Describe how the organization assess the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.Aligning community services using community identified health indicatorsMercy Hospital works to align our services with the health needs of the community by using the health indicators listed in the Community Health Profile for Cumberland County, annual data provided by Portland's Public Health Division, and a comprehensive asset map and analysis provided by Catholic Health East. These health indicators are as follow: Health Status; Access to Health Care;Physical Activity; Asthma; Tobacco Use; Diabetes; Nutrition; Hypertension; Overweight and Obesity; Mammogram; Medical Care Costs; Pap smear, Alcohol/Drug Abuse, and Safety/Security/ Domestic Violence. The indicators targeted by Mercy's outreach efforts are:(1) Access to Health Care;(2) Alcohol/Drug Abuse;(3) Health Status,(4) Medical Care Costs;(5) Nutrition, and(6) Diabetes.The following are examples of Mercy Hospital Community Services and the relevant community health indicator:(1) Access to Health Care - Volunteer Services, Community Health Outreach Workers (CHOW), Mercy's OB Clinic, and Interpreter's Training Sponsorship;(2) Alcohol/Drug Abuse - HOME Team and Portland's Area Regional Consortium Advisory Board;(3) Health Status - Cancer Support Groups, Pastoral Care - Hospice Visits, McAuley Residence and Hearts to Souls Event;(4) Medical Care Costs - Advanced Patient Advocacy, McAuley Residence, and Community Health Outreach Worker Training;(5) Nutrition - Nutrition Education and Counseling and "Cooking for One" Class; and(6) Diabetes - Diabetes Self-Management Education Program.H.O.M.E. TeamChronically homeless persons in Portland use an inordinate amount of resources without benefit of improved health status or overall quality of life. Many of these homeless individuals end up in hospital emergency departments and the county jail at great cost to the local municipalities and state. In July 2010, the H.O.M.E. Team - Mobile Van Unit with Street Intervention Workers - was launched to engage chronically homeless individuals in services that will get them off the streets and into safe, stabilized situations. By going to the streets and reaching out directly to this group, the H.O.M.E. Team has formed relationships, identified unmet social service needs, and made appropriate referrals to community programs. Through active assessment, intervention and referral services, the team has guided these individuals to the appropriate services by accessing the current service delivery system and has markedly reduced the number of contacts with Portland Police and Fire and Rescue. An analysis from June 2011 through December 2011 showed that the HOME Team had roughly 175 contacts per week and 75 weekly interventions for public intoxication and disruptive behavior. These encounters provide an opportunity to refer the chronically homeless persons to social service programs (i.e., Milestone Shelter and Detox program, Oxford St. Shelter, Preble Street Day Shelter, Amistad Drop in Center, and Healthcare for the Homeless). The team achieved a 10% reduction in Emergency Department visits at Mercy Hospital and a 30% reduction at Maine Medical Center for this target population. The data also suggests a significant drop in the number of police responses to high frequency users who were passed out on the street. It should be noted that police policy changed in May of 2010 as to when they would respond to calls for service involving layouts. Even when controlling for this change in police policy, the data suggests an 82 percent drop in police responses to calls for individuals who are passed out on the street.Community Health Outreach WorkersThrough a partnership with the city of Portland, Mercy employs two Community Health Outreach Workers (CHOW) to assist with community outreach and care navigation for patients with diverse backgrounds. The Latino CHOW works primarily at the Portland Community Free Clinic coordinating care and assisting patients with access to follow up care with a Mercy provider or specialist. The Somali CHOW works in Mercy's Fore River Family Practice and manages a case load of patients, ensuring that patients with chronic disease or behavioral health concerns successfully navigate the system of care. Both of the CHOWs provide necessary translation of documents or flyers.Minority Health Program (MHP)The Minority Health Program (MHP) of the Public Health Division, Health and Human Services Department, and City of Portland was established to help address the health related issues and needs of all minority communities in the Greater Portland area. MHP links people to needed services and improves the communities' health status through Community Health Outreach Workers (CHOWs) and community partnerships. Among the Minority Populations Served include the following racial and ethnic groups:MHP Current Projects are as follows:ACCESS Project - MHP partners with Mercy Hospital, Maine Medical Center and Ingraham to improve health care access to the ethnic minority communities in the Greater Portland area. The project has four major components. Major Events - Each year, MHP hosts an event in one of the minority communities celebrating their culture and highlighting specific health issues that are a concern in those communities. Some examples include: the Exercise for Health and Love health fair and screening, and the Latino Soccer Tournament. Mattina R. Proctor Diabetes CenterThe Diabetes Self-Management Education Program (DSME) at Mercy Hospital assists persons with diabetes in acquiring the knowledge, skills, and attitudes necessary to achieve and maintain good diabetes control. DSME is offered in group or individual sessions that include general DSME, insulin initiation/adjustment, self-blood glucose management, gestational diabetes counseling, and insulin pump therapy. The target audience is newly diagnosed or previously diagnosed adults with diabetes, which includes Type 1, Type 2, and gestational diabetes and their significant others. Both the nurse and dietician conduct an individual needs assessment with each client and clients attending group classes have a post-assessment interview within one month of completing the classes. Follow-up group is offered monthly continuing for up to one year. Education services for patients are scheduled at intervals based on individual needs and assessment of health status, knowledge, skills, and