2013-11-13T11:32:23-06:00 2012-12-31 440160260 BKD LLP 312 WALNUT STREET SUITE 300 CINCINNATI OH 45202 990 2012-01-01 341344482 MERCY HEALTH SYSTEM - NORTHERN REGION MERC 4192514000 2200 Jefferson Avenue Toledo OH 43604 DONALD KLINE 2013-10-30 true P00961884 5136218300 2012 2016-02-24 21:20:13Z MERCY HEALTH PARTNERS ANDREA PRICE 2200 JEFFERSON AVENUE TOLEDO OH 43604 174722198 false 0928 X WWW.MERCYWEB.ORG X 1999 OH THE PRIMARY EXEMPT PURPOSE OF MERCY HEALTH PARTNERS IS TO EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. 20 14 1292 19 274759 -196448 0 0 110243233 173706431 -519088 -3057426 424208 997683 110148353 171646688 0 0 0 0 49277038 89565119 0 0 0 61714999 87470431 110992037 177035550 -843684 -5388862 73657785 113033855 48382947 47545390 25274838 65488465 X MERCY HEALTH PARTNERS EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. true false 136053415 0 150377298 MERCY HEALTH PARTNERS PROVIDES SERVICES AND SUPPORT TO AFFILIATED HEALTH CARE FACILITIES, INCLUDING BUT NOT LIMITED TO: PROVIDING STRATEGIC LEADERSHIP, FOCUSING RESOURCES TO ASSURE THE HEALING MISSION, EFFECTIVELY MANAGING CARE, IMPROVING CLINICAL OUTCOMES AND REDUCING OPERATING COSTS. 17671071 0 23054374 MERCY DEFIANCE HOSPITAL EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. MERCY DEFIANCE HOSPITAL ACCOMPLISHES THIS PURPOSE BY DEMONSTRATING BEHAVIORS REFLECTING OUR CORE VALUES OF COMPASSION, EXCELLENCE, HUMAN DIGNITY, JUSTICE, SACREDNESS OF LIFE AND SERVICE. TOTAL CHARITY CARE PROVIDED WAS $621,185 SERVING 2,631 INDIVIDUALS. 153724486 true false false true false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false true true true true false false true 0 0 1292 true true true false false false false false false false false false X 20 14 true false false false true true true true true false false true true true true true true false true false X TRAVIS CRUM 5136392800 615 ELSINORE PLACE CINCINNATI OH 45202 ANDREA PRICE 50.00 7.00 X X 535930 0 46132 CHARLES E GALLAGHER 1.00 3.00 X X 0 0 0 DENNIS G JOHNSON 1.00 3.00 X X 0 0 0 KAREN L FRAKER 1.00 3.00 X X 0 0 0 MICHAEL P KILLIAN 0.50 1.50 X X 0 0 0 RALPH A THAN 0.50 2.50 X X 0 0 0 SR MILDRED ELY HM 0.50 1.50 X X 0 0 0 ALLEN GASPAR MD 0.50 43.50 X 0 250696 43348 ANTHONY J ARMSTRONG MD 0.50 42.50 X 0 324076 54897 BRENT COUSINO 0.50 1.50 X 0 0 0 BRIAN SMITH 0.50 48.00 X 0 512193 186636 CAROL BINTZ 0.50 1.50 X 0 0 0 DENISE M HASBROOK 0.50 1.50 X 0 0 0 ERICH R PONTASCH MD 0.50 1.50 X 0 7167 0 GARY SMITH 0.50 1.50 X 0 0 0 GREGORY KASPER MD 0.50 2.50 X 0 119600 0 JOHN H HARRIS III 0.50 2.50 X 0 0 0 JOHN M STARCHER JR 0.50 58.80 X 0 875292 26045 JON M LEVINE 0.50 1.50 X 0 0 0 JUDGE VERNELIS K ARMSTRONG 0.50 1.50 X 0 0 0 KRISHNA RAGOTHAMAN MD 0.50 1.50 X 0 25315 0 MARK RIDENOUR 0.50 1.50 X 0 0 0 PAMELA HOWELL-BEACH 0.50 1.50 X 0 0 0 PAUL BISHOP 0.50 1.50 X 0 0 0 ROOSEVELT GANT 0.50 1.50 X 0 0 0 TED BARBER MD 0.50 1.50 X 0 15500 0 VIJAY M ADAPPA MD 0.50 1.50 X 0 6000 0 ROBERT MOON 50.00 9.00 X 637238 0 44598 BARRY HUDGIN 50.00 6.00 X 169103 0 52368 CAROL WHITTAKER 50.00 5.00 X 163826 0 185323 GARY GEORGE 50.00 5.00 X 280156 0 162967 IMRAN ANDRABI MD 50.00 5.50 X 463145 0 100065 JOSEPH GLASS 50.00 5.00 X 228740 0 51377 KATRINA ENGLISH 50.00 0.00 X 0 200449 37903 KEVIN COOK 1.00 56.00 X 0 410571 62269 MICHELE MONTAGUE 50.00 4.00 X 186097 0 88129 THOMAS ARQUILLA 50.00 5.00 X 326682 0 51915 ADNAN ALKHALILI MD 55.00 0 X 708330 0 35080 MOHAMMAD ALNSOUR MD 55.00 0 X 702944 0 30208 NASFAT SHEHADEH MD 55.00 0 X 588656 0 41083 STANLEY TAO MD 55.00 0 X 499994 0 19112 THOMAS F WALSH MD 55.00 0 X 487499 0 39052 DAVID AROSE 0.00 0.00 X 0 263878 27963 DENNIS SHERRY 0.00 0.00 X 255872 0 95145 H TERRENCE SMITH 0.00 0.00 X 204603 0 72127 SAMANTHA PLATZKE 0.00 40.00 X 0 626631 109760 SCOTT SHOOK 0.00 0.00 X 280791 0 247920 STEVEN L MICKUS 0.00 56.40 X 0 1456282 181182 TODD WARNER 0.00 0.50 X 204501 0 74413 WILLIAM SUTTON 0.00 55.00 X 241556 0 90757 7165663 5093650 2257774 114 true true false 0 0 NET PATIENT SERVICE REVENUE 621990 70176256 70176256 ADMINISTRATIVE & SUPPORT SERVICES FEE 561499 102734564 102459805 274759 MISCELLANEOUS 900099 173569 173569 EXEMPT FUNCTION RENTAL INCOME 622042 622042 0 0 0 0 0 173706431 18084 18084 0 0 0 0 0 1110497 1965013 -1110497 -1965013 -3075510 -3075510 0 0 0 MISCELLANEOUS 900099 997683 997683 0 0 0 0 0 0 997683 171646688 