2012-05-08T11:01:13-05:00 2011-06-30 990 2010-07-01 311439334 MOUNT CARMEL HEALTH SYSTEM MOUN 6145464300 6150 EAST BROAD STREET COLUMBUS OH 432131574 JACQUELINE PRIMEAU 6145464300 2012-05-08 2010 2016-02-24 21:20:13Z CLAUS VON ZYCHLIN 6150 EAST BROAD STREET COLUMBUS OH 432131574 201266771 0 0928 X WWW.MOUNTCARMELHEALTH.COM X 1995 OH HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT 15 6 9180 50 3383075 -45583 0 7222 173499288 161040579 11257861 22497162 13495028 17528551 198252177 201073514 733277 754254 0 0 68353761 69644837 0 0 0 126879059 117254472 195966097 187653563 2286080 13419951 656577204 802050566 421842032 473568234 234735172 328482332 X MOUNT CARMEL HEALTH SYSTEM'S PURPOSE IS TO GOVERN, MANAGE AND PROVIDE ADMINISTRATIVE SERVICES TO ITS SUBSIDIARIES. THE ADMINISTRATIVE SERVICES PROVIDED BY MOUNT CARMEL HEALTH SYSTEM FOR THE SUBSIDIARIES ALLOW FOR ECONOMIES OF SCALE THAT PERMIT THE SUBSIDIARIES TO PROVIDE HEALTHCARE SERVICES TO PATIENTS AT A REASONABLE COST. 0 0 140531944 754254 169864185 MOUNT CARMEL HEALTH SYSTEM, AN OHIO NOT-FOR-PROFIT CORPORATION, OWNS AND/OR OPERATES FIVE HOSPITALS IN THE COLUMBUS, OHIO AREA CONTAINING 1,195 BEDS AND VARIOUS OTHER ACUTE AND NONACUTE HEALTH SERVICE PROVIDERS AS WELL AS A LICENSED HEALTH MAINTENANCE ORGANIZATION. THE HEALTH SYSTEM PROVIDES SERVICES TO PATIENTS WHO RESIDE IN CENTRAL OHIO. OHIO NOT-FOR-PROFIT MEMBER ORGANIZATIONS INCLUDE MOUNT CARMEL HEALTH, SAINT ANN'S HOSPITAL, MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL, DILEY RIDGE MEDICAL CENTER, MOUNT CARMEL CARE CONTINUUM SERVICES CORPORATION, MOUNT CARMEL COLLEGE OF NURSING, MOUNT CARMEL HEALTH SYSTEM FOUNDATION, MOUNT CARMEL HEALTH PLAN, INC., AND MOUNT CARMEL HEALTH INSURANCE COMPANY. OHIO FOR-PROFIT MEMBER ORGANIZATIONS INCLUDE MOUNT CARMEL HEALTH HORIZONS CORPORATION, MOUNT CARMEL HEALTH PROVIDERS, INC., PRIMARY CARE NETWORK OF OHIO INC., AND MOUNT CARMEL BEHAVIORAL HEALTHCARE SERVICES.MOUNT CARMEL HEALTH SYSTEM IS A MEMBER OF TRINITY HEALTH.FOR MORE INFORMATION ON SPECIFIC SERVICES PROVIDED, PLEASE SEE MOUNT CARMEL HEALTH SYSTEM'S WEBSITE AT WWW.MOUNTCARMELHEALTH.COM. MISSIONTHE MISSION STATEMENT FOR MOUNT CARMEL HEALTH SYSTEM IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTHIN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US. 140531944 1 0 0 1 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 1112 0 1 9180 1 1 1 0 0 0 0 0 0 0 0 0 X 15 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X JACQUELINE PRIMEAU 6145464300 6150 EAST BROAD STREET COLUMBUS OH 43213 X STAMPP CORBIN 2.00 X X 0 0 0 MICHAEL FLOWERS 2.00 X X 0 0 0 MATTHEW HABASH 2.00 X X 0 0 0 CHARLES HICKEY MD 2.00 X 0 0 0 SR RUTH M NICKERSON CSC 2.00 X X 0 0 0 DAVID STEWART MD 2.00 X 0 0 0 M ROSITA SCHILLER RSM 2.00 X 