attitudes, behavioral goal achievement, and post-partum clinical outcomes. Education materials are offered in various languages and literacy levels. A detailed follow up plan for each patient is communicated to the referring provider. Our professional staff includes an Endocrinologist Medical Director, Nurse Manager, RN Clinical Dietician, RN diabetes educator.Mercy's OB ClinicIn 2011, the Mercy Hospital OB Clinic provided low risk prenatal care for 689 patients; many of whom have diverse backgrounds and limited English proficiency. The clinic is open two days per week and staffed with Nurse Midwives and professional nurses. Staff administers a psycho-social assessment to include a risk assessment for domestic violence, nutritional screens, prenatal lab work, adolescent screens for young women under 18 years of age and add appropriate supports to foster safe and health delivery. Referrals occur from the community and primary care physicians. Mercy's Volunteer Program In 2011, 463 volunteers gave of their skills, time and energy to our healthcare system. Their contribution was as varied as the individuals providing the support services to patients and clerical assistance to staff. Volunteers provided support in most hospital departments and at primary and specialty care sites throughout the year: in filing records, escorting patients, knitting for The Birthplace, registering patients for our flu and vascular clinics, greeting visitors, staffing the Gift Shop, and assisting with childcare in our transitional housing program. Portland is one of nine designated Refugee Resettlement Community in the United States and welcomes primary and secondary immigrants as well as those seeking political asylum from around the world. The Manager of Mission Services works closely with the Department of Health and Human Services to develop meaningful roles for mothers involved in Maine's welfare to work program called ASPIRE and new immigrants to assist them to become accustomed to the workplace environment. In 2011, we offered English as a second language classes for volunteers and staff in partnership with Portland's Adult Education. Mercy's Employee Health office provided TB tests, flu shots, and inoculations for measles, mumps, rubella, and varicella for 144 senior and 147 junior volunteers. 18 volunteers required additional lab work. Part VI, Line 3: The following is taken from our charity care policy and describes how the organization informs and educates patients on charity care: Public Notice of the availability of assistance through this policy is made through each of the following means:1. Posting notices in a visible manner in locations where there is a high volume of inpatient or outpatient admitting/registration, such as emergency departments, billing offices, admitting offices, and hospital outpatient service settings.2. Posting notice of availability of assistance and contact numbers and location on the organization's website.3. Providing uninsured patients the Financial Assistance application upon registration to the hospital. Upon request, a full text copy of the Charity Care policy should be made available. 4. Making available to the public on a reasonable basis: the annual charity care provided; the unreimbursed costs of care provided to the beneficiaries of government programs that serve the poor (being defined as shortfalls between costs and off-setting reimbursement/revenue that the organization experiences in providing care under the Medicaid and local/county indigent programs for care provided to Medicare beneficiaries who are dually eligible for Medicaid). Posted notices (as listed above) shall be in the primary languages(s) of the service area and in a manner consistent with all applicable federal and state laws and regulations. Should any provision of this Policy conflict with the State of Maine requirements surrounding Charity Care, State law shall supersede the conflicting policy provision and the facility shall act in conformance with applicable State law. Part VI, Line 4: The geographic area served by Mercy Hospital programs is primarily Cumberland and York counties, in south coastal Maine. Two distinct geographic exceptions are the Mercy Recovery Center, Maine's largest addiction treatment facility, which serves patients statewide, and the Northern New England Eating Disorders Program, the only such program located north of Massachusetts. The "community" can be defined in micro fashion, i.e. the city and discreet neighborhood in which Mercy is located, and in macro fashion, i.e. the larger geographical service area (primarily the two counties, but with a widening catchment area). Portland and the West End - Mercy's acute care campuses at Fore River and State Street are located in the West End neighborhood of Portland (Cumberland County), the state's most populous city (pop. 63,591). While population density for the state as a whole is 37 people per square mile, and for Portland itself is 3,029 people per square mile, in the West End (the state's most densely populated neighborhood) the density measure is 10,568 people per square mile. While median income is lower in Portland than in the rest of the state, median income in the West End is lower than Portland's by $7,800 ($35,770 vs. $43,603). In addition, while as a designated Refugee Resettlement city Portland has a more culturally and ethnically diverse population than Maine (9.4% vs. 3.6% non-white), a larger percentage of residents are foreign born (8.1% vs. 7.6%) in the West End than in the rest of Portland. Portland is home to the largest population of Somali / Sudanese / Rwandan and other pan-African populations in Maine, as well as large populations of Hispanics, Asians, Russians and other ethnic groups. In summary, Portland is more densely populated, poorer and more culturally diverse than the rest of Maine, and our immediate neighborhood, the West End, is even more so in all three categories. Portland is also home to a significant population of homeless individuals, drawn to the city by the network of homeless-serving social service agencies, including a dedicated FQHC operated by the City of Portland Public Health Division, located less than a mile from Mercy's State Street campus. This FQHC is strictly for homeless individuals, though Portland Public Health and Mercy Hospital collaborate to provide clinic based services to the poor who are Medicaid (MaineCare) ineligible by subsidizing