Mercy Medical Center of Oshkosh Inc: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
Mercy Medical Center of Oshkosh Inc (EIN 39-0806268)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-15
IRS object ID
201132279349302573
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-15T12:40:43-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 12237AddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code543072237ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390806268EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Medical Center of Oshkosh IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMERCNameControl
Phone9207382000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 S Oakwood RoadAddressLine1
CityOshkoshCity
StateWIState
ZIP Code54904ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJEFF BADGERName
TitleCFOTitle
Phone9207382000Phone
Date Signed2011-08-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTerri Rexrode CPA MSTName
Phone9206620016Phone
Date Prepared2011-08-11DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJEFF BADGERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 S Oakwood RoadAddressLine1
CityOshkoshCity
StateWIState
ZIP Code54904ZIPCode
FieldValueIRS element (for citing)
Gross Receipts122774688GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501cXOrganization501c
Web Sitewww.affinityhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1891YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionWE PROUDLY SERVE THE OSHKOSH COMMUNITY WITH A HISTORY OF MORE THAN A CENTURY OF QUALITY CARE. THE FACILITY PROVIDES TOTAL HEALTH CARE, INCLUDING EMERGENCY/TRAUMA CARE AND SURGICAL SERVICES AS WELL AS MANY MEDICAL SPECIALTIES SUCH AS CARDIOLOGY, ONCOLOGY, ORTHOPEDICS, INTENSIVE CARE, OBSTETRICS AND NEUROSURGERY. MERCY IS THE HOME OF THE KENNEDY CENTER FOR THE HIP AND KNEE, A NATIONALLY-RECOGNIZED PROGRAM FOR HIP REPLACEMENT. WITH 157 PATIENT BEDS AND MORE THAN 300 MEDICAL STAFF, MERCY MEDICAL CENTER TREATS PATIENTS WITH DIGNITY AND COMPASSION.AVAILABLE SERVICES: CANCER; CARDIAC REHABILITATION; CARDIOVASCULAR SURGERY; DIABETES, NUTRITION AND ENDOCRINOLOGY; ER; GENERAL SURGERY; GYNECOLOGY; HOSPITALIST; LABORATORY; LIFELINE HOME MONITORING; NEPHROLOGY; OBSTETRICS; ORTHOPEDICS; PAIN MANAGEMENT; PALLIATIVE CARE (END OF LIFE CARE); PHARMACY; PSYCHIATRY/PSYCHOLOGY; PULMONOLOGY; RADIOLOGY; REHABILITATION SERVICES; SLEEP LAB; SPIRITUAL SERVICES; SPORTS MEDICINE; VASCULAR MEDICINE; WOUND CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees926TotalNbrEmployees
Total Nbr Volunteers662TotalNbrVolunteers
Total Gross UBI385701TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year631475ContributionsGrantsPriorYear
Contributions Grants Current Year184995ContributionsGrantsCurrentYear
Program Service Revenue Prior Year114472306ProgramServiceRevenuePriorYear
Program Service Revenue CY115923135ProgramServiceRevenueCY
Investment Income Prior Year4702358InvestmentIncomePriorYear
Investment Income Current Year4788089InvestmentIncomeCurrentYear
Other Revenue Prior Year492003OtherRevenuePriorYear
Other Revenue Current Year-76187OtherRevenueCurrentYear
Total Revenue Prior Year120298142TotalRevenuePriorYear
Total Revenue Current Year120820032TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year329054GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY590755GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year48355168SalariesEtcPriorYear
Salaries Etc Current Year50584347SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year54096946OtherExpensePriorYear
Other Expenses Current Year50550105OtherExpensesCurrentYear
Total Expenses Prior Year102781168TotalExpensesPriorYear
Total Expenses Current Year101725207TotalExpensesCurrentYear
Revenues Less Expenses Prior Year17516974RevenuesLessExpensesPriorYear
Revenues Less Expenses CY19094825RevenuesLessExpensesCY
Total Assets BOY238701098TotalAssetsBOY
Total Assets EOY251577831TotalAssetsEOY
Total Liabilities BOY60157186TotalLiabilitiesBOY
Total Liabilities EOY55699954TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY178543912NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY195877877NetAssetsOrFundBalancesEOY
Mission DescriptionMercy Medical Center has adopted the mission statement of Affinity Health System. THE MISSION OF AFFINITY HEALTH SYSTEM IS TO LIVE OUT THE HEALING MINISTRY OF CHRIST BY PROVIDING SERVICES THAT PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE, ESPECIALLY THE POOR.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense76774690Expense
Revenue114399747Revenue
