2015-05-14T09:10:43-05:00 2014-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2013-07-01 311551871 MERCY HARVARD HOSPITAL INC HARV 8159435431 901 GRANT STREET HARVARD IL 60033 JOHN COOK CHAIRPERSON 8159435431 2015-05-05 1 BRADLEY S MCGUIRE CPA P00643763 6087525835 2015-05-05 X 2013 2016-02-25 16:41:14Z KATHY SCHACK 901 GRANT STREET HARVARD IL 60033 25307775 0 X WWW.MERCYHEALTHSYSTEM.ORG X IL TO PROVIDE QUALITY HEALTH CARE TO THE HARVARD COMMUNITY AND SURROUNDING AREA. 8 7 242 30 0 0 19416 50632 23343986 25115249 3142 6106 1209229 135788 24575773 25307775 0 0 0 0 10353198 10375562 0 0 0 13088956 14496499 23442154 24872061 1133619 435714 20344043 19527397 18694850 17442490 1649193 2084907 TO PROVIDE QUALITY HEALTH CARE TO THE HARVARD COMMUNITY AND SURROUNDING AREA. 0 0 19059016 25136164 HOSPITAL DISCHARGES 379, EMERGENCY VISITS 6,152, OUTPATIENT SURGERY CASES 1,853, NURSING HOME DISCHARGES 159 19059016 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 49 0 1 242 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 IL X SHANNON DUNPHY-ALEXANDER 6087566642 1000 MINERAL POINT JANESVILLE WI 535475003 KATHY SCHACK CHAIRPERSON & DIRECTOR 1.00 X X 0 0 0 WESLEY JOST VICE-CHAIR & DIRECTOR 1.00 X X 0 0 0 P CASEY VORIS SECRETARY/TREAS & DIRECTOR 1.00 X X 0 0 0 JENI HALLATT DIRECTOR 1.00 X 0 0 0 RON KIERAS DIRECTOR 1.00 X 0 0 0 CARLOS AREVALO DIRECTOR 1.00 X 0 0 0 JAY SCHULZ DIRECTOR 1.00 X 0 0 0 ALLEN CASTILLO DIRECTOR 1.00 X 0 0 0 JOHN COOK CFO 1.00 55.00 X 0 378933 37682 WENDI AUBRY PHARMACIST TEAM LEAD 40.00 X 149575 0 16107 CYNTHIA BANGERT DIRECTOR 40.00 X 126357 0 21595 WYNN BIEDERMANN CHIEF NURSING OFFICER 40.00 X 147787 0 11257 LAURA LEAHEY RN/HIB 47.60 X 122773 0 10004 KHRISTINE SCHRADER SHIFT COORD 47.80 X 138036 0 18308 684528 378933 114953 5 0 1 0 MAGILL CONSTRUCTION COMPANY 977 KOOPMAN LN ELKHORN WI 53121 CONSTRUCTION 187248 PER MAR SECURITY SERVICES PO BOX 1101 DAVENPORT IA 528051101 SECURITY SERVICES 108593 PRN HEALTH 740 FORD STREET STE A KIMBERLY WI 54136 CONTRACT NURSING 102153 3 42693 7939 50632 PATIENT SERVICE REVENUE 621110 25035002 25035002 CAFETERIA 722210 80247 80247 25115249 6106 6106 101162 0 101162 101162 101162 MISCELLANEOUS 900099 34626 34626 34626 25307775 25136164 0 120979 X 8161814 6251665 1910149 267653 205013 62640 1363703 990747 372956 582392 446305 136087 5200 5200 3683839 3312027 371812 115081 1339 113742 2382424 2116698 265726 89860 89860 405223 342515 62708 23009 11297 11712 21438 12710 8728 569020 440854 128166 1844317 1428903 415414 252532 252532 BAD DEBTS 2649962 2649962 INTERCOMPANY EXPENSES 885437 885437 OTHER TAXES 835047 52603 782444 MAINTENANCE AND REPAIRS 517303 437417 79886 216807 106429 110378 24872061 19059016 5813045 0 749629 896201 3449360 4562209 624866 568271 213365 184724 34623103 21811285 14081477 12811818 1225346 504174 20344043 19527397 1126758 1140691 17568092 16301799 18694850 17442490 X 1649193 2084907 1649193 2084907 20344043 19527397 435714 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 222604 222604 20826729 12285138 8541591 13573770 9526147 4047623 12811818 DUE TO RELATED PARTIES 16297590 LONG-TERM CAPITAL LEASE 4209 16301799 1 1 X 1 X 1 X 1 1 0 1 1 139124 139124 0.00560 3440170 1974217 1465953 0.05890 8293 5402 2891 0.00010 3587587 1979619 1607968 0.06460 32185 32185 0.00130 4374670 2599807 1774863 0.07140 26108 26108 0.00100 4432963 2599807 1833156 0.07370 8020550 4579426 3441124 0.13830 1 782279 106703 3549548 5601768 -2052220 X 1 1 1 1 MERCY HARVARD HOSPITAL 901 GRANT STREET HARVARD IL 60033 X X X X MERCY HARVARD HOSPITAL 1 1 X X X X X X X X 13 1 0 1 X MERCYHEALTHSYSTEM.ORG/LOCATION/MERCY-HARV X MERCYHEALTHSYSTEM.ORG X X X X X X X X X 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X 1 X 0 1 X 0 0 MERCY HARVARD HOSPITAL PART V, SECTION B, LINE 3: MERCY HEALTH SYSTEM 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 AND SECONDARY DATA SOURCES.MERCY HEALTH SYSTEM DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF MCHENRY COUNTY RESIDENTS. THE FIFTY QUESTION SURVEY WAS DISTRIBUTED TO 1,245 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 10.4% OF HOUSEHOLDS THAT RECEIVED THE SURVEY. 