2014-05-13T10:50:02-05:00 2013-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2012-07-01 390816848 MERCY HEALTH SYSTEM CORPORATION MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 JAVON BEA 6087566000 2014-05-06 1 WILLIAM T MURPHY CPA P00074580 6087525835 2014-05-06 2012 2015-11-30 17:44:51Z X JAVON BEA PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 503893124 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 8 3841 0 10489650 0 269195 192379 464397477 482875091 465256 906429 -2530008 4487239 462601920 488461138 0 0 0 0 274568874 283427073 0 0 0 172508843 186769727 447077717 470196800 15524203 18264338 453287213 460754384 319217698 305574103 134069515 155180281 THE MISSION OF MERCY HEALTH SYSTEM IS TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES RESULTING IN HEALING IN THE BROADEST SENSE. 0 0 377709347 474547840 HOSPITAL DISCHARGES 8,400, NURSING HOME ADMISSIONS 274, BIRTHS 859, OUTPATIENT VISITS 1,145,410 377709347 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 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 1 450 0 1 3841 1 1 1 0 0 0 0 0 0 0 0 0 X 10 8 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 1.00 X 1097 0 0 THOMAS POOL 1.00 X 15000 0 0 LARRY SQUIRE 1.00 X 3718 0 0 ELIZABETH HANSCH 1.00 X 0 0 0 DAVE SYVERSON 1.00 X 15000 0 0 MARK GOELZER MD 55.00 X 474156 0 29991 ROBERT CONSIGNY 1.00 X 0 0 0 STEVE VAN GALDER 1.00 X 0 0 0 KATHERINE SCHACK 1.00 X 12561 0 0 MARK KOPP 1.00 X 0 0 0 BARB BORTNER 55.00 X 185153 0 35086 DAN COLBY 55.00 X 210562 0 21232 DAVID KURTZ 55.00 X 197682 0 27817 JOHN COOK 55.00 X 347668 0 35301 KATHY HARRIS 55.00 X 129791 0 27341 RUTH YARBROUGH 55.00 X 233056 0 21569 RICHARD GRUBER 55.00 X 162287 0 23142 RALPH TOPINKA 55.00 X 364700 0 20539 JOSEPH NEMETH 55.00 X 194728 0 23671 SUE RIPSCH 55.00 X 347224 0 31533 JENNIFER HALLATT 1.00 X 202544 0 34453 JAVON BEA 55.00 X X 5169487 0 34716 VIKRAM KHANNA 40.00 X 1549258 0 48572 BRADLEY FIDELER 40.00 X 1495019 0 41424 DAVID PITTENGER 40.00 X 1368843 0 40949 ROBB WHINNEY 40.00 X 1184988 0 31743 LANDON RIGGS 40.00 X 1087939 0 40533 14952461 0 569612 377 0 1 0 WALSH CONSTRUCTION COMPANY II LLC 929 WEST ADAMS CHICAGO IL 60607 CONSTRUCTION 8860311 MAGILL CONSTRUCTION COMPANY 977 KOOPMAN LANE ELKHORN WI 53121 CONSTRUCTION 7657106 ELLERBE BECKET INC 1178 PAYSPHERE CIR CHICAGO IL 60674 ARCHITECTUAL/ENGINEERING SERVICES 1905898 QUEST DIAGNOSTICS 12989 COLLECTIONS CENTER DR CHICAGO IL 606930129 LABORATORY DIAGNOSTIC SERVICES 1390348 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 SOFTWARE/SYSTEM MAINTENANCE 1341704 41 148000 32444 11935 192379 PATIENT SERVICE REVENUE 621110 471210590 471210590 UNRELATED BUSINESS INCOME 561000 10489650 10489650 CAFETERIA 722210 1174851 1174851 482875091 725637 725637 15604311 8467 15431918 68 172393 8399 180792 180792 