DescriptionMercy Medical Center proudly serves the Oshkosh community with a history of more than a century of quality care. The facility provides total health care, including emergency/trauma care and surgical services as well as many medical specialties such as cardiology, oncology, orthopedics, intensive care, obstetrics and neurosurgery. Mercy is the home of the Kennedy Center for the Hip and Knee, a nationally-recognized program for hip replacement. With 157 patient beds and more than 300 medical staff, Mercy Medical Center treats patients with dignity and compassion.Available Services: Cancer, Cardiac Rehabilitation, Cardiovascular Surgery, Diabetes, Nutrition and Endocrinology, Emergency/Trauma, General Surgery, Gynecology, Hospitalist, Laboratory, Lifeline Home Monitoring, Nephrology, Obstetrics, Orthopaedics, Pain Management, Palliative Care (End of Life Care), Pharmacy, Psychiatry/Psychology, Pulmonology, Radiology (X-ray and Imaging), Rehabilitation Services, Sleep Lab, Spiritual Services, Sports Medicine, Vascular Medicine, Wound Care.Description
Total Program Service Expense76774690TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109659NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees926NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JEFF BADGERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9207201300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11570 Midway PlaceAddressLine1
CityMenashaCity
StateWIState
ZIP Code54952ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
BARBARA STRAND
BOARD MEMBER0.30X024672544862
CARLA ALTEPETER
BOARD MEMBER0.30X000
CATHERINE TIERNEY
BOARD SECRETARY0.30X000X
DANIEL E NEUFELDER
PRESIDENT/CEO - AHS11.00X19458354499656151X
DAVID GITTER
BOARD TREASURER0.30X000X
DAVID ROMOND
BOARD MEMBER0.30X035699573445
FRANK CHYBOWSKI
BOARD MEMBER0.30X042668146174
FRED KLEIN MD
BOARD MEMBER0.30X000
JOHN RUSSO
BOARD MEMBER0.30X000
JOSEPH MCCORMICK
BOARD MEMBER0.30X0110309040904
MARY HARP-JIRSCHELE
BOARD MEMBER0.30X000
RICHARD WELLS
BOARD MEMBER0.30X000
Stacey Sensor DO
Board MemBER0.30X047471237600
STEPHEN MORTON
BOARD MEMBER0.30X000
SUSAN VETTE
BOARD MEMBER0.30X000
THOMAS SCHMIDT
BOARD MEMBER0.30X000
WAYNE Trembly
BOARD MEMBER0.30X000
JAY MULLER MD
BOARD MEMBER0.30X035062038744
MARK FAUSTICH MD
BOARD MEMBER0.30X034137835789
JOHN OLIVERIO
PRESIDENT - WHEATON0.30X01737485222799X
NICHOLAS DESIEN
President - Ministry0.30X01204340731736X
JEFF BADGER
CFO - AHS11.0010630629774458682X
William Calhoun
President - MMC11.00270205034481X
GINGER SELLE
VP PATIENT CARE40.00161495033244X
NICHOLAS SYLVIA
PHARMACY DIRECTOR40.00161173012899X
LARRY CROTS
PHARMACIST40.0013741907908X
DAVID HOFFMAN
PHARMACIST40.00125941090870X
MATTHEW NICHOLAS
CLINICAL LEAD PHARMACIST40.00124531014720X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1281653TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7084766TotalReportableCompFrmRltdOrgs
Total Other Compensation1581008TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Affinity Health System inc
1570 Midway PlmenashaWI54952Salaries, Legal, Consulting, Misc Serv11266893
Ministry Health Care inc
11925 W Lake Park Dr Suite 100MilwaukeeWI53224Management1133590
St Elizabeth Hospital
1506 S Oneida StAppletonWI54915Salaries, Lab Services1075641
Network Health System inc
1570 Midway PlMenashaWI54952Physician Services, Salaries, Misc Serv754237
Marshfield Laboratories
1000 N Oak AveMarshfieldWI54449Lab Services375702
FieldValueIRS element (for citing)
Number Of Contractors GT100 K13NumberOfContractorsGT100K
All Other Contributions184995AllOtherContributions
Total Contributions184995TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Net patient revenue an624100114399747114399747
103 CAFETERIA & VENDIN72221056617715729$550,448
OUT PATIENT LAB REVENU621500391235391235
OTHER NON OPERATING RE624100349013$349,013
GIFT SHOP & AUXILIARY453220216963$216,963
FieldValueIRS element (for citing)
Total Program Service Revenue115923135TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4649498TotalRevenueColumn
Exclusion$4,649,498ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1878469Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1954656Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-76187Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-76187TotalRevenueColumn
Unrelated Business Revenue-21263UnrelatedBusinessRevenue
Exclusion-$54,924ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6Securities
Other138585Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities6Securities
Other138585Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column138591TotalRevenueColumn
Exclusion$138,591ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column120820032TotalRevenueColumn
Related Or Exempt Function Income114399747RelatedOrExemptFunctionIncome
Unrelated Business Revenue385701UnrelatedBusinessRevenue
Exclusion$5,849,589ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total590755Total
Program Services590755ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total635787Total
Management And General635787ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total38610651Total
Program Services29021369ProgramServices
Management And General9589282ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1579795Total
