2015-05-15T10:01:51-05:00 2014-06-30 861065772 DELOITTE TAX LLP 1700 MARKET STREET 25TH FLOOR PHILADELPHIA PA 191033984 990 2013-07-01 231396763 Mercy Suburban Hospital MERC 6105676000 One West Elm Street No 100 Conshohocken PA 194284108 Joseph H Bradley CFO/Senior VP of Finance 6105676000 2015-05-09 1 WILLIAM J HOMER P00994519 2152462300 2013 2016-03-07 17:11:31Z Susan Croushore One West Elm Street No 100 Conshohocken PA 194284108 95268806 0 0928 X www.mercyhealth.org X 1944 PA See Schedule O.Mercy Suburban Hospital is a member of Mercy Health System of Southeastern PA ("SEPA"). Our mission is to be a partner in the healing ministry of the Catholic Church in the spirit of the Catholic Health Ministries.To fulfill that mission, we strive to create an environment that is caring and compassionate within our health system and in our service to the community. We are dedicated to being a transforming, healing presence that supports healthy communities, addresses the diverse health needs of our neighbors at every stage of life, and is accessible to all, including the often forgotten poor and disadvantaged. Through innovative medicine and compassionate care, our hospitals work together to nurture our patients and their families through the healing process with superior services and spiritual support. SEPA is a member of Trinity Health. 12 10 869 75 0 0 6746 135933 48403218 92982548 2000 0 315807 2130795 48727771 95249276 9489 0 0 0 24925625 47183038 0 0 0 29760252 56820435 54695366 104003473 -5967595 -8754197 86823024 36143894 86470310 65376188 352714 -29232294 X See Schedule O.Mercy Suburban Hospital is a member of Mercy Health System of Southeastern PA ("SEPA"). Our mission is to be a partner in the healing ministry of the Catholic Church in the spirit of the Catholic Health Ministries.To fulfill that mission, we strive to create an environment that is caring and compassionate within our health system and in our service to the community. We are dedicated to being a transforming, healing presence that supports healthy communities, addresses the diverse health needs of our neighbors at every stage of life, and is accessible to all, including the often forgotten poor and disadvantaged. Through innovative medicine and compassionate care, our hospitals work together to nurture our patients and their families through the healing process with superior services and spiritual support. SEPA is a member of Trinity Health. 0 0 88284708 94784999 See Schedule O.Patient Care: Mercy Suburban Hospital provides quality healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Mercy Suburban Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services, and further that our mission is to serve the community with respect to providing healthcare services and healthcare education. Mercy Suburban Hospital remains focused on our mission to further the healing ministry of Jesus Christ, especially for the poor and underserved community. Mercy Suburban Hospital provides free care, subsidizes the care of Medicare and Medicaid patients where the government reimbursement is below cost, and sponsors health programs and activities for the community. These programs include wellness programs, community education programs, special programs for the elderly, handicapped, medically underserved and a variety of broad community support activities. Mercy Suburban Hospital serviced 5,028 discharges providing 24,476 patient days of which patients covered under the Medicare program were 2,788 discharges and 13,906 patient days. Patients covered under the Medicaid program were 925 discharges and 4,493 patient days. Mercy Suburban Hospital provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. To the extent that reimbursement from Medicaid is below cost, Mercy Suburban Hospital recognizes these amounts as charity care in meeting its mission to the community. The unreimbursed value of providing care to these patients was $1,127,520 for the twelve-month period ended June 30, 2014. Charity care is also provided through many reduced price services and free programs offered throughout the year based upon the activities and services which Mercy Suburban Hospital believes will serve a bona fide community health need. These include:(1) Benefits for the Broader Community: (a) Community Health Improvement Services and Community Benefit Operations: $216,781 (b) Subsidized Health Services: $1,653,285 (c) Cash and in kind Contributions to Community Groups: $171,950 The Total Benefits for the Broader Community was $2,042,016These also include: (2) Benefits to the Poor: (a) Traditional Charity Care Cost: $1,127,520 (b) Unpaid Costs of Medicaid $4,931,830 Total Benefit to the Poor was $6,059,350. The Total Community Benefit for the twelve-month period ended June 30, 2014 was $8,101,366. The total expense incurred to Mercy Suburban Hospital for program services for the twelve-month period ending June 30, 2014 was $88,284,708 (83,621 Patients). 