0 0 0 CLAUS VON ZYCHLIN 16.00 X X 0 729816 103949 MICHAEL GONSIOROWSKI 2.00 X 0 0 0 PHILLIP SHUBERT MD 2.00 X 486043 0 41512 SUSAN TOMASKY 2.00 X 0 0 0 J RICHARD O'CONNELL 2.00 X X 0 761373 137960 CARL BERASI DO 2.00 X 0 0 0 JOHN PEREZ 2.00 X X 0 0 0 JORGE GOMEZ 2.00 X 0 0 0 VALERIANA MOELLER 2.00 X 0 0 0 SR JOY O'GRADY 2.00 X 0 0 0 ANANTHA PADMANABHAN MD 2.00 X 0 0 0 JACQUELINE PRIMEAU 16.00 X 0 412533 35393 RONALD WHITESIDE 15.00 X 0 446715 205163 ALAN PAPA 2.00 X 0 286426 38702 CYNTHIA SHEETS 40.00 X 0 383623 58505 PAULA AUTRY 2.00 X 0 344535 33643 JANET MEEKS 2.00 X 0 364707 81974 JOHN HEISLER 13.00 X 0 299529 39854 HUGH JONES 13.00 X 0 272001 33639 JOSEPH SWEDISH 2.00 X 0 2853932 791453 KEDRICK ADKINS 2.00 X 0 1160870 198248 MICHAEL SLUBOWSKI 2.00 X 0 1153164 271732 MICHAEL MURPHY 2.00 X 0 539823 68542 RICHARD STRECK 50.00 X 0 487810 41919 MICHELE HELBIG 50.00 X 191534 0 39336 LYNDON CHRISTMAN 50.00 X 196212 0 17200 MARY ANN WOLF 50.00 X 189892 0 45203 KAREN GEISLER 50.00 X 181125 0 60765 1244806 10496857 2344692 349 0 1 0 MCKINSEY AND COMPANY INC PO BOX 7247 PHILADELPHIA PA 19170 CONSULTING SERVICES 1897500 DAWSON HEALTHCARE 3650 OLENTANGY RIVER ROAD COLUMBUS OH 43214 TEMPORARY SERVICES 1807066 BVK DIRECT 250 WEST COVENTRY CT STE 300 MILWAUKEE WI 53217 MARKETING & ADVERTISING 1659768 PREMIER COURIER INC 3687 INTERCHANGE ROAD COLUMBUS OH 43204 DELIVERY SERVICES 943021 DATA IMAGE HOPEWELL 2345 GRATIOT RD NEWARK OH 43055 MISCELLANEOUS SERVICES 666032 56 7222 7222 SUBSIDIARY FEES 900099 159472297 159472297 GIFT SHOPS 453220 1459275 1459275 CAFETERIA REVENUE 900099 109007 109007 161040579 8136460 8136460 3753588 3753588 3753588 3753588 14068967 484992 193257 14068967 291735 14360702 14360702 MANAGEMENT FEES 561499 4013912 3511984 501928 PROFESSIONAL FEES 900099 1415497 431635 983862 8345554 6448269 1897285 13774963 201073514 169864185 3383075 27819032 754254 754254 5613179 5613179 119710 119710 49826879 25416691 24410188 3281827 1674060 1607767 7211488 3678580 3532908 3591754 1832154 1759600 886049 886049 9294106 9142721 151385 4562100 4558952 3148 6587150 6543409 43741 44050896 44050382 514 3197873 2732266 465607 447844 446176 1668 161583 159196 2387 16604193 16319549 284644 979670 979670 INTERCO. PURCHASED SERV 20732064 17589625 3142439 CONTRACT LABOR 4862729 2243447 2619282 EQUIPMENT MAINTENANCE 1844510 49411 1795099 SUBSCRIPTIONS AND DUES 1745285 258199 1487086 UBI TAXES 182600 182600 1115820 914843 200977 187653563 140531944 47121619 0 19206 650 20153908 17372206 28691399 23206731 954957 858455 2602479 1505706 221849012 136338957 89614465 85510055 254090226 233014438 128693109 272793665 1151934 1077614 130605521 166711046 656577204 802050566 48897995 58789074 53000 313 372891037 414778847 421842032 473568234 X 