Program Services1188527ProgramServices
Management And General391268ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7363592Total
Program Services5460500ProgramServices
Management And General1903092ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2394522Total
Program Services1772440ProgramServices
Management And General622082ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total332Total
Management And General332ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total8344Total
Management And General8344ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total10621294Total
Program Services4669216ProgramServices
Management And General5952078ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total20410406Total
Program Services19501936ProgramServices
Management And General908470ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8488Total
Program Services3188ProgramServices
Management And General5300ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1981681Total
Program Services1418894ProgramServices
Management And General562787ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total192327Total
Program Services21246ProgramServices
Management And General171081ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2292851Total
Program Services1641692ProgramServices
Management And General651159ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6818832Total
Program Services4983665ProgramServices
Management And General1835167ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total545542Total
Management And General545542ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
bad debt expense34672343467234
Medicaid Assessment29259792925979
Miscellaneous89165738571853086
GIFT SHOP & AUXILIARY E223598223598
DUES AND LICENSES1615406947892062

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total101725207Total
Program Services76774690ProgramServices
Management And General24950517ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5363BOY
EOY5363EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY7109362BOY
EOY2586675EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY14548350BOY
EOY15249048EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY130357428BOY
EOY145955692EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2475805BOY
EOY2244814EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY420784BOY
EOY865555EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis176090494LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec107147054LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY69528656BOY
EOY68943440EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1800985BOY
EOY1847397EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY12454365BOY
EOY13879847EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY238701098BOY
EOY251577831EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13072920BOY
EOY10508696EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY40222220BOY
EOY37291638EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6862046BOY
EOY7899620EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY60157186BOY
EOY55699954EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY178543912BOY
EOY195877877EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY178543912BOY
EOY195877877EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY238701098BOY
EOY251577831EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$6,601OtherActivitiesAmount
Total Lobbying Expenditures IIB6601TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationWHA AND CHA MEMBERSHIP DUESExplanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1201514OtherCostOrOtherBasis
Book Value1201514BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis110443198OtherCostOrOtherBasis
Depreciation51675855Depreciation
Book Value58767343BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis922955OtherCostOrOtherBasis
Depreciation855649Depreciation
Book Value67306BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis59490421OtherCostOrOtherBasis
Depreciation51471537Depreciation
Book Value8018884BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4032406OtherCostOrOtherBasis
Depreciation3144013Depreciation
Book Value888393BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings68943440TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
OTHER A/R102303
OTHER ASSET1345549
RElated PArty A/R12431995
FieldValueIRS element (for citing)
Total Book Value Other Assets13879847TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Due to 3rd party - reserve$638,390
Other liabilities$17,396
Pension liability$6,915,229
457b plan$328,605
FieldValueIRS element (for citing)
Total Of Amounts7899620TotalOfAmounts
Total Revenue120820032TotalRevenue
Total Expenses101725207TotalExpenses
Excess Or Deficit For Year19094825ExcessOrDeficitForYear
Net Unrealized GL On Investments30643NetUnrealizedGLOnInvestments