the Portland Free Clinic with funding and volunteers. A second FQHC, the Portland Community Health Center for MaineCare eligible individuals and children opened in 2009 Mercy Hospital provides the necessary ancillary services and referrals for inpatient admissions from the FQHCs.Mercy's involvement in a wide range of community benefit initiatives to improve the health and lives of individuals and families in the city of Portland, is discussed elsewhere in this narrative. Overall Service Area - While the Portland community is a major focus of Mercy healthcare and community involvement, the organization's catchment area (Cumberland and York counties, and wider) also includes more rural areas such as Gorham ("very rural" designation, with a pop. of 4,302) , Standish ("rural" pop. 9,895) , and Buxton ("rural" pop. 8,072). To facilitate access to primary care - the basic building block of healthcare reform - in these outlying rural areas, Mercy has established primary care practice (PCP) sites in several of them: Windham; Gorham; Standish; Falmouth; Yarmouth; and West Falmouth. These are in addition to PCP sites in Portland and Westbrook. Part VI, Line 5: In addition to the activities listed in Part VI, Line 2, the Hospital maintains an open medical staff and is governed by a board consisting largely of independent members. Reports Filed With States Part VI, Line 7 AL,CT,DE,FL,GA,ME,MA,NJ,NY,NC,PA X X X 1 1 0 1 0 0 0 1 0 1 0 William Demicco 255422 0 1533 0 12761 0 10051 0 18597 0 298364 0 0 0 Eileen Skinner 0 356895 0 90250 0 126182 0 9930 0 29316 0 612573 0 0 Anthony Marple Sch O 0 203808 0 0 0 22261 0 2223 0 18895 0 247187 0 0 Michael Hachey Sch O 0 239506 0 36882 0 51615 0 10413 0 26330 0 364746 0 0 Robert Nutter 0 207579 0 34393 0 30318 0 9441 0 26925 0 308656 0 0 Scott Rusk 0 295006 0 13629 0 6188 0 3063 0 27483 0 345369 0 0 James Shrum 0 190000 0 9154 0 4138 0 1759 0 27778 0 232829 0 0 Gregory Pomeroy 484728 0 215770 0 7647 0 10413 0 26695 0 745253 0 0 0 Marc Hodroff 375808 0 75000 0 19117 0 10413 0 17828 0 498166 0 0 0 Gregory Adey 375808 0 75000 0 17843 0 10413 0 22387 0 501451 0 0 0 Adam Owen 520000 0 0 0 -7140 0 0 0 23923 0 536783 0 0 0 Christopher Kleeman 367154 0 85000 0 -3777 0 356 0 24458 0 473191 0 0 0 Edward Ted McCarthy 177104 0 6100 0 15493 0 8162 0 19825 0 226684 0 0 0 Part I, Line 1a As part of the compensation plan, executives receive a discretionary spending account for certain eligible expenses incurred. Payments of these expenses are made on a grossed-up basis. Mercy Hospital provides local housing for one executive. Part I, Line 3 The organization relied on a related organization that used one or more of the methods described below to establish the top management official's compensation: - Compensation committee - Independent compensation consultants - Written employment contract - Compensation survey or study - Approval by the board or compensation committee. Part I, Line 4b The following individuals received taxable SERP payments: Michael Hachey - $25,602; Robert Nutter - $20,328; Colleen Hilton - $14,420; Eileen Skinner - $103,112. Part I, Line 6 An individual listed on Form 990 Part VII Section A received incentive compensation related to the contribution margin associated with office-based services. Under this arrangement, the individual was paid (a) up to 17.5% of the excess of the current year's actual contribution margin over the prior year's contribution margin and (b) up to 17.5% of the excess of the current year's actual contribution margin over the budgeted contribution margin with a combined payment cap not to exceed $120,000. Part I, Line 7 Company compensation programs include various incentive/bonus programs where fixed payments measured in terms of a percentage of base salary may be made in relation to performance or goal achievements. Maine Health and Higher Educational 010314384 560425G61 2006-12-20 68400000 Construction of Fore River Hospital 0 0 0 Maine Health and Higher Educational 010314384 560427JA5 2010-06-24 11275000 Refinancing 1998A Bonds 0 0 0 68400000 4710502 496240 195080 62998175 2008 0 0 1 1 715000 11275000 1097744 112393 10064863 2010 1 0 1 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 1 1 0 1 Pallas Capital Corporation 2.500000000000 1 0 0 0 0 0 0 0 0 X Schedule K Supplental Information Part III, Line 3a: The Company has entered into various management and service contracts. Collectively, these contracts do not constitute an amount of private business use that exceeds the prescribed percentage. Maine Surgical Group Paul Bloch, MD, Board Member 32260 Payment for physician services related to vascular services to Maine Surgical Care Group, where Dr. Paul Bloch is a partner. 0 William Demicco MD William Demicco, MD, Board Member 274991 Dr. Demicco is a Mercy Hospital employed Pulmonologist and is paid for his work as a physician. 0 UNUM Joseph R Foley, Board Member 120227 Mercy Hospital purchases LTC insurance from UNUM, where Mr. Foley is an executive and an officer. 0 Yvonne Bonney Mina Thimi Mina, Board Member 157049 Mr. Thimi Mina, a Board Member of Mercy Hospital, is married to Ms. Yvonne Bonney Mina, an employee of Mercy Hospital who was paid a salary for her work as a CRNA in 2011. 0 Sysco North New England Gregory Otterbein, Board Member 624027 Mercy Hospital purchases food services from Sysco North New England, where Mr. Otterbein is President. 0 Maine Cardiology Associates Jeffrey Rosenblatt, MD, Board Member (Former) 119193 Payment for physician services related to cardiology services to Maine Cardiology Associates, where Dr. Jeffrey Rosenblatt is a partner. 