2023-05-15T14:24:02-05:00 2022-06-30 390859910 BAKER TILLY US LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2021-07-01 391035110 MERCY ASSISTED CARE INC MERC 6087542201 PO BOX 5003 - 901 MINERAL POINT A JANESVILLE WI 535485003 JAVON BEA PRESIDENT/CEO 6087542201 2023-05-12 1 JAVON BEA XXX-XX-XXXX TROY MARINE CPA P00187863 6087525835 2023-05-12 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MERCYHEALTH AT HOME JAVON BEA PO BOX 5003 - 901 MINERAL POINT AVE JANESVILLE WI 535485003 16228667 0 X HTTPS://MERCYASSISTEDCARE.ORG/ X 1985 WI EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE. 8 6 112 6 738883 231965 12288 81563 9342867 10366693 554 165 1756038 2162088 11111747 12610509 0 0 0 0 7242265 7836380 0 0 0 2876582 2697256 10118847 10533636 992900 2076873 9245473 11848284 1971628 2497566 7273845 9350718 X THE MISSION OF MERCY ASSISTED CARE, INC. (MAC) IS TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE. 0 0 9255963 11378289 VISITS: SKILLED NURSING 19,741, HOSPICE HOMECARE 7,417HOSPITAL COMMUNITY BENEFIT REPORT - IRS FORM 990, SUPPLEMENT PART III:THE COMMUNITY BENEFIT CONTRIBUTION OF MAC 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 BENEFIT1. MERCY ASSISTED CARE'S (MAC) COMMITMENT TO PROVIDING COMMUNITY BENEFIT - NOTE: MUCH OF THE COMMUNITY BENEFIT FOR ALL THE ENTITIES OF THE ENTIRE MERCY HEALTH CORPORATION (PARENT COMPANY OF MAC) IS PROVIDED AT THE MERCY HEALTH SYSTEM CORPORATION LEVEL.A. THE MISSION OF MAC 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 AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY OF JANESVILLE AND SOUTHERN WISCONSIN WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, 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 PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXISTS. THESE ACTIVITIES INCLUDE PARTICIPATION IN HEALTH FAIRS; FLU AND DIABETES CLINICS; FOOT CLINICS; HOSPICE SUPPORT GROUPS; AND A RADIO HEALTH LINE.SERVICES PROVIDED INCLUDE: SKILLED CARE (NURSING/THERAPISTS/AIDS ), HOSPICE, SUPPORTIVE AND EXTENDED HOME CARE. ADDITIONALLY, SALES AND RENTALS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES ARE PROVIDED TO THE COMMUNITY. MAC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, MERCY ASSISTED CARE, INC. RECOGNIZES THESE AMOUNTS AS CHARITY CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE, AS DETERMINED BY A PATIENT'S INABILTIY TO PAY DUE TO THEIR FINANCIAL CONDITION, AND UNCOMPENSATED CARE (BAD DEBT) ARE OTHER MEANS BY WHICH MERCY ASSISTED CARE, INC. PROVIDED FOR MEDICAL CARE AND WAS NOT COMPENSATED.B. MAC 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. MAC HAS WORKED WITH VARIOUS COMMUNITY ORGANIZATIONS TO HELP MEET THESE NEEDS:1) MAC SUBSIDIZES ITS HOSPICE PROGRAM (THROUGH FUNDRAISING/DONATIONS FROM MERCYHEALTH DEVELOPMENT 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), MAC PROVIDES TRAINING OPPORTUNITIES FOR NURSES, PHYSICIANS, AND OTHER HEALTH PROFESSIONALS. C. COMMUNITY/CHARITY CARE IS PROVIDED BY MAC 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 PATIENT'S INQUIRIES. TRANSLATION SERVICES ARE AVAILABLE AS NEEDED.2. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION- MAC HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY.- MAC PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS.3. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMSMAC OFFERS MANY REDUCED PRICE SERVICES AND FREE PROGRAMS THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH MAC 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.ORGSECTION 2 - QUANTIFIABLE COMMUNITY BENEFITFISCAL YEAR ENDED JUNE 30, 2022:1) CHARITY CARE - AT COST $42,8712) MEDICAID SHORTFALL - NET EXPENSE $200,635 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $243,506 9255963 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 112 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 WI IL X TODD ANDERSON VP & CFO 8159716738 2400 N ROCKTON AVE ROCKFORD IL 61103 JAVON R BEA PRESIDENT & CEO (SEE PAGES 32-35) 1.00 66.00 X X 0 11908792 619061 MARK L GOELZER MD DIRECTOR/PHYSICIAN 1.00 45.00 X 0 444609 28511 ROWLAND J MCCLELLAN CHAIR & DIRECTOR 1.00 6.00 X X 0 14276 0 THOMAS R POOL VICE CHAIR 1.00 6.00 X X 0 13500 0 THOMAS D BUDD SECRETARY & TREASURER 1.00 6.00 X X 0 13691 0 DAVE L SYVERSON DIRECTOR 1.00 6.00 X 0 15306 0 KATHERINE A SCHACK DIRECTOR 1.00 6.00 X 0 13500 0 WESLEY M JOST DIRECTOR 1.00 6.00 X 0 13693 0 TODD ANDERSON VICE PRESIDENT/CFO 1.00 56.00 X 0 767925 45782 KIMBERLY SCACCIA VP - REVENUE CYCLE 1.00 40.00 X 0 432755 52988 KAYLIE FUHRMAN RN HOME HEALTH HOSPICE 5 54.00 X 155501 0 32534 TRACI HEINTZELMAN RN HOME HEALTH HOSPICE 1 54.00 X 160461 0 13947 DAWN KLOCKOW DIRECTOR OF HOME HEALTH 40.00 X 150106 0 28299 JEFFREY LEVERENZ DIRECTOR OF BUSINESS OPERATIONS 40.00 X 120227 0 30499 BRANDON COOLEY HOME HEALTH THERAPY SUPERVISOR 40.00 X 135145 0 6054 SHANNON DUNPHY-ALEXANDER SR EXECUTIVE DIRECTOR 1.00 56.00 X 0 319804 16364 721440 13957851 874039 12 1 1 0 SOUTHERN WISCONSIN ROOFING 3202 KINGSLEY WAY MADISON WI 53713 WATERPROOFING/ROOF WORK 125000 ROCK HAVEN PO BOX 920 JANESVILLE WI 535470920 HOSPITALIZATION SERIVCES-HOSPICE 122062 2 81563 81563 PATIENT SERVICE REVENU 621610 9963200 9963200 RENT FROM AFFILIATED O 531190 403493 403493 10366693 165 165 5772130 3618158 2153972 1415089 738883 MISCELLANEOUS 900099 8116 8116 8116 12610509 11378289 738883 411774 6366078 5479106 886972 245014 212535 32479 766928 675728 91200 458360 388552 69808 5000 5000 382306 313253 69053 928 928 40825 41391 -566 234233 234233 300020 298709 1311 -26995 -19679 -7316 705402 619963 85439 27889 27889 DRUGS & MEDICAL SUPPLIE 463123 459040 4083 EQUIPMENT REPAIRS & MAI 245446 206849 38597 BAD DEBT 218734 218734 UNREL. BUS. INC. TAX 35129 35129 65216 63603 1613 10533636 9255963 1277673 0 900 900 3111564 5402473 1519651 1771945 775234 858590 15593 12420 13554312 9769136 3810781 3785176 11750 16780 9245473 11848284 1628898 1411938 342730 1085628 1971628 2497566 X 7273845 9350718 7273845 9350718 9245473 11848284 2076873 0 X 0 1 X 1 1 1 X 1471 89 12288 81563 95411 13058347 13974628 14568210 14770583 14875608 71247376 13059818 13974717 14568210 14782871 14957171 71342787 0 0 0 71342787 576 1164 1515 554 165 3974 81861 129651 104689 140916 231965 689082 82437 130815 106204 141470 232130 693056 1480 877 804 4095 8116 15372 13143735 14106409 14675218 14928436 15197417 72051215 0.99020 0.99980 0.00960 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8040465 5918162 2122303 224958 182338 42620 5288889 3668636 1620253 3785176 THIRD PARTY PAYABLES 252159 DUE TO MHS 797722 DUE TO MHH 25600 DUE TO ROCKFORD HEALTH SYSTEM 10147 1085628 0 1 0 0 0 0 0 0 0 JAVON R BEA PRESIDENT & CEO (SEE PAGES 32-35) 0 1570273 0 1475763 0 8862756 0 602150 0 16911 0 12527853 0 5837133 TODD ANDERSON VICE PRESIDENT/CFO 0 545321 0 211257 0 11347 0 11600 0 34182 0 813707 0 0 KIMBERLY SCACCIA VP - REVENUE CYCLE 0 310535 0 120856 0 1364 0 11600 0 41388 0 485743 0 0 MARK L GOELZER MD DIRECTOR/PHYSICIAN 0 324023 0 116186 0 4400 0 11600 0 16911 0 473120 0 0 SHANNON DUNPHY-ALEXANDER SR EXECUTIVE DIRECTOR 0 244896 0 74682 0 226 0 11600 0 4764 0 336168 0 0 KAYLIE FUHRMAN RN HOME HEALTH HOSPICE 5 148932 0 0 0 6569 0 0 0 32534 0 188035 0 0 0 DAWN KLOCKOW DIRECTOR OF HOME HEALTH 143811 0 0 0 6295 0 0 0 28299 0 178405 0 0 0 TRACI HEINTZELMAN RN HOME HEALTH HOSPICE 1 153986 0 0 0 6475 0 0 0 13947 0 174408 0 0 0 JEFFREY LEVERENZ DIRECTOR OF BUSINESS OPERATIONS 94227 0 0 0 26000 0 0 0 30499 0 150726 0 0 0 PART I, LINE 3 THE CEO IS PAID FROM A RELATED ORGANIZATION, MERCY HEALTH SYSTEM CORPORATION (MHSC). MHSC USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATION, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE MERCY COMPENSATION COMMITTEE OF MHSC IS COMPRISED OF THE BOARD CHAIRPERSON, VICE CHAIR, AND SECRETARY/TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED 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 2021. PART I, LINE 4B INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $5,837,133. PART II, LINE 1: 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 $3.4 BILLION IN FY2022. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 1.9 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,000+ 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 11 STRAIGHT YEARS. THE TURNAROUND OF 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 TWO 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, SECTION A, LINE 1A 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, SECTION A, LINE 6 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 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, SECTION A, LINE 7A SEE NARRATIVE FOR PART VI, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE NARRATIVE FOR PART VI, LINE 6 FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C 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, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT AVE JANESVILLE WI 53548 390912682 SUPPORT OF HEALTHCARE WI 501(C)(3) LINE 12C, III-FI MERCY HEALTH SYSTEM CORPORATION 0 MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT AVE JANESVILLE WI 53548 390816848 HEALTHCARE WI 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCY HARVARD HOSPITAL INC 901 GRANT STREET HARVARD IL 60033 311551871 HEALTHCARE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 200 LAKE AVE WOODSTOCK IL 60098 201673011 NONE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCY HEALTH CORPORATION 2400 N ROCKTON AVE ROCKFORD IL 61103 472158680 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 12A, I N/A 0 JAVON BEA HOSPITAL 2400 N ROCKTON AVE ROCKFORD IL 61103 362167847 HEALTHCARE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 MERCYHEALTH DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 363197918 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 12A, I MERCY HEALTH CORPORATION 0 MERCYHEALTH VISITING NURSES ASSOCIATION 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(C)(3) LINE 10 MERCY HEALTH CORPORATION 0 ROCKFORD HEALTH PHYSICIANS 2400 N ROCKTON AVE ROCKFORD IL 61103 363907436 HEALTHCARE IL 501(C)(3) LINE 3 MERCY HEALTH CORPORATION 0 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 53548 391520130 MANAGEMENT OF UNION EMPLOYEES WI N/A C 0 MERCYCARE INSURANCE COMPANY 580 N WASHINGTON ST JANESVILLE WI 53546 391768192 INSURANCE WI N/A C 0 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 580 N WASHINGTON ST JANESVILLE WI 53546 201482553 INSURANCE WI N/A C 0 ROCKFORD HEALTH INSURANCE LTD WELLESLY HOUSE SO 2ND FL PEMBROKE HM BD INSURANCE BD N/A C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0