MERCY HARVARD HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MERCY HARVARD HOSPITAL INC (EIN 31-1551871)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202211369349312216
- Schema version
- 2020v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T15:14:55-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 MIDLAND COURT PO BOX 8130 | AddressLine1Txt |
| City | JANESVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535478130 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311551871 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HARVARD HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HARV | BusinessNameControlTxt |
| Phone | 8159435431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 GRANT STREET | AddressLine1Txt |
| City | HARVARD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60033 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAVON BEA | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 8159435431 | PhoneNum |
| Signature | 2022-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JAVON | PersonFirstNm |
| Person Last | BEA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TROY MARINE CPA | PreparerPersonNm |
| PTIN | P00187863 | PTIN |
| Phone | 6087525835 | PhoneNum |
| Preparation | 2022-05-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAVON BEA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 GRANT STREET | AddressLine1Txt |
| City | HARVARD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,891,651 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MERCYHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 201 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $18,866 | PYContributionsGrantsAmt |
| CY Contributions Grants | $32,074 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $33,790,951 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,851,576 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,953 | PYOtherRevenueAmt |
| CY Other Revenue | $8,001 | CYOtherRevenueAmt |
| PY Total Revenue | $33,814,770 | PYTotalRevenueAmt |
| CY Total Revenue | $34,891,651 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,932,883 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,341,884 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,077,050 | PYOtherExpensesAmt |
| CY Other Expenses | $15,305,718 | CYOtherExpensesAmt |
| PY Total Expenses | $28,009,933 | PYTotalExpensesAmt |
| CY Total Expenses | $27,647,602 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,804,837 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,244,049 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,141,332 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,753,948 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,478,773 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,847,340 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,662,559 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,906,608 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF MERCY HARVARD HOSPITAL, INC. (MHH) IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,433,822 | ExpenseAmt |
| Revenue | $34,702,869 | RevenueAmt |
| Desc | HOSPITAL DISCHARGES 401, EMERGENCY VISITS 4,034, OUTPATIENT SURGERY CASES 1,771, NURSING HOME DISCHARGES 79.MERCY HARVARD HOSPITAL, INC. IS LOCATED IN MCHENRY COUNTY, ILLINOIS. IT IS LICENSED FOR 25 ACUTE AND 45 LONG-TERM CARE BEDS. IT IS A CRITICAL ACCESS HOSPITAL WITH 24/7 EMERGENCY SERVICES AND OUTPATIENT SURGERY. | Desc |
| Total Program Service Expenses | $22,433,822 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 201 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TODD ANDERSON VP & CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8159716738 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2400 N ROCKTON AVE | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61103 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| JAVON R BEA | |||||||||
| PRESIDENT & CEO (SEE PAGES 57-60) | 1.00 | 66.00 | Yes (X) | Yes (X) | $0 | $5,057,986 | $7,074,160 | ||
| MARK L GOELZER MD | |||||||||
| DIRECTOR/PHYSICIAN | 1.00 | 45.00 | Yes (X) | $0 | $501,965 | $29,148 | |||
| ROWLAND J MCCLELLAN | |||||||||
| CHAIR & DIRECTOR | 1.00 | 6.00 | Yes (X) | Yes (X) | $0 | $15,634 | $0 | ||
| WESLEY M JOST | |||||||||
| DIRECTOR | 1.00 | 6.00 | Yes (X) | $0 | $15,557 | $0 | |||
| THOMAS D BUDD | |||||||||
| SECRETARY & TREASURER | 1.00 | 6.00 | Yes (X) | Yes (X) | $0 | $15,308 | $0 | ||