Other-$1,791,503OtherAmount
Total Adjustments-1760860TotalAdjustments
Excess Or Deficit Per FS17333965ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt122390567TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal122390567RevenueSubtotal
Other Revenues Not Included-1570535OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-1570535RevenueNotRptdOnFinStmt
Total Revenue Per Form990120820032TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt102865510TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal102865510ExpensesSubtotal
Other Expenses Not Included-1140303OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt-1140303ExpensesNotRptdOnFinStmt
Total Expenses Per Form990101725207TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:FASB ASC Subtopic 740-10, Income Taxes Overall, prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The amount of unrecognized tax expense related to these criteria for the Corporation was zero as of September 30, 2010 and 2009.
Part XI, Line 8 - Other Adjustments:Pension Adjustment: -1791503.
Part XII, Line 4b - Other Adjustments:restricted contributions IN NET ASSETS: 167158. expense allocated to rental income: -1954656. GIFT SHOP AND AUXILIARY REVENUE: 216963.
Part XIII, Line 4b - Other Adjustments:EXPENSE ALLOCATED TO RENTAL INCOME: -1954656. Payment to sponsorship organization: 590755. GIFT SHOP AND AUXILIARY EXPENSES: 223598.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage662.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served336PersonsServed
Total Community Benefit Expense916998TotalCommunityBenefitExpense
Net Community Benefit Expense916998NetCommunityBenefitExpense
Percent Of Total Expense0.00930PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served11412PersonsServed
Total Community Benefit Expense2563755TotalCommunityBenefitExpense
Net Community Benefit Expense2563755NetCommunityBenefitExpense
Percent Of Total Expense0.02610PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense353903TotalCommunityBenefitExpense
Net Community Benefit Expense353903NetCommunityBenefitExpense
Percent Of Total Expense0.00360PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served11748PersonsServed
Total Community Benefit Expense3834656TotalCommunityBenefitExpense
Net Community Benefit Expense3834656NetCommunityBenefitExpense
Percent Of Total Expense0.03900PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served2131PersonsServed
Total Community Benefit Expense184629TotalCommunityBenefitExpense
Direct Offsetting Revenue15140DirectOffsettingRevenue
Net Community Benefit Expense169489NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served42PersonsServed
Total Community Benefit Expense474767TotalCommunityBenefitExpense
Direct Offsetting Revenue218984DirectOffsettingRevenue
Net Community Benefit Expense255783NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served2070PersonsServed
Total Community Benefit Expense5756109TotalCommunityBenefitExpense
Direct Offsetting Revenue5078025DirectOffsettingRevenue
Net Community Benefit Expense678084NetCommunityBenefitExpense
Percent Of Total Expense0.00690PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served3830PersonsServed
Total Community Benefit Expense374461TotalCommunityBenefitExpense
Direct Offsetting Revenue1DirectOffsettingRevenue
Net Community Benefit Expense374460NetCommunityBenefitExpense
Percent Of Total Expense0.00380PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs18NumberOfActivitiesOrPrograms
Persons Served8073PersonsServed
Total Community Benefit Expense6789966TotalCommunityBenefitExpense
Direct Offsetting Revenue5312150DirectOffsettingRevenue
Net Community Benefit Expense1477816NetCommunityBenefitExpense
Percent Of Total Expense0.01500PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs18NumberOfActivitiesOrPrograms
Persons Served19821PersonsServed
Total Community Benefit Expense10624622TotalCommunityBenefitExpense
Direct Offsetting Revenue5312150DirectOffsettingRevenue
Net Community Benefit Expense5312472NetCommunityBenefitExpense
Percent Of Total Expense0.05400PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served446PersonsServed
Total Community Building Expense332TotalCommunityBuildingExpense
Net Community Building Expense332NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served446PersonsServed
Total Community Building Expense332TotalCommunityBuildingExpense
Net Community Building Expense332NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,534,138BadDebtExpenseAmount
Amount Reimbursed By Medicare39654632AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare43474699CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-3820067MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1500 S OAKWOOD RAODAddressLine1
CityOshkoshCity
StateWIState