173431672 274759 -2059743 0 0 0 0 0 0 0 0 9012339 8002957 1009382 0 0 0 0 0 60633607 53847692 6785915 4849137 4342435 506702 10332062 9098637 1233425 4737974 4238836 499138 7639667 4976170 2663497 517125 0 517125 922395 0 922395 3968450 3571605 396845 0 819800 0 819800 7188602 6469741 718861 0 1985770 1608422 377348 15634524 14116410 1518114 32960053 29664048 3296005 0 5110559 4249605 860954 1108053 973254 134799 0 76676 69008 7668 228831 185026 43805 0 5615112 5025437 589675 2368373 2112835 255538 MEMBERSHIP DUES 681539 570088 111451 MEDICAL SUPPLIES 391724 352552 39172 OTHER EXPENSES 253178 249728 3450 0 0 0 0 177035550 153724486 23311064 0 0 -1304547 -1351563 5151532 11779277 0 0 33845284 62601946 1244118 2112501 677951 1868825 135839013 112459290 16189825 23379723 16472749 5331596 0 0 0 0 1489326 1380873 5822224 73657785 113033855 17560649 24433649 0 30822298 23111741 48382947 47545390 X 25274838 65488465 25274838 65488465 73657785 113033855 X -5388862 1235293 44367195 X false true X true false X X X false false false MERCY ST CHARLES HOSPITAL 344445373 3 false true true 0 MERCY ST ANNE HOSPITAL 311556401 3 false true true 0 MERCY HOSPITAL OF TIFFIN 344431174 3 false true true 0 MERCY HOSPITAL OF WILLARD 341577110 3 false true true 0 MERCY ST VINCENT MEDICAL CENTER 344428250 3 false true true 0 MERCY DEFIANCE HOSPITAL 020701635 3 false true true 0 6 0 true true false true 0 false true 20988 true 0 false true 4791 25779 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 LOBBYING ACTIVITIES PERFORMED INCLUDE BOTH THE USE OF VOLUNTEERS ENCOURAGED TO WRITE LETTERS TO PUBLIC OFFICIALS ON ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE TO PROVIDE HEALTH SERVICES TO THE COMMUNITIES SERVED, AND THE USE OF PAID STAFF MEMBERS AND MANAGEMENT PERSONNEL. PAID MANAGEMENT PERSONNEL REGULARLY ISSUE MAILINGS TO LEGISLATORS ATTEMPTING TO INFLUENCE LEGISLATIVE MATTERS AND REFERENDUM, AND ORGANIZE AND HOST MEETINGS AMONG HOSPITAL EXECUTIVES AND THEIR LEGISLATORS REGARDING ISSUES THAT IMPACT THE ORGANIZATION'S ABILITY TO CONTINUE PROVIDING HEALTHCARE SERVICES TO ITS PATIENTS AND TO CONTINUE IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. PAID STAFF MEMBERS HAVE, ON LIMITED OCCASIONS, WRITTEN TO LEGISLATORS ON SUCH ISSUES. THE PRIMARY PURPOSE FOR LOBBYING ACTIVITIES IS TO ENHANCE THE ORGANIZATION'S PUBLIC POSITION ON LEGISLATIVE AND REGULATORY ISSUES THAT IMPACT PATIENT CARE THROUGHOUT OUR SYSTEM. THE ORGANIZATION FOCUSES ON PUBLIC POLICY ISSUES THAT EXTEND OUR HEALING MINISTRY TO THOSE WHO ARE POOR AND UNDERSERVED IN THE COMMUNITIES WE SERVE. TO CARRY OUT THESE EFFORTS, THE ORGANIZATION PARTNERS WITH EXPERT CONSULTANTS AND PROFESSIONAL TRADE ASSOCIATIONS TO BUILD AWARENESS AND EXECUTE SPECIFIC STRATEGIES THAT WILL YIELD A FAVORABLE OUTCOME FOR PATIENT CARE IN THE ORGANIZATION'S FACILITIES WHERE THEY ARE TREATED. 6055398 6055398 8695546 2773387 5922159 719677 97396 622281 118911487 108575179 10336308 1456905 1013328 443577 23379723 LONG TERM INTERCO CHP PPIC CAPITALIZATION 788160 SECURITY DEPOSIT - WINTHROP LEASING 602736 INVESTMENT IN DEFIANCE CLINIC 1664836 GOODWILL 2547695 OTHER INTANGIBLE ASSETS 115655 LAND LEASE 101167 LOAN ORIGINATION FEES 1975 5822224 0 PENSION LIABILITY 12374520 DEFERRED COMPENSATION PLAN 2965551 RETIREE MEDICAL LIABILITY 1439560 CURRENT PORTION L/T DEBT (CHP) 1976668 LONG TERM DEBT (CHP) 1711264 UNEMPLOYMENT SELF INSURANCE LIABILITY TRUST 37471 SERP LIABILITY 260855 DEFIANCE NON-COMPETE AGREEMENT 613063 DEFIANCE CLINIC PROPERTIES PURCHASE AGREEMENT 1732789 23111741 X FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 CATHOLIC HEALTH PARTNERS AND AFFILIATED ENTITIES COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2012 AND 2011, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2012 OR 2011. true true X true X true X true true true false true true 2631 802959 181774 621185 0.00350 15786 5362208 2911525 2450683 0.01380 0 0.00000 0 18417 6165167 3093299 3071868 0.01730 147 100298 100298 0.00060 0 0.00000 0 0.00000 0 0.00000 15177 15177 0.00000 0 147 115475 0 115475 0.00060 0 18564 6280642 3093299 3187343 0.01790 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 false 2571468 0 6650079 7948015 -1297936 X true true DEFIANCE CLINIC PROPERTIES RENTAL 0.49 0 0.51 1 1 MERCY DEFIANCE HOSPITAL

1404 E SECOND STREET DEFIANCE OH 43513