| DAVE L SYVERSON | |||||||||
| DIRECTOR | 1.00 | 6.00 | Yes (X) | $0 | $15,110 | $0 | |||
| THOMAS R POOL | |||||||||
| VICE CHAIR & DIRECTOR | 1.00 | 6.00 | Yes (X) | Yes (X) | $0 | $15,000 | $0 | ||
| KATHERINE A SCHACK | |||||||||
| DIRECTOR | 1.00 | 6.00 | Yes (X) | $0 | $15,000 | $0 | |||
| TODD ANDERSON | |||||||||
| VICE PRESIDENT/CFO (AS OF 05/2020) | 1.00 | 56.00 | Yes (X) | $0 | $542,858 | $18,158 | |||
| SHANNON DUNPHY-ALEXANDER | |||||||||
| SR EXECUTIVE DIRECTOR | 1.00 | 56.00 | Yes (X) | $0 | $313,241 | $15,917 | |||
| KIMBERLY SCACCIA | |||||||||
| VP - REVENUE CYCLE (EFF. 03/2020) | 1.00 | 40.00 | Yes (X) | $0 | $299,091 | $21,962 | |||
| TIMOTHY ALLEN AUBRY | |||||||||
| PHARMACIST TEAM LEAD | 40.00 | 0.00 | $165,546 | $0 | $17,960 | Yes (X) | |||
| THERESA GAYLE HOLLINGER | |||||||||
| DIRECTOR | 40.00 | 0.00 | $158,043 | $0 | $25,306 | Yes (X) | |||
| BRENDA BOTE-CATACUN | |||||||||
| RN HOSPITAL 1 | 49.00 | 0.00 | $134,940 | $0 | $32,573 | Yes (X) | |||
| KHRISTINE M SCHRADER | |||||||||
| RN SHIFT COORDINATOR | 44.00 | 0.00 | $140,560 | $0 | $22,873 | Yes (X) | |||
| SUSAN F TOWNE | |||||||||
| ULTRASOUND RADIOGRAPHER 3 | 43.50 | 0.00 | $141,064 | $0 | $9,382 | Yes (X) | |||
| PAUL VAN DEN HEUVEL FORMER | |||||||||
| VICE PRESIDENT (THROUGH 04/2020) | 0.00 | 55.00 | $0 | $240,858 | $27,557 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $740,153 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,047,608 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $7,294,996 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUSION MEDICAL STAFFING LLC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 82674 | AddressLine1Txt |
| City | LINCOLN | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 685012674 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | CONTRACT NURSING | ServicesDesc |
| Compensation | $156,031 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $32,074 | AllOtherContributionsAmt |
| Total Contributions | $32,074 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 621110 | $33,113,681 | $33,113,681 | |
| PROVIDER RELIEF FUNDS | 900099 | $1,589,188 | $1,589,188 | |
| RENT FROM AFFILIATED O | 531190 | $74,724 | $74,724 | |
| CAFETERIA | 722210 | $62,919 | $62,919 | |
| MEALS ON WHEELS | 624210 | $11,064 | $11,064 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,851,576 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $8,001 | TotalRevenueColumnAmt |
| Exclusion | $8,001 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $8,001 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,891,651 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,702,869 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $156,708 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,957,626 | TotalAmt |
| Program Services | $7,283,457 | ProgramServicesAmt |
| Management And General | $2,674,169 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $319,594 | TotalAmt |
| Program Services | $248,979 | ProgramServicesAmt |
| Management And General | $70,615 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,220,952 | TotalAmt |
| Program Services | $938,048 | ProgramServicesAmt |
| Management And General | $282,904 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $843,712 | TotalAmt |
| Program Services | $647,729 | ProgramServicesAmt |
| Management And General | $195,983 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,105 | TotalAmt |
| Management And General | $5,105 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,689,736 | TotalAmt |
| Program Services | $3,452,837 | ProgramServicesAmt |
| Management And General | $236,899 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,124 | TotalAmt |
| Program Services | $225 | ProgramServicesAmt |
| Management And General | $30,899 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,109 | TotalAmt |
| Program Services | $28,343 | ProgramServicesAmt |
| Management And General | $28,766 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,484 | TotalAmt |
| Program Services | $14,242 | ProgramServicesAmt |
| Management And General | $346,242 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396,539 | TotalAmt |
| Program Services | $815 | ProgramServicesAmt |
| Management And General | $395,724 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,260 | TotalAmt |
| Program Services | $17,754 | ProgramServicesAmt |
| Management And General | $7,506 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,610 | TotalAmt |