ZIP Code54904ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart I, Line 3c: It is the policy of Mercy Medical Center to provide medically necessary health care services to people in the communities it serves, regardless of their ability to pay. Affinity Care financial assistance is granted based upon the patient's inability to pay and to individuals who are uninsured, underinsured or medically indigent. Affinity Care works in collaboration with other financial (both public and private) assistance programs. This is to ensure holistic wellness of patients by facilitating knowledge of available services and programs for health while practicing good stewardship of funds. Key criteria utilized to determine eligibility for Affinity Care financial assistance includes family size, federal poverty income guidelines and available assets. The available asset test includes consideration of the amount of equity in a home, automobiles, and savings accounts which are considered part of total allowable income when assessing against the federal poverty income guidelines.IncomeBasedCriteria
Costing Method UsedPart I, Line 7: Amounts calculated in Part I, Line 7 are determined both on a cost accounting system and a cost-to-charge ratio. Other Benefits are determined based on the direct and indirect costs (where allocated) associated with a program net of earned revenue. Detail for each program/activity is maintained and determined at the department level. Charity care and means-tested programs are determined based on a cost-to-charge ratio consistent with Worksheet 2, Ratio of Patient Care Cost to Charges. Prior year cost report settlements are excluded from the shortfall calculation in order to get a true fiscal year shortfall amount.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: Bad debt expense of $3,467,234 included on Form 990, Part IX, Line 25 was excluded from the denominator per instructions when calculating the percent of total expenses on Schedule H.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: No footnote exists in Mercy Medical Center's financials statements that describe bad debt expense. Bad debt expense is recorded in a consistent manner with the organization's collection policies. Bad debt expense includes accounts which are written off and estimates made on live accounts based on historical payment trends and account modeling.A number of patients are truly unable to pay their out-of-pocket liability, but do not complete the process required to apply for financial assistance under the hospital's Affinity Care policy. These patients would qualify for Affinity Care if they completed the charity application, so the bad debt expense associated with treating them should be treated as community benefit. The organization does have a presumptive eligibility program in place to help identify indigent patients and minimize the instances of when they become a bad debt. The administrative requirements to determine whether patients who do not cooperate with the financial assistance process would have qualified for charity can be burdensome, particularly for small balances.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: The shortfall associated with Medicare should be considered a community benefit for several reasons. First, IRS Rev. Rul. 69-545, which established the community benefit standard for non-profit hospitals, states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. This implies that treating Medicare patients is a community benefit. Second, for-profit specialty hospitals have been carving out certain high-margin services (i.e. cardiac, orthopedics, and oncology), leaving general acute care hospitals with lower-margin Medicare services. This indicates that Medicare losses can be a result of rendering these lower-margin services (which benefit the community) rather than inefficient operations. Lastly, the community which the organization serves has Medicare as the largest payer. The organization must accept these patients regardless of whether they make a surplus or deficit from providing such services. If the Medicare participation is premised on this fact, then providing Medicare services promotes access to healthcare services which is a community benefit. The demographic of the community is also an aging and underserved population who experience issues with access to healthcare services. Without tax-exempt hospitals providing Medicare services, CMS would bear the burden of directly providing services to the elderly.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: Mercy Medical Center has a debt collection policy which sets forth collection practices for patients who are known to qualify or may qualify for financial assistance under the charity care program. Sufficient financial counseling support is made available to patients so they can easily access patient financial service representatives and have their questions answered, and gain an understanding of the reasons why they owe a balance. Accounts are designated as charity care in the business offices so no additional time is spent on collection efforts.DebtCollectionPolicy
