2012-05-15T14:24:13-05:00 2011-06-30 MCGLADREY LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2010-07-01 362170152 Mercy Hospital and Medical Center MERC 3125672000 2525 South Michigan Avenue Chicago IL 606162477 Thomas J Garvey 3125672000 2012-05-15 1 Zack Fortsch 3126343400 2010 2016-02-24 21:20:13Z Sr Sheila Lyne RSM 2525 South Michigan Avenue Chicago IL 606162477 257068703 0 0928 X www.mercy-chicago.org X 1852 IL Mercy fosters an environment of healing, providing access and needed care with compassion and excellence to the diverse communities it serves. 16 14 2095 0 347998 -1610 2145410 1357728 246592774 254100071 -66718 250649 1607761 1341114 250279227 257049562 29822 40465 0 0 115153946 119517048 0 0 0 125983592 124041231 241167360 243598744 9111867 13450818 151633009 174574023 97382832 106483483 54250177 68090540 X Mercy fosters an environment of healing, providing access and needed care with compassion and excellence to the diverse communities it serves. 0 0 197046469 40465 255024012 Mercy Hospital and Medical Center is a 479 bed acute care facility providing quality health care to over 200,000 residents embracing a broad cultural mix. Mercy, established in 1852, strives to provide a broad spectrum of health care services, appropriate to the needs of and accessible to people in the communities it serves. Since its inception, Mercy Hospital and Medical Center has had an unwavering commitment to serving the community, including the under-insured and under-privileged.Founded in 1852, Mercy Hospital and Medical Center enjoys the honor of being Chicago's first chartered hospital and the first hospital in Illinois. For more than 155 years, Mercy has been an innovative pioneer in both patient care and medical education, and Mercy's leadership legacy continues today. Recognized nationally for excellence, Mercy stands at the intersection of pioneering medicine and compassionate patient care.Our centers of excellence (twelve in all) and specialty care centers provide leading edge care with a patient-first perspective, and continually pioneer new approaches in the fields of heart and endovascular care, cancer care, women's health care, diabetes treatment and minimally invasive surgery. Mercy is also home to one of the city's leading heart & vascular centers and is currently recognized as one of the nation's 10 Top Cardiovascular Hospitals by Thomson Healthcare.Mercy is steadfastly committed to investing in technologies that allow our providers to deliver the highest quality care. Recent examples of this commitment include:-A hospital-wide implementation of electronic health records, make Mercy one of only 7% of U.S. hospitals to implement EHR.-Recent acquisitions of a state-of-the-art linear accelerator and digital mammography equipment.-Mercy was one of the first hospitals in Illinois to acquire a 64-slice scanner and remains at the forefront of cardiac testing and imaging.-Other plans for Mercy include a planned expansion of our critical care unit and gastrointestinal laboratory suites, providing for enhanced care to patients.Mercy's medical staff consists of more than 489 providers in 32 specialties. Our providers are recognized leaders in their field, both locally and internationally, and are often sough for expert advice and consultation.Mercy has a long and proud tradition of teaching, and medical education remains central to our mission today. Mercy maintains affiliations with Chicago's leading medical universities and offers four freestanding residency programs, as well as three integrated residency programs. Our sponsored residency programs include Internal Medicine, Obstetrics/Gynecology, Diagnostic Radiology and Podiatry. Our affiliated residency programs include Surgery, Emergency Medicine and Pathology.As a major urban hospital, Mercy provides residents with ample caseloads and a broad education experience. Two on-site clinics, the Doctors Office Center and the Mercy Family Health Center, accommodate 65,000 patient visits per year in all major specialties and sub-specialties. There are an additional 100,000 patients visits in Mercy's satellite clinics located throughout the Chicago area.Located minutes from Chicago's Loop, Mercy serves a diverse patient population, ranging from upscale urban redevelopment areas to established ethnic neighborhoods. Mercy's population virtually mirrors that of Chicago, a city known for its ethnic and socioeconomic diversity.Patient Days = 72,463 including 4,502 nursery days.Emergency Room and Cast Room Visits = 58,583 197046469 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 155 0 1 2095 1 1 1 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Iris Chan 3125672000 2525 South Michigan Avenue Chicago IL 606162477 William Brown 1.00 X 0 0 0 Susan Gallagher 1.00 X X 0 0 0 Elzie Higginbottom 1.00 X 