OTHER INVESTMENTS 900099 4441164 4441164 MISCELLANEOUS 900099 46075 46075 4487239 488461138 471210590 10489650 6568519 8128658 8128658 225061909 183460792 41601117 6772208 5474419 1297789 30039541 22901534 7138007 13424757 10069842 3354915 893967 893967 42700 42700 41932 41932 25547057 14927898 10619159 3898426 31973 3866453 78162239 73638441 4523798 1099785 355020 744765 8753506 7852508 900998 1034109 428349 605760 1416527 980592 435935 8149506 7310677 838829 24594488 22068244 2526244 1038040 -181404 1219444 BAD DEBTS 20828853 20828853 0 0 WI MEDICAID & OTHER TAX 6935306 6935306 0 0 EQUIPMENT REPAIRS & MAI 6705531 4479573 2225958 0 INTER-ENTITY TRANSACTIO -6070228 -4947629 -1122599 0 3697983 1094359 2603624 470196800 377709347 92487453 0 21020 22285 5873542 9996299 67719511 78130447 10180930 10104452 4618871 5603206 512233047 220470765 289726471 291762282 68047607 50226624 7099261 14908789 453287213 460754384 63856664 56498293 4853930 7084631 250507104 241991179 319217698 305574103 X 134069515 155180281 134069515 155180281 453287213 460754384 X 18264338 -427572 3274000 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27078424 27078424 285409615 95232538 190177077 5264360 3681205 1583155 183821537 116729259 67092278 10659111 4827763 5831348 291762282 INVEST. - FUTURE REPLACE OF PROP, PLANT & EQUIPMENT 14204848 C ASSETS UNDER BOND INDENTURE AGREEMENT 4299716 C DEFERRED COMPENSATION 7493141 C INVESTMENT IN MERCYCARE 18985273 C INVESTMENTS - OTHER 4634237 C BOND PROJECT FUND 609409 C 50226624 DEFERRED COMPENSATION 7493141 PENSION LIABILITY 28175000 CAPITAL LEASES PAYABLE 269577 DUE TO RELATED PARTY 206053461 241991179 488461138 0 488461138 0 488461138 470196800 0 470196800 0 470196800 1 1 X 1 X 1 X 1 1 1 0 1 1 5844677 0 5844677 0.01240 58788928 35130927 23658001 0.05030 5318936 3166257 2152679 0.00460 69952541 38297184 31655357 0.06730 1580407 195976 1384431 0.00290 4740364 870003 3870361 0.00820 14426491 11215984 3210507 0.00680 0 416993 416993 0.00090 21164255 12281963 8882292 0.01880 91116796 50579147 40537649 0.08610 52000 52000 0.00010 32000 32000 0.00010 20000 20000 0.00000 34000 34000 0.00010 138000 138000 0.00030 1 8800311 1126440 57136944 69203901 -12066957 X 1 1 2 1 MERCY HOSPITAL

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 1 X X X X X X X X 12 1 1 1 X 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 1 1 X X X 1 X 0 1 X 0 0 MERCY WALWORTH HOSPITAL AND MEDICAL CENT 2 1 X X X X X X X X 12 1 1 1 X 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 1 1 X X X 1 X 0 1 X 0 0 50 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 PART I, LINE 6A: MERCY HEALTH SYSTEM, CORP. (MHS) SUBMITS AN ANNUAL COMMUNITY BENEFIT STATEMENT TO THE WISCONSIN HOSPITAL ASSOCIATION. PERIODICALLY, IT PUBLISHES A PAMPHLET EXPLAINING THE COMMUNITY BENEFITS THAT MERCY HEALTH SYSTEM CORP, 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). 