234735172 328482332 234735172 328482332 656577204 802050566 X 13419951 80327209 X X 0 1 1 X 1 1 X X X 0 0 0 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 870790288 3 0 1 1 0 MOUNT CARMEL HEALTH 314379602 3 0 1 1 0 ST ANN'S HOSPITAL 314412701 3 0 1 1 0 TRINITY HEALTH CORPORATION 351443425 11 1 1 1 21108931 DILEY RIDGE MEDICAL CENTER 342032340 3 0 1 1 0 5 21108931 0 1 0 0 0 1 10864 1 77442 0 0 88306 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: MOUNT CARMEL HEALTH SYSTEM HAS MADE GRANTS TO OTHER ORGANIZATIONS IN THE FORM OF MEMBERSHIP DUES PAID TO A NATIONAL HEALTH CARE ORGANIZATION. THIS ORGANIZATION HAS PROVIDED MOUNT CARMEL HEALTH SYSTEM WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. IN ADDITION, PAYMENTS WERE MADE TO LOBBYING FIRMS TO ASSIST WITH FEDERAL EARMARK REQUESTS AND STATE LEGISLATIVE ADVOCACY. MOUNT CARMEL HEALTH SYSTEM MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 32473597 32473597 71321398 35455495 35865903 107930932 100868215 7062717 6930323 3192762 15247 10107838 85510055 ABSOLUTE RETURN STRATEGY FUNDS 126293364 F COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 35362141 F BOND FUND 111138160 F 272793665 OTHER RECEIVABLES 7336388 INTERCOMPANY ACCOUNTS RECEIVABLES 85178413 INVESTMENT IN AFFILIATES 22245763 INTERCOMPANY OTHER LONG TERM ASSET 51809621 OTHER 140861 166711046 INTERCOMPANY ACCOUNTS PAYABLE 2617252 DEFERRED COMPENSATION LIABILITY 634649 OTHER CURRENT LIABILITIES 572717 OTHER LONG TERM LIABILITIES 2518727 INTERCOMPANY NOTES PAYABLE 406876620 LEASE OBLIGATION 1558882 414778847 0 CAPITAL PARK FAMILY HEALTH CENTER INC 2150 AGLER RD COLUMBUS OH 43224 383765547 501(C)3 250000 COMMUNITY BENEFIT AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)3 30000 COMMUNITY BENEFIT THE COLUMBUS COALITION AGAINST FAMILY VIOLENCE 655 EAST LIVINGSTON AVENUE COLUMBUS OH 43205 542143915 501(C)3 10000 COMMUNITY BENEFIT ARTHRITIS FOUNDATION INC 3740 RIDGE MILL DRIVE HILLIARD OH 43026 314419290 501(C)3 7000 COMMUNITY BENEFIT WESTERVILLE AREA CHAMBER OF COMMERCE 99 COMMERCE PARK DRIVE WESTERVILLE OH 43081 310737083 501(C)(6) 8560 COMMUNITY BENEFIT LOWER LIGHTS CHRISTIAN HEALTH CENTER 1251 WEST BROAD STREET COLUMBUS OH 43222 311810355 501(C)3 200000 COMMUNITY BENEFIT WESTERVILLE AREA RESOURCE MINISTRY 175A E BROADWAY WESTERVILLE OH 43081 311640355 501(C)3 17500 COMMUNITY BENEFIT MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVENEU WHITE PLAINS NY 10605 131846366 501(C)3 5500 COMMUNITY BENEFIT GAHANNA CONVENTION AND VISITORS BUREAU 181 GRANVILLE STREET GAHANNA OH 43230 800322167 501(C)6 26500 COMMUNITY BENEFIT WESTERVILLE HISTORICAL SOCIETY P O BOX 1063 WESTERVILLE OH 43086 510162929 501(C)3 10000 COMMUNITY BENEFIT WESTERVILLE PARKS FOUNDATION 350 N CLEVELAND AVE WESTERVILLE