88284708 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 169 0 869 1 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Anthony D Fanelli Jr 6105676000 1 West Elm Street Suite 100 Conshohocken PA 194284108 Sister Kathleen BoyceRSM Chairperson 1.00 1.10 X 0 0 0 David D Clark President & CEO MHS 0.10 60.90 X X 0 1423878 100932 Susan Croushore President & CEO MHS 0.10 59.90 X X 0 0 0 Kathryn Conallen SVP,CEO MHS Acute Oper. 9.00 51.00 X X 67357 381685 16604 Reverend Byron L Craig Board Member 1.00 0.00 X 0 0 0 Ivette V Diaz RSM Board Member 1.00 0.00 X 0 0 0 Margaret M Dolan Board Member 1.00 0.00 X 0 0 0 George J Falconero CPA Chairperson 1.00 0.00 X X 0 0 0 Robert J Pearlstein DO Board Member 1.00 0.00 X 0 0 0 Joseph J Pizonka Esquire Board Member 1.00 0.00 X 0 0 0 Sister Cathe Shoulberg RSM Board Member 1.00 0.00 X 0 0 0 Joseph P Valerio Jr Board Member 1.00 0.00 X 0 0 0 Scott Yarmark DO Board Member 1.00 0.00 X 0 0 0 Joseph H Bradley Senior VP & CFO MHS 0.10 59.90 X 0 486679 35893 Mark T Bullock Assistant Secretary 0.10 59.90 X 0 481027 34899 Vincent P Haley Esquire Corporate Secretary 1.00 2.10 X 0 0 0 David A Wajda CFO MSH & NAZ 9.00 51.00 X 39226 222279 30227 Peter B Kenniff CFO MSH 60.00 0.00 X 149999 0 9239 Christina FitzPatrick Executive Director 49.00 11.00 X 280582 61591 22981 Michael Magro Associate CMO 56.00 4.00 X 257914 19413 32004 Leslie Tupchong Chair Dept of Rad Ther 40.00 0.00 X 438729 0 46459 Mary Ellen Rauner Chief Nursing Officer 40.00 0.00 X 160612 0 13558 Lynn Muholland Registered Nurse 40.00 0.00 X 135642 0 17327 Phyllis Beidler Directory Surgery Serv 40.00 0.00 X 126884 0 11051 Gary Garlotta Registered Nurse 40.00 0.00 X 120578 0 26718 Joice Joseph Nuclear Medicine Tech 40.00 0.00 X 113241 0 26217 Ann M Depietro Registered Nurse 40.00 0.00 X 115816 0 15397 2006580 3076552 439506 41 0 1 0 PREMIER ANESTHESIA OF PA PC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 PHYSICIAN SERVICES 1221212 SODEXO INC PO BOX 81049 WOBURN MA 18131 FOOD SERVICES 1173762 RADIOLOGY AFFILIATES OF CENTRAL NJ PA 3625 QUAKERBRIDGE ROAD HAMILTON NJ 08619 PHYSICIAN SERVICES 657969 CANDESCENT HEALING LLC 32 ELM PLACE SUTIE 1 SOUTH RYE NY 10580 WOUND CARE SERVICES 638987 COGENT HEALTHCARE PENNSYLVANIA PO BOX 645037 CINCINNATI OH 45264 PHYSICIAN SERVICES 519732 26 33204 102729 135933 Net Patient Service Re 622110 92982548 92982548 92982548 328627 0 328627 328627 328627 19247 33204 19530 -283 -283 Medicare/Medicaid Mean 900099 1613163 1613163 Other Outside Clinical 621498 51769 51769 Lab, X-Ray, MRI Revenu 621512 47876 47876 89643 89643 1802451 95249276 94784999 0 328344 X 1519308 1519308 36307823 30045199 6262624 1008195 834294 173901 5685617 4704922 980695 2662095 2202918 459177 96471 79831 16640 11016 11016 12832 12832 26491513 22623760 3867753 243988 201903 42085 483603 400188 83415 139644 115557 24087 1314133 1087462 226671 148 123 25 95942 79393 16549 1352188 1118953 233235 5008348 4144473 863875 1592873 1318123 274750 Patient Supplies 12995975 12995975 0 0 Medical Assessment Expe 1929579 1929579 0 0 Affiliate Subsidized Ph 1386682 1386682 0 0 Non-Medical Supplies 683230 565382 117848 0 2982270 2449991 532279 104003473 88284708 15718765 0 11724837 9776662 2331520 2315990 861476 952784 16346925 866270 49201561 15480655 2818345 1212451 19885285 6405352 86823024 36143894 18358945 28016530 35972539 800000 700000 31338826 36659658 86470310 65376188 X 62206 -29680507 290508 448213 0 352714 -29232294 86823024 36143894 X -8754197 -20830811 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 12832 0 0 12832 0 Part II-B, Line 1: The organization, either directly or through its member organization, is a participant in representative trade group(s) that promote the interests of health care and health care providers generally, including but not limited to, with federal, state and local elected officials and governmental agencies. This advocacy may include issues related to legislation. The organization, either directly or through its member organization, pays dues to the representative trade groups consistent with the participation requirements of such trade groups. Additionally, the organization has, either directly or through its member organization, contracts with registered lobbying firms that advocate on its behalf with federal, state and local elected officials and governmental agencies. This advocacy may include issues related to legislation. The organization, either directly or through its member organization, maintains contracts with the lobbying firms and compensation is paid through an annual retainer or other agreed upon fee structure set in advance. Compensation to such lobbying firms is not contingent upon the outcome of any engagement. Organization employees engage in advocacy efforts on issues related to health care and health care providers. Such activities consist of written and verbal communications with federal, state and local elected officials and governmental agencies on health care and health care providers generally. Where appropriate, certain organization employees are registered as lobbyists. 