2016-05-10T14:41:55-05:00 2015-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2014-07-01 390816848 MERCY HEALTH SYSTEM CORPORATION MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 JAVON BEA CEO 6087566000 2016-05-09 1 BRADLEY S MCGUIRE CPA P00643763 6087525835 2016-05-09 X 2014 2016-08-17 19:52:53Z JAVON BEA PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 540200479 0 X WWW.MERCYHEALTHSYSTEM.ORG X 1972 WI THE MISSION OF MERCY HEALTH SYSTEM IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES RESULTING IN HEALING IN THE BROADEST SENSE. 10 7 3876 0 10543700 0 263821 211005 515758827 540911259 293559 1387588 2856252 -4058585 519172459 538451267 0 0 0 0 297341530 310745853 0 0 0 206767003 211011871 504108533 521757724 15063926 16693543 497525602 515850817 303051697 309395101 194473905 206455716 X THE MISSION OF MERCY HEALTH SYSTEM IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES RESULTING IN HEALING IN THE BROADEST SENSE. 0 0 417872148 529080363 HOSPITAL DISCHARGES 8,600, NURSING HOME ADMISSIONS 294, BIRTHS 1,055, OUTPATIENT VISITS 1,215,194MERCY HEALTH SYSTEM CONTINUES ITS TRADITION OF GIVING BACK TO EACH OF THE COMMUNITIES WE SERVE IN A WIDE VARIETY OF FASHIONS. ONE OF THE LARGER AREAS OF CONTRIBUTION IS IN THE AREA OF PUBLIC HEALTH SERVICES. THIS INCLUDES EXTENSIVE DONATIONS OF TIME AND SUPPLIES TO HEALTHNET OF ROCK COUNTY, A LARGE FREE PRIMARY CARE CLINIC SERVING THE REGION. MORE THAN EIGHTY PERCENT OF THE PHYSICIAN SERVICES PROVIDED AT THE CLINIC ARE SUPPLIED THROUGH MERCY HEALTH SYSTEM. WE HAVE A SIMILAR COMMITMENT TO OPEN ARMS FREE CLINIC THAT SERVICES LOW INCOME RESIDENTS IN WALWORTH COUNTY. ADDITIONALLY, WE PROVIDE HEALTH SCREENING AND RELATED SERVICES AT NUMEROUS EVENTS IN ROCK AND WALWORTH COUNTIES IN WISCONSIN AND MCHENRY COUNTY IN ILLINOIS.MERCY ALSO PROVIDES FINANCIAL AND IN KIND CONTRIBUTIONS TO OTHER PRIVATE NOT FOR PROFIT HEALTH RELATED AGENCIES AND ORGANIZATION IN OUR SERVICE AREA. BENEFICIARIES INCLUDED BUT ARE NOT LIMITED TO THE AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, UNITED WAY ORGANIZATIONS IN ROCK, WALWORTH, AND MCHENRY COUNTIES, YWCA CARE HOUSE, YMCA, AMERICAN LUNG ASSOCIATION, WALWORTH COUNTY ALLIANCE FOR CHILDREN, TURNING POINT WOMEN'S CENTER IN MCHENRY, OPEN ARMS FREE CLINIC, AND THE RED CROSS, TO NAME JUST A FEW RECIPIENTS.MERCY ALSO ENCOURAGES ITS PARTNERS (EMPLOYEES) TO DONATE THEIR TIME AND ENERGY TO SUPPORT A WHOLE HOST OF COMMUNITY BASED CAUSES. THOUSANDS OF HOURS EACH YEAR ARE DONATED TO NOT FOR PROFIT AND PUBLIC AGENCIES THROUGHOUT OUR SERVICE AREA. EXAMPLES OF VOLUNTEER ACTIVITIES BEING SUPPORTED INCLUDE NURSING SERVICES AT COMMUNITY AND FREE CLINICS THROUGHOUT THE REGION, MEALS ON WHEELS DELIVERY ACTIVITIES, ACTIVE INVOLVEMENT AS GOVERNING BOARD MEMBERS FOR SUCH ORGANIZATIONS AS UNITED WAY, CRIME STOPPERS, ROTARY BOTANICAL GARDENS, HEALTHNET, AND MANY OTHER ORGANIZATIONS.ANOTHER EXAMPLE OF MERCY'S COMMITMENT TO COMMUNITY IS ITS SUPPORT OF THE OPERATIONS THROUGH OFFERING SAFE RESIDENCE TO HOMELESS WOMEN AND THEIR CHILDREN AT THE HOUSE OF MERCY HOMELESS CENTER. SINCE ITS OPENING IN 1996, THE CENTER HAS SERVED MORE THAN 5500 PERSONS, MOST OF WHOM ARE UNDER THE AGE OF 18 AT THE CENTER. THE CENTER OFFERS A SAFE HARBOR FOR THESE INDIVIDUALS AS WELL AS CASE MANAGEMENT, ASSISTANCE WITH JOB SEARCHES, FINDING PERMANENT HOUSING AND EDUCATION. 417872148 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 402 0 1 3876 1 1 1 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IL WI X JOHN COOK 6087566642 1000 MINERAL POINT JANESVILLE WI 535475003 ROWLAND MCCLELLAN CHAIRPERSON & DIRECTOR 1.00 X 0 0 0 THOMAS POOL VICE-CHAIRPERSON & DIRECTO 1.00 X 19500 0 0 LARRY SQUIRE TREASURER & DIRECTOR 1.00 X 2333 0 0 ELIZABETH HANSCH DIRECTOR 1.00 X 0 0 0 DAVE SYVERSON DIRECTOR 1.00 X 15000 0 0 MARK GOELZER MD DIRECTOR/PHYSICIAN 55.00 X 457757 0 31022 KATHERINE SCHACK DIRECTOR 1.00 X 664 0 0 MARK KOPP DIRECTOR 1.00 X 1735 0 0 DENNIS UEHARA DIRECTOR 1.00 55.00 X 0 0 0 CURTIS WORDEN DIRECTOR 1.00 X 0 0 0 BARB BORTNER VICE-PRESIDENT 55.00 X 216651 0 36963 DAN COLBY VICE-PRESIDENT 55.00 X 273892 0 30198 DAVID KURTZ VICE-PRESIDENT 55.00 X 254723 0 27222 JOHN COOK VICE-PRESIDENT 55.00 X 414941 0 39695 KATHLEEN HARRIS VICE-PRESIDENT 55.00 X 146755 0 30816 RUTH YARBROUGH VICE-PRESIDENT 55.00 X 272996 0 24986 RICHARD GRUBER VICE-PRESIDENT 55.00 X 225377 0 30391 E PATRICK CRANLEY VICE-PRESIDENT 55.00 X 13288 0 0 JOANNA BENNING VICE-PRESIDENT 55.00 X 0 0 0 