OH 43081 311719247 501(C)3 8780 COMMUNITY BENEFIT WORTHINGTON AREA CHAMBER OF COMMERCE 25 W NEW ENGLAND AVE WORTHINGTON OH 43085 311037348 501(C)(6) 9072 COMMUNITY BENEFIT YOUNG WOMEN'S CHRISTIAN ASSOCIATION 65 S FOURTH STREET COLUMBUS OH 43215 314379597 501(C)(3) 6250 COMMUNITY BENEFIT CATHOLIC CHARITIES OF WEST MICHIGAN 40 JEFFERSON SE GRAND RAPIDS MI 49503 381358001 501(C)(3) 7500 COMMUNITY BENEFIT COUNCIL ON HEALTHY MOTHERS AND BABIES PO BOX 3384 DUBLIN OH 43016 421546970 501(C)(3) 6500 COMMUNITY BENEFIT WESTERVILLE SUNRISE ROTARY FOUNDATION PO BOX 2700 WESTERVILLE OH 43086 311481931 501(C)(3) 10125 COMMUNITY BENEFIT 13 3 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY MOUNT CARMEL HEALTH SYSTEM 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 X X X X 0 1 0 0 0 0 0 0 0 CLAUS VON ZYCHLIN 0 473259 0 163784 0 92773 0 78441 0 25508 0 833765 0 0 PHILLIP SHUBERT MD 461221 0 0 0 24822 0 27504 0 14008 0 527555 0 0 0 J RICHARD O'CONNELL 0 533392 0 113794 0 114187 0 116680 0 21280 0 899333 0 0 JACQUELINE PRIMEAU 0 352917 0 57813 0 1803 0 26296 0 9097 0 447926 0 0 RONALD WHITESIDE 0 364897 0 76374 0 5444 0 186369 0 18794 0 651878 0 0 ALAN PAPA 0 235984 0 49248 0 1194 0 18296 0 20406 0 325128 0 0 CYNTHIA SHEETS 0 314475 0 67546 0 1602 0 49141 0 9364 0 442128 0 0 PAULA AUTRY 0 283564 0 60031 0 940 0 15096 0 18547 0 378178 0 0 JANET MEEKS 0 299570 0 62254 0 2883 0 63744 0 18230 0 446681 0 0 JOHN HEISLER 0 244593 0 52651 0 2285 0 22844 0 17010 0 339383 0 0 HUGH JONES 0 224633 0 46882 0 486 0 17882 0 15757 0 305640 0 0 JOSEPH SWEDISH 0 1240774 0 645161 0 967997 0 763945 0 27508 0 3645385 0 690161 KEDRICK ADKINS 0 717356 0 326029 0 117485 0 184461 0 13787 0 1359118 0 0 MICHAEL SLUBOWSKI 0 701008 0 291561 0 160595 0 246925 0 24807 0 1424896 0 42832 MICHAEL MURPHY 0 343184 0 68618 0 128021 0 47238 0 21304 0 608365 0 0 RICHARD STRECK 0 390057 0 93958 0 3795 0 23231 0 18688 0 529729 0 0 MICHELE HELBIG 185728 0 4705 0 1101 0 25964 0 13372 0 230870 0 0 0 LYNDON CHRISTMAN 192122 0 0 0 4090 0 16931 0 269 0 213412 0 0 0 MARY ANN WOLF 181391 0 4596 0 3905 0 37301 0 7902 0 235095 0 0 0 KAREN GEISLER 175535 0 4545 0 1045 0 43861 0 16904 0 241890 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 2010). THE FOLLOWING ACCRUALS FOR 2010 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS $113,498 MICHAEL MURPHY $26,316 J. RICHARD O'CONNELL $83,058 MICHAEL SLUBOWSKI $136,445 JOSEPH SWEDISH $223,342 CLAUS VON ZYCHLIN $55,997 PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUALS FOR 2010 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS $49,977 JANET MEEKS $39,260 CYNTHIA SHEETS $13,940 MICHAEL SLUBOWSKI $77,185 JOSEPH SWEDISH $511,613 RONALD WHITESIDE $141,850 NEW ALBANY HOSPITAL MANAGEMENT COMPANY II LLC (NAHMC) CARL BERASI, MCHS TRUSTEE, IS A PART OWNER, BD MEMBER & EMPLOYEE OF NAHMC 2041425 NEW ALBANY MANAGEMENT COMPANY II LLC CONTRACTS WITH MOUNT CARMEL HEALTH SYSTEM TO PROVIDE MANAGEMENT SERVICES TO MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL. THESE TRANSACTIONS WERE ALL AT ARMS LENGTH. 