1605142 1605142 10011242 155322 9855920 62 -62 3924660 337647 3587013 805881 373239 432642 15480655 Intercompany Receivables 6403332 Investment in East Norriton Medical Associates 2020 6405352 Third-Party Payables 2047840 Long-Term Sick Retirement Reserve 240768 Pension Liabilities 1573978 Intercompany Liabilities 32797072 36659658 GOLF OUTING 52451 33204 19247 3841 13510 2179 52451 33204 19247 3841 13510 2179 19530 -283 1 1 1 X 1 X 1 1 1 0 1 1 1127520 1127520 0.01080 20507175 15575345 4931830 0.04740 21634695 15575345 6059350 0.05820 216781 216781 0.00210 1653285 1653285 0.01590 171950 171950 0.00170 2042016 2042016 0.01970 23676711 15575345 8101366 0.07790 1 2232800 26449410 28606630 -2157220 X 1 1 1 East Norriton Medical Associates Medical Office Building 0.24860 0.17390 1 1 Mercy Suburban Hospital 2701 Dekalb Pike East Norriton PA 194011820 www.mercyhealth.org 197201 X X X X Mercy Suburban Hospital 1 X X X X X X X X X 13 1 0 1 X http://www.mercyhealth.org/about/communit X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X X 1 0 X 1 X 0 0 Mercy Suburban Hospital Part V, Section B, Line 3: Information on the health status and health care needs of Mercy Suburban Hospital's service area residents was collected from the community through two community meetings with residents, public health representatives, service providers, and advocates knowledgeable about community health. Twenty-four community leaders, providers, public health representatives, and residents participated. The participating groups, organizations, and individuals included Catholic Social Services, Client Service Manager, Dean of Health Sciences, Director of Community Health, J.K. Gotwals Elementary School, Montgomery County Health Department, Montgomery County MH/MR, Norristown Area School District, local government officials, North Penn Community Health Foundation, NAMI PA, School Nurse, St. Francis of Assisi/St. Vincent de Paul, Stewart Middle School, Talone Insurance Inc., and VNA Community Services. Mercy Suburban Hospital Part V, Section B, Line 7: Mercy Suburban Hospital identified fourteen different significant health needs and implementation strategies were developed for nine of those needs, leaving five that were not addressed. The five unaddressed needs related to: 1. Prescriptions for older adults and low income populations. 2. Understanding and trust in the publicly funded health care and insurance system among low income residents. 3. Dental care for older adults and low income populations. 4. Mental health for area residents, particularly low-income residents and the Latino population. 5. Vision care for older adults and low income populations. Mercy Suburban Hospital did not address these needs because they lacked the expertise and competencies needed to address the issue effectively. Mercy Suburban Hospital Part V, Section B, Line 12i: The Hospital recognizes that not all patients are able to provide complete financial and/or social information. Therefore, approval for financial support may be determined based on available information. Examples of presumptive cases include: deceased patients with no known estate, the homeless, unemployed patients, non-covered medically necessary services provided to patients qualifying for public assistance programs, patient bankruptcies, and members of religious organizations who have taken a vow of poverty and have no resources individually or through the religious order. For the purpose of helping financially needy patients, a third-party is utilized to conduct a review of patient information to assess financial need. This review utilizes a healthcare industry-recognized, predictive model that is based on public record databases. These public records enable the Hospital to assess whether the patient is characteristic of other patients who have historically qualified for financial assistance under the traditional application process. In cases where there is an absence of information provided directly by the patient, and after efforts to confirm coverage availability, the predictive model provides a systematic method to grant presumptive eligibility to financially needy patients. Mercy Suburban Hospital Part V, Section B, Line 18e: The organization does not take any of the actions listed on Line 17 with respect to patients eligible for assistance under the organization's FAP. Mercy Suburban Hospital Part V, Section B, Line 20d: The hospital facility used Medicaid rates when calculating the maximum amounts that can be charged. Part I, Line 6a: Mercy Suburban Hospital reports its community benefit information as part of the consolidated community benefit information reported by Trinity Health (EIN 35-1443425) in its audited financial statements, available at www.trinity-health.org. In addition, Mercy Suburban Hospital includes a copy of its most recently filed Schedule H on both its own website and Trinity Health's website. Part I, Line 7: The best available data was used to calculate the cost amounts reported in item 7. For certain categories, primarily total charity care and means-tested government programs, specific cost-to-charge ratios were calculated and applied to those categories. The cost-to-charge ratio was derived from worksheet 2, ratio of patient care cost-to-charges. In other categories, the best available data was derived from the Hospital's cost accounting system. Part III, Line 2: The figures were calculated based on the cost-to-charge ratio. The cost-to-charge ratio was derived by dividing total operating expenses by total gross patient charges. The cost-to-charge ratio was applied to total bad debt write-offs to calculate the costs for line 2. Any discounts provided or payments made to a particular patient account are applied to that patient account prior to any bad debt write-off and are thus not included in bad debt expense. As a result of the payment and adjustment activity being posted to bad debt accounts, we are able to report bad debt expense net of these transactions. Part III, Line 3: Mercy Suburban Hospital uses a predictive model that incorporates three distinct variables in combination to predict whether a patient qualifies for charity: (1) Socio-economic score, (2) Estimated Federal Poverty Level (FPL), and (3) Homeownership. Based on the model, charity care can still be extended to patients even if they have not responded to financial counseling efforts and all other funding sources have been exhausted. Mercy Suburban Hospital is recording amounts as charity care (instead of bad debt expense) based on the results of the predictive model. Therefore, Mercy Suburban Hospital is reporting zero on line 3, since theoretically any potential charity care should have been identified through the predictive model. Part III, Line 4: Mercy Suburban Hospital is included in the consolidated financial statements of Trinity Health. The following is the text of the allowance for doubtful accounts footnote from page 14 of those statements: "The Corporation recognizes a significant amount of patient service revenue at the time the services are rendered even though the Corporation does not assess the patient's ability to pay at that time. As a result, the provision for bad debts is presented as a deduction from patient service revenue (net of contractual provisions and discounts). For uninsured and underinsured patients that do not qualify for charity care, the Corporation establishes an allowance to reduce the carrying value of such receivables to their estimated net realizable value. This allowance is established based on the aging of accounts receivable and the historical collection experience by Regional Health Ministry and for each type of payor. A significant portion of the Corporation's provision for doubtful accounts relates to self-pay patients, as well as co-payments and deductibles owed to the Corporation by patients with insurance." Part III, Line 8: Line 6, Costing Methodology - Medicare costs were obtained from the filed Medicare cost report. The costs are based on Medicare allowable costs as reported on worksheet B, column 27, which exclude direct medical education costs. Inpatient Medicare costs are calculated based on a combination of allowable cost per day times Medicare days for routine services and cost-to-charge ratio times Medicare charges for ancillary services. Outpatient Medicare costs are calculated based on cost-to-charge ratio times Medicare charges by ancillary department.Line 7, Shortfall - Mercy Suburban Hospital does not believe any Medicare shortfall should be treated as community benefit. This is similar to CHA recommendations, which state that serving Medicare patients is not a differentiating feature of tax-exempt healthcare organizations and that the existing community benefit framework allows community benefit programs that serve the Medicare population to be counted in other community benefit categories. Part III, Line 9b: The Hospital's collection policy contains provisions on the collection practices to be followed for patients who are known to qualify for financial assistance. Charity discounts are applied to the amounts that qualify for financial assistance. Collection practices for the remaining balances are clearly outlined in the organization's collection policy. The Hospital has implemented billing and collection practices for patient payment obligations that are fair, consistent and compliant with state and federal regulations. Part VI, Line 2: Mercy Suburban Hospital assesses the health status of its community in the normal course of operations and in the continuous efforts to improve patient care and the health of the overall community. The hospital may use patient data, public health data, annual County Health Rankings, market studies, and geographical maps showing areas of high utilization for emergency services and inpatient care, which may indicate populations of individuals who do not have access to preventative services or are uninsured, in the assessment of the community. Part VI, Line 3: Mercy Suburban Hospital is committed to:- Providing access to quality healthcare services with compassion, dignity and respect for those we serve, particularly the poor and the underserved in our communities- Caring for all persons, regardless of their ability to pay for services- Assisting patients who cannot pay for part or all of the care they receive- Balancing needed financial assistance for some patients with broader fiscal responsibilities in order to sustain viability and provide the quality and quantity of services for all who may need care in a communityIn accordance with American Hospital Association recommendations, Mercy Suburban Hospital has adopted the following guiding principles when handling the billing, collection and financial support functions for our patients: - Provide effective communications with patients regarding hospital bills- Make affirmative efforts to help patients apply for public and private financial support programs- Offer financial support to patients with limited means- Implement policies for assisting low-income patients in a consistent manner- Implement fair and consistent billing and collection practices for all patients with patient payment obligationsMercy Suburban Hospital communicates effectively with patients regarding patient payment obligations. Financial counseling is provided to patients about their payment obligations and hospital bills. Information on hospital-based financial support policies and external programs that provide coverage for services are made available to patients during the pre-registration and registration processes and/or through communications with patients seeking financial assistance. Financial counselors make affirmative efforts to help patients apply for public and private programs for which they may qualify and that may assist them in obtaining and paying for healthcare services. Every effort is made to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial support can be made during any stage of the patient's stay after stabilization or collection cycle. Mercy Suburban Hospital offers financial support to patients with limited means. This support is available to uninsured and underinsured patients who do not qualify for public programs or other assistance. Notification about financial assistance, including contact information, is available through patient brochures, messages on patient bills, posted notices in public registration areas including emergency rooms, admitting and registration departments, and other patient financial services offices. Summaries of hospital programs are made available to appropriate community health and human services agencies and other organizations that assist people in need. Information regarding financial assistance programs is also available on hospital websites. In addition to English, this information is also available in Spanish or other languages, reflecting other primary languages spoken by the population serviced by our hospital. Mercy Suburban Hospital has established a written policy for the billing, collection and support for patients with payment obligations. Mercy Suburban Hospital makes every effort to adhere to the policy and is committed to implementing and applying the policy for assisting patients with limited means in a professional, consistent manner. Part VI, Line 4: Mercy Suburban Hospital (MSH) is located in MO West (19403), Montgomery County. Its primary and secondary service area comprises 9 zip codes across central Montgomery County. This is primarily an affluent community with the exception of Norristown (19401) which is a diverse community that has been designated by the state and federal government as a medically underserved population (MUP). The total service area population is projected to increase by 2.2% while the female population of child bearing age is projected to decrease by 1.2% between 2014 and 2019. The minority population represents 28% of the total population and is projected to increase by 10%. The overall service area is affluent with an average household income of $99,909 and unemployment at 5.3%. Part VI, Line 5: Our community benefit activities include going directly into underserved communities/populations and providing health screenings, immunizations and health care education. Our community benefit programs also ensure establishing primary care physician offices in medically underserved areas. In addition, we maintain a 24-hour emergency room, an open medical staff and a board comprised largely of independent members of the community. Part VI, Line 6: Mercy Suburban Hospital is a member of Trinity Health, one of the largest Catholic health care delivery systems in the country. Trinity Health annually requires that all member organizations define - and achieve - community benefit goals that include implementing needed services or expanding access to services for low-income individuals. As a not-for-profit health system, Trinity Health reinvests its profits back into the community through programs serving those who are poor and uninsured, helping manage chronic conditions like diabetes, providing health education, promoting wellness and reaching out to underserved populations. Overall, the organization invests more than $800 million in such community benefits and works to ensure that its member hospitals and other entities/affiliates enhance the overall health of the communities they serve by addressing each community's specific needs.For more information about Trinity Health, visit www.trinity-health.org. 1 1 0 0 0 0 0 0 0 David D Clark President & CEO MHS 0 447055 0 268049 0 708774 0 78783 0 22149 0 1524810 0 0 Kathryn Conallen SVP,CEO MHS Acute Oper. 57790 327476 8269 46857 1298 7352 1940 10990 551 3123 69848 395798 0 0 Joseph H Bradley Senior VP & CFO MHS 0 345493 0 127985 0 13201 0 13288 0 22605 0 522572 0 0 Mark T Bullock Assistant Secretary 0 348122 0 125029 0 7876 0 11680 0 23219 0 515926 0 0 David A Wajda CFO MSH & NAZ 33141 187796 6085 34483 0 0 1746 9897 2788 15796 43760 247972 0 0 Peter B Kenniff CFO MSH 148925 0 0 0 1074 0 8371 0 868 0 159238 0 0 0 Christina FitzPatrick Executive Director 217362 47714 56768 12461 6452 1416 10603 2327 8242 1809 299427 65727 0 0 Michael Magro Associate CMO 231924 17457 25990 1956 0 0 12763 961 17000 1280 287677 21654 0 0 Leslie Tupchong Chair Dept of Rad Ther 438729 0 0 0 0 0 19190 0 27269 0 485188 0 0 0 Mary Ellen Rauner Chief Nursing Officer 160486 0 0 0 126 0 2408 0 11150 0 174170 0 0 0 Lynn Muholland Registered Nurse 135507 0 135 0 0 0 4775 0 12552 0 152969 0 0 0 Part I, Line 3 The organization relied on a related Section 501(c)(3) organization that used one or more of the methods described below to establish the top management official's compensation: - Compensation committee - Independent compensation consultant - Written employment contract - Compensation survey or study - Approval by the board or compensation committee. Part I, Lines 4a-b Line 4a: David Clark received severance payments totaling $524,990. Line 4b: Supplemental Executive Retirement Plan is provided to certain key executive employees. Contributions made to the plan on their behalf are vested and reflected in their compensation at the time of the contribution. Form 990, Part VI, Section A, line 6 SEPA is the sole corporate member of the organization. Form 990, Part VI, Section A, line 7a The Board of Directors of SEPA has the authority to appoint members of the governing body. Form 990, Part VI, Section A, line 7b The governing body can make recommendations for certain types of actions that require approval by the Board of Directors of SEPA. Some examples include appointing or removing members of the governing body, amending Articles of Incorporation, and amending Bylaws. Form 990, Part VI, Section B, line 11 The organization took steps to educate management, members of the board and members of appropriate subcommittees of the board on the compliance requirements mandated by the Form 990. It continues to maintain a process to address questions or concerns surrounding tax reporting requirements. The Form 990 is reviewed by management, and the process for preparing the filing is reviewed by the SEPA Compliance Committee, which is a subcommittee of the SEPA Board of Directors. The full board is appraised of management's and the committee's findings from these reviews. Form 990, Part VI, Section B, line 12c The organization has adopted SEPA's Policy 96-04-09 which sets forth the organization's conflict-of-interest policy and processes. Annually, all those serving the organization and affiliates in a position to affect business decisions, including directors, officers, members of a board-designated committee, and key employees and physicians, receive a copy of the policy and annual disclosure statement to be completed. Disclosures of financial interest or other reportable circumstances as defined in the policy are submitted and reviewed by SEPA's Board or senior management as defined in the policy. The determination of whether a disclosure constitutes a conflict of interest is made by SEPA's Board or an appropriate committee thereof comprised of disinterested persons and without the participation of the affected individual except to respond to questions about the disclosure. Lastly, the policy addresses potential disciplinary action for violations of the policy. The policy is available to the public upon request. Form 990, Part VI, Section B, line 15 The organization relies on Catholic Health East, a related Section 501(c)(3) organization, and on Catholic Health East procedures to determine the compensation of the CEO. For other employees, SEPA's process for determining compensation includes the following: SEPA's Board has an independent committee to review and approve all elements of remuneration. SEPA's Board and the independent committee have established a compensation philosophy which details the objectives of market positioning and pay elements. The committee engages with external consultants to provide market data comparing roles to similarly-sized health systems utilizing both title and job content comparisons. The committee reviews the market analysis, approves any salary adjustments for the executive population, considers both reasonableness and effectiveness of all remunerative programs and establishes the detailed performance expectations which are incorporated into the incentive plan. All of these discussions and decisions are documented through the provision of meeting minutes. Form 990, Part VI, Section C, line 19 Organizational Articles of Incorporation, Corporate Bylaws, governance policies believed to be of interest to the public, conflict-of-interest policy, and IRS Form 990 are available to the public upon request. Form 990, Part IX, line 11g RHC Internal Assessment: Program service expenses 10,616,406. Management and general expenses 2,212,884. Fundraising expenses 0. Total expenses 12,829,290. Physician Fees Clinical: Program service expenses 4,068,065. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,068,065. Service Contracts: Program service expenses 2,594,908. Management and general expenses 540,883. Fundraising expenses 0. Total expenses 3,135,791. All other expenses: Program service expenses 2,580,618. Management and general expenses 537,907. Fundraising expenses 0. Total expenses 3,118,525. Contract Services Administration: Program service expenses 1,665,454. Management and general expenses 347,147. Fundraising expenses 0. Total expenses 2,012,601. Reference Lab: Program service expenses 1,098,309. Management and general expenses 228,932. Fundraising expenses 0. Total expenses 1,327,241. Form 990, Part XI, line 9: Restricted Contributions 157,705. Asset Impairment -31,306,197. Transfer to Affiliate 6,655,601. Pension Adjustment -446,343. Restructuring Costs -152,319. Opening Balance Sheet Adjustments 4,276,772. Loss on Extinguishment of Debt -16,030. Disclosure Statement Related to Form 5471 Disclosure Statement Related to Form 5471 Filed by Catholic Health East, Saint Michael's Medical Center, and Trinity Health - Michigan Under the constructive ownership rules of Internal Revenue Code Sections 318(a) and 958(b), the organization is required to file Form 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, as a Category 4 and/or Category 5 filer with respect to Stella Maris Insurance Company Limited, Chestnut Risk Services, LTD, and Venzke Insurance Company, LTD (collectively, the "foreign corporations"). This filing requirement is, or will be, satisfied through the filing of Forms 5471 with respect to the foreign corporations on the organization's behalf by the U.S. organizations identified below. Foreign Corporation: Stella Maris Insurance Company U.S. Organization: Catholic Health East Address: 3805 West Chester Pike, Suite 100, Newtown Square, Pennsylvania 19073 Identifying Number of U.S. Tax Return with Which Form 5471 was filed: 23-2929748 IRS Service Center Where U.S. Return Was Filed: Ogden, UT Foreign Corporation: Chestnut Risk Services, LTD U.S. Organization: Saint Michael's Medical Center Address: 111 Central Avenue, Newark, New Jersey 07102 Identifying Number of U.S. Tax Return with Which Form 5471 was filed: 26-2616046 IRS Service Center Where U.S. Return Was Filed: Ogden, UT Foreign Corporation: Venzke Insurance Company, LTD U.S. Organization: Trinity Health - Michigan Address: 20555 Victor Parkway, Livonia, MI 48152 Identifying Number of U.S. Tax Return with which Form 5471 was filed: 38-2113393 IRS Service Center Where U.S. Return Was Filed: Ogden, UT EAST NORRITON PHYSICIAN SERVICES C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 232515999 PHYSICIAN SERVICES PA 501(c)(3) Line 3 MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET CONSHOHOCKEN PA 19428 231352191 ACUTE CARE HOSPITAL PA 501(c)(3) Line 3 MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY FAMILY SUPPORT 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD PA 19064 232325059 HOME HEALTH PA 501(c)(3) Line 9 MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY HEALTH FOUNDATION OF SOUTHEASTERN PENNSYLVANIA C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 232829864 FUNDRAISING PA 501(c)(3) Line 11b, II MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY HEALTH PLAN C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 222483605 HEALTH PLANS PA 501(c)(3) Line 11b, II MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET CONSHOHOCKEN PA 19428 232212638 MANAGEMENT & SUPPORT SERVICES PA 501(c)(3) Line 11b, II CATHOLIC HEALTH EAST 1 MERCY HOME HEALTH 1001 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