General ExplanationPart VI, Line 8, list of states receiving community benefit report: WIMercy Medical Center files their community benefit results in the State of Wisconsin. Their data is incorporated into a report for all Affinity Health System that ultimately is published in the area newspapers.GeneralExplanation
Needs AssessmentPart VI, Line 2: Mercy Medical Center performs community health needs assessments as needed. Planning workgroups consisting of community partners (e.g. Community Health Improvement Partnership (CHIP)) are formed to define the community and its health needs through review of United Way Life Study results, Healthy People Initiatives, census documents, and local government health and welfare agencies. Considering other community resources/assets, data collection methods are used to identify particular problems or subgroups and areas known to have high poverty rates and to be underserved. The data is analyzed and priorities are set based on trending information which may target a specific need. When a need is identified, the hospital will collaborate through community partnerships (or individually) to address the identified need. Outcomes from the programs are measured and considered in subsequent community health needs assessments. The leadership at Affinity takes their commitment to the health and well-bring of the community it serves very seriously. In fact, it is listed as one of the key strategic goals of the health system. Senior leaders and management are also highly encouraged to provide direct service to the poor in their communities. Mercy Medical Center and the leadership also subscribe to publications like the Advisory Board to compare national trends to local trends to ensure the hospital is resourcing areas to meet patient needs.NeedsAssessment
Patient Education AssistancePart VI, Line 3: Mercy Medical Center goes to great lengths in order to inform and educate patients/persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs and under the organization's Affinity Care policy. The Affinity Care policy and application is posted on the organization's website. Admissions and other key areas contain summary information of the Affinity Care policy. As part of the intake/discharge process, patients are provided with a copy of the policy and other information for financial assistance. If during the course of the patient registration process, care encounter, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to Mercy Medical Center's Affinity Care program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of Affinity Care financial assistance can be initiated by any member of the hospital's workforce, including medical staff members, who become aware of the patient's potential need for Affinity Care financial assistance. The Affinity Care policy was also translated into dialects prevalent in the community in order to reach out to those that may speak another language (Spanish and Hmong). Patient Registration staff and Financial Counselors are provided with scripts to follow when interacting with patients. As part of the Affinity Care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs.PatientEducationAssistance
Community InformationPart VI, Line 4: While there is growing agreement in the United States about what constitutes a non-profit hospital's "community benefit", this is a work in progress. The organization provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. Mercy Medical Center, like most community hospitals, was created and is maintained in order to provide care locally-care that without our hospital, may not be available locally.Certain specialized services available include: I/P Adult Behavioral Health services, I/P Rehabiliatation services, I/P Sub-acute(SNF) services.CommunityInformation
Community Building ActivitiesPart VI, Line 5: Community-building activities include programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental problems. These activities support community assets by offering the expertise and resources of the organization. Costs for these activities include cash, in-kind donations, and expenditures for the development of a variety of community health programs and partnerships.CommunityBuildingActivities