0 PNC BANK MICHAEL GONSIOROWSKI, MCHS TRUSTEE, IS REG. PRES. OF PNC'S CNTRL OH REGION 1555050 PNC BANK PROVIDES COMMERCIAL BANKING SERVICES TO MOUNT CARMEL HEALTH SYSTEM. 0 ANGELA SMITH FAMILY MEMBER OF CYNTHIA SHEETS, KEY EMPLOYEE 87711 EMPLOYMENT ARRANGEMENT 0 MICHAEL SLAPER FAMILY MEMBER OF MATTHEW HABASH, OFFICER AND TRUSTEE 31999 EMPLOYMENT ARRANGEMENT 0 MCMC PROFESSIONAL OFFICE BUILDING III DAVID STEWART, MCHS TRUSTEE, HAS A >5% OWNERSHIP INTEREST IN THIS J/V 103379 MCHS RECEIVES INCOME AND DISTRIBUTIONS FROM ITS OWN PARTNERSHIP INTEREST IN MCMC PROF. OFFICE BLDG. III. 0 GREEN STREET SURGERY CENTER ANATHA PADMANABHAN, MCHS TRUSTEE, HAS A >5% OWNERSHIP INTEREST IN THIS J/V 586475 MCHS RECEIVES RENTAL INCOME AND DISTRIBUTIONS FROM ITS OWN PARTNERSHIP INTEREST IN GREEN STREET SURGERY CENTER. 0 AMERICAN ELECTRIC POWER SUSAN TOMASKY, MCHS TRUSTEE, IS AN OFFICER OF AMERICAN ELECTRIC POWER 824015 AMERICAN ELECTRIC POWER PROVIDES UTILITY SERVICES TO MOUNT CARMEL HEALTH SYSTEM. 0 TAYLOR STATION SURGICAL CENTER PAULA AUTRY & HUGH JONES, KEY EMPLOYEES, ARE BOTH BOARD MEMBERS OF THIS J/V 1846516 MCHS RECEIVES INTEREST INCOME AND DISTRIBUTIONS FROM ITS OWN PARTNERSHIP INTEREST IN TAYLOR STATION SURGICAL CENTER. 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MOUNT CARMEL HEALTH SYSTEM IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF MOUNT CARMEL HEALTH SYSTEM. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF MOUNT CARMEL HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION 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 MOUNT CARMEL HEALTH SYSTEM IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE FINANCE COMMITTEE AS WELL AS THE BOARD OF TRUSTEES. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MOUNT CARMEL HEALTH SYSTEM 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 MOUNT CARMEL HEALTH SYSTEM, WHICH INCLUDES TRUSTEES, 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 MOUNT CARMEL HEALTH SYSTEM'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MOUNT CARMEL HEALTH SYSTEM 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 TRUSTEES OF MOUNT CARMEL HEALTH SYSTEM IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO MOUNT CARMEL HEALTH SYSTEM. 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 TRUSTEES OF MOUNT CARMEL HEALTH SYSTEM ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MOUNT CARMEL HEALTH SYSTEM ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 MOUNT CARMEL HEALTH SYSTEM 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. ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, 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 PAULA AUTRY - 53 HOURS JOHN HEISLER - 39 HOURS HUGH JONES - 35 HOURS JANET MEEKS - 53 HOURS MICHAEL MURPHY - 53 HOURS J. RICHARD O'CONNELL - 53 HOURS ALAN PAPA - 53 HOURS JACQUELINE PRIMEAU - 48 HOURS CYNTHIA SHEETS - 16 HOURS PHILLIP SHUBERT, MD - 53 HOURS MICHAEL SLUBOWSKI - 53 HOURS JOSEPH SWEDISH - 53 HOURS CLAUS VON ZYCHLIN - 48 HOURS RONALD WHITESIDE - 44 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 31,898,974. EQUITY TRANSFERS FROM AFFILIATES: 41,404,970. OTHER: 7,023,265. TOTAL TO FORM 990, PART XI, LINE 5: 80,327,209. FORM 990, PART XII, LINE 2: MOUNT CARMEL HEALTH SYSTEM'S FINANCIAL INFORMATION WAS INCLUDED IN THE FY11 CONSOLIDATED FINANCIAL STATEMENTS OF MOUNT CARMEL HEALTH SYSTEM, AS WELL AS THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. BOTH SETS OF CONSOLIDATED FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 AMICARE HOSPICE SERVICES INC 27870 CABOT DRIVE NOVI MI 483772920 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 0 BATTLE CREEK HEALTH SYSTEM 300 NORTH AVENUE BATTLE CREEK MI 49016 382776791 HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH - MICHIGAN 0 BATTLE CREEK HEALTH SYSTEM AUXILIARY 300 NORTH AVENUE BATTLE CREEK MI 49016 383355520 SUPPORT OF TAX EXEMPT HEALTH ORGANIZATION MI 501(C)(3) 11, TYPE I BATTLE CREEK HEALTH SYSTEM 0 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP 0 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I BAUM HARMON MERCY HOSPITAL 0 CAPITAL PARK FAMILY HEALTH CENTER INC 6150 EAST BROAD STREET COLUMBUS OH 43213 311387838 OPERATION OF A FEDERALLY QUALIFIED HEALTH CENTER (FORMERLY) OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES MI 501(C)(3) 11, TYPE II TRINITY HEALTH-MICHIGAN 0 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 0 CRANBROOK HOSPICE CARE 281 ENTERPRISE COURT BLOOMFIELD HILLS MI 48302 383320699 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE IA 52001 262227941 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 HACKLEY HOSPITAL 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 494433302 381358196 HEALTHCARE SERVICES MI 501(C)(3) 3 MERCY HEALTH PARTNERS 0 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON MI 494433302 382299878 SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY MI 501(C)(3) 11, TYPE III-FI MERCY HEALTH PARTNERS 0 HACKLEY LIFE COUNSELING 1352 TERRACE ST MUSKEGON MI 494423545 381386362 COUNSELING, EDUCATION, AND SUPPORT MI 501(C)(3) 9 MERCY HEALTH PARTNERS 0 HACKLEY VISITING NURSE SERVICES AND HOSPICE INC 888 TERRACE ST MUSKEGON MI 49440 381359598 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