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 $2,866,033 OF EXPENSES (COLUMN C) AND $754,173 OF NET EXPENSES (COLUMN E) ATTRIBUTABLE TO THE COSTS OF TRAUMA SURGEONS. THESE SURGEONS STAFF THE LEVEL II TRAUMA PROGRAM OF MERCY HEALTH SYSTEM CORPORATION 24/7. MERCY SOUTH - FAMILY PRACTICE CLINIC WAS ALSO INCLUDED IN THIS LINE: EXPENSES IN COLUMN C TOTALED $3,199,672 AND COLUMN E HAD $82,736 OF NET EXPENSES. PART I, L7 COL(F): BAD DEBT EXPENSE OF $20,828,853 INCLUDED ON FORM 990, PART IX, LINE 25, WAS EXCLUDED FROM EXPENSES WHEN CALCULATING THE PERCENTAGE IN THIS COLUMN. PART II: 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 4: BAD DEBT EXPENSE IS ACCOUNTED FOR IN THE FOLLOWING MANNER (AS DETAILED IN NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH SYSTEM CORPORATION AND SUBSIDIARIES). 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, MHSC ANALYZES HISTORICAL LOSS EXPERIENCE ON REVENUE FOR ALL PAYORS. USING THE LOSS EXPERIENCE RATE, MHSC 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 MERCY'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 12.8%. 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 MERCY'S TWO HOSPITALS' MEDICARE COST REPORTS. PART III, LINE 9B: PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MERCY'S COMMUNITY CARE PROGRAM, WILL RECEIVE A 20% DISCOUNT FROM MERCY'S STANDARD FEE SCHEDULE. ALL SELF-PAY PATIENTS MEET WITH PATIENT FINANCIAL COUNSELORS AND DISCUSS PAYMENT OPTIONS INCLUDING MERCY'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. MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 3: THE STEERING COMMITTEE FOR THE ROCK COUNTY NEEDS ASSESSMENT SURVEY WAS COMPOSED OF A CORE GROUP OF AGENCIES AND COMMUNITY MEMBERS WHO REPRESENTED THE SPECTRUM OF THE HEALTHCARE INFRASTRUCTURE WITHIN THE COUNTY. COMMUNITY PARTNERS ENGAGED IN THIS PROCESS INCLUDE REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS:- BELOIT MEMORIAL HOSPITAL - BELOIT AREA COMMUNITY HEALTH CENTER- EDGERTON HOSPITAL - HEALTHNET OF ROCK COUNTY - MERCY HEALTH SYSTEM - ROCK COUNTY PUBLIC HEALTH DEPARTMENT- ROCK COUNTY HUMAN SERVICES - ST. MARY'S JANESVILLE HOSPITAL - THE UNIVERSITY OF WISCONSIN EXTENSION OFFICE STEERING COMMITTEE MEMBERS CONDUCTED NINE FOCUS GROUPS WITH ROCK COUNTY RESIDENTS FROM EACH MAJOR COMMUNITY. THE FOCUS GROUPS SOUGHT FEEDBACK FROM COMMUNITY MEMBERS REGARDING THEIR PERCEPTIONS OF HEALTH SERVICES IN THE AREA. OVER THE NINE FOCUS SESSIONS, RESIDENTS OF ROCK COUNTY OFFERED VARIOUS PERSPECTIVES ON OPPORTUNITIES FOR IMPROVEMENT AND ANSWERED THE QUESTION, "WHAT CONSTITUTES A HEALTHY COMMUNITY?" TO COMPLEMENT THE FOCUS GROUP DISCUSSIONS, THE STEERING COMMITTEE DISTRIBUTED HEALTH QUESTIONNAIRES TO A RANDOM SAMPLE OF ROCK COUNTY