Other InformationPart VI, Line 6: Mercy Medical Center's governing board consists primarily of persons who reside within the primary service area. They are not employees of the organization.The organization strives to further its exempt purposes by the following:Mercy Medical Center participates in government-sponsored health programs (Medicare, Medicaid, CHAMPUS, General Relief, Specialized County Programs and Area Prisons).Mercy Medical Center donates food to area shelters.Mercy Heatlh Foundation donated funds to support area organizations that provide services to the following sectors of our population: low-income, physically and mentally challenged and chronically ill. Mercy Medical Center works with local Police departments in the performance of sexual assault exams. The patient does not incur a bill for the exam and the charges are written off. Mercy Medical Center provides community health improvement services through health education lectures, health fairs and support groups.Mercy Medical Center conducts Cardiac & Pulmonary Rehabilitation family education sessions.Discounted care is provided to low income families up to 662% of Federal Poverty Guidelines.Mercy Medical Center is a Disproportionate Share Hospital with a combined Medicaid and SSI utilization of over 20.45%.Mercy Medical Center provides a subsidy to a School of Radiologic Technology Program.Mercy Medical Center serves as a sponsor site for clinical training of college students in various health care programs.Mercy Medical Center helps to subsidize an area community clinic that serves the uninsured and low income members of the community. Support consists of cash donations for operations, use of clinic building and lab and x-ray services.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: Mercy Medical Center, of Oshkosh, Wisconsin is part of an affiliated health care system called Affinity Health System. Affinity Health System also has two other hospitals, St. Elizabeth Hospital, in Appleton , WI and Calumet Medical Center, in Chilton, WI. The latter hospital qualifies as a Critical Access Hospital. In addition to the hospitals, Affinity Health System also has 25 area clinics under the control of Affinity Medical Group. The mission of Affinity, as a Catholic health care system, is to live out the healing ministry of by providing services that promote the health and well being of the communities we serve, especially the poor. Affinity Health System is sponsored equally by two Catholic health systems, Ministry Health Care, headquartered in Milwaukee, WI and Wheaton Franciscan Health Care, also headquartered in Milwaukee, WI. Mercy Medical Center and St. Elizabeth Hospital both subsidize area community medical clinics as well as community dental clinics. The 3 hospitals and the 25 clinics provide free or minimal cost health education , support and screening services for the populations they serve. Mercy Medical Center and St. Elizabeth Hospital both provide support for educational programs to educate future health care professionals. There is also an expectation that all people in management services at Affinity Health System will provide direct services to the poor. Mercy Medical Center has a foundation which is not included within the operations of the organization. The foundation provides cash donations which help support the mission of the organization and the affiliated health care system. Examples of the donations are included in item #6 above.AffiliatedHealthCareSystem

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1MINISTRY HEALTH CARE INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111925 WEST LAKE PARK DRAddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53224ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient391490371EINOfRecipient
Amount Of Cash Grant590755AmountOfCashGrant
Purpose Of GrantGrant to serve the poor.PurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: EACH YEAR MERCY MEDICAL CENTER PROVIDES A GRANT BASED ON AN INTEGRATION AGREEMENT. THE INTEGRATION AGREEMENT SUBSTANTIATES THE AMOUNT AND THE RECIPIENT OF THE GRANT.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses0WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BARBARA STRAND
0245788000937022625022237029158700
DANIEL E NEUFELDER
139448390570526241473932511703311606325083167887020935658637400
DAVID ROMOND
03569950000056169017276043044000
FRANK CHYBOWSKI
04252750001406025758020416047285500
JOSEPH MCCORMICK
0110203500010550187590221450114399400
Stacey Sensor DO
0474503000209019676017924051231200
JAY MULLER MD
0350236000384018826019918038936400
MARK FAUSTICH MD
0339519000185902869107098037716700
JOHN OLIVERIO
08977900477700036199501584820643170196028400
NICHOLAS DESIEN
0905799023399506454607101120216240193607600
JEFF BADGER
761472132752489269718526714751103192890251201434112174534098700
William Calhoun
200745061966074940150170194640304686000
GINGER SELLE
14158901967902270156290176150194739000
NICHOLAS SYLVIA
16107400099011487014120174072000
DAVID HOFFMAN
12304000029010699050209650216811000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1bBUSINESS TRAVEL EXPENSES FOR SPOUSES OF EXECUTIVES AND GOLF CLUB MEMBERSHIP FOR EXECUTIVES ARE REIMBURSED AS PART OF THEIR EXECUTIVE FLEX CREDIT ACCOUNT. RECEIPTS ARE PROVIDED TO SR. ADMINISTRATIVE ASSISTANT IN HR WHO REVIEWS FOR ACCURACY, COMPLETES A REIMBURSEMENT FORM WITH SUBSTANTIATION TO PAYROLL FOR REIMBURSEMENT.