WWW.MERCYWEB.ORG X X X MERCY DEFIANCE HOSPITAL 1 true true 200 true 400 true X X X X true true X X X X X X true false X X X X true X false false 2 MERCY DEFIANCE CLINIC

1400 E SECOND STREET DEFIANCE OH 43512

PHYSICIAN GROUP MERCY NAPOLEAN CLINIC

1426 NORTH SCOTT STREET NAPOLEON OH 43545

FAMILY PRACTICE AND MEDICAL SPECIALIST SERVICES Community benefit report prepared by related organization Schedule H, Part I, Line 6a MERCY HEALTH PARTNERS Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 COST OF CHARITY CARE WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 2. THE COST RELATED TO MEDICAID PATIENTS WAS ALSO DETERMINED USING THE COST TO CHARGE RATIO USING WORKSHEET 2 AND INCLUDED BOTH INPATIENTS AND OUTPATIENTS FOR TRADITIONAL MEDICAID AND MEDICAID MANAGED CARE PLANS. FOR SUBSIDIZED SERVICES THE HOSPITAL'S COST ACCOUNTING SYSTEM IS USED TO DETERMINE COST RELATED TO THE SPECIFIC SERVICE FOR COMMERCIAL PATIENTS ONLY. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON THE HOSPITAL'S HISTORICAL COLLECTION EXPERIENCE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED ON PAST COLLECTION EXPERIENCE. THE HOSPITAL'S CONCENTRATION OF CREDIT RISK RELATED TO NET PATIENT ACCOUNTS IS LIMITED DUE TO THE DIVERSITY OF PATIENTS AND PAYORS. NET PATIENT ACCOUNTS CONSIST OF AMOUNTS DUE FROM GOVERNMENTAL PROGRAMS (PRIMARILY MEDICARE AND MEDICAID), PRIVATE INSURANCE COMPANIES, MANAGED CARE PROGRAMS AND PATIENTS THEMSELVES. NET PATIENT SERVICE REVENUE FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS RECOGNIZED BASED ON CONTRACTUAL RATES FOR SERVICES RENDERED. THE HOSPITAL RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). AMOUNTS RECOGNIZED ARE SUBJECT TO ADJUSTMENT UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE WHEN SERVICES ARE PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. ANY DISCOUNTS APPLIED TO SELF-PAY PATIENTS WOULD BE DEEMED EITHER CHARITY OR A CONTRACTUAL ADJUSTMENT. BAD DEBT WOULD BE BASED ON THE BALANCE AFTER THE CHARITY OR CONTRACTUAL ADJUSTMENT THAT IS DEEMED UNCOLLECTABLE FOLLOWING A REASONABLE COLLECTION EFFORT. Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, Line 3 THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DOES NOT PERMIT THE COST OF PATIENTS WHO ARE UNCOOPERATIVE OR UNABLE TO BE LOCATED TO BE RECLASSIFIED FROM BAD DEBT TO FINANCIAL ASSISTANCE. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY REQUIRES AN APPLICATION AND SUPPORTING DOCUMENTATION. THEREFORE, ZERO DOLLARS ARE BEING REPORTED ON PART III, LINE 3 AS AMOUNTS INCLUDED IN BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY ("CHA GUIDELINES") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE BAD DEBT EXPENSE AS COMMUNITY BENEFIT. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE HOSPITAL ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AS AN OPERATING EXPENSE. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, B. SIGNIFICANT ACCOUNTING POLICIES, NET PATIENT ACCOUNTS AND NET PATIENT SERVICE REVENUE (PAGE 12) STATES NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON THE HISTORICAL COLLECTION EXPERIENCE OF EACH REGIONAL AFFILIATE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED UPON PAST COLLECTION EXPERIENCE. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE HOSPITAL FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY ("CHA GUIDELINES") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE MEDICARE LOSSES AS COMMUNITY BENEFIT. THE HOSPITAL'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE MEDICARE AMOUNTS IN PART III. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE NOT SENT TO A COLLECTION AGENCY. THE ORGANIZATION REPEATEDLY OFFERS PATIENTS ACCESS TO FINANCIAL HELP DURING THEIR HOSPITAL STAY AND AFTER, AS WELL AS WITH EACH BILLING NOTICE. BILLS ARE SENT TO A COLLECTION AGENCY AS A LAST RESORT AND ONLY: WHEN PATIENTS HAVE THE ABILITY TO PAY SOME PORTION OF THEIR HEALTHCARE EXPENSES BUT REFUSE TO DO SO; WHEN PATIENTS REFUSE TO WORK WITH THE ORGANIZATION TO DETERMINE IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE VIA FEDERAL, STATE, LOCAL OR HOSPITAL ASSISTANCE PROGRAMS; WHEN THE ORGANIZATION IS UNABLE TO LOCATE THE PATIENT OR PERSON RESPONSIBLE FOR THE BILL. Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) MERCY DEFIANCE HOSPITAL - THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS BASED UPON FEDERAL POVERTY LEVELS STATED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.; Needs assessment. Schedule H, Part VI, Line 2 MERCY DEFIANCE HOSPITAL ASSESSES AND CONTINUALLY RESPONDS TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. MERCY DEFIANCE HOSPITAL JOINS AN EXISTING COMMUNITY-BASED NEEDS ASSESSMENT EVERY THREE YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. THE HOSPITAL INCORPORATES PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. MERCY DEFIANCE RECOGNIZES THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS OF UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. MERCY DEFIANCE HOSPITAL HAS A DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT EFFORT. MERCY DEFIANCE HOSPITAL WORKS CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES AND TO AVOID DUPLICATION. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 MERCY DEFIANCE POSTS ITS CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY DEPARTMENTS AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. MERCY DEFIANCE PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. ADDITIONALLY, A COPY OF THE POLICY OR A SUMMARY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION IS INCLUDED IN PATIENT BILLS. MERCY DEFIANCE DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. THE HOSPITAL ELIGIBILITY LINK PROGRAM (HELP) IS A FREE REFERRAL SERVICE PROVIDED BY MERCY DEFIANCE. THE PURPOSE OF HELP IS TO ASSIST PATIENTS IN OBTAINING MEDICAL BENEFITS THROUGH FEDERAL, STATE, AND HOSPITAL PROGRAMS. HELP REPRESENTATIVES WILL PROVIDE THE FOLLOWING SERVICES AT NO COST TO THE PATIENT: * EXPLORE ELIGIBILITY UNDER PUBLIC ASSISTANCE PROGRAMS * FILE APPLICATIONS ON PATIENT'S BEHALF * SCHEDULE AND ATTEND APPOINTMENTS * PROVIDE TRANSPORTATION WHEN NECESSARY * PROVIDE MEDICAL DOCUMENTATION TO SOCIAL SECURITY ADMINISTRATION FOR DISABILITY CLAIMS. THROUGH HELP, PATIENTS AND THEIR COUNSELORS LOOK AT WHAT OPTIONS ARE AVAILABLE. MERCY DEFIANCE UNDERSTANDS THAT NOT EVERYONE CAN PAY FOR HEALTHCARE SERVICES. HELP IS HERE TO OFFER OPTIONS AND ASSISTANCE FOR THOSE WHO ARE UNINSURED OR UNDERINSURED. HELP IS AN EXTENSION OF MERCY DEFIANCE'S MISSION TO IMPROVE THE HEALTH OF OUR COMMUNITY WITH EMPHASIS ON THE POOR AND UNDERSERVED. MEETING THE NEEDS OF THOSE WITH LIMITED RESOURCES HAS ALWAYS BEEN THE HEART OF OUR MISSION. MERCY DEFIANCE IS PROUD TO MAKE OUR FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PUBLIC THROUGH OUR WEBSITE, WHICH CAN BE FOUND AT WWW.MERCYWEB.ORG. Community information. Schedule H, Part VI, Line 4 MERCY DEFIANCE HOSPITAL SERVES A GEOGRAPHIC AREA PRIMARILY AROUND DEFIANCE COUNTY. THE POPULATION OF MERCY DEFIANCE HOSPITAL'S PRIMARY SERVICE AREA IS APPROXIMATELY 78,000. OUR COMMUNITY IS CHANGING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THERE ARE 6 HOSPITALS WITHIN THE FIVE-COUNTY AREA AROUND DEFIANCE. THE DEMOGRAPHIC AREA SERVED BY MERCY DEFIANCE HOSPITAL INCLUDES THE FOLLOWING STATISTICS: APPROXIMATELY 41% OF THE POPULATION IS BETWEEN THE AGES OF 35 AND 64, AND 16% IS AGE 65 OR OLDER. MEDIAN HOUSEHOLD INCOME IS $46,000, WITH 55% OF HOUSEHOLD INCOMES OF $50,000 OR LESS. DEFIANCE COUNTY HAS A POPULATION OF APPROXIMATELY 39,000. 4.5% OF RESIDENTS ARE IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES. 17.5% OF FAMILIES ARE ON MEDICAID OR OTHER ASSISTANCE, AND 15% OF HOUSEHOLDS ARE UNINSURED. IN THE COMMUNITY SERVED BY MERCY DEFIANCE HOSPITAL HEART DISEASE, CANCER, STROKE, LUNG DISEASES AND DIABETES ARE THE MAJOR HEALTH PROBLEMS AND/OR LEADING CAUSES OF DEATH. EACH OF THESE IS PREVENTABLE THROUGH PROPER CARE AND MAINTAINING CONTROL OF THE ILLNESS/DISEASE AS WELL AS LEADING HEALTHIER LIVES. MERCY DEFIANCE HOSPITAL WORKS CLOSELY WITH LOCAL COMMUNITY AGENCIES AND HEALTH DEPARTMENTS TO ADDRESS THESE PROBLEMS AND MINIMIZE THE EFFECTS ON THOSE WHO SUFFER. Promotion of community health Schedule H, Part VI, Line 5 MERCY DEFIANCE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, THE HOSPITAL ALSO PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. MERCY DEFIANCE HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA (WITH CERTAIN LIMITED EXCEPTIONS INVOLVING TRADITIONALLY EXCLUSIVE HOSPITAL-BASED SERVICES). THE MAJORITY OF THE GOVERNING BODY CONSISTS OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY SERVED BY HOSPITAL. THE HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT -SPONSORED HEALTH CARE PROGRAMS. Affiliated health care system Schedule H, Part VI, Line 6 MERCY DEFIANCE HOSPITAL IS A MEMBER OF MERCY HEALTH PARTNERS-NORTHERN REGION AND AFFILIATED WITH ST. VINCENT MERCY MEDICAL CENTER, ST. CHARLES MERCY HOSPITAL, RIVERSIDE MERCY HOSPITAL, MERCY HOSPITAL TIFFIN, AND MERCY HOSPITAL WILLARD. ALL ARE OHIO NON-PROFIT CORPORATIONS. THE HOSPITAL IS SPONSORED BY THE SISTERS OF MERCY AND SISTERS OF CHARITY OF MONTREAL (GREY NUNS) AND IS AN INTEGRAL PART OF THE COMMUNITY. MERCY HEALTH PARTNERS-NORTHERN REGION COMMUNITY BENEFIT FOR 2012 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2012 COMMUNITY BENEFIT: $86.5 MILLION BENEFITS TO THE BROADER COMMUNITY: $15.6 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $25.9 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $27.6 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $17.3 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 9.7 PERCENT MERCY DEFIANCE HOSPITAL IS A MEMBER OF CATHOLIC HEALTH PARTNERS (CHP). CHP IS THE CONTINUATION OF THE HEALTH MINISTRY STARTED MORE THAN 150 YEARS AGO BY OUR CO-SPONSORING CONGREGATIONS: THE SISTERS OF MERCY, REGIONAL COMMUNITY OF CINCINNATI (OH) (NOW THE SISTERS OF MERCY, SOUTH CENTRAL COMMUNITY); THE MID-ATLANTIC COMMUNITY; THE SISTERS OF HUMILITY OF MARY; THE FRANCISCAN SISTERS OF THE POOR; AND COVENANT HEALTH SYSTEMS. OUR SYSTEM OF REGIONAL HEALTH CARE PROVIDERS SERVES LOCAL HEALTH NEEDS IN COMMUNITIES IN OHIO AND KENTUCKY. CHP IS FOCUSED ON IMPROVING THE HEALTH OF COMMUNITIES WE SERVE BY PROVIDING INTEGRATED HEALTH SERVICES THROUGH FACILITIES THAT INCLUDE ACUTE CARE HOSPITALS, SENIOR HEALTH AND HOUSING FACILITIES, HOME HEALTH AGENCIES, HOSPICE PROGRAMS, OUTREACH SERVICES AND WELLNESS CENTERS. OUR HOSPITALS INCLUDE CRITICAL ACCESS FACILITIES OFFERING ESSENTIAL HEALTH SERVICES THAT WOULD OTHERWISE NOT EXIST IN THOSE COMMUNITIES. WE CARE FOR EVERYONE WHO COMES TO US, REGARDLESS OF THEIR ABILITY TO PAY. AS WE HAVE DONE FOR DECADES, WE PROVIDE EXTENSIVE SERVICES TO THE BROADER COMMUNITY, WITH EMPHASIS ON SERVICES FOR PERSONS WHO ARE POOR AND UNDER-SERVED. CHP'S HOME OFFICE PROVIDES SERVICES AND SUPPORT TO THE ENTIRE SYSTEM, INCLUDING BUT NOT LIMITED TO: PROVIDING GOVERNANCE, MANAGEMENT OVERSIGHT, STRATEGIC LEADERSHIP, FOCUSING RESOURCES TO ASSURE THE HEALING MISSION, PROVIDING ACCESS TO LOWER COST DEBT FINANCING TO SUPPORT OPERATIONS, IMPROVING CLINICAL OUTCOMES AND REDUCING OPERATING COSTS. SYSTEM-WIDE COMMUNITY BENEFIT FOR 2012 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2012 COMMUNITY BENEFIT: $385.4 MILLION BENEFITS TO THE BROADER COMMUNITY $72.5 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID $155.0 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY $126.3 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR $31.7 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 10.4 PERCENT true true false false false false false true false ADNAN ALKHALILI MD 321230 0 386290 0 810 0 19637 0 15443 0 743410 0 0 0 ALLEN GASPAR MD 0 247132 0 0 0 3564 0 18684 0 24664 0 294044 0 0 ANDREA PRICE 523863 0 2000 0 10067 0 18044 0 28088 0 582062 0 0 0 ANTHONY J ARMSTRONG MD 0 317648 0 5245 0 1183 0 44646 0 10251 0 378973 0 0 BARRY HUDGIN 157570 0 0 0 11533 0 46074 0 6294 0 221471 0 0 0 BRIAN SMITH 0 413415 0 0 0 98778 0 151298 0 35338 0 698829 0 0 CAROL WHITTAKER 155627 0 0 0 8199 0 176959 0 8364 0 349149 0 0 0 DAVID AROSE 0 214606 0 46850 0 2422 0 17526 0 10437 0 291841 0 0 DENNIS SHERRY 244470 0 0 0 11402 0 75053 0 20092 0 351017 0 0 0 GARY GEORGE 266465 0 2000 0 11691 0 152755 0 10212 0 443123 0 0 0 H TERRENCE SMITH 0 0 0 0 204603 0 60750 0 11377 0 276730 0 0 0 IMRAN ANDRABI MD 432907 0 20728 0 9510 0 75944 0 24121 0 563210 0 0 0 JOHN M STARCHER JR 0 190253 0 275000 0 410039 0 18301 0 7744 0 901337 0 0 JOSEPH GLASS 178208 0 0 0 50532 0 32211 0 19166 0 280117 0 0 0 KATRINA ENGLISH 0 159915 0 39120 0 1414 0 15455 0 22448 0 238352 0 0 KEVIN COOK 0 398268 0 2000 0 10303 0 38129 0 24140 0 472840 0 0 MICHELE MONTAGUE 177033 0 0 0 9064 0 69942 0 18187 0 274226 0 0 0 MOHAMMAD ALNSOUR MD 319110 0 381348 0 2486 0 14490 0 15718 0 733152 0 0 0 NASFAT SHEHADEH MD 588132 0 0 0 524 0 16772 0 24311 0 629739 0 0 0 ROBERT MOON 430569 0 99242 0 107427 0 17500 0 27098 0 681836 0 0 0 SAMANTHA PLATZKE 0 456297 0 80844 0 89490 0 78816 0 30944 0 736391 0 0 SCOTT SHOOK 0 0 0 0 280791 0 247920 0 0 0 528711 0 0 0 STANLEY TAO MD 499508 0 0 0 486 0 13455 0 5657 0 519106 0 0 0 STEVEN L MICKUS 0 827750 0 346416 0 282116 0 149330 0 31852 0 1637464 0 0 THOMAS ARQUILLA 315803 0 0 0 10879 0 30210 0 21705 0 378597 0 0 0 THOMAS F WALSH MD 485177 0 0 0 2322 0 18059 0 20993 0 526551 0 0 0 TODD WARNER 203506 0 0 0 995 0 53890 0 20523 0 278914 0 0 0 WILLIAM SUTTON 210779 0 2000 0 28777 0 77346 0 13411 0 332313 0 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 THE COMPENSATION OF ANDREA PRICE, PRESIDENT AND CEO, MHP-NORTHERN REGION, IS DETERMINED BY CATHOLIC HEALTH PARTNERS (CHP), A RELATED TAX-EXEMPT ORGANIZATION. CHP UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE WHEN DETERMINING MS. PRICE'S COMPENSATION. Severance or change-of-control payment Schedule J, Part I, Line 4a SEVERANCE BENEFITS CONSISTING OF CONTINUATION OF BASE SALARY AND INSURANCE BENEFITS WERE PROVIDED TO LISTED INDIVIDUALS FOR SPECIFIED PERIODS. THE LISTED INDIVIDUALS EXECUTED RELEASES AND WAIVERS OF CLAIMS IN EXCHANGE FOR THE SEVERANCE BENEFITS. SALARY CONTINUATION AMOUNTS PROVIDED DURING THE YEAR TO LISTED INDIVIDUALS WERE AS FOLLOWS: JOSEPH GLASS $36,550; STEVEN L. MICKUS $15,000; H. TERRENCE SMITH $201,456. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b THE MERCY HEALTH PARTNERS (MHP) - NORTHERN REGION NONQUALIFIED SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN IS FOR CERTAIN HIGHLY COMPENSATED INDIVIDUALS AS DETERMINED BY THE BOARD OF TRUSTEES' EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE TO PROVIDE A BENEFIT TO REPLACE THE BENEFIT THESE PARTICIPANTS WOULD HAVE RECEIVED UNDER THE FORMULA OF THE APPLICABLE QUALIFIED PLAN PRIOR TO ITS AMENDMENT TO COMPLY WITH THE OMNIBUS BUDGET RECONCILIATION ACT OF 1993, AND PROVIDING A DEFERRED COMPENSATION PLAN OF 5% OF ANNUAL BASE SALARY TO RETAIN EXECUTIVES. PARTICIPANTS VEST IN THIS PLAN AND RECEIVE A BENEFIT UNDER THIS PLAN ONCE THEY HAVE SATISFIED BOTH OF THESE TWO CONDITIONS: (1) MEET THE VESTING REQUIREMENTS OF THE APPLICABLE QUALIFIED PLAN, AND (2) COMPLETE A 24-MONTH POST-EMPLOYMENT NON-COMPETE REQUIREMENT. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: SCOTT SHOOK $280,791; WILLIAM SUTTON $12,204; IMRAN ANDRABI, MD $0; GARY GEORGE $0; CAROL WHITTAKER $0; JOSEPH GLASS $0; BARRY HUDGIN $0; DENNIS SHERRY $0; TODD WARNER $0. TERMS AND CONDITIONS OF THE CHP SERP PLAN SCHEDULE J, PART I, LINE 4B THE CATHOLIC HEALTH PARTNERS (CHP) SERP PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION AND ANNUAL INTEREST CREDITS. PARTICIPANTS VEST 50%, 75%, AND 100% IN THEIR ACCOUNTS AFTER 5, 6, AND 7 YEARS OF SERVICE, RESPECTIVELY, VESTING OCCURS EARLIER FOR DEATH OR TOTAL DISABILITY OR REACHING AGE 60 WHILE EMPLOYED, OR INVOLUNTARY TERMINATION OF EMPLOYMENT WITHIN 24 MONTHS AFTER A CHANGE IN CONTROL OF THE ORGANIZATION OR DUE TO POSITION ELIMINATION, PAYMENTS DURING EMPLOYMENT ARE MADE FOR REQUIRED TAX WITHHOLDINGS. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS AFTER TERMINATION OF EMPLOYMENT. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: JOHN M. STARCHER, JR. $21,395; STEVEN L. MICKUS $234,135; BRIAN SMITH $78,749; SAMANTHA PLATZKE $83,378; ANDREA PRICE $0. THE CHP EXECUTIVE RETENTION PLAN SCHEDULE J, PART I, LINE 4B THE CATHOLIC HEALTH PARTNERS (CHP) EXECUTIVE RETENTION PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES EMPLOYMENT CONTINUATION INCENTIVES TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION AND ANNUAL INTEREST CREDITS. PARTICIPANTS VEST AND CEASE TO RECEIVE CREDITS AFTER 5 YEARS OF PLAN PARTICIPATION PROVIDED THEY REMAIN EMPLOYED. VESTING AND CESSATION OF CREDITS OCCUR EARLIER FOR DEATH OR TOTAL DISABILITY WHILE EMPLOYED, INVOLUNTARY TERMINATION OF EMPLOYMENT WITHIN 24 MONTHS AFTER A CHANGE IN CONTROL OF THE ORGANIZATION, OR, FOR CERTAIN PARTICIPANTS, UPON BEING OFFERED A SPECIFIED PROMOTION. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS UPON VESTING. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO RETENTION PLAN PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: JOHN M. STARCHER, JR. $383,081; STEVEN L. MICKUS $0; ROBERT MOON $57,490. TERMS AND CONDITIONS OF THE SRMC SERP PLAN SCHEDULE J, PART I, LINE 4B THE ST. RITA'S MEDICAL CENTER 457(F) PLAN PROVIDES A FLEXIBLE BENEFIT ALLOWANCE TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATE. THIS ALLOWANCE, WHICH IS BASED ON A SPECIFIED PERCENTAGE OF COMPENSATION, MAY BE ALLOCATED AMONG VARIOUS INSURANCE AND DEFERRED COMPENSATION BENEFIT OPTIONS. AMOUNTS INCLUDIBLE IN TAXABLE COMPENSATION FOR LISTED PARTICIPATING INDIVIDUALS IN THE REPORTING YEAR WERE AS FOLLOWS: BRIAN SMITH $0. TERMS AND CONDITIONS OF THE CMHP SERP PLAN SCHEDULE J, PART I, LINE 4B THE COMMUNITY MERCY HEALTH PARTNERS (CMHP) SERP PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO PERSONS SELECTED BY THE CMHP COMMITTEE. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION AND ANNUAL INVESTMENT RETURNS AND/OR LOSSES. PARTICIPANTS VEST THE LATER OF FIVE YEARS OF ACTIVE SERVICE OR THE SECOND ANNIVERSARY OF HIS OR HER SEPARATION FROM SERVICE WITH THE EMPLOYER. VESTING OCCURS EARLIER FOR DEATH OR TOTAL DISABILITY. PAYMENTS DURING EMPLOYMENT ARE MADE FOR REQUIRED TAX WITHHOLDING. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS AFTER TERMINATION OF EMPLOYMENT. AMOUNTS INCLUDABLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: KATRINA ENGLISH $0. Non-fixed payments Schedule J, Part I, Line 7 THE ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION FOR LISTED INDIVIDUALS. THE ORGANIZATION'S BOARD OF TRUSTEES ESTABLISHES OBJECTIVE THRESHOLDS FOR QUALITY, COMMUNITY BENEFIT, AND FINANCIAL PERFORMANCE WHICH MUST BE ACHIEVED FOR INCENTIVES TO BE AWARDED. THE BOARD ALSO ESTABLISHES THRESHOLD, TARGET AND MAXIMUM LEVELS FOR INCENTIVE AWARDS. WITHIN THESE ESTABLISHED PARAMETERS, THE CEO RECOMMENDS INCENTIVE AWARDS FOR LISTED INDIVIDUALS TO THE BOARD'S EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE. THE BOARD COMMITTEE REVIEWS AND APPROVES OR MODIFIES THE CEO'S RECOMMENDATIONS. New program services Form 990, Part III, Line 2 MERCY HEALTH PARTNERS ACQUIRED MERCY HOSPITAL OF DEFIANCE, LLC (MERCY DEFIANCE HOSPITAL) ON JANUARY 1, 2012. MERCY DEFIANCE HOSPITAL INCLUDES A 23-BED PROGRESSIVE CARE UNIT FOR INPATIENTS, SURGICAL SUITE FOR INPATIENT AND OUTPATIENT PROCEDURES, AN OBSERVATION UNIT, AND AN EMERGENCY CENTER THAT IS STAFFED BY SPECIALISTS IN EMERGENCY MEDICINE AND OPEN 24 HOURS A DAY, SEVEN DAYS A WEEK. Family/business relationships amongst interested persons Form 990, Part VI, Section A, Line 2 ANTHONY ARMSTRONG AND VERNELIS ARMSTRONG - FAMILY RELATIONSHIP Classes of members or stockholders Form 990, Part VI, Section A, Line 6 CATHOLIC HEALTH PARTNERS IS THE SOLE MEMBER OF MERCY HEALTH PARTNERS - NORTHERN REGION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a CATHOLIC HEALTH PARTNERS (CHP) APPROVES MEMBERS THAT ARE APPOINTED TO THE BOARD OF TRUSTEES. ALL OF THE BOARD OF TRUSTEES HAVE FULL VOTING RIGHTS. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b CERTAIN MATTERS REQUIRE APPROVAL OF THE CHP CORPORATE MEMBER, CHP GOVERNING BODY, OR CHP CEO. THE REGULATIONS OF THE ORGANIZATION DESCRIBE THE LEVEL OF APPROVAL REQUIRED FOR VARIOUS DECISIONS. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE FORM 990 IS PREPARED BY THE CHP TAX DEPARTMENT AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. A COPY OF THE FORM 990 IS THEN REVIEWED BY MANAGEMENT. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE FOR APPROVAL. ADDITIONALLY, THE COMPENSATION COMMITTEE REVIEWS ALL COMPENSATION RELATED SCHEDULES AND DISCLOSURES. BOTH THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE AND THE COMPENSATION COMMITTEE ARE INDEPENDENT OF THE FILING ORGANIZATION. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. Conflict of interest policy Form 990, Part VI, Section B, Line 12c FOR BOARD AND/OR SUBCOMMITTEE MEETINGS - ALL MUST FILE A CONFLICT OF INTEREST FORM. THE COMMITTEE CHAIR OR BOARD CHAIR IS NOTIFIED OF ANY CONFLICTS FOR ANY OF THE COMMITTEE MEMBERS OR BOT MEMBERS. AT THE BEGINNING OF ALL BOARD MEETINGS OR COMMITTEE MEETINGS, MEMBERS ARE REMINDED THAT THEY ARE TO NOTIFY THE CHAIR OF ANY CONFLICTS AND RECUSE THEMSELVES AS NECESSARY FROM THE DISCUSSION AND/OR VOTE. FOR KEY EMPLOYEES THEIR MANAGER IS NOTIFIED OF ANY CONFLICTS REPORTED ON THE COI FORM. IF A CONFLICT EXISTS, WE REQUIRE THE EMPLOYEE TO RECUSE THEMSELVES FROM THE ISSUE. COMPENSATION FORM 990, PART VI, LINE 15A THE COMPENSATION OF THE ORGANIZATION'S CEO OR TOP MANAGEMENT OFFICIAL IS DETERMINED BY CATHOLIC HEALTH PARTNERS, A RELATED TAX-EXEMPT ORGANIZATION. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b COMPENSATION IS REVIEWED ANNUALLY BY AN INDEPENDENT QUALIFIED CONSULTANT. THE EXECUTIVE VALUATION COMPENSATION COMMITTEE OF THE BOARD CONTEMPORANEOUSLY RECORDS THE DELIBERATION AND DECISION. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE CATHOLIC HEALTH PARTNERS WEBSITE. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 PENSION ADJUSTMENT - 8875646; POST RETIREMENT PENSION ADJUSTMENT - 154491; EQUITY TRANSFER FROM MSVMC - 16449826; EQUITY TRANSFER FROM MSCH - 10470709; EQUITY TRANSFER FROM MSAH - 6157351; EQUITY TRANSFER FROM MTH - 4023210; EQUITY TRANSFER FROM MWH - 1230019; INVESTMENT IN DEFIANCE CLINIC PROPERTIES - -1442057; RAC TRANSFER FROM CHP - -1424000; MHD PAYMENT TO DEFIANCE CLINIC JV SHAREHOLDERS - -128000; MPE BILLING SERVICES LLC 2200 JEFFERSON AVENUE TOLEDO OH 43604 264779623 BILLING SERVICES OH 0 5431949 MERCY HEALTH SYSTEM-NORTHERN REGION MERCY EYE INSTITUTE LLC 2200 JEFFERSON AVENUE TOLEDO OH 43604 320297989 OPTOMETRY SERVICES OH 78771 1310083 MERCY HEALTH SYSTEM-NORTHERN REGION MERCY RADIOLOGY GROUP 2200 JEFFERSON AVENUE TOLEDO OH 43604 274431092 RADIOLOGY SERVICES OH 0 868774 MERCY HEALTH SYSTEM-NORTHERN REGION MERCY HOSPITAL OF DEFIANCE LLC 1404 E SECOND STREET DEFIANCE OH 43512 020701635 HOSPITAL OH 3186553 15697942 MERCY HEALTH SYSTEM-NORTHERN REGION MERCY MEDICAL PARTNERS NORTHERN REGION LLC 1400 E SECOND STREET DEFIANCE OH 43512 320350047 HEALTH CARE OH -5596757 1929147 MERCY HEALTH SYSTEM-NORTHERN REGION CATHOLIC HEALTH PARTNERS 615 ELSINORE PLACE CINCINNATI OH 45202 HEALTHCARE SYSTEM PARENT OH 501(C)(3) 11 - Type III - FI NA false CATHOLIC HEALTH PARTNERS FOUNDATION 615 ELSINORE PLACE CINCINNATI OH 45202 FUNDRAISING OH 501(C)(3) 7 CATHOLIC HEALTH PARTNERS false CATHOLIC HEALTHCARE PARTNERS HOUSING DEVELOPMENT 615 ELSINORE PLACE CINCINNATI OH 45202 HUD PARENT OH 501(C)(3) 9 CATHOLIC HEALTH PARTNERS false CATHOLIC HEALTHCARE PARTNERS RETIREMENT TRUST 615 ELSINORE PLACE CINCINNATI OH 45202 RETIREMENT TRUST OH 501(C)(3) 8 CATHOLIC HEALTH PARTNERS false COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM 3700 KOLBE ROAD LORAIN OH 44053 REGIONAL PARENT OH 501(C)(3) 11 - Type II CATHOLIC HEALTH PARTNERS false COMMUNITY HEALTH PARTNERS REGIONAL MEDICAL CENTER 3700 KOLBE ROAD LORAIN OH 44053 HOSPITAL OH 501(C)(3) 3 COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM false ALLEN MEDICAL CENTER 200 WEST LORAIN ST OBERLIN OH 44074 HOSPITAL OH 501(C)(3) 3 COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM false COMMUNITY HEALTH PARTNERS REGIONAL FOUNDATION 3700 KOLBE ROAD LORAIN OH 44053 FOUNDATION OH 501(C)(3) 11 - Type III - FI COMMUNITY HEALTH PARTNERS REGIONAL MEDICAL CENTER false COMMUNITY HEALTH PARTNERS PHYSICIANS OFFICE BUILDINGS 3700 KOLBE ROAD LORAIN OH 44053 MEDICAL OFFICE RENTAL OH 501(C)(3) 9 COMMUNITY HEALTH PARTNERS REGIONAL MEDICAL CENTER false ALLEN MEDICAL CENTER MEDICAL OFFICE BUILDING 200 WEST LORAIN ST OBERLIN OH 44074 MEDICAL OFFICE RENTAL OH 501(C)(3) 11 - Type II ALLEN MEDICAL CENTER false MERCY HEALTH PARTNERS OF SOUTHWEST OHIO 4600 MCAULEY PLACE CINCINNATI OH 45242 REGIONAL PARENT OH 501(C)(3) 11 - Type III - FI CATHOLIC HEALTH PARTNERS false MERCY HEALTH PARTNERS OF SOUTHWEST OHIO FOUNDATION 4600 MCAULEY PLACE CINCINNATI OH 45242 FOUNDATION OH 501(C)(3) 7 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY HOSPITALS WEST 2446 KIPLING AVENUE CINCINNATI OH 45239 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY HOSPITAL ANDERSON 7500 STATE ROAD CINCINNATI OH 45255 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false THE SISTERS OF MERCY OF HAMILTON OHIO 3000 MACK ROAD FAIRFIELD OH 45014 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false THE SISTERS OF MERCY OF CLERMONT COUNTY OHIO 3000 HOSPITAL DRIVE BATAVIA OH 45103 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY FRANCISCAN SENIOR HEALTH AND HOUSING SERVICES INC 7010 ROWAN HILLS DR CINCINNATI OH 45227 RETIREMENT HOME OH 501(C)(3) 9 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY SACRED HEART INC 2120 PAYNE STREET LOUISVILLE KY 40206 RETIREMENT HOME KY 501(C)(3) 9 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY LONG TERM CARE INITIATIVE 4915 CHARLESTOWN RD NEW ALBANY IN 47150 RETIREMENT HOME 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