0 X 11 25234 Cost or selling price X Other: 1 5000 Cost or selling price 0 0 1 0 Form 990, Part VI, Section A, line 2 Mr. Joe Gray and Mr. Jon Jennings are members of the Board of Directors/Trustees of Mercy Health System of Maine (MHSM) and Mercy Hospital. Mr. Jennings is a key investor in the Thompson's Point Project in Portland, a $100 million complex (convention center hotel, parking garage, etc.). Mr. Gray is a consultant for the Thompson's Point Project. MHSM and Mercy Hospital are not parties to this transaction. Form 990, Part VI, Section A, line 6 Mercy Health System of Maine (MHSM) is the sole Member of Mercy Hospital. Form 990, Part VI, Section A, line 7a Mercy Health System of Maine (MHSM) is the sole Member of Mercy Hospital. MHSM approves all members of the Board of Trustees of Mercy Hospital. Form 990, Part VI, Section A, line 7b MHSM has reserved powers in the following areas: - changes in articles of incorporation; - in Key and non-Key Bylaws Provisions, appoint and remove Trustees; - approve philosophy and mission, strategic plan, operating plan and budget; - significant Financial transactions, significant budget variances and - establishment or dissolution of organizational relationships. Form 990, Part VI, Section B, line 11 The Board of Directors/Trustees received education about the revised Form 990 during the October Board meeting. The Board discussed significant issues included in the draft Form 990 for Mercy Health System of Maine, MHSM, and for Mercy Hospital during this meeting. The Finance and Audit Committee of MHSM received education about the revised Form 990 at the September Committee meeting and reviewed the Form 990 for MHSM and Mercy Hospital at the October Committee meeting. The Finance Committee approved Form 990 for MHSM and Mercy Hospital for submission to the IRS during the October Finance Committee meeting. Form 990, Part VI, Section B, line 12c Mercy Hospital Attachment A to the Bylaws sets forth the organization's conflict of interest policy and processes. Annually, all those serving Mercy Hospital in a fiduciary capacity, including directors, trustees, officers, non-Board committee members 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 Chairman of the Board and Compliance Officer. Summary information is reported to the Governance Committee and entire Board. This 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 dis-interested 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 15 Mercy Hospital's process for determining compensation 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 Mercy Hospital roles to similarly sized health systems utilizing both title and job content comparisons. The committee reviews the market analysis, approves any salary adjustments for the executive and employed physician populations, considers both reasonableness and effectiveness of all remunerative programs and establishes the 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 Organizational Articles of Incorporation, Corporate Bylaws, governance policies, conflict of interest policy and audited financial statements are available upon request. IRS Form 990 is posted on the Mercy Hospital website. Average hours devoted to related organization(s) when related compensation Form 990, Part VII: Individuals compensated by a related organization have responsibilities and perform services for Mercy Hospital and Mercy Health System. The amount of compensation appearing in Columns (E) and (F) reflect the services performed for the entire health system as a whole and not merely a single organization within the health system. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -2,087,863. Transfers to/from Affliliates 647,797. Total to Form 990, Part XI, Line 5: -1,440,066. Explanation of financial statements: Form 990, Part XII, Line 2a & 2b: Financial statements were audited on a consolidated basis. Explanation of required audits not obtained: Form 990, Part XII, Line 3B: At the time of filing, the required A-133 audit has not been performed. Catholic Health East is coordinating the scheduling of this audit for all of it's members and will have them completed by the required due dates. Disclosure Statement Related to Form 5471 Filed by Catholic Health East and Saint Michael's Medical Center Under the constructive ownership rule of Internal Revenue Code Sections 318(a) and 958(b), the organization is required to file Form 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, as a Category 4 and/or Category 5 filer with respect to Stella Maris Insurance Company Limited and Chestnut Risk Services, LTD (collectively, the "foreign corporations"). This filing requirement is, or will be, satisfied through the filing of Forms 5471 with respect to the foreign corporations on the organization's behalf by the U.S. organizations identified below. Foreign Corporation: Stella Maris Insurance Company U.S. Organization: Catholic Health East Address: 3805 West Chester Pike, Suite 100, Newtown Square, Pennsylvania 19073 Identifying Number of U.S. Tax Return with Which Form 5471 was filed: 23-2929748 IRS Service Center Where U.S. Return Was Filed: Ogden, UT Foreign Corporation: Chestnut Risk Services, LTD U.S. Organization: Saint Michael's Medical Center Address: 111 Central Avenue, Newark, New Jersey 07102 Identifying Number of U.S. Tax Return with Which Form 5471 was filed: 26-2616046 IRS Service Center Where U.S. Return Was Filed: Ogden, UT Catholic Health East 3805 West Chester Pike Suite 100 Newtown Square PA 19073 232929748 Management Services PA 501(c)(3) Line 11a, I N/A 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 Mercy Health System of Maine 144 State Street Portland MA 04101 010484074 Management & Support Services ME 501(c)(3) Line 11c, III-FI Catholic Health East 1 St Peter's Health Partners 315 South Manning Blvd Albany NY 12208 453570715 Management & Support Services NY 501(c)(3) Line 11b, II Catholic Health East 1 St Peter's Health Care Services 315 South Manning Blvd Albany NY 12208 222702507 Management & Support Services NY 501(c)(3) Line 9 St Peter's Health Partners 1 St Peter's Hospital 315 South Manning Blvd Albany NY 12208 141348692 Hospital NY 501(c)(3) Line 3 St Peter's Health Care Services 1 St Peter's Hospital Foundation Inc 319 South Manning Blvd Suite 309 Albany NY 12208 222262982 Fundraising & Public Relations NY 501(c)(3) Line 7 St Peter's Health Care Services 1 Eddy Licensed Home Care Agency 433 River St Suite 3000 Troy NY 12180 141818568 Home Health NY 501(c)(3) Line 3 LTC(Eddy) Inc 1 The Community Hospice Foundation Inc 295 Valley View Blvd Rensselaer NY 12144 222692940 Fundraising & Public Relations NY 501(c)(3) Line 7 The Community Hospice Inc 1 The Community Hospice Inc 295 Valley View Blvd Rensselaer NY 12144 141608921 Serving seriously ill people & their families NY 501(c)(3) Line 3 St Peter's Health Care Services 1 Villa Mary Immaculate 301 Hackett Blvd Albany NY 12208 141438749 Nursing Home & Physical Rehab NY 501(c)(3) Line 3 St Peter's Hospital 1 Warde Service Corporation Inc 159 Wolf Road 3rd Floor Albany NY 12205 141732097 Supporting & strengthing the ministries of rel. sr. mercy NY 501(c)(3) Line 9 St Peter's Health Care Services 1 Mercy Care for Kids Inc 310 South Manning Blvd Albany NY 12208 141717564 Day care center NY 