Part I, Line 4b:John Oliverio received a 2009 taxable payout of $346,993 related to a supplemental nonqualified retirement plan known as Wheaton Franciscan Services Benefit Restoration Plan.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 6The corporate members of Mercy Medical Center of Oshkosh, Inc. are Ministry Health Care, Inc. and Affinity Health System, Inc.
Form 990, Part VI, Section A, line 7aMinistry Health Care has the power to approve and remove directors from Mercy Medical Center of Oshkosh, Inc.
Form 990, Part VI, Section A, line 7bAmendments of the articles of incorporation and bylaws must be approved by Ministry Health Care, Inc.
Form 990, Part VI, Section B, line 11THE CONTROLLER AND CFO OF AFFINITY HEALTH SYSTEM PERFORM A DETAIL REVIEW OF THE 990. AFTER MANAGEMENT REVIEW, A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING.
Form 990, Part VI, Section B, line 12cThe board of directors receives a conflict of interest questionnaire every year.
Form 990, Part VI, Section B, line 15Each year the organization engages an independent compensation firm to provide market data for CEO, executives and key employee positions. This study is shared with the compensation committee of the board of directors for their review and recommendations regarding any compensation changes. The compensation committee is comprised of independent members. The CEO reviews each executive and key employee's annual performance appraisal ratings in making his compensation recommendations to the compensation committee. The compensation committee has the final authority to approve any and all amounts of compensation for members of the executive team. The final approval of compensation amounts are documented.
Form 990, Part VI, Section C, line 19The organization believes the financial statements, governing documents, and policies are the property of the organization and are not available for public inspection.
Form 990, Part VIIFrank Chybowski, MD worked an average of 40 hours per week for a related organization. Mark Faustich, MD worked an average of 40 hours per week for a related organization. Joseph McCormick, MD worked an average of 40 hours per week for a related organization. Jay Muller, MD worked an average of 40 hours per week for a related organization. David Romond, MD worked an average of 40 hours per week for a related organization. Stacey Sensor, DO worked an average of 40 hours per week for a related organization. Barbara Strand, MD worked an average of 40 hours per week for a related organization. Daniel Neufelder worked an average of 29 hours per week for related organizations. Jeff Badger worked an average of 29 hours per week for related organizations. William Calhoun worked an average of 29 hours per week for related organizations. John Oliverio worked an average of 40 hours per week for a related organization. Nicholas Desien worked an average of 40 hours per week for a related organizaton.HOURS WORKED FOR RELATED ORGANIZATIONS
Form 990, Part XI, Line 2B-2CMercy Medical Center of Oshkosh, Inc. (Organization) does not receive separately audited financial statements. The Organization is audited and reported through consolidated financial statements. The audit committee is responsible for the auditor selection. The audit statements are reviewed by the Controller, CFO, Ministry Health CFO, and the audit committee. This process has not changed from the prior year.Process for oversight of audit and selection of an indepedent accountant

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
St Elizabeth Hospital Inc
1506 S Oneida StreetAppletonWI54915390816818Health Care ServicesWI501(c)(3)3N/A
Network Health System Inc
1570 Midway PlMenashaWI54952391127163Clinical Healthcare ServicesWI501(c)(3)3N/A
St Elizabeth Hospital Foundation Inc
1506 South Oneida StreetAppletonWI54915391256677Raise funds in support of St.Elizabeth Hospital and related entitiesWI501(c)(3)11a-IN/A
Affinity Health System Inc
1570 Midway PlMenashaWI54952391568866Support related healthcare OrganizationsIL501(c)(3)11a-IN/A
Ministry Health Care Inc
11925 W Lake Park DriveMilwaukeeWI53224391490371support related healthcare OrganizationsWI501(c)(3)11a-IN/A
Wheaton Franciscan Services Inc
26 W171 Roosevelt RoadWheatonIL60187363262111Support related healthcare OrganizationsIL501(c)(3)11a-IN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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