JOSEPH NEMETH VICE-PRESIDENT 55.00 X 229563 0 28952 SUE RIPSCH VICE-PRESIDENT 55.00 X 408512 0 34595 JENNIFER HALLATT VICE-PRESIDENT 1.00 X 240824 0 41637 PAUL VAN DEN HEUVEL VICE-PRESIDENT 1.00 X 321557 0 39065 JAVON BEA PRESIDENT & DIRECTOR 55.00 X X 8005192 0 38785 BRADLEY FIDELER PHYSICIAN 40.00 X 1389324 0 44924 MERLE RUST PHYSICIAN 40.00 X 1265325 0 44441 ROBB WHINNEY PHYSICIAN 40.00 X 1188907 0 34767 CRAIG LYON PHYSICIAN 40.00 X 1156541 0 40504 JONATHAN EHRHARDT PHYSICIAN 40.00 X 1097779 0 28328 17619136 0 627291 325 0 1 0 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 SOFTWARE/SYSTEM MAINTENANCE 3489643 MAGILL CONSTRUCTION COMPANY 977 KOOPMAN LANE ELKHORN WI 53121 CONSTRUCTION 2868447 HAYES LOCUMS LLC 6700 N ANDREWS AVE STE 600 FORT LAUDERDALE FL 33309 PHYSICIAN LOCUM 1907992 WALSH CONSTRUCTION COMPANY II LLC 929 WEST ADAMS CHICAGO IL 60607 CONSTRUCTION 1656452 CAMELOT RADIOLOGY ASSOCIATES 3849 N PERRYVILLE RD ROCKFORD IL 61114 PHYSICIAN SERVICES 1013916 49 119870 37794 53341 211005 PATIENT SERVICE REVENUE 621110 529080363 529080363 UNRELATED BUSINESS INCOME 561000 10543700 10543700 CAFETERIA 722210 1287196 1287196 540911259 1365279 1365279 1761394 10127 1748415 797 12979 9330 22309 22309 MISCELLANEOUS 900099 24601 24601 OTHER INVESTMENTS 900099 -4083186 -4083186 -4058585 538451267 529080363 10543700 -1383801 11465076 11465076 245123814 198971029 46152785 7804014 6259599 1544415 31897171 24086976 7810195 14455778 10776172 3679606 861718 861718 45100 45100 33035 33035 28536009 16003141 12532868 2922634 29538 2893096 89521539 84516705 5004834 1072397 364988 707409 8627984 7739906 888078 1087435 493135 594300 1504964 1082196 422768 9229088 8279138 949950 25883670 23197204 2686466 5248405 3682329 1566076 BAD DEBTS 23755339 23755339 EQUIPMENT REPAIRS & MAI 8069744 5360792 2708952 WI MEDICAID & OTHER TAX 7825864 7825864 INTER-ENTITY TRANSACTIO -7150979 -5527125 -1623854 3937925 975222 2962703 521757724 417872148 103885576 0 24990 26759 19975876 42527506 87097875 92564232 10737552 11486031 5824521 3631138 550894358 269989734 288590194 280904624 73661949 72290520 11612645 12420007 497525602 515850817 60162338 67931328 7104728 5942428 235784631 235521345 303051697 309395101 X 194473905 206455716 194473905 206455716 497525602 515850817 X 16693543 -1186128 -3525604 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27052591 27052591 303684416 117743138 185941278 5414556 4207254 1207302 201330721 142793763 58536958 13412074 5245579 8166495 280904624 INVEST. - FUTURE REPLACE OF PROP, PLANT & EQUIPMENT 32902139 C ASSETS UNDER BOND INDENTURE AGREEMENT 4355413 C DEFERRED COMPENSATION 12545681 C INVESTMENT IN MERCYCARE 17732416 C INVESTMENTS - OTHER 4754871 C 72290520 DEFERRED COMPENSATION 12545681 PENSION LIABILITY 23408000 CAPITAL LEASES PAYABLE 119500 DUE TO RELATED PARTY 198001399 DUE TO THIRD PARTIES 1446765 235521345 1 1 X 1 X 1 X 1 1 0 0 2594823 0 2594823 0.00520 145920882 98833216 47087666 0.09460 4736755 2818984 1917771 0.00390 153252460 101652200 51600260 0.10370 1588117 186781 1401336 0.00280 6205630 814443 5391187 0.01080 15993759 12329893 3663866 0.00740 0 0 0.00000 856316 0 856316 0.00170 24643822 13331117 11312705 0.02270 177896282 114983317 62912965 0.12640 54100 54100 0.00010 33290 33290 0.00010 20810 20810 0.00000 35370 35370 0.00010 143570 143570 0.00030 1 9065269 1571011 59026628 91163939 -32137311 X 1 1 2 1 MERCY HOSPITAL AND TRAUMA CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 X X X X 2 MERCY WALWORTH HOSPITAL AND MEDICAL CENT N2950 STATE ROAD 67 LAKE GENEVA WI 53147 X X X X MERCY HOSPITAL AND TRAUMA CENTER 1 0 0 1 X X X X X X X X 13 1 1 1 1 X MERCYHEALTHSYSTEM.ORG X 1 13 1 MERCYHEALTHSYSTEM.ORG 0 0 1 X 150.000000000000 300.000000000000 X X X X X X 1 1 X X X 1 X MERCYHEALTHSYSTEM.ORG X MERCYHEALTHSYSTEM.ORG X MERCYHEALTHSYSTEM.ORG X X X X 1 X 0 X X 1 X 0 0 MERCY WALWORTH HOSPITAL AND MEDICAL CENT 2 0 0 1 X X X X X X X X 13 1 1 1 1 X MERCYHEALTHSYSTEM.ORG X 1 13 1 MERCYHEALTHSYSTEM.ORG 0 0 1 X 150.000000000000 300.000000000000 X X X X X X 1 1 X X X 1 X MERCYHEALTHSYSTEM.ORG X MERCYHEALTHSYSTEM.ORG X MERCYHEALTHSYSTEM.ORG X X X X 1 X 0 X X 1 X 0 0 MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 5: MERCY HEALTH SYSTEM CORP (MHS) SET OUT TO GATHER INFORMATION ON THE COMMUNITY OF ROCK COUNTY, WISCONSIN. MHS COLLABORATED WITH BELOIT HEALTH SYSTEM, ROCK COUNTY HEALTH DEPARTMENT, UNIVERSITY OF WISCONSIN - EXTENSION ROCK COUNTY, ROCK COUNTY, HEALTHNET OF ROCK COUNTY, EDGERTON HOSPITAL AND HEALTH SERVICES, SSM HEALTHCARE OF WISCONSIN. THE GROUP GATHERED INFORMATION THROUGH HOUSEHOLD SURVEYS AND SECONDARY DATA SOURCES.MHS DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF ROCK COUNTY RESIDENTS. THE FIFTY QUESTION SURVEY WAS DISTRIBUTED TO 2,000 MEMBERS OF THE COMMUNITY AND COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. A RESPONSE WAS RECEIVED FROM 32.8% OF HOUSEHOLDS THAT RECEIVED THE SURVEY. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, MHS ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING WISCONSIN COUNTY HEALTH RANKINGS, WISCONSIN DEPARTMENT OF TRANSPORTATION, DEPARTMENT OF EDUCATION, WISCONSIN DEPARTMENT OF HEALTH SERVICES, U.S. CENSUS BUREAU, AND OTHERS. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF ROCK COUNTY AND THE COMMUNITY AS A WHOLE. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 5: MERCY HEALTH SYSTEM CORP (MHS) DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF WALWORTH COUNTY RESIDENTS. THE SURVEY, DISTRIBUTED TO 2000 MEMBERS OF THE COMMUNITY, COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. A RESPONSE WAS RECEIVED FROM 14.4% OF HOUSEHOLDS THAT RECEIVED THE SURVEY (288 SURVEYS). ONCE THE SURVEY RESPONSES WERE TABULATED, THE SURVEY RESULTS WERE EVALUATED AND ANALYZED FOR HEALTH AND DEMOGRAPHIC TRENDS. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, MHS ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTES COUNTY HEALTH RANKINGS, WISCONSIN DEPARTMENT OF PUBLIC HEALTH, AND THE UNITED STATES CENSUS BUREAU. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF WALWORTH COUNTY. MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 6A: BELOIT HEALTH SYSTEM, EDGERTON HOSPITAL AND HEALTH SERVICES, SSM HEALTHCARE OF WI MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 6A: AURORA LAKELAND MEDICAL CENTER MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 6B: ROCK COUNTY HEALTH DEPARTMENT, UNIVERSITY OF WISCONSIN - EXTENSION ROCK COUNTY, ROCK COUNTY, HEALTH NET OF ROCK COUNTY, ROCK COUNTY HEALTH DEPARTMENT MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 6B: DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS); PUBLIC HEALTH; MEDICAL COLLEGE OF WISCONSIN (WALWORTH COUNTY PUBLIC HEALTH STUDENT); DENTAL PERFECTIONS; DUNCAN MEDICATION & CONSULTING SERVICES LLC; ROCK-WALWORTH COMMUNITY ACTION; ST. BENEDICT CHURCH; UW-EXTENSION; GODFREY, LEIBSLE, BLACKBURN, & HOWARTH ; ELKHORN SCHOOLS; GATEWAY TECHNICAL COLLEGE; AURORA HEALTH CARE EAST TROY; COMMUNITY HEALTH SYSTEMS INC.; WALWORTH COUNTY JOB CENTER; FORT HEALTH CARE; ROCK-WALWORTH COMPREHENSIVE FAMILY SERVICES; UW-WHITEWATER; VIP SERVICES INC.; UNIV. HEALTH & COUNSELING CENTER; FAMILY LIVING EDUCATOR; UW-EXTENSION; PARENT CONNECTIONS-ELKHORN SCHOOL DISTRICT; LAKELAND ANIMAL SHELTER; FRANKLIN HEALTH DEPARTMENT; BENEFIT CONCEPTS INC.; AND SEAL A SMILE MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 11: CONSISTENT WITH THE ROCK AND WALWORTH COUNTY COMMUNITY NEEDS ASSESSMENT ACTION PLANS, MERCY CONTINUES TO ROLL OUT ITS IMPLEMENTATION PLANS. PROMOTING HYPERTENSION AWARENESS, SUPPORTING OBESITY EDUCATION AND SMOKING CESSATION PROGRAMS ARE PRIORITIES IN ROCK AND WALWORTH COUNTIES.MERCY PARTNERS WITH MULTIPLE COMMUNITY BASED ORGANIZATIONS IN ROCK AND WALWORTH COUNTY TO ACCOMPLISH SUCCESSFUL IMPLEMENTATION OF THESE STRATEGIES. DURING THE COURSE OF TAX YEAR 2014 (FISCAL YEAR JULY 1, 2014-JUNE 30, 2015), MERCY 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 BOTH COUNTIES. MERCY 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 BOTH COUNTIES PROMOTING THESE PROGRAMS.IN THE AREA OF OBJECTIVES RELATED TO MENTAL HEALTH CARE, AUTISM SUPPORT AND DECREASING SUBSTANCE ABUSE, MERCY CONTINUES TO ATTEMPT TO BUILD ADDITIONAL CAPACITY FOR OUTPATIENT THERAPY AND EDUCATION. MERCY HAS PARTNERED WITH A FOUNDATION IN WALWORTH COUNTY AND BEEN SUCCESSFUL IN GAINING GRANT-IN-AID FUNDING FROM A NEW YORK BASED FOUNDATION TO INCREASE AUTISM SUPPORT PROGRAMS FOR TRAINING, EDUCATION, AND EQUIPMENT AND SERVICES GRANTS TO PARENTS OF AUTISTIC CHILDREN IN ROCK AND WALWORTH COUNTIES. THESE OBJECTIVES ARE SCHEDULED FOR IMPLANTATION DURING TAX YEAR 2015 (FISCAL YEAR JULY 1, 2015 - JUNE 30, 2016) AND ARE BEING FURTHER ROLLED OUT.IN THE AREA OF DENTAL CARE, MONIES ARE BEING PROVIDED THROUGH GENERAL GRANTS AND SPONSORSHIPS TO THE REGIONAL FREE DENTAL CLINIC. 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 ROCK AND WALWORTH COUNTIES. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 11: CONSISTENT WITH THE ROCK AND WALWORTH COUNTY COMMUNITY NEEDS ASSESSMENT ACTION PLANS, MERCY CONTINUES TO ROLL OUT ITS IMPLEMENTATION PLANS. PROMOTING HYPERTENSION AWARENESS, SUPPORTING OBESITY EDUCATION AND SMOKING CESSATION PROGRAMS ARE PRIORITIES IN ROCK AND WALWORTH COUNTIES.MERCY PARTNERS WITH MULTIPLE COMMUNITY BASED ORGANIZATIONS IN ROCK AND WALWORTH COUNTY TO ACCOMPLISH SUCCESSFUL IMPLEMENTATION OF THESE STRATEGIES. DURING THE COURSE OF TAX YEAR 2014 (FISCAL YEAR JULY 1, 2014-JUNE 30, 2015), MERCY 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 BOTH COUNTIES. MERCY 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 BOTH COUNTIES PROMOTING THESE PROGRAMS.IN THE AREA OF OBJECTIVES RELATED TO MENTAL HEALTH CARE, AUTISM SUPPORT AND DECREASING SUBSTANCE ABUSE, MERCY CONTINUES TO ATTEMPT TO BUILD ADDITIONAL CAPACITY FOR OUTPATIENT THERAPY AND EDUCATION. MERCY HAS PARTNERED WITH A FOUNDATION IN WALWORTH COUNTY AND BEEN SUCCESSFUL IN GAINING GRANT-IN-AID FUNDING FROM A NEW YORK BASED FOUNDATION TO INCREASE AUTISM SUPPORT PROGRAMS FOR TRAINING, EDUCATION, AND EQUIPMENT AND SERVICES GRANTS TO PARENTS OF AUTISTIC CHILDREN IN ROCK AND WALWORTH COUNTIES. THESE OBJECTIVES ARE SCHEDULED FOR IMPLANTATION DURING TAX YEAR 2015 (FISCAL YEAR JULY 1, 2015 - JUNE 30, 2016) AND ARE BEING FURTHER ROLLED OUT.IN THE AREA OF DENTAL CARE, MONIES ARE BEING PROVIDED THROUGH GENERAL GRANTS AND SPONSORSHIPS TO THE REGIONAL FREE DENTAL CLINIC. 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 ROCK AND WALWORTH COUNTIES. MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 16I: AVAILABLE THROUGH PATIENT FINANCIAL COUNSELORS WHO DO PRE- OR POST-FOLLOW UP WITH SELF-PAY PATIENTS. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 16I: AVAILABLE THROUGH PATIENT FINANCIAL COUNSELORS WHO DO PRE- OR POST-FOLLOW UP WITH SELF-PAY PATIENTS. MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE AVERAGE COMMERCIAL CHARGE. MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE AVERAGE COMMERCIAL CHARGE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 16A WEBSITE: MERCYHEALTHSYSTEM.ORG MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 16B WEBSITE: MERCYHEALTHSYSTEM.ORG MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 16C WEBSITE: MERCYHEALTHSYSTEM.ORG MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 16A WEBSITE: MERCYHEALTHSYSTEM.ORG MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 16B WEBSITE: MERCYHEALTHSYSTEM.ORG MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 16C WEBSITE: MERCYHEALTHSYSTEM.ORG 51 MERCY MANOR TRANSITION CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 SKILLED NURSING/SUB-ACUTE CARE FACILITY MERCY REGIONAL CANCER CENTER 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 RADIATION ONCOLOGY CLINIC/RADIATION THERAPY FACILITY HOUSE OF MERCY HOMELESS SHELTER 320 LINCOLN STREET JANESVILLE WI 53548 HOMELESS CENTER MERCY ALGONQUIN MEDICAL CENTER 2401 HARNISH DRIVE SUITE 101 ALGONQUIN WI 60102 OUTPATIENT PHYSICIAN CLINIC MERCY BARIATRIC WELLNESS CENTER 250 E CENTER DRIVE SUITE 201 VERNON HILLS WI 60061 OUTPATIENT PHYSICIAN CLINIC MERCY BARRINGTON MEDICAL CENTER 500 WEST HIGHWAY 22 BARRINGTON WI 60010 OUTPATIENT PHYSICIAN CLINIC MERCY BELOIT MEDICAL CENTER 2825 PRAIRIE AVENUE BELOIT WI 53511 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY BRODHEAD MEDICAL CENTER 2310 FIRST CENTER AVENUE BRODHEAD WI 53520 OUTPATIENT PHYSICIAN CLINIC MERCY CENTER FOR CORRECTIVE EYE SURGERY 5400 W ELM STREET SUITE 120 MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC MERCY CENTER FOR CORRECTIVE EYE SURGERY 8780 W GOLF ROAD STE 304 NILES IL 60714 OUTPATIENT PHYSICIAN CLINIC MERCY CLINIC EAST 3524 EAST MILWAUKEE STREET JANESVILLE WI 53546 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY CLINIC EAST PHARMACY 3524 EAST MILWAUKEE STREET JANESVILLE WI 53546 RETAIL PHARMACY MERCY CLINIC SOUTH 849 KELLOGG AVENUE JANESVILLE WI 53546 RESIDENCY PROGRAM / OUTPATIENT PHYSICIAN CLINIC MERCY CLINIC WEST 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC & MEDICAL ONCOLOGY MERCY CLINIC WEST PHARMACY 1000 MINERAL POINT AVENUE JANESVILLE WI 53548 RETAIL PHARMACY MERCY CRYSTAL LAKE CHIROPRACTIC AND REHA 330 W TERRA COTTA ROAD RTE 176 CRYSTAL LAKE IL 60014 CHIROPRACTOR MERCY CRYSTAL LAKE MEDICAL CENTER EAST 390 CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY CRYSTAL LAKE MEDICAL CENTER WEST 350 CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY CRYSTAL LAKE OBGYN 750 E TERRA COTTA STE B CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY CRYSTAL LAKE MEDICAL CENTER SOUTH 415-A CONGRESS PARKWAY CRYSTAL LAKE IL 60014 OUTPATIENT PHYSICIAN CLINIC MERCY DELAVAN MEDICAL CENTER 1038 E GENEVA ST DELAVAN WI 53115 OUTPATIENT PHYSICIAN CLINIC MERCY EDGERTON MEDICAL CENTER 217 N MAIN STREET EDGERTON WI 53534 OUTPATIENT PHYSICIAN CLINIC MERCY EVANSVILLE MEDICAL CENTER 300 UNION STREET EVANSVILLE WI 53536 OUTPATIENT PHYSICIAN CLINIC MERCY HARVARD CLINIC SOUTH 348 S DIVISION HARVARD IL 60033 OUTPATIENT PHYSICIAN CLINIC MERCY HEALTH MALL 1010 NORTH WASHINGTON JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY HEALTH MALL PHARMACY 1010 NORTH WASHINGTON JANESVILLE WI 53548 RETAIL PHARMACY MERCY LAKE GENEVA MEDICAL CENTER 350 PELLER ROAD LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC MERCY LAKESIDE ORTHOPAEDICS 352 PELLER ROAD LAKE GENEVA WI 53147 OUTPATIENT PHYSICIAN CLINIC MERCY MCHENRY INTERNAL MEDICINE CENTER 633 RIDGEVIEW DRIVE MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC MERCY MCHENRY MEDICAL CENTER 3922 MERCY DRIVE MCHENRY IL 60050 OUTPATIENT PHYSICIAN CLINIC MERCY MILTON MEDICAL CENTER 725 SOUTH JANESVILLE STREET MILTON WI 53563 OUTPATIENT PHYSICIAN CLINIC MERCY MILTON PHARMACY 725 SOUTH JANESVILLE STREET MILTON WI 53563 RETAIL PHARMACY MERCY NORTHWEST WOMEN'S GROUP 47 WEST ACORN LANE LAKE IN THE HILLS IL 601564804 OUTPATIENT PHYSICIAN CLINIC MERCY OPTIONS-COOPERATIVE CHILDCARE INST 20 EAST COURT STREET JANESVILLE WI 53548 TREATMENT FACILITY FOR ADOLESCENTS MERCY OPTIONS-JANESVILLE 903 MINERAL POINT AVENUE JANESVILLE WI 53548 PHYSICIAN & THERAPIST SERVICES: MENTAL HEALTH & ADDICTION TREATMENT MERCY REGIONAL DIALYSIS CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 DIALYSIS CENTER MERCY REGIONAL LUNG CENTER 903 MINERAL POINT AVENUE JANESVILLE WI 53548 PHYSICIANS CLINIC & SLEEP DISORDER CENTER MERCY RICHMOND MEDICAL CENTER 9715 PRAIRIE RIDGE RICHMOND IL 60071 OUTPATIENT PHYSICIAN CLINIC MERCY SHARON MEDICAL CENTER 118 PLAIN STREET SHARON WI 53585 OUTPATIENT PHYSICIAN CLINIC MERCY SPORTS MEDICINE AND REHABILITATION 557 NORTH WASHINGTON JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC AND REHABILITATION FACILITY MERCY TERRACE 510 N TERRACE STREET JANESVILLE WI 53548 OUTPATIENT PHYSICIAN CLINIC MERCY WALWORTH PHARMACY N2950 STATE ROAD 67 LAKE GENEVA WI 53147 RETAIL PHARMACY MERCY WHITEWATER MEDICAL CENTER 507 WEST MAIN STREET WHITEWATER WI 53190 OUTPATIENT PHYSICIAN CLINIC MERCY WHITEWATER SPORTS MEDICINE & REHAB 519 WEST MAIN STREET WHITEWATER WI 53190 OUTPATIENT PHYSICIAN CLINIC AND REHABILITATION FACILITY MERCY WOODSTOCK MEDICAL CENTER 2000 LAKE AVENUE WOODSTOCK IL 60098 OUTPATIENT PHYSICIAN CLINIC/URGENT CARE FACILITY MERCY WOODSTOCK PHARMACY 2000 LAKE AVENUE WOODSTOCK IL 60098 RETAIL PHARMACY MERCY WOMEN'S HEALTHCARE CENTER - ALCONQ 2230 N HUNTINGTON DR ALGONQUIN IL 60102 OUTPATIENT PHYSICIAN CLINIC MERCY WOMEN'S HEALTHCARE CENTER - ELGIN 750 FLETCHER DR STE 206 ELGIN IL 60123 OUTPATIENT PHYSICIAN CLINIC WOMEN'S HEALTH CENTER - HOFFMAN ESTATES 1555 BARRINGTON RD STE 2300A HOFFMAN ESTATES IL 60169 OUTPATIENT PHYSICIAN CLINIC MERCY ELKHORN MEDICAL CENTER 839 N WISCONSIN ST ELKHORN WI 53121 OUTPATIENT PHYSICIAN CLINIC MERCYCARE BUILDING 580 N WASHINGTON ST JANESVILLE WI 53548 AUTISM PROGRAM / EMS TRAINING PART I, LINE 6A: MERCY HEALTH SYSTEM, CORP (MHS) SUBMITS AN ANNUAL COMMUNITY BENEFIT STATEMENT TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). PERIODICALLY, IT PUBLISHES A PAMPHLET EXPLAINING THE COMMUNITY BENEFITS THAT MHS, AND THE RELATED ORGANIZATIONS OF MHS PROVIDE TO THE COMMUNITIES THEY SERVE. MHS HAS SUPPLIED SUPPLEMENTAL COMMUNITY BENEFIT STATEMENT INFORMATION WITH ITS 990 TAX RETURN SINCE FISCAL YEAR 2006 (TAX FORM 2005). MHS ISSUED A PRESS RELEASE RELATING TO THE HEALTH SYSTEM'S PRIOR YEAR'S COMMUNITY BENEFITS AND HAS THE SAME ON ITS WEBSITE; IT FURTHER REFERENCES THE AVAILABILITY OF WHA'S 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; HEALTH PROFESSIONS EDUCATION; SUBSIDIZED HEALTH SERVICES; CASH AND IN-KIND CONTRIBUTIONS) WERE DETERMINED USING ACTUAL DEPARTMENT/SERVICE SPECIFIC DATA AND/OR COST ACCOUNTING DERIVED DATA. PART I, LINE 7G: THE SUBSIDIZED HEALTH CARE LINE INCLUDES $3,446,340 OF EXPENSES (COLUMN C) AND $1,667,081 OF NET EXPENSES (COLUMN E) ATTRIBUTABLE TO THE COSTS OF TRAUMA SURGEONS. THESE SURGEONS STAFF THE LEVEL II TRAUMA PROGRAM OF MERCY HEALTH SYSTEM CORP 24/7. MERCY SOUTH - FAMILY PRACTICE CLINIC WAS ALSO INCLUDED IN THIS LINE: EXPENSES IN COLUMN C TOTALED $3,426,774 AND COLUMN E HAD $267,858 OF NET EXPENSES. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $23,755,339 INCLUDED ON FORM 990, PART IX, LINE 25, WAS EXCLUDED FROM EXPENSES WHEN CALCULATING THE PERCENTAGE IN THIS COLUMN. PART II, COMMUNITY BUILDING ACTIVITIES: MERCY'S MANY HEALTH IMPROVEMENT AND BENEFIT SERVICES/OPERATIONS WERE THE RESULT OF MERCY FILLING A COMMUNITY NEED. MERCY'S COLLABORATIVE EFFORTS AND THE EFFORTS OF ITS RELATED ENTITIES HAVE BROUGHT ASSISTANCE TO THE AREA'S UNDERSERVED (AS DETAILED IN #2 ABOVE). PART III, LINE 2: THE COST OF BAD DEBT ON LINE 2, PART III, 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 HEALTH SYSTEM CORP'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 17.33%. 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 ALLIANCE, INC AND AFFILIATES - MERCY ALLIANCE, INC IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORP). PATIENT ACCOUNTS RECEIVABLE ARE RECORDED . . . NET OF CONTRACTUAL ADJUSTMENTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH REFLECTS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED . . . IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, ALLIANCE ANALYZES HISTORICAL LOSS EXPERIENCE ON REVENUE FOR ALL PAYORS. USING THE LOSS EXPERIENCE RATE, ALLIANCE ESTIMATES THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: DATA FOR LINES 5 & 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MERCY HEALTH SYSTEM CORP'S TWO MEDICARE COST REPORTS (MERCY HOSPITAL AND TRAUMA CENTER-JANESVILLE, AND MERCY WALWORTH HOSPITAL). PART III, LINE 9B: PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MERCY HEALTH SYSTEM'S (MHS) COMMUNITY CARE PROGRAM, WILL RECEIVE A 20% DISCOUNT FROM MHS'S STANDARD FEE SCHEDULE. ALL SELF-PAY PATIENTS MEET WITH PATIENT FINANCIAL COUNSELORS AND DISCUSS PAYMENT OPTIONS INCLUDING MHS'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: MERCY HEALTH SYSTEM CORP (MHS), ALONG WITH ITS SISTER ORGANIZATION, MERCY HARVARD HOSPITAL (MHH), WORKS IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF ROCK (WI), WALWORTH (WI) AND MCHENCY (IL) COUNTIES TO COMPLETE. MERCY HEALTH SYSTEM CORP HAS DEDICATED STAFF THAT WORKS WITH VARIOUS AGENCIES/PROGRAMS TO ASSESS HEALTH NEEDS IN THE COMMUNITIES THAT MHH AND MHS SERVE. COLLABORATIVE EXAMPLES OF MERCY AND MERCY'S RELATED ENTITIES INCLUDE: 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. THIS FIRST-OF-ITS-KIND PARTNERSHIP IS THE RESULT OF YEARS OF WORK WITH LOCAL PARTNERS AND THE FEDERAL GOVERNMENT TO DESIGN AND DEBUT A NEW MODEL OF CAR FOR THE UNDERSERVED. THE CLINIC SEES OVER 200 NEW PATIENTS EACH MONTH, HAS SIGNIFICANTLY IMPROVED PATIENT OUTCOMES, AND HAS SAVED MILLION IN UNNECESSARY EMERGENCY DEPARTMENT COSTS. II) HEALTHNET FREE CLINIC IN JANESVILLE: MERCY PHYSICIANS VOLUNTEER THEIR SERVICES. MERCY ALSO DONATES LAB, RADIOLOGY AND OTHER ANCILLARY SERVICES TO PATIENTS. III) FAMILY HEALTH PARTNERSHIP CLINIC AND WELL CHILD CLINIC IN WOODSTOCK, IL AND HARVARD FREE CLINIC IN MCHENRY COUNTY, IL: MERCY PHYSICIANS 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. V) ROCK COUNTY HEALTH DEPARTMENT: BIOTERRORISM READINESS PROJECT. VI) RED CROSS: BLOOD DRIVE AND COOPERATIVE VOLUNTEER EFFORTS. VII) UNITED WAY: FUND RAISING CAMPAIGN AND ROCK COUNTY NEEDS ASSESSMENT SURVEY CONTRIBUTOR. VIII) AREA POLICE AND FIRE DEPARTMENTS: PROVIDE PORTABLE DEFIBRILLATORS FOR POLICE VEHICLES AND FREE OR REDUCED-COST PARAMEDIC/EMT EDUCATIONAL OPPORTUNITIES. IX) COMMUNITY ACTION, INC.: MERCY LEADERSHIP SERVES ON STRATEGIC PLANNING COMMITTEE AND COMMUNITY ACTION DEVELOPMENT BOARD. 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, 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 HOSPITAL AND TRAUMA CENTER IS LOCATED IN JANESVILLE, WI: ROCK COUNTY. IT IS ONE OF TWO ACUTE CARE HOSPITALS IN JANESVILLE, WI. IT IS LICENSED FOR 240 ACUTE BEDS. IT HAS 24/7 EMERGENCY SERVICES, WITH A TRAUMA II DESIGNATION. IT IS A TEACHING HOSPITAL WITH A RESIDENCY PROGRAM.UNEMPLOYMENT IN ROCK COUNTY (2013) WAS AT 8.6% WHILE THE STATE (WI) AND THE NATION WERE AT 7.0% AND 7.5%, RESPECTIVELY. MEDIAN HOUSEHOLD INCOME (2012) WAS $50,316 IN ROCK COUNTY, WHICH IS LOWER THAN BOTH THE STATES $52,627 AND NATIONAL MEDIAN OF $53,046. IN 2012, 13.5% OF ROCK COUNTY RESIDENTS LIVED BELOW THE POVERTY LEVEL; THIS IS LARGER THAN THE STATES AVERAGE OF 12.5%, BUT LESS THAN THE NATIONAL AVERAGE OF 14.9%. OVER 50% OF STUDENTS