RESIDENTS. THE FORTY-NINE QUESTION SURVEY, DISTRIBUTED TO 1,300 MEMBERS OF THE COMMUNITY, COVERED A WAIDE RANGE OF TOPICS RANGING FROM ACCESS TO CARE, QUALITY OF LIFE, CHRONIC ILLNESSES, AND LIFESTYLE FACTORS. RESPONSE RATE WAS 19.6%. ONCE THE SURVEY RESPONSES WERE TABULATED, THE SURVEY RESULTS WERE EVALUATED AND ANALYZED FOR HEALTH AND DEMOGRAPHIC TRENDS. A LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) WAS CONDUCTED. THIS PROVIDED A COMPREHENSIVE ASSESSMENT OF ALL THE ORGANIZATIONS AND ENTITIES THAT CONTRIBUTE TO THE DELIVERY OF HEALTH SERVICES IN THE AREA. IT MEASURED THE CAPABILITIES AND NEEDS OF THE HEALTH INFRASTRUCTURE ITSELF. IN ADDITION TO THE DATA GATHERED FROM HOUSEHOLD SURVEYS AND FOCUS GROUPS, THE COMMITTEE ALSO ANALYZED HEALTH-RELATED DATA FROM A VARIETY OF EXISTING SOURCES, INCLUDING THE WISCONSIN DEPARTMENT OF TRANSPORTATION, WISCONSIN COUNTY HEALTH RANKINGS, DEPARTMENT OF EDUCATION AND WISCONSIN DEPARTMENT OF HEALTH SERVICES. SECONDARY SOURCE DATA, WHEN COMBINED WITH THE QUALITATIVE AND QUANTITATIVE INFORMATION GATHERED FROM THE MAPP ASSESSMENTS, PROVIDED THE STEERING COMMITTEE WITH A CLEAR PICTURE OF WHAT IS WORKING WELL IN ADDITION TO IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT FOR THE HEALTHCARE INFRASTRUCTURE OF ROCK COUNTY. -- INFORMATION TAKEN DIRECTLY FROM ROCK COUNTY'S NEEDS ASSESSMENT DOCUMENT MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 3: WALWORTH COUNTIES COMMUNITY HEALTH IMPROVEMENT PLAN AND PROCESS (CHIPP) STEERING COMMITTEE MEMBERS WAS COMPRISED OF REPRESENTATIVES OF THE COMMUNITY, LEADERS WITH KNOWLEDGE OF THE COMMUNITY, AND INDIVIDUALS INTERESTED AND COMMITTED TO CREATING A HEALTHIER COMMUNITY.CHIPP STEERING COMMITTEE MEMBERS:AURORA LAKELAND MEDICAL CENTER, ELKHORN SCHOOLS, ROCK-WALWORTH COMMUNITY ACTION, MERCY HEALTH SYSTEMS (WALWORTH HOSPITAL), ELKHORN SCHOOL DISTRICT, COMMUNITY HEALTH SYSTEMS INC., AURORA HEALTH CARE, GATEWAY TECHNICAL COLLEGE, WALWORTH COUNTY JOB CENTER, AURORA HEALTH CARE EAST TROY, UW-WHITEWATER, ST. BENEDICT CHURCH, FORT HEALTH CARE, UNIV. HEALTH & COUNSELING CENTER, GODFREY, LEIBSLE, BLACKBURN, & HOWARTH, DENTAL PERFECTIONS, UW-EXTENSION, LAKELAND ANIMAL SHELTER, FRANKLIN HEALTH DEPARTMENT, MEDICAL COLLEGE OF WISCONSIN - WALWORTH, BENEFIT CONCEPTS INC., ROCK-WALWORTH COMPREHENSIVE FAMILY SRV, CO. PUBLIC HEALTH STUDENT, DUNCAN MEDICATION & CONSULTING SRV LLC, VIP SERVICES INC. EXPERTISE WAS ALSO DERIVED FROM A PLAN DEVELOPED BY THE STATE OF WISCONSIN AND FROM COUNTY HEALTH RANKINGS: HEALTHIEST WISCONSIN 2020 IMPROVEMENT PLAN, IDENTIFIES 12 HEALTH FOCUS PRIORITY AREAS AND 9 HEALTH INFRASTRUCTURE PRIORITY AREAS THAT ARE THE UNDERLYING AND INTERRELATED CAUSES OF MANY DISEASES AND HEALTH CONDITIONS IN THE STATE OF WISCONSIN. (THESE AREAS WERE IDENTIFIED DURING A TWO YEAR, INTERDISCIPLINARY STATEWIDE STUDY). THE COUNTY HEALTH RANKINGS, A SURVEY APPLIED NATIONWIDE TO DETERMINE THE HEALTH STATUS OF COUNTIES IN A VARIETY OF DIFFERENT AREAS, AND TO ALLOW COMPARISONS BETWEEN THE HEALTH STATUS ACROSS STATES, WAS USED PRIMARILY IN THE IDENTIFICATION OF STRATEGIC ISSUES AND TO HELP PUT INTO CONTEXT THE STATE OF HEALTH IN WALWORTH COUNTY. FOCUS GROUPS WERE CONDUCTED DURING THE COURSE OF THE COMMUNITY HEALTH IMPROVEMENT PROCESS TO GAIN A BETTER UNDERSTANDING OF WHAT HEALTH ISSUES AFFECT WALWORTH COUNTY RESIDENTS AND HOW HEALTH IS PERCEIVED IN THE COUNTY. RESPONSES WERE COLLECTED FROM THE SCHOOL NURSES OF WALWORTH COUNTY, SCHOOL SYSTEMS, THE PUBLIC HEALTH STAFF, WIC STAFF, DHHS MANAGEMENT TEAM AND EARLY HEAD START STAFF. RESULTS FROM THIS SECTION REFLECT OPINION AND PERCEPTION AND MAY NOT ACTUALLY BE INDICATIVE OF THE ACTUAL HEALTH STATUS, BUT HELPED THE STEERING COMMITTEE TO UNDERSTAND COMMUNITY PERCEPTION OF HEALTH. -- INFORMATION TAKEN DIRECTLY FROM THE WALWORTH COUNTY CHIP DOCUMENT MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 4: BELOIT, EDGERTON, ST MARY'S JANESVILLE MERCY WALWORTH HOSPITAL AND MEDICAL CENT PART V, SECTION B, LINE 4: AURORA LAKELAND MEDICAL CENTER MERCY HOSPITAL AND TRAUMA CENTER PART V, SECTION B, LINE 14G: 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 14G: AVAILABLE THROUGH PATIENT FINANCIAL COUNSELORS WHO DO PRE- OR POST-FOLLOW UP WITH SELF-PAY PATIENTS. PART VI, LINE 2: MERCY HEALTH SYSTEM CORPORATION DOES COMMUNITY NEEDS ASSESSMENTS IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF WALWORTH (WI), ROCK (WI), AND MCHENRY (IL) COUNTIES EVERY 18 MONTHS. MERCY HAS DEDICATED STAFF THAT WORKS WITH VARIOUS AGENCIES/PROGRAMS OF NEARBY COMMUNITIES TO ASSESS HEALTH NEEDS. 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) COOPERATIVE CHILD CARE INSTITUTE: COLLABORATION WITH JANESVILLE PUBLIC SCHOOL DISTRICT AND ROCK COUNTY HUMAN SERVICES TO SERVE EMOTIONALLY CHALLENGED CHILDREN. IV) FAMILY HEALTH PARTNERSHIP CLINIC AND WELL CHILD CLINIC IN WOODSTOCK, IL AND HARVARD FREE CLINIC IN MCHENRY COUNTY, IL: MERCY PHYSICIANS VOLUNTEER THEIR SERVICES. V) FAMILY HEALTH PARTNERSHIP CLINIC: MCHENRY COUNTY DEPARTMENT OF HEALTH COLLABORATION TO PROVIDE MAMMOGRAMS AT MERCY FACILITIES FOR WOMEN WHO CANNOT OTHERWISE AFFORD THE SERVICE. VI) ROCK COUNTY HEALTH DEPARTMENT: BIOTERRORISM READINESS PROJECT. VII) RED CROSS: BLOOD DRIVE AND COOPERATIVE VOLUNTEER EFFORTS. VIII) UNITED WAY: FUND RAISING CAMPAIGN AND ROCK COUNTY NEEDS ASSESSMENT SURVEY CONTRIBUTOR IX) AREA POLICE AND FIRE DEPARTMENTS: PROVIDE PORTABLE DEFIBRILLATORS FOR POLICE VEHICLES AND FREE OR REDUCED-COST PARAMEDIC/EMT EDUCATIONAL OPPORTUNITIES. X) 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: ONE HOSPITAL OF MERCY HEALTH SYSTEM CORPORATION IS LOCATED IN JANESVILLE, WI. IT IS NOW ONE OF TWO ACUTE CARE HOSPITALS LOCATED IN JANESVILLE, WI. IT IS LICENSED FOR 240 BEDS AND IS LOCATED IN ROCK COUNTY, WI. ABOUT 13% OF ROCK COUNTY RESIDENTS LIVED BELOW THE POVERTY LEVEL IN 2009. THIS PROPORTION EXCEEDS THE STATE AVERAGE (12.4%) BUT IS LESS THAN THE NATIONAL AVERAGE (15.1%). APPROXIMATELY 16% OF CHILDREN LIVE IN POVERTY, WHICH IS GREATER THAN BOTH THE STATE AVERAGE (14%) AND NATIONAL BENCHMARK (11%). MEDIAN HOUSEHOLD INCOME IS $49,347, WHICH IS LOWER THAN BOTH THE STATE AND NATIONAL AVERAGES OF $49,994 AND $51,425, RESPECTIVELY. HIGH UNEMPLOYMENT RATES AND A DECREASING LABOR FORCE ARE TWO FACTORS CONTRIBUTING TO THE OVERALL ECONOMIC CLIMATE IN THE COUNTY. ROCK COUNTY HAS EXPERIENCED UNEMPLOYMENT RATES GREATER THAN THE STATE AND NATIONAL AVERAGES FOR SEVERAL YEARS; HOWEVER, THE COUNTY'S RATE HAS BEEN ON A DOWNWARD TREND SINCE 2009. WHILE THE LABOR FORCE DECLINED CONSIDERABLY FROM 2006 THROUGH 2010, ECONOMIC DEVELOPMENT EFFORTS HAVE RESULTED IN LABOR FORCE GROWTH IN 2010 AND 2011. ROCK COUNTY'S UNEMPLOYMENT RATE AS OF 2011 WAS AT 9.8%, COMPARED TO WISCONSIN'S 7.6%. MERCY HEALTH SYSTEM'S SECOND HOSPITAL IS IN WALWORTH COUNTY. IT IS DESIGNATED AS A CRITICAL ACCESS 25 BED HOSPITAL. WALWORTH COUNTY WAS ALSO ESTIMATED TO HAVE APPROXIMATELY 10.3% OF THE POPULATION BELOW THE POVERTY LEVEL; THIS REPRESENTS A SIGNIFICANT INCREASE SINCE 2000. WALWORTH'S UNEMPLOYMENT RATE IN 2011 WAS 7.9%. THE TWO HOSPITALS' PAYOR DEMOGRAPHICS INCLUDED 38.8% MEDICARE, AND 14.2% MEDICAID FOR THE FISCAL YEAR OF JULY 1, 2012 - JUNE 30, 2013 (AS DETERMINED BY CHARGES BILLED). PART VI, LINE 5: THE HOSPITALS OF MERCY HEALTH SYSTEM HAVE AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. MERCY HEALTH SYSTEM HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY. PART VI, LINE 6: MERCY HEALTH SYSTEM CORPORATION OPERATES TWO HOSPITALS AND HAS COMMUNITY CLINICS LOCATED THROUGHOUT SIX COUNTIES OF WISCONSIN AND ILLINOIS. IT IS PART OF A LARGER INTEGRATED HEALTH SYSTEM AND 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 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 HARVARD HOSPITAL PROVIDES ACUTE CARE SERVICES IN MCHENRY COUNTY ILLINOIS. 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 SHELTERED 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 1,037 IN CALENDAR YEAR 2012. 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. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 MARK GOELZER MD 468860 0 0 0 5296 0 16548 0 13443 0 504147 0 0 0 BARB BORTNER 129477 0 51734 0 3942 0 12073 0 23013 0 220239 0 0 0 DAN COLBY 180252 0 22695 0 7615 0 13117 0 8115 0 231794 0 0 0 DAVID KURTZ 132598 0 51734 0 13350 0 12550 0 15267 0 225499 0 0 0 JOHN COOK 248191 0 93750 0 5727 0 16548 0 18753 0 382969 0 0 0 KATHY HARRIS 85197 0 33826 0 10768 0 7567 0 19774 0 157132 0 0 0 RUTH YARBROUGH 161459 0 60489 0 11108 0 14800 0 6769 0 254625 0 0 0 RICHARD GRUBER 135240 0 17245 0 9802 0 10039 0 13103 0 185429 0 0 0 RALPH TOPINKA 254147 0 95625 0 14928 0 16548 0 3991 0 385239 0 0 0 JOSEPH NEMETH 138223 0 52729 0 3776 0 12347 0 11324 0 218399 0 0 0 SUE RIPSCH 242195 0 92270 0 12759 0 16548 0 14985 0 378757 0 0 0 JENNIFER HALLATT 143999 0 56250 0 2295 0 13340 0 21113 0 236997 0 0 0 JAVON BEA 940949 0 755086 0 3473452 0 16548 0 18168 0 5204203 0 0 0 VIKRAM KHANNA 1547550 0 0 0 1708 0 16548 0 32024 0 1597830 0 0 0 BRADLEY FIDELER 1493401 0 0 0 1618 0 16548 0 24876 0 1536443 0 0 0 DAVID PITTENGER 1367225 0 0 0 1618 0 16548 0 24401 0 1409792 0 0 0 ROBB WHINNEY 1183922 0 0 0 1066 0 16548 0 15195 0 1216731 0 0 0 LANDON RIGGS 1086609 0 0 0 1330 0 15236 0 25297 0 1128472 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 341463 EMPLOYMENT - PHYSICIAN 0 JAMIE KURTZ FAMILY MEMBER OF DAVID KURTZ, OFFICER 35308 EMPLOYMENT - PATIENT ACCOUNT REPRESENTATIVE 0 LISA NEMETH FAMILY MEMBER OF JOSEPH NEMETH, OFFICER 15159 EMPLOYMENT - REIMBURSEMENT ANALYST 0 JOANNA BENNING FAMILY MEMBER OF JAVON BEA, PRESIDENT & DIRECTOR 98844 EMPLOYMENT - DIRECTOR 0 MEGAN KRAUSE FAMILY MEMBER OF SUE RIPSCH, OFFICER 82436 EMPLOYMENT - MANAGER 0 LAUREN GRUBER FAMILY MEMBER OF RICHARD GRUBER, OFFICER 50531 EMPLOYMENT - RN/HIB 0 FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS OR WILL BE CONDUCTED 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 2012. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGES IN PENSION OBLIGATIONS 3,274,000. TOTAL NUMBER OF VOLUNTEERS FORM 990, PART I, LINE 6 MERCY HEALTH SYSTEM CORPORATION HAS REPORTED ZERO FOR THE TOTAL NUMBER OF VOLUNTEERS. THIS IS DUE TO THE FACT THAT ALL 1,037 VOLUNTEERS FOR THE MERCY HEALTH SYSTEM CORPORATION ARE TECHNICALLY VOLUNTEERS OF THE MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS AND AS SUCH HAVE BEEN REPORTED ON THEIR TAX RETURN. PLEASE SEE THE MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS TAX RETURN FOR MORE INFORMATION ON MERCY VOLUNTEER ACTIVITIES. 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 MERCY HEALTH SYSTEM & THE HOUSE OF MERCY 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 ALLIANCE INC 901 GRANT STREET HARVARD IL 60033 311551871 MEDICAL HEALTHCARE IL 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 72500 1.00000 0 MERCYCARE INSURANCE COMPANY 3430 PALMER DRIVE JANESVILLE WI 53545 391768192 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 115756854 42645419 1.00000 0 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 3430 PALMER DRIVE JANESVILLE WI 53545 201482553 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 1.00000 0 1 0 0 0 1 0 0 0 0 1 1 0 0 1 1 0 1 1 0 MERCYCARE INSURANCE COMPANY Q 7152400 COST OF SERVICES PROVIDED