501(c)(3) Line 9 St Peter's Health Care Services 1 Our Lady of Mercy Life Center 2 Mercycare Lane Guilderland NY 12084 141743506 Nursing Home Facility NY 501(c)(3) Line 3 St Peter's Health Care Services 1 St Peter's Auxiliary 315 South Manning Blvd Albany NY 01228 222843206 Auxiliary NY 501(c)(3) Line 11a, I St Peter's Health Care Services 1 Memorial Hospital Albany NY 600 Northern Blvd Albany NY 12204 141338457 General Hospital NY 501(c)(3) Line 3 Northeast Health Inc 1 Beechwood Inc 2212 Burdett Ave Troy NY 12180 141651563 Real estate holding NY 501(c)(2) N/A LTC (Eddy) Inc 1 Beverwyck Inc 40 Autumn Drive Slingerlands NY 12159 141717028 Independent/Assisted Living Retirement Community NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Capital Region Geriatric Center Inc 421 West Columbia St Cohoes NY 12047 141701597 Nursing Home NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Senior Care Connection Inc 504 State St Schenectady NY 12305 141708754 PACE Program NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Glen Eddy Inc One Glen Eddy Drive Niskayuna NY 12309 141794150 Independent/Assisted Living Community NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Hawthorne Ridge Inc 30 Community Way East Greenbush NY 12061 800102840 Independent/Assisted Living Retirement Community NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Heritage House Nursing Center Inc 2920 Tibbits Ave Troy NY 12180 141725101 Nursing home NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Home Aid Service of Eastern New York Inc 433 River St Suite 3000 Troy NY 12180 141514867 Home care NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 James A Eddy Memorial Geriatric Center Inc 2256 Burdett Ave Troy NY 12180 222570478 Nursing home NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 LTC (Eddy) Inc 2212 Burdett Ave Troy NY 12180 222564710 Elderly health/housing supporting org NY 501(c)(3) Line 11a, I Northeast Health Inc 1 The Marjorie Doyle Rockwell Center Inc 421 West Columbia St Cohoes NY 12047 141793885 Adult Home/Alzheimers NY 501(c)(3) Line 9 LTC (Eddy) Inc 1 Samaritan Hospital of Troy New York 2215 Burdett Ave Troy NY 12180 141338544 General hospital NY 501(c)(3) Line 3 Northeast Health Inc 1 Shaker Properties Inc 2212 Burdett Ave Troy NY 12180 223119822 Real Estate holding NY 501(c)(2) N/A Northeast Health Inc 1 Sunnyview Hospital & Rehabilitation Ctr 1270 Belmont Ave Schenectady NY 12308 141338386 Rehabilitation hospital NY 501(c)(3) Line 3 LTC (Eddy) Inc 1 Empire Home Infusion Service Inc 10 Blacksmith Drive Malta NY 12020 141795732 Home care NY 501(c)(3) Line 9 Home Aid Service of Eastern New York Inc 1 Samaritan Child Care Center Inc 2213 Burdett Ave Troy NY 12180 141710225 Child day care NY 501(c)(3) Line 9 Northeast Health Inc 1 The Northeast Health Foundation Inc 2224 Burdett Ave Troy NY 12180 222743478 Supporting foundation NY 501(c)(3) Line 7 Northeast Health Inc 1 Northeast Health Inc 2212 Burdett Ave Troy NY 12180 042450756 Supporting Organization NY 501(c)(3) Line 11b, II St Peter's Health Partners 1 Seton Health System Inc 1300 Massachusetts Avenue Troy NY 12180 141776186 Hospital NY 501(c)(3) Line 3 St Peter's Health Partners 1 Seton Auxiliary Inc 1300 Massachusetts Avenue Troy NY 12180 141505031 Supporting Organization NY 501(c)(3) Line 9 Seton Health System Inc 1 Seton Health at Schuyler Ridge Residential Healthcare 1 Abele Blvd Clifton Park NY 12065 141756230 Skilled Nursing NY 501(c)(3) Line 9 Seton Health System Inc 1 Seton Health Foundation 1300 Massachusetts Avenue Troy NY 12180 222345416 Supporting Organization NY 501(c)(3) Line 11a, I Seton Health System Inc 1 Seton Licensed Home Care Inc 1300 Massachusetts Avenue Troy NY 12180 141809134 Licensed Home Health Agency NY 501(c)(3) Line 3 Seton Health System Inc 1 Vincentian Health Services 1300 Massachusetts Avenue Troy NY 12180 141685163 Discontinued Operations NY 501(c)(3) Line 11a, I Seton Health System Inc 1 St Mary's Woodland Village Inc 1300 Massachusetts Avenue Troy NY 12180 141675183 Discontinued Operations NY 501(c)(3) Line 9 Seton Health System Inc 1 Brightside Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 01040 042182395 Behavioral Care MA 501(c)(3) Line 9 Sisters of Providence Health System Inc 1 Farren Care Center Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 01040 042501711 Long Term Care MA 501(c)(3) Line 3 Sisters of Providence Health System Inc 1 Mercy Hospital Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 01040 043398280 Acute Care MA 501(c)(3) Line 3 Sisters of Providence Health System Inc 1 Mercy Specialist Physicians Inc c/o SPHS 1221 Main Street No 108 Holyoke MA 01040 264033168 Neurosurgery Medical Services MA 501(c)(3) Line 3 Sisters of Providence Health System Inc 1 Sisters of Providence Care Centers Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 01040 222541103 Long Term Care MA 501(c)(3) Line 3 Sisters of Providence Health System Inc 1 Sisters of Providence Health System Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 01040 043398374 Management & Support Services MA 501(c)(3) Line 11a, I Catholic Health East 1 McAuley Center Inc 275 Steele Road West Hartford CT 06117 061058086 Independent Living CT 501(c)(3) Line 9 Mercy Community Health Inc 1 Mercy Community Health Inc 2021 Albany Avenue West Hartford CT 06117 061492707 Management & Support Services CT 501(c)(3) Line 11a, I Catholic Health East 1 Mercy Community HomeCare Services 2021 Albany Avenue West Hartford CT 06117 061488137 In Home Health Care CT 501(c)(3) Line 9 Mercy Community Health Inc 1 Mercy Services 2021 Albany Avenue West Hartford CT 06117 061453323 Support Services CT 501(c)(3) Line 1 Mercy Community Health Inc 1 Mercyknoll Inc 2021 Albany Avenue West Hartford CT 06117 060757380 Skilled Nursing CT 501(c)(3) Line 3 Mercy Community Health Inc 1 Saint Mary Home II Inc 2021 Albany Avenue West Hartford CT 06117 061164104 Elderly Care CT 501(c)(3) Line 3 Mercy Community Health Inc 1 St Mary Home Incorporated 2021 Albany Avenue West Hartford CT 06117 060646843 Skilled Nursing CT 501(c)(3) Line 3 Mercy Community Health Inc 1 Mercy Healthcare Center 114 Wawbeek Avenue Tupper Lake NY 12986 150532211 Hospital NY 501(c)(3) Line 3 Catholic Health East 1 Mercy Uihlein Health Corporation 185 Old Military Road Lake Placid NY 12946 161535133 Hospital NY 501(c)(3) Line 11b, II Mercy Healthcare Center 1 Uihlein Mercy Center 185 Old Military Road Lake Placid NY 12946 150532190 Hospital