IN THE JANESVILLE SCHOOL DISTRICT WERE ECONOMICALLY DISADVANTAGED STUDENTS (SCHOOL YEAR 2012-2013).MERCY WALWORTH HOSPITAL IS LOCATED IN LAKE GENEVA WI WHICH IS IN WALWORTH COUNTY, WI. IT IS A CRITICAL ACCESS HOSPITAL LICENSED FOR 25 ACUTE BEDS THAT PROVIDES 24/7 EMERGENCY SERVICES. MERCY HEALTH SYSTEM CORP DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF WALWORTH COUNTY RESIDENTS. THE SURVEY, DISTRIBUTED TO 2000 MEMBERS OF THE COMMUNITY, COVERED VARIOUS TOPICS, INCLUDING ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. A RESPONSE WAS RECEIVED FROM 14.4% OF HOUSEHOLDS THAT RECEIVED THE SURVEY (288 SURVEYS). ONCE THE SURVEY RESPONSES WERE TABULATED, THE SURVEY RESULTS WERE EVALUATED AND ANALYZED FOR HEALTH AND DEMOGRAPHIC TRENDS. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, MERCY HEALTH SYSTEM ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTES COUNTY HEALTH RANKINGS, WISCONSIN DEPARTMENT OF PUBLIC HEALTH, AND THE UNITED STATES CENSUS BUREAU. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE INFORMATION GATHERED FROM THE HOUSEHOLD SURVEYS, PROVIDED A PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF WALWORTH COUNTY. UNEMPLOYMENT IN WALWORTH COUNTY (2013) WAS AT 7.0%; THIS MATCHED THE STATES (WI) RATE AND WAS BETTER THAN THE NATIONAL AVERAGE OF 7.5%. APPROXIMATELY 50% OF STUDENTS IN THE LAKE GENEVA J1 SCHOOL DISTRICT WERE ECONOMICALLY DISADVANTAGED STUDENTS (SCHOOL YEAR 2012-2013). MERCY HEALTH SYSTEM CORPS PAYOR DEMOGRAPHICS FOR ITS HOSPITALS INCLUDE 40.49% MEDICARE, AND 15.82% MEDICAID FOR THE FISCAL YEAR OF JULY 1, 2014 JUNE 30, 2015 (AS DETERMINED BY CHARGES BILLED). PART VI, LINE 5: MERCY HEALTH SYSTEM CORP (MHS) HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREAS. MHS HAS A GOVERNING BODY COMPRISED OF A MAJORITY OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY. PART VI, LINE 6: MERCY HEALTH SYSTEM CORPORATION (MHS) HAS TWO HOSPITALS THAT PROVIDE ACUTE CARE SERVICES IN ROCK AND WALWORTH COUNTIES OF WISCONSIN. MHS ALSO OPERATES COMMUNITY CLINICS LOCATED THROUGHOUT SIX COUNTIES OF WISCONSIN AND ILLINOIS. IT IS PART OF A LARGER INTEGRATED HEALTHCARE SYSTEM AND IS AFFILIATED WITH OTHER SEPARATELY REPORTED ORGANIZATIONS.MERCY ALLIANCE INC. IS THE PARENT COMPANY OF MHS, MERCY HARVARD HOSPITAL, INC., AND MERCY ASSISTED CARE INC. MERCY HARVARD HOSPITAL PROVIDES ACUTE CARE SERVICES IN MCHENRY COUNTY, ILLINOIS. MERCY ASSISTED CARE PROVIDES HOME HEALTH SERVICES, HOSPICE, AND DME (DURABLE MEDICAL EQUIPMENT) SERVICES; THUS PROVIDING CONTINUATION OF CARE TO MHS PATIENTS AND THE COMMUNITY AS A WHOLE.MHS WORKS WITH THE MERCY 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 290 INDIVIDUALS PER YEAR THE LAST THREE YEARS.MERCY HOSPITAL ASSOCIATION OF VOLUNTEERS, INC. IS THE ORGANIZATION/TAX ENTITY OF MERCYS VOLUNTEERS. VOLUNTEERS NUMBERED 1,431 IN CALENDAR YEAR 2014. THIS ORGANIZATION NOT ONLY SUPPORTS MERCYS SERVICES, BUT PROVIDES BENEFITS TO THE COMMUNITY AS A WHOLE. IN CONJUNCTION WITH MHS 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 WI,IL X X X X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 MARK GOELZER MD DIRECTOR/PHYSICIAN 453043 0 0 0 4714 0 17160 0 13862 0 488779 0 0 0 BARB BORTNER VICE-PRESIDENT 138043 0 75288 0 3320 0 14119 0 22844 0 253614 0 0 0 DAN COLBY VICE-PRESIDENT 182449 0 82473 0 8970 0 17160 0 13038 0 304090 0 0 0 DAVID KURTZ VICE-PRESIDENT 135957 0 103889 0 14877 0 11346 0 15876 0 281945 0 0 0 JOHN COOK VICE-PRESIDENT 268004 0 140656 0 6281 0 17160 0 22535 0 454636 0 0 0 KATHLEEN HARRIS VICE-PRESIDENT 88158 0 51942 0 6655 0 8780 0 22036 0 177571 0 0 0 RUTH YARBROUGH VICE-PRESIDENT 168823 0 91244 0 12929 0 17160 0 7826 0 297982 0 0 0 RICHARD GRUBER VICE-PRESIDENT 130941 0 82314 0 12122 0 14517 0 15874 0 255768 0 0 0 JOSEPH NEMETH VICE-PRESIDENT 139639 0 80675 0 9249 0 14731 0 14221 0 258515 0 0 0 SUE RIPSCH VICE-PRESIDENT 252313 0 132817 0 23382 0 17160 0 17435 0 443107 0 0 0 JENNIFER HALLATT VICE-PRESIDENT 152798 0 83905 0 4121 0 16082 0 25555 0 282461 0 0 0 PAUL VAN DEN HEUVEL VICE-PRESIDENT 224270 0 84375 0 12912 0 16037 0 23028 0 360622 0 0 0 JAVON BEA PRESIDENT & DIRECTOR 1076489 0 3313796 0 3614907 0 17160 0 21625 0 8043977 0 0 0 BRADLEY FIDELER PHYSICIAN 1388496 0 0 0 828 0 17160 0 27764 0 1434248 0 0 0 MERLE RUST PHYSICIAN 1264497 0 0 0 828 0 17160 0 27281 0 1309766 0 0 0 ROBB WHINNEY PHYSICIAN 1188367 0 0 0 540 0 17160 0 17607 0 1223674 0 0 0 CRAIG LYON PHYSICIAN 1156217 0 0 0 324 0 17085 0 23419 0 1197045 0 0 0 JONATHAN