2024-05-15T17:54:07+00:00 2023-06-30 390859910 Baker Tilly US LLP 500 Midland Court PO Box 8130 Janesville WI 53547 990 2022-07-01 391035110 Mercy Assisted Care Inc MERC 6087542201 PO BOX 5003 901 MINERAL POINT Ave JANESVILLE WI 535485003 Javon Bea President/Ceo 2024-05-15 false Javon Bea 999009999 Troy E Marine CPA P00187863 6087525835 2022 2023-04-26 12:10:37Z MERCYHEALTH AT HOME JAVON BEA PO BOX 5003 901 MINERAL POINT Ave JANESVILLE WI 535485003 18908808 false X HTTPS://MERCYASSISTEDCARE.ORG/ X 1985 WI EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE. 8 6 112 6 1271609 474946 81563 226181 10366693 11260860 165 -13371 2162088 3482810 12610509 14956480 0 0 7836380 9745883 0 0 2697256 3112217 10533636 12858100 2076873 2098380 11848284 14233277 2497566 2784179 9350718 11449098 THE MISSION OF MERCY ASSISTED CARE, INC. (MAC) IS TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE. false false 11384000 13031305 VISITS: SKILLED NURSING 18,397, HOSPICE HOMECARE 8,338. HOSPITAL COMMUNITY BENEFIT REPORT - IRS FORM 990, SUPPLEMENT PART III: The community benefit contribution of Mercy Assisted Care, Inc. includes programs and activities that improve access to health care and improve health in our communities. In order to portray the full breadth of our contribution, our community benefit information is described below: Section 1: Qualitative Description of Community Benefit - describes the organization's community benefit mission, how the mission is translated into a proactive approach designed to meet community health needs, how the organization meets tax-exempt requirements, and a description of community benefit programs and services that highlight the organization's impact on community health. Section 2: Quantitative Description of Community Benefit - describes the organization's community benefit contribution in financial terms presenting the amount of charity care, the unpaid shortfall from government health care for the indigent, and the net expense of community benefit services. SECTION 1-QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT 1. Mercy Assisted Care Inc.'s Commitment to Providing Community Benefit: A. The Mission of the Mercy Assisted Care, Inc. is "to provide exceptional healthcare services resulting in healing in its broadest sense." Mercy Assisted Care provides quality medical care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Mercy Assisted Care, it is recognized that not all individuals possess the ability to purchase essential medical services. Therefore, in keeping its Mission, Mercy Assisted Care routinely provides: 1.) free care and/or subsidized care, 2.) care to persons covered by governmental programs that are reimbursed below cost, and 3.) health activities and educational and support programs to the communities it serves in southern Wisconsin and northern Illinois. These activities include wellness programs, community education programs, special programs for the elderly, handicapped, medically underserved, and a variety of broad community support activities. Many of the services of Mercy Assisted Care are focused on keeping the elderly and medically frail in the type of independent setting most appropriate to their medical condition. B. Mercy Assisted Care considers its target populations to be residents of Rock and Walworth Counties in Wisconsin, as well as parts of McHenry County in Illinois. The System uses multiple strategies to identify needs in these communities. These strategies include one-on-one meetings with local community leaders, formal surveys, participation on community task forces, suggestions from patients, and direct input from its employees. Mercy Assisted Care has worked with various community organizations to help meet these needs: 1.) Mercy Assisted Care subsidizes its Hospice program (through fundraising/donations from Mercy Foundation) so that this program is available to those in need within the community. 2) It provides health screenings and health education seminars at public events and at its own sites throughout the target area. 3) Along with its sister-corporation (Mercy Health System Corporation), Mercy Assisted Care, provides training opportunities for nurses, physicians, and other health professionals. C. Community/Charity Care is provided by Mercy Assisted Care to customers who are unable to pay for all or a portion of their charges and who meet eligibility requirements. Eligibility is based on the following: individual or family income, individual or family assets, family size, and other sources of payment for services. Eligibility for all other categorical aids is a prerequisite before qualifying for community care. Patients that qualify will receive a reduction in the balance owed and extended payment terms. The amount of the Community Care benefit is based on the patient's ability to pay and the size of the outstanding balance. If patient income and family assets are less than 200% of the federal poverty guidelines, then Mercy will cover 100% of their outstanding balance via its Community Care Program. If patient income and family assets fall between 201% and 300% of the federal poverty guideline, then a patient's balance can be reduced as much as 90%. Mercy has procedures in place to inform the public about the availability of financial aid/charity care. Information is made available at the time of registration, through patient financial counselors, and at the customer service patient accounts areas. Training is provided to personnel as to how to communicate this program's availability to patients and how to direct patients' inquiries. Translation services are available as needed. 2. Organizational Description for Tax Exemption - Mercy Assisted Care, Inc has a governing body in which independent persons representative of the community comprise a majority. - Mercy Assisted Care, Inc. participates in Medicaid, Medicare, CHAMPUS, Tricare, and other government-sponsored health care programs. 3. Description of Community Benefit Programs Mercy Assisted Care offers many reduced price services and free programs throughout the year based upon activities and services which Mercy Assisted Care, Inc. believes will serve a bona fide community health need. Some of the programs include: - Participation in health fairs - Participation in Hospice Support Groups. 4. Links to Additional Community Benefit Information Mercy Health System's web page: www.mercyhealthsystem.org Much of the Community Benefit for all the entities of the entire Mercyhealth organization (parent company of Mercy Assisted Care, Inc.) is provided at the Mercy Health System Corporation. SECTION 2 - QUANTIFIABLE COMMUNITY BENEFIT FISCAL YEAR ENDED JUNE 30, 2023: 1) CHARITY CARE - AT COST $31,334 2) MEDICAID SHORTFALL - NET EXPENSE $192,996 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $224,330 11384000 true true false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 15 0 112 true true false false false false false false false false false false false X 8 6 false false false false true true true true true false false false true true true true true false false false IL WI X TODD ANDERSON VP & CFO 8159716738 8201 E Riverside Blvd ROCKFORD IL 61114 Javon R Bea PRESIDENT/CEO (see schedule J, pages 32 - 33) 1.0 66.0 X X 0 11130143 430877 Rowland J McClellan Chair & Director 1.0 6.0 X X 0 19324 0 Thomas D Budd secretary & treasurer 1.0 6.0 X X 0 12086 0 Thomas R Pool Vice Chair & Director 1.0 6.0 X X 0 13500 0 Dave L Syverson Director 1.0 6.0 X 0 17334 0 Katherine A Schack Director 1.0 6.0 X 0 13500 0 Mark L Goelzer MD Director/Physician 1.0 61.0 X 0 504123 29529 Wesley M Jost Director 1.0 6.0 X 0 13955 0 Kimberly Scaccia VP - Revenue Cycle 1.0 61.0 X 0 499300 64924 Todd Anderson Vice President/CFO 1.0 61.0 X 0 828491 76813 Brandon Cooley Home Health Therapy Supervisor 40.0 0.0 X 142434 0 12078 Dawn Klockow Director of Home Health 40.0 0.0 X 155368 0 36008 Kaylie Fuhrman RN HOME HEALTH HOSPICE 5 54.7 0.0 X 162051 0 38468 Shelley Herbst-Nguyen Home Health Therapy Supervisor 40.0 0.0 X 123885 0 5226 Traci Heitzelman RN HOME HEALTH HOSPICE 1 54.0 0.0 X 161022 0 20865 James Davis former VICE-PRESIDENT 0.0 0.0 X 0 213871 34294 744760 13265627 749082 15 true true false ROCK HAVEN PO BOX 920 JANESVILLE WI 535470920 HOSPITALIZATION SERIVCES-HOSPICE 196437 SOUTHERN WISCONSIN ROOFING 3202 KINGSLEY WAY MADISON WI 53713 WATERPROOFING/ROOF WORK 110000 2 226181 226181 PATIENT SERVICE REVENUE 621610 10828522 10828522 RENT FROM AFFILIATED Organization 531190 432338 432338 0 0 0 0 11260860 2120 2120 0 0 0 15491 0 -15491 -15491 -15491 7411229 3936837 3474392 2202783 1271609 MISCELLANEOUS 900099 8418 8418 0 0 0 0 8418 14956480 13031305 1271609 427385 7876772 6812402 1064370 250004 219771 30233 1068895 926554 142341 550212 502971 47241 5000 5000 470626 460745 9881 0 2217 2217 71163 62820 8343 234834 234834 334708 333811 897 1355 1355 828073 750858 77215 29000 29000 DRUGS & MEDICAL SUPPLIES 367124 363337 3787 EQUIPMENT REPAIRS & MAINTENANCE 440639 361332 79307 BAD DEBT 253777 253777 UNREL. BUS. INC. TAX 55015 55015 18686 14556 4130 0 12858100 11384000 1474100 0 900 850 5402473 5106788 1771945 2422673 0 0 0 0 858590 1238013 12420 4668 15138260 11417800 3785176 3720460 0 0 16780 1739825 11848284 14233277 1411938 2336636 0 0 1085628 447543 2497566 2784179 9350718 11449098 9350718 11449098 11848284 14233277 2098380 0 X false true X true true true X 89 12288 81563 226181 320121 13974628 14568210 14770583 14875608 16816887 75005916 0 0 0 13974717 14568210 14782871 14957171 17043068 75326037 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 75326037 1164 1515 554 165 2120 5518 129651 104689 140916 231965 474946 1082167 130815 106204 141470 232130 477066 1087685 0 877 804 4095 8116 8418 22310 14106409 14675218 14928436 15197417 17528552 76436032 0.9855 0.9902 0.01 0.01 X Schedule A, Part III, Line 12 EXPLANATION FOR OTHER INCOME: MISCELLANEOUS Schedule A, Part III, Line 12 Other Income DESCRIPTION - MISCELLANEOUS, COLUMN A - 877.0, COLUMN B - 804.0, COLUMN C - 4095.0, COLUMN D - 8116.0, COLUMN E - 8418.0, COLUMN F - 22310.0; RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7993185 6094275 1898910 224958 198996 25962 6920117 5124529 1795588 3720460 Due from MERCY HEALTH CORPORATION 11750 Due from MERCYHEALTH VISITING NURSES ASSOCIATION Due from MERCY HEALTH SYSTEM CORPORATION 1320028 Due from MERCY HARVARD HOSPITAL 408047 1739825 THIRD PARTY PAYABLES 263718 DUE TO MERCY HEALTH SYSTEM CORPORATION DUE TO MERCY HARVARD HOSPITAL 326 DUE TO ROCKFORD HEALTH SYSTEM 9587 Due to MERCYHEALTH VISITING NURSES ASSOCIATION 173912 447543 true true false false false false false false false Javon R Bea PRESIDENT/CEO (see schedule J, pages 32 - 33) 0 2193820 0 1660233 0 7276090 0 413098 0 17779 0 11561020 0 4953609 Mark L Goelzer MD Director/Physician 0 312319 0 187404 0 4400 0 12200 0 17329 0 533652 0 0 James Davis former VICE-PRESIDENT 0 79369 0 0 0 134502 0 4471 0 29823 0 248165 0 0 Todd Anderson Vice President/CFO 0 564084 0 252851 0 11556 0 40746 0 36067 0 905304 0 0 Kimberly Scaccia VP - Revenue Cycle 0 314004 0 147040 0 38256 0 21669 0 43255 0 564224 0 0 Kaylie Fuhrman RN HOME HEALTH HOSPICE 5 155023 0 0 0 7028 0 3229 0 35239 0 200519 0 0 0 Dawn Klockow Director of Home Health 126217 0 21006 0 8145 0 6516 0 29492 0 191376 0 0 0 Traci Heitzelman RN HOME HEALTH HOSPICE 1 147090 0 3642 0 10290 0 6501 0 14364 0 181887 0 0 0 Brandon Cooley Home Health Therapy Supervisor 126766 0 15668 0 0 0 5697 0 6381 0 154512 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE CEO IS PAID FROM A RELATED ORGANIZATION, MERCY HEALTH SYSTEM OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE VICE CHAIR, AND SECRETARY/TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED CORPORATION (MHSC). MHSC USES THE FOLLOWING TO ESTABLISH THE COMPENSATION FORM 990 OF OTHER ORGANIZATION, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION MERCY COMPENSATION COMMITTEE OF MHSC IS COMPRISED OF THE BOARD CHAIRPERSON, BY INDEPENDENT LEGAL COUNSEL AND AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE, LEGAL COUNSEL, AND THE COMPENSATION CONSULTANT MEET THROUGHOUT THE YEAR AND REPORT DIRECTLY TO THE BOARD OF DIRECTORS ANNUALLY. THIS PROCESS WAS COMPLETED FOR 2022. Schedule J, Part I, Line 4a Severance or change-of-control payment James Davis received 26 weeks severance pay $119,025 in 2022. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $4,953,609 Todd Anderson participated in the 457(f) plan during Calendar year 2022. However, he did not receive a payout during calendar year 2022. Schedule J, Part II JAVON R. BEA - DEFERRED COMPENSATION PAYMENT MR. BEA HAS BEEN EMPLOYED BY MHSC AS PRESIDENT AND CEO OVER THE PAST 30 YEARS. DURING THIS TIME, MR. BEA HAS LED AN INCREDIBLE TRANSFORMATION TAKING A SMALL, SINGLE, STAND-ALONE COMMUNITY HOSPITAL AND CREATING A VERTICALLY INTEGRATED HEALTH SYSTEM WITH 85 FACILITIES IN 50 COMMUNITIES THROUGHOUT SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INCREASING GROSS REVENUE FROM $33 MILLION TO OVER $3.6 BILLION IN FY2023. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 1.8 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,500+ PARTNERS IN HEALTH CARE. TODAY, MHSC HAS BECOME THE LARGEST EMPLOYER IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. THIS GROWTH CAN BE ATTRIBUTED TO MR. BEA'S VISIONARY LEADERSHIP. LEADERSHIP THAT HAS LED TO MHSC RECEIVING NUMEROUS NATIONAL RECOGNIZED AWARDS INCLUDING BEING NAMED THE FIRST FULLY INTEGRATED HEALTH SYSTEM TO RECEIVE THE MALCOLM BALDRIGE NATIONAL QUALITY AWARD, THE MAGNET RECOGNITION AWARD, BEING RANKED #1 AND #2 ON AARP'S TOP 100 BEST PLACES TO WORK FOR WORKERS OVER 50 AND BEING RANKED IN THE TOP 25 ON THE TOP 100 INTEGRATED HEALTHCARE NETWORKS LIST BY MODERN HEALTHCARE FOR OVER 12 STRAIGHT YEARS. THE TURNAROUND OF THE MHSC IMPLEMENTED BY MR. BEA IS UNPARALLELED. BY PIONEERING A "PARTNERSHIP MODEL" OF COMPENSATION AND DESIGNING A CUSTOM CULTURE OF EXCELLENCE, MR. BEA IS VITAL TO THE DECADES-LONG AND CONTINUING GROWTH AT MHSC. THIS SUCCESS HAS MADE MR. BEA A HIGHLY SOUGHT AFTER SPEAKER AND CONSULTANT AS HE IS NOW WELL-RENOWNED FOR HIS INNOVATIONS IN THE AREAS OF INTEGRATED HEALTHCARE AND PHYSICIAN PARTNERSHIP MODELS. THE TREMENDOUS SUCCESS OF MHSC UNDER THE LEADERSHIP OF MR. BEA HAS ALLOWED HIM TO RECEIVE PAYOUTS FROM A DEFERRED COMPENSATION PACKAGE WHICH MHSC HAS BEEN PAYING INTO OVER MANY YEARS. THESE PAYMENTS ONLY BECAME PAYABLE IF MHSC ATTAINED CERTAIN DEFINED FINANCIAL AND STRATEGIC GOALS AND THE AMOUNTS ARE AT RISK EVERY SINGLE YEAR. AS INDICATED ABOVE, MANY OF THESE GOALS WERE ACHIEVED WITHIN THE PAST FEW YEARS RESULTING IN A RELEASE OF THESE DEFERRED PAYMENTS WHICH IMPACTED MR. BEA'S COMPENSATION REPORTING. THE SETTING OF THESE GOALS WERE LAID OUT BY THE BOARD OF DIRECTORS IN COOPERATION WITH NATIONALLY RECOGNIZED COMPENSATION ATTORNEYS AND CONSULTANTS TO MAKE SURE ALL FACTORS WERE TAKEN INTO CONSIDERATION. MR. BEA'S COMPENSATION HAS ALSO BEEN SCRUTINIZED BY NUMEROUS OUTSIDE ORGANIZATIONS AND MOST IMPORTANTLY, THE INTERNAL REVENUE SERVICE; AND HAS PASSED INSPECTION IN EACH CASE. TOTAL COMPENSATION IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OF MHSC. Form 990, Part VI, Line 1a Delegate broad authority to a committee THE VOTING MEMBERS OF THE EXECUTIVE COMMITTEE CONSISTS OF EIGHT INDIVIDUALS, EACH OF WHOM SHALL HAVE A VOTE, INCLUDING THE CEO, THE CHAIRMAN, VICE-CHAIRMAN, IMMEDIATE PAST CHAIRMAN, TREASURER, AND TWO ADDITIONAL DIRECTORS OF THE BOARD. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE A PHYSICIAN. THE EXECUTIVE COMMITTEE SHALL IN ALL INSTANCES BE COMPRISED OF AT LEAST 51% COMMUNITY MEMBERS. IN THE EVENT THAT ONE OR MORE OF THE AFOREMENTIONED VOTING MEMBERS OF THE EXECUTIVE COMMITTEE IS UNABLE TO SERVE IN SUCH CAPACITY, THEN THE CHAIRMAN OF THE CORPORATION SHALL DESIGNATE A REPLACEMENT FROM AMONG THE BOARD MEMBERS. THE EXECUTIVE COMMITTEE SHALL MEET AS NEEDED. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS, DUTIES, RESPONSIBILITIES AND AUTHORITY OF THE BOARD, EXCEPT AS PROHIBITED BY LAW. Form 990, Part VI, Line 6 Classes of members or stockholders MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF MERCY ASSISTED CARE, INC. (MAC). THE SOLE MEMBER SHALL HAVE POWERS AND VOTING RIGHTS TO DO THE FOLLOWING: (A) APPOINT ALL THE DIRECTORS OF THE CORPORATION (B) NOMINATE TO THE CORPORATION'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION PRESIDENT (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS (D) APPROVE ANNUAL BUDGETS, AND STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS OF THE CORPORATION (E) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AUTHORIZING THE PLEDGE OR TRANSFER OF ASSETS TO MHC OR AS DIRECTED BY MHC, OR THE EXECUTION OF CONTRACTS) WHICH WOULD IMPROVE THE CREDIT WORTHINESS OR OTHERWISE RESULT IN FINANCIAL BENEFIT TO MHC AND ITS TAX-EXEMPT AFFILIATED CORPORATIONS (PROVIDED THAT UNDER NO CIRCUMSTANCES MAY MHC REQUIRE TRANSFER OF ASSETS IN VIOLATION OF LAW OR THE TERMS OF ANY CHARITABLE TRUST OR DONATION) (F) APPROVE ALL CONTRACTS OF INDEBTEDNESS EFFECTIVE FOR LONGER THAN EIGHTEEN MONTHS (G) APPROVE ALL PLANS OF MERGER OR CONSOLIDATION (H) APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION (I) APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION (J) APPROVE MATERIAL AMENDMENTS TO THE CORPORATION'S STANDARD FORM OF PHYSICIAN EMPLOYMENT AGREEMENT, PROVIDED THE CORPORATION SHALL HAVE THE AUTHORITY TO NEGOTIATE THE TERMS AND CONDITIONS OF INDIVIDUAL PHYSICIAN MERCY ASSISTED CARE, INC. 39-1035110 EMPLOYMENT AGREEMENTS SO LONG AS THE NEGOTIATED TERMS AND CONDITIONS ARE CONSISTENT WITH THE REQUIREMENTS OF APPLICABLE LAW AND THE STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS APPROVED BY MHC (K) APPROVE MATERIAL AMENDMENTS TO THE STANDARD COMPENSATION SYSTEM USED BY THE CORPORATION TO ESTABLISH INDIVIDUAL PHYSICIAN COMPENSATION (L) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AMENDING THE ARTICLES OF INCORPORATION OR BYLAWS), OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, IF MHC DETERMINES THAT FAILURE TO TAKE THE ACTION, OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, MAY RESULT IN THE CORPORATIONS FAILURE TO OBTAIN OR MAINTAIN ITS EXEMPTION AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body SEE NARRATIVE FOR PART VI, LINE 6. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders SEE NARRATIVE FOR PART VI, LINE 6. Form 990, Part VI, Line 11b Review of form 990 by governing body MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. Form 990, Part VI, Line 12c Conflict of interest policy BY WRITTEN POLICY, MHC SENDS OUT, ON AN ANNUAL BASIS, THE CORPORATE CONFLICT AND DUALITY OF INTEREST POLICY TO ALL BOARD MEMBERS, CORPORATE OFFICERS AND OTHER KEY INDIVIDUALS (THOSE HAVING RESPONSIBILITY AND AUTHORITY TO MAKE FINAL DECISIONS REGARDING THE ACQUISITION OF PRODUCTS OR SERVICES). EACH RECIPIENT IS REQUIRED TO COMPLETE A FINANCIAL INTEREST DISCLOSURE STATEMENT, WHICH IS SUBMITTED TO THE MHC COMPLIANCE DEPARTMENT FOR REVIEW. WITH RESPECT TO PHYSICIANS AND MANAGERS WHO ARE KEY INDIVIDUALS, ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE APPROPRIATE EXECUTIVE STAFF MEMBER FOR FOLLOW UP WITH THE DISCLOSING PARTY IN ORDER TO REVIEW THE MATTER IN MORE DETAIL. THIS INCLUDES EMPHASIZING THAT THE DISCLOSING PARTY IS NOT PERMITTED TO PARTICIPATE IN ANY NEGOTIATIONS FOR THE PURCHASE OF ANY PRODUCTS OR SERVICES WHERE THE CONFLICT IS DEEMED MATERIAL, OR AUTHORIZE THE SUBSEQUENT PURCHASE OF RELATED GOODS AND SERVICES. THE DISCLOSING PARTY IS ALSO REQUIRED TO IDENTIFY EACH AND EVERY INSTANCE OF A POTENTIAL CONFLICT AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. A SIMILAR PROCESS IS FOLLOWED FOR THE BOARD OF DIRECTORS, EXCEPT THAT ANY POTENTIAL CONFLICT IS REVIEWED BY THE BOARD'S GOVERNANCE COMMITTEE. BOARD MEMBERS MAY COMMENT ON TRANSACTIONS WHERE THERE IS A POTENTIAL CONFLICT, BUT CANNOT VOTE ON THE RELATED MATTER AND MAY BE REQUIRED TO LEAVE ANY MEETING WHERE THE POTENTIAL CONFLICT IS REVIEWED BY THE BOARD OR WHERE THE BOARD TAKES ACTION TO EITHER APPROVE OR NOT APPROVE THE PROPOSED TRANSACTION. A BOARD MEMBER ALSO HAS A CONTINUING DUTY TO REPORT ANY CONFLICTS AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. IN THE EVENT THAT A POTENTIAL CONFLICT OF INTEREST IS REPORTED OR DISCOVERED OUTSIDE THE ESTABLISHED PROCESS, APPROPRIATE REVIEW AND ACTION WOULD BE TAKEN. THIS PROCESS WAS LAST COMPLETED IN DEC. 2021, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2021 CONFLICTS IDENTIFIED. MHC AND MAC HAVE THE SAME BOARD, AND THEREFORE THE MHC QUESTIONNAIRE IS USED TO ALSO ADDRESS POTENTIAL AND ACTUAL CONFLICTS FOR THE FILING ORGANIZATION. THE MHC CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. Form 990, Part VI, Line 19 Required documents available to the public NO DOCUMENTS AVAILABLE TO THE PUBLIC. MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT AVE JANESVILLE WI 53548 390912682 HEALTHCARE WI 501(c)(3) Type III-FI MERCY HEALTH SYSTEM CORPORATION false MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT AVE JANESVILLE WI 53548 390816848 HEALTHCARE WI 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCY HARVARD HOSPITAL INC 901 GRANT STREET HARVARD IL 60033 311551871 HEALTHCARE IL 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 200 LAKE AVE WOODSTOCK IL 60098 201673011 HEALTHCARE IL 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCY HEALTH CORPORATION 8201 E Riverside Blvd ROCKFORD IL 61114 472158680 HEALTHCARE IL 501(c)(3) Type I NA false JAVON BEA HOSPITAL 8201 E Riverside Blvd Rockford IL 61114 362167847 HEALTHCARE IL 501(c)(3) 3 MERCY HEALTH CORPORATION false MERCYHEALTH DEVELOPMENT FOUNDATION 8201 E Riverside Blvd ROCKFORD IL 61114 363197918 HEALTHCARE IL 501(c)(3) Type I MERCY HEALTH CORPORATION false MERCYHEALTH VISITING NURSES ASSOCIATION 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(c)(3) 10 MERCY HEALTH CORPORATION false ROCKFORD HEALTH PHYSICIANS 8201 E Riverside Blvd ROCKFORD IL 61114 363907436 HEALTHCARE IL 501(c)(3) 3 MERCY HEALTH CORPORATION false JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 53548 391520130 MANAGEMENT OF UNION EMPLOYEES WI NA C Corporation false MERCYCARE INSURANCE COMPANY 580 N WASHINGTON ST JANESVILLE WI 53546 391768192 INSURANCE WI NA C Corporation false MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 580 N WASHINGTON ST JANESVILLE WI 53546 201482553 INSURANCE WI NA C Corporation false ROCKFORD HEALTH INSURANCE LTD INSURANCE BD NA C Corporation false false false false false false false false false false true true false false true true true true false false