NY 501(c)(3) Line 3 Mercy Healthcare Center 1 St James Mercy Foundation Inc 411 Canisteo Street Hornell NY 14843 161486437 Foundation NY 501(c)(3) Line 7 St James Mercy Health System Inc 1 St James Mercy Health System Inc 411 Canisteo Street Hornell NY 14843 223127184 Management & Support Services NY 501(c)(3) Line 11b, II Catholic Health East 1 St James Mercy Hospital 411 Canisteo Street Hornell NY 14843 160743310 Hospital NY 501(c)(3) Line 3 St James Mercy Health System Inc 1 Marian Community Hospital 100 Lincoln Avenue Carbondale PA 18407 240711230 Hospital PA 501(c)(3) Line 3 Maxis Health System 1 Marian Community Hospital Auxiliary 100 Lincoln Avenue Carbondale PA 18407 251874733 Fundraising PA 501(c)(3) Line 11b, II Maxis Health System 1 Maxis Foundation 100 Lincoln Avenue Carbondale PA 18407 232330090 Fundraising PA 501(c)(3) Line 11b, II Maxis Health System 1 Maxis Health System 100 Lincoln Avenue Carbondale PA 18407 911940902 Health Care System PA 501(c)(3) Line 11b, II Catholic Health East 1 Maxis Medical Services 100 Lincoln Avenue Carbondale PA 18407 232577185 Physician Practices PA 501(c)(3) Line 3 Maxis Health System 1 Tri-County Human Services Center Inc PO Box 517 Carbondale PA 18407 231938528 Behavioral Health Organization PA 501(c)(3) Line 7 Maxis Health System 1 Columbus Acquisition Corp 1160 Raymond Boulevard Newark NJ 07102 262616342 Inactive Entity NJ 501(c)(3) Line 9 Saint Michaels Medical Center 1 Saint Michaels Medical Center 111 Central Avenue Newark NJ 07102 262616046 Hospital NJ 501(c)(3) Line 3 Catholic Health East 1 St James Care Inc 1160 Raymond Boulevard Newark NJ 07102 262616230 Inactive Entity NJ 501(c)(3) Line 9 Saint Michaels Medical Center 1 St Michaels Medical Center Foundation 1160 Raymond Boulevard Newark NJ 07102 223311976 Foundation NJ 501(c)(3) Line 11a, I Saint Michaels Medical Center 1 University Heights Property Company Inc 1160 Raymond Boulevard Newark NJ 07102 223100162 Medical Property Holding Company NJ 501(c)(2) N/A Saint Michaels Medical Center 1 Life St Francis Corporation 601 Hamilton Avenue Trenton NJ 08629 222797282 Health Services NJ 501(c)(3) Line 11a, I St Francis Medical Center Trenton NJ 1 St Francis Medical Center Foundation NJ 601 Hamilton Avenue Trenton NJ 08629 521025476 Foundation NJ 501(c)(3) Line 11a, I St Francis Medical Center Trenton NJ 1 St Francis Medical Center Trenton NJ 601 Hamilton Avenue Trenton NJ 08629 223431049 Hospital NJ 501(c)(3) Line 3 Catholic Health East 1 Langhorne MRI Inc 1201 Langhorne-Newtown Road Langhorne PA 19047 232519529 Inactive Entity PA 501(c)(3) Line 9 St Mary Medical Center 1 Langhorne Physician Services Inc 1201 Langhorne-Newtown Road Langhorne PA 19047 232571699 Physician Services PA 501(c)(3) Line 9 St Mary Medical Center 1 LIFE St Mary 1201 Langhorne-Newtown Road Langhorne PA 19047 262976184 Elderly Care PA 501(c)(3) Line 9 St Mary Medical Center 1 St Mary Medical Center 1201 Langhorne-Newtown Road Langhorne PA 19047 231913910 Hospital PA 501(c)(3) Line 3 Catholic Health East 1 St Mary Medical Center Foundation Inc 1201 Langhorne-Newtown Road Langhorne PA 19047 232567468 Foundation PA 501(c)(3) Line 7 St Mary Medical Center 1 East Norriton Physician Services c/o One West Elm Street Conshohocken PA 19428 232515999 Physician Services PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 Mercy Catholic Medical Center of Southeastern Pennsylvania One West Elm Street Conshohocken PA 19428 231352191 Acute Care Hospital PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 Mercy Family Support 1001 Baltimore Pike Suite 301 Springfield PA 19064 232325059 Home Health PA 501(c)(3) Line 9 Mercy Health System of Southeastern Pennsylvania 1 Mercy Health Foundation of Southeastern Pennsylvania c/o MHS One West Elm Street Conshohocken PA 19428 232829864 Fundraising PA 501(c)(3) Line 11b, II Mercy Health System of Southeastern Pennsylvania 1 Mercy Health Plan c/o One West Elm Street Conshohocken PA 19428 222483605 Health Plans PA 501(c)(3) Line 11b, II Mercy Health System of Southeastern Pennsylvania 1 Mercy Health System of Southeastern Pennsylvania One West Elm Street Conshohocken PA 19428 232212638 Management & Support Services PA 501(c)(3) Line 11b, II Catholic Health East 1 Mercy Home Health 1001 Baltimore Pike Suite 310 Springfield PA 19064 231352099 Home Health PA 501(c)(3) Line 9 Mercy Health System of Southeastern Pennsylvania 1 Mercy Home Health Services 1001 Baltimore Pike Suite 301 Springfield PA 19064 232325058 Home Health PA 501(c)(3) Line 11b, II Mercy Health System of Southeastern Pennsylvania 1 Mercy Management of Southeastern Pennsylvania One West Elm Street Conshohocken PA 19428 232627944 Physician Practices PA 501(c)(3) Line 11b, II Mercy Health System of Southeastern Pennsylvania 1 Mercy Suburban Hospital One West Elm Street Conshohocken PA 19428 231396763 Acute Care Hospital PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 Nazareth Health Care Foundation 2701 Holme Avenue Philadelphia PA 19152 232300951 Fundraising PA 501(c)(3) Line 11b, II Mercy Health System of Southeastern Pennsylvania 1 Nazareth Hospital 2601 Holme Avenue Philadelphia PA 19152 232794121 Acute Care Hospital PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 Nazareth Physician Services Inc 2601 Holme Avenue Philadelphia PA 19152 203261266 Physician Practices PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 NE Physician Services 2601 Holme Avenue Philadelphia PA 19152 232497355 Physician Practices PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 St Agnes Continuing Care Center 1900 S Broad Street Philadelphia PA 19145 232840137 Continuing Care Services PA 501(c)(3) Line 3 Mercy Health System of Southeastern Pennsylvania 1 St Agnes Continuing Care Center Foundation 1900 S Broad Street Philadelphia PA 19145 232415137 Fundraising PA 501(c)(3) Line 11b, II Mercy Health System of Southeastern Pennsylvania 1 Life at Lourdes Inc 1600 Haddon Avenue Camden NJ 08108 261854750 Elderly Care NJ 501(c)(3) Line 3 Our Lady of Lourdes Health Care Services 1 Lourdes Ancillary Services 1600 Haddon Avenue Camden NJ 08103 222568525 Supporting Organization NJ 501(c)(3) Line 11b, II Our Lady of Lourdes Health Care Services 1 Lourdes Dialysis at Innova Inc 1600 Haddon Avenue Camden NJ 08108 263237625 Hospital NJ 501(c)(3) Line 3 Our Lady of Lourdes Health Care Services 1 Lourdes Medical Center Burlington County 218 Sunset Road Willingboro NJ 08046 223612265 Hospital NJ 501(c)(3) Line 