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, ILLINOIS DEPARTMENT OF PUBLIC HEALTH, THE UNITED STATES CENSUS BUREAU, AND THE KAISER FAMILY FOUNDATION STATE HEALTH FACTS. 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 MCHENRY COUNTY AND SPECIFICALLY, THE HARVARD, ILLINOIS COMMUNITY. MERCY HARVARD HOSPITAL PART V, SECTION B, LINE 14G: AVAILABLE THROUGH PATIENT FINANCIAL COUNSELORS WHO DO PRE- OR POST-FOLLOW UP WITH SELF-PAY PATIENTS. MERCY HARVARD HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE COMMERCIAL CHARGE. 3 MERCY HARVARD CARE CENTER 901 HAYES STREET HARVARD IL 60033 NURSING HOME FACILITY MERCY HARVARD HOSPITAL CLINIC 1001 GRANT STREET HARVARD IL 60033 PHYSICIAN CLINIC MERCY HARVARD REHABILITATION AND FITNESS 1000 HAYES STREET HARVARD IL 60033 REHABILITATION CENTER PART I, LINE 3C: FAMILY SIZE AND LIMIT OF ASSETS PART I, LINE 6A: MERCY HARVARD HOSPITAL (MHH) HAS PREPARED A COMMUNITY BENEFIT REPORT FOR FILING WITH ITS 990 TAX RETURN PRIOR TO ITS REQUIREMENT. IT FOLLOWED A RECOMMENDED FORMAT AND MIRRORED THAT OF ITS SISTER ORGANIZATION, MERCY HEALTH SYSTEM CORPORATION'S, FILING OF COMMUNITY BENEFITS WITH THE WISCONSIN HOSPITAL ASSOCIATION. 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, LINE 7G: N/A PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $2,649,962 INCLUDED ON FORM 990, PART IX, LINE 25, WAS EXCLUDED FROM EXPENSES WHEN CALCULATING THE PERCENTAGE IN THIS COLUMN. 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 HARVARD HOSPITAL, INC.) 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 COLLECTIBILITY 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.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. THE ESTIMATE OF BAD DEBT DOLLARS THAT MAY HAVE BEEN COVERED THROUGH MHH'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 13.64%. THIS FIGURE WAS BASED ON THE PERCENT OF BAD DEBT ACCOUNT DOLLARS THAT ARE RECLASSIFIED FOR CHARITY AND/OR BANKRUPTCY PURPOSES. PART III, LINE 8: DATA FOR LINES 5 & 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MHH'S MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MHH'S COMMUNITY CARE PROGRAM, WILL RECEIVE A 20% 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: COMMUNITY NEEDS ASSESSMENTS ARE CONDUCTED EVERY 18 MONTHS. MHH AND MHH'S SISTER ORGANIZATION, MERCY HEALTH SYSTEM CORP (MHS) WORK IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF WALWORTH (WI), ROCK (WI) AND MCHENRY (IL) COUNTIES TO COMPLETE. MERCY HARVARD HOSPITAL, INC. (MHH) COMPLETES AN ANNUAL CRITICAL ACCESS HOSPITAL ASSESSMENT. NEEDS ASSESSMENT SURVEYS ARE COMPLETED AS REQUIRED BY THE STATE OF ILLINOIS.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 CARE FOR THE UNDERSERVED. THE CLINIC SEES OVER 200 NEW PATIENTS EACH MONTH, HAS SIGNIFICANTLY IMPROVED PATIENT OUTCOMES, AND HAS SAVED MILLIONS 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 HARVARD HOSPITAL IS LOCATED IN MCHENRY COUNTY, ILLINOIS. IT IS A 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., MHH HAS BEEN ABLE TO PROVIDE A NEW LEVEL OF CARE AND MORE MEDICAL SPECIALTIES. MEDIAN HOUSEHOLD INCOME IN HARVARD IS $45,991, WHICH IS LOWER THAN BOTH THE COUNTY AND STATE MEDIANS OF $76,482 AND $55,735, RESPECTIVELY. IN 2010 HARVARD HAD A GREATER PROPORTION OF RESIDENTS WHO WERE UNEMPLOYED, COMPARED