0 0 0 William Kresse 1.00 X 0 0 0 John McCarthy 1.00 X X 0 0 0 Betsy Meisenheimer 1.00 X 0 0 0 Sr Lenore Mulvihill RSM 1.00 X 0 0 0 Michelle Murphy 1.00 X 0 0 0 Langdon Neal 1.00 X 0 0 0 Renee Togher 1.00 X 0 0 0 Steven Potts 1.00 X 0 0 0 Thomas Reger 1.00 X X 0 0 0 Sr Betty Smith RSM 1.00 X 0 0 0 Raymond Spaeth II 1.00 X 0 0 0 Rohitkumar Vasa 1.00 X 15449 0 0 Michael McDonnell 40.00 X 337349 0 21039 Sr Sheila Lyne RSM 40.00 X 10259 0 1341 Richard Cerceo 40.00 X 327701 0 21813 Thomas J Garvey 40.00 X 308892 0 24485 Barbara Townsend 40.00 X 224349 0 13130 Carla Campbell 40.00 X 157726 0 23126 Paul Jones 40.00 X 325759 0 429 Ann Garcelon 40.00 X 235006 0 12723 Charles Lawler 40.00 X 220276 0 17643 Phillip Ahn 40.00 X 244794 0 18444 Abdulhamid Kanji 40.00 X 207591 0 9994 2615151 0 164167 131 0 1 0 CPS MedManagement LLC 6409 Quail Hollow Road Memphis TN 38120 Pharmacy Management 4636901 Shiftwise Corporate 2501 SW 1st Ave Suite 200 Portland OR 97201 Automated Staffing Services 3529680 University of Illinois 11600 UIH M/C 722 Chicago IL 60612 Residency Program 2451198 Aramark CTS Inc 10510 Twin Lakes Parkway Charlotte NC 28269 Biomedical Management 1930550 Morrison Management 200 E 5th Ave Suite 126 Naperville IL 60563 Food Service Managment 1671781 103 425000 702640 230088 1357728 Medicare/Medicaid Pmts 900099 163563337 163563337 Net Patient Serv. Rev. 900099 88433361 88433361 Other Program Serv. Re 900099 1481721 1481721 Reference Lab 621500 347998 347998 Laboratory Services - 541900 163533 163533 110121 110121 254100071 245174 245174 47917 47917 47917 47917 24616 19141 5475 5475 5475 Jt.Venture Revenue 541900 1071373 1071373 Medical Student Traini 611710 20000 20000 Hospital Preparedness 541900 15000 15000 186824 165566 21258 1293197 257049562 255024012 347998 319824 9785 9785 30680 30680 2015415 363860 1651555 98175861 83935637 14240224 1576116 1293344 282772 11281651 9568066 1713585 6468005 5476987 991018 9332100 6567450 2764650 508495 508495 86000 86000 120000 120000 16149484 11342257 4807227 616992 70 616922 39242145 35266019 3976126 4092093 3273674 818419 5123178 1635813 3487365 92621 15442 77179 271465 90432 181033 684463 16018 668445 9271525 2596929 6674596 6927197 6782881 144316 Bad Debts 17157447 17157447 Provider Tax 7194748 7194748 Equipment Rent/Maintena 3971479 2389781 1581698 Tests and Analysis 1270416 1270416 1929383 768733 1160650 243598744 197046469 46552275 0 8300 8400 13589876 30545012 30656926 37594923 1859410 1484238 2592179 2556177 3809489 5368707 217758439 145120254 71162709 72638185 14106065 10227823 0 13848055 14150558 151633009 174574023 28866277 32598885 1501473 1376469 19421961 38613577 6000000 41593121 33894552 97382832 106483483 X 50088726 63570377 3848891 4207603 312560 312560 54250177 68090540 151633009 174574023 X 13450818 389545 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 120000 0 1 16482 136482 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: American Hospital Association lobbying dues - $10,027 Metropolitan Chicago Healthcare Council lobbying dues - $6,455 6319970 6319970 56303057 41932528 14370529 8707029 2155973 6551056 143105352 100998815 42106537 3323031 32938 3290093 72638185 Third Party Settlements 4168512 Interest in Net Assets of Foundation 3736573 Unamortized Financing Costs 3522605 Investment in Joint Ventures 1550105 Intangible Assets 342153 Cash Surrender Value 740502 Deferred Cost - Miscellaneous 90108 14150558 Reserve for Self Insurance Claims 33213500 Due to Parent 681052 33894552 Description of Uncertain Tax Positions Under FIN 48: Part X: Mercy Hospital and Medical Center has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of federal income taxes under Section 501(c)(3) of the Internal Revenue Code. Mercy Hospital and Medical Center files a Form 990 (Return of Organization Exempt from Income Tax) annually. When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. UBIT is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Form 990 filed by Mercy Hospital and Medical Center is subject to examination by the Internal Revenue Service (IRS) up to three years from the extended due date of each return. Form 990 filed by Mercy Hospital and Medical Center is no longer subject to examination for the years ended June 30, 2007 and prior. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 3891416 3891416 0.01720 62377443 73392427 -11014984 0.00000 66268859 73392427 -7123568 0.01720 7706338 7127569 578769 0.00260 6978601 4078518 2900083 0.01280 39792387 34861750 4930637 0.02180 1552745 1552745 0.00690 56030071 46067837 9962234 0.04410 122298930 119460264 2838666 0.06130 1 6957344 0 90170910 72081729 18089181 X 1 1 1 Mercy Adv MRI LLC Sub-lease MRI Equipment 0.65000 0.00000 0.35000 2 Mercy Hrt & Vascular LLC Sub-lease CT Equipment 0.51000 0.00000 0.49000 1 1 Mercy Hospital and Medical Center