EHRHARDT PHYSICIAN 1097419 0 0 0 360 0 17160 0 11168 0 1126107 0 0 0 PART I, LINE 1A RESIDENCE FOR PERSONAL USE - THE CEO IS PROVIDED WITH A RESIDENCE. THE COST OF RENTING THE RESIDENCE IS TREATED AS TAXABLE COMPENSATION. PAYMENTS FOR BUSINESS USE OF PERSONAL RESIDENCE - THE CEO IS REIMBURSED FOR INTERNET ACCESS AND COMMUNICATION COSTS USED FOR BUSINESS PURPOSES AT HIS PERSONAL RESIDENCE. THE REIMBURSEMENT IS TREATED AS TAXABLE COMPENSATION. HEALTH CLUB DUES - THE CEO IS REIMBURSED FOR HEALTH CLUB DUES. THIS IS TREATED AS TAXABLE COMPENSATION. PERSONAL SERVICES - THE CEO IS REIMBURSED FOR INCOME TAX PREPARATION SERVICES. THIS IS TREATED AS TAXABLE COMPENSATION. KRISTEN GOELZER FAMILY MEMBER OF MARK GOELZER, DIRECTOR 355171 EMPLOYMENT - PHYSICIAN 0 JAMIE KURTZ FAMILY MEMBER OF DAVID KURTZ, OFFICER 37858 EMPLOYMENT - PATIENT ACCOUNT REPRESENTATIVE 0 JOANNA BENNING FAMILY MEMBER OF JAVON BEA, PRESIDENT & DIRECTOR 106032 EMPLOYMENT - DIRECTOR 0 MEGAN KRAUSE FAMILY MEMBER OF SUE RIPSCH, OFFICER 100243 EMPLOYMENT - MANAGER 0 LAUREN GRUBER FAMILY MEMBER OF RICHARD GRUBER, OFFICER 24956 EMPLOYMENT - RN/HIB 0 FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO REPORT ALL CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR INVESTIGATING ALL CONFLICTS AND REPORTING TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE MERCY ALLIANCE COMPENSATION COMMITTEE IS COMPRISED OF THE BOARD CHAIRPERSON, SECRETARY, AND THE TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED BY INDEPENDENT LEGAL COUNCIL AND AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE, LEGAL COUNCIL, AND THE COMPENSATION CONSULTANT MEET THROUGHOUT THE YEAR AND REPORT DIRECTLY TO THE BOARD OF DIRECTORS ANNUALLY. THIS PROCESS WAS COMPLETED FOR 2014. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGES IN PENSION OBLIGATIONS -3,552,000. OTHER 26,396. MERCY ALLIANCE INC 1000 MINERAL POINT AVE JANESVILLE WI 53548 391679859 SUPPORT OF HEALTHCARE WI 501(C)(3) LINE 11A, I MERCYROCKFORD HEALTH SYSTEM CORPORATION 0 MERCY FOUNDATION INC 1000 MINERAL POINT AVE JANESVILLE WI 53548 237275336 SUPPORT OF HEALTHCARE WI 501(C)(3) LINE 11A, I MERCY HEALTH SYSTEM CORPORATION 0 MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT AVE JANESVILLE WI 53548 390912682 SUPPORT OF HEALTHCARE WI 501(C)(3) LINE 11C, III-FI MERCY HEALTH SYSTEM CORPORATION 0 MERCY ASSISTED CARE INC 901 MINERAL POINT AVE JANESVILLE WI 53548 391035110 HEALTHCARE WI 501(C)(3) LINE 9 MERCY ALLIANCE INC 0 MERCY HARVARD HOSPITAL INC 901 GRANT STREET HARVARD IL 60033 311551871 HEALTHCARE IL 501(C)(3) LINE 3 MERCY ALLIANCE INC 0 HARVARD MEMORIAL HOSPITAL FOUNDATION 901 GRANT STREET HARVARD IL 60033 364308662 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 11A, I MERCY HARVARD HOSPITAL INC 0 MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 1000 MINERAL POINT AVE JANESVILLE WI 535475003 201673011 NONE IL 501(C)(3) LINE 3 MERCY ALLIANCE INC 0 MERCYROCKFORD HEALTH SYSTEM CORPORATION 2400 N ROCKTON AVE ROCKFORD IL 61103 472158680 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 11A, I N/A 0 ROCKFORD MEMORIAL HOSPITAL 2400 N ROCKTON AVE ROCKFORD IL 61103 362167847 HEALTHCARE IL 501(C)(3) LINE 3 ROCKFORD HEALTH SYSTEM 0 ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 363197915 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 11C, III-FI MERCYROCKFORD HEALTH SYSTEM CORPORATION 0 ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 363197918 SUPPORT OF HEALTHCARE IL 501(C)(3) LINE 11A, I ROCKFORD HEALTH SYSTEM 0 VISITING NURSES ASSN OF THE ROCKFORD AREA 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(C)(3) LINE 9 ROCKFORD HEALTH SYSTEM 0 ROCKFORD HEALTH PHYSICIANS 2400 N ROCKTON AVE ROCKFORD IL 61103 363097436 HEALTHCARE IL 501(C)(3) LINE 3 ROCKFORD HEALTH SYSTEM 0 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT AVE JANESVILLE WI 53548 391520130 MANAGEMENT OF UNION EMPLOYEES WI MERCY HEALTH SYSTEM CORPORATION C 200 1.00000 1 MERCYCARE INSURANCE COMPANY 580 N WASHINGTON ST JANESVILLE WI 53546 391768192 INSURANCE WI MERCY HEALTH SYSTEM CORPORATION C 101883691 46162778 1.00000 1 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 580 N WASHINGTON ST JANESVILLE WI 53546 201482553 INSURANCE WI MERCY HEALTH SYSTEM CORPORATION C 1.00000 1 ROCKFORD HEALTH INSURANCE LTD WELLESLEY HOUSE SO 2ND FL PEMBROOKE, HM BD INSURANCE BD N/A C 0 1 1 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 MERCYCARE INSURANCE COMPANY Q 7663492 COST OF SERVICES PROVIDED