TO THE COUNTY AND STATE RATES. IN 2012, MCHENRY COUNTY HAD AN UNEMPLOYMENT RATE OF 8.4% COMPARED TO ILLINOIS' 8.9% AND US RATE OF 8.1%.APPROXIMATELY 20% OF HARVARD RESIDENTS HAD EARNINGS BELOW THE POVERTY LEVEL IN 2010. THIS PROPORTION EXCEEDS BOTH THE COUNTY (4.2%) AND STATE (9.2%) RATES. ONE IN FOUR HARVARD FAMILIES LIVE IN POVERTY. SLIGHTLY MORE THAN TWO PERCENT OF FAMILIES IN THE HARVARD COMMUNITY RECEIVE CASH PUBLIC ASSISTANCE, COMPARED TO 1.2% ACROSS MCHENRY COUNTY AND 2.0% ACROSS ILLINOIS. SIMILARLY, 12.9% OF FAMILIES RECEIVED FOOD STAMP BENEFITS IN 2010, WHICH IS GREATER THAN BOTH THE MCHENRY COUNTY AND ILLINOIS RATES OF 3.8% AND 9.1%, RESPECTIVELY.THE HOSPITALS' PAYOR DEMOGRAPHICS INCLUDE 36.0% MEDICARE, AND 16.8% MEDICAID FOR THE FISCAL YEAR OF JULY 1, 2013 - JUNE 30, 2014 (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 ALLIANCE INC. IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORPORATION, MERCY ASSISTED CARE INC, AND MERCY HARVARD HOSPITAL INC. 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 AND DME (DURABLE MEDICAL EQUIPMENT) SERVICES; THUS PROVIDING CONTINUATION OF CARE TO MERCY HEALTH SYSTEM PATIENTS AND THE COMMUNITY AS A WHOLE. MERCY HEALTH SYSTEM CORP. 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/YEAR THE LAST THREE YEARS.MERCY HOSPITAL ASSOCIATION OF VOLUNTEERS, INC. IS THE ORGANIZATION/TAX ENTITY OF MERCY'S VOLUNTEERS. VOLUNTEERS NUMBERED 1,470 IN CALENDAR YEAR 2013. 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 WI,IL 0 0 0 0 0 0 0 0 0 JOHN COOK CFO 0 258028 0 115445 0 5460 0 16851 0 20831 0 416615 0 0 WENDI AUBRY PHARMACIST TEAM LEAD 149456 0 0 0 119 0 7848 0 8259 0 165682 0 0 0 WYNN BIEDERMANN CHIEF NURSING OFFICER 147569 0 0 0 218 0 7497 0 3760 0 159044 0 0 0 KHRISTINE SCHRADER SHIFT COORD 137789 0 0 0 247 0 6995 0 11313 0 156344 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 REVIEW IS COMPLETED BY MANAGEMENT OF ORGANIZATION AND AVAILABLE TO BOARD FOR REVIEW 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 C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 3,312,027. MANAGEMENT AND GENERAL EXPENSES 371,812. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,683,839. MERCY ALLIANCE INC 1000 MINERAL POINT JANESVILLE WI 535475003 391679859 MANAGEMENT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) 11A N/A 0 MERCY FOUNDATION INC 1000 MINERAL POINT JANESVILLE WI 535475003 237275336 TO SUPPORT THE HOUSE OF MERCY HOMELESS SHELTER WI 501(C)(3) 11A MERCY HEALTH SYSTEM CORPORATION 0 MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT JANESVILLE WI 535475003 390912682 TO SUPPORT MERCY HEALTH SYSTEM CORPORATION WI 501(C)(3) 11C MERCY HEALTH SYSTEM CORPORATION 0 MERCY ASSISTED CARE INC 901 MINERAL POINT JANESVILLE WI 535475003 391035110 HOME HEALTH CARE & SERVICES WI 501(C)(3) 9 MERCY ALLIANCE INC 0 MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT JANESVILLE WI 535475003 390816848 MEDICAL HEALTHCARE WI 501(C)(3) 3 MERCY ALLIANCE INC 0 HARVARD MEMORIAL HOSPITAL FOUNDATION 901 GRANT STREET HARVARD IL 60033 364308662 TO SUPPORT MERCY HARVARD HOSPITAL, INC. IL 501(C)(3) 11A MERCY HARVARD HOSPITAL INC 0 MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 1000 MINERAL POINT JANESVILLE WI 535475003 201673011 NONE IL 501(C)(3) 3 MERCY ALLIANCE INC 0 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 535475003 391520130 MANAGEMENT ENTITY OF UNION EMPLOYEES WI MERCY HEALTH SYSTEM CORPORATION C 1 MERCYCARE INSURANCE COMPANY 3430 PALMER DRIVE JANESVILLE WI 53545 391768192 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 1 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 3430 PALMER DRIVE JANESVILLE WI 53545 201482553 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0