2525 South Michigan Avenue Chicago IL 606162477

X X X X NA 1 14 Mercy Medical on Pulaski - North

5525 South Pulaski Chicago IL 60629

Clinic - Primary and Specialty Physicians Mercy Medical at Dearborn

47 West Polk Chicago IL 60605

Integrative Medicine, Primary and Specialty Physicians Mercy Medical at 43rd Street

4321 South Pulaski Chicago IL 60632

Clinic - Primary Care Physicians Mercy Medical on Michigan

2930 South Michigan Chicago IL 60616

Physical Therapy, Hand Rehabilitation & Primary Care Physicians Mercy Works on Ashland

3316 South Ashland Chicago IL 60608

Clinic - Occupational Medicine Mercy Medical in Chatham

8541 South Street Chicago IL 60619

Clinic - Physician Offices Mercy Medical at 2600

2600 South Michigan Avenue Chicago IL 60616

Clinic - Occupational Medicine Mercy Heart and Vascular LLC

2525 South Michigan Avenue Chicago IL 60616

Sub-lease CT equipment Mercy Advanced MRI LLC

2525 South Michigan Avenue Chicago IL 60616

Sub-lease MRI Equipment Mercy Medical in Bridgeport

2837 South Halsted Chicago IL 60608

Clinic - Primary Care and Specialty Physicians Mercy Medical in Chinatown

2323 South Wentworth Chicago IL 60616

Clinic - Primary Care Physicians Mercy Works at Cumberland

4900 North Cumberland Chicago IL 60706

Clinic - Occupational Medicine Mercy Medical in Bridgeport

3700 South Wallace Chicago IL 60609

Clinic - Primary Care Physicians Mercy Medical

2850 South Wabash Chicago IL 60609

Clinic - Primary Care Physicians Part I, Line 3c: Mercy Hospital and Medical Center uses the FPG to determine free and discounted care. Patients with eligible assets and income above the 200%, but not exceeding 600% of FPG, adjusted for family size, will receive a discount on medically necessary services provided to them, based upon a sliding scale established by hospital policy. Part I, Line 6a: Mercy Hospital and Medical Center prepared an annual Community Benefit Report which is submitted to the Attorney General of the State of Illinois. Part I, Line 7: The costing methodology used to calculate the amounts reported in the table is the cost-to-charge ratio derived from the IRS's Schedule H, Worksheet 2. Part I, Line 7g: Mercy Hospital and Medical Center did not include any costs attributable to a physician clinic as Subsidized Health Services. Part I, L7 Col(f): There was a total Bad Debt Expense of $17,157,447 subtracted from total expenses. Part II: None Part III, Line 4: The cost methodology used to calculate the amount reported as Bad Debt Expense, at cost, is the cost-to-charge ratio derived from the IRS's Schedule H, worksheet 2.Audited Financial Statements footnote regarding bad debt expense:The collection of receivables from third-party payors and patients is the Corporation's primary source of cash for operations and is critical to its operating performance. The primary collection risks relate to uninsured patient accounts and patient accounts for which the primary insurance payor has paid, but patient responsibility amounts (deductibles and co-payments) remain outstanding. Patient receivables, where a third-party payor is responsible for paying the amount, are carried at a net amount determined by the original charge for the service provided, less an estimate made for contractual adjustments or discounts provided to third-party payors. Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by third-party payors and less an estimated allowance for uncollectible receivables. Management estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each payor type. Recoveries of receivables previously written off are recorded as a reduction of the provision for uncollectible accounts when received. The past due status of receivables is determined on a case-by-case basis depending on the payor responsible. Interest is generally not charged on past due accounts. Receivables or payables related to estimated settlements on various payor contracts, primarily Medicare, are reported as amounts due from or to third-party payors. Significant changes in payor mix, business office operations, economic conditions or trends in federal and state governmental health care coverage could affect the Corporation's collection of accounts receivable, cash flows and results of operations. Part III, Line 8: The costing methodology used to calculate the amount reported as Medicare Revenue and Medicare Allowance Cost were derived from the Medicare Cost Report. Part III, Line 9b: Mercy Hospital and Medical Center's Charity Care Policy contains provisions for the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. MANG and Financial Assistance Applications will be taken for all uninsured inpatients that have not yet applied for Medicaid. Medical Assistance-No Grant (MANG) and Financial Assistance Applications may also be taken on outpatients on a case-by-case basis. However, these patients will be assessed for Charity or Financial Assistance only if they are denied for Medicaid. During the Financial Assistance process, the patient may be treated as self-pay, in accordance with hospital policies. Failure to comply with the payment arrangement terms of any remaining balance after the financial assistance adjustment is applied may result in the claim being referred to an outside collection agency. The discount will still be applicable. Accounts already placed at an outside agency may be considered for Charity of Financial Assistance. The patient must provide required information for the agency to complete the Charity or Financial Assistance application. Once approved, the account will be recalled from the agency and adjusted in accordance with Mercy's Charity Care Policy. Part VI, Line 2: To plan and deliver medical care, Mercy Hospital and Medical Center annually assesses the health care needs of our community using proprietary and community data and sources, including admission and discharge information, community demographics including race, ethnicity, gender and age, patient and community surveys, targeted community needs assessments and collaborative relationships and health events with community agencies and groups including neighborhood churches, local schools and universities, elderly/retirement associations and centers, and community based health centers. Reviewing and analyzing gathered data confirms an ethnically, racially and age diverse community with specific health challenges, needs and barriers that face these populations.Mercy Hospital and Medical Center is in the process of developing a formal assessment infrastructure that will expand our community assessment process and facilitate a stronger strategy to address our community's needs. Part VI, Line 3: All of Mercy Hospital and Medical Center's patient statements include a message, in two languages, to advise the patient of the availability of the hospital's financial assistance programs and indicates the patient may qualify for the program. The message includes phone numbers to call and hours of operation. Mercy Hospital's website (www.mercy-chicago.org) provides detailed information regarding the financial assistance programs available, provides the phone number of the financial counselors and the ability to download a request form for determination of charity care eligibility. Patients are given a packet upon admission that contains information about Mercy Hospital and Medical Center's financial assistance program and other financial assistance programs available (All Kids formerly KidsCare, Illinois Breast and Cervical Cancer Program-IBCCP) etc. and meet for a one-on-one interview with a Financial Aid Counselor. Mercy Hospital and Medical Center's Financial Counselors undergo financial assistance training upon employment plus an annual (and as-needed) in-service training to update new laws and policy changes. All third parties are required to follow hospital policies regarding the availability of financial assistance and provide appropriate forms to determine if eligibility is met. Part VI, Line 4: Eighteen Chicago zip codes make up the primary service area for Mercy Hospital and Medical Center. Four zip codes (60616, 60608, 60609 and 60653) make up approximately 50% of Mercy's inpatient admissions. Ten zip codes (60632, 60629, 60636, 60621, 60615, 60637, 60649, 60619, 60620 and 60628) are located South and West of the core market. Four zip codes (60604, 60605, 60661 and 60607) are located to the North. Mercy's primary service areas are the Near-South side and Mid-South sides of Chicago and serve the ethnically diverse neighborhoods of Chinatown, Pilsen, Armour Square, Douglas, Oakland, Fuller Park, Grant Boulevard and Kenwood, which together extend from Roosevelt Road on the North, Lake Michigan on the East, 51st/55th Streets on the South and as far West as Western Avenue. In Mercy's core market, approximately 79,000 or 30.84% of individuals are below the Federal Poverty Guidelines (FPG). In Mercy's secondary market, approximately 157,000 or 22.21% of individuals are below FPG. In the zip codes North of the hospital, approximately 6,700 or 20.55% are below poverty levels. Part VI, Line 6: Mercy Hospital and Medical Center extends medical staff privileges to all qualified physicians. This helps ensure high quality and easily accessible care is available in a variety of primary and specialty care areas.Mercy Hospital and Medical Center participates in Medicare, Medicaid, Champus, Tri-care, and All Kids, and Family Care and other government sponsored health care programs and offers charity care on a sliding fee scale. Mercy's state-of-the-art Emergency Center offers comprehensive emergency services in a spacious, private and compassionate setting. The Center features 25 private treatment suites, two nurses' stations, spacious waiting areas, private triage areas and a six-bay ambulance area with private entrance. One of the treatment suites is a "decontamination" room for emergencies involving chemical exposure. As a Level II Trauma Center, the Center is equipped to handle all medical emergencies, injuries and illnesses with 24 hour access to both trauma surgeons and a wide array of medical specialists. Mercy's Emergency Center serves all people, regardless of ethnicity, gender, religion or ability to pay. Mercy Hospital and Medical Center assures their uninsured and underinsured patients that they will receive the same high quality medical care as those who are insured. During the past two years, Mercy Hospital and Medical Center opened a new state-of-the-art Cancer Center that utilizes the latest cancer technology and physicians that work collaboratively to provide superior cancer care. Mercy Hospital and Medical Center is aggressively addressing disparities in cancer care.Mercy Hospital and Medical Center promotes financial assistance to all who might be eligible to receive it. Policies governing such assistance are available to staff and patients in a variety of manners. Information is available on our website (www.mercy-chicago.org), through an admission packet given to patients, and with one-on-one interviews with Financial Counselors. The information is provided in two languages. Mercy Hospital and Medical Center offers a number of on-going programs that further assist the enhancement of the health status of the population it serves. Mercy offers events focusing on chronic disease, nutrition and exercise, as well, as smoking cessation. Special events include blood pressure screening, Living Well workshops, Identity Theft in Today's Society-Protecting Your Privacy and Security and community blood drives. Wellness and health education classes (i.e. Eat Right Every Bite, Education for Life-Diabetes Management, Center for Weight Management Information Class) are offered regularly and most are free of charge. Since its first chartering, Mercy Hospital and Medical Center has served as a teaching hospital and pioneer in medicine and medical education. Mercy has had a long standing relationship with the University of Illinois College of Medicine and provides residency training in Internal Medicine, Obstetrics and Gynecology and Podiatry. Mercy also has affiliated programs in Surgery, Emergency Medicine and Radiology. Mercy also presents at various community organizations and local schools a program providing attendees information about health care career opportunities, hiring requirements, customer service, and question and answer periods. Several management leaders participate on various community task forces (i.e. Chicago Breast Cancer Task Force) or serve on the board of trustees for various organizations (i.e. Chair of the Board of Trustees of Mother McAuley High School to ensure the provision of high quality education of young women).Consistent with our non-profit status, Mercy Hospital and Medical Center uses operating margin as a catalyst for reinvestment in facilities, technology, staff and medical services for the community. Part VI, Line 7: Mercy Hospital and Medical Center, a non-for-profit hospital established in 1852, is Chicago's first hospital. Its mission is to provide a broad spectrum of health care services appropriate to the needs of and accessible to people in the communities it serves. From its very inception, Mercy Hospital has had an unwavering commitment to serving the community, including the underinsured and underprivileged. In order to meet the health care needs of the residents of the community and to maintain Mercy's status as a viable teaching hospital, it is constantly evaluating a strengthening its clinical programs on the main hospital campus and at satellite facilities located throughout the city of Chicago. As an active participant in the health and wellness of its community, Mercy is dedicated to partnering with residents, community leaders, businesses and other health providers to support the health needs and foster the economic growth of the diverse communities served by Mercy. Mercy is relentless in its efforts to make certain that residents have access to appropriate health programs and services and is committed to utilizing its resources to maximize the number of community residents who are able to access programs and services at Mercy. To that end, Mercy is committed to the following goals:1. Mercy will maintain and abide by a charity care policy that offers free and discounted care to those unable to pay for medical care and services. 2. Mercy will provide clinical internships and residencies for physicians, nurses, allied health professionals and other pursuing health related professions and careers. Clinical rotations are provided in Respiratory Therapy, Occupational Therapy and Radiology.3. Mercy will offer education programs, workshops and health fairs for community residents. Programs are offered on a weekly rotating basis. Among health fairs offered are Back to School, Memorial Health, Diabetes and Health and Fitness Awareness Day.4. Mercy partners with Chicago area schools to provide medical care to students, to provide community service opportunities and to mentor students who have expressed an interest in pursuing health careers. Mercy maintains two school-based health centers in Wendell Phillips and Percy Dunbar Vocational Career Academies on the near South Side of Chicago. Both are highly regarded in the community for their role in reducing the barriers adolescents face in seeking health care services. Mercy also provides support and learning opportunities for students attending Christo Rey, De La Salle and other public and private schools in the area. Mercy is also an active participant in Chicago Public School Health Career Academy Program.5. Mercy supports the efforts and programs of the Mercy Family Health Center, which annually provides over 40,000 primary care and specialty visits for its patients.6. Mercy provides outreach programs that provide health screening and health education to community residents. Programs offered include (but not limited to) Go Red for Women, CarFit Community Event, Lunch and Learn Series, Senior Fest, Wellness Health Screenings and Free People's Clinic.7. Mercy will continue to operate and support the Emergency Department to meet the acute medical care needs of the community. 8. Mercy will provide representatives to area boards and community organizations to assist in improving the health and economic strength of the community.9. Mercy provides free or discounted meeting space for community workshops, meetings and activities.10. Mercy will train and deploy volunteers to meet the needs of its patients and programs. Mercy has approximately 80 volunteers.11. Mercy supports and maintains an eldercare program to offer free information, education and counseling to senior citizens and their families regarding issues related to aging. This program offers assistance with clarifying and applying for governmental and other programs related to health care, medical coverage, housing and other social programs. In some cases a program representative will make home visits to the elderly to address social and medical needs.12. Mercy provides language assistance services at the Hospital and at satellites, to meet the needs of patients and visitors. 13. Mercy participates in research activities to advance medical knowledge and services.14. Mercy is a leader in preparation of its staff and facility to respond to the use or threatened use of bioterrorism, including but not limited to use of viruses, bacteria, fungi, toxins from living organisms, or chemicals to produce death and/or disease in humans and living system. Reports Filed With States Part VI, Line 7 IL 1 Mercy Diagnostic and Treatment Center 2525 South Michigan Avenue Chicago IL 606162477 363720708 501(c)(3) 9785 Maternal/Child Health 1 0 Employee Scholarship Program 5 30680 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Organization's relevant disbursements are monitored to ensure that they are made for intended use. X X 0 0 0 0 0 0 0 0 0 Michael McDonnell 224349 0 113000 0 0 0 4821 0 16218 0 358388 0 0 0 Richard Cerceo 327701 0 0 0 0 0 8355 0 13458 0 349514 0 0 0 Thomas J Garvey 308892 0 0 0 0 0 9140 0 15345 0 333377 0 0 0 Barbara Townsend 224349 0 0 0 0 0 4784 0 8346 0 237479 0 0 0 Carla Campbell 157726 0 0 0 0 0 4856 0 18270 0 180852 0 0 0 Paul Jones 325759 0 0 0 0 0 0 0 429 0 326188 0 0 0 Ann Garcelon 170206 0 64800 0 0 0 5658 0 7065 0 247729 0 0 0 Charles Lawler 196276 0 24000 0 0 0 0 0 17643 0 237919 0 0 0 Phillip Ahn 182127 0 62667 0 0 0 5007 0 13437 0 263238 0 0 0 Abdulhamid Kanji 207591 0 0 0 0 0 0 0 9994 0 217585 0 0 0 Form 990, Part VI, Section A, line 6 Mercy Hospital and Medical Center has one member, Mercy Health System of Chicago. Form 990, Part VI, Section A, line 7b The following items must be submitted to and received approval of the System prior to becoming effective. A. Any changes in the mission, vision or values of the Medical Center. B. Amendments of the Articles of Incorporation or by-laws of the Medical Center. C. Merger, consolidation, dissolution or name change of the Medical Center. D. Any expenditure by the Medical Center in excess of $1,000,000, not previously approved in the Annual Budget, and, subject to the above-stated amount, any plan for construction, purchase, sale, lease, exchange, gift, pledge or mortgage of any real property or interest therein, or the disposition of any asset of the Medical Center not previously approved in the Annual Budget. E. Annual Budget and Strategic Plan of the Medical Center. F. Election or removal of the President/CEO of the Medical Center. G. Long-term borrowing by the Medical Center where repayment is due more than three years from date debt is incurred. H. Candidates elected as Board members or officers of the Medical Center. I. Removal of a director or officer of the Medical Center. Form 990, Part VI, Section B, line 11 A draft copy of Form 990 and related schedules is provided to senior management for review and comments. The Finance Committee of the Board of Directors reviews a final draft of Form 990 and related schedules and is given an opportunity to ask questions and comment. The Board of Directors is provided with a copy of Form 990 and related schedules to review and discuss before it is filed. Form 990, Part VI, Section B, line 12c The purpose of the Conflict of Interest Policy is to protect the interest of the Corporation when it is contemplating entering into a transaction or arrangement that might benefit the private interest of a Corporate Person (defined as a member of the Board of Directors, Board Committee members and officers) or might be adverse to the Corporation. The policy is intended to supplement, but not replace, any applicable state laws governing conflicts of interest applicable to nonprofit and charitable corporations. Definitions: A. Any Corporate Person who has a direct or indirect financial interest, as defined below, is an interested person. If a person is an interested person with respect to any entity in the health care system of which the Corporation is a part, he or she is an interested person with respect to all entities in the health care system. B. Financial Interest - A person has a financial interest if the person has, directly or indirectly, through business, investment or family: 1. An ownership or investment interest in any entity with which the Corporation has a transaction or arrangement, or 2. A compensation arrangement with the Corporation or with any entity or individual with which the Corporation has a transaction or arrangement, or 3. A potential ownership or investment interest in, or compensation arrangement with, any entity or individual with whom the Corporation is negotiating a transaction or arrangement. Compensation includes direct and indirect remuneration as well as gifts or favors that are substantial in nature. 4. A financial interest is not necessarily a conflict of interest. Under Section III-B, a person who has a financial interest may have a conflict of interest only if the Audit Committee decides that a conflict of interest exists. Procedures: A. Duty to Disclose - An interested Person or Corporate Person must disclose the existence of his or her financial interest and must be given the opportunity to disclose all material facts to the Audit Committee. B. Determining whether a Conflict of Interest Exists - After disclosure of the financial interest and all material facts, and after any discussion with the interested person, the Audit Committee decides if a conflict of interest exists. C.Procedures for Addressing the Conflict of Interest: 1. After exercising due diligence, the Audit Committee shall determine how the conflict of interest will be resolved. The Audit Committee shall recommend appropriate action to the Board of Directors. D. Violations of the Conflicts of Interest Policy: 1. If any Corporate person has reasonable cause to believe that another Corporate Person has failed to disclose actual or possible conflicts of interest, that person shall inform the Audit Committee. The Audit Committee shall inform the subject person of the basis for such believe and afford that person a opportunity to explain the alleged failure to disclose. 2. If, after hearing the response of the person and making further investigation as warranted, the Audit Committee shall take appropriate disciplinary and corrective action. The minutes of the Audit Committee shall contain the names of the person(s) found to have an actual or possible conflict of interest as well as the nature and content of the actual or possible conflict and its discussion, the decision of the Audit Committee as to whether a conflict of interest in fact exists and the committee's recommendation to the Board of Directors. The names of the person(s) present for discussion and the votes relating to the discussion. All Corporate Persons, shall at the time of appointment or commencement to service to the Corporation, and annually thereafter, sign a statement ("Disclosure Certificate") affirming that such person has received a copy of the conflicts of interest policy, has read and understand the policy, has agreed to comply with the policy, and understands that the Corporation is a charitable organization and that in order to maintain its Federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. The certifier has a continuing and ongoing duty, to immediately report any conflict or duality of interest as same arises. Periodic reviews shall be conducted. Every two years, all Mercy mangers (i.e. employees with the title of supervisor, manager, director, vice president, chief operating officer and/or president/chief executive officer) and certain other key employees will be required to sign an agreement regarding conflicts of interest, which includes a duty to disclose any actual, apparent or potential conflicts. Periodic checks will be conducted by the Human Resources Department to determine changes that have occurred, however, all employees are expected to exercise good judgment and discretion in evaluating a particular activity so as to avoid any actual or apparent conflicts of interest. In addition, all employees have a responsibility to promptly disclose in writing any activity that might be deemed to create a conflict of interest for review and approval by his/her supervisor. Mercy prohibits all employees from accepting gifts, gratuities, or entertainment from individuals and firms with whom Mercy does business. It is also a violation to give gifts to individuals or firms with whom Mercy does business. Excluded from this prohibition is the exchange of normal business courtesies such as luncheons or dinners, when they are proper and consistent with regular business practice. Employees who fail to disclose potential conflicts of interest and/or who engage in an activity that constitutes a conflict of interest will be subject to disciplinary action including termination. Form 990, Part VI, Section B, line 15 Mercy Hospital and Medical Center uses an executive compensation survey compiled by Sullivan Cotter & Associates. The Vice President of Human Resources reviews the salary survey data each year and presents the results to the Executive Committee of the Board of Directors. The Executive Committee reviews the data and makes a recommendation to adjust the CEO's salary, when supported by the data, to the full Board of Directors. Minutes of all Board of Director meetings are recorded. Mercy Hospital does not have a formal compensation committee; however, the Executive Committee assumes this function. No outside compensation consultants are used. Form 990, Part VI, Section C, line 19 Mercy Hospital and Medical Center makes its governing documents, Conflict of Interest Policy and Financial Statements available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in booked income from Joint Ventures to K1s 36,480. Change in Hospital interest in Net Assets of the Foudation 363,400. Temporarily Restricted Net Assets released for operations -10,335. Total to Form 990, Part XI, Line 5: 389,545. Mercy Health System of Chicago 2525 South Michigan Avenue Chicago IL 606162477 363163327 Supporting Organization IL 501(c)(3) 11 - Type I N/A 0 Mercy Foundation Inc 2525 South Michigan Avenue Chicago IL 606162477 363227350 Fund Raising IL 501(c)(3) 11 - Type I N/A 1 Mercy Diagnostic and Treatment Center 2525 South Michigan Avenue Chicago IL 606162477 363720708 Clinic IL 501(c)(3) 3 N/A 1 Mercy Heart & Vascular LLC 2525 South Michigan Avenue Chicago IL 606162477 205272726 Sublease CT Equipment IL N/A Related 626013 298256 0 0 0.51000 Mercy Adv MRI LLC 2525 South Michigan Avenue Chicago IL 606162477 262116721 Sublease MRI Equipment IL N/A Related 445361 1436811 0 0 0.65000 Mercy Services Inc 2525 South Michigan Avenue Chicago IL 606162477 363227348 Dormant IL N/A C 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Mercy Foundation Inc C 425000 Cash Mercy Foundation Inc N 79639 Cash Mercy Diagnostic & Treatment Center P 464336 Cash Mercy Foundation Inc L 315911 Cash