3 Our Lady of Lourdes Health Care Services 1 Our Lady of Lourdes Health Care Services 1600 Haddon Avenue Camden NJ 08103 222568528 Management & Support Services NJ 501(c)(3) Line 11b, II Catholic Health East 1 Our Lady of Lourdes Health Foundation Inc 1600 Haddon Avenue Camden NJ 08103 222351960 Foundation NJ 501(c)(3) Line 7 Our Lady of Lourdes Health Care Services 1 Our Lady of Lourdes Medical Center 1600 Haddon Avenue Camden NJ 08103 210635001 Hospital NJ 501(c)(3) Line 3 Our Lady of Lourdes Health Care Services 1 Franciscan Eldercare Corporation PO Box 2500 Wilmington DE 19805 223008680 Eldercare DE 501(c)(3) Line 9 St Francis Hospital 1 St Francis Foundation PO Box 2500 Wilmington DE 19805 510374158 Foundation DE 501(c)(3) Line 11b, II St Francis Hospital 1 St Francis Hospital PO Box 2500 Wilmington DE 19805 510064326 Hospital DE 501(c)(3) Line 3 Catholic Health East 1 LIFE at St Francis Healthcare Inc 7th Clayton Streets Wilmington DE 19805 452569214 Elderly Care DE 501(c)(3) Line 3 St Francis Hospital 1 McAuley Ministries McAuley Hall 3333 Fifth Avenue Pittsburgh PA 15213 943436142 Management & Support Services PA 501(c)(3) Line 9 Pittsburgh Mercy Health System 1 Mercy Jeannette Hospital 3805 West Chester Pike Newtown Square PA 19073 251310602 Inactive Entity PA 501(c)(3) Line 9 Pittsburgh Mercy Health System 1 Mercy Life Center Corporation 1200 Reedsdale Street Pittsburgh PA 15233 251604115 Community Treatment PA 501(c)(3) Line 9 Pittsburgh Mercy Health System 1 Pittsburgh Mercy Health System 3333 5th Avenue Pittsburgh PA 15213 251464211 Management & Support Services PA 501(c)(3) Line 11b, II Catholic Health East 1 St Joseph's of the Pines Inc 100 Gossman Drive Suite B Southern Pines NC 28387 560694200 Hospital NC 501(c)(3) Line 3 Catholic Health East 1 Life St Joseph of the Pines Inc 100 Gossman Drive Suite B Southern Pines NC 28387 272159847 Healthcare Services NC 501(c)(3) Line 3 St Joseph's of the Pines Inc 1 Mercy Senior Care Inc 212 West Third Street PO Box 866 Rome GA 30162 581366508 Community Outreach GA 501(c)(3) Line 7 Saint Joseph's Health System Inc 1 Good Samaritan HospitalInc 1201 Siloam Road Greensboro GA 30462 261720984 Hospital GA 501(c)(3) Line 3 Saint Joseph's Health System Inc 1 Saint Joseph's Health System Inc 5673 Peachtree-Dunwoody Road Suite Atlanta GA 30342 581744848 Management & Support Services GA 501(c)(3) Line 11b, II Catholic Health East 1 Saint Joseph's Mercy Care Services Inc 5673 Peachtree-Dunwoody Road Suite Atlanta GA 30342 581752700 Community Outreach GA 501(c)(3) Line 7 Saint Joseph's Health System Inc 1 Saint Joseph's Mercy Foundation Inc 5673 Peachtree-Dunwoody Road Suite Atlanta GA 30342 581448522 Fundraising GA 501(c)(3) Line 11b, II Saint Joseph's Health System Inc 1 Mercy Services Downtown Inc 5673 Peachtree-Dunwoody Road Suite Atlanta GA 30342 272046353 Real Estate Holding Company GA 501(c)(3) Line 11b, II Saint Joseph's Health System Inc 1 St Mary's Health Care System Inc 1230 Baxter Street Athens GA 30606 580566223 Hospital GA 501(c)(3) Line 3 Catholic Health East 1 St Mary's Foundation Inc 1230 Baxter Street Athens GA 30606 582544232 Fundraising GA 501(c)(3) Line 11b, II St Mary's Health Care System Inc 1 St Mary's Highland Hills Inc 1230 Baxter Street Athens GA 30606 020576648 Assisted Living & Retirement Community GA 501(c)(3) Line 3 St Mary's Health Care System Inc 1 St Mary's Medical Group Inc 1230 Baxter Street Athens GA 30606 261858563 Hospital / Physician Services GA 501(c)(3) Line 3 St Mary's Health Care System Inc 1 Mercy Medical Corporation PO Box 1090 101 Villa Drive Daphne AL 36526 636002215 Hospital AL 501(c)(3) Line 3 Catholic Health East 1 Mercy LIFE of Alabama PO Box 1090 101 Villa Drive Daphne AL 36526 273163002 Hospital AL 501(c)(3) Line 3 Mercy Medical Corporation 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 11b, II Catholic Health East 1 St Francis Hospital Inc 33920 US Highway 19 North Suite 269 Palm Harbor FL 34684 590624442 Hospital FL 501(c)(3) Line 11a, I Allegany Franciscan Ministries Inc 1 Holy Cross Hospital Inc 4725 North Federal Highway Ft Lauderdale FL 33308 590791028 Hospital FL 501(c)(3) Line 3 Catholic Health East 1 Holy Cross Long-Term Inc 4725 North Federal Highway Ft Lauderdale FL 33308 650787320 Medical Services FL 501(c)(3) Line 3 Holy Cross Hospital Inc 1 Holy Cross Medical Properties Inc 4725 North Federal Highway Ft Lauderdale FL 33308 650666283 Medical Building Real Estate Management FL 501(c)(2) N/A Holy Cross Hospital Inc 1 Mercy Hospital Foundation Inc 3663 South Miami Avenue Miami FL 33133 591709438 Fundraising FL 501(c)(3) Line 7 Mercy Hospital Inc 1 Mercy Hospital Inc 3663 South Miami Avenue Miami FL 33133 590791034 Hospital FL 501(c)(3) Line 3 Catholic Health East 1 Mercy Medical Development Inc 3663 South Miami Avenue Miami FL 33133 592789194 Outpatient Services FL 501(c)(3) Line 9 Mercy Hospital Inc 1 Mercy Mission Services Inc 3663 South Miami Avenue Miami FL 33133 650435764 Health Care FL 501(c)(3) Line 11a, I Mercy Hospital Inc 1 Mercy Outpatient Services Inc DBA Sister Emmanuel Hospital 3663 South Miami Avenue Miami FL 33133 510461511 Hospital FL 501(c)(3) Line 3 Mercy Hospital Inc 1 Global Health Ministry 3805 West Chester Pike Suite 100 Newtown Square PA 19073 233068656 Health Care PA 501(c)(3) Line 7 Catholic Health East 1 VNA Home Health & Hospice 50 Foden Road South Portland ME 04106 010246804 Home Health & Hospice ME 501(c)(3) Line 11a, I Mercy Health System of Maine 1 Providence Place Inc 5 Gamelin Street Holyoke MA 01040 043404084 Retirement Community MA 501(c)(3) Line 9 Sisters of Providence Health System Inc 1 Intercoastal Health Systems 3805 West Chester Pike Suite 100 Newtown Square PA 19073 650556413 Management & Support Services PA 501(c)(3) Line 11a, I Catholic Health East 1 Sunnyview Hospital & Rehabilitation Center Foundation 1270 Belmont Ave Schenectady NY 12308 222505127 Supporting foundation NY 501(c)(3) Line 11a, I Sunnyview Hospital & Rehabilitation Ctr 0 St Peter's Ambulatory Surgery Center LLC 1375 Washington Avenue Ste 201 Albany NY 12206 460463892 Surgery NY N/A Catherine Horan Building Limited Partnership 1221 Main Street Room 108 Holyoke MA 010400000 042723429 Property Management MA N/A Western Massachusetts PETCT Imaging Center LLC 100 Bayview Circle Ste 400 Newport Beach CA 92660 204744663 Outpatient Medical Services DE N/A Central New Jersey Heart Services LLC 10720 Sikes Places Ste 300 Charlotte NC 28277 208525458 Cardiac Program NJ N/A Langhorne MOB Partners LP 1201 Langhorne-Newtown Road Langhorne PA 19047 232622772 Investment and operation of a medical building PA N/A SMMC MOB II LP 1201 Langhorne-Newtown Road Langhorne PA 19047 364559869 Investment and operation of a medical building PA N/A The Ambulatory Surgery Center at St Mary LLC 1203 Langhorne-Newton Road Langhorne PA 19047 232871206 Outpatient Surgery PA N/A AmeriHealth Mercy Health Plan 200 Stevens Drive Suite 350 Philadelphia PA 19113 232859523 Medicaid Managed Care Organization PA N/A Amerihealth Mercy of Indiana LLC 200 STEVENS DRIVE Suite 350 Philadelphia PA 19113 204948091 PREPAID HEALTH CARE SERVICES IN N/A East Norriton Medical Associates One West Elm Street Conshohocken PA 19428 232319531 Medical Office Building PA N/A East Norriton Medical Associates One West Elm Street Conshohocken PA 19428 232319531 Medical Office Building PA N/A Gateway Health Plan 300 Grant Street Pittsburgh PA 15219 251691945 Medicaid & Medicare/Special Needs Managed Care Organization PA N/A Keystone Mercy Health Plan 100 Stevens Drive Philadelphia PA 19113 232842344 Medicaid Managed Care Organization PA N/A MercyManor Partnership PO Box 10086 Toledo OH 436990086 521931012 Nursing Home PA N/A St Agnes Long Term Intensive Care LLP 1900 S Broad Street Philadelphia PA 19145 200984882 Long Term Intensive Care PA N/A Nazareth Medical Office Building Associates LP c/o Nazareth Hospital 2601 Holme Av Philadelphia PA 19152 232388040 Medical Office Building PA N/A Nazareth Medical Office Building Associates LP c/o Nazareth Hospital 2601 Holme Av Philadelphia PA 19152 232388040 Medical Office Building PA N/A St Agnes Long Term Intensive Care LLP 1900 S Broad Street Philadelphia PA 19145 200984882 Long Term Intensive Care PA N/A SJV Management LLC 200 Century Pkwy Ste 200E Mount Laurel NJ 08054 202273476 Radiology NJ N/A Physicians Outpatient Surgery Center LLC 1000 NE 56th Oakland Park FL 33334 352325646 Ambulatory Surgery Center FL N/A Center for Surgery & Digestive Orders 3641 South Miami Avenue Miami FL 33133 510438152 Outpatient Medical Services FL N/A Samaritan Medical Office Building Inc 2212 Burdett Avenue Troy NY 12180 141607244 Real Estate NY N/A C Affiliated Management Services Corporation Inc 1300 Massachusetts Avenue Troy NY 12180 141668024 Real Estate NY N/A C Catherine Horan Building Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 010400000 042938180 Building Management MA N/A C Diversified Community Services Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 010400000 043128890 Medical Services MA N/A C Mercy Inpatient Medical Associates Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 010400000 043029829 Medical Services MA N/A C Providence Home Care Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 010400000 043317426 Health Care Services MA N/A C System Coordinated Services Inc c/o SPHS 1221 Main Street Suite 108 Holyoke MA 010400000 042938181 Lab Services MA N/A C Physicians Medical Office Building Condominium Trust 1221 Main Street Room 108 Holyoke MA 010400000 046608649 Property Management MA N/A C SJM Properties Inc 411 Canisteo Street Hornell NY 148482104 161294991 Property Holdings NY N/A C Carbondale Area Physicians' Association PC 100 Lincoln Ave Carbondale PA 18407 232801677 Medical Insurance Contracting PA N/A C Carbondale Area Physicians' PHO Inc 100 Lincoln Ave Carbondale PA 18407 232801676 Inactive PA N/A C Carbondale Physicians' Services Inc 100 Lincoln Ave Carbondale PA 18407 232365077 Pharmacy PA N/A C Chestnut Risk Services Ltd 11 Victoria Street Hamilton BD Insurance BD N/A C LifeCare Physicians PC 601 Hamilton Avenue trenton NJ 086291986 261649038 Health Care Services NJ N/A C Multicare Plus Inc 601 Hamilton Avenue Trenton NJ 086291986 223435844 Inactive NJ N/A C Langhorne Services II Inc 1201 Langhorne-Newtown Road Langhorne PA 190470000 253795549 General Partner of LMOB Partners, II PA N/A C Langhorne Services Inc 1201 Langhorne-Newtown Road Langhorne PA 190470000 232625981 General Partner of LMOB Partners PA N/A C AMHP Holdings Corp 200 Stevens Drive Philadelphia PA 19113 261144363 Behavorial Health PA N/A C Select Health of South Carolina Inc 4390 Belle Oaks Drive Suite 400 Charleston SC 29405 571032456 Health Maintenance Organization SC N/A C Gateway Health Plan Inc 600 Grant Street Pittsburgh PA 15219 251505506 Health Care PA N/A C Gateway Health Plan Inc of Ohio 600 Grant Street Pittsburgh PA 15219 300282076 Health Care PA N/A C MCMC Eastwick Inc c/o MHS One West Elm Street Conshohocken PA 19428 232184261 Medical Office Buildings PA N/A C Community Behavorial Healthcare Network of PA Inc 8040 Carlson Road Harrisburg PA 17112 251765391 Behavorial Health PA N/A C Health Management Services Org Inc 500 Grove Street Suite 100 Haddon Heights NJ 08035 223366580 Health Care Billing NJ N/A C Jeannette Medical Providers 3805 West Chester Pike Newtown Square PA 19073 251787334 Holding Company PA N/A C Jeannette OBGYN Group 1 Inc 3805 West Chester Pike Newtown Square PA 19073 232890748 Holding Company PA N/A C Jeannette Primary Care Group 1 Inc 3805 West Chester Pike Newtown Square PA 19073 232890743 Holding Company PA N/A C Georgia Health Enterprises LLC 11440 Commerce Park Drive Reston VA 20191 541806329 Healthcare VA N/A C St Mary's Highland Hills Village Inc 1660 Jennings Mill Pkly Bogart GA 30622 582276801 Assisted Living GA N/A C GHE Physicians PC 3500 Piedmont Road Atlanta GA 30305 582277939 Practice Management GA N/A C Nursing Network Inc 4725 North Federal Highway Fort Lauderdale Highwa FL 333080000 591145192 Medical Services FL N/A C Mercy Physician Group Inc 3663 South Miami Avenue Miami FL 33133 202970015 Health Care FL N/A C Stella Maris Insurance Company Limited PO Box 69 Grand Cayman Cayman Islands CJ KY1-1102 980078266 Insurance CJ N/A C Catholic Health East Senior Services 3805 West Chester Pike Suite 100 Newtown Square PA 19073 371572595 Senior Services PA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Mercy Health System of Maine O 2485095 Direct costs Catholic Health East O 6421765 Direct costs Visiting Nurse and Hospice Association P 96132 Direct costs The organization timely filed a request for an additional three month extension to November 15, 2012, but the IRS approval letter for the "Application for Extension of Time to File an Exempt Organization Return" had the extended due date to file as August 15, 2012. The August 15, 2012, date appears to be an IRS error.