| Program Services | $3,411 | ProgramServicesAmt |
| Management And General | $1,199 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,121 | TotalAmt |
| Program Services | $221,154 | ProgramServicesAmt |
| Management And General | $54,967 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,627,006 | TotalAmt |
| Program Services | $1,303,122 | ProgramServicesAmt |
| Management And General | $323,884 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $319,530 | TotalAmt |
| Program Services | $194,649 | ProgramServicesAmt |
| Management And General | $124,881 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBTS | $4,403,259 | $4,403,259 | |
| DRUGS & MEDICAL SUPPLIE | $2,580,778 | $2,434,181 | $146,597 |
| TAXES AND ASSESSMENTS | $836,862 | $836,862 | |
| MAINTENANCE AND REPAIRS | $452,626 | $346,573 | $106,053 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,569 | TotalAmt |
| Program Services | $58,182 | ProgramServicesAmt |
| Management And General | $181,387 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,647,602 | TotalAmt |
| Program Services | $22,433,822 | ProgramServicesAmt |
| Management And General | $5,213,780 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,111,860 | BOYAmt |
| EOY | $16,665,536 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,491,134 | BOYAmt |
| EOY | $3,240,870 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $972,172 | BOYAmt |
| EOY | $1,061,950 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,346 | BOYAmt |
| EOY | $24,795 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,968,370 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $33,279,041 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,315,499 | BOYAmt |
| EOY | $8,689,329 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,321 | BOYAmt |
| EOY | $71,468 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,141,332 | BOYAmt |
| EOY | $29,753,948 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,033,140 | BOYAmt |
| EOY | $1,773,873 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,445,633 | BOYAmt |
| EOY | $11,073,467 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,478,773 | BOYAmt |
| EOY | $12,847,340 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,662,559 | BOYAmt |
| EOY | $16,906,608 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,662,559 | BOYAmt |
| EOY | $16,906,608 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,141,332 | BOYAmt |
| EOY | $29,753,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $7,244,049 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | $0 | PoliticalExpendituresAmt |
| Volunteer Hours | 0 | VolunteerHoursCnt |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $10,964 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,964 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PERCENTAGE OF THE 2021 ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES WERE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $222,604 | OtherCostOrOtherBasisAmt |
| Book Value | $222,604 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,231,266 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,327,699 | DepreciationAmt |
| Book Value | $4,903,567 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,631,415 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,229,444 | DepreciationAmt |
| Book Value | $3,401,971 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $883,085 | OtherCostOrOtherBasisAmt |
| Depreciation | $721,898 | DepreciationAmt |
| Book Value | $161,187 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,689,329 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO MERCY HEALTH CORPORATION | $6,078,374 |
| DUE TO OTHER RELATED PARTIES | $3,646,276 |
| THIRD - PARTY PAYABLES | $1,348,817 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $11,073,467 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,564 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $77,564 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,564 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $77,564 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,595 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,595 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,798,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,376,962 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,421,841 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14720 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,300 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,814,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,376,962 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,437,736 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14790 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,892,262 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,376,962 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,515,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $855,445 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $172,800 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,742,608 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,276,862 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,534,254 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HARVARD HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 GRANT STREET | AddressLine1Txt |
| City | HARVARD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | MERCYHEALTHSYSTEM.ORG/LOCATION/MERCYHE | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HARVARD HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | MERCYHEALTHSYSTEM.ORG/COMMUNITY-NEEDS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | MERCYHEALTHSYSTEM.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | MERCYHEALTHSYSTEM.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | MERCYHEALTHSYSTEM.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Defer Deny Rqr Payment | Yes (X) | PermitDeferDenyRqrPaymentInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Engage Defer Deny Rqr Payment | Yes (X) | EngageDeferDenyRqrPaymentInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MERCY HARVARD HOSPITAL | PART V, SECTION B, LINE 5: MERCY HARVARD HOSPITAL/MERCY HEALTH CORPORATION SET OUT TO GATHER INFORMATION ON THE COMMUNITY OF HARVARD, ILLINOIS AS WELL AS MCHENRY COUNTY AS A WHOLE. DATA WAS GATHERED THROUGH HOUSEHOLD SURVEYS, COMMUNITY LEADER/STAKEHOLDER SURVEYS, AND SECONDARY DATA SOURCES.HEALTH QUESTIONNAIRES WERE DISTRIBUTED TO A MAILING LIST VIA THE US POSTAL SERVICE. A SECONDARY DISTRIBUTION OF QUESTIONNAIRES WAS DONE BY CREATION OF AN ONLINE SURVEY (ENGLISH AND SPANISH); THE SURVEY WEB LINK WAS DISTRIBUTED VIA EMAIL. AN ADDITIONAL/FINAL DISTRIBUTION TECHNIQUE USED WAS THE IN-PERSON DISTRIBUTION OF SURVEYS TO THE THIRD GRADE CLASS FAMILIES OF HARVARD'S CROSBY ELEMENTARY SCHOOL, VARIOUS BUSINESSES, CHURCHES, AND CHARITABLE ORGANIZATIONS. THE SURVEY WAS CONDUCTED IN THE 60033 AREA CODE, AND CONSISTED OF 34 QUESTIONS AND COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. DATA COLLECTION YIELDED A TOTAL OF 358 USABLE RESPONSES, EXCEEDING THE THRESHOLD OF THE DESIRED 90% CONFIDENCE INTERVAL IN SAMPLING. A KEY INFORMANT SURVEY WAS CONDUCTED AMONG LEADERS IN THE HARVARD COMMUNITY. STAKEHOLDERS TARGETED WERE SCHOOL LEADERS, BUSINESS OWNERS, RELIGIOUS LEADERS, CITY OFFICIALS, COMMUNITY PROGRAM LEADERS, POLICE AND FIRE OFFICIALS. THE PURPOSE OF THIS SEPARATE SURVEY WITH THIS SPECIFIC GROUP OF PEOPLE WAS TO GARNER INSIGHT FROM THOSE MEMBERS OF THE COMMUNITY THAT ARE DIRECTLY INVOLVED IN THE CARE AND WELLBEING OF BOTH THE COMMUNITY AND ITS RESIDENTS. KEY INFORMANTS WERE ASKED SEVERAL SUBJECTIVE QUESTIONS. ANSWERS VARIED BASED ON THE PARTICIPANT'S OCCUPATION/ROLE IN THE COMMUNITY. THOUGH THERE WAS A LARGE VARIANCE IN ANSWERS, FOUR BARRIERS EMERGED AMONG THE RESPONDENTS: ACCESS TO TRANSPORTATION, LACK OF EMPLOYMENT OPPORTUNITIES, LOW INCOME, AND LANGUAGE BARRIERS. WHEN ASKED TO RATE HEALTH AND QUALITY OF LIFE IN HARVARD, TWO-THIRDS OF THE RESPONDENTS GENERALLY AGREED THAT THE HEALTH AND QUALITY OF LIFE HAS STAYED THE SAME OR IMPROVED, WHICH THEY ATTRIBUTED TO THE CRITICAL ACCESS HOSPITAL AND NEW INITIATIVES MADE BY THE NEW MAYOR AND OTHER NEW COMMUNITY LEADERS WITHIN THE SCHOOL DISTRICT.IN ADDITION TO THE DATA GATHERED, MHC/MHH ANALYZED DEMOGRAPHIC, SOCIOECONOMIC AND HEALTH-RELATED DATA FROM A VARIETY OF PUBLICLY AVAILABLE SOURCES, INCLUDING THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH, THE UNITED STATES CENSUS BUREAU, AND THE CENTER FOR DISEASE CONTROL'S COUNTY HEALTH RANKINGS. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS AND KEY INFORMANT SURVEYS, PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF MCHENRY COUNTY AND SPECIFICALLY, THE HARVARD, ILLINOIS COMMUNITY. |
| MERCY HARVARD HOSPITAL | PART V, SECTION B, LINE 6B: MERCY HARVARD HOSPITAL WORKED WITH ITS AFFILIATED ORGANIZATION: MERCY HEALTH SYSTEM CORPORATION. MERCY HEALTH SYSTEM HAS CLINIC FACILITIES IN AND AROUND MCHENRY COUNTY. |
| MERCY HARVARD HOSPITAL | PART V, SECTION B, LINE 11: THE 2019 HEALTHY COMMUNITY STUDY INCLUDED ANALYSIS OF VARIOUS EXTANT DATA RELATED TO DEMOGRAPHICS, SOCIAL AND ECONOMIC FACTORS, PHYSICAL ENVIRONMENT, CLINICAL CARE, HEALTHY BEHAVIORS, AND HEALTH OUTCOMES. IN ADDITION, THE SURVEY TOOL TARGETED THE FOLLOWING HEALTH RELATED AREAS: HEALTH ISSUES IN THE COMMUNITY; UNHEALTHY BEHAVIORS IN THE COMMUNITY; WELL-BEING; ACCESSIBILITY TO CARE; AND HEALTHY BEHAVIORS. IN THE ANALYSIS, SOME DEMOGRAPHIC AND SOCIAL AND ECONOMIC DEFICITS WERE REVEALED. SPECIFICALLY, THE LOCAL COMMUNITY SHOWED DEFICITS AROUND MEDIAN INCOME, UNEMPLOYMENT AND POVERTY PERCENTAGES AS COMPARED TO THE STATE AND TO THE US. IN ADDITION, THE DATA REVEALED DEFICITS IN EDUCATIONAL ATTAINMENT RATES AROUND COLLEGE DIPLOMA RATES AS COMPARED TO THE STATE. WHILE THESE ARE CRUCIAL AREAS THAT NEED TO BE ADDRESSED BY THE COMMUNITY, MANY OTHER ORGANIZATIONS ARE MORE KNOWLEDGEABLE AND BETTER EQUIPPED TO DEVELOP STRATEGIES TO IMPROVE THESE AREAS. MERCYHEALTH HAS AND CONTINUES TO FOCUS ON HOW TO AFFECT THE GENERAL HEALTH OF THE POPULATION BY IMPROVING PATIENT ACCESS TO HEALTHCARE SERVICES, PROMOTING HEALTHY LIFESTYLES AND WELLNESS THROUGH COMMUNITY EDUCATION AND SCREENINGS, IDENTIFYING AND INCREASING THE NUMBER OF PROVIDERS AND SPECIALTIES THAT ARE OFFERED LOCALLY AND PROACTIVELY ADDRESSING INDIVIDUALS' CHRONIC DISEASE CONDITIONS. IN ADDITION, MERCYHEALTH SUPPORTS THE INDIGENT BY PROVIDING VARIOUS VOLUNTEER AND MONETARY DONATIONS TO SUPPORT LOCAL ORGANIZATIONS AND PARTNERS WITH LOCAL ORGANIZATIONS SUCH AS THE COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS HARVARD CLINIC TO OFFER LOW COST AND FREE MEDICAL SERVICES TO THOSE IN NEED.CONSISTENT WITH THE MCHENRY COUNTY COMMUNITY NEEDS ASSESSMENT ACTION PLAN, MERCY ROLLED OUT ITS IMPLEMENTATION PLAN: IMPROVING THE GENERAL HEALTH OF INDIVIDUALS; IMPROVING THE HEALTH STATUS OF INDIVIDUALS WITH CHRONIC ILLNESSES AND PROMOTING HEALTHY LIFESTYLES THROUGH EDUCATIONAL OFFERINGS; IMPROVING THE HEALTH OF PATIENTS WITH SPECIFIC NEEDS, INCLUDING MENTAL HEALTH, SUBSTANCE ABUSE, AND GERIATRIC HEALTH NEEDS.FINALLY IN THE AREA OF SCREENINGS, MERCY PARTNERS WITH COMMUNITY AGENCIES AND MERCY STAFF TO OFFER SCREENINGS AT HEALTH FAIRS, MERCY SPONSORED EVENTS, AND THROUGH FREE AND SLIDING FEE SCALE PRIMARY CLINICS IN MCHENRY COUNTY.IN RESPONSE TO COVID-19 AND TO EFFECTIVELY CARE FOR THE NEEDS OF THE COMMUNITY, MERCY HARVARD HOSPITAL PROVIDED ALTERNATIVE EDUCATION TO EMERGENCY MEDICAL SERVICE (EMS) PERSONNEL FOR ENHANCED SAFETY AND TREATMENT PROTOCOLS. MERCY EXPANDED TELEMEDICINE SERVICES TO INCREASE VIRTUAL ACCESS FOR OUR PATIENTS AND ALLOW EMS CREWS TO BE AVAILABLE FOR THOSE WITH CRITICAL ILLNESSES. MERCY HARVARD HOSPITAL PROVIDED COMMUNITY EDUCATION VIDEOS ADDRESSING COVID-19 QUESTIONS AND CONCERNS ALONG WITH HOW TO SAFELY WEAR A MASK.MERCY HARVARD HOSPITAL PARTNERS WITH MULTIPLE COMMUNITY BASED ORGANIZATIONS IN MCHENRY COUNTY TO ACCOMPLISH SUCCESSFUL IMPLEMENTATION OF THESE STRATEGIES. DURING THE COURSE OF THIS TAX YEAR 2020 (FISCAL YEAR JULY 1, 2020-JUNE 30, 2021), AND THE PRIOR TAX YEARS, MERCY HARVARD HOSPITAL PARTICIPATED IN NUMEROUS COMMUNITY HEALTH FAIRS, PROVIDED FREE SCREENINGS AT OUR CLINICS AND IN CONJUNCTION WITH COMMUNITY-BASED ORGANIZATIONS, OFFERED SCREENINGS TO FREE AND SLIDING FEE SCHEDULE PRIMARY CARE CLINICS, AND SCHOOL DISTRICTS IN MCHENRY COUNTY. MERCY HARVARD HOSPITAL ALSO PROVIDES FINANCIAL INCENTIVES FOR THEIR EMPLOYEES TO PARTICIPATE IN SMOKING CESSATION PROGRAMS. ALL OF THESE EFFORTS ARE SUPPORTED THROUGH BROAD BASED MARKETING AND ADVERTISING PROGRAMS DIRECTED TO AUDIENCES IN THE COUNTY PROMOTING THESE PROGRAMS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - MERCYHEALTH CARE CENTER | ||||
| 901 GRANT STREET | HARVARD | IL | 60033 | NURSING HOME FACILITY |
| 2 - MERCY HARVARD HOSPITAL CLINIC | ||||
| 1001 GRANT STREET | HARVARD | IL | 60033 | PHYSICIAN CLINIC |
| 3 - MERCY HARVARD REHAB AND FITNESS CENTER | ||||
| 1000 N HAYES STREET | HARVARD | IL | 60033 | REHABILITATION CENTER |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HOSPITAL OFFERS A 25% SELF-PAY DISCOUNT TO ALL UNINSURED PATIENTS ON ALL MEDICALLY NECESSARY SERVICES. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE FOLLOWING: INDIVIDUAL OR HOUSEHOLD INCOME, INDIVIDUAL OR HOUSEHOLD ASSETS, HOUSEHOLD SIZE, AND OTHER SOURCES OF PAYMENT FOR SERVICES. THE AMOUNT OF ASSISTANCE IS BASED ON THE PATIENT'S ABILITY TO PAY AND THE SIZE OF THEIR OUTSTANDING BALANCE. IF PATIENT INCOME AND HOUSEHOLD ASSETS ARE LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES, THEN MERCY WILL COVER 100% OF THEIR OUTSTANDING BALANCE. IF THE PATIENT'S INCOME AND HOUSEHOLD ASSETS FALL BETWEEN 200% AND 300% OF THE FEDERAL POVERTY GUIDELINES, THEN A PATIENT'S REMAINING BALANCE CAN BE REDUCED AS MUCH AS 90% AND PAYMENT ARRANGEMENTS CAN BE EXTENDED FOR AS LONG AS TWENTY-FOUR (24) MONTHS OR LONGER IF THERE ARE EXTENUATING CIRCUMSTANCES. |
| PART I, LINE 6A: | MERCY HEALTH SYSTEM CORP., A RELATED ORGANIZATION OF MERCY HARVARD HOSPITAL, PREPARED A COMMUNITY BENEFIT REPORT. |
| PART I, LINE 7: | A COST-TO-CHARGE RATIO METHODOLOGY WAS USED TO DETERMINE COSTS ASSOCIATED WITH CHARITY CARE, UNREIMBURSED MEDICAID, AND OTHER MEANS TESTED GOVERNMENT PROGRAMS. THE COST-TO-CHARGE RATIO WAS DERIVED FROM IRS WORKSHEET 2: RATIO OF PATIENT CARE COST-TO CHARGE. THE COST OF THE OTHER BENEFITS REFERENCED IN THE TABLE OF LINE 7 (COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS; SUBSIDIZED HEALTH SERVICES; CASH AND IN-KIND CONTRIBUTIONS) WERE DETERMINED USING ACTUAL DEPARTMENT/SERVICE SPECIFIC DATA AND /OR COST ACCOUNTING DERIVED DATA. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE OF $4,403,259 INCLUDED ON FORM 990, WAS EXCLUDED FROM EXPENSES WHEN CALCULATING THE PERCENTAGE IN THIS COLUMN. |
| PART I, LINE 5B: | ACTUAL REVENUE WAS HIGHER THAN BUDGETED, AND AS SUCH THE ANTICIPATED CHARITY IMPACT WOULD BE HIGHER. THE ORGANIZATION STILL PROVIDED CARE REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. |
| PART III, LINE 2: | THE COST OF BAD DEBT EXPENSE WAS DETERMINED BY APPLYING THE COST-TO-CHARGE RATIO TO THOSE CHARGES ESTIMATED AND EXPENSED AS UNCOLLECTIBLE. |
| PART III, LINE 3: | THE ESTIMATE OF BAD DEBT DOLLARS THAT MAY HAVE BEEN COVERED THROUGH MERCY HARVARD HOSPITAL'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 20.2%. THIS FIGURE WAS BASED ON THE PERCENT OF BAD DEBT ACCOUNT DOLLARS THAT ARE RECLASSIFIED FOR CHARITY AND/OR BANKRUPTCY PURPOSES. |
| PART III, LINE 4: | BAD DEBT EXPENSE IS ACCOUNTED FOR IN THE FOLLOWING MANNER (AS DETAILED IN NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH CORPORATION, INC. MERCY HEALTH CORPORATION, INC. IS THE PARENT COMPANY OF MERCY HARVARD HOSPITAL.PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE CORPORATION ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE CORPORATION ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENT, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.CONSISTENT WITH THE CORPORATION'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE CORPORATION HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE CORPORATION EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. THE CORPORATION'S POLICY IS TO PROVIDE A DISCOUNT FROM ESTABLISHED CHARGES TO UNINSURED PATIENTS. THIS POLICY DID NOT CHANGE IN 2021 AND 2020.THE CORPORATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. |
| PART III, LINE 8: | DATA FOR LINES 5 & 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MERCY HARVARD HOSPITAL'S MEDICARE COST REPORT. |
| PART III, LINE 9B: | PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MERCY HARVARD HOSPITAL'S (MHH) COMMUNITY CARE PROGRAM, WILL RECEIVE A 25% DISCOUNT FROM MHH'S STANDARD FEE SCHEDULE. ALL SELF-PAY PATIENTS MEET WITH PATIENT FINANCIAL COUNSELORS AND DISCUSS PAYMENT OPTIONS INCLUDING MHH'S COMMUNITY CARE PROGRAM. PATIENTS MUST APPLY FOR COMMUNITY CARE AND SUPPLY MERCY WITH THE NECESSARY FINANCIAL AND OTHER INFORMATION REQUIRED. PATIENTS WHO QUALIFY FOR COMMUNITY CARE BENEFITS WILL RECEIVE A REDUCTION IN THE BALANCE OWED, EXTENDED PAYMENT TERMS, OR BOTH. THE AMOUNT OF THE COMMUNITY CARE BENEFIT WILL BE BASED ON THE PATIENT'S ABILITY TO PAY AND THE SIZE OF THE OUTSTANDING BALANCE. |
| PART VI, LINE 2: | THE HOSPITALS OF MERCYHEALTH CORPORATION, INC. WORK IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF ROCK (WI), WALWORTH (WI), MCHENRY (IL) AND WINNEBAGO (IL) COUNTIES TO COMPLETE. COLLABORATIVE EXAMPLES OF MERCYHEALTH ORGANIZATIONS PROVIDING CARE TO THE COMMUNITY INCLUDE (BUT AREN'T LIMITED TO): I) THE COMMUNITY HEALTH CENTER AT MERCY CLINIC SOUTH: PARTNERSHIP WITH THE COMMUNITY HEALTH CENTER, INC. OF BELOIT, WI IN 2006. MERCY PARTNERED WITH COMMUNITY HEALTH CENTER, INC TO OPEN THIS CLINIC IN JANESVILLE. IT PROVIDES FREE AND LOW-COST CARE TO LOW-INCOME, UNINSURED AND UNDERINSURED PATIENTS. II) RONALD MCDONALD CARE MOBILE PROVIDES FREE DENTAL AND MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN IN FIVE NORTHERN ILLINOIS COUNTIES. SINCE ITS INCEPTION IN 2003, IT HAS PROVIDED CARE TO MORE THAN 7,500 CHILDREN. THE CARE MOBILE IS COMPLETELY FUNDED BY PHILANTHROPY FROM THE MERCYHEALTH DEVELOPMENT FOUNDATION, JAVON BEA HOSPITAL AUXILIARY, AND THE RONALD MCDONALD CHARITIES OF MADISON. III) HEALTHNET FREE CLINIC IN JANESVILLE; FAMILY HEALTH PARTNERSHIP CLINIC AND WELL CHILD CLINIC IN WOODSTOCK, IL; HARVARD FREE CLINIC IN MCHENRY COUNTY, IL; AND THE BRIDGE CLINIC OF ROCKFORD, IL., ARE SOME OF THE VENUES FOR UNINSURED OR UNDERINSURED INDIVIDUALS TO RECEIVE CARE. MANY MERCY PHYSICIANS AND OTHER HEALTH CARE PROVIDERS VOLUNTEER THEIR SERVICES. IV) FAMILY HEALTH PARTNERSHIP CLINIC: MCHENRY COUNTY DEPARTMENT OF HEALTH COLLABORATION TO PROVIDE MAMMOGRAMS AT MERCY FACILITIES FOR WOMEN WHO CANNOT OTHERWISE AFFORD THE SERVICE. JAVON BEA HOSPITAL CONTINUES TO PARTNER WITH A SILVER LINING FOUNDATION TO PROVIDE SCREENING MAMMOGRAMS AND OTHER BREAST RELATED SERVICES. V) RED CROSS: BLOOD DRIVE AND COOPERATIVE VOLUNTEER EFFORTS. VI) UNITED WAY: FUNDRAISING CAMPAIGN VII) AREA POLICE AND FIRE DEPARTMENTS: PROVIDE FREE OR REDUCED-COST PARAMEDIC/EMT EDUCATIONAL OPPORTUNITIES. VIII) EMPLOYEE PARTICIPATION ON COMMUNITY BOARDS. AN EXAMPLE: COMMUNITY ACTION, INC. (A NOT-FOR-PROFIT ORGANIZATION OFFERING PROGRAMS TO FIGHT POVERTY IN ROCK AND WALWORTH COUNTIES.) |
| PART VI, LINE 3: | ALL UNINSURED PATIENTS ARE NOTIFIED OF MERCY'S FINANCIAL AIDE POLICY UPON REGISTRATION. INFORMATION IS ALSO AVAILABLE AT THE HEALTH SYSTEM'S WEBSITE, IN OUR EMERGENCY ROOMS, MEDICAL LABS, ADMITTING DEPARTMENTS, OUTPATIENT RADIOLOGY, REGISTRATION DESKS, PATIENT FINANCIAL SERVICES OFFICES, AND WITH THE PATIENT FINANCIAL COUNSELORS. APPROPRIATE PERSONNEL HAVE BEEN TRAINED ON HOW TO INTERACT WITH PATIENTS ABOUT FINANCIAL AID AVAILABILITY, AND HOW TO DIRECT PATIENTS TO APPROPRIATE FINANCIAL AID STAFF. THE HOSPITALS HAVE TRANSLATION SERVICES AVAILABLE AS NEEDED. |
| PART VI, LINE 4: | MERCY HARVARD HOSPITAL IS LOCATED IN MCHENRY COUNTY, ILLINOIS. IT IS LICENSED FOR 25 ACUTE AND 45 LONG TERM CARE BEDS. IT IS A CRITICAL ACCESS HOSPITAL WITH 24/7 EMERGENCY SERVICES AND OUTPATIENT SURGERY. SINCE 2003 AND ITS AFFILIATION WITH MERCY HEALTH SYSTEM CORP., MERCY HARVARD HOSPITAL HAS BEEN ABLE TO PROVIDE A NEW LEVEL OF CARE AND MORE MEDICAL SPECIALTIES.MEDIAN HOUSEHOLD INCOME IN HARVARD WAS $52,585 (2017), WHICH WAS LOWER THAN BOTH THE COUNTY AND STATE MEDIANS OF $82,230 AND $61,229, RESPECTIVELY. IN 2017, HARVARD HAD A GREATER PROPORTION OF RESIDENTS WHO WERE UNEMPLOYED AT 8.4%, COMPARED TO THE COUNTY, STATE AND NATIONAL RATES. APPROXIMATELY 13.2% OF HARVARD RESIDENTS HAD EARNINGS BELOW THE POVERTY LEVEL IN 2019. THIS PROPORTION EXCEEDS BOTH THE COUNTY (5.9%) AND STATE (12.1%) RATES. THE HOSPITAL'S PAYOR DEMOGRAPHICS INCLUDE 41.80% MEDICARE, AND 15.94% MEDICAID FOR THE FISCAL YEAR OF JULY 1, 2020 - JUNE 30, 2021 (AS DETERMINED BY CHARGES BILLED). |
| PART VI, LINE 5: | MERCY HARVARD HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. MERCY HARVARD HOSPITAL HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY. |
| PART VI, LINE 6: | MERCY HARVARD HOSPITAL PROVIDES ACUTE CARE SERVICES IN MCHENRY COUNTY, ILLINOIS. IT IS PART OF A LARGER INTEGRATED HEALTHCARE SYSTEM AND IS AFFILIATED WITH OTHER SEPARATELY REPORTED ORGANIZATIONS. MERCY HEALTH CORPORATION IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORPORATION, MERCY ASSISTED CARE INC., AND MERCY HARVARD HOSPITAL, INC., ALONG WITH JAVON BEA HOSPITAL (ROCKFORD), ROCKFORD HEALTH PHYSICIANS, AND MERCYHEALTH VISITING NURSES ASSOCIATION. MERCY HEALTH SYSTEM CORPORATION OPERATES TWO HOSPITALS AND HAS COMMUNITY CLINICS LOCATED THROUGHOUT SIX COUNTIES OF WISCONSIN AND ILLINOIS. MERCY ASSISTED CARE PROVIDES HOME HEALTH SERVICES, HOSPICE, AND DME (DURABLE MEDICAL EQUIPMENT) SERVICES; THUS PROVIDING CONTINUATION OF CARE TO MERCY HEALTH SYSTEM PATIENTS AND THE COMMUNITY AS A WHOLE. JAVON BEA HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO RESIDENTS OF ROCKFORD, ILLINOIS AND THE SURROUNDING COMMUNITIES. THE ROCKFORD HEALTH PHYSICIANS PROVIDE PHYSICIAN AND AMBULATORY CARE SERVICES AT SEVERAL ILLINOIS SITES.MERCY HEALTH SYSTEM CORP. WORKS WITH THE MERCYHEALTH DEVELOPMENT FOUNDATION, INC. TO OPERATE A HOMELESS SHELTER IN JANESVILLE, WI: THE HOUSE OF MERCY HOMELESS CENTER PROVIDES SHELTER, SUPPORT, AND TRAINING TO WOMEN, CHILDREN, AND FAMILIES TO HELP FIGHT HOMELESSNESS. IT OPENED IN 1996, AND NOW SHELTERS AN AVERAGE OF 243 INDIVIDUALS PER YEAR, BASED ON THE PRIOR THREE YEARS.MERCY HOSPITAL ASSOCIATION OF VOLUNTEERS, INC. IS THE ORGANIZATION/TAX ENTITY OF MERCY'S VOLUNTEERS. VOLUNTEERS NUMBERED 905 IN CALENDAR YEAR 2020; THOUGH MANY WERE FURLOUGHED DUE TO COVID. THIS ORGANIZATION NOT ONLY SUPPORTS MERCY'S SERVICES, BUT PROVIDES BENEFITS TO THE COMMUNITY AS A WHOLE. IN CONJUNCTION WITH MERCY HEALTH SYSTEM'S MEAL PREPARATION, THE VOLUNTEERS PARTICIPATE IN AND OVERSEE A MEALS-ON-WHEELS PROGRAM: PARTICIPANT/NUTRITION SPECIFIC MEALS ARE PREPARED AND DELIVERED TO THE ELDERLY NEEDING ASSISTANCE IN JANESVILLE. THE VOLUNTEER ASSOCIATION RUNS A HOSPITALITY HOUSE IN WHICH FAMILY MEMBERS OF PATIENTS ARE OFFERED FREE HOUSING DURING THEIR LOVED ONES EXTENDED HOSPITAL STAY AND REHABILITATION. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAVON R BEA | ||||||||||||||
| PRESIDENT & CEO (SEE PAGES 57-60) | $0 | $1,471,858 | $0 | $0 | $0 | $3,586,128 | $0 | $7,056,412 | $0 | $17,748 | $0 | $12,132,146 | $0 | $0 |
| TODD ANDERSON | ||||||||||||||
| VICE PRESIDENT/CFO (AS OF 05/2020) | $0 | $355,005 | $0 | $182,313 | $0 | $5,540 | $0 | $0 | $0 | $18,158 | $0 | $561,016 | $0 | $0 |
| MARK L GOELZER MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | $0 | $355,312 | $0 | $142,289 | $0 | $4,364 | $0 | $11,400 | $0 | $17,748 | $0 | $531,113 | $0 | $0 |
| SHANNON DUNPHY-ALEXANDER | ||||||||||||||
| SR EXECUTIVE DIRECTOR | $0 | $237,151 | $0 | $75,861 | $0 | $229 | $0 | $11,400 | $0 | $4,517 | $0 | $329,158 | $0 | $0 |
| KIMBERLY SCACCIA | ||||||||||||||
| VP - REVENUE CYCLE (EFF. 03/2020) | $0 | $227,500 | $0 | $67,625 | $0 | $3,966 | $0 | $0 | $0 | $21,962 | $0 | $321,053 | $0 | $0 |
| PAUL VAN DEN HEUVEL FORMER | ||||||||||||||
| VICE PRESIDENT (THROUGH 04/2020) | $0 | $141,873 | $0 | $66,244 | $0 | $32,741 | $0 | $17,847 | $0 | $9,710 | $0 | $268,415 | $0 | $0 |
| TIMOTHY ALLEN AUBRY | ||||||||||||||
| PHARMACIST TEAM LEAD | $148,553 | $0 | $0 | $0 | $16,993 | $0 | $0 | $0 | $17,960 | $0 | $183,506 | $0 | $0 | $0 |
| THERESA GAYLE HOLLINGER | ||||||||||||||
| DIRECTOR | $149,295 | $0 | $0 | $0 | $8,748 | $0 | $0 | $0 | $25,306 | $0 | $183,349 | $0 | $0 | $0 |
| BRENDA BOTE-CATACUN | ||||||||||||||
| RN HOSPITAL 1 | $129,266 | $0 | $0 | $0 | $5,674 | $0 | $0 | $0 | $32,573 | $0 | $167,513 | $0 | $0 | $0 |
| KHRISTINE M SCHRADER | ||||||||||||||
| RN SHIFT COORDINATOR | $114,560 | $0 | $0 | $0 | $26,000 | $0 | $0 | $0 | $22,873 | $0 | $163,433 | $0 | $0 | $0 |
| SUSAN F TOWNE | ||||||||||||||
| ULTRASOUND RADIOGRAPHER 3 | $130,835 | $0 | $0 | $0 | $10,229 | $0 | $0 | $0 | $9,382 | $0 | $150,446 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2020. |
| PART I, LINES 4A-B | PAUL VAN DEN HEUVEL RECEIVED SEVERANCE OF $27,693 IN 2020 FROM MERCY HEALTH SYSTEM CORPORATION, A RELATED ORGANIZATION. INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $2,627,335. |
| 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 $3.3 BILLION IN FY2021. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 2.1 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,300+ 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | 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 THREE 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 HARVARD HOSPITAL, INC. (MHH). 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 2021, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2020 CONFLICTS IDENTIFIED. MHC AND MHH 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. |
| FORM 990, PART IX, LINE 11G | OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 447,205. MANAGEMENT AND GENERAL EXPENSES 236,899. TOTAL EXPENSES 684,104. PHYSICIAN LOCUM SERVICES: PROGRAM SERVICE EXPENSES 3,005,632. TOTAL EXPENSES 3,005,632. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 ASSISTED CARE INC | |||||||||||
| 901 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 391035110 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | 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 | 0 | N/A | |
| 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 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |||||||||||||
| INSURANCE | N/A | C | 0 | WELLESLEY HOUSE SO